916: BENZODIAZEPINE BOLUSES VERSUS PROPOFOL OR DEXMEDETOMIDINE INFUSIONS IN CRITICALLY ILL ADULT PATIENTS

Abstract

Introduction: Critically ill patients who require mechanical ventilation (MV) are administered sedative medications to promote compliance with the ventilator and reduce anxiety and agitation. Previous studies have shown worse outcomes with benzodiazepine infusions compared to infusions of propofol or dexmedetomidine. There are limited studies evaluating boluses of benzodiazepines titrated to lighter depths of sedation in this population. The purpose of this study is to compare MV days in patients who received PRN benzodiazepine doses vs. continuous infusion of propofol or dexmedetomidine. Methods: This was a single center, retrospective study of patients admitted to the medical intensive care unit (ICU) at Denver Health Medical Center from 2016 to 2020 requiring MV and sedated with either continuous infusion of propofol or dexmedetomidine (Infusion) vs. boluses of midazolam or lorazepam (Bolus). The primary outcome for this study is duration of MV. Secondary outcomes include average RASS score while on MV, ICU length of stay (LOS), 90-day mortality, delirium incidence, and hypotension requiring vasopressors. Results: 101 patients were included in the analysis;(50 in the Bolus group and 51 in the Infusion group). There were no significant differences between baseline characteristics in the two groups. For the primary outcome, the duration of MV in the Bolus group was 1 day [IQR 1-3] vs. 2 days [IQR 1-3.5] (P=.297) in the Infusion group. In the Bolus group, ICU LOS was 4 [IQR 2-6] vs. 3 days [IQR 1-4], (P=.009). The average RASS score was -0.85 in the Bolus group vs. -0.99 in the Infusion group, (P=1.6). 90-day mortality was 24% in the Bolus group vs. 2%, (P=.001). The incidence of ICU delirium was 70% vs. 65%, (P=.57). 70% of patients in the Bolus group compared to 49% in the Infusion group required vasopressors, (P=.03). Conclusions: There was no difference in the duration of MV between patients who received continuous infusions of propofol or dexmedetomidine vs benzodiazepine bolus sedation strategy. However, use of PRN boluses was associated with an increase in ICU LOS, 90-day mortality, and vasopressor use. Limitations include a retrospective study design and confounding factors such as acuity of illness as well as hemodynamic instability at baseline. Further study is warranted to confirm findings.