Pmu1 Propofol Versus Midazolam for Sedation in Adult Patients in Intensive Care Unit (Icu): A Meta-Analysis

Abstract

Objectives: To compare propofol and midazolam in adult intensive care patients in relation to length of ICU stay, length of mechanical ventilation (MV) and time until extubation. Methods: MEDLINE, EMBASE, LILACS and Cochrane databases were searched from inception until July 2019 to retrieve RCTs that compared propofol and midazolam use as sedatives in adult ICU patients. There was no language restriction. We extracted and combined data from studies that reported to length of ICU stay, length of MV and time until extubation. A random-effects, meta-analytic model was applied in all calculations. Cochrane collaboration tool and GRADE were used to assess bias and certainty of the outcomes of the included studies, respectively. Two groups of patients were analyzed: elective surgical patients and critically ill patients. Results: Elective surgical patients receiving propofol reduced ICU stay by 5.07 hours (MD -5.07; 95% CI -8.68 to -1.45; p ,0.006, I 2 = 41 %, 5 studies), MV time by 4.28 hours (MD -4.28; 95% CI -4.62 to -3.94 (p ,0.00001, I 2 = 0, 3 studies), extubation time by 1.92 hours (MD -1.92; 95% CI -2.71 to -1.13; p ,0.00001, I 2 = 89%, 9 studies) compared to patients receiving midazolam. Critically ill patients receiving propofol reduced extubation time by 32.68 hours (MD -32.68; 95% CI -48.37 to -16.98; p ,0.0001, I 2 = 97%, 7 studies) compared to patients receiving midazolam. GRADE was very low for all outcomes. Conclusions: We conclude that propofol is a safe sedation strategy for general and elective surgery patients in the ICU. It is associated with improved outcomes when compared to the use of midazolam. Our data is in accordance with the recent sedation guideline (PADIS) recommendations where propofol can be used as the first-line sedative in adult ICU patients.

A cost-effectiveness analysis of propofol versus midazolam for the sedation of adult patients admitted to the intensive care unit

“…Our group previously performed a systematic review followed by a meta-analysis comparing the use of propofol (a nonbenzodiazepine) with that of midazolam (a benzodiazepine). ( 7 ) Thus, we built a simple decision tree based on the results of our previous study. This study suggests that a propofol-based sedation regimen is cost-effective for sedation in critically ventilated adults in the ICU compared to a midazolam-based sedation regimen.…”

“…The clinical differences in the length of stay in the ICU and the duration of mechanical ventilation between the propofol and midazolam regimens incorporated in the model came from the results of a meta-analysis of 23 controlled studies, unlike a previous study whose data came from only two small controlled studies. ( 7 )…”

“…In the studies included in this meta-analysis, the hospitalization period ranged from 224 to 660 hours. ( 7 )…”

“…The clinical data inputs were from a previously published meta-analysis, ( 7 ) where the use of propofol reduced ICU stays by 47.97 hours and mechanical ventilation by 21.65 hours.…”