Comparison between midazolam and propofol in acute phase for ventilated patients with sepsis: a post‐hoc analysis of the DESIRE trial
Aim There are few assessments of sedatives during the acute phase under sedation protocols for patients with sepsis. We aimed to compare the influence of different sedation strategies using midazolam and propofol under light sedation on clinical outcomes of ventilated patients with sepsis. Methods T...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Acute Medicine & Surgery |
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| Online Access: | https://doi.org/10.1002/ams2.746 |
| _version_ | 1797976116811530240 |
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| author | Noriko Miyagawa Yu Kawazoe Tetsuya Sato Shigeki Kushimoto Kyohei Miyamoto Yoshinori Ohta Takeshi Morimoto Hitoshi Yamamura DESIRE Trial Investigators |
| author_facet | Noriko Miyagawa Yu Kawazoe Tetsuya Sato Shigeki Kushimoto Kyohei Miyamoto Yoshinori Ohta Takeshi Morimoto Hitoshi Yamamura DESIRE Trial Investigators |
| author_sort | Noriko Miyagawa |
| collection | DOAJ |
| description | Aim There are few assessments of sedatives during the acute phase under sedation protocols for patients with sepsis. We aimed to compare the influence of different sedation strategies using midazolam and propofol under light sedation on clinical outcomes of ventilated patients with sepsis. Methods This study was a post‐hoc analysis of data from the dexmedetomidine for sepsis in the ICU Randomized Evaluation (DESIRE) trial. Patients were divided into propofol and midazolam groups based on continuously used drug, and sedation control between groups compared on day three. We assessed the incidence of delirium, length of ICU stay, number of ventilator‐free days within the first 28 days, and mortality after 28 days. Results The midazolam and propofol groups consisted of 51 and 66 patients, respectively. Both groups had similar characteristics, except for age and emergency surgery. The number of well‐controlled sedation patients in the propofol group on day three was significantly higher than that in the midazolam group (odds ratio [OR] 3.9, 95% CI [1.30, 11.7]). The incidence of daily coma and delirium within the initial week was different between groups and increased with midazolam administration (P = 0.0138). The number of Confusion Assessment Method for ICU‐positive patients was significantly higher in the midazolam group than in the propofol group (OR 5.71, 95% CI [2.30, 14.2]). Conclusion In patients with sepsis required mechanical ventilation, sedation with midazolam based on a light sedation protocol may be associated with inappropriate sedation during the acute phase, with increased coma and delirium as compared to propofol. |
| first_indexed | 2024-04-11T04:46:14Z |
| format | Article |
| id | doaj.art-068469c1e8214865bbaa235f72706ebd |
| institution | Directory Open Access Journal |
| issn | 2052-8817 |
| language | English |
| last_indexed | 2024-04-11T04:46:14Z |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Acute Medicine & Surgery |
| spelling | doaj.art-068469c1e8214865bbaa235f72706ebd2022-12-27T12:22:50ZengWileyAcute Medicine & Surgery2052-88172022-01-0191n/an/a10.1002/ams2.746Comparison between midazolam and propofol in acute phase for ventilated patients with sepsis: a post‐hoc analysis of the DESIRE trialNoriko Miyagawa0Yu Kawazoe1Tetsuya Sato2Shigeki Kushimoto3Kyohei Miyamoto4Yoshinori Ohta5Takeshi Morimoto6Hitoshi Yamamura7DESIRE Trial InvestigatorsDepartment of Emergency and Critical Care Medicine Sendai City Hospital Sendai JapanDivision of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai JapanDepartment of Emergency and Critical Care Medicine Tohoku University Hospital Sendai JapanDivision of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai JapanDepartment of Emergency and Critical Care Medicine Wakayama Medical University Wakayama JapanDepartment of Community Emergency Medicine Hyogo College of Medicine Nishinomiya JapanDepartment of Clinical Epidemiology Hyogo College of Medicine Nishinomiya JapanOsaka Prefectural Nakakawachi Emergency and Critical Care Center Higashiosaka JapanAim There are few assessments of sedatives during the acute phase under sedation protocols for patients with sepsis. We aimed to compare the influence of different sedation strategies using midazolam and propofol under light sedation on clinical outcomes of ventilated patients with sepsis. Methods This study was a post‐hoc analysis of data from the dexmedetomidine for sepsis in the ICU Randomized Evaluation (DESIRE) trial. Patients were divided into propofol and midazolam groups based on continuously used drug, and sedation control between groups compared on day three. We assessed the incidence of delirium, length of ICU stay, number of ventilator‐free days within the first 28 days, and mortality after 28 days. Results The midazolam and propofol groups consisted of 51 and 66 patients, respectively. Both groups had similar characteristics, except for age and emergency surgery. The number of well‐controlled sedation patients in the propofol group on day three was significantly higher than that in the midazolam group (odds ratio [OR] 3.9, 95% CI [1.30, 11.7]). The incidence of daily coma and delirium within the initial week was different between groups and increased with midazolam administration (P = 0.0138). The number of Confusion Assessment Method for ICU‐positive patients was significantly higher in the midazolam group than in the propofol group (OR 5.71, 95% CI [2.30, 14.2]). Conclusion In patients with sepsis required mechanical ventilation, sedation with midazolam based on a light sedation protocol may be associated with inappropriate sedation during the acute phase, with increased coma and delirium as compared to propofol.https://doi.org/10.1002/ams2.746Deliriummidazolampropofolsedationsepsis |
| spellingShingle | Noriko Miyagawa Yu Kawazoe Tetsuya Sato Shigeki Kushimoto Kyohei Miyamoto Yoshinori Ohta Takeshi Morimoto Hitoshi Yamamura DESIRE Trial Investigators Comparison between midazolam and propofol in acute phase for ventilated patients with sepsis: a post‐hoc analysis of the DESIRE trial Acute Medicine & Surgery Delirium midazolam propofol sedation sepsis |
| title | Comparison between midazolam and propofol in acute phase for ventilated patients with sepsis: a post‐hoc analysis of the DESIRE trial |
| title_full | Comparison between midazolam and propofol in acute phase for ventilated patients with sepsis: a post‐hoc analysis of the DESIRE trial |
| title_fullStr | Comparison between midazolam and propofol in acute phase for ventilated patients with sepsis: a post‐hoc analysis of the DESIRE trial |
| title_full_unstemmed | Comparison between midazolam and propofol in acute phase for ventilated patients with sepsis: a post‐hoc analysis of the DESIRE trial |
| title_short | Comparison between midazolam and propofol in acute phase for ventilated patients with sepsis: a post‐hoc analysis of the DESIRE trial |
| title_sort | comparison between midazolam and propofol in acute phase for ventilated patients with sepsis a post hoc analysis of the desire trial |
| topic | Delirium midazolam propofol sedation sepsis |
| url | https://doi.org/10.1002/ams2.746 |
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