Impact of Continuous-Infusion Sedation and Analgesia Discontinuation Post-Tracheostomy

Introduction: Tracheostomy placement in ICU patients has been associated with decreased need for continuous sedation and analgesia, potentially enhancing recovery through elements of the ABCDEF bundle such as earlier ventilator weaning, reduced delirium, improved sleep, and greater mobility. Over-sedation can impede these elements. Literature suggests that minimizing sedation post-tracheostomy may improve length of stay (LOS). This study aimed to assess whether discontinuation of continuous infusion (CI) sedation and analgesia within 48 hours of tracheostomy improves LOS and other clinical outcomes in ICU patients post-tracheostomy.


Methods: This retrospective cohort study evaluated adult ICU patients who were mechanically ventilated for > 96 hours and received a tracheostomy between November 2023 and May 2025 at a large community teaching hospital. Patients receiving extracorporeal membrane oxygenation were excluded. Two groups were compared: those who discontinued CI sedation or analgesia that promote deeper sedation levels (fentanyl, hydromorphone, propofol, midazolam, lorazepam) within 48 hours post-tracheostomy, and those who did not. The primary outcome was hospital LOS. Secondary outcomes included ICU and ventilator LOS, delirium incidence (via CAM-ICU) at 24, 48, and 72 hours, mobility frequency, and discharge disposition. Statistical analysis included t-tests, Mann-Whitney U, and chi-square tests.


Results: Among 302 patients analyzed, 265 (88%) were off CI within 48 hours, while 37 (12%) remained on. The early discontinuation group showed shorter LOS: median hospital LOS was 31 vs 35 days (p=0.103), ventilator LOS was significantly shorter (17 vs 24 days, p< 0.005), and ICU LOS was 12 vs 14 days (p=0.158). Delirium rates were lower in the early CI discontinuation group at 48 hours (37% vs 43%) and 72 hours (35% vs 49%). Mobility within 72 hours post-tracheostomy was low in both groups (1-9%). Mortality/hospice rates were higher in patients with prolonged CI.


Conclusions: Discontinuing continuous infusion sedation and analgesia within 48 hours post-tracheostomy may contribute to shorter ventilator LOS and lower delirium rates. Early mobility is an opportunity for clinical improvement.