Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients

Crit Care Med. 2005 Nov;33(11):2527-33. doi: 10.1097/01.ccm.0000186898.58709.aa.


Objective: To assess the impact of tracheotomy on sedative administration, sedation level, and autonomy of mechanically-ventilated intensive care unit (ICU) patients.

Design, setting, and patients: 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.

Interventions: None.

Measurements and main 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/( and from 44 (16, 128) to 7 (1, 42) mg/( (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%).

Conclusion: 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.

MeSH terms

  • Algorithms
  • Anesthetics, Intravenous*
  • Conscious Sedation*
  • Female
  • Fentanyl*
  • Humans
  • Intensive Care Units
  • Male
  • Midazolam*
  • Middle Aged
  • Respiration, Artificial*
  • Retrospective Studies
  • Tracheotomy*


  • Anesthetics, Intravenous
  • Midazolam
  • Fentanyl