ELECTRONIC SUPPLEMENTARY MATERIAL
The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis Efeito econômico do uso da oxigenação extracorpórea para suporte de pacientes adultos com insuficiência respiratória grave no Brasil: uma análise hipotética
Marcelo Park1,2, Pedro Vitale Mendes1,2, Fernando Godinho Zampieri1, Luciano Cesar Pontes Azevedo1,2, Eduardo Leite Vieira Costa2,3, Fernando Antoniali4, Gustavo Calado de Aguiar Ribeiro4, Luiz Fernando Caneo5,6, Luiz Monteiro da Cruz Neto1, Carlos Roberto Ribeiro Carvalho3, Evelinda Marramon Trindade6, the ERICC research group, and the ECMO group of the Hospital Sírio Libanês and Hospital das Clínicas de São Paulo
This electronic supplementary material shows the patients did not receive dialysis or supplemental oxygen origin of the values used in the simulations presented after six months of evaluation. in the manuscript. Data representing the hospital flow The costs used in the analysis were collected from of patients with severe respiratory failure were extracted payments made by SUS for the necessary equipment from two Brazilian case series. The first is the ERICC over an average of three months in 2012; the analysis did (Epidemiology of Respiratory Insufficiency in Critical not account for the costs of medical professionals. This Care) study,(1) which characterized 7,465 patients survey was conducted by the NATS of HCFMUSP, which admitted to 45 Brazilian intensive care units (ICU) over belongs to the Brazilian Network for Health Technology two months in 2011. Of these patients, 773 required Assessment (Rede Brasileira de Avaliação de Tecnologias em mechanical ventilation for more than 72 hours, and 242 Saúde; REBRATS) of the Ministry of Health. This survey were diagnosed with acute respiratory distress syndrome. has been used for other cost effectiveness analyses. The second series was from theHospital das Clínicas of Tables 1 and 2 show the events and periods of the Faculdade de Medicina of the Universidade de São Paulo mechanical ventilation, ECMO, admittance to ICU, (HCFMUSP) where ten patients with extremely severe and so on that were also used for the Markov model respiratory failure (who were classified as dying) received probability calculations. Table 3 shows the summary of extracorporeal membrane oxygenation (ECMO),(2) costs, which are detailed in tables 4 through 9. The details resulting in a six-month survival rate of 40%. These of the support days are shown in tables 10 through 20.
Table 1 - The need for support, days of support, and days of hospitalization for patients with acute respiratory distress syndrome. The data were extracted from the ERICC study (242 patients) and a Brazilian series of respiratory support using extracorporeal membrane oxygenation (10 patients) With use of ECMO Without use of ECMO (N=10) (N=242) Survivors Non-survivors Survivors Non-survivors (N=4) (N=6) (N=116) (N=126) Days on MV 7 (6-8) 10 (4-16) 11 (8-14) 11 (8-14) Days in ICU without MV 4 (4-5) 0 6 (4-8) 3 (1-5) Days in infirmary for rehabilitation 13 (10-15) 0 19 (15-23) 8 (4-12) Days in ICU 11 (9-13) 15 (7-22) 18 (15-21) 14 (1-17) Days in hospital 24 (21-27) 10 (4-16) 37 (32-42) 22 (1-27)
Need for CRRT (%) 75 84 19 7 Days on CRRT 3 (2-4) 9 (3-15) 3 (2-4) 3 (2-4) Days on ECMO 5 (4-7) 10 (4-16) ------
Patients weaned from ECMO (%) 100 9 ------ECMO - extracorporeal membrane oxygenation; MV - mechanical ventilation; ICU - intensive care unit; CRRT - continuous renal replacement therapy. The results are expressed as the means (95% confidence intervals).
Rev Bras Ter Intensiva. 2014;26(3):00-00 Table 2 - The need for support, support days, and hospitalization days for Table 3 - The general panorama of the unit costs associated with the resources inpatients with acute respiratory distress syndrome (i.e., a ratio of partial necessary for each patient with severe respiratory failure pressure of oxygen in the blood to the fraction of inspired oxygen of <100mmHg). Events and interventions Value The data were extracted from the ERICC study: 35 of the 43 patients who died in the intensive care unit and had acute respiratory distress syndrome ECMO cannulation R$ 18,164.41 Non-survivors (P/F <100) First day of severe RF R$ 3,316.89 (N=5) Days on MV with severe RF R$ 2,714.51 Days on MV 8 (5-11) CRRT installation R$ 878.16 Days in ICU without MV 4 (0-8) Daily ECMO increase R$ 134.50 Days in infirmary for rehabilitation 3 (1-5) Daily CRRT increase R$ 718.05 Days in ICU 12 (8-16) Days extubated in ICU R$ 2,200.25 Days in hospital 15 (11-19) Days in infirmary R$ 1,429.44
Need for CRRT (%) 60 ECMO - extracorporeal membrane oxygenation; RF - respiratory failure; MV - mechanical ventilation; CRRT - continuous renal replacement therapy; ICU - intensive care unit. Days on CRRT 3 (2-4) Days on ECMO ---
Patients weaned from ECMO (%) --- P/F - a ratio of partial pressure of oxygen in the blood to the fraction of inspired oxygen; MV - mechanical ventilation; ICU - intensive care unit; CRRT - continuous renal replacement therapy; ECMO - extracorporeal membrane oxygenation. The results are expressed as the means (95% confidence intervals).
Table 4 - Description of materials necessary for the installation of an extracorporeal membrane oxygenation system for one patient with costs for the respective necessary materials Item Cost Number Total cost Disposable hypodermic needle 30x7 R$ 0.02 2 R$ 0.04 Disposable hypodermic needle 40x8 R$ 0.10 2 R$ 0.20 ECMO apparatus R$ 17,430.00 1 R$ 17,430.00 Nurse assistance in placing catheters R$ 45.00 3 R$ 135.00 Atracurium 10mg/mL 5mL R$ 4.31 1 R$ 4.31 Surgical field sterile disposable waterproof table R$ 4.04 1 R$ 4.04 Surgical field/Plast/Transp 600x450mm R$ 10.70 4 R$ 42.82 Chlorhexidine (0.5% to 2%) 100mL R$ 1.25 1 R$ 1.25 Chlorhexidine digluconate oral rinse 2% R$ 1.22 1 R$ 1.22
Sterile gauze pad, 7.5x7.5cm (10 pack) R$ 0.27 6 R$ 1.62 Vascular consultation R$ 68.00 1 R$ 68.00 Dressing for central catheter 5x4cm R$ 1.80 2 R$ 3.60 Macrodrip equipment -130cm R$ 1.11 1 R$ 1.11 Disposable brush with chlorhexidine oral rinse 2% R$ 0.93 3 R$ 2.79 Fentanyl (citrate) (0.05mg/mL) 10mL R$ 2.45 1 R$ 2.45 Nylon thread 3/0W/1AG 3.0cm 3/8C TR45cm R$ 0.74 2 R$ 1.48 Disposable surgical cap R$ 0.09 3 R$ 0.27 Heparin sodium (5,000IU/mL) 5mL R$ 6.31 1 R$ 6.31 Installation of conventional cardiopulmonary bypass circuit R$ 330.00 1 R$ 330.00 Lidocaine (2%) without adrenaline 20mL R$ 1.17 1 R$ 1.17 Hypoallergenic sterile surgical gloves size 7.5 R$ 1.40 3 R$ 4.21 Hypoallergenic sterile surgical gloves size 8.0 R$ 1.37 3 R$ 4.11 Disposable surgical mask with adequate softness R$ 0.06 3 R$ 0.18 Midazolam (hydrochloride) (5mg/mL) 3mL R$ 0.73 1 R$ 0.73 Disposable sterile arm protector R$ 2.31 2 R$ 4.62 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation Disposable sterile body protector R$ 1.75 2 R$ 3.50 Posteroanterior chest x-ray R$ 20.00 1 R$ 20.00 Disposable syringe 10mL R$ 0.18 1 R$ 0.18 Disposable syringe 20mL R$ 0.27 1 R$ 0.27 Saline (0.9%) 500mL R$ 1.51 2 R$ 3.02 Cervical ultrasound with color Doppler R$ 23.98 1 R$ 23.98 Upper abdomen ultrasound R$ 13.98 1 R$ 13.98 Arterial color Doppler ultrasound of the right lower limb R$ 23.98 1 R$ 23.98 Venous color Doppler ultrasound of the right lower limb R$ 23.98 1 R$ 23.98 Total R$ 18,164.42 ECMO - extracorporeal membrane oxygenation.
