Continuous infusions of lorazepam, midazolam, and propofol for sedation of the critically ill surgery trauma patient: A prospective, randomized comparison

McCollam, Jill Shwed; OʼNeil, Michael G.; Norcross, E. Douglas; Byrne, Thomas; Reeves, Scott

doi:10.1097/00003246-199911000-00022

Cited by 77 publications

(38 citation statements)

References 16 publications

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“…Additional limitations of past work include incorporation of medication costs instead of overall hospitalization costs, data collection within different countries during times when comparative exchange rates are difficult to now appreciate, consideration of only short-term sedation, lack of sensitivity analysis use to examine the impact of data input uncertainty, and inclusion of propofol costs based on its more expensive branded formulation. (32,(34)(35)(36)(37) Because of the ubiquity of sedative use in the ICU setting, we believe that our results underscore the importance of determining whether clinically important differences exist among commonly used sedatives with respect to mechanical ventilation-free days and length of stay. For example, assuming equivalence in ventilator-free days and length of stay, a hospital treating 1,000 ventilated patients annually could theoretically save over $300,000 by using midazolam instead of propofol.…”

Section: Discussionmentioning

confidence: 79%

Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation*

Cox

Reed

Govert

et al. 2008

Critical Care Medicine

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Objective-The economic implications of sedative choice in the management of patients receiving mechanical ventilation are unclear because of differences in costs and clinical outcomes associated with specific sedatives. Therefore, we aimed to determine the cost-effectiveness of the most commonly used sedatives prescribed for mechanically ventilated critically ill patients.Design, Setting, and Patients-Adopting the perspective of a hospital, we developed a probabilistic decision model to determine if continuous propofol or intermittent lorazepam was associated with greater value when combined with daily awakenings. We also evaluated the comparative value of continuous midazolam in secondary analyses. We assumed that patients were managed in a medical intensive care unit and expected to require ventilation for at least 48 hours. Author contributions:Christopher Cox: Final approval, concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript, statistical analysis, obtaining funding, administrative support, and supervision. Shelby Reed: Final approval, concept and design, analysis and interpretation of data, critical revision of the manuscript, and administrative, technical, or material support. Joseph Govert: Final approval, concept and design, analysis and interpretation of data, critical revision of the manuscript, administrative support, and supervision. Jo Ellen Rodgers: Final approval, conception and design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript, obtaining funding, and supervision. Stacy Campbell-Bright: Final approval, acquisition of data, analysis and interpretation of data, critical revision of the manuscript, and administrative support. John Kress: Final approval, concept and design, acquisition of data, drafting of the manuscript, obtaining funding, administrative support, critical revision of the manuscript, and supervision. Shannon Carson: Final approval, concept and design, acquisition of data, analysis and interpretation of data, obtaining funding, critical revision of the manuscript, and supervision. NIH Public AccessAuthor Manuscript Crit Care Med. Author manuscript; available in PMC 2009 October 19. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptModel inputs were derived from primary analysis of randomized controlled trial data, medical literature, Medicare reimbursement rates, pharmacy databases, and institutional data.Main Results-We measured cost-effectiveness as costs per mechanical ventilator-free day within the first 28 days after intubation. Our base-case probabilistic analysis demonstrated that propofol dominated lorazepam in 91% of simulations and, on average, was both $6,378 less costly per patient and associated with over three additional mechanical ventilator-free days. The model did not reveal clinically meaningful differences between propofol and midazolam on costs or measures of effectiveness.Conclusion-Propofol ...

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Section: Discussionmentioning

confidence: 79%

Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation*

Cox

Reed

Govert

et al. 2008

Critical Care Medicine

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“…3 Common adverse effects of benzodiazepines include respiratory depression, hypotension, and delayed awakening. 4 There may be increased risk of delirium with benzodiazepines, particularly continuous intravenous infusions 5 and lorazepam. 6 Propofol-an agent in its own class-provides rapid onset and rapid resolution of sedation, although effects may linger following prolonged infusions.…”

Section: Pharmacology Of Relevant Sedativesmentioning

confidence: 99%

“…Infect Control Hosp Epidemiol 2016; [1][2][3][4][5][6][7][8][9] Healthcare-associated infections (HAIs) remain a significant source of morbidity and mortality among critically ill patients. According to national surveillance data from 2013, 51% of central line-associated bloodstream infections and 75% of catheter-associated urinary tract infections occurred in intensive care unit (ICU) patients.…”

mentioning

confidence: 99%

The Relationship Between Sedatives, Sedative Strategy, and Healthcare-Associated Infection: A Systematic Review

Caroff

Szumita

2016

Infect. Control Hosp. Epidemiol.

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BACKGROUND Healthcare-associated infections (HAIs) cause significant morbidity in critically ill patients. An underappreciated but potentially modifiable risk factor for infection is sedation strategy. Recent trials suggest that choice of sedative agent, depth of sedation, and sedative management can influence HAI risk in mechanically ventilated patients. OBJECTIVE To better characterize the relationships between sedation strategies and infection. METHODS Systematic literature review. RESULTS We found 500 articles and accepted 70 for review. The 3 most common sedatives for mechanically ventilated patients (benzodiazepines, propofol, and dexmedetomidine) have different pharmacologic and immunomodulatory effects that may impact infection risk. Clinical data are limited but retrospective observational series have found associations between sedative use and pneumonia whereas prospective studies of sedative interruptions have reported possible decreases in bloodstream infections, pneumonia, and ventilator-associated events. CONCLUSION Infection rates appear to be highest with benzodiazepines, intermediate with propofol, and lowest with dexmedetomidine. More data are needed but studies thus far suggest that a better understanding of sedation practices and infection risk may help hospital epidemiologists and critical care practitioners find new ways to mitigate infection risk in critically ill patients. Infect Control Hosp Epidemiol 2016;1-9.

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“…8 Likewise, specific sedative agents largely are indistinguishable with respect to the quality or utility of sedation. The development of validated sedation scales, however, may facilitate the identification of clinically relevant differences between agents.…”

Section: Agentsmentioning

confidence: 99%

What Is the Best Way to Sedate Critically Ill Patients?

Tung¹,

OʼConnor²

2010

Evidence-Based Practice of Critical Care

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Continuous infusions of lorazepam, midazolam, and propofol for sedation of the critically ill surgery trauma patient: A prospective, randomized comparison

Cited by 77 publications

References 16 publications

Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation*

Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation*

The Relationship Between Sedatives, Sedative Strategy, and Healthcare-Associated Infection: A Systematic Review

What Is the Best Way to Sedate Critically Ill Patients?

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