title: Diazepam or midazolam for orotracheal intubation in the ICU?
abstract: OBJECTIVE
  to compare clinical and cost effectiveness of midazolam and diazepam for urgent intubation.
  
  
  METHODS
  patients admitted to the Central ICU of the Santa Casa Hospital Complex in Porto Alegre, over the age of 18 years, undergoing urgent intubation during 6 months were eligible. Patients were randomized in a single-blinded manner to either intravenous diazepam or midazolam. Diazepam was given as a 5 mg intravenous bolus followed by aliquots of 5 mg each minute. Midazolam was given as an intravenous bolus of 5 mg with further aliquots of 2.5 mg each minute. Ramsay sedation scale 5-6 was considered adequate sedation. We recorded time and required doses to reach adequate sedation and duration of sedation.
  
  
  RESULTS
  thirty four patients were randomized, but one patient in the diazepam group was excluded because data were lost. Both groups were similar in terms of illness severity and demographics. Time for adequate sedation was shorter (132 ± 87 sec vs. 224 ± 117 sec, p = 0.016) but duration of sedation was similar (86 ± 67 min vs. 88 ± 50 min, p = 0.936) for diazepam in comparison to midazolam. Total drug dose to reach adequate sedation after either drugs was similar (10.0 [10.0-12.5] mg vs. 15.0 [10.0-17.5] mg, p = 0.248). Arterial pressure and sedation intensity reduced similarly overtime with both drugs. Cost of sedation was lower for diazepam than for midazolam (1.4[1.4-1.8] vs. 13.9[9.4-16.2] reais, p <0.001).
  
  
  CONCLUSIONS
  intubation using intravenous diazepam and midazolam is effective and well tolerated. Sedation with diazepam is associated to a quicker sedation time and to lower costs.
authors.affiliation: Intensive Care Unit, Dr. Bartholomeu Tocchini Hospital, Bento Gonçalves, RS, Brazil.
authors.forename: Lísia
authors.initials: L
authors.lastname: Gehrke
authors.affiliation: Department of Clinical Medicine, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Roselaine P
authors.initials: RP
authors.lastname: Oliveira
authors.affiliation: Intensive Care Unit, Pompéia Hospital, Caxias do Sul, RS, Brazil.
authors.forename: Maicon
authors.initials: M
authors.lastname: Becker
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Friedman
mesh_terms: D054810:Deep Sedation / Q000191:economics; D003975:Diazepam / Q000008:administration & dosage* / Q000191:economics; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000191:economics; D007275:Injections, Intravenous; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000191:economics; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000191:economics; D008875:Middle Aged; D016037:Single-Blind Method
chemical_list: D006993:Hypnotics and Sedatives; D003975:Diazepam; D008874:Midazolam