Table 5 - The daily costs of maintaining extracorporeal membrane oxygenation for one patient Item Cost Number Total cost Disposable hypodermic needle 40x8 R$ 0.10 3 R$ 0.30 Infusion pump R$ 6.07 1 R$ 6.07 Coagulogram R$ 17.80 4 R$ 71.20 Dressing for central catheter 5x4cm R$ 1.80 3 R$ 5.40 Haptoglobin R$ 5.12 1 R$ 5.12 Heparin sodium (5,000IU/mL) 5mL R$ 6.31 6 R$ 37.87 Hypoallergenic sterile surgical gloves size 8.0 R$ 1.37 3 R$ 4.11 Disposable syringe 20mL R$ 0.27 3 R$ 0.81 Sodium chloride solution (0.9%) 100mL R$ 1.21 3 R$ 3.63 Total R$ 134.51 ECMO - extracorporeal membrane oxygenation.
Table 6 - Materials and costs on the first day of slow renal replacement Item Cost Number Total cost Disposable hypodermic needle 30x7 R$ 0.02 1 R$ 0.02 Disposable hypodermic needle 40x8 R$ 0.10 11 R$ 1.10 Nursing Care in placing catheters R$ 45.00 1 R$ 45.00 Sodium bicarbonate (8.4%) 250mL R$ 10.63 10 R$ 106.33 Infusion pump R$ 6.07 4 R$ 24.28 Calcium chloride (10%) 5mL R$ 0.81 18 R$ 14.58 Ionized calcium R$ 5.12 8 R$ 40.96 Calcium/serum R$ 5.12 4 R$ 20.48 Surgical field, 600x450mm R$ 10.70 2 R$ 21.41 Surgical field sterile disposable waterproof table R$ 4.04 1 R$ 4.04 Double-lumen catheter for hemodialysis 12Fx20cm R$ 59.90 1 R$ 59.90 Potassium chloride (19.1%) - injectable solution 10mL R$ 0.21 5 R$ 1.04
Sodium chloride (20%) 20mL (ampoule) R$ 0.14 5 R$ 0.70 Chlorhexidine (0.5% to 2%) 100mL R$ 1.25 1 R$ 1.25 Chlorhexidine digluconate oral rinse 2% R$ 1.22 1 R$ 1.22 Ionized chloride/serum R$ 10.24 4 R$ 40.96
Sterile gauze pad 7.5x7.5cm (10 pack) R$ 0.27 2 R$ 0.54 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation Dressing for peripheral catheter 5x7.5cm R$ 1.58 1 R$ 1.58 Disposable brush with chlorhexidine oral rinse 2% R$ 0.93 1 R$ 0.93 Nylon thread 3/0W/1AG 3.0cm 3/8C TR45cm R$ 0.74 1 R$ 0.74 Phosphorus R$ 5.12 4 R$ 20.48 Venous blood gas analysis R$ 17.55 8 R$ 140.40 Disposable surgical cap R$ 0.09 1 R$ 0.09 Hemofiltration and continuous hemodialysis kit R$ 91.25 1 R$ 91.25 2% Lidocaine without adrenaline 20mL R$ 1.17 1 R$ 1.17 Hypoallergenic sterile surgical gloves size 7.5 R$ 1.40 2 R$ 2.81 Magnesium/serum R$ 5.12 4 R$ 20.48 Disposable surgical mask with adequate softness R$ 0.06 1 R$ 0.06 Potassium/serum R$ 5.12 4 R$ 20.48 Disposable sterile arm protector R$ 2.31 1 R$ 2.31 Disposable sterile body protector R$ 1.75 1 R$ 1.75 Posteroanterior chest x-ray R$ 20.00 1 R$ 20.00 Disposable syringe 10mL R$ 0.18 1 R$ 0.18 Disposable syringe 20mL R$ 0.27 10 R$ 2.70 Blood gas syringe R$ 2.14 4 R$ 8.56 Sodium/serum R$ 5.12 4 R$ 20.48 ACD solution 3,000mL R$ 22.88 2 R$ 45.76 Sodium chloride solution (0.9%) 50mL R$ 1.19 6 R$ 7.14 Sodium chloride electrolyte solution (0.61%) w/magnesium for hemodialysis R$ 8.50 10 R$ 85.00 Total R$ 878.16
Table 7 - Materials used and costs associated with slow renal replacement maintenance Item Cost Number Total cost Disposable hypodermic needle 40x8 R$ 0.10 10 R$ 1.00 Sodium bicarbonate (8.4%) 250mL R$ 10.63 10 R$ 106.33 Infusion pump R$ 6.07 4 R$ 24.28 Calcium chloride (10%) 5mL R$ 0.81 18 R$ 14.58 Ionized calcium R$ 5.12 8 R$ 40.96 Calcium/serum R$ 5.12 4 R$ 20.48 Potassium chloride (19.1%) - injectable solution 10mL R$ 0.21 5 R$ 1.04
Sodium chloride (20%) 20mL (ampoule) R$ 0.14 5 R$ 0.70 Ionized chloride/serum R$ 10.24 4 R$ 40.96
Sterile gauze pad 7.5x7.5cm (10 pack) R$ 0.27 2 R$ 0.54 Dressing for peripheral catheter, 5x7.5cm R$ 1.58 1 R$ 1.58 Phosphorus R$ 5.12 4 R$ 20.48 Venous blood gas analysis R$ 17.55 8 R$ 140.40 Hemofiltration and continuous hemodialysis kit R$ 91.25 1 R$ 91.25 Hypoallergenic sterile surgical gloves size 7.5 R$ 1.40 2 R$ 2.80 Magnesium/serum R$ 5.12 4 R$ 20.48 Disposable surgical mask with adequate softness R$ 0.06 1 R$ 0.06 Potassium/serum R$ 5.12 4 R$ 20.48 Disposable syringe 20mL R$ 0.27 10 R$ 2.70 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation Blood gas syringe R$ 2.14 4 R$ 8.56 Sodium/serum R$ 5.12 4 R$ 20.48 ACD solution 3,000mL R$ 22.88 2 R$ 45.76 Sodium chloride solution (0.9%) 50mL R$ 1.19 6 R$ 7.14 Sodium chloride electrolyte solution (0.61%) w/magnesium for hemodialysis R$ 8.50 10 R$ 85.00 Total R$ 718.04
