Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: A centre randomised, cross-over, open-label study in the Netherlands
Objective: Compare duration of mechanical ventilation (MV), weaning time, ICU-LOS (ICU-LOS), efficacy and safety of remifentanil-based regimen with conventional sedation and analgesia. Design: Centre randomised, open-label, crossover, 'real-life' study. Setting: 15 Dutch hospitals. Patients: Adult medical and post-surgical ICU patients with anticipated short-term (2-3 days) MV. Interventions: Patient cohorts were randomised to remifentanil-based regimen (n = 96) with propofol as required, for a maximum of 10 days, or to conventional regimens (n = 109) of propofol, midazolam or lorazepam combined with fentanyl or morphine. Measurements and main results: Outcomes were weaning time, duration of MV, ICU-LOS, sedation- and analgesia levels, intensivist/ICU nurse satisfaction, adverse events, mean arterial pressure, heart rate. Median duration of ventilation (MV) was 5.1 days with conventional treatment versus 3.9 days with remifentanil (NS). The remifentanil-based regimen reduced median weaning time by 18.9 h (P = 0.0001). Median ICU-LOS was 7.9 days versus 5.9 days, respectively (NS). However, the treatment effects on duration of MV and ICU stay were time-dependent: patients were almost twice as likely to be extubated (P = 0.018) and discharged from the ICU (P = 0.05) on day 1-3. Propofol doses were reduced by 20% (P = 0.05). Remifentanil also improved sedation-agitation scores (P < 0.0001) and intensivist/ICU nurse satisfaction (P < 0.0001). All other outcomes were comparable. Conclusions: In patients with an expected short-term duration of MV, remifentanil significantly improves sedation and agitation levels and reduces weaning time. This contributes to a shorter duration of MV and ICU-LOS.
|Keywords||Analgesia, Intensive care, Mechanical ventilation, Netherlands, Remifentanil, Sedation, Weaning, adult, aged, analgesia, article, artificial ventilation, clinical trial, cohort analysis, comparative study, controlled clinical trial, controlled study, crossover procedure, drug dose reduction, drug withdrawal, extubation, female, fentanyl, heart rate, hospital discharge, human, hypnotic agent, hypotension, intensive care nursing, intensive care unit, length of stay, lorazepam, major clinical study, male, mean arterial pressure, midazolam, morphine, motor dysfunction, multicenter study, neuritis, nurse, open study, postoperative care, propofol, randomized controlled trial, remifentanil, satisfaction, sedation, time, treatment duration, withdrawal syndrome|
|Persistent URL||dx.doi.org/10.1007/s00134-008-1328-9, hdl.handle.net/1765/18523|
|Journal||Intensive Care Medicine|
Rozendaal, F.W, Spronk, P.E, Snellen, F.F, Schoen, A, van Zanten, A.R.H, Foudraine, N.A, … Bakker, J. (2009). Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: A centre randomised, cross-over, open-label study in the Netherlands. Intensive Care Medicine, 35(2), 291–298. doi:10.1007/s00134-008-1328-9