Sedation is frequently required for mechanically ventilated intensive care unit (ICU) patients to reduce anxiety, provide comfort, and assist in providing optimal respiratory support. It is estimated that each year, there are nearly 1 million US patients treated with a continuous, intravenous sedative in an ICU setting.
A University of Utah study shows for the first time that continuous infusion benzodiazepines — a class of sedatives that includes lorazepam and midazolam, once considered the standard of care in the ICU — are linked to an increased likelihood of death among patients who receive mechanical ventilation, when compared to the sedative propofol. The research was published in the American Journal of Respiratory and Critical Care Medicine (AJRCCM).
The authors analyzed data, called Project IMPACT, on 13,692 mechanically ventilated patients from 104 US hospitals during the years 2003 – 2009. They found that overall ICU mortality was 19.7% in propofol treated patients as compared to 28.8% in midazolam treated patients, and 19.3% for propofol compared to 25.2% for lorazepam treated patients. Those treated with benzodiazepines also spent significantly more time on mechanical ventilation, and a longer time in the ICU.
“We found there are better, safer ways than benzodiazepines to sedate people that can still deliver all the sedation you need while minimizing some of the complications associated with mechanical ventilation,” said senior author Richard Barton, MD, professor of surgery and director of the surgical intensive care unit (SICU) at University of Utah Hospital.
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