Table 8 - Materials used and the cost of the first day of intensive care unit hospitalization for one patient with severe respiratory failure Item Cost Number Total cost Disposable hypodermic needle 30x7 R$ 0.02 2 R$ 0.04 Disposable hypodermic needle 40x8 R$ 0.10 24 R$ 2.40 Albumin R$ 5.12 1 R$ 5.12 Nursing care in endotracheal intubation for adult R$ 16.46 1 R$ 16.46 Nursing care in placing catheters R$ 45.00 2 R$ 90.00 Respiratory physiotherapy care for patients on mechanical ventilation R$ 6.80 1 R$ 6.80 Physiotherapeutic evaluation R$ 50.00 1 R$ 50.00 Bilirubin R$ 10.24 1 R$ 10.24 Urine collection bag 28x20cm R$ 0.15 1 R$ 0.15 Infusion pump R$ 6.07 4 R$ 24.28 Ionized calcium R$ 5.12 1 R$ 5.12 Calcium/serum R$ 5.12 1 R$ 5.12 Surgical field, 600x450mm R$ 10.70 2 R$ 21.41 Surgical field sterile disposable waterproof table R$ 4.04 2 R$ 8.08 Surgical field/inc plast/transp 600x450mm R$ 10.70 2 R$ 21.41 Tracheal cannula (disposable) with balloon DI 8.0xOD10.9mm R$ 10.31 1 R$ 10.31 Capnograph R$ 5.71 1 R$ 5.71 Radial arterial catheter 20GA R$ 72.00 1 R$ 72.00 Catheter for hemodialysis. Triple lumen 11/12F 15cm R$ 58.00 1 R$ 58.00 Cisatracurium 2mg/mL R$ 22.11 12 R$ 265.38 Sodium chloride (0.9%) 10mL ampoule R$ 0.08 6 R$ 0.48 Chlorhexidine (0.5% to 2%) 100mL R$ 1.25 3 R$ 3.75 Chlorhexidine digluconate oral rinse 2% R$ 1.22 2 R$ 2.44 Ionized chloride/serum R$ 10.24 1 R$ 10.24 Coagulogram R$ 17.80 1 R$ 17.80
Sterile gauze pad 7.5x7.5cm (10 pack) R$ 0.27 14 R$ 3.78 Control of diuresis per period R$ 8.37 3 R$ 25.11 Creatinine/serum R$ 5.12 1 R$ 5.12 General culture R$ 14.85 3 R$ 44.56 Central catheter dressing 5x4cm R$ 1.80 1 R$ 1.80 Dressing for peripheral catheter 5x7.5cm R$ 1.58 1 R$ 1.58 Dextrostix (CBG control) R$ 8.23 12 R$ 98.76 ICU daily rate R$ 790.00 1 R$ 790.00 Closed system liquid diet kit R$ 28.50 4 R$ 114.00
Nutritionally complete diet for normal catheter (L) R$ 10.03 1 R$ 15.05 Electrocardiogram by nurse or doctor R$ 14.00 1 R$ 14.00 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation Disposable heart monitor electrode for adult R$ 0.21 5 R$ 1.07 Nurse R$ 116.64 1 R$ 116.64 Enoxaparin 40mg R$ 3.49 1 R$ 3.49 Macrodrip equipment with 5mL approximate capacity R$ 6.42 8 R$ 51.36 Infusion pump equipment R$ 4.36 4 R$ 17.44 Disposable brush with chlorhexidine oral rinse 2% R$ 0.93 2 R$ 1.86 Fentanyl (citrate) (0.05mg/mL) 10mL R$ 2.45 5 R$ 12.25 Adult sterile viral and bacterial filter R$ 7.70 1 R$ 7.70 Nylon thread 3/0W/1AG 3.0cm 3/8C TR 45cm R$ 0.74 2 R$ 1.48 Fixative for endotracheal tube R$ 5.51 1 R$ 5.51 Fluconazole (200mg) injectable solution 100mL R$ 2.35 2 R$ 4.70 Phosphorus R$ 5.12 1 R$ 5.12 Arterial blood gas analysis R$ 17.55 4 R$ 70.20 Venous blood gas analysis R$ 17.55 4 R$ 70.20 Glucose R$ 5.12 1 R$ 5.12 Disposable surgical cap R$ 0.09 2 R$ 0.18 Blood culture, aerobic R$ 35.60 1 R$ 35.60 Blood culture, anaerobic R$ 35.60 1 R$ 35.60 Complete blood and platelet count R$ 17.80 1 R$ 17.80 Imipenem/cilastatin sodium 500mg intravenous R$ 14.71 4 R$ 58.83 Regular fast acting human insulin 100IU/mL 5 to 10mL vial/ampoule R$ 8.21 1 R$ 8.21 Disposable kit for invasive hemodynamic monitoring R$ 38.98 2 R$ 77.96 Lactate dehydrogenase (LDH) R$ 5.12 1 R$ 5.12 Lidocaine (2%) without adrenaline 20mL R$ 1.17 2 R$ 2.34 Hypoallergenic sterile surgical gloves size 7.5 R$ 1.40 27 R$ 37.80 Magnesium/serum R$ 5.12 1 R$ 5.12 Disposable surgical mask with adequate softness R$ 0.06 17 R$ 1.02 Disposable mask for respiratory protection R$ 0.79 6 R$ 4.71 Cardiac monitoring R$ 123.11 1 R$ 123.11 Pulse oximetry R$ 6.80 1 R$ 6.80 Polygraph R$ 162.91 1 R$ 162.91 Polymyxin B 500,000IU R$ 23.74 4 R$ 94.98 Potassium/serum R$ 5.12 1 R$ 5.12 Intravenous propofol emulsion (10mg/mL) 20mL R$ 2.63 24 R$ 65.75 C-reactive protein R$ 5.12 1 R$ 5.12 Disposable sterile arm protector R$ 2.31 17 R$ 39.27 Disposable sterile body protector R$ 1.75 17 R$ 29.75 Posteroanterior chest x-ray R$ 20.00 1 R$ 20.00 Ranitidine hydrochloride 50mg R$ 0.20 3 R$ 0.59 Disposable syringe 10mL R$ 0.18 5 R$ 0.90 Disposable syringe 20mL R$ 0.27 17 R$ 4.59 Blood gas syringe R$ 2.14 4 R$ 8.56 Tracheal care endotracheal suction system (14 gauge) R$ 33.50 1 R$ 33.50 Sodium/serum R$ 5.12 1 R$ 5.12 Sodium chloride solution (0.9%) 100mL R$ 1.21 8 R$ 9.68 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation Sodium chloride solution (0.9%) 50mL R$ 1.19 11 R$ 13.09 Ringer lactate solution 500mL R$ 1.10 6 R$ 6.60 Polyurethane enteral nutrition catheter 8F R$ 6.94 1 R$ 6.94 Disposable tracheal aspiration catheter 12 gauge R$ 0.40 6 R$ 2.40 Foley catheter with 5 cc balloon 12 gauge R$ 0.55 1 R$ 0.55 Bladder/relief pump R$ 14.41 1 R$ 14.41 Glutamic oxaloacetic transaminase (GOT) R$ 5.12 1 R$ 5.12 Glutamic pyruvic transaminase (GPT) R$ 5.12 1 R$ 5.12 Urea/serum R$ 5.12 1 R$ 5.12 Urine culture R$ 17.55 2 R$ 35.10 Vancomycin R$ 56.96 1 R$ 56.96 Vancomycin hydrochloride (500mg) 10mL R$ 2.16 4 R$ 8.64 Ventilator/respirator R$ 34.86 1 R$ 34.86 Checking vital signs R$ 15.18 1 R$ 15.18 Total R$ 3,315.75 ICU - intensive care unit.
