&lt;p&gt;Cost-Minimization Analysis of Dexmedetomidine Compared to Other Sedatives for Short-Term Sedation During Mechanical Ventilation in the United States&lt;/p&gt;

Aggarwal, Jyoti; Lustrino, Jacqueline; Stephens, Jennifer; Morgenstern, Diana; Tang, Wing Yu

doi:10.2147/ceor.s242994

Cited by 13 publications

(15 citation statements)

References 32 publications

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“…Furthermore, the result of the primary outcome of this systematic review supports the recommendation of the European Society of Anaesthesiology 35 for the use of dexmedetomidine over other sedative agents such as benzodiazepines, despite the financial cost of dexmedetomidine being higher than other medications used in ICU. 36 However, the clinical patient benefits such as reduction in delirium, shortened duration of mechanical ventilation, and ICU length of stay and its associated cost reductions are thought to outweigh the high financial cost of dexmedetomidine. 35,36 Moreover, the SCCM in their latest PADIS guidelines also recommended the shift to light sedation agents such as dexmedetomidine as the choice of sedation in ICU.…”

Section: Discussionmentioning

confidence: 99%

“…36 However, the clinical patient benefits such as reduction in delirium, shortened duration of mechanical ventilation, and ICU length of stay and its associated cost reductions are thought to outweigh the high financial cost of dexmedetomidine. 35,36 Moreover, the SCCM in their latest PADIS guidelines also recommended the shift to light sedation agents such as dexmedetomidine as the choice of sedation in ICU. 12 To provide further support to this thesis, a study by Pasero et al 37 consisted of a structured consensus of 17 intensivists from 17 Italian ICUs who were experienced and experts in PAD management, considered dexmedetomidine the first-line sedative.…”

Section: Discussionmentioning

confidence: 99%

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Early sedation with dexmedetomidine in post‐operative adult intensive care unit patients

Yiewong

Corry

Mooney

2023

Nursing in Critical Care

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BackgroundDelirium is a leading healthcare concern in adult Intensive Care Units (ICU) and has a reported prevalence of up to 80%. Although individual studies report that early sedation with dexmedetomidine in post‐operative patients including its nocturnal administration can improve sleep quality and reduction in ICU delirium, these have not been synthesized in a systematic review.AimThe aim of this systematic review was to evaluate the effectiveness of early administration of dexmedetomidine infusion in the prevention of delirium, reduction in agitation, and improved sleep quality among post‐operative adults in ICU.MethodsA systematic search was conducted across PubMed, CINAHL, MEDLINE, and EMBASE, together with a search for grey literature. Two authors independently screened the search results, extracted data, and assessed risk of bias (ROB). Data were meta‐analysed using RevMan 5.4 software. A simplified Cochrane approach was used in this review.ResultsFive randomized controlled trials with 2173 participants were included. ROB was assessed with the five studies included in this review. Of the five included studies, two were identified as having components with a high ROB; one study reporting high ROB in the domain of other biases, and the other study in the domains of allocation concealment as well as in the domains of blinding of participants and personnel. All other studies and domains were either low or unclear ROB. The result indicated that the incidence of delirium was reduced among the dexmedetomidine group (RR: 0.08, 95% CI −0.15 to −0.01, 3 studies, 1045 patients) when compared with those who received other medications. There was no difference in agitation (RR: 0.85, 95% CI 0.51 to 1.44, 2 studies, 779 patients), and although better sleep was associated with the dexmedetomidine group, no data focusing on the sleep quality was reported.ConclusionThe pooled result of this systematic review indicated a reduction in the incidence of delirium among ventilated patients who received early administration of dexmedetomidine post‐operatively. Although pooled sample sizes are relatively high, each outcome is based on one or two studies of primarily low or unclear ROB. Further research is warranted to determine the potential benefit of dexmedetomidine on agitation and sleep quality.Relevance to clinical practiceThe findings from this study support the use of light sedation, such as dexmedetomidine as recommended in the Society of Critical Care Medicine's guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early sedation with dexmedetomidine in post‐operative adult intensive care unit patients

Yiewong

Corry

Mooney

2023

Nursing in Critical Care

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“…However, they concluded that DEX was more economical when considering the cost of managing mechanical ventilation and delirium 22 . In addition, in another study comparing the economic feasibility of MDZ, DEX, and propofol in an intensive care set- ting, DEX was reported to be the least expensive 23 . Sedation agents have been compared for their vital sign stability and cost as well as various other variables, and each study has shown slightly different results.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of vital sign stability and cost effectiveness between midazolam and dexmedetomidine during third molar extraction under intravenous sedation

