A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients

Shannon S Carson, John P Kress, Jo Ellen Rodgers, Ajeet Vinayak, Stacy Campbell-Bright, Joseph Levitt, Sharya Bourdet, Anastasia Ivanova, Ashley G Henderson, Anne Pohlman, Lydia Chang, Preston B Rich, Jesse Hall
Critical Care Medicine 2006, 34 (5): 1326-32

OBJECTIVE: To compare duration of mechanical ventilation for patients randomized to receive lorazepam by intermittent bolus administration vs. continuous infusions of propofol using protocols that include scheduled daily interruption of sedation.

DESIGN: A randomized open-label trial enrolling patients from October 2001 to March 2004.

SETTING: Medical intensive care units of two tertiary care medical centers.

PATIENTS: Adult patients expected to require mechanical ventilation for >48 hrs and who required > or =10 mg of lorazepam or a continuous infusion of a sedative to achieve adequate sedation.

INTERVENTIONS: Patients were randomized to receive lorazepam by intermittent bolus administration or propofol by continuous infusion to maintain a Ramsay score of 2-3. Sedation was interrupted on a daily basis for both groups.

MEASUREMENTS AND MAIN RESULTS: The primary outcome was median ventilator days. Secondary outcomes included 28-day ventilator-free survival, intensive care unit and hospital length of stay, and hospital mortality. Median ventilator days were significantly lower in the daily interruption propofol group compared with the intermittent bolus lorazepam group (5.8 vs. 8.4, p = .04). The difference was largest for hospital survivors (4.4 vs. 9.0, p = .006). There was a trend toward greater ventilator-free survival for patients in the daily interruption propofol group (median 18.5 days for propofol vs. 10.2 for lorazepam, p = .06). Hospital mortality was not different.

CONCLUSIONS: For medical patients requiring >48 hrs of mechanical ventilation, sedation with propofol results in significantly fewer ventilator days compared with intermittent lorazepam when sedatives are interrupted daily.

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