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Use and costs of inhaled nitric oxide and inhaled epoprostenol in adult critically ill patients: A quality improvement project.
Davis, Stephanie L; Crow, Jessica R; Fan, John R; Mattare, Katie; Whitman, Glenn; Brower, Roy G; Rowden, Annette; Pustavoitau, Aliaksei.
Afiliación
  • Davis SL; Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD.
  • Crow JR; Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD.
  • Fan JR; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD.
  • Mattare K; Department of Respiratory Therapy, Johns Hopkins Hospital, Baltimore, MD.
  • Whitman G; Department of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD.
  • Brower RG; Department of Medicine, Johns Hopkins Hospital, Baltimore, MD.
  • Rowden A; Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD.
  • Pustavoitau A; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Am J Health Syst Pharm ; 76(18): 1413-1419, 2019 Sep 03.
Article en En | MEDLINE | ID: mdl-31372630
PURPOSE: Inhaled epoprostenol and inhaled nitric oxide are pulmonary vasodilators commonly used in the management of acute respiratory distress syndrome and right ventricular failure; however, they have vastly different cost profiles. The purpose of the project was to transition from nitric oxide to epoprostenol as the inhaled pulmonary vasodilator (IPV) of choice in adult critically ill patients and evaluate the effect of the transition on associated usage and costs. METHODS: A single-center, prospective, before and after quality improvement project including adult patients receiving inhaled nitric oxide, inhaled epoprostenol, or both was conducted in 7 adult intensive care units, operating rooms, and postanesthesia care units of a tertiary care academic medical center. The total number of patients, hours of therapy, and costs for each agent were compared between stages of protocol implementation and annually. RESULTS: Seven hundred twenty-nine patients received inhaled nitric oxide, inhaled epoprostenol, or both during the study period. The monthly inhaled nitric oxide use in number of patients, hours, and cost decreased during all stages of the project (p < 0.01). The monthly inhaled epoprostenol use in number of patients, hours, and cost increased during all stages (p < 0.01). Overall, total IPV use increased during the study. However, despite this increase in usage, there was a 47% reduction in total IPV cost. CONCLUSION: Implementation of a staged protocol to introduce and expand inhaled epoprostenol use in adult critically ill patients resulted in decreased use and cost of inhaled nitric oxide. The total cost of all IPV was decreased by 47% despite increased IPV use.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Síndrome de Dificultad Respiratoria / Vasodilatadores / Epoprostenol / Mejoramiento de la Calidad / Óxido Nítrico Tipo de estudio: Evaluation_studies / Guideline / Health_economic_evaluation / Observational_studies / Risk_factors_studies / Sysrev_observational_studies Aspecto: Implementation_research Límite: Adult / Humans Idioma: En Revista: Am J Health Syst Pharm Asunto de la revista: FARMACIA / HOSPITAIS Año: 2019 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Síndrome de Dificultad Respiratoria / Vasodilatadores / Epoprostenol / Mejoramiento de la Calidad / Óxido Nítrico Tipo de estudio: Evaluation_studies / Guideline / Health_economic_evaluation / Observational_studies / Risk_factors_studies / Sysrev_observational_studies Aspecto: Implementation_research Límite: Adult / Humans Idioma: En Revista: Am J Health Syst Pharm Asunto de la revista: FARMACIA / HOSPITAIS Año: 2019 Tipo del documento: Article Pais de publicación: Reino Unido