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The risk of delirium after sedation with propofol or midazolam in intensive care unit patients.
van Gelder, Thomas G; van Diem-Zaal, Irene J; Dijkstra-Kersten, Sandra M A; de Mul, Nikki; Lalmohamed, Arief; Slooter, Arjen J C.
Afiliación
  • van Gelder TG; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
  • van Diem-Zaal IJ; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
  • Dijkstra-Kersten SMA; Department of Intensive Care Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
  • de Mul N; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
  • Lalmohamed A; UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
  • Slooter AJC; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Br J Clin Pharmacol ; 90(6): 1471-1479, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38482541
ABSTRACT

AIM:

Knowledge of risk factors may provide strategies to reduce the high burden of delirium in intensive care unit (ICU) patients. We aimed to compare the risk of delirium after deep sedation with propofol versus midazolam in ICU patients.

METHODS:

In this prospective cohort study, ICU patients who were in an unarousable state for ≥24 h due to continuous sedation with propofol and/or midazolam were included. Patients admitted ≤24 h, those with an acute neurological disorder and those receiving palliative sedation were excluded. ICU patients were assessed daily for delirium during the 7 days following an unarousable state due to continuous sedation.

RESULTS:

Among 950 included patients, 605 (64%) subjects were delirious during the 7 days after awaking. The proportion of subsequent delirium was higher after midazolam sedation (152/207 [73%] patients) and after both propofol and midazolam sedation (257/377 [68%] patients), compared to propofol sedation only (196/366 [54%] patients). Midazolam sedation (adjusted cause-specific hazard ratio [adj. cause-specific HR] 1.32, 95% confidence interval [CI] 1.05-1.66) and propofol and midazolam sedation (adj. cause-specific HR 1.29, 95% CI 1.06-1.56) were associated with a higher risk of subsequent delirium compared to propofol sedation only.

CONCLUSION:

This study among sedated ICU patients suggests that, compared to propofol sedation, midazolam sedation is associated with a higher risk of subsequent delirium. This risk seems more apparent in patients with high cumulative midazolam intravenous doses. Our findings underpin the recommendations of the Society of Critical Care Medicine Pain, Agitation/sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep (disruption) guidelines to use propofol over benzodiazepines for sedation in ICU patients.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Midazolam / Propofol / Delirio / Sedación Profunda / Hipnóticos y Sedantes / Unidades de Cuidados Intensivos Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Clin Pharmacol Año: 2024 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Midazolam / Propofol / Delirio / Sedación Profunda / Hipnóticos y Sedantes / Unidades de Cuidados Intensivos Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Br J Clin Pharmacol Año: 2024 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Reino Unido