• Journal of critical care · Oct 2022

    Observational Study

    Propofol versus midazolam sedation in patients with cardiogenic shock - an observational propensity-matched study.

    • Clemens Scherer, Jan Kleeberger, Antonia Kellnar, Leonhard Binzenhöfer, Enzo Lüsebrink, Thomas J Stocker, Stefan A Berghoff, Alix Keutner, Manuela Thienel, Simon Deseive, Konstantin Stark, Daniel Braun, Mathias Orban, Tobias Petzold, Stefan Brunner, Christian Hagl, Jörg Hausleiter, Steffen Massberg, and Martin Orban.
    • Department of Medicine I, University Hospital, LMU Munich, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.
    • J Crit Care. 2022 Oct 1; 71: 154051.

    PurposeBenzodiazepines are recommended as first line sedative agent in ventilated cardiogenic shock patients, although data regarding the optimal sedation strategy are sparse. The aim of this study was to investigate the hemodynamic effects of propofol versus midazolam sedation in our cardiogenic shock registry.Materials And MethodsMechanically ventilated patients suffering from cardiogenic shock were retrospectively enrolled from the cardiogenic shock registry of the university hospital of Munich. 174 patients treated predominantly with propofol were matched by propensity-score to 174 patients treated predominantly with midazolam.ResultsCatecholamine doses were similar on admission but significantly lower in the propofol group on days 1-4 of ICU stay. Mortality rate was 38% in the propofol and 52% in the midazolam group after 30 days (p = 0.002). Rate of ≥BARC3 bleeding was significantly lower in the propofol group compared to the midazolam group (p = 0.008). Sedation with midazolam was significantly associated with ICU mortality.ConclusionIn this observational cohort study, sedation with propofol in comparison to midazolam was linked to a reduced dose of catecholamines, decreased mortality and bleeding rates for patients with cardiogenic shock. Based on this study and in contrast to current recommendations, propofol should be given consideration for sedation in cardiogenic shock patients.Copyright © 2022 Elsevier Inc. All rights reserved.

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