NDLI: Tracheotomy does not affect reducing sedation requirements of patients in intensive care

Content Provider	Springer Nature : BioMed Central
Author	Veelo, Denise P Dongelmans, Dave A Binnekade, Jan M Korevaar, Johanna C Vroom, Margreeth B Schultz, Marcus J
Abstract	Introduction Translaryngeal intubated and ventilated patients often need sedation to treat anxiety, agitation and/or pain. Current opinion is that tracheotomy reduces sedation requirements. We determined sedation needs before and after tracheotomy of intubated and mechanically ventilated patients. Methods We performed a retrospective analysis of the use of morphine, midazolam and propofol in patients before and after tracheotomy. Results Of 1,788 patients admitted to our intensive care unit during the study period, 129 (7%) were tracheotomized. After the exclusion of patients who received a tracheotomy before or at the day of admittance, 117 patients were left for analysis. The daily dose (DD; the amount of sedatives for each day) divided by the mean daily dose (MDD; the mean amount of sedatives per day for the study period) in the week before and the week after tracheotomy was 1.07 ± 0.93 DD/MDD versus 0.30 ± 0.65 for morphine, 0.84 ± 1.03 versus 0.11 ± 0.46 for midazolam, and 0.62 ± 1.05 versus 0.15 ± 0.45 for propofol (p < 0.01). However, when we focused on a shorter time interval (two days before and after tracheotomy), there were no differences in prescribed doses of morphine and midazolam. Studying the course in DD/MDD from seven days before the placement of tracheotomy, we found a significant decline in dosage. From day -7 to day -1, morphine dosage (DD/MDD) declined by 3.34 (95% confidence interval -1.61 to -6.24), midazolam dosage by 2.95 (-1.49 to -5.29) and propofol dosage by 1.05 (-0.41 to -2.01). After tracheotomy, no further decrease in DD/MDD was observed and the dosage remained stable for all sedatives. Patients in the non-surgical and acute surgical groups received higher dosages of midazolam than patients in the elective surgical group. Time until tracheotomy did not influence sedation requirements. In addition, there was no significant difference in sedation between different patient groups. Conclusion In our intensive care unit, sedation requirements were not further reduced after tracheotomy. Sedation requirements were already sharply declining before tracheotomy was performed.
Related Links	https://ccforum.biomedcentral.com/counter/pdf/10.1186/cc4961.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	13648535
DOI	10.1186/cc4961
Journal	Critical Care
Issue Number	4
Volume Number	10
Language	English
Publisher	BioMed Central
Publisher Date	2006-07-10
Access Restriction	Open
Subject Keyword	Intensive Critical Care Medicine Emergency Medicine Intensive Care Unit Morphine Midazolam Intensive Care Unit Patient Spontaneous Breathing Trial
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	10.4/2023

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
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Tracheotomy does not affect reducing sedation requirements of patients in intensive care – a retrospective study

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