Effect of Non-benzodiazepine Versus Benzodiazepine Sedation on Days Alive and Free of Mechanical Ventilation in the Surgical/Trauma Intensive Care Unit

BACKGROUND: Data comparing benzodiazepine (BZD) to nonbenzodiazepine (non-BZD) sedatives in patients on mechanical ventilation (MV) demonstrate non-BZD sedation is associated with reduced duration of MV and lower mortality and delirium rates in medical and cardiac intensive care unit (ICU) populations. Limited data exist in surgical/trauma ICU (STICU) populations. OBJECTIVE: Evaluate BZD versus non-BZD sedation on days alive and free of MV at 28 days in STICU patients. METHODS: This single-center, institutional review board-approved, retrospective cohort study evaluated adult patients admitted to the STICU, intubated for ≥24 hours, and required continuous non-BZD versus BZD sedation in a level I trauma academic hospital. Primary outcome was days alive and free of MV at 28 days. Secondary outcomes included percent of time patients were oversedated and rates of delirium and ventilator-associated pneumonia (VAP). A multivariable model was constructed to determine independent predictors of being alive and free of MV at 28 days. RESULTS: = 0.0007). CONCLUSIONS AND RELEVANCE: In STICU patients requiring MV, non-BZD sedation was associated with more ventilator-free days, less time oversedated, reduced delirium, and reduced VAP. These findings extend prior ICU sedation data into the STICU population supporting the use of non-BZD strategies when clinically appropriate to optimize patient outcomes.