PMU1 PROPOFOL VERSUS MIDAZOLAM FOR SEDATION IN ADULT PATIENTS IN INTENSIVE CARE UNIT (ICU): A META-ANALYSIS

Abstract

To compare propofol and midazolam in adult intensive care patients in relation to length of ICU stay, length of mechanical ventilation (MV) and time until extubation. MEDLINE, EMBASE, LILACS and Cochrane databases were searched from inception until July 2019 to retrieve RCTs that compared propofol and midazolam use as sedatives in adult ICU patients. There was no language restriction. We extracted and combined data from studies that reported to length of ICU stay, length of MV and time until extubation. A random-effects, meta-analytic model was applied in all calculations. Cochrane collaboration tool and GRADE were used to assess bias and certainty of the outcomes of the included studies, respectively. Two groups of patients were analyzed: elective surgical patients and critically ill patients. Elective surgical patients receiving propofol reduced ICU stay by 5.07 hours (MD -5.07; 95% CI -8.68 to -1.45; p <0.006, I2 = 41 %, 5 studies), MV time by 4.28 hours (MD -4.28; 95% CI -4.62 to -3.94 (p <0.00001, I2 = 0, 3 studies), extubation time by 1.92 hours (MD -1.92; 95% CI -2.71 to -1.13; p <0.00001, I2 = 89%, 9 studies) compared to patients receiving midazolam. Critically ill patients receiving propofol reduced extubation time by 32.68 hours (MD -32.68; 95% CI -48.37 to -16.98; p <0.0001, I2 = 97%, 7 studies) compared to patients receiving midazolam. GRADE was very low for all outcomes. We conclude that propofol is a safe sedation strategy for general and elective surgery patients in the ICU. It is associated with improved outcomes when compared to the use of midazolam. Our data is in accordance with the recent sedation guideline (PADIS) recommendations where propofol can be used as the first-line sedative in adult ICU patients.