Medscape Medical News 2009. © 2009 Medscape
Mortality rates are significantly higher when a benzodiazepine is the sedating agent used in a mechanically ventilated patient, and hospital and intensive care unit (ICU) length of stay is more than a day longer, investigators at the University of Utah told attendees of the Society of Critical Care Medicine 38th Critical Care Congress.
The 2002 guidelines for sedation with mechanically ventilated patients recommend benzodiazepines, given either intermittently (BZD-I) or continuously (BZD-C) as the drugs of choice. However, recent studies indicate worse outcomes with benzodiazepines than with propofol, said Nick W. Lombardo, PharmD, from the Department of Pharmacy Services at the University of Utah Hospital and Clinics in Salt Lake City.
Using a database of 21,872 ICU patients on mechanical ventilation for a minimum of 48 hours at 131 institutions between 2000 and 2007, Dr. Lombardo’s team divided patients according to sedating agent. There were 743 patients who received BZD-I, 5366 patients who received BZD-C, and 15,763 who received propofol.
Hospital length of stay, ICU length of stay, and mechanical ventilation time were all significantly longer in both benzodiazepine groups than in the propofol group.
Mean hospital length of stay was 21.4 days with propofol, 25.4 days with BZD-C, and 25.8 days with BZD-I. Mean ICU length of stay was 9.0 days with propofol, 10.1 days with BZD-C, and 9.8 days with BZD-I.
In addition, hospital mortality was 28.0% with propofol, 35.9% with BZD-C, and 35.1% with BZD-I. ICU mortality was 18.4% with propofol, 26.2% with BZD-C, and 22.7% with BZD-I.
Logistic regression models showed that BZD-C and BZD-I use was associated with a significant increase in ICU and hospital mortality compared with propofol (P < .001 for all).
“Our results suggest that previous SCCM recommendations for benzodiazepine use should be reexamined,” Dr. Lombardo told Medscape Critical Care. “In addition, compared to benzodiazepine, propofol has the potential for dramatic reductions in morbidity, mortality, and the cost of medical care.”
“Future studies of ICU sedation must look beyond the quality or quantity of sedation to focus on additional important clinical outcomes,” Richard R. Riker, MD, from the University of Vermont Medical Center and director of critical care research at Maine Medical Center in Portland, told Medscape Critical Care.
“These would include prevalence of delirium, duration of mechanical ventilation, ICU length of stay, rates of nosocomial infection, long-term cognitive function and mortality.”
Dr. Lombardo has disclosed no relevant financial relationships. Dr. Riker receives support from Aspect Medical Systems Inc, AstraZeneca, Eli Lilly, Hospira, and Takeda.
Society of Critical Care Medicine (SCCM) 38th Critical Care Congress: Abstract 674. Presented February 3, 2009.