Effect of sedation with midazolam combined with propofol on delirium in mechanically ventilated patients in intensive care unit

Abstract

Objective To evaluate the effect of sedation with midazolam combined with propofol on delirium in mechanically ventilated patients in the intensive care unit(ICU). Methods Five hundred and twenty-two patients who required sedation and analgesia, endotracheal intubation and mechanical ventilation used to assist respiration, aged 28-64 yr, weighing 41-82 kg, were randomized into 2 groups according to the sedation protocols during therapy: sedation with midazolam group(group M, n=240)and sedation with midazolam + propofol group(group MP, n=232). In M and MP groups, sedation was induced with midazolam infusion 0.03-0.17 mg/min, and analgesia was induced with sufentanil infusion 0.07-0.14 μg/min.In group MP, when hemodynamics was stable, pressure support was 8-10 cmH2O, tidal volume>400 ml, RR <25 bpm, and FiO2<45%, sedation was induced with propofol infusion 0.8-2.0 mg/min instead, lasting for 12-24 h. Richmond Agitation Sedation Scale score was maintained at -1 to -2 during ventilation.The development and duration of delirium were recorded.Delirium was divided into hyperactive delirium, hypoactive delirium and mixed delirium 3 subtypes, and the development and duration of the 3 subtypes of delirium were also recorded. Results There was no significant difference between the two groups in the incidence and duration of delirium.Compared to group M, the incidence of hyperactive delirium was significantly decreased, and no significant change was found in the incidence of hypoactive delirium and mixed delirium and the duration of the 3 subtypes of delirium in group MP. Conclusion Sedation with midazolam and propofol can decrease the development of hyperactive delirium, but can not shorten the duration of delirium in mechanically ventilated patients in the ICU. Key words: Midazolam; Propofol; Conscious sedation; Delirium; Respiration, artificial