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Journal of Anesthesia

, Volume 30, Issue 5, pp 763–769 | Cite as

The relationship between sedative drug utilization and outcomes in critically ill patients undergoing mechanical ventilation

  • Kenshi Hayashida
  • Takeshi Umegaki
  • Hiroshi Ikai
  • Genki Murakami
  • Masaji Nishimura
  • Yuichi ImanakaEmail author
Original Article

Abstract

Objectives

The objectives of this study were to describe current sedative drug utilization patterns in critically ill patients undergoing mechanical ventilation (MV) in intensive care units (ICUs) in Japanese hospitals and to elucidate the relationship of these utilization patterns with patient clinical outcomes.

Method

Analysis of hospital claims data derived from the Quality Indicator/Improvement Project identified 12,395 critically ill adult patients who had undergone MV while hospitalized in the ICUs of 114 Japanese hospitals and had been discharged between April 2008 and March 2010. Descriptive statistics were calculated for the daily utilization of sedative drugs, opioids, and muscle relaxants in this patient sample, and the relationship between drug utilization and patient outcomes using Cox proportional hazards analysis were examined.

Results

Of the 12,395 patients included in the analysis, 7300 (58.9 %), 580 (4.7 %), and 671 (5.4 %) received sedative drugs, opioids, and muscle relaxants, respectively, for ≥2 days after intubation. Compared to the other patient groups, there was a higher proportion of males in the group given sedative drugs and the patients were significantly younger (P < 0.001). Propofol was the most frequently used sedative drug, followed by benzodiazepines, barbiturates, and dexmedetomidine. The mortality rate was lower and ventilator weaning was earlier among patients who received only propofol than among those who received only benzodiazepines. Muscle relaxants were associated with increased duration of MV.

Conclusions

This is the first study based on a large-scale analysis in Japan to elucidate sedative drug utilization patterns and their relationship with outcomes in critically ill patients. The most commonly used sedative was propofol, which was associated with favorable patient outcomes. Further prospective research must be conducted to discern effective sedative drug utilization.

Keywords

Mechanical ventilation Sedative drugs Opioids Muscle relaxants Mortality Intensive care units Japan 

Notes

Acknowledgments

This work was financially supported in part by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science ([A]25253033).

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interests to declare.

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Copyright information

© Japanese Society of Anesthesiologists 2016

Authors and Affiliations

  • Kenshi Hayashida
    • 1
  • Takeshi Umegaki
    • 2
  • Hiroshi Ikai
    • 3
  • Genki Murakami
    • 1
  • Masaji Nishimura
    • 4
  • Yuichi Imanaka
    • 3
    Email author
  1. 1.Department of Medical Informatics and Management, University HospitalUniversity of Occupational and Environmental HealthKitakyushu, FukuokaJapan
  2. 2.Department of AnesthesiologyKansai Medical UniversityHirakata, OsakaJapan
  3. 3.Department of Healthcare Economics and Quality ManagementKyoto University Graduate School of MedicineSakyo-ku, KyotoJapan
  4. 4.Department of Emergency and Critical Care MedicineTokushima University Graduate SchoolTokushimaJapan

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