Published in Am J Respir Crit Care Med. 2014 Apr
Authors: Lonardo NW et al.
Rationale: Mechanically ventilated ICU patients are frequently managed using a continuous infusion sedative. Though recent guidelines suggest avoiding benzodiazepines for sedation, this class of drugs is still widely employed. There are limited data comparing sedative agents in terms of clinical outcomes in an ICU setting.
Objectives: Comparison of propofol to midazolam and lorazepam in adult, ICU patients.
Methods: Data were obtained from a multi-center ICU database (2003-2009). Patient selection criteria included; age greater than 18 years, single ICU admission with single ventilation event (greater than 48 hours), and treatment with continuously infused sedation (propofol, midazolam, or lorazepam).
Propensity score analysis (1:1) was employed and mortality measured. Cumulative incidence and competing risk methodology were used to examine time to ICU discharge and ventilator removal. Measurements and Main
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 to midazolam or lorazepam treated; (risk ratio 0.76; 95% confidence interval [CI], 0.69 to 0.82) and (risk ratio 0.78; 95% CI, 0.68 to 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 less than 0.001) and earlier removal from the ventilator (84.4% vs 75.1%; 79.2% vs 71.9%, P less than 0.001) when compared to 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 and increased likelihood of earlier ICU discharge as well as earlier discontinuation of mechanical ventilation.