Mechanically ventilated patients are often administered analgesic medications such as dexmedetomidine (DEX) and lorazepam (LZP) to reduce pain and anxiety. Studies have suggested that benzodiazepines may increase the risk of developing acute brain dysfunction, mechanical ventilation time, and length of stay (LOS) (Pandharipande PP, et al. JAMA 2007). Although Clinical Practice Guidelines recommend use of DEX over LZP (Barr J, et al. Crit Care Med. 2013), they are graded 2B (weak with moderate clinical evidence) and not universally applied. We investigated if the LOS differs in patients receiving DEX versus LZP while admitted in an intensive care unit (ICU).
We captured data on all ICU patients administered either DEX or LZP at Grand View Hospital from August 2011 to August 2013. The mean and median ICU LOS, and mean treatment duration, was compared between groups. Additionally, the mean per patient and total costs of DEX or LZP were calculated.
Data from 30 ICU patients treated with DEX and 15 treated with LZP were analyzed. We observed mean and median ICU LOS to be 13 & 11 days (range 1-56 days) in patients administered DEX, and 18 & 15 days (range 7-56 days) in patients administered LZP, respectively. The mean therapeutic duration for anxiolytic use was 4.0 days (range 1-14) with DEX, and 4.2 days (range 1-10) with LZP. For DEX, the therapy indication was mechanical ventilation (n=25), ethanol withdrawal (n=2), agitation (n=2), and non-rebreather (n=1). The indication for LZP use was mechanical ventilation for all patients (n=15). The mean per patient and total cost was found to be $809.74 & $24,292.07 for DEX, and $121.40 & $1,820.98 for LZP, respectively.
ICU LOS may be shorter for patients receiving DEX versus LZP as a sole means for sedation. Mean therapeutic cost of DEX was $688 per patient higher than LZP, but overall ICU expenditures in mechanically ventilated patients are expected to be more than $2,000 per day (Dasta JF, et al. Crit Care Med. 2005) and there may be a substantial overall economic benefit with reduction in ICU LOS.