Table 9 - Materials used and the cost per day for one patient with severe respiratory failure in the intensive care unit Item Cost Number Total cost Disposable hypodermic needle 40x8 R$ 0.10 23 R$ 2.30 Albumin R$ 5.12 1 R$ 5.12 Respiratory physiotherapy care for patients under mechanical ventilation R$ 6.80 1 R$ 6.80 Physiotherapeutic evaluation R$ 50.00 1 R$ 50.00 Bilirubin R$ 10.24 1 R$ 10.24 Urine collection bag 28x20cm R$ 0.15 1 R$ 0.15 Infusion pump R$ 6.07 4 R$ 24.28 Ionized calcium R$ 5.12 1 R$ 5.12 Calcium/serum R$ 5.12 1 R$ 5.12 Capnograph R$ 5.71 1 R$ 5.71 Cisatracurium 2mg/mL R$ 22.11 12 R$ 265.38 Sodium chloride (0.9%) 10mL ampoule R$ 0.08 18 R$ 1.44 Chlorhexidine (0.5% to 2%) 100mL R$ 1.25 2 R$ 2.50 Ionized chloride/serum R$ 10.24 1 R$ 10.24 Coagulogram R$ 17.80 1 R$ 17.80
Sterile gauze pad 7.5x7.5cm (10 pack) R$ 0.27 10 R$ 2.70 Control of diuresis per period R$ 8.37 3 R$ 25.11 Creatinine/serum R$ 5.12 1 R$ 5.12 Dextrostix (CBG control) R$ 8.23 12 R$ 98.76 ICU daily rate R$ 790.00 1 R$ 790.00 Closed system liquid diet kit R$ 28.50 4 R$ 114.00
Nutritionally complete diet for normal catheter (L) R$ 10.03 1.5 R$ 15.05 Disposable heart monitor electrode (adult) R$ 0.21 5 R$ 1.07 Nurse R$ 116.64 1 R$ 116.64 Enoxaparin 40mg R$ 3.49 1 R$ 3.49 Macrodrip equipment with an approximate capacity of 5mL R$ 6.42 8 R$ 51.36 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation Infusion pump equipment R$ 4.36 4 R$ 17.44 Fentanyl (citrate) (0.05mg/mL) 10mL R$ 2.45 4 R$ 9.80 Sterile viral and bacterial filter for adult R$ 7.70 1 R$ 7.70 Fixative for endotracheal tube R$ 5.51 1 R$ 5.51 Fluconazole (200mg) injectable solution 100mL R$ 2.35 2 R$ 4.70 Phosphorus R$ 5.12 1 R$ 5.12 Arterial blood gas analysis R$ 17.55 4 R$ 70.20 Venous blood gas analysis R$ 17.55 4 R$ 70.20 Glucose R$ 5.12 1 R$ 5.12 Complete blood and platelet count R$ 17.80 1 R$ 17.80 Imipenem/cilastatin sodium 500mg intravenous R$ 14.71 4 R$ 58.83 Regular fast acting human insulin (100IU/mL), 5 to 10mL vial/ampoule R$ 8.21 1 R$ 8.21 Lactate dehydrogenase (LDH) R$ 5.12 1 R$ 5.12 Hypoallergenic sterile surgical gloves size 7.5 R$ 1.40 21 R$ 29.40 Magnesium/serum R$ 5.12 1 R$ 5.12 Disposable surgical mask with adequate softness R$ 0.06 15 R$ 0.90 Disposable mask for respiratory protection R$ 0.79 6 R$ 4.71 Cardiac monitoring R$ 123.11 1 R$ 123.11 Pulse oximetry R$ 6.80 1 R$ 6.80 Polygraph R$ 162.91 1 R$ 162.91 Polymyxin B, 500,000IU R$ 23.74 4 R$ 94.98 Potassium/serum R$ 5.12 1 R$ 5.12 Intravenous propofol emulsion (10mg/mL) 20mL R$ 2.63 24 R$ 63.18 C-reactive protein R$ 5.12 1 R$ 5.12 Disposable sterile arm protector R$ 2.31 15 R$ 34.65 Disposable sterile body protector R$ 1.75 15 R$ 26.25 Posteroanterior chest x-ray R$ 20.00 1 R$ 20.00 Ranitidine hydrochloride 50mg R$ 0.20 3 R$ 0.59 Disposable syringe 10mL R$ 0.18 3 R$ 0.54 Disposable syringe 20mL R$ 0.27 24 R$ 6.48 Blood gas syringe R$ 2.14 4 R$ 8.56 Tracheal care endotracheal suction system (14 gauge) R$ 33.50 1 R$ 33.50 Sodium/serum R$ 5.12 1 R$ 5.12 Sodium chloride solution (0.9%) 50mL R$ 1.19 11 R$ 13.09 Sodium chloride solution (0.9%) 100mL R$ 1.21 8 R$ 9.68 Disposable tracheal aspiration catheter, 12 gauge R$ 0.40 6 R$ 2.40 Glutamic oxaloacetic transaminase (GOT) R$ 5.12 1 R$ 5.12 Glutamic pyruvic transaminase (GPT) R$ 5.12 1 R$ 5.12 Urea/serum R$ 5.12 1 R$ 5.12 Vancomycin R$ 56.96 1 R$ 56.96 Vancomycin hydrochloride (500mg) 10mL R$ 2.16 4 R$ 8.64 Ventilator/respirator R$ 34.86 1 R$ 34.86 Checking vital signs R$ 15.18 1 R$ 15.18 Total R$ 2,714.46 ICU - intensive care unit.
Rev Bras Ter Intensiva. 2014;26(3):00-00 Table 10 - Comparative evaluation of support for all patients with insufficiency, with or without the use of extracorporeal membrane oxygenation, with a survival rate of 40% Characteristics Without ECMO in strategy With ECMO in strategy p value
Evaluated patients (N) 10,000,000 (1,000/year) -
Patients using NIV (N/year) 227±13 -
Patients using MV (N/year) 665±15 -
Patients with severe hypoxemia (N/year) 107±10 -
Patients using ECMO (N/year) - 54±7 -
Average cost per patient (R$/year) 62,995±393 62,689±399 <0.001 Six-month QALY 0.206±0.007 0.212±0.007 <0.001 QALY 9.4±0.3 9.5±0.3 <0.001
Survivors (N/year) 508±16 513±16 <0.001
Lives saved (N) 4±6 Six-month QALY 0.006±0.002 QALY gain 0.155±0.109
Cost increase (R$) -301±160
Cost benefit ratio (R$/six-month QALY) -30,913±3,729,529
Cost utility ratio (R$/QALY) -2,386±58,224
Cost per life saved (R$/life) -16±161 This analysis includes all patients, including those treated with noninvasive ventilation. ECMO - extracorporeal membrane oxygenation; NIV - noninvasive ventilation; MV - mechanical ventilation; QALY - quality-adjusted life-years.
Table 11 - Comparative evaluation of support of all patients with insufficiency, with and without use of extracorporeal membrane oxygenation, with 60% survival of patients using extracorporeal membrane oxygenation Characteristics Without ECMO in strategy With ECMO in strategy p value
Evaluated patients (N) 10,000,000 (1,000/year) -
Patients using NIV (N/year) 227±13 -
Patients using MV (N/year) 665±15 -
Patients with severe hypoxemia (N/year) 108±10 -
Patients using ECMO (N/year) - 54±7 -
Average cost per patient (R$/year) 62,993±393 63,007±392 <0.001 Six-month QALY 0.206±0.007 0.218±0.007 <0.001 QALY 9.4±0.3 10.0±0.3 <0.001
Survivors (N/year) 508±16 523±16 <0.001
Lives saved (N) 16±7 Six-month QALY gain 0.011±0.003 QALY gain 0.376±0.124
Cost increase (R$) -14±172
Cost benefit ratio (R$/six-month QALY) -1.752±18.176
Cost utility ratio (R$/QALY) -90±8.114
Cost per life saved (R$/life) -5±9 This analysis includes all patients, including those treated with noninvasive ventilation. ECMO - extracorporeal membrane oxygenation; NIV - noninvasive ventilation; MV - mechanical ventilation; QALY- quality-adjusted life-years.
