Cody Craven, PharmD, BCCCP,
Emergency Medicine Clinical Pharmacy Specialist
HCA Research Medical Center
Kansas City, MO
Disclosure information not submitted.
Stacy Revelle, PharmD, BCPS
Emergency Medicine Clinical Pharmacy Specialist
SSM Health Saint Louis University Hospital, Missouri, United States
Disclosure information not submitted.
Robert Sbertoli, PharmD, BCCCP
Pulmonary/Critical Care Pharmacy Clinical Specialist
SSM Health Saint Louis University Hospital, United States
Disclosure information not submitted.
Title: Intermittent Benzodiazepines as Initial Sedation in Patients Requiring Mechanical Ventilation
Introduction: In patients requiring mechanical ventilation, sedation is an integral part of post-intubation management. Current guidelines make a conditional recommendation for the use of propofol or dexmedetomidine over sedation with a benzodiazepine. However, the available literature only assesses continuous infusion benzodiazepines. Intermittently dosed benzodiazepines offer unique administrative advantages over continuous infusions and have not been associated with an increased risk of delirium. The objective of this study was to determine if an initial sedation strategy using intermittent benzodiazepines achieves similar rates of target sedation compared with continuous infusions of propofol or dexmedetomidine.
Methods: This single-center, retrospective chart review included patients 18 years of age and older who required mechanical ventilation for a period of at least 48 hours. Patients were excluded who received treatment for alcohol or benzodiazepine withdrawal, status epilepticus, or who received an additional sedative agent in the first 24 hours post-intubation. The primary outcome was the proportion of time achieving target sedation level assessed at 48 hours post-intubation. Secondary outcomes included time to extubation, need for re-intubation, self-extubation, cumulative dose of benzodiazepines received, progression to other sedatives, all-cause mortality, intensive care unit (ICU) length of stay, presence of delirium, and incidence of hypotension or bradycardia.
Results & Conclusions: Of 661 patients screened for enrollment, 51 received at least 24 hours of sedation with intermittent benzodiazepines (19), propofol (19), or dexmedetomidine (13). The median age was 64, and patients were primarily cared for by the medical ICU (MICU) service (70.6%). A significant difference was not observed between the three groups with regards to the time at target sedation. There was also no difference in the prevalence of delirium or other adverse events between groups. The median length of stay in the ICU was 7.6 days for the entire cohort and was similar between groups. Intermittent benzodiazepines appear to have similar efficacy in achieving target sedation levels compared with continuous propofol or dexmedetomidine, and short-term courses are not likely to be associated with an increased risk of delirium