Mo Yoonsun, Shcherbakova Natalia, Zeibeq John, Muzykovsky Karina, Li Wai Kin, Gasperino James
Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, 75 DeKalb Avenue, Brooklyn, NY, 11201, USA.
Pharmacy Department, The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY, 11201, USA.
Int J Clin Pharm. 2020 Dec;42(6):1419-1424. doi: 10.1007/s11096-020-01103-3. Epub 2020 Aug 29.
Background Despite the advantages of dexmedetomidine (DEX) over propofol (PRO) including minimal respiratory depression and the potential for preventing and/or treating intensive care unit (ICU) delirium, PRO has been the preferred agent due to its lower cost. However, the acquisition cost of DEX has considerably decreased as a generic version of DEX has recently become available. Objective To evaluate clinical and economic outcomes of DEX-based sedation compared to PRO in the ICU. Setting A retrospective cohort study of 86 ICU patients who received either DEX or PRO for a period ≥ 12 h. Method Patients were matched by age, sex, and Sequential Organ Failure Assessment scores in a 1:1 ratio. Main outcome measure Clinical outcomes included the duration of mechanical ventilation (MV), ICU and hospital length of stay (LOS), and requirements of concomitant sedatives and opioids. Economic outcomes included the ICU and hospital costs as well as the cost of sedatives or combined sedatives and opioids per patient. Results There were no significant differences in ICU and hospital LOS and time on MV in both groups (median ICU LOS 7 [DEX] vs. 9 [PRO] days, p = 0.07; median hospital LOS 12 [DEX] vs. 14 [PRO] days, p = 0.261; median time of MV 144 [DEX] vs. 158 [PRO] hours, p = 0.176). DEX-based sedation compared to PRO was associated with similar ICU and hospital costs (US$ 67,561 vs. 78,429, p = 0.39; US$ 71,923 vs. 71,084, p = 0.1). Conclusion The clinical outcomes and economic impact associated with DEX- and PRO-based sedation were similar.
尽管右美托咪定（DEX）相较于丙泊酚（PRO）具有诸多优势，包括呼吸抑制作用极小以及预防和/或治疗重症监护病房（ICU）谵妄的潜力，但由于PRO成本较低，一直是首选药物。然而，随着DEX的仿制药最近上市，其购置成本已大幅下降。目的：评估在ICU中，与PRO相比，基于DEX的镇静的临床和经济结果。设置：对86例接受DEX或PRO治疗≥12小时的ICU患者进行回顾性队列研究。方法：根据年龄、性别和序贯器官衰竭评估评分，将患者按1:1比例进行匹配。主要结局指标：临床结局包括机械通气（MV）持续时间、ICU和医院住院时间（LOS）以及辅助镇静剂和阿片类药物的需求。经济结局包括ICU和医院成本以及每位患者的镇静剂或联合镇静剂和阿片类药物成本。结果：两组在ICU和医院LOS以及MV时间方面无显著差异（ICU中位LOS：DEX组7天 vs. PRO组9天，p = 0.07；医院中位LOS：DEX组12天 vs. PRO组14天，p = 0.261；MV中位时间：DEX组144小时 vs. PRO组158小时，p = 0.176）。与PRO相比，基于DEX的镇静与相似的ICU和医院成本相关（67,561美元 vs. 78,429美元，p = 0.39；71,923美元 vs. 71,084美元，p = 0.1）。结论：基于DEX和PRO的镇静的临床结局和经济影响相似。
