Objective: To measure the impact of a national propofol shortage on the duration of mechanical ventilation.
Design: Before–after study.
Setting: Three, noncardiac surgery, adult intensive care units at a 320-bed academic medical center.
Patients: Consecutive patients requiring mechanical ventilation ≥48 hrs, administered a continuously infused sedative ≥24 hrs, extubated, and successfully discharged from the intensive care unit were compared between before (December 1, 2008 to May 31, 2009) and after (December 1, 2009, to May 31, 2010) a propofol shortage.
Measurements and Main Results: Sedation drug use and common factors affecting time on mechanical ventilation were collected and if found either to differ significantly (p ≤ .10) between the two groups or to have an unadjusted significant association (p ≤ .10) with time on mechanical ventilation were included in a multivariable model. The unadjusted analyses revealed that the median (interquartile range) duration of mechanical ventilation increased from 6.7 (9.8; n = 153) to 9.6 (9.5; n = 128) days (p = .02). Fewer after-group patients received ≥24 hrs of continuously infused propofol (94% vs. 15%, p < .0001); more received ≥24 hrs of continuously infused lorazepam (7% vs. 15%, p = .037) and midazolam (30% vs. 81%, p < .0001). Compared with the before group, the after group was younger, had a higher admission Acute Physiology and Chronic Health Evaluation II score, was more likely to be admitted by a surgical service, have acute alcohol withdrawal, and be managed with pressure-controlled ventilation as the primary mode of mechanical ventilation. Of these five factors, only the Acute Physiology and Chronic Health Evaluation II score, admission service, and use of a pressure-controlled ventilation affected duration of mechanical ventilation across both groups. Although a regression model revealed that Acute Physiology and Chronic Health Evaluation II score (p < .0001), admission by a medical service (p = .009), and use of pressure-controlled ventilation (p = .02) each affected duration of mechanical ventilation in both groups, inclusion in either the before- or after-propofol shortage groups (i.e., high vs. low use of propofol) did not affect duration of mechanical ventilation (p = .35).
Conclusions: An 84% decrease in propofol use in the adult intensive care units at our academic institution as a result of a national shortage did not affect duration of mechanical ventilation.
From the Department of Pharmacy (RR, SB), Tufts Medical Center, Boston, MA; the Biostatistics Research Center (RR), Institute for Clinical Research and Health Policy Studies, the Division of Pulmonary, Critical Care and Sleep Medicine (AC, AG, EG), the Departments of Surgery and Anesthesiology (SAN), and the Department of Respiratory Care (WH), Tufts Medical Center, Boston, MA; and the School of Pharmacy (MN, SB, JWD), Northeastern University, Boston, MA.
* See also p. 661.
Dr. Devlin received honoraria/speaking fees and a grant from Hospira Pharmaceuticals. The remaining authors have not disclosed any potential conflicts of interest.
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