title: Changing sedative infusion from propofol to midazolam improves sublingual microcirculatory perfusion in patients with septic shock.
abstract: OBJECTIVE
  The goal of this study was to explore possible microcirculatory alterations by changing sedative infusion from propofol to midazolam in patients with septic shock.
  
  
  METHODS
  Patients (n=16) were sedated with propofol during the first 24 hours after intubation, then with midazolam, following a predefined algorithm. Systemic hemodynamics, perfusion parameters, and microcirculation were assessed at 2 time points: just before stopping propofol and 30 minutes after the start of midazolam infusion. Sublingual microcirculation was evaluated by sidestream dark-field imaging.
  
  
  RESULTS
  The microvascular flow index and the proportion of perfused small vessels were greater when patients were on midazolam than when on propofol infusion (2.8 [2.4-2.9] vs 2.3 [1.9-2.6] and 96.4% [93.7%-97.6%] vs 92.7% [88.3%-94.7%], respectively; P<.005), and the flow heterogeneity index was greater with propofol than with midazolam use (0.49 [0.2-0.8] vs 0.19 [0.1-0.4], P<.05). There were no significant changes in systemic hemodynamics and perfusion parameters either during propofol use or during midazolam infusions. Data are presented as median (25th-75th percentiles).
  
  
  CONCLUSIONS
  In this study, sublingual microcirculatory perfusion improved when the infusion was changed from propofol to midazolam in patients with septic shock. This observation could not be explained by changes in systemic hemodynamics.
authors.affiliation: Laboratory for Clinical and Experimental Research on Vascular Biology-BioVasc, Biomedical Center, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil; Intensive Care Unit, Casa de Saúde São José, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil. Electronic address: guipenna@terra.com.br.
authors.forename: Guilherme Loures
authors.initials: GL
authors.lastname: Penna
authors.forename: Fernanda M
authors.initials: FM
authors.lastname: Fialho
authors.forename: Pedro
authors.initials: P
authors.lastname: Kurtz
authors.forename: André M
authors.initials: AM
authors.lastname: Japiassú
authors.forename: Marcelo
authors.initials: M
authors.lastname: Kalichsztein
authors.forename: Gustavo
authors.initials: G
authors.lastname: Nobre
authors.forename: Nivaldo Ribeiro
authors.initials: NR
authors.lastname: Villela
authors.forename: Eliete
authors.initials: E
authors.lastname: Bouskela
mesh_terms: D018806:APACHE; D000368:Aged; D000465:Algorithms; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D008874:Midazolam / Q000494:pharmacology*; D009060:Mouth Floor / Q000098:blood supply*; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood*
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol
keywords: Hypnotics and sedatives; Microcirculation; Midazolam; Propofol; Sepsis; Shock