Sedation and Analgesia in Patients Undergoing Tracheostomy in COVID-19, a Multi-Center Registry

Christopher M. Kapp; Ardian Latifi; David Feller-Kopman; Joshua H. Atkins; Esther Ben Or; David Dibardino; Andrew R. Haas; Jeffrey Thiboutot; Christoph T. Hutchinson

doi:10.1177/08850666211045896

Sedation and Analgesia in Patients Undergoing Tracheostomy in COVID-19, a Multi-Center Registry

Christopher M. Kapp^*, Ardian Latifi, David Feller-Kopman, Joshua H. Atkins, Esther Ben Or, David Dibardino, Andrew R. Haas, Jeffrey Thiboutot, Christoph T. Hutchinson

^*Corresponding author for this work

Medicine, Pulmonary Division

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

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.

Original language	English (US)
Pages (from-to)	240-247
Number of pages	8
Journal	Journal of Intensive Care Medicine
Volume	37
Issue number	2
DOIs	https://doi.org/10.1177/08850666211045896
State	Published - Feb 2022

Funding

Each author's role is as follows (all authors reviewed and edited the paper), CK – data collection, analysis, primary writer for the paper. AL, JT, DFK, CH – data collection, analysis, help with writing. EB, DD, AH – data collection We would like to further acknowledge all of the medical professionals that worked through the COVID-19 pandemic. The author(s) received no financial support for the research, authorship and/or publication of this article.

Keywords

acute respiratory distress syndrome
covid-19
physical therapy
sedation
tracheostomy tube

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

Access to Document

10.1177/08850666211045896

Cite this

@article{4b02b4d91cf645d9ab6e5459b914856d,

title = "Sedation and Analgesia in Patients Undergoing Tracheostomy in COVID-19, a Multi-Center Registry",

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.",

keywords = "acute respiratory distress syndrome, covid-19, physical therapy, sedation, tracheostomy tube",

author = "Kapp, {Christopher M.} and Ardian Latifi and David Feller-Kopman and Atkins, {Joshua H.} and {Ben Or}, Esther and David Dibardino and Haas, {Andrew R.} and Jeffrey Thiboutot and Hutchinson, {Christoph T.}",

note = "Funding Information: Each author's role is as follows (all authors reviewed and edited the paper), CK – data collection, analysis, primary writer for the paper. AL, JT, DFK, CH – data collection, analysis, help with writing. EB, DD, AH – data collection We would like to further acknowledge all of the medical professionals that worked through the COVID-19 pandemic. The author(s) received no financial support for the research, authorship and/or publication of this article. Publisher Copyright: {\textcopyright} The Author(s) 2021.",

year = "2022",

month = feb,

doi = "10.1177/08850666211045896",

language = "English (US)",

volume = "37",

pages = "240--247",

journal = "Journal of Intensive Care Medicine",

issn = "0885-0666",

publisher = "SAGE Publications Inc.",

number = "2",

}

TY - JOUR

T1 - Sedation and Analgesia in Patients Undergoing Tracheostomy in COVID-19, a Multi-Center Registry

AU - Kapp, Christopher M.

AU - Latifi, Ardian

AU - Feller-Kopman, David

AU - Atkins, Joshua H.

AU - Ben Or, Esther

AU - Dibardino, David

AU - Haas, Andrew R.

AU - Thiboutot, Jeffrey

AU - Hutchinson, Christoph T.

N1 - Funding Information: Each author's role is as follows (all authors reviewed and edited the paper), CK – data collection, analysis, primary writer for the paper. AL, JT, DFK, CH – data collection, analysis, help with writing. EB, DD, AH – data collection We would like to further acknowledge all of the medical professionals that worked through the COVID-19 pandemic. The author(s) received no financial support for the research, authorship and/or publication of this article. Publisher Copyright: © The Author(s) 2021.

PY - 2022/2

Y1 - 2022/2

N2 - 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.

AB - 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.

KW - acute respiratory distress syndrome

KW - covid-19

KW - physical therapy

KW - sedation

KW - tracheostomy tube

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DO - 10.1177/08850666211045896

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SN - 0885-0666

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JO - Journal of Intensive Care Medicine

JF - Journal of Intensive Care Medicine

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ER -

Sedation and Analgesia in Patients Undergoing Tracheostomy in COVID-19, a Multi-Center Registry

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