Abstract
BACKGROUND: For logistical reasons sedation studies are often carried out in elective surgical patients and the results extrapolated to the general intensive care unit (ICU) population. We question the validity of this approach. We compared the two sedation regimens used in our general ICU in a trial structured to mimic clinical practice as closely as possible. RESULTS: Forty patients were randomised to intermittent diazepam or continuous midazolam and sedation monitored with hourly sedation scores; 31 patients completed the study. Scores indicating undersedation were more common with diazepam (P <0.01); overall adequate sedation midazolam 64.7%, diazepam 35.7% (P =0.21). No patient exhibited inappropriately prolonged sedation. Cost was: midazolam AUS$1.98/h; diazepam AUS$0.06/h. CONCLUSION: Both regimens produced rapid onset of acceptable sedation but undersedation appeared more common with the cheaper diazepam regimen. At least 140 patients should be studied to provide evidence applicable to the general ICU population. Used alone, a sedation score may be an inappropriate outcome measure for a sedation trial.
Highlights
To provide the highest quality patient care, an intensive care unit (ICU) must constantly review treatment in search of ‘best practice’ for that unit
Twenty patients were randomised to each group and a total of 31 patients completed the study (17 in the midazolam group and 14 in the diazepam group)
There was no significant difference between the two groups in the sex distribution, age, admission Acute Physiology And Chronic Health Evaluation (APACHE) II score, mortality, incidence of renal or hepatic impairment, or dose of morphine per hour given during the study period (Table 4)
Summary
To provide the highest quality patient care, an intensive care unit (ICU) must constantly review treatment in search of ‘best practice’ for that unit. ICU sedation regimens provide a good example of the difficulty of extrapolating evidence from the literature to one’s own practice. For logistical reasons most sedation studies in intensive care are carried out on patients undergoing short-term sedation following elective surgical procedures. This patient population is not representative of the population of our general ICU, making such results inapplicable to our patients. For logistical reasons sedation studies are often carried out in elective surgical patients and the results extrapolated to the general intensive care unit (ICU) population. We compared the two sedation regimens used in our general ICU in a trial structured to mimic clinical practice as closely as possible
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