Cost of non-indicated bronchodilator therapy in critically ill, mechanically ventilated patients

Kenneth E. Wood, A. L. Flaten, R. L. Sorkness

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Purpose: Metered-Dose-Inhaler (MDI) or nebulized bronchodilator therapy is frequently utilized in critically ill, mechanically ventilated patients. This study was undertaken to define the cost implications of non-indicated bronchodilator therapy that resulted in no clinical response to the initial treatment. Methods: Over four months, 74 consecutive patients with orders for bronchodilator therapy were concurrently reviewed to assess the indications for therapy which were defined as a history of COPD, asthma, previous bronchodilator use, wheezing or auto-peep ≥ 4. Response to therapy was derived from comparison to paired ventilated patients without orders for bronchodilator therapy and was defined as a decrease in auto-peep > 1 or resistance > 5 or an increase in pulse oximetric saturations > 3%. All treatments during mechanical ventilation and post-extubation were recorded and cost was derived from the hospital cost-accounting system. Results: 31% (23/74) of the patients with orders for bronchodilator therapy did not have an accepted indication and 87% (20/23) without indications did not show any response to initial treatment. The total cost of non-indicated, non-responsive therapy for four months was $10,015.00 and most likely exceeds $30,000.00 per year. 52% (12/23) of the patients with no indications were discharged from the hospital with prescriptions for bronchodilators. Treatments and costs are depicted below. Conclusions: A substantial number of critically ill, mechanically ventilated patients who receive bronchodilator therapy without a defined indication, fail to respond to initial therapy, and may incur unnecessary costs. Clinical Implications: Applying indication criteria to bronchodilator therapy can result in cost savings and more optimal use of resources. Therapy Albuterol Neb Albuterol mdi Ipratropium neb Ipratopium mdi # Treatments Total 256 951 4 99 Cost/Treatment $8.75 $7.20 $9.25 $9.00 Total Cost $2,240.00 $6,847.00 $37.00 $891.00.

Original languageEnglish (US)
Pages (from-to)354S-355S
Issue number4 SUPPL.
StatePublished - Oct 1998

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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