• Daniel R Austin, Yvonne Lai, Ariel Mueller, and Kenneth T Shelton.
• Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
• J. Cardiothorac. Vasc. Anesth. 2022 May 1; 36 (5): 1343-1349.

ObjectivesTo examine the use of inhaled nitric oxide (iNO) and inhaled epoprostenol (iPGI2) before and after implementation of an iPGI2-preferential protocol and the associated cost differences after rollout.DesignA single-center, retrospective analysis.SettingA quaternary university hospital.ParticipantsAll patients admitted to the Heart Center Intensive Care Unit (HCICU) who required inhaled pulmonary vasodilator use between December 2017 and November 2019.InterventionsNone.Measurements And Main ResultsThe HCICU comprised 84% of hospital-wide iNO utilization and 59% of hospital-wide iPGI2 use across the entire study period. There was no significant difference in postsurgical HCICU admission rates across the study period. There was a significant decrease in iNO mean monthly use from 578 ± 230 to 69 ± 71 hours, and a significant concurrent increase in iPGI2 from 756 ± 443 to 1,210 ± 547 hours after the implementation of a protocol. There were no changes in the average length of ICU stay between the 2 time periods. The protocol implementation led to a projected annual savings of roughly $1,180,000.ConclusionsThese findings showed that multidisciplinary protocol development and implementation can have a substantial impact on medication utilization and lead to significant reductions in cost.Copyright © 2021 Elsevier Inc. All rights reserved.

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