A Lack of Evidence of Superiority of Propofol Versus Midazolam for Sedation in Mechanically Ventilated Critically Ill Patients : A Qualitative and Quantitative Systematic Review

Article Article scientifique Méta-analyse A Lack of Evidence of Superiority of Propofol Versus Midazolam for Sedation in Mechanically Ventilated Critically Ill Patients : A Qualitative and Quantitative Systematic Review eng 2001-04 author Walder Bernhard Divisions of Surgical Intensive Care, Department APSIC, University Hospitals of Geneva, Switzerland. Bernard.Walder@hcuge.ch 124875 author Elia Nadia 0000-0003-1787-9288 87569 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Henzi Iris 49758 author Romand Jacques-André 121831 author Tramer Martin 124140 Décanat et administration de la faculté de médecine (ADMED) 975-983 10.1097/00000539-200104000-00033 11273936 0003-2999 https://journals.lww.com/00000539-200104000-00033 Unlabelled: Propofol and midazolam are often used for sedation in the intensive care unit. The aim of this systematic review was to estimate the efficacy and harm of propofol versus midazolam in mechanically ventilated patients. A systematic search (Medline, Cochrane Library, Embase, bibliographies), any language, up to June 1999 was performed for reports of randomized comparisons of propofol with midazolam. Data from 27 trials (1624 adults) were analyzed. The average duration of sedation varied between 4 and 339 h. In 10 trials, the duration of adequate sedation was longer with propofol (weighted mean difference 2.9 h; 95% confidence interval [CI], 0.2-5.6 h). In 13 trials (mostly postoperative), sedation lasted 4 to 35 h; in 9 of those, average weaning time from mechanical ventilation with propofol was 0.8-4.3 h; with midazolam it was 1.5-7.2 h (weighted mean difference 2.2 h [95% CI, 0.8 to 3.7 h]). In 8 trials, sedation lasted 54 to 339 h; there was a lack of evidence for difference in weaning times. Arterial hypotension (relative risk 2.5 [95% CI, 1.3 to 4.5]; number-needed-to-treat, 12), and hypertriglyceridemia (relative risk 12.1 [95%CI, 2.9 to 49.7]; number-needed-to-treat, 6) occurred more often with propofol. The duration of adequate sedation time is longer with propofol compared with midazolam. In postoperative patients with sedation <36 h, weaning is faster with propofol. Implications: The duration of adequate sedation time is longer with propofol compared with midazolam. In postoperative patients with sedation < 36 h, weaning is faster with propofol. Critical Care Critical Illness / therapy Humans Hypnotics and Sedatives / adverse effects Hypnotics and Sedatives / therapeutic use Midazolam / adverse effects Midazolam / therapeutic use Propofol / adverse effects Propofol / therapeutic use Randomized Controlled Trials as Topic Respiration, Artificial Time Factors Ventilator Weaning Dewey 617 Swiss National Science Foundation Evidence-Based Anaesthesia (PROSPER). 51939 CH Careers 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false 47 La médecine périopératoire et l'anesthésie 70 Anesthesia and analgesia 92 4 c4accf0a-3667-4539-b0e9-2ba624fbb970 Article (Published version) Restricted a_lack_of_evidence_of_superiority_o.pdf 148943 application/pdf 6edc104a4547984b3baf6222851c23e15fe40360555b3c62c254e76b3d4fe3b8 restrictedAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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A Lack of Evidence of Superiority of Propofol Versus Midazolam for Sedation in Mechanically Ventilated Critically Ill Patients : A Qualitative and Quantitative Systematic Review	Anesthesia and analgesia			2001	15	0

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