Sedation use before and after tracheostomy in ICU.

Objective. To study the total amount of sedative drugs administered to patients in the intensive care unit (ICU) before and after tracheostomy. Design. Prospective observational study. Setting. Twelve-bedded general ICU that was expanded to an 18-bedded general ICU. Subjects. Twenty-two patients who had a tracheostomy inserted during their ICU stay. Interventions. None. End points. The total amount of sedative drugs administered to patients three days before and three days after insertion of tracheostomy. Measurements and main results. During the study period 447 patients were admitted to ICU, 27 (5.6%) had a tracheostomy. Four patients were excluded from the study because of the presence of hypoxic brain damage or a permanent tracheostomy prior to ICU admission. Twenty-three patients were studied. The median age was 65, median initial 24  h APACHE II score was 22, median length of stay was 36 days, and median time of performing the tracheostomy was 14 days. Twelve (52%) patients died and one patient was transferred to another centre the day after tracheostomy and was therefore not included in the comparison of sedation use before and after tracheostomy. Alfentanil, morphine, propofol and midazolam were used in 17 (77.3%), 8 (36.4%), 19 (86.4%) and 9 (40.9%) patients respectively. Overall, there was a significant reduction in the total amount of alfentanil ( p =0.01) and propofol ( p =0.01) administered before and after tracheostomy. One patient (4.5%) did not receive sedation before or after tracheostomy. Sedative drug use was reduced after tracheostomy in 13 (59%) patients and slightly increased in one (4.5%) patient. Sedative drugs were altered in 7 (31.8%) patients. Ten patients received only propofol and/or alfentanil for sedation. For these patients, there was a significant reduction in the use of both these agents after tracheostomy, p =0.02 and p [ABSTRACT FROM AUTHOR]