Use of intravenous infusion sedation among mechanically ventilated patients in the United States.
OBJECTIVE
Many studies compare the efficacy of different forms of intravenous infusion sedation for critically ill patients, but little is known about the actual use of these medications. We sought to describe current use of intravenous infusion sedation in mechanically ventilated patients in U.S. intensive care units.


METHODS
Retrospective cohort study of intravenous infusion sedation among mechanically ventilated patients. Intravenous sedatives examined included benzodiazepines (midazolam and lorazepam), propofol, and dexmedetomidine. Use was defined as having received an intravenous infusion for any time period during the stay in intensive care.


METHODS
One hundred seventy-four intensive care units contributing data to Project IMPACT from 2001 through 2007.


METHODS
All patients who received mechanical ventilation.


METHODS
None.


RESULTS
Of 109,671 mechanically ventilated patients, 56,443 (51.5%, 95% confidence interval 51.2-51.8) received one or more intravenous infusion sedatives. Sedative use increased over time, from 39.7% (38.7-40.6) of patients in 2001 to 66.7% (65.7-67.7) in 2007 (p < .001). Most patients who received intravenous infusion sedation received propofol (82.2%, 81.9-82.5) vs. benzodiazepines (31.1%, 30.7-31.5) or dexmedetomidine (4.0%, 3.8-4.2). Of the patients, 66.2% (65.8-66.6) received only propofol, and 16.2% (15.9-16.5) only benzodiazepines. Among patients mechanically ventilated >96 hrs, propofol infusions were more common. Intravenous infusion narcotics (fentanyl, morphine, or hydromorphone) were used more frequently among patients who received benzodiazepines (70.1%, 69.1-71.0) compared with propofol (23.9%, 23.5-24.3), p < .001.


CONCLUSIONS
The percentage of mechanically ventilated patients receiving intravenous infusion sedation has increased over time. Sedation with an infusion of propofol was much more common than with benzodiazepines or dexmedetomidine, even for patients mechanically ventilated beyond 96 hrs.
Wunsch
Hannah
H
Department of Anesthesiology, Columbia University, New York, NY, USA. hw2125@columbia.edu
Kahn
Jeremy M
JM
Kramer
Andrew A
AA
Rubenfeld
Gordon D
GD
D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014481:United States
D006993:Hypnotics and Sedatives