948

Abstract

Introduction: Critically ill patients often require sedation to treat agitation and anxiety associated with their care. The current guidelines no longer recommend benzodiazepines routinely for sedation of mechanically ventilated patients due to their prolonged sedative effects and high propensity for inducing delirium. At this time, nonbenzodiazepine sedatives like propofol and dexmedetomidine are preferred for routine sedation of mechanically ventilated patients. However, due to a recent national drug shortage of propofol, sedation with benzodiazepines has been occurring more frequently despite guideline recommendations. Methods: A retrospective chart review was performed from January 1, 2013 to July 31, 2013 to assess sedation practice in mechanically ventilated patients. This time period was divided into two groups: propofol shortage and propofol available. January 1, 2013 through March 31, 2013 was defined as propofol shortage based on drastic reduction in overall hospital usage and the implementation of propofol restrictions for use. The time period of May 1, 2013 through July 31, 2013 was defined as propofol available due to drug allocation and removal of restrictions for use. The two time periods were compared to evaluate sedation therapy, ventilator days and ICU length of stay. Results: During the propofol shortage, there were 244 patients that were mechanically ventilated. Sedation therapy in these patients consisted of propofol (only) (26%); propofol + continuous infusion midazolam (12%); dexmedetomidine (alone) (17%); demedetomidine + continuous infusion midazolam (6%); continuous infusion midazolam (alone) (2%); continuous infusion midazolam +/- propofol +/- dexmedtomidine (18%); and intermittent midazolam (6%). In the propofol available group, 247 patients were mechanically ventilated. Sedation therapy for this group consisted of propofol (alone) (55%); propofol + continuous infusion midazolam (6%); dexmedetomidine (alone) (2%); dexmedetomidine + continuous infusion midazolam (1%); continuous infusion midazolam (alone) (<1%); continuous infusion midazolam +/- propofol +/- dexmedetomidine (7%); and intermittent midazolam (2%). The mean ventilator days for the propofol shortage group and propofol available group were 4.15 days and 4.00 days respectively (p=0.36). The ICU length of stay in the propofol shortage group was 6.98 days compared to 5.79 days in the propofol available group (p=0.02). Conclusions: Overall, the above data shows that there was no statistical difference in ventilator days for the propofol shortage and propofol available groups. However, there was a statistically significant increase in ICU length of stay in the propofol shortage group. The lack of difference in ventilator days between groups may be explained by the continued partial availability of propofol during the time of shortage as well as an increased use of dexmedetomidine. The increase in ICU length of stay, this is most likely due to the increased use of continuous infusion midazolam in the propofol shortage group resulting in prolonged sedation and/or delirium post-extubation.