Propofol vs midazolam for ICU sedation : a Canadian multicenter randomized trial.
OBJECTIVE
To determine whether sedation with propofol would lead to shorter times to tracheal extubation and ICU length of stay than sedation with midazolam.


METHODS
Multicenter, randomized, open label.


METHODS
Four academic tertiary-care ICUs in Canada.


METHODS
Critically ill patients requiring continuous sedation while receiving mechanical ventilation.


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


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, > or = 24 h, < 72 h, or > 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.
Hall
R I
RI
Department of Anesthesia, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. rihall@is.dal.ca
Sandham
D
D
Cardinal
P
P
Tweeddale
M
M
Moher
D
D
Wang
X
X
Anis
A H
AH
D000368:Aged; D003422:Critical Care; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D015742:Propofol; D012121:Respiration, Artificial; D013997:Time Factors
D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol