HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (32) Citing Articles via Google Scholar Google Scholar Articles by Hall, R. I. Articles by Anis, A. H. Search for Related Content PubMed PubMed Citation Articles by Hall, R. I. Articles by Anis, A. H.

Propofol vs Midazolam for ICU Sedation^*

A Canadian Multicenter Randomized Trial

Richard I. Hall, MD, FCCP; Dean Sandham, MD, FCCP; Pierre Cardinal, MD; Martin Tweeddale, MD; David Moher, MSc; Xiaohua Wang, MSc STAT; Aslam H. Anis, PhD and for the Study Investigators

^* From the Queen Elizabeth II Health Sciences Centre (Dr. Hall), Halifax, Nova Scotia, Canada; Foothills Hospital (Dr. Sandham), University of Calgary, Calgary, Alberta, Canada; Ottawa General Hospital (Dr. Cardinal), Ottawa, Ontario, Canada; Vancouver General Hospital (Dr. Tweeddale), Vancouver, British Columbia, Canada; Ottawa Civic Hospital (Mr. Moher), Ottawa, Ontario, Canada; St. Paul’s Hospital (Mrs. Wang), Vancouver, British Columbia, Canada; and the Department of Health Care and Epidemiology (Dr. Anis), University of British Columbia, Vancouver, British Columbia, Canada. A list of additional study investigators is located in ^{Appendix 1}.

Correspondence to: Richard I. Hall, MD, FCCP, Department of Anesthesia, Queen Elizabeth II Health Sciences Centre, 1796 Summer St, Halifax, Nova Scotia, Canada B3H 3A7; e-mail: rihall{at}is.dal.ca

Study objectives: To determine whether sedation with propofol would lead to shorter times to tracheal extubation and ICU length of stay than sedation with midazolam.

Design: Multicenter, randomized, open label.

Setting: Four academic tertiary-care ICUs in Canada.

Patients: Critically ill patients requiring continuous sedation while receiving mechanical ventilation.

Interventions: Random allocation by predicted requirement for mechanical ventilation (short sedation stratum, < 24 h; medium sedation stratum, 24 and < 72 h; and long sedation stratum, 72 h) to sedation regimens utilizing propofol or midazolam.

Measurements and results: Using an intention-to-treat analysis, patients randomized to receive propofol in the short sedation stratum (propofol, 21 patients; midazolam, 26 patients) and the long sedation stratum (propofol, 4 patients; midazolam, 10 patients) were extubated earlier (short sedation stratum: propofol, 5.6 h; midazolam, 11.9 h; long sedation stratum: propofol, 8.4 h; midazolam, 46.8 h; p < 0.05). Pooled results showed that patients treated with propofol (n = 46) were extubated earlier than those treated with midazolam (n = 53) (6.7 vs 24.7 h, respectively; p < 0.05) following discontinuation of the sedation but were not discharged from ICU earlier (94.0 vs 63.7 h, respectively; p = 0.26). Propofol-treated patients spent a larger percentage of time at the target Ramsay sedation level than midazolam-treated patients (60.2% vs 44.0%, respectively; p < 0.05). Using a treatment-received analysis, propofol sedation either did not differ from midazolam sedation in time to tracheal extubation or ICU discharge (sedation duration, < 24 h) or was associated with earlier tracheal extubation but longer time to ICU discharge (sedation duration, 24 h, < 72 h, or 72 h).

Conclusions: The use of propofol sedation allowed for more rapid tracheal extubation than when midazolam sedation was employed. This did not result in earlier ICU discharge.

Key Words: ICU • mechanical ventilation • midazolam • multicenter • propofol • randomized clinical trial • sedation

This article has been cited by other articles:

				P. S. Myles and D. McIlroy Fast-Track Cardiac Anesthesia: Choice of Anesthetic Agents and Techniques Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 5 - 16. [Abstract] [PDF]

				M. Nirmalan, P. M. Dark, P. Nightingale, and J. Harris Editorial IV: Physical and pharmacological restraint of critically ill patients: clinical facts and ethical considerations Br. J. Anaesth., June 1, 2004; 92(6): 789 - 792. [Full Text] [PDF]

				E. W. Ely, B. Truman, A. Shintani, J. W. W. Thomason, A. P. Wheeler, S. Gordon, J. Francis, T. Speroff, S. Gautam, R. Margolin, et al. Monitoring Sedation Status Over Time in ICU Patients: Reliability and Validity of the Richmond Agitation-Sedation Scale (RASS) JAMA, June 11, 2003; 289(22): 2983 - 2991. [Abstract] [Full Text] [PDF]

				E. Martin, G. Ramsay, J. Mantz, and S. T. J. Sum-Ping The Role of the {alpha}2-Adrenoceptor Agonist Dexmedetomidine in Postsurgical Sedation in the Intensive Care Unit J Intensive Care Med, January 1, 2003; 18(1): 29 - 41. [Abstract] [PDF]