Aust Crit Care
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Review Comparative Study
Propofol or midazolam--which is best for the sedation of adult ventilated patients in intensive care units? A systematic review.
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). ⋯ 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.
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The Lyell McEwin Health Service (LMHS) is a major public hospital located in the northern suburbs of Adelaide, a region where the death rate from ischaemic heart disease (IHD) is higher than the expected death rate in the population. A retrospective case note study conducted at this hospital investigated the duration that patients with unstable angina pectoris (UA) or acute myocardial infarction (AMI) spent in the emergency department (ED) before admission to the critical care unit (CCU) and the factors that contributed to delays of greater than 70 minutes. All patients admitted to the LMHS over an 18 month period with a discharge diagnosis related group (DRG) for AMI and UA were included in the study. ⋯ The mean duration for patients with AMI was 124 minutes, whilst for UA the duration was 190 minutes (difference = 66 minutes, p<0.001). Other factors that were significant were gender (females = mean duration 29 minutes > males, p=0.015), and mode of transport to the ED (arrival by ambulance mean duration 30 minutes < private transport, Recommendations arising from this study included that a system be established to enable the rapid assessment of all patients suspected of suffering AMI and UA, inclusive of their expeditious transfer to the CCU. In addition, a staff development programme was proposed to ensure medical and nursing staff became aware of a bias in this hospital toward transferring male patients in a shorter timeframe than females with the same DRG.