Cost-effectiveness of Inhaled Sedation Versus Intravenous Propofol in Mechanically Ventilated Critically Ill Patients: a Retrospective ICU Study

Sedation is an essential component of care for critically ill patients receiving invasive mechanical ventilation in the intensive care unit (ICU). It helps improve patient comfort, reduce metabolic demand, and facilitate ventilator synchrony. Intravenous propofol is widely used for this purpose because of its rapid onset and titratability, but it may be associated with adverse effects such as hypotension, hyperlipidemia, and propofol infusion syndrome. Inhaled sedation with volatile anesthetic agents has re-emerged as an alternative approach in ICU patients, with potential advantages including lower drug accumulation, rapid pulmonary elimination, and possibly shorter duration of mechanical ventilation and ICU stay.

This study is a retrospective observational cohort study conducted in the ICU of Hospital H+ Querétaro. It will include adult patients who required at least 24 hours of mechanical ventilation and received either inhaled sedation or continuous intravenous propofol sedation during their ICU stay. Patients with extracorporeal membrane oxygenation, severe traumatic brain injury, transfer to another unit, or less than 24 hours of mechanical ventilation will be excluded.

The primary objective is to compare the total cost of inhaled sedation versus intravenous propofol in mechanically ventilated critically ill patients. Secondary objectives are to compare duration of mechanical ventilation, ICU length of stay, adverse events, and indirect costs between the two sedation strategies. The primary outcome is total cost of care, while secondary outcomes include days on mechanical ventilation, ICU stay, and adverse events. Additional variables such as age, sex, SOFA score, APACHE II score, and comorbidities will also be collected.

Data will be collected through review of electronic medical records and recorded in a standardized format. Statistical analysis will be performed using STATA. Descriptive statistics will summarize baseline characteristics and outcomes, and inferential analyses will be used to compare groups, with adjustment for relevant covariates when appropriate. The aim of the study is to determine whether inhaled sedation may represent a cost-effective strategy that improves resource use and clinical outcomes in the ICU setting.