A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients.
OBJECTIVE
To compare duration of mechanical ventilation for patients randomized to receive lorazepam by intermittent bolus administration vs. continuous infusions of propofol using protocols that include scheduled daily interruption of sedation.


METHODS
A randomized open-label trial enrolling patients from October 2001 to March 2004.


METHODS
Medical intensive care units of two tertiary care medical centers.


METHODS
Adult patients expected to require mechanical ventilation for >48 hrs and who required > or =10 mg of lorazepam or a continuous infusion of a sedative to achieve adequate sedation.


METHODS
Patients were randomized to receive lorazepam by intermittent bolus administration or propofol by continuous infusion to maintain a Ramsay score of 2-3. Sedation was interrupted on a daily basis for both groups.


RESULTS
The primary outcome was median ventilator days. Secondary outcomes included 28-day ventilator-free survival, intensive care unit and hospital length of stay, and hospital mortality. Median ventilator days were significantly lower in the daily interruption propofol group compared with the intermittent bolus lorazepam group (5.8 vs. 8.4, p = .04). The difference was largest for hospital survivors (4.4 vs. 9.0, p = .006). There was a trend toward greater ventilator-free survival for patients in the daily interruption propofol group (median 18.5 days for propofol vs. 10.2 for lorazepam, p = .06). Hospital mortality was not different.


CONCLUSIONS
For medical patients requiring >48 hrs of mechanical ventilation, sedation with propofol results in significantly fewer ventilator days compared with intermittent lorazepam when sedatives are interrupted daily.
Division of Pulmonary and Critical Care, Department of Medicine, University of North Carolina at Chapel Hill, 4134 Bioinformatics Building, Chapel Hill, NC 27599-7020, USA. scarson@med.unc.edu
Shannon S
SS
Carson
John P
JP
Kress
Jo Ellen
JE
Rodgers
Ajeet
A
Vinayak
Stacy
S
Campbell-Bright
Joseph
J
Levitt
Sharya
S
Bourdet
Anastasia
A
Ivanova
Ashley G
AG
Henderson
Anne
A
Pohlman
Lydia
L
Chang
Preston B
PB
Rich
Jesse
J
Hall
D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007902:Length of Stay; D008140:Lorazepam / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage*; D012121:Respiration, Artificial; D015300:Ventilator Weaning
D006993:Hypnotics and Sedatives; D008140:Lorazepam; D015742:Propofol