Intensive Care Medicine

, Volume 23, Issue 12, pp 1258–1263

Midazolam versus propofol for long-term sedation in the ICU: a randomized prospective comparison

  • A. A. Weinbroum
  • V. Rudick
  • P. Sorkine
  • M. Freedman
  • E. Geller
  • P. Halpern
Original

DOI: 10.1007/s001340050495

Cite this article as:
Weinbroum, A.A., Rudick, V., Sorkine, P. et al. Intensive Care Med (1997) 23: 1258. doi:10.1007/s001340050495

Abstract

Objective: To compare the efficacy, safety, and cost of midazolam and propofol in prolonged sedation of critically ill patients.

Design: Randomized, prospective study.

Setting: General intensive care unit (ICU) in a 1100-bed teaching hospital.

Patients: 67 critically ill, mechanically ventilated patients.

Interventions: Patients were invasively monitored and mechanically ventilated. A loading dose [midazolam 0.11 ± 0.02 (SEM) mg · kg−1, propofol 1.3 ± 0.2 mg · kg−1] was administered, followed by continuous infusion, titrated to achieve a predetermined sedation score. Sedation was continued as long as clinically indicated.

Measurements and results: Mean duration of sedation was 141 and 99 h (NS) for midazolam and propofol, respectively, at mean hourly doses of 0.070 ± 0.003 mg · kg−1 midazolam and 1.80 ± 0.08 mg · kg−1 propofol. Overall, 68 % of propofol patients versus 31 % of midazolam (p<0.001) patients had a > 20 % decrease in systolic blood pressure after the loading dose, and 26 versus 45 % (p<0.01) showed a 25 % decrease in spontaneous minute volume. Propofol required more daily dose adjustments (2.1 ± 0.1 vs 1.4 ± 0.1, p<0.001). Nurserated quality of sedation with midazolam was higher (8.2 ± 0.1 vs 7.3 ± 0.1 on a 10-cm visual analog scale, p<0.001). Resumption of spontaneous respiration was equally rapid. Recovery was faster after propofol (p<0.02), albeit with a higher degree of agitation. Amnesia was evident in all midazolam patients but in only a third of propofol patients. The cost of propofol was 4–5 times higher.

Conclusions: Both drugs afforded reliable, safe, and controllable long-term sedation in ICU patients and rapid weaning from mechanical ventilation. Midazolam depressed respiration, allowed better maintenance of sedation, and yielded complete amnesia at a lower cost, while propofol caused more cardiovascular depression during induction.

Key words

Midazolam Propofol ICU Prolonged sedation 

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • A. A. Weinbroum
    • 1
  • V. Rudick
    • 1
  • P. Sorkine
    • 1
  • M. Freedman
    • 1
  • E. Geller
    • 1
  • P. Halpern
    • 2
  1. 1.Departments of Anesthesiology and Critical Care Medicine, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of MedicineTel-Aviv UniversityIsrael
  2. 2.Department of Emergency Medicine, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of MedicineTel-Aviv UniversityTel-AvivIsrael

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