LORAZEPAM AND MIDAZOLAM IN THE INTENSIVE-CARE UNIT - A RANDOMIZED, PROSPECTIVE, MULTICENTER STUDY OF HEMODYNAMICS, OXYGEN-TRANSPORT, EFFICACY, AND COST

Objectives: To evaluate and compare the clinical efficacy, impact on h emodynamic and oxygen transport variables, safety profiles, and cost e fficiency of sedation and anxiolysis with lorazepam vs. continuous inf usion of midazolam in critically ill, intensive care unit patients. De sign: Multicenter, prospective, randomized, open-label study. Setting: Teaching hospitals. Patients: Ninety five critically ill, mechanicall y ventilated patients with fiberoptic pulmonary artery catheters in pl ace were randomly assigned to receive short term (8 hrs) sedation with either intermittent intravenous injection lorazepam (group A, n = 50) or continuous intravenous infusion midazolam (group B, n = 45) titrat ed to clinical response. Measurements and Main Results: The severity o f illness, demographic characteristics, levels of anxiety and agitatio n, hemodynamic parameters, oxygen transport variables, quality of seda tion, nursing acceptance, and laboratory chemistries reflecting drug s afety were recorded. There were no significant differences with regard to demographic data, hemodynamic and oxygen transport variables, or l evels of anxiety and agitation between the two groups at baseline, 5 m ins, 30 mins, and 4 and 8 hrs after administration of sedation. There were no significant differences in the quality of sedation or anxiolys is. Midazolam treated patients used significantly larger amounts of dr ug for similar levels of sedation and anxiolysis (14.4 +/- 1.2 mg/8 hr s vs. 1.6 +/- 0.1 mg/8 hrs, p = .001). Both drugs were safely administ ered and patient and nurse satisfaction was similar. Conclusions: Seda tion and anxiolysis with lorazepam or midazolam in critically ill pati ents is safe and clinically effective. Hemodynamic and oxygen transpor t variables are similarly affected by both drugs. The dose of midazola m required for sedation is much larger than the dose of lorazepam requ ired for sedation, and midazolam is therefore less cost efficient.