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

• Published in: PloS one 2021-12, Vol.16 (12), p.e0261305-e0261305
• Main Authors: Tsunemitsu, Takefumi, Kataoka, Yuki, Matsumoto, Masaru, Hashimoto, Takashi, Suzuki, Takao
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Adverse events; Aged; Analgesics; Anesthesia; Benzodiazepines; Biology and Life Sciences; Body weight; Central Nervous System Depressants - administration & dosage; Cohort analysis; Comorbidity; Complications and side effects; Confidence intervals; Critical care; Delirium; Dosage; Drug dosages; Efficiency; Enteral Nutrition - methods; Female; Fentanyl; Health aspects; Health risks; Humans; Hypnotics; Hypnotics and Sedatives - administration & dosage; Hypotension; Indenes - administration & dosage; Intensive care; Intensive Care Units - statistics & numerical data; Intravenous administration; Length of Stay; Male; Mechanical ventilation; Medical records; Medicine and Health Sciences; Melatonin; Melatonin - administration & dosage; Middle Aged; Ostomy; Patient outcomes; Patients; Propofol; Propofol - administration & dosage; Psychotropic drugs; Regression analysis; Regression models; Research and Analysis Methods; Respiration, Artificial - methods; Retrospective Studies; Safety; Sedatives; Sleep; Sleep - drug effects; Statistical analysis; Tertiary; Ventilation; Ventilators
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0261305

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. 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. 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. Early enteral SPM administration reduced the average daily propofol dose per body weight without increasing adverse events.