Kim

Park

Han

et al. 2022

JKAOMS

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Objectives: To compare the vital sign stability and cost of two commonly used sedatives, midazolam (MDZ) and dexmedetomidine (DEX). Patients and Methods: This retrospective study targeted patients who underwent mandibular third molar extractions under intravenous sedation using MDZ or DEX. The predictor variable was the type of sedative used. The primary outcome variables were vital signs (heart rate and blood pressure), vital sign outliers, and cost of the sedatives. A vital sign outlier was defined as a 30% or more change in vital signs during sedation; the fewer changes, the higher the vital sign stability. The secondary outcome variables included the observer's assessment of alertness/sedation scale, level of amnesia, patient satisfaction, and bispectral index score. Covariates were sex, age, body mass index, sleeping time, dental anxiety score, and Pederson scale. Descriptive statistics were computed including propensity score matching (PSM). The P-value was set at 0.05. Results: The study enrolled 185 patients, 103 in the MDZ group and 82 in the DEX group. Based on the data after PSM, the two samples had similar baseline covariates. The sedative effect of both agents was satisfactory. Heart rate outliers were more common with MDZ than with DEX (49.3% vs 22.7%, P=0.001). Heart rate was higher with MDZ (P=0.000). The cost was higher for DEX than for MDZ (29.27±0.00 USD vs 0.37±0.04 USD, P=0.000). Conclusion: DEX showed more vital sign stability, while MDZ was more economical. These results could be used as a reference to guide clinicians during sedative selection.

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“…A secondary analysis of the SEDCOM trial ( 27) (an RCT comparing dexmedetomidine and midazolam for sedation in critically ill patients) (38) showed a median total intensive care unit cost savings of $9,679 using dexmedetomidine in patients ventilated for more than 24 h. The primary cost drivers were reduced costs of ICU stay and reduced costs of mechanical ventilation. Aggarwal et al (39) conducted a cost-minimization analysis for short sedation in ICU, demonstrating that dexmedetomidine was associated with significant cost savings of ∼$6,000 compared with propofol and midazolam in mechanically ventilated, adult patients undergoing short-term sedation (<24 h). Although the limited generalizability of cost data outside the US, the costsaving was mainly related to the reduced ICU length of stay and the required monitoring.…”

Section: The "How"mentioning

confidence: 99%

Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients

et al. 2022

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The clinical approach to sedation in critically ill patients has changed dramatically over the last two decades, moving to a regimen of light or non-sedation associated with adequate analgesia to guarantee the patient’s comfort, active interaction with the environment and family, and early mobilization and assessment of delirium. Although deep sedation (DS) may still be necessary for certain clinical scenarios, it should be limited to strict indications, such as mechanically ventilated patients with Acute Respiratory Distress Syndrome (ARDS), status epilepticus, intracranial hypertension, or those requiring target temperature management. DS, if not indicated, is associated with prolonged duration of mechanical ventilation and ICU stay, and increased mortality. Therefore, continuous monitoring of the level of sedation, especially when associated with the raw EEG data, is important to avoid unnecessary oversedation and to convert a DS strategy to light sedation as soon as possible. The approach to the management of critically ill patients is multidimensional, so targeted sedation should be considered in the context of the ABCDEF bundle, a holistic patient approach. Sedation may interfere with early mobilization and family engagement and may have an impact on delirium assessment and risk. If adequately applied, the ABCDEF bundle allows for a patient-centered, multidimensional, and multi-professional ICU care model to be achieved, with a positive impact on appropriate sedation and patient comfort, along with other important determinants of long-term patient outcomes.

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<p>Cost-Minimization Analysis of Dexmedetomidine Compared to Other Sedatives for Short-Term Sedation During Mechanical Ventilation in the United States</p>

Cited by 13 publications

References 32 publications

Early sedation with dexmedetomidine in post‐operative adult intensive care unit patients

Early sedation with dexmedetomidine in post‐operative adult intensive care unit patients

Comparison of vital sign stability and cost effectiveness between midazolam and dexmedetomidine during third molar extraction under intravenous sedation

Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients

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