Midazolam and 2% propofol in long-term sedation of traumatized, critically ill patients: Efficacy and safety comparison

Sandiumenge, Alberto; Riera, J. A. Sanchez-Izquierdo; Vazquez, Dario Toral; Borges, Marcio Sa; Rodriguez, Josefa Peinado; López, E. Alted

doi:10.1097/00003246-200011000-00009

Cited by 74 publications

(23 citation statements)

References 20 publications

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“…A higher number of therapeutic failures because of sedative inefficacy was seen in the propofol group compared with the midazolam group [26]. We also found that two patients had therapeutic failure in group P, due to inadequate sedation at the highest dosage of sedative.…”

Section: Discussionmentioning

confidence: 60%

Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients: a prospective, randomized study

et al. 2014

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IntroductionMidazolam and propofol used alone for long-term sedation are associated with adverse effects. Sequential use may reduce the adverse effects, and lead to faster recovery, earlier extubation and lower costs. This study evaluates the effects, safety, and cost of midazolam, propofol, and their sequential use for long-term sedation in critically ill mechanically ventilated patients.MethodsA total of 135 patients who required mechanical ventilation for >3 days were randomly assigned to receive midazolam (group M), propofol (group P), or sequential use of both (group M-P). In group M-P, midazolam was switched to propofol until the patients passed the spontaneous breathing trial (SBT) safety screen. The primary endpoints included recovery time, extubation time and mechanical ventilation time. The secondary endpoints were pharmaceutical cost, total cost of ICU stay, and recollection to mechanical ventilation-related events.ResultsThe incidence of agitation following cessation of sedation in group M-P was lower than group M (19.4% versus 48.7%, P = 0.01). The mean percentage of adequate sedation and duration of sedation were similar in the three groups. The recovery time, extubation time and mechanical ventilation time of group M were 58.0 (interquartile range (IQR), 39.0) hours, 45.0 (IQR, 24.5) hours, and 192.0 (IQR, 124.0) hours, respectively; these were significantly longer than the other groups, while they were similar between the other two groups. In the treatment-received analysis, ICU duration was longer in group M than group M-P (P = 0.016). Using an intention-to-treat analysis and a treatment-received analysis, respectively, the pharmaceutical cost of group M-P was lower than group P (P <0.01) and its ICU cost was lower than group M (P <0.01; P = 0.015). The proportion of group M-P with unbearable memory of the uncomfortable events was lower than in group M (11.7% versus 25.0%, P <0.01), while the proportion with no memory was similar (P >0.05). The incidence of hypotension in group M-P was lower than group (P = 0.01).ConclusionSequential use of midazolam and propofol was a safe and effective sedation protocol, with higher clinical effectiveness and better cost-benefit ratio than midazolam or propofol used alone, for long-term sedation of critically ill mechanically ventilated patients.Trial registrationCurrent Controlled Trials ISRCTN01173443. Registered 25 February 2014.

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Section: Discussionmentioning

confidence: 60%

Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients: a prospective, randomized study

et al. 2014

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“…Of the studies using the Ramsay scale, recommended ranges were 2 to 3 (recommended in two studies [21,22]), 2 to 4 (two studies [23,24]), 2 to 5 (two studies [25,26]), 3 to 4 (two studies [27,28]) and 4 to 5 (one study [29]), while three studies did not recommend specific levels but recommended that levels be optimised for each individual patient [30-32]. This variation was reflected in the other scales used; for studies recommending a modified Ramsay scale, recommended ranges were 1 to 4 [33], 3 to 4 [34], 4 [35], and 5 to 6 (the last range being specifically for seriously injured patients [36]) or targets optimised for each patient [37,38]. The stated SAS (Riker Sedation-Agitation Scale) target level was 1 to 3 [39], 4 [40,41], or 3 to 4 [42].…”

Section: Resultsmentioning

confidence: 99%

“…The remaining included studies comprised studies of sedative drugs [21-26,29,31-34,36,37,39-42,45-50], studies investigating different sedation devices or scales [27,28,38,51,52], and studies looking at the introduction of a sedation guideline or protocol [3,35,53,54]. Studies varied by design and aim, by sedatives used, by scales and definitions of sub-optimal sedation used, and by the way incidence was reported (as a proportion of measurements, patients, or time).…”

Section: Resultsmentioning

confidence: 99%

The incidence of sub-optimal sedation in the ICU: a systematic review

Jackson¹,

Proudfoot²,

Cann³

et al. 2009

Crit Care

113

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IntroductionPatients in intensive care units (ICUs) are generally sedated for prolonged periods. Over-sedation and under-sedation both have negative effects on patient safety and resource use. We conducted a systematic review of the literature in order to establish the incidence of sub-optimal sedation (both over- and under-sedation) in ICUs.MethodsWe searched Medline, Embase and CINAHL (Cumulative Index to Nursing and Allied Health Literature) online literature databases from 1988 to 15 May 2008 and hand-searched conferences. English-language studies set in the ICU, in sedated adult humans on mechanical ventilation, which reported the incidence of sub-optimal sedation, were included. All abstracts were reviewed twice by two independent reviewers, with all conflicts resolved by a third reviewer, to check that they met the review inclusion criteria. Full papers of all included studies were retrieved and were again reviewed twice against inclusion criteria. Data were doubly extracted. Study aims, design, population, comparisons made, and data on the incidence of sub-optimal, optimal, over-sedation or under-sedation were extracted.ResultsThere was considerable variation between included studies in the definition of optimal sedation and in the scale or method used to assess sedation. Across all included studies, a substantial incidence of sub-optimal sedation was reported, with a greater tendency toward over-sedation.ConclusionsOur review suggests that improvements in the consistent definition and measurement of sedation may improve the quality of care of patients within the ICU.

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“…Similarly no significant differences were seen in haemodynamic variables between the two groups. Interestingly, there was a higher incidence of therapeutic failure in the propofol group either because of inadequate sedation or hypertriglyceridemia [33]. Other smaller, underpowered studies have also failed to demonstrate a difference in outcomes between these two agents [34].…”

Section: Benzodiazepinesmentioning

confidence: 99%

Sedation in Traumatic Brain Injury

Flower

Hellings

2012

Emergency Medicine International

119

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Several different classes of sedative agents are used in the management of patients with traumatic brain injury (TBI). These agents are used at induction of anaesthesia, to maintain sedation, to reduce elevated intracranial pressure, to terminate seizure activity and facilitate ventilation. The intent of their use is to prevent secondary brain injury by facilitating and optimising ventilation, reducing cerebral metabolic rate and reducing intracranial pressure. There is limited evidence available as to the best choice of sedative agents in TBI, with each agent having specific advantages and disadvantages. This review discusses these agents and offers evidence-based guidance as to the appropriate context in which each agent may be used. Propofol, benzodiazepines, narcotics, barbiturates, etomidate, ketamine, and dexmedetomidine are reviewed and compared.

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Midazolam and 2% propofol in long-term sedation of traumatized, critically ill patients: Efficacy and safety comparison

Cited by 74 publications

References 20 publications

Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients: a prospective, randomized study

Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients: a prospective, randomized study

The incidence of sub-optimal sedation in the ICU: a systematic review

Sedation in Traumatic Brain Injury

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