Remifentanil versus  Morphine Analgesia and Sedation for Mechanically Ventilated Critically Ill Patients

Abstract

A remifentanil-based regimen was more effective in the provision of optimal analgesia-sedation than a standard morphine-based regimen. The remifentanil-based regimen allowed a more rapid emergence from sedation and facilitated earlier extubation.

A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients

“…Fourthly, our study and three previous studies [22,26,30] were performed principally on surgical patients. We note that the studies performed on mixed medical/surgical populations have yielded positive results in favor of remifentanil [27,28,31].…”

“…Fentanyl and sufentanil are the opioids of choice in Germany [1,24,25]. In the four studies where the control group received morphine [26][27][28][29] the result was significantly in favor of remifentanil. Studies comparing fentanyl and remifentanil have, on the other hand, yielded mixed results [22,30].…”

Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: a centre randomised, cross-over, open-label study in the Netherlands

“…This caused the study to be underpowered. To date, three studies have shown a significant reduction in the duration of MV with remifentanil compared to conventional regimens [14,17,18], whereas 1 other did not [19]. For the day 4-10 treatment period, no significant difference was found whilst one would expect patients undergoing longer sedation to benefit even more due to the favourable pharmacokinetics of remifentanil.…”

“…The shorter median weaning time in the remifentanil arm is probably directly related to remifentanil's pharmacokinetic profile. Three active comparator studies have also shown significant reductions in weaning time with remifentanil [14,15,18], whereas 1 other has not [20].…”

“…Previous studies showed mixed results: two studies found a significant reduction in ICU-LOS with remifentanil vs. conventional regimens [17,18], whereas four others did not [14,15,19,20]. Discharge from ICU depends not only on treatment-related factors, but also on managerial factors, such as the availability of beds and staff, and time of the day.…”