(1722) Effect of Sedation Practices on Days Alive and Free From Ventilation in the Surgical/Trauma ICU

Introduction: Previous data comparing benzodiazepine (BZD) to non-benzodiazepine (non-BZD) sedatives in mechanically ventilated patients have shown that sedation with non-BZD, such as propofol and dexmedetomidine, is associated with reduced duration of mechanical ventilation (MV) as well as lower mortality and rates of delirium in medical and cardiac intensive care unit (ICU) populations. Limited data exist evaluating this in the surgical/trauma ICU (STICU). Our objective is to evaluate BZD versus non-BZD-based sedation on days alive and free of MV at 28 days in STICU patients.

Methods: This single-center, retrospective study evaluated patients admitted to the STICU in a large level 1 trauma academic hospital between 7/2020-8/2023. Patients were eligible if 18 years and intubated for ≥24 hours requiring continuous sedation with propofol, dexmedetomidine, ketamine, midazolam, or lorazepam. The primary outcome was days alive and free of MV at 28 days. Secondary outcomes included ICU and hospital mortality, ICU and hospital length of stay, time on MV, percent alive and free of MV at 14- and 28-days, and percent of time within target sedation range.

Results: 102 patients met inclusion criteria for inclusion with 51 patients per group. 48% were trauma, 33% were emergent surgery, and 19% were elective surgery patients. Patients had similar baseline characteristics except lower GCS on STICU admission in patients admitted for surgery in the BZD group (9 vs 11; p=0.005), and more traumatic brain injuries in the BZD group (3 vs 14; p=0.006). Patients on non-BZD sedation experienced more days alive and free of MV at 28 days than those on BZD sedation (24 [IQR 18-25] vs 23 days [IQR 19-24]; p=0.0433), respectively.

Conclusions: Use of non-BZD vs BZD for continuous sedation STICU patients was associated with more days alive and free of MV at 28 days, a higher rate of being alive and free of MV at 14 and 28 days, and more time at target sedation. These data support routine of non-BZD-based sedation in surgical/trauma ICU patients on MV over BZD, consistent with other ICU populations and current practice guidelines.