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Journal de Pharmacie Clinique

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Cost evaluation of three morphinic agonists and midazolam in patient with intubation and mechanically ventilated in intensive care unit Volume 23, issue 1, janvier-février-mars 2004

Authors
Pharmacie centrale, Centre hospitalier Manchester, Charleville‐Mézières Service de réanimation, Centre hospitalier Manchester, Charleville‐Mézières

Sedation and analgesia for mechanically ventilated patient in Intensive Care Unit (ICU) use a morphinic agonist in association with midazolam. Three morphinic agonists are used in this indication: fentanyl, sufentanil (Sufenta TM) and remifentanil (Ultiva TM). A six‐month prospective study about patient receiving fentanyl, sufentanil or remifentanil, with or without midazolam, in ICU, aims us to evaluate economical (direct costs) advantages of these medicines in Intensive Care Unit. Fentanyl was used as referent treatment. 62 patients have been followed and mean age was 64.3 years. Daily cost of treatment was 1.6 time higher in sufentanil and 2.6 with remifentanil groups (p < 0.001) than fentanyl. Cost of fentanyl associated with midazolam was 26.2 € per day and per patient. Morphinic agonists represent the major part of expenditure. A 50% decrease of midazolam consumption was observed in remifentanil group. The average lengths of treatment were 3 days in this group, 5 days with fentanyl and sufentanil. After the end of infusion, 1 to 3 minutes offset was observed with remifentanil, contrary to fentanyl and sufentanil that presented prolonged pharmacological effects and release effect. This study allowed us to define use of morphinic agonists for analgesia and sedation of patient with mechanically ventilation in ICU. Fentanyl is recommended in first intention and prolonged intubations. Remifentanil is restrained to short time intubation and patients requiring frequent therapeutic interruptions of treatment. Fentanyl and sufentanil substitutes remifentanil in the case of a longer analgesia.