Study objectives: To determine whether sedation with
propofol would lead to shorter times to tracheal extubation and ICU
length of stay than sedation with midazolam.
Multicenter, randomized, open label.
academic tertiary-care ICUs in Canada.
Critically ill patients requiring continuous sedation while
receiving mechanical ventilation.
Random allocation by predicted requirement for mechanical ventilation
(short sedation stratum, < 24 h; medium sedation stratum,≥
24 and < 72 h; and long sedation stratum, ≥ 72 h) to sedation
regimens utilizing propofol or midazolam.
results: Using an intention-to-treat analysis, patients
randomized to receive propofol in the short sedation stratum (propofol,
21 patients; midazolam, 26 patients) and the long sedation stratum
(propofol, 4 patients; midazolam, 10 patients) were extubated earlier
(short sedation stratum: propofol, 5.6 h; midazolam, 11.9 h;
long sedation stratum: propofol, 8.4 h; midazolam, 46.8 h;
p < 0.05). Pooled results showed that patients treated with propofol
(n = 46) were extubated earlier than those treated with midazolam
(n = 53) (6.7 vs 24.7 h, respectively; p < 0.05) following
discontinuation of the sedation but were not discharged from ICU
earlier (94.0 vs 63.7 h, respectively; p = 0.26).
Propofol-treated patients spent a larger percentage of time at the
target Ramsay sedation level than midazolam-treated patients (60.2% vs
44.0%, respectively; p < 0.05). Using a treatment-received
analysis, propofol sedation either did not differ from midazolam
sedation in time to tracheal extubation or ICU discharge (sedation
duration, < 24 h) or was associated with earlier tracheal extubation
but longer time to ICU discharge (sedation duration, ≥ 24 h, < 72
h, or ≥ 72 h).
Conclusions: The use of propofol
sedation allowed for more rapid tracheal extubation than when midazolam
sedation was employed. This did not result in earlier ICU