Rev Bras Ter Intensiva. 2014;26(3):00-00 Table 12 - Cannulation costs of veno-venous extracorporeal membrane oxygenation ECMO VV cannulation Number Cost/item Disposable hypodermic needle 30x 2 R$ 0.02 Disposable hypodermic needle 40x8 2 R$ 0.10 ECMO apparatus 1 R$ 17,430.00 Nursing care in placing catheters (Central/dissection/phlebotomy and others) 3 R$ 45.00 Atracurium (10mg/mL) 5mL 2 R$ 4.31 Surgical field sterile disposable waterproof table 1 R$ 4.04 Surgical field/inc plast/transp 600x450mm 4 R$ 10.70 Chlorhexidine (0.5% to 2%) 100mL 1 R$ 1.25 Chlorhexidine digluconate oral rinse 2% 1 R$ 1.22
Sterile gauze pad, 7.5x7.5cm (10 pack) 6 R$ 0.27 Vascular consultation 1 R$ 68.00 Central catheter dressing, 5x4cm 2 R$ 1.80 Macrodrip equipment, 130cm 1 R$ 1.11 Disposable brush with chlorhexidine oral rinse 2% 3 R$ 0.93 Fentanyl (citrate) (0.05mg/mL)10mL 1 R$ 2.45 Nylon thread 3/0W/1AG 3.0cm 3/8c tr45cm 2 R$ 0.74 Disposable surgical cap 3 R$ 0.09 Heparin sodium (5,000IU/mL) 5mL 1 R$ 6.31 Installation of conventional cardiopulmonary bypass circuit 1 R$ 330.00 Lidocaine (2%) without adrenaline 20mL 1 R$ 1.17 Hypoallergenic sterile surgical gloves size 7.5 3 R$ 1.40 Hypoallergenic sterile surgical gloves size 8.0 3 R$ 1.37 Disposable surgical mask with adequate softness 3 R$ 0.06 Midazolam (hydrochloride) (5mg/mL) 3mL 1 R$ 0.73 Disposable sterile arm protector 2 R$ 2.31 Disposable sterile body protector 2 R$ 1.75 Posteroanterior chest x-ray 1 R$ 20.00 Disposable syringe 10mL 1 R$ 0.18 Disposable syringe 20mL 1 R$ 0.27 Saline (0.9%) 500mL 2 R$ 1.51 Cervical ultrasound with color Doppler 2 R$ 23.98 Upper abdomen ultrasound 1 R$ 13.98 Arterial color Doppler ultrasound of the right lower limb 2 R$ 23.98 Venous color Doppler ultrasound of the right lower limb 2 R$ 23.98 ECMO - extracorporeal membrane oxygenation; VV - veno-venous.
Table 13 - Costs of the first day of hospitalization in the intensive care unit among patients with severe respiratory failure Item Cost/Item Number needed Total Disposable hypodermic needle, 30x7 R$ 0.02 2 R$ 0.04 Disposable hypodermic needle, 40x8 R$ 0.10 24 R$ 2.40 Albumin R$ 5.12 1 R$ 5.12 Nursing care in adult endotracheal intubation R$ 16.46 1 R$ 16.46 Nursing care in placing catheters (Central/dissection/phlebotomy and other) R$ 45.00 2 R$ 45.00 Respiratory physiotherapy care for patients under mechanical ventilation R$ 6.80 1 R$ 6.80 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation Physiotherapeutic evaluation R$ 50.00 1 R$ 50.00 Bilirubin R$ 10.24 1 R$ 10.24 Urine collection bag, 28x20cm R$ 0.15 1 R$ 0.15 Infusion pump R$ 6.07 4 R$ 24.28 Ionized calcium R$ 5.12 1 R$ 5.12 Calcium/serum R$ 5.12 1 R$ 5.12 Surgical field/inc plast/transp 600x450mm R$ 10.70 2 R$ 10.70 Surgical field, 600x450mm R$ 10.70 2 R$ 10.70 Surgical field sterile disposable waterproof table R$ 4.04 2 R$ 8.08 Tracheal cannula (disposable) with balloon DI 8.0 xOD10 9mm R$ 10.31 1 R$ 10.31 Capnograph R$ 5.71 1 R$ 5.71 Radial arterial catheter, 20GA R$ 72.00 1 R$ 72.00 Triple lumen hemodynamic catheter 11/12F 15cm R$ 58.00 1 R$ 58.00 Cisatracurium, 2mg/mL R$ 22.11 12 R$ 265.38 Sodium chloride (0.9%), 10mL ampoule R$ 0.08 6 R$ 0.48 Chlorhexidine (0.5% to 2%), 100mL R$ 1.25 3 R$ 3.75 Chlorhexidine digluconate oral rinse, 2% R$ 1.22 2 R$ 2.44 Ionized chloride/serum R$ 10.24 1 R$ 10.24 Coagulogram R$ 17.80 1 R$ 17.80
Sterile gauze pad, 7.5x7.5cm (10 pack) R$ 0.27 14 R$ 3.78 Diuresis control by period R$ 8.37 3 R$ 8.37 Creatinine/serum R$ 5.12 1 R$ 5.12 General culture R$ 14.85 3 R$ 44.56 Central catheter dressing, 5x4cm R$ 1.80 1 R$ 1.80 Dressing for peripheral catheter, 5x7.5cm R$ 1.58 1 R$ 1.58 Dextrostix (CBG control) R$ 8.23 12 R$ 8.23 ICU daily rate R$ 790.00 1 R$ 790.00 Closed system liquid diet kit R$ 28.50 4 R$ 114.00
Nutritionally complete diet for normal catheter (L) R$ 10.03 1.5 R$ 15.05 Electrocardiogram by nurse or doctor R$ 14.00 1 R$ 14.00 Disposable cardiac monitoring electrode with AG/AGCL (adult) R$ 0.21 5 R$ 0.21 Nurse (a) R$ 116.64 1 R$ 116.64 Enoxaparin, 40mg R$ 3.49 1 R$ 3.49 Macrodrip equipment with 5mL approximate capacity R$ 6.42 8 R$ 51.36 Infusion pump equipment R$ 4.36 4 R$ 17.44 Disposable brush with chlorhexidine oral rinse, 2% R$ 0.93 2 R$ 1.86 Fentanyl (citrate) (0.05mg/mL),10mL R$ 2.45 5 R$ 12.25 Adult sterile viral and bacterial filter R$ 7.70 1 R$ 7.70 Nylon thread 3/0W/1AG 3.0cm 3/8c TR 45cm R$ 0.74 2 R$ 1.48 Fixative for endotracheal tube R$ 5.51 1 R$ 5.51 Fluconazole (200mg) injectable solution, 100mL R$ 2.35 2 R$ 4.70 Phosphorus R$ 5.12 1 R$ 5.12 Arterial blood gas analysis R$ 17.55 4 R$ 70.20 Venous blood gas analysis R$ 17.55 4 R$ 70.20 Glucose R$ 5.12 1 R$ 5.12 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation Disposable surgical cap R$ 0.09 2 R$ 0.18 Blood culture, aerobic R$ 35.60 1 R$ 35.60 Blood culture, anaerobic R$ 35.60 1 R$ 35.60 Complete blood and platelet count R$ 17.80 1 R$ 17.80 Imipenem/cilastatin sodium, 500mg intravenous R$ 14.71 4 R$ 58.83 Regular fast acting human insulin (100IU/mL), 5 to 10mL vial/ampoule R$ 8.21 1 R$ 8.21 Disposable kit for invasive hemodynamic monitoring R$ 38.98 2 R$ 77.96 LDH (lactate dehydrogenase) R$ 5.12 1 R$ 5.12 Lidocaine (2%) without adrenaline, 20mL R$ 1.17 2 R$ 2.34 Hypoallergenic sterile surgical gloves