Propofol better sedative compared to midazolam in ICU patients, finds study

Critically ill patients require invasive mechanical ventilation, analgesia and sedation are routinely used to achieve comfort and reduce ventilator-asynchrony in them. A new study by Raphaela Garcia and a team in Brazil has pointed out that propofol is a better sedative compared to midazolam in Intensive care patients. The study has been published in the Journal of Critical Care.

The objective of the study was to compare outcomes of adult patients admitted to ICU- length of ICU stay, length of mechanical ventilation (MV), and time until extubation- according to the use of propofol versus midazolam.

The researchers used MEDLINE, EMBASE, LILACS, and Cochrane databases to retrieve RCTs that compared propofol and midazolam used as sedatives in adult ICU patients. A random-effects, meta-analytic model was applied in all calculations. The Cochrane collaboration tool and GRADE were used for assessment. Patients were separated into two groups: acute surgical patients whose hospitalization was up to 24 h and critically ill patients, hospitalized over 24 h and whose profile mostly was a mix of surgical, medical, and trauma patients.

Researchers found that globally, propofol was associated with a reduced MV time of 4.46 h (MD: -4.46 [95% CI -7.51 to−1.42] p =0.004, I2=63%, 6 studies) and extubation time of 7.95 h (MD: -7.95 [95% CI -9.86 to−6.03] p < 0.00001, I2= 98%, 16 studies). Acute surgical patients when sedation with propofol compared to midazolam showed a reduced ICU stay of 5.07 h (MD: -5.07 [95% CI -8.68 to −1.45] p = 0.006, I2 = 41%, 5 studies), MV time of 4.28 h (MD: −4.28; [95% CI -4.62 to −3.94] p < 0.0001, I2 = 0%, 3 studies), extubation time of 1.92 h (MD: −1.92; [95% CI -2.71 to−1.13] p=0.00001, I2=89%, 9 studies). In critically-ill patients sedation with propofol compared to midazolam also showed a reduced extubation time of 32.68 h (MD: -32.68 [95% CI -48.37 to −16.98] p = 0.0001, I2 = 97%, 9 studies). GRADE score was very low for all outcomes.

The researchers concluded that "Sedation with propofol compared to midazolam is associated with improved clinical outcomes in ICU, with reduced ICU stay MV time and extubation time in acute surgical patients and reduced extubation time in critically-ill patients."

For further information:

Raphaela Garcia, Jorge I.F. Salluh, MD., Teresa Raquel Andrade, MSc., Daniela Farah, PharmD. PhD.

Paulo S.L. da Silva, MD., Danielle F. Bastos, Marcelo C.M. Fonseca, MD. PhD. "A systematic review and meta-analysis of propofol versus midazolam sedation in adult intensive care (ICU) patients" Journal of Critical Care 64 (2021) 91–99.