Dataset Information

Impact of a remifentanil supply shortage on mechanical ventilation in a tertiary care hospital: a retrospective comparison.

ABSTRACT:

Background

The continuous administration of opioids in critical care patients is a common therapy for the tolerance of mechanical ventilation. Opioid choice has a crucial impact on the length of mechanical ventilation. Owing to its very short context-sensitive half-life, remifentanil widens the available options for sedoanalgetic strategies. Supply disruption of such established intensive care medication has been reported to worsen clinical outcomes.

Methods

This retrospective study investigated the influence of a nationwide supply shortage of remifentanil on mechanical ventilation and ventilation-associated outcomes at three perioperative intensive care units (ICUs) in a tertiary care hospital in Vienna. Two groups were followed: patients admitted to the ICU during the remifentanil shortage (July 1, 2016 to September 30, 2016) and a control group one year after the remifentanil shortage (July 1, 2017 to September 30, 2017). Included patients were adults, received mechanical ventilation for at least 6 h, were admitted less than 90 days in the respective ICU, and survived their admission.

Results

For comparison, Poisson count regression models and logistic regression models were computed. To compensate for multiple testing, the significance level was split (0.02 for the primary and 0.006 for secondary outcome parameters). Patients in the remifentanil shortage group received significantly longer mechanical ventilation (risk ratio 2.19, 95% confidence interval 2.14-2.24, P?<0.001) with significantly prolonged ICU stay (P?<0.001), days with non-invasive ventilation (P?<0.001), and length of hospital stay (P?<0.001). No significant difference was found in the occurrence of pneumonia (P?=?0.040) and sepsis (P?=?0.061). A greater proportion of patients in the shortage group underwent secondary tracheostomy (P?<0.001).

Conclusions

The remifentanil shortage caused a significant impairment of essential outcome parameters in the ICU.

SUBMITTER: Klaus DA

PROVIDER: S-EPMC6204001 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Publications

Impact of a remifentanil supply shortage on mechanical ventilation in a tertiary care hospital: a retrospective comparison.

Klaus Daniel A DA de Bettignies Albert M AM Seemann Rudolf R Krenn Claus G CG Roth Georg A GA

Critical care (London, England) 20181026 1

<h4>Background</h4>The continuous administration of opioids in critical care patients is a common therapy for the tolerance of mechanical ventilation. Opioid choice has a crucial impact on the length of mechanical ventilation. Owing to its very short context-sensitive half-life, remifentanil widens the available options for sedoanalgetic strategies. Supply disruption of such established intensive care medication has been reported to worsen clinical outcomes.<h4>Methods</h4>This retrospective stu ...[more]

PMID: 30367645

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Project description:INTRODUCTION: Patients requiring prolonged acute mechanical ventilation (PAMV) represent one-third of those who need mechanical ventilation, but they utilize two-thirds of hospital resources devoted to mechanical ventilation. Measures are needed to optimize the efficiency of care in this population. Both duration of intensive care unit stay and mechanical ventilation are associated with anemia and increased rates of packed red blood cell (pRBC) transfusion. We hypothesized that transfusions among patients receiving PAMV are common and associated with worsened clinical and economic outcomes. METHODS: A retrospective analysis of a large integrated claims database covering a 5-year period (January 2000 to December 2005) was conducted in adult patients receiving PAMV (mechanical ventilation for >/= 96 hours). The incidence of pRBC transfusions was examined as the main exposure variable, and hospital mortality served as the primary outome, with hospital length of stay and costs being secondary outcomes. RESULTS: The study cohort included 4,344 hospitalized patients receiving PAMV (55% male, mean age 61.5 +/- 16.4 years). Although hemoglobin level upon admission was above 10 g/dl in 75% of patients, 67% (n = 2,912) received at least one transfusion, with a mean of 9.1 +/- 12.0 units of pRBCs transfused per patient over the course of hospitalization. In regression models adjusting for confounders, exposure to pRBCs was associated with a 21% increase in the risk for hospital death (95% confidence interval [CI] = 1.00 to 1.48), and marginal increases in length of stay (6.3 days, 95% CI = 5.1 to 7.6) and cost ($48,972, 95% CI = $45,581 to $52,478). CONCLUSION: Patients receiving PAMV are at high likelihood of being transfused with multiple units of blood at relatively high hemoglobin levels. Transfusions independently contribute to increased risk for hospital death, length of stay, and costs. Reducing exposure of PAMV patients to blood may represent an attractive target for efforts to improve quality and efficiency of health care delivery in this population.

Project description:Background: Hyponatremia (serum sodium concentration <135 mEq/L) is the most common electrolyte abnormality among hospitalized patients. Our aim was to study the epidemiology of hyponatremia in hospitalized patients, as well as the short-term mortality rates, the length of stay (LOS), and associated hospital costs. Methods: This retrospective cohort study included 6,539 hospitalizations in the internal medicine ward of a Swiss tertiary-care teaching hospital between January 1, 2012, and December 31, 2018 (42.7% women, mean age 69 years). Using serum sodium concentration, we identified hospitalizations with hyponatremia and calculated the prevalence of overall hyponatremia, admission hyponatremia (AH), hospital-acquired hyponatremia (HAH), and persistent hyponatremia (PH) at discharge. We also studied the impact of hyponatremia on 30-day readmissions, in-hospital and 30-day mortality, and hospital LOS and costs, using multivariable logistic regression and Cox proportional hazards models, with normal natremia as reference. Results: Prevalence of overall hyponatremia was 32.5% [95% confidence interval (CI), 31.3-33.6%], while prevalence of PH among hospitalizations with AH and HAH was 33.7% (31.7-35.8%). After multivariable adjustment, hyponatremia was associated with increased hospital costs (CHF 19,025 ± 485 vs. 14,962 ± 341, p < 0.001) and LOS (13.4 ± 0.2 vs. 10.7 ± 0.2 days, p < 0.001). Increased severity of hyponatremia was associated with higher hospital costs and LOS (p for trend <0.001). There was a trend toward more frequent 30-day readmissions associated with hyponatremia [adjusted odds ratio (OR), 1.15 (1.01-1.31), p = 0.032], mainly with PH: adjusted OR = 1.41 (1.17-1.71), p < 0.001. No association was found between severity of hyponatremia and readmissions. Hyponatremia was associated with an increase of in-hospital [adjusted OR = 1.94 (1.49-2.53), p < 0.001] and 30-day mortality: adjusted OR = 1.80 (1.44-2.24), p < 0.001. Increased severity of hyponatremia was associated with higher in-hospital and 30-day mortality (p for trend < 0.001). Conclusions: Hyponatremia is highly prevalent among hospitalized patients and associated with an increase of LOS, early hospital readmission, in-hospital and 30-day mortality, and hospital costs. PH was associated with a substantial increase of the risk of early hospital readmission and 30-day mortality.

Dataset Information

Impact of a remifentanil supply shortage on mechanical ventilation in a tertiary care hospital: a retrospective comparison.

Background

Methods

Results

Conclusions

Publications

Impact of a remifentanil supply shortage on mechanical ventilation in a tertiary care hospital: a retrospective comparison.

Similar Datasets

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