Sedation during mechanical ventilation: A trial of benzodiazepine and opiate in combination*

Mar 17, 2006Critical care medicine

Sedation with combined benzodiazepine and opioid during mechanical ventilation

AI simplified

Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

Co-sedation with midazolam and fentanyl resulted in 4.2 hours per day with an 'off-target' Ramsay Sedation Score compared to 9.1 hours for midazolam alone.

Fewer episodes of patient-ventilator asynchrony were observed in the co-sedation group, with 0.4 episodes per day versus 1.0 in the midazolam-only group.
Co-sedation demonstrated trends toward quicker sedation onset and fewer dose adjustments needed, although these findings were not statistically significant.
The total cost of sedative drugs was lower for the co-sedation group, indicating potential cost-effectiveness.
A trend was noted for increased ileus episodes in the co-sedation group, with 2 cases compared to 0 in the midazolam-only group.
Overall, co-sedation may provide more reliable sedation and easier titration during mechanical ventilation.

AI simplified

OBJECTIVE: To compare the efficacy of continuous intravenous sedation with midazolam alone vs. midazolam plus fentanyl ("co-sedation") during mechanical ventilation.

DESIGN: A randomized, prospective, controlled trial.

SETTING: A ten-bed medical intensive care unit at a university hospital.

PATIENTS: Thirty patients with respiratory failure who were expected to require >48 hrs of mechanical ventilation and who were receiving a sedative regimen that did not include opiate pain control.

INTERVENTIONS: An intravenous infusion of either midazolam alone or co-sedation was administered by a nurse-implemented protocol to achieve a target Ramsay Sedation Score set by the patient's physician. Study duration was 3 days, with a brief daily "wake-up."

MEASUREMENTS AND MAIN RESULTS: We recorded the number of hours/day that patients were "off-target" with their Ramsay Sedation Scores, the number of dose titrations per day, the incidence of patient-ventilator asynchrony, and the time required to achieve adequate sedation as measures of sedative efficacy. We also recorded sedative cost in U.S. dollars and adverse events including hypotension, hypoventilation, ileus, and coma. Compared with the midazolam-only group, the co-sedation group had fewer hours per day with an "off-target" Ramsay Score (4.2 +/- 2.4 and 9.1 +/- 4.9, respectively, p < .002). Fewer episodes per day of patient-ventilator asynchrony were noted in the co-sedation group compared with midazolam-only (0.4 +/- 0.1 and 1.0 +/- 0.2, respectively, p < .05). Co-sedation also showed nonsignificant trends toward a shorter time to achieve sedation, a need for fewer dose titrations per day, and a lower total sedative drug cost. There was a trend toward more episodes of ileus with co-sedation compared with midazolam-only (2 vs. 0).

CONCLUSIONS: In mechanically ventilated patients, co-sedation with midazolam and fentanyl by constant infusion provides more reliable sedation and is easier to titrate than midazolam alone, without significant difference in the rate of adverse events.

Full Text

Full text is available at the source.

View full text ↗

Sedation during mechanical ventilation: A trial of benzodiazepine and opiate in combination*

Abstract

Full Text

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the circadian biology brief

Abstract

Full Text

Related papers

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the circadian biology brief