Propofol is the first-line sedative recommended for patients in ICU, especially those needing help with their breathing from a ventilator. The challenge is that it is currently administered on a ‘one-size fits all’ basis and there is a wealth of published evidence that patients are suffering harm as a consequence. In particular, the absence of being able to measure how much propofol is in each patient’s blood stream whilst they are being given it is resulting in excessive sedation, a higher incidence of pneumonia whilst on the ventilator, and delirium at any time in their hospital stay.
And as we know from numerous studies some patients even die when they might not have.
In addition, hospitals are wasting money. Spending longer on a ventilator or suffering delirium significantly increases the length of stay in hospital. ICU beds are typically the most expensive beds in any hospital, requiring a high ratio of patients to nurses. This is usually one nurse to every patient on a ventilator.
The results of a prospective study in the Netherlands looking at delirium in ICU patients were published a few weeks ago. The researchers found that of 950 patients being given propofol or midazolam and in an unrousable state (i.e. excessively sedated) for more than 24 hrs, 64% were delirious during the first 7 days after awakening. Delirium is distressing for patients and their relatives (read our blog Delirium – Somnus Scientific (somnus-scientific.com) and extremely demanding for nursing staff to manage. It can have long lasting consequences.
Using ProSedTM, our first near-patient, rapid propofol monitor promises to personalise and improve sedation administration. This will improve outcomes (including survival) for patients and reduce the burden of post-ICU rehabilitation on hospitals, families, and the broader health and care system.
Whilst ICU doctors and nurses are very excited about the potential offered by using ProSedTM, hospital finance staff will only really agree to its use if we can demonstrate cost savings. For that reason, we have built a Cost Consequence model for every ICU in England that shows the financial benefit of improving sedation management with regular propofol measurement, even after the cost of the tests is taken into account. We have been able to access named, ICU specific financial data via NHS England that means our modelling illustrates the savings that follow even modest reductions in the time spent on a ventilator or sedation-related harm.
We will soon commence clinical testing with our partner ICUs. ProSedTM promises the holy grail of both improving outcomes for patients and saving money for hospitals.
