Propofol is associated with favorable outcomes compared with benzodiazepines in ventilated intensive care unit patients.
BACKGROUND
Mechanically ventilated intensive care unit (ICU) patients are frequently managed using a continuous-infusion sedative. Although recent guidelines suggest avoiding benzodiazepines for sedation, this class of drugs is still widely used. There are limited data comparing sedative agents in terms of clinical outcomes in an ICU setting.


OBJECTIVE
Comparison of propofol to midazolam and lorazepam in adult ICU patients.


METHODS
Data were obtained from a multicenter ICU database (2003-2009). Patient selection criteria included age greater than or equal to 18 years, single ICU admission with single ventilation event (>48 h), and treatment with continuously infused sedation (propofol, midazolam, or lorazepam). Propensity score analysis (1:1) was used and mortality measured. Cumulative incidence and competing risk methodology were used to examine time to ICU discharge and ventilator removal.


RESULTS
There were 2,250 propofol-midazolam and 1,054 propofol-lorazepam matched patients. Hospital mortality was statistically lower in propofol-treated patients as compared with midazolam- or lorazepam-treated patients (risk ratio, 0.76; 95% confidence interval [CI], 0.69-0.82 and risk ratio, 0.78; 95% CI, 0.68-0.89, respectively). Competing risk analysis for 28-day ICU time period showed that propofol-treated patients had a statistically higher probability for ICU discharge (78.9% vs. 69.5%; 79.2% vs. 71.9%; P < 0.001) and earlier removal from the ventilator (84.4% vs. 75.1%; 84.3% vs. 78.8%; P < 0.001) when compared with midazolam- and lorazepam-treated patients, respectively.


CONCLUSIONS
In this large, propensity-matched ICU population, patients treated with propofol had a reduced risk of mortality and had both an increased likelihood of earlier ICU discharge and earlier discontinuation of mechanical ventilation.
1 Pharmacy Department.
Nick W
NW
Lonardo
Mary C
MC
Mone
Raminder
R
Nirula
Edward J
EJ
Kimball
Kyle
K
Ludwig
Xi
X
Zhou
Brian C
BC
Sauer
Kevin
K
Nechodom
Chiachen
C
Teng
Richard G
RG
Barton
D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001569:Benzodiazepines / Q000008:administration & dosage*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D015399:Nursing Research; D015742:Propofol / Q000008:administration & dosage*; D012121:Respiration, Artificial / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D014139:Tracheostomy / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome; D014589:Utah / Q000453:epidemiology
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D008140:Lorazepam; D008874:Midazolam; D015742:Propofol