size 7.5 R$ 1.40 27 R$ 37.80 Magnesium/serum R$ 5.12 1 R$ 5.12 Disposable surgical mask with adequate softness R$ 0.06 17 R$ 1.02 Disposable mask for respiratory protection R$ 0.79 6 R$ 4.71 Cardiac monitoring R$ 123.11 1 R$ 123.11 Pulse oximetry R$ 6.80 1 R$ 6.80 Polygraph R$ 162.91 1 R$ 162.91 Polymyxin B, 500,000IU R$ 23.74 4 R$ 94.98 Potassium/serum R$ 5.12 1 R$ 5.12 Intravenous propofol emulsion (10mg/mL), 20mL R$ 2.63 25 R$ 65.75 C-reactive protein R$ 5.12 1 R$ 5.12 Disposable sterile arm protector R$ 2.31 17 R$ 39.27 Disposable sterile body protector R$ 1.75 17 R$ 29.75 Posteroanterior chest x-ray R$ 20.00 1 R$ 20.00 Ranitidine hydrochloride, 50mg R$ 0.20 3 R$ 0.59 Disposable syringe, 10mL R$ 0.18 5 R$ 0.90 Disposable syringe, 20mL R$ 0.27 17 R$ 4.59 Blood gas syringe R$ 2.14 4 R$ 8.56 Tracheal care endotracheal suction system (14 gauge) R$ 33.50 1 R$ 33.50 Sodium/serum R$ 5.12 1 R$ 5.12 Sodium chloride solution (0.9%), 50mL R$ 1.19 11 R$ 13.09 Sodium chloride solution (0.9%),100mL R$ 1.21 8 R$ 9.68 Ringer lactate solution, 500mL R$ 1.10 6 R$ 6.60 Polyurethane enteral nutrition catheter, 8F R$ 6.94 1 R$ 6.94 Disposable tracheal aspiration catheter, 12 gauge R$ 0.40 6 R$ 2.40 Foley catheter with 5 cc balloon, 12 gauge R$ 0.55 1 R$ 0.55 Bladder/relief pump R$ 14.41 1 R$ 14.41 Glutamic oxaloacetic transaminase (GOT) R$ 5.12 1 R$ 5.12 Glutamic pyruvic transaminase (GPT) R$ 5.12 1 R$ 5.12 Urea/serum R$ 5.12 1 R$ 5.12 Urine culture R$ 17.55 2 R$ 35.10 Vancomycin R$ 56.96 1 R$ 56.96 Vancomycin, hydrochloride (500mg), 10mL R$ 2.16 4 R$ 8.64 Ventilator/respirator R$ 34.86 1 R$ 34.86 Checking vital signs R$ 15.18 1 R$ 15.18
Rev Bras Ter Intensiva. 2014;26(3):00-00 Table 14 - Costs of routine days of hospitalization in intensive care unit on mechanical ventilation Item Cost/item Number needed Total Disposable hypodermic needle, 40x8 R$ 0.10 23 R$ 2.30 Albumin R$ 5.12 1 R$ 5.12 Respiratory physiotherapy care for patients under mechanical ventilation R$ 6.80 1 R$ 6.80 Physiotherapeutic evaluation R$ 50.00 1 R$ 50.00 Bilirubin R$ 10.24 1 R$ 10.24 Urine collection bag, 28x20cm R$ 0.15 1 R$ 0.15 Infusion pump R$ 6.07 4 R$ 24.28 Ionized calcium R$ 5.12 1 R$ 5.12 Calcium/serum R$ 5.12 1 R$ 5.12 Capnograph R$ 5.71 1 R$ 5.71 Cisatracurium, 2mg/mL R$ 22.11 12 R$ 265.38 Sodium chloride (0.9%), 10mL ampoule R$ 0.08 18 R$ 1.44 Chlorhexidine (0.5% to 2%), 100mL R$ 1.25 2 R$ 2.50 Ionized chloride/serum R$ 10.24 1 R$ 10.24 Coagulogram R$ 17.80 1 R$ 17.80
Sterile gauze pad, 7.5x7.5cm (10 pack) R$ 0.27 10 R$ 2.70 Control of diuresis per period R$ 8.37 3 R$ 8.37 Creatinine/serum R$ 5.12 1 R$ 5.12 Dextrostix (CBG control) R$ 8.23 12 R$ 8.23 ICU daily rate R$ 790.00 1 R$ 790.00 Closed system liquid diet kit R$ 28.50 4 R$ 114.00
Nutritionally complete diet for normal catheter (L) R$ 10.03 1.5 R$ 15.05 Disposable Cardiac monitoring electrode with AG/AGCL for adult R$ 0.21 5 R$ 0.21 Nurse (a) R$ 116.64 1 R$ 116.64 Enoxaparin, 40mg R$ 3.49 1 R$ 3.49 Macrodrip equipment with 5mL approximate capacity R$ 6.42 8 R$ 51.36 Infusion pump equipment R$ 4.36 4 R$ 17.44 Fentanyl (citrate) (0.05mg/mL), 10mL R$ 2.45 4 R$ 9.80 Adult sterile viral and bacterial filter R$ 7.70 1 R$ 7.70 Fixative for endotracheal tube R$ 5.51 1 R$ 5.51 Fluconazole (200mg) injectable solution 100mL R$ 2.35 2 R$ 4.70 Phosphorus R$ 5.12 1 R$ 5.12 Arterial blood gas analysis R$ 17.55 4 R$ 70.20 Venous blood gas analysis R$ 17.55 4 R$ 70.20 Glucose R$ 5.12 1 R$ 5.12 Complete blood and platelet count R$ 17.80 1 R$ 17.80 Imipenem/cilastatin sodium, 500mg intravenous R$ 14.71 4 R$ 58.83 Regular fast acting human insulin 100IU/mL5 to 10mL vial/ampoule R$ 8.21 1 R$ 8.21 Lactate dehydrogenase (LDH) R$ 5.12 1 R$ 5.12 Hypoallergenic sterile surgical gloves size 7.5 R$ 1.40 21 R$ 29.40 Magnesium/serum R$ 5.12 1 R$ 5.12 Disposable surgical mask with adequate softness R$ 0.06 15 R$ 0.90 Disposable mask for respiratory protection R$ 0.79 6 R$ 4.71 Cardiac monitoring R$ 123.11 1 R$ 123.11 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation Pulse oximetry R$ 6.80 1 R$ 6.80 Polygraph R$ 162.91 1 R$ 162.91 Polymyxin B, 500,000IU R$ 23.74 4 R$ 94.98 Potassium/serum R$ 5.12 1 R$ 5.12 Intravenous propofol emulsion (10mg/mL), 20mL R$ 2.63 24 R$ 63.18 C-reactive protein R$ 5.12 1 R$ 5.12 Disposable sterile arm protector R$ 2.31 15 R$ 34.65 Disposable sterile body protector R$ 1.75 15 R$ 26.25 Posteroanterior chest x-ray R$ 20.00 1 R$ 20.00 Ranitidine hydrochloride, 50mg R$ 0.20 3 R$ 0.59 Disposable syringe, 10mL R$ 0.18 3 R$ 0.54 Disposable syringe, 20mL R$ 0.27 24 R$ 6.48 Blood gas syringe R$ 2.14 4 R$ 8.56 Tracheal care endotracheal suction system (14 gauge) R$ 33.50 1 R$ 33.50 Sodium/serum R$ 5.12 1 R$ 5.12 Sodium chloride solution (0.9%), 50mL R$ 1.19 11 R$ 13.09 Sodium chloride solution (0.9%), 100mL R$ 1.21 8 R$ 9.68 Disposable tracheal aspiration catheter, 12 gauge R$ 0.40 6 R$ 2.40 Glutamic oxaloacetic transaminase (GOT) R$ 5.12 1 R$ 5.12 Glutamic pyruvic transaminase (GPT) R$ 5.12 1 R$ 5.12 Urea/serum R$ 5.12 1 R$ 5.12 Vancomycin R$ 56.96 1 R$ 56.96 Vancomycin hydrochloride (500mg), 10mL R$ 2.16 4 R$ 8.64 Ventilator/respirator R$ 34.86 1 R$ 34.86 Checking vital signs R$ 15.18 1 R$ 15.18
