• Brittany R Weger, Shannon Marie Carabetta, Lindsey Gignac, Sarah Hayes, and J Totty Johnson.
• Ascension St. Vincent's Riverside, 1 Shircliff Way, Jacksonville, FL 32204, USA. Electronic address: brittany.weger@ascension.org.
• J Crit Care. 2025 Feb 1; 85: 154935154935.

PurposeThe purpose of this study was to evaluate the effect of propofol versus midazolam on vasopressor requirements in patients with septic shock to better guide sedative selection.MethodsThis was a multicenter, retrospective, observational, IRB-approved, non-inferiority cohort study. Included individuals were ≥ 18 years of age, had a diagnosis of septic shock, and exclusive administration of propofol or midazolam for at least 12 h. The primary outcome was maximum increase in vasopressor requirements within the first 12 h following sedative initiation.ResultsFor the primary outcome of maximum increase in norepinephrine equivalents (NEE) within 12 h, propofol was non-inferior to midazolam (0.09 vs. 0.129 μg/kg/min, p = 0.002). No difference was seen between the propofol and midazolam groups for the secondary outcome of maximum increase in NEE within 3 h (0.02 vs 0.04 μg/kg/min, p = 0.208), however, the propofol group had a significantly lower increase within 6 h (0.06 vs 0.086 μg/kg/min, p = 0.043) and 24 h (0.11 vs 0.25 μg/kg/min, p = 0.013).ConclusionIn patients with septic shock, vasopressor requirement increases with propofol were non-inferior to midazolam within the first 12 h.Copyright © 2024 Elsevier Inc. All rights reserved.

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