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Clinical Investigations in Critical Care |

Propofol vs Midazolam for ICU Sedation*: A Canadian Multicenter Randomized Trial

Richard I. Hall, MD, FCCP; Dean Sandham, MD, FCCP; Pierre Cardinal, MD; Martin Tweeddale, MD; David Moher, MSc; Xiaohua Wang, MSc STAT; Aslam H. Anis, PhD; for the Study Investigators; for the Study Investigators
Author and Funding Information

Affiliations: *From the Queen Elizabeth II Health Sciences Centre (Dr. Hall), Halifax, Nova Scotia, Canada; Foothills Hospital (Dr. Sandham), University of Calgary, Calgary, Alberta, Canada; Ottawa General Hospital (Dr. Cardinal), Ottawa, Ontario, Canada; Vancouver General Hospital (Dr. Tweeddale), Vancouver, British Columbia, Canada; Ottawa Civic Hospital (Mr. Moher), Ottawa, Ontario, Canada; St. Paul’s Hospital (Mrs. Wang), Vancouver, British Columbia, Canada; and the Department of Health Care and Epidemiology (Dr. Anis), University of British Columbia, Vancouver, British Columbia, Canada.,  A list of additional study investigators is located in Appendix 1.

Correspondence to: Richard I. Hall, MD, FCCP, Department of Anesthesia, Queen Elizabeth II Health Sciences Centre, 1796 Summer St, Halifax, Nova Scotia, Canada B3H 3A7; e-mail: rihall@is.dal.ca



Chest. 2001;119(4):1151-1159. doi:10.1378/chest.119.4.1151
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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.

Design: Multicenter, randomized, open label.

Setting: Four academic tertiary-care ICUs in Canada.

Patients: Critically ill patients requiring continuous sedation while receiving mechanical ventilation.

Interventions: 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.

Measurements and 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 discharge.

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