Table 15 - Renal replacement therapy implementation costs Item Cost/item Number needed Total Disposable hypodermic needle, 30x7 R$ 0.02 1 R$ 0.02 Disposable hypodermic needle, 40x8 R$ 0.10 11 R$ 1.10 Nursing Care in placing catheters R$ 45.00 1 R$ 45.00 Sodium bicarbonate (8.4%), 250mL R$ 10.63 10 R$ 106.33 Infusion pump R$ 6.07 4 R$ 24.28 Calcium chloride (10%), 5mL R$ 0.81 18 R$ 14.58 Ionized calcium R$ 5.12 8 R$ 40.96 Calcium/serum R$ 5.12 4 R$ 20.48 Surgical field, 600x450mm R$ 10.70 2 R$ 10.70 Surgical field sterile disposable waterproof table R$ 4.04 1 R$ 4.04 Double-lumen catheter for hemodialysis 12 F x 20cm width with introducer kit R$ 59.90 1 R$ 59.90 Potassium chloride (19.1%) injectable solution, 10mL R$ 0.21 5 R$ 1.04
Sodium chloride (20%), 20mL (ampoule) R$ 0.14 5 R$ 0.70 Chlorhexidine (0.5% to 2%), 100mL R$ 1.25 1 R$ 1.25 Chlorhexidine digluconate oral rinse, 2% R$ 1.22 1 R$ 1.22 Ionized chloride/serum R$ 10.24 4 R$ 40.96
Sterile gauze pad, 7.5x7.5cm (10 pack) R$ 0.27 2 R$ 0.27 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation Dressing for peripheral catheter, 5x7.5cm R$ 1.58 1 R$ 1.58 Disposable brush with chlorhexidine oral rinse, 2% R$ 0.93 1 R$ 0.93 Nylon thread 3/0 13.0cm 3/8c tr45cm R$ 0.74 1 R$ 0.74 Phosphorus R$ 5.12 4 R$ 20.48 Venous blood gas analysis R$ 17.55 8 R$ 140.40 Disposable surgical cap R$ 0.09 1 R$ 0.09 Hemofiltration and continuous hemodialysis kit R$ 91.25 1 R$ 91.25 Lidocaine (2%) without adrenaline, 20mL R$ 1.17 1 R$ 1.17 Hypoallergenic sterile surgical gloves size 7.5 R$ 1.40 2 R$ 1.40 Magnesium/serum R$ 5.12 4 R$ 20.48 Disposable surgical mask with adequate softness R$ 0.06 1 R$ 0.06 Potassium/serum R$ 5.12 4 R$ 20.48 Disposable sterile arm protector R$ 2.31 1 R$ 2.31 Disposable sterile body protector R$ 1.75 1 R$ 1.75 Posteroanterior chest x-ray R$ 20.00 1 R$ 20.00 Disposable syringe, 10mL R$ 0.18 1 R$ 0.18 Disposable syringe, 20mL R$ 0.27 10 R$ 2.70 Blood gas syringe R$ 2.14 4 R$ 8.56 Sodium/serum R$ 5.12 4 R$ 20.48 ACD solution, 3,000mL R$ 22.88 2 R$ 45.76 Sodium chloride solution (0.9%), 50mL R$ 1.19 6 R$ 7.14 Sodium chloride electrolyte solution (0.61%) with magnesium for hemodialysis, 5,000mL R$ 8.50 10 R$ 85.00
Table 16 - Daily cost of extracorporeal circulation oxygenation Item Cost/item Number needed Total Disposable hypodermic needle, 40x8 R$ 0.10 3 R$ 0.30 Infusion pump R$ 6.07 1 R$ 6.07 Coagulogram R$ 17.80 4 R$ 71.20 Central catheter dressing, 5x4cm R$ 1.80 3 R$ 5.40 Haptoglobin R$ 5.12 1 R$ 5.12 Heparin sodium (5,000IU/mL), 5mL R$ 6.31 6 R$ 37.87 Hypoallergenic sterile surgical gloves size 8.0 R$ 1.37 3 R$ 4.11 Disposable syringe, 20mL R$ 0.27 3 R$ 0.81 Sodium chloride solution (0.9%), 100mL R$ 1.21 3 R$ 3.63 ECMO - Extracorporeal circulation oxygenation.
Table 17 - Daily costs of renal replacement therapy Item Cost/Item Number needed Total Disposable hypodermic needle, 40x8 R$ 0.10 10 R$ 1.00 Sodium bicarbonate (8.4%), 250mL R$ 10.63 10 R$ 106.33 Infusion pump R$ 6.07 4 R$ 24.28 Calcium chloride (10%), 5mL R$ 0.81 18 R$ 14.58 Ionized calcium R$ 5.12 8 R$ 40.96 Calcium/serum R$ 5.12 4 R$ 20.48 Potassium chloride (19.1%) injectable solution, 10mL R$ 0.21 5 R$ 1.04 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation
Sodium chloride (20%), 20mL (ampoule) R$ 0.14 5 R$ 0.70 Ionized chloride/serum R$ 10.24 4 R$ 40.96
Sterile gauze pad, 7.5x7.5cm (10 pack) R$ 0.27 2 R$ 0.27 Dressing for peripheral catheter, 5x7.5cm R$ 1.58 1 R$ 1.58 Phosphorus R$ 5.12 4 R$ 20.48 Venous blood gas analysis R$ 17.55 8 R$ 140.40 Hemofiltration and continuous hemodialysis kit R$ 91.25 1 R$ 91.25 Hypoallergenic sterile surgical gloves size 7.5 R$ 1.40 2 R$ 1.40 Magnesium/serum R$ 5.12 4 R$ 20.48 Disposable surgical mask with adequate softness R$ 0.06 1 R$ 0.06 Potassium/serum R$ 5.12 4 R$ 20.48 Disposable syringe, 20mL R$ 0.27 10 R$ 2.70 Blood gas syringe R$ 2.14 4 R$ 8.56 Sodium/serum R$ 5.12 4 R$ 20.48 ACD solution, 3,000mL R$ 22.88 2 R$ 45.76 Sodium chloride solution (0.9%), 50mL R$ 1.19 6 R$ 7.14 Sodium chloride electrolyte solution (0.61%) w/magnesium for hemodialysis, 5,000mL R$ 8.50 10 R$ 85.00
Table 18 - Daily costs of extubated patients in the intensive care unit Item Cost/item Number needed Total Disposable hypodermic needle, 40x8 R$ 0.10 10 R$ 1.00 Albumin R$ 5.12 1 R$ 5.12 Physiotherapeutic evaluation R$ 50.00 1 R$ 50.00 Bilirubin R$ 10.24 1 R$ 10.24 Urine collection bag, 28x20cm R$ 0.15 1 R$ 0.15 Ionized calcium R$ 5.12 1 R$ 5.12 Calcium/serum R$ 5.12 1 R$ 5.12 Capnograph R$ 5.71 1 R$ 5.71 Disposable oxygen catheter, N6 R$ 0.27 1 R$ 0.27 Sodium chloride (0.9%), 10mL ampoule R$ 0.08 6 R$ 0.48 Chlorhexidine (0.5% to 2%), 100mL R$ 1.25 2 R$ 2.50 Ionized chloride/serum R$ 10.24 1 R$ 10.24 Coagulogram R$ 17.80 1 R$ 17.80
Sterile gauze pad, 7.5x7.5cm (10 pack) R$ 0.27 10 R$ 2.70 Diuresis control per period R$ 8.37 3 R$ 8.37 Creatinine/serum R$ 5.12 1 R$ 5.12 Dextrostix (CBG control) R$ 8.23 12 R$ 8.23 ICU daily rate R$ 790.00 1 R$ 790.00 Closed system liquid diet kit R$ 28.50 4 R$ 114.00
Nutritionally complete diet for normal catheter (L) R$ 10.03 1.5 R$ 15.05 Disposable heart monitor electrode for adult R$ 0.21 5 R$ 0.21 Nurse (a) R$ 116.64 1 R$ 116.64 Enoxaparin, 40mg R$ 3.49 1 R$ 3.49 Macrodrip equipment with 5mL approximate capacity R$ 6.42 8 R$ 51.36 Fluconazole (200mg) injectable solution, 100mL R$ 2.35 2 R$ 4.70 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation Phosphorus R$ 5.12 1 R$ 5.12 Arterial blood gas analysis R$ 17.55 4 R$ 70.20 Venous blood gas analysis R$ 17.55 4 R$ 70.20 Glucose R$ 5.12 1 R$ 5.12 Complete blood and platelet count R$ 17.80 1 R$ 17.80 Imipenem/cilastatin sodium, 500mg intravenous R$ 14.71 4 R$ 58.83 Lactate dehydrogenase (LDH) R$ 5.12 1 R$ 5.12 Hypoallergenic sterile surgical gloves size 7.5 R$ 1.40 15 R$ 21.05 Magnesium/serum R$ 5.12 1 R$ 5.12 Disposable surgical mask with adequate softness R$ 0.06 15 R$ 0.90 Cardiac monitoring R$ 123.11 1 R$ 123.11 Pulse oximetry R$ 6.80 1 R$ 6.80 Polygraph R$ 162.91 1 R$ 162.91 Polymyxin B, 500,000IU R$ 23.74 4 R$ 94.98 Potassium/serum R$ 5.12 1 R$ 5.12 C-reactive protein R$ 5.12 1 R$ 5.12 Disposable sterile arm protector R$ 2.31 15 R$ 34.65 Disposable sterile body protector R$ 1.75 15 R$ 26.25 Posteroanterior chest x-ray R$ 20.00 1 R$ 20.00 Ranitidine hydrochloride, 50mg R$ 0.20 3 R$ 0.59 Disposable syringe, 20mL R$ 0.27 9 R$ 2.43 Blood gas syringe R$ 2.14 4 R$ 8.56 Sodium/serum R$ 5.12 1 R$ 5.12 Sodium chloride solution (0.9%), 100mL R$ 1.21 6 R$ 7.26 Glutamic oxaloacetic transaminase (GOT) R$ 5.12 1 R$ 5.12 Glutamic pyruvic transaminase (GPT) R$ 5.12 1 R$ 5.12 Urea/serum R$ 5.12 1 R$ 5.12 Vancomycin R$ 56.96 1 R$ 56.96 Vancomycin hydrochloride (500mg), 10mL R$ 2.16 4 R$ 8.64 Checking vital signs R$ 15.18 1 R$ 15.18 ICU - intensive care unit.
Table 19 - Daily costs of patients in the infirmary Item Cost/Item Number needed Total Disposable hypodermic needle, 40x8 R$ 0.10 4 R$ 0.40 Albumin R$ 5.12 1 R$ 5.12 Physiotherapeutic evaluation R$ 50.00 1 R$ 50.00 Bilirubin R$ 10.24 1 R$ 10.24 Urine collection bag, 28x20cm R$ 0.15 1 R$ 0.15 Ionized calcium R$ 5.12 1 R$ 5.12 Calcium/serum R$ 5.12 1 R$ 5.12 Disposable oxygen catheter, N6 R$ 0.27 1 R$ 0.27 Chlorhexidine (0.5% to 2%), 100mL R$ 1.25 2 R$ 2.50 Ionized chloride/serum R$ 10.24 1 R$ 10.24 Coagulogram R$ 17.80 1 R$ 17.80 Continue...
Rev Bras Ter Intensiva. 2014;26(3):00-00 ... continuation
Sterile gauze pad, 7.5x7.5cm (10 pack) R$ 0.27 10 R$ 2.70 Control of diuresis per period R$ 8.37 3 R$ 8.37 Creatinine/serum R$ 5.12 1 R$ 5.12 Daily room R$ 360.00 1 R$ 360.00 Closed system liquid diet kit R$ 28.50 4 R$ 114.00
Nutritionally complete diet for normal catheter (L) R$ 10.03 1.5 R$ 15.05 Nurse (a) R$ 116.64 1 R$ 116.64 Enoxaparin, 40mg R$ 3.49 1 R$ 3.49 Phosphorus R$ 5.12 1 R$ 5.12 Arterial blood gas analysis R$ 17.55 4 R$ 70.20 Venous blood gas analysis R$ 17.55 4 R$ 70.20 Glucose R$ 5.12 1 R$ 5.12 Complete blood and platelet count R$ 17.80 1 R$ 17.80 Lactate dehydrogenase (LDH) R$ 5.12 1 R$ 5.12 Sterile hypoallergenic surgical gloves size 7.5 R$ 1.40 15 R$ 21.05 Magnesium/serum R$ 5.12 1 R$ 5.12 Disposable surgical mask with adequate softness R$ 0.06 15 R$ 0.90 Cardiac monitoring R$ 123.11 1 R$ 123.11 Polygraph R$ 162.91 1 R$ 162.91 Potassium/serum R$ 5.12 1 R$ 5.12 C-reactive protein R$ 5.12 1 R$ 5.12 Disposable sterile arm protector R$ 2.31 15 R$ 34.65 Disposable sterile body protector R$ 1.75 15 R$ 26.25 Posteroanterior chest x-ray R$ 20.00 1 R$ 20.00 Ranitidine hydrochloride, 50mg R$ 0.20 3 R$ 0.59 Disposable syringe, 20mL R$ 0.27 3 R$ 0.81 Blood gas syringe R$ 2.14 4 R$ 8.56 Sodium/serum R$ 5.12 1 R$ 5.12 Glutamic oxaloacetic transaminase (GOT) R$ 5.12 1 R$ 5.12 Glutamic pyruvic transaminase (GPT) R$ 5.12 1 R$ 5.12 Urea/serum R$ 5.12 1 R$ 5.12 Vancomycin R$ 56.96 1 R$ 56.96 Checking vital signs R$ 15.18 1 R$ 15.18
Rev Bras Ter Intensiva. 2014;26(3):00-00 Table 20 - Average number of patient support days ... continuation Category/characteristic Days NIMV survivors ECMO survivors Days on MV 5 Days on ECMO 6 Days in ICU without MV 6 Days on MV without ECMO 2 Days in infirmary 10 Days in ICU without MV 4 Days on renal replacement 3 Days in infirmary 13 NIMV non-survivors Days on renal replacement 3 Days on MV 11 ECMO non-survivors Days in ICU without MV 3 Days on ECMO 3 Days in infirmary 10 Days on MV without ECMO 2 Days on renal replacement 3 Days in ICU without MV 0 Non-survivors with severe hypoxemia without ECMO Days on renal replacement 9 Days on MV 12 MV survivors Days in ICU without MV 4 Days on MV 11 Days on renal replacement 6 Days in ICU without MV 6 Survivors with severe hypoxemia without ECMO Days in infirmary 19 Days on MV 15 Days on renal replacement 3 Days in ICU without MV 8 MV non-survivors Days on renal replacement 8 Days on MV 11 Days in infirmary 10 Days in ICU without MV 3 ECMO - extracorporeal membrane oxygenation; MV - mechanical ventilation; ICU - intensive care unit. Days in infirmary 19 Days on renal replacement 5 Continue...
REFERENCES
1. Azevedo LC, Park M, Salluh JI, Rea-Neto A, Souza-Dantas VC, Varaschin P, Oliveira MC, Tierno PF, Dal-Pizzol F, Silva UV, Knibel M, Nassar AP Jr, Alves RA, Ferreira JC, Teixeira C, Rezende V, Martinez A, Luciano PM, Schettino G, Soares M; The ERICC (Epidemiology of Respiratory Insufficiency in Critical Care) investigators. Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care. 2013;17(2):R63. 2. Park M, Azevedo LC, Mendes PV, Carvalho CR, Amato MB, Schettino GP, et al. First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation. Clinics (São Paulo). 2012;67(10):1157-63.
Rev Bras Ter Intensiva. 2014;26(3):00-00