Effect of enterally administered sleep-promoting medication on the intravenous sedative dose and its safety and cost profile in mechanically ventilated patients: A retrospective cohort study

Abstract

Background The clinical effect of enteral administration of sleep-promoting medication (SPM) in mechanically ventilated patients remains unclear. This study aimed to investigate the relationship between enteral SPM administration and the intravenous sedative dose and examine the safety and cost of enteral SPM administration. Methods This single-center retrospective cohort study was conducted in a Japanese tertiary hospital intensive care unit (ICU). The exposure was enteral SPM administration during mechanical ventilation. The outcome was the average daily propofol dose per body weight administered as a continuous sedative during mechanical ventilation. Patients were divided into three groups based on the timing of SPM administration at ICU admission: “administration within 48 hours (early administration [EA]),” “administration after 48 hours (late administration [LA]),” and “no administration (NA).” We used multiple linear regression models. Results Of 123 included patients, 37, 50, and 36 patients were assigned to the EA, LA, and NA groups, respectively. The average daily propofol dose per body weight was significantly lower in the EA group than in the LA and NA groups (β -5.13 [95% confidence interval (CI) -8.93 to -1.33] and β -4.51 [95% CI -8.59 to -0.43], respectively). Regarding safety, enteral SPM administration did not increase adverse events, including self-extubation. The total cost of neuroactive drugs tended to be lower in the EA group than in the LA and NA groups. Conclusions Early enteral SPM administration reduced the average daily propofol dose per body weight without increasing adverse events.

Nursing strategies for the mechanically ventilated patient

“…Aside from providing nutritional support, a nasogastric tube is beneficial for administration of medications that can help minimize the dosages needed for injectable opioids or sedation. Use of trazodone has been shown to help reduce the amount of needed propofol for ventilated patients (120). Consideration should be had to determine what each patient needs (121).…”