Propofol Is Associated with Favorable Outcomes Compared with Benzodiazepines in Ventilated Intensive Care Unit Patients
Propofol Is Associated with Favorable Outcomes Compared with Benzodiazepines in Ventilated Intensive Care Unit Patients
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DOI：
10.1164/rccm.201312-2291oc
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发表时间：
2014-06-01
影响因子：
24.7
通讯作者：
Barton, Richard G.
中科院分区：
文献类型：
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作者：
Lonardo, Nick W.;Mone, Mary C.;Barton, Richard G.
原理：机械通气重症监护病房（ICU）患者经常使用持续输注镇静剂。尽管最近的指南建议避免使用苯二氮卓类药物镇静，但这类药物仍被广泛使用。比较镇静药在ICU环境下的临床结果的数据有限。目的：比较异丙酚与咪达唑仑和劳拉西泮在成人ICU患者中的应用。方法：数据来源于2003-2009年多中心ICU数据库。患者的选择标准包括年龄大于或等于18岁，单次ICU住院，单次通气事件（>48 h），持续输注镇静（异丙酚、咪达唑仑或劳拉西泮）。采用倾向评分分析（1:1）并测量死亡率。累积发生率和竞争风险方法用于检查ICU出院时间和呼吸机拆除时间。测量结果及主要结果：异丙酚-咪达唑仑配对患者2250例，异丙酚-劳拉西泮配对患者1054例。与咪达唑仑或劳拉西泮治疗的患者相比，异丙酚治疗的患者住院死亡率在统计学上较低（风险比为0.76；95%可信区间[CI]为0.69-0.82，风险比为0.78；95% CI为0.68-0.89）。28天ICU时间的竞争风险分析显示，异丙酚组患者ICU出院的概率（78.9% vs. 69.5%; 79.2% vs. 71.9%, P < 0.001）和较早取下呼吸机的概率（84.4% vs. 75.1%; 84.3% vs. 78.8%, P < 0.001）分别高于利尼达唑仑组和劳西泮组。结论：在这个大的、倾向匹配的ICU人群中，接受异丙酚治疗的患者死亡风险降低，早期ICU出院和早期停止机械通气的可能性增加。
Rationale: Mechanically ventilated intensive care unit (ICU) patients are frequently managed using a continuous-infusion sedative. Although recent guidelines suggest avoiding benzodiazepines for sedation, this class of drugs is still widely used. There are limited data comparing sedative agents in terms of clinical outcomes in an ICU setting.Objectives: Comparison of propofol to midazolam and lorazepam in adult ICU patients.Methods: Data were obtained from a multicenter ICU database (2003-2009). Patient selection criteria included age greater than or equal to 18 years, single ICU admission with single ventilation event (>48 h), and treatment with continuously infused sedation (propofol, midazolam, or lorazepam). Propensity score analysis (1:1) was used and mortality measured. Cumulative incidence and competing risk methodology were used to examine time to ICU discharge and ventilator removal.Measurements and Main Results: There were 2,250 propofol-midazolam and 1,054 propofol-lorazepam matched patients. Hospital mortality was statistically lower in propofol-treated patients as compared with midazolam- or lorazepam-treated patients (risk ratio, 0.76; 95% confidence interval [CI], 0.69-0.82 and risk ratio, 0.78; 95% CI, 0.68-0.89, respectively). Competing risk analysis for 28-day ICU time period showed that propofol-treated patients had a statistically higher probability for ICU discharge (78.9% vs. 69.5%; 79.2% vs. 71.9%; P < 0.001) and earlier removal from the