Your browser doesn't support javascript.
Sedation and Analgesia in Patients Undergoing Tracheostomy in COVID-19, a Multi-Center Registry.
Kapp, Christopher M; Latifi, Ardian; Feller-Kopman, David; Atkins, Joshua H; Ben Or, Esther; Dibardino, David; Haas, Andrew R; Thiboutot, Jeffrey; Hutchinson, Christoph T.
  • Kapp CM; 12247University of Illinois at Chicago, Chicago, IL, USA.
  • Latifi A; 1466Johns Hopkins University, Baltimore, MD, USA.
  • Feller-Kopman D; 4456Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
  • Atkins JH; 6569University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
  • Ben Or E; 1466Johns Hopkins University, Baltimore, MD, USA.
  • Dibardino D; 6569University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
  • Haas AR; 6569University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
  • Thiboutot J; 1466Johns Hopkins University, Baltimore, MD, USA.
  • Hutchinson CT; 6569University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
J Intensive Care Med ; 37(2): 240-247, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1463146
ABSTRACT

INTRODUCTION:

Patients with COVID-19 ARDS require significant amounts of sedation and analgesic medications which can lead to longer hospital/ICU length of stay, delirium, and has been associated with increased mortality. Tracheostomy has been shown to decrease the amount of sedative, anxiolytic and analgesic medications given to patients. The goal of this study was to assess whether tracheostomy decreased sedation and analgesic medication usage, improved markers of activity level and cognitive function, and clinical outcomes in patients with COVID-19 ARDS. STUDY DESIGN AND

METHODS:

A retrospective registry of patients with COVID-19 ARDS who underwent tracheostomy creation at the University of Pennsylvania Health System or the Johns Hopkins Hospital from 3/2020 to 12/2020. Patients were grouped into the early (≤14 days, n = 31) or late (15 + days, n = 97) tracheostomy groups and outcome data collected.

RESULTS:

128 patients had tracheostomies performed at a mean of 19.4 days, with 66% performed percutaneously at bedside. Mean hourly dose of fentanyl, midazolam, and propofol were all significantly reduced 48-h after tracheostomy fentanyl (48-h pre-tracheostomy 94.0 mcg/h, 48-h post-tracheostomy 64.9 mcg/h, P = .000), midazolam (1.9 mg/h pre vs. 1.2 mg/h post, P = .0012), and propofol (23.3 mcg/kg/h pre vs. 8.4 mcg/kg/h post, P = .0121). There was a significant improvement in mobility score and Glasgow Coma Scale in the 48-h pre- and post-tracheostomy. Comparing the early and late groups, the mean fentanyl dose in the 48-h pre-tracheostomy was significantly higher in the late group than the early group (116.1 mcg/h vs. 35.6 mcg/h, P = .03). ICU length of stay was also shorter in the early group (37.0 vs. 46.2 days, P = .012).

INTERPRETATION:

This data supports a reduction in sedative and analgesic medications administered and improvement in cognitive and physical activity in the 48-h period post-tracheostomy in COVID-19 ARDS. Further, early tracheostomy may lead to significant reductions in intravenous opiate medication administration, and ICU LOS.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Analgesia Type of study: Controlled clinical trial / Observational study / Randomized controlled trials / Risk factors Limits: Humans Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2022 Document Type: Article Affiliation country: 08850666211045896

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Analgesia Type of study: Controlled clinical trial / Observational study / Randomized controlled trials / Risk factors Limits: Humans Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2022 Document Type: Article Affiliation country: 08850666211045896