The effects of midazolam or propofol plus fentanyl on ICU mortality: a retrospective study based on the MIMIC-IV database

Abstract

Background: Patients in the intensive care unit (ICU) are often under stress and fail to cooperate well with invasive treatments. Analgesia and sedation are of great significance for reducing the suffering of patients and ensuring the application and effectiveness of treatment. For better clinical choice, we aimed to explore the effect of the combination of propofol + fentanyl or midazolam + fentanyl on the short-term prognosis of hospitalized patients in the ICU.Methods: According to the inclusion and exclusion criteria, we retrospectively included patients in the MIMIC-IV database receiving midazolam + fentanyl or propofol + fentanyl analgesic and sedative treatment using Structured Query Language (SQL) to extract clinical data from the MIMIC-IV database. The primary endpoint was the death rate within 28 days after the patient was admitted to the ICU. Doubly robust estimation was used to infer the relationship between sedation and analgesia and 28 days outcome. The gradient boosted model (GBM) was used to estimate the propensity score (PS) of the patient's sedation and analgesia program, PS was used as the weight, and the inverse probabilities weighting (IPW) model was used to generate a weighted cohort.Results: In total, 4,188 cases were included, with 2,174 (51.9%) in the propofol group and 2,014 (48.1%) in the midazolam group. In the PS score matching cohort, the 28-day mortality of patients in the midazolam group was 30.8%, and the 28-day mortality of patients in the propofol group was 25.5%. The adjusted odds ratio (OR) value was 1.421 [95% confidence interval (CI): 1.118-1.806, P<0.001]. Patients in the propofol group did not use vasoactive drugs for a longer period of time than the midazolam group, and patients in the propofol group received significantly more fluids than those in the midazolam group in the first three days after admission to the ICU.Conclusions: Compared with midazolam combined with fentanyl, propofol combined with fentanyl for sedation and analgesia can reduce the risk of short-term death in ICU patients.

Propofol vs Midazolam As the Initial Sedation Strategy for Mechanically Ventilated Patients: A Single-Center Experience From Saudi Arabia

“…Also, Sun W et al found that patients who use midazolam have a higher 28-day mortality rate of 30.8%. In contrast, patients who used propofol had a 28-day mortality rate of 25.5% [ 19 ]. Also, Sun W et al concluded that patients who use midazolam have an adjusted odds ratio of 1.42 of having more than 28 days mortality when compared to patients who use propofol [ 19 ].…”

“…In contrast, patients who used propofol had a 28-day mortality rate of 25.5% [ 19 ]. Also, Sun W et al concluded that patients who use midazolam have an adjusted odds ratio of 1.42 of having more than 28 days mortality when compared to patients who use propofol [ 19 ]. In addition, the aforementioned results are supported by similar results concluded by Lonardo NW et al, who claim that mechanically ventilated patients who were on propofol had less mortality in comparison to patients who were on midazolam [ 16 ].…”

Effect of Stress Ulcers Prophylaxis, Sedative and Statin on Ventilator-Associated Pneumonia: A Retrospective Analysis Based on MIMIC Database

“…The 2013 Pain, Agitation, and Delirium (PAD) guidelines stated that non-benzodiazepine is better choice than benzodiazepines for mechanically ventilated adult patients sinceof the former improved length of stay, duration of MV, 90-day mortality and psychological dysfunction in ICU patients ( Barr et al, 2013 ). Another study showed that the 28-day mortality rate of patients treated with midazolam was 30.8%, and the propofol group was 25.5%, the adjusted odds ratio (OR) value was 1.421 [95% confidence interval (CI): 1.118–1.806, p < 0.001], with a significantly lower mortality rate in the propofol group ( Sun et al, 2022 ). Many previous studies do not support the choice of midazolam as a sedation regimen in patients with MV, mainly considering that midazolam is easy to accumulate in patients’ tissues, resulting in prolonged metabolism and elimination time ( Spina and Ensom, 2007 ).…”

Effect of age and ICU types on mortality in invasive mechanically ventilated patients with sepsis receiving dexmedetomidine: a retrospective cohort study with propensity score matching

“…The following variables were extracted from the MIMIC-IV database using Structured Query Language (SQL): age, sex, body mass index (BMI), admission type, type of ICU on admission, co-morbidities, laboratory tests, vital signs, SOFA score, Charlson Comorbidities Index (CCI) score, medication information, mechanical ventilation, and renal replacement therapy (RRT). The SQL are widely used for the extraction of data from MIMIC-IV database ( Sun et al, 2022 ; Gu et al, 2023 ; Ning et al, 2023 ). The SQL script codes were available from the GitHub website ( https://github.com/MIT-LCP/mimic-iv ).…”