Pharmacoeconomic assessment of propofol 2% used for prolonged sedation
Pharmacoeconomic assessment of propofol 2% used for prolonged sedation
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DOI：
10.1097/00003246-200102000-00018
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发表时间：
2001-02-01
影响因子：
8.8
通讯作者：
Castellano-Hernández, M
中科院分区：
文献类型：
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作者：
Barrientos-Vega, R;Sánchez-Soria, MM;Castellano-Hernández, M
目的：为了证明使用丙泊酚2%在有效性和用于延长镇静的唤醒时间方面与丙泊酚1%相当。设计：开放标签，病例队列研究，历史对照队列，IV期临床试验。设置：社区医院的内科和外科重症监护室（ICU）。患者：51例连续患者（内科、外科和创伤）进入我们的ICU需要机械通气>24小时。所有患者均接受2%丙泊酚（1-6 mg kg（-1）hr（-1），从最低剂量开始）和氯化吗啡（0.5 mg.kg（-1）.24 hr（-1））。推荐4-5级镇静（Ramsay量表）。当临床上有撤机指征时，镇静和镇痛突然中断，机械通气中断，患者连接到T桥。结果测量：无法达到所需的镇静水平与建议的最高剂量率，高血糖>500 mg/dL，被认为是治疗失败。观察两组患者从停止机械通气到拔管的时间。这些变量，以及不同的项目相关的ICU成本，研究组和两个历史组之间进行了比较，镇静与丙泊酚1%和咪达唑仑。结果：镇静的持续时间为122.4 +/- 89.2（SD）小时的丙泊酚2%组。丙泊酚2%组和丙泊酚1%组的高血糖发生率分别为3.9%和20.4%（p = 0.016）。丙泊酚2%组和丙泊酚1%组的治疗失败率分别为19.6%和33.4%（p = 0.127）。高甘油三酯血症的发生率较低与达到撤机的患者数量较高相关。两个丙泊酚组的撤机时间相似，2%丙泊酚组为32.3小时（1，744美元），咪达唑仑组为97.9小时（5，287美元）。咪达唑仑组的镇静费用为每小时2.68美元，丙泊酚组为每小时7.69美元。丙泊酚组有一个有利的成本效益比，归因于较短的撤机时间，虽然效益低于预期，因为更高的剂量丙泊酚2%比丙泊酚1%，需要在第一个48小时（p <0.05）。结论：新的丙泊酚2%制剂是一种有效的镇静剂，是安全的，因为相关的高血压的频率低。与咪达唑仑相比，使用2%丙泊酚的脱机时间较短，弥补了其成本的增加。丙泊酚2%的经济效益低于预期，因为在前48小时内需要的丙泊酚2%剂量高于丙泊酚1%。
Objective: To demonstrate that the use of propofol 2% is comparable to propofol 1% in effectiveness and in the wake-up time used for prolonged sedation.Design: Open-label, case cohort study with a cohort of historical controls, phase IV clinical trial.Setting: Medical and surgical intensive care unit (ICU) in a community hospital.Patients: Fifty-one consecutive patients (medical, surgical, and trauma) admitted to our ICU requiring mechanical ventilation for >24 hrs.Methods: All patients received propofol 2% (1-6 mg kg(-1) hr(-1), starting with the lowest dose) and morphine chloride (0.5 mg.kg(-1) .24 hrs(-1)). A 4-5 level of sedation (Ramsay scale) was recommended. When weaning was indicated clinically, sedation and analgesia were interrupted abruptly, mechanical ventilation was discontinued, and the patient was connected to a T-bridge.Outcome Measurements: inability to attain the desired level of sedation with the highest dose rate of proposal, and hypertriglyceridemia >500 mg/dL, were considered therapeutic failure. The time between discontinuation of mechanical ventilation and extubation was measured. Those variables, as well as different items related to ICU cost, were compared between the study group and two historical groups sedated with propofol 1% and midazolam.Results: The duration of sedation was 122.4 +/- 89.2 (SD) hrs for the propofol 2% group. The frequency of hypertriglyceridemia was 3.9% and 20.4% for the propofol 2% and the propofol 1% groups, respectively (p = .016). Therapeutic failure rates were 19.6% and 33.4% for the propofol 2% and propofol 1% groups, respectively (p =.127). The lower frequency of hypertriglyceridemia was associated with a higher number of patients reaching weaning. Weaning time was similar in the two propofol groups, 32.3 hrs ($1,744) for the propofol 2% group vs. 97.9 hrs ($5,287) for the midazolam group. Cost of sedation was $2.68 per hour for the midazolam group and $7.69 per hour for the propofol group. There was a favorable cost-benefit ratio for the propofol group, attributable to the shorter weaning time, although benefit was less than expected because higher doses of propofol 2% than propofol 1% were required during the first 48 hrs (p < .05).Conclusions: The new propofol 2% preparation is an effective sedative agent and is safe because of the low frequency of associated hypertriglyceridemia. The shorter weaning time associated with the use of propofol 2% as compared with midazolam compensates for its elevated cost. The economic benefit of propofol 2% is less than expected because higher doses of propofol 2% than propofol 1% are required over the first 48 hrs.