Propofol or midazolam - which is best for the sedation of adult ventilated patients in intensive care units? A systematic review

Abstract

Intensive care patients are commonly sedated to maintain comfort and to facilitate life saving therapy. Although sedation is ordered by medical staff, nurses are usually responsible for its administration and titration and thus the question of which drug regime should be chosen is an important practice issue for nurses (1,2). This paper is a report on a systematic review that was conducted to compare the effectiveness of two of the most common drugs used for the sedation of adult ventilated patients in Australian intensive care units (ICUs)--propofol and midazolam (3). All randomised controlled trials (RCTs) which compared propofol with midazolam for the sedation of adult ventilated patients in ICUs were included in the study. The outcome measures evaluated were the quality of sedation achieved, the length of time from cessation of sedation till extubation, recovery time, duration of admission to the ICU and the incidence of haemodynamic complications. Meta-analysis was used to compare results of studies where subjects had the same characteristics and the outcome criteria were measured in the same manner. The review found that infusions of both midazolam and propofol appear to provide similar quality sedation, that extubation time and recovery time is shorter in patients sedated with propofol and that haemodynamic complications related to either drug regime are not usually clinically significant.