A lack of evidence of superiority of propofol versus midazolam for sedation in mechanically ventilated critically ill patients: A qualitative and quantitative systematic review

Propofol and midazolam are often used for sedation in the intensive care un it. The aim of tl-Lis systematic review was to estimate the efficacy and ha rm of propofol versus midazolam in mechanically ventilated patients. A syst ematic search (Medline, Cochrane Library, Embase, bibliographies), any lang uage, up to June 1999 was performed for reports of randomized comparisons o f propofol with midazolam. Data from 27 trials (1624 adults) were analyzed. The average duration of sedation varied between 4 and 339 h. In 10 trials, the duration of adequate sedation was longer with propofol (weighted mean difference 2.9 h; 95% confidence interval [CI], 0.2-5.6 h). In 13 trials (m ostly postoperative), sedation lasted 4 to 35 h; in 9 of those, average wea ning time from mechanical ventilation with propofol was 0.8-4.3 h; with mid azolam it was 1.5-7.2 h (weighted mean difference 2.2 h [95% CI, 0.8 to 3.7 h]). Ln 8 trials, sedation lasted 54 to 339 h; there was a lack of evidenc e for difference in weaning times. Arterial hypotension (relative risk 2.5 [95% CI, 1.3 to 4.5]; number-needed-to-treat, 12), and hypertriglyceridemia (relative risk 12.1 [95%CI, 2.9 to 49.7]; number-needed-to-treat, 6) occur red more often with propofol. The duration of adequate sedation time is lon ger with propofol compared with midazolam. In postoperative patients with s edation <36 h,weaning is faster with propofol.