Continuous infusion of lorazepam versus midazolam in patients in the intensive care unit: Sedation with lorazepam is easier to manage and is more cost-effective

Objective: To evaluate the effectiveness of lorazepam and midazolam for lon g-term sedation of critically ill, mechanically ventilated patients. Design: Double-blind, randomized, controlled study. Setting: Medical intensive care unit in a university teaching hospital. Patients: Sixty-four evaluable adult patients admitted to the intensive car e department requiring mechanical ventilation for >3 days. Interventions: Patients were randomized to receive blinded solutions of eit her lorazepam or midazolam by continuous infusion. The lowest dose that ach ieved an adequate sedation was infused. The maximum dose allowed for each d rug was 60 mg/hr for midazolam and 4 mg/hr for lorazepam, Sedation was asse ssed initially and at least every 8 hrs thereafter on a seven-point scale i f the sedation was adequate and every 2 hrs if it was not, Measurements and Main Results: Measurements included the score on the sedation scale, the t ime between determination of the desired level of sedation and the achievem ent of that level, and plasma concentrations. It is significantly easier to reach a desired level of sedation with lorazepam than with midazolam, No d ifference in recovery was found in the 24 hrs after discontinuation of ther apy. The fact that there are many factors influencing midazolam pharmacokin etics may explain the more difficult management of desired sedation levels. The equipotent dose of 10 mg of midazolam proved to be 0.7 mg of lorazepam in long-term sedation. The average cost for therapy with midazolam was app roximately ten times more than that with lorazepam, Conclusions: Lorazepam is a useful alternative to midazolam for the long-te rm sedation of patients in the medical intensive care unit and provides eas ier management of the sedation level. Sedation with lorazepam offers a sign ificant cost-savings.