title: Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients.
abstract: OBJECTIVE
  To assess the impact of tracheotomy on sedative administration, sedation level, and autonomy of mechanically-ventilated intensive care unit (ICU) patients.
  
  
  METHODS
  In this observational study, the charts of all consecutive patients undergoing mechanical ventilation requiring tracheotomy over a 14-month period in our 18-bed tertiary care ICU were reviewed retrospectively. Patients' sedation levels (according to the Riker's 7-level sedation-agitation score) and intravenous (fentanyl and midazolam) and oral (clorazepate and haloperidol) sedative administration were measured daily during the 7 days before and after tracheotomy. We also recorded patients for whom chair positioning and oral alimentation became possible in the days following tracheotomy.
  
  
  METHODS
  None.
  
  
  RESULTS
  Tracheotomy was performed on 72 (23.1%) of the 312 patients undergoing mechanical ventilation for > or = 48 hrs. After tracheotomy, median (25th, 75th percentiles) fentanyl and midazolam administration decreased from 866 (191, 1672) to 71 (3, 426) microg/(patient.day) and from 44 (16, 128) to 7 (1, 42) mg/(patient.day) (p < .001), respectively. Concomitant median time spent heavily sedated decreased from 7 (3, 17) to 1 (0, 6) hrs/day (p < .001), with no increase in agitation time. During the 7 days following tracheotomy, partial oral alimentation became possible for 35 patients (48.6%) and out-of-bed positioning became possible for 16 patients (22.2%).
  
  
  CONCLUSIONS
  On the basis of these observations, we conclude that tracheotomized mechanically ventilated ICU patients required less intravenous sedative administration, spent less time heavily sedated, and achieved more autonomy earlier.
authors.affiliation: Service de Réanimation Médicale, Hôpital Pitié-Salpêtrière, Paris, France.
authors.forename: Ania
authors.initials: A
authors.lastname: Nieszkowska
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Hichem
authors.initials: H
authors.lastname: Ksibi
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.forename: Claude
authors.initials: C
authors.lastname: Gibert
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
mesh_terms: D000465:Algorithms; D018686:Anesthetics, Intravenous; D016292:Procedural Sedation; D005260:Female; D005283:Fentanyl; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014140:Tracheotomy
chemical_list: D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl