A cost analysis of enterally administered XXXX in the pediatric intensive care unit.

@entity1 @entity1363 @entity2934
OBJECTIVE: To determine the cost savings of replacing intravenous @entity1363 with enterally administered @entity2934 in mechanically ventilated @entity1 who require long-term continuous sedation. DESIGN: Retrospective review of @entity1 treated according to a preestablished pediatric intensive care unit (ICU) sedation protocol. SETTING: Twenty-six-bed pediatric ICU in a tertiary care @entity1 's hospital. @entity1 : The records of 30 mechanically ventilated @entity1 were analyzed. The median age was 1.5 yrs and the median weight was 8.0 kg. @entity1 required continuous sedation for a total of 16 days (median). INTERVENTIONS: According to our pediatric ICU sedation protocol, @entity1363 infusion was continued until the hourly @entity1363 requirement was stable for at least 24 hrs. Thereafter, @entity1 with a nasojejunal tube who were likely to require a minimum of three additional days of continuous sedation were transitioned from intravenous @entity1363 to enterally administered @entity2934 . The goal in transitioning therapy was to titrate the @entity2934 dose and reduce @entity1363 administration while maintaining an unchanged level of sedation. MEASUREMENTS AND MAIN RESULTS: The rate of @entity1363 administration was significantly (p<.05) reduced beginning on day 1 of @entity2934 treatment. @entity1363 was successfully discontinued in 24 (80%) @entity1 in 3 days (median), and adequate and appropriate sedation was maintained with @entity2934 monotherapy. Six @entity1 in whom @entity1363 could not be discontinued experienced a 52% reduction in the rate of @entity1363 administration as a result of adding @entity2934 . Total projected @entity1363 utilization was defined as the sum of @entity1363 administration before initiating @entity2934 and the projected @entity1363 requirement after initiating @entity2934 . Projected @entity1363 cost was calculated as the product of total projected @entity1363 utilization and @entity1363 acquisition cost. Actual expenditures for both @entity1363 and @entity2934 were subtracted from the projected @entity1363 cost to calculate the estimated cost savings. Overall, @entity1363 utilization (in milligrams) was reduced by 46.7+/-27.6% (median 52). Total projected @entity1363 cost for the 30 @entity1 was  90,771. The actual cost of @entity1363 and @entity2934 combined was  47,867, resulting in a cost savings of  42,904. CONCLUSIONS: Transitioning from intravenous @entity1363 to enterally administered @entity2934 in critically ill @entity1 who require long-term sedation results in significant cost savings. The oral formulation of @entity2934 was convenient to use, inexpensive, and effective in maintaining a continuous and appropriate level of sedation once @entity1363 was discontinued.
