SEDATION OF CRITICALLY ILL PATIENTS DURING MECHANICAL VENTILATION - ACOMPARISON OF PROPOFOL AND MIDAZOLAM

Propofol (P) and midazolam (M) are frequently given by continuous infu sion for sedation in critically ill, mechanically ventilated patients. We compared these drugs with regard to: (1) time-to-awaken; (2) repro ducibility of bedside assessments of level of sedation; (3) time-to-se dation; and (4) change in oxygen consumption (over dotVO(2)) from awak e to sedated state. Seventy-three patients were prospectively randomiz ed to receive either P (n = 37) or M (n = 36). Wake-up times after sto pping the drug were assessed by blinded and unblinded observers, by as king patients to perform simple tasks. Times to sedate were assessed b y consensus agreement among nurses and investigators. Demographics and APACHE II scores were not different between P and M. The P group had a significantly narrower range of wake-up times with a higher likeliho od of waking in less than 60 min. Blinded versus unblinded observation s had excellent correlation. Average time to sedate and decrease in ov er dotVO(2) were not different. We conclude that in this patient popul ation: (1) both P and M achieved optimal sedation in a large fraction of patients when administered by specified dosing protocols; (2) P had a faster, more reliable, wake-up time; (3) assessments of time-to-awa ken were objective and reproducible; (4) time to sedation was not sign ificantly different; (5) over dotVO(2) decreased similarly with both.