Utilization patterns, relative costs, and length of stay following adoption of MICU sedation guidelines

Objective: To determine patterns and frequency of sedative, analgesic, and neuromuscular blocker (NMB) use in a medical intensive care unit (MICU); to describe drug costs, and to describe MICU length of stay and self-extubation related to medication use following implementation of sedation guidelines. Design: Prospective cohort study. Subjects., One hundred patients requiring mechanical ventilation consecutively admitted to an MICU. Measurement. The following data were concurrently collected from medical records: demographic characteristics; clinical variables; sedative, analgesic, and NMB use; MICU length of stay; and self-extubation events. Results: The 85 patients who received a study medication were given a mean of 2.5 (+/-1.5) medications each. Morphine was the most commonly used analgesic (n = 39), primarily as an as-needed bolus. Fentanyl exceeded morphine in acquisition cost and days of use even at equipotent doses. Lorazepam was the most commonly used (n = 71) and least expensive sedative. Only 12 patients received an NMB. Length. of stay was associated with the number of drug classes received (p = 0.0002) but not with the type of drug used. Fifty-nine patients received two or more drugs, usually a benzodiazepine and an analgesic. Conclusions. Benzodiazepines were used more often than analgesics in the MICU. Most patients received lorazepam and morphine on an as-needed basis, as specified by the guidelines, at less cost than with continuous infusion. There was no evidence that as-needed use of morphine or lorazepam increased MICU length of stay or self-extubation.