Midazolam or Propofol - which is better in acute phase for ventilated patients with sepsis

A recent study reported that Propofol is a better choice of sedative compared to Midazolam based on a light sedation protocol that might be associated with inappropriate sedation during the acute phase, with increased coma and delirium.

The study was an analysis of data from the dexmedetomidine for sepsis in the ICU Randomized Evaluation (DESIRE) trial. Patients were divided into propofol and midazolam groups based on continuously used drug, and sedation control between groups compared on day three. They assessed the incidence of delirium, length of ICU stay, number of ventilator‐free days within the first 28 days, and mortality after 28 days.

The results showed that both groups had similar characteristics, except for age and emergency surgery. The number of well‐controlled sedation patients in the propofol group on day three was significantly higher than that in the midazolam group. The incidence of daily coma and delirium within the initial week was different between groups and increased with midazolam administration. The number of Confusion Assessment Method for ICU‐positive patients was significantly higher in the midazolam group than in the propofol group.

Hence, it was concluded that in patients with sepsis required mechanical ventilation, sedation with midazolam based on a light sedation protocol may be associated with inappropriate sedation during the acute phase, with increased coma and delirium as compared to propofol.