Evaluation of sedation and analgesia needs in COVID-19 patients undergoing tracheostomy

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Created On: 08/12/2021

Evaluation of sedation and analgesia needs in COVID-19 patients undergoing tracheostomy

A retrospective multi-centre registry study was carried out to determine if tracheostomy reduced sedation and analgesic medication usage, enhanced the markers of activity level and cognitive function, and clinical outcomes in people having COVID-19 Acute Respiratory Distress Syndrome (ARDS).

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Key take away

Tracheostomy is associated with a decline in sedatives and analgesics, and improvement in physical activity and cognitive function in people with COVID-19 Acute Respiratory Distress Syndrome.

Background

Method

This study included individuals with coronavirus ARDS who underwent tracheostomy. The recruited people were grouped into early (≤14 days, 31 participants) or late (15 + days, 97 participants) tracheostomy groups. Collection of the outcome data was done.

Result

Overall, 128 participants had tracheostomies carried out at a mean of 19.4 days, with 66% carried out percutaneously at the bedside. The mean hourly dose of fentanyl, midazolam, and propofol substantially dropped forty-eight hours after tracheostomy, as shown in Table 1:

A remarkable improvement was noted in the mobility score and Glasgow Coma Scale in the 48-hour before and after tracheostomy. Compared to the early group, the late group exhibited substantially higher mean fentanyl dose in the 48-hour pre-tracheostomy. The intensive care unit length of stay was also shorter in the early group, as shown in Table 2:

Conclusion

A decrease in sedatives and analgesics administered and enhancement in physical activity and cognitive function was noted in the 48-hour period post-tracheostomy in patients with coronavirus ARDS. Moreover, an early tracheostomy can substantially reduce intravenous opiate medication administration and intensive care unit length of stay.