Abstract
Introduction Side effects of traditional analgo-sedative agents call the attention to alternative strategies of sedation for critically ill patients; volatile anaesthetics (VAs) are considered potential substitutes in selected categories of patients. MIRUS™ (Pall Corporation and TIM Germany) is an innovative system for the administration of VAs to these patients admitted in intensive care unit (ICU). Methods The aim of this study was to analyse the clinical and economical characteristics of MIRUS™, following the Health Technology Assessment principles (HTA); in particular, the study was focused on defining a cost/efficacy ratio of the use of MIRUS™ in an ICU with 8 beds and 80 procedures/year. HTA allows predicting the system impact in the clinical pathway before material introduction. Results The assessment showed that MIRUS™ could be innovative, safe and efficient, especially when applied to critically ill patients with compromised organ function. For the purposes of assessment, three classes of ICU treatments have been defined: short- (6–24 h), medium- (24–96 h) and long-term (>96 h) sedation (SS, MS, LS). Based on the technical characteristics of system, MIRUS™ could be considered unfit for LS. Considering clinical characteristics, effects on patients, sedation times and costs, the HTA shows how the procedure costs are different for each class. Conclusions In conclusion, the use of MIRUS™ could be useful and effective for critically ill patients, in which standard sedation may be associated with drug hangover. This assessment seems economically advantageous for SS, where cost/efficacy ratios are positive performing 400 procedures/year, while for MS the cost of drugs impacts on the procedure cost. Therefore, looking at the potential clinical benefits on all potential treatable patients, the best addition strategy of the system in the hospital should be evaluated to optimize the cost/efficacy ratio.
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References
Barr J., et al.: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical care medicine 41.1 (2013): 263–306.
Reade M. C., and Simon F.: Sedation and delirium in the intensive care unit. New England Journal of Medicine 370.5 (2014): 444–454.
Baron R., et al.: Evidence and consensus-based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015)–short version. GMS German Medical Science 13 (2015).
Soukup J., et al.: State of the art: sedation concepts with volatile anesthetics in critically ill patients. Journal of critical care 24.4 (2009): 535–544.
Jerath A., et al.: Volatile Anesthetics. Is a New Player Emerging in Critical Care Sedation?. American journal of respiratory and critical care medicine 193.11 (2016): 1202–1212.
Grabitz S. D., et al.: Dose-dependent protective effect of inhalational anesthetics against postoperative respiratory complications: a prospective analysis of data on file from three hospitals in New England. Critical care medicine 45.1 (2017): e30–e39.
O’Gara B., and Daniel T.: Lung protective properties of the volatile anesthetics. Intensive care medicine 42.9 (2016): 1487–1489.
Bellgardt M., et al.: Inhalative Anästhetika in der Intensivmedizin. Intensivmedizin up2date 9.03 (2013): 185–204.
Bomberg H., et al.: Evaluating the efficiency of desflurane reflection in two commercially available reflectors. Journal of clinical monitoring and computing (2016): 1–10.
Vinnikov V., et al.: Automated control of end-tidal volatile anaesthetic concentration using the MIRUS™ system: a comparison of isoflurane, sevoflurane and desflurane in anaesthesia. Critical Care 19.1 (2015): P495.
Bomberg H., et al.: A novel device for target controlled administration and reflection of desflurane–the Mirus™. Anaesthesia 69.11 (2014): 1241–1250.
Miniati R., et al.: Development of sustainable models for technology evaluation in hospital. Technology and Health Care 22.5 (2014): 729–739.
Frosini F., et al.: Integrated HTA-FMEA/FMECA methodology for the evaluation of robotic system in urology and general surgery. Technology and Health Care 24.6 (2016): 873–887.
Romagnoli S., et al.: The New MIRUS System for Short-Term Sedation in Postsurgical ICU Patients. Critical care medicine 45.9 (2017): e925–e931.
Mancinelli P., et al.: MIRUS™, a new system for sedation with halogenates in the ICU: a preliminary study of feasibility in postsurgical patients. Critical Care 19.1 (2015): P492.
Drummond, M. F., et al.: Methods for the economic evaluation of health care programmes. Oxford university press, 2015.
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Ciagli, E. et al. (2019). A Preliminary Cost/Efficacy Analysis of MIRUS™ System for Sedation of Critical Patients. In: Lhotska, L., Sukupova, L., Lacković, I., Ibbott, G. (eds) World Congress on Medical Physics and Biomedical Engineering 2018. IFMBE Proceedings, vol 68/2. Springer, Singapore. https://doi.org/10.1007/978-981-10-9038-7_17
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DOI: https://doi.org/10.1007/978-981-10-9038-7_17
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