Sedation of critically ill patients during mechanical ventilation. A comparison of propofol and midazolam.

Abstract

Propofol (P) and midazolam (M) are frequently given by continuous infusion for sedation in critically ill, mechanically ventilated patients. We compared these drugs with regard to: (1) time-to-awaken; (2) reproducibility of bedside assessments of level of sedation; (3) time-to-sedation; and (4) change in oxygen consumption (V O2) from awake to sedated state. Seventy-three patients were prospectively randomized to receive either P (n=37) or M (n=36). Wake-up times after stopping the drug were assessed by blinded and unblinded observers, by asking patients to perform simple tasks. Times to sedate were assessed by consensus agreement among nurses and investigators. Demographics and APACHE II scores were not different between P and M. The P group had a significantly narrower range of wake-up times with a higher likelihood of waking in less than 60 min. Blinded versus unblinded observations had excellent correlation. Average time to sedate and decrease in V O2 were not different. We conclude that in this patient population: (1) both P and M achieved optimal sedation in a large fraction of patients when administered by specified dosing protocols; (2) P had a faster, more reliable, wake-up time; (3) assessments of time-to-awaken were objective and reproducible; (4) time to sedation was not significantly different; (5) V O2 decreased similarly with both.

Therapeutic Approach to the Critically Poisoned Patient

“…Continuous infusion of midazolam, compared with continuous infusion of propofol or lorazepam, lengthens time until the patient is awake and extubated after sedation has been stopped [193][194][195]. In critically ill patients, the midazolam half-life and volume of distribution are increased [196].…”

Daily Interruptions of Sedation: A Clinical Approach to Improve Outcomes in Critically Ill Patients

“…Kress and colleagues 8 introduced the concept of DIS in 1996. They conducted a trial in which 73 patients were randomized to receive a continuous infusion of propofol or midazolam.…”

La sédation comme facteur de risque d’infection acquise en réanimation

“…Seul le propofol inhibait la production d'IL-2 et stimulait la production d'IFN-γ. Kress et al [56] ont comparé le propofol et le midazolam dans une étude randomisée portant sur 73 patients. Le groupe propofol présentait des temps de réveil à l'arrêt de la perfusion de l'agent sédatif significativement plus rapides, avec une plus forte probabilité d'un réveil en moins de 60 minutes.…”