The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

MEDICATION COST SAVINGS UTILIZING DRÄGER EVITA4 & DURA2 VENTILATORS

Lori Hand, B.Sc., R.R.T., C.H.T.; Lisa O'Drowsky, B.Sc., R.R.T. Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada

BACKGROUND: Positive pressure mechanical ventilation with deep sedation and/or muscle paralysis often results in reduced, even elimination of, diaphragmatic motility. Alveoli become hypoventilated in regions near the diaphragm leading to ventilation perfusion (V/Q) mismatch in the lung. The goal of technologically advanced mechanical ventilators is to restore or maintain spontaneous breathing despite poor gas exchange in hopes of alleviating V/Q mismatch. Analgesia, not sedation or paralysis should be the goal in managing mechanically ventilated patients. With decreased utilization of sedative and/or paralytic agents, costs are directly reduced in medication use, potentially decreased ventilator hours and fewer intensive care patient days. Unlike traditional mechanical ventilators, the Drager Evita4 and Dura2 ventilators possess a ?floating? exhalation valve which does not wholly occlude the expiratory limb outlet during any phase of the respiratory cycle. This allows the patient to cough or initiate spontaneous breathing at any point within the mechanical cycle, leading to increased patient comfort (decreased ventilator asynchrony) with a concomitant reduction in sedatives and paralytics. Purpose: To identify if the Drager Evita4 and Dura2 ventilators, with advanced technology of the "floating" exhalation valve, lead to a decrease in sedation and/or paralytic requirements, compared to conventional mechanical ventilators, and; to determine daily cost savings per case in sedation and paralytics, of Drager Evita4 and Dura2 mechanically ventilated patients. METHOD: A retrospective chart review of one patient included review of bedside flowsheets and medication profiles. All intravenous and bolus administrations of lorazepam (AtivanÒ) and vecuronium (NorcuronÒ) were respectively totaled for the period the patient was ventilated with a mechanical ventilator not possessing a ?floating? exhalation valve. In consultation with the clinical pharmacist, costs for each medication were calculated for a 24 hour period. RESULTS and EXPERIENCE: An estimated total cost savings of $100.00 (Canadian) in sedation and paralytic over a 24 hour period was revealed. This was identified when the Drager Evita4 was changed to an alternate brand of ventilator on a patient who previously did not require sedation and paralysis. Once placed on like parameters on the alternate ventilator, sedation and paralysis were necessitated within thirty minutes to effectively ventilate the patient. When the patient was placed back on the Drager Evita4, both the sedative and paralytic were discontinued over an 18 hour period.

Conclusions: Due to the advanced technology of the "floating" exhalation valve in the Drager Evita4 and Dura2 ventilators, less sedation and/or paralytics are required to comfortably and effectively mechanically ventilate patients. This reduction in medication requirements may result in cost savings seen in medication utilization and, potential fewer ventilator and intensive care patient days. The anticipated medication cost savings over a 12 month period would offset the majority of capital purchase costs of the Drager Evita4 and Dura2 ventilators. This finding prompts further review of medication requirements in patients ventilated with Drager Evita4 and Dura2 ventilators.

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