title: Impact of a national propofol shortage on duration of mechanical ventilation at an academic medical center.
abstract: OBJECTIVE
  To measure the impact of a national propofol shortage on the duration of mechanical ventilation.
  
  
  METHODS
  Before-after study.
  
  
  METHODS
  Three, noncardiac surgery, adult intensive care units at a 320-bed academic medical center.
  
  
  METHODS
  Consecutive patients requiring mechanical ventilation ≥48 hrs, administered a continuously infused sedative ≥24 hrs, extubated, and successfully discharged from the intensive care unit were compared between before (December 1, 2008 to May 31, 2009) and after (December 1, 2009, to May 31, 2010) a propofol shortage.
  
  
  METHODS
  None.
  
  
  RESULTS
  Sedation drug use and common factors affecting time on mechanical ventilation were collected and if found either to differ significantly (p ≤ .10) between the two groups or to have an unadjusted significant association (p ≤ .10) with time on mechanical ventilation were included in a multivariable model. The unadjusted analyses revealed that the median (interquartile range) duration of mechanical ventilation increased from 6.7 (9.8; n = 153) to 9.6 (9.5; n = 128) days (p = .02). Fewer after-group patients received ≥24 hrs of continuously infused propofol (94% vs. 15%, p < .0001); more received ≥24 hrs of continuously infused lorazepam (7% vs. 15%, p = .037) and midazolam (30% vs. 81%, p < .0001). Compared with the before group, the after group was younger, had a higher admission Acute Physiology and Chronic Health Evaluation II score, was more likely to be admitted by a surgical service, have acute alcohol withdrawal, and be managed with pressure-controlled ventilation as the primary mode of mechanical ventilation. Of these five factors, only the Acute Physiology and Chronic Health Evaluation II score, admission service, and use of a pressure-controlled ventilation affected duration of mechanical ventilation across both groups. Although a regression model revealed that Acute Physiology and Chronic Health Evaluation II score (p < .0001), admission by a medical service (p = .009), and use of pressure-controlled ventilation (p = .02) each affected duration of mechanical ventilation in both groups, inclusion in either the before- or after-propofol shortage groups (i.e., high vs. low use of propofol) did not affect duration of mechanical ventilation (p = .35).
  
  
  CONCLUSIONS
  An 84% decrease in propofol use in the adult intensive care units at our academic institution as a result of a national shortage did not affect duration of mechanical ventilation.
authors.affiliation: Department of Pharmacy, Tufts Medical Center, Boston, MA, USA.
authors.forename: Russel
authors.initials: R
authors.lastname: Roberts
authors.forename: Robin
authors.initials: R
authors.lastname: Ruthazer
authors.forename: Amy
authors.initials: A
authors.lastname: Chi
authors.forename: Aarti
authors.initials: A
authors.lastname: Grover
authors.forename: Matthew
authors.initials: M
authors.lastname: Newman
authors.forename: Shubha
authors.initials: S
authors.lastname: Bhat
authors.forename: Stacey
authors.initials: S
authors.lastname: Benotti
authors.forename: Erik
authors.initials: E
authors.lastname: Garpestad
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Nasraway
authors.forename: William
authors.initials: W
authors.lastname: Howard
authors.forename: John W
authors.initials: JW
authors.lastname: Devlin
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000600:supply & distribution*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015742:Propofol / Q000008:administration & dosage / Q000600:supply & distribution*; D012121:Respiration, Artificial / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D015300:Ventilator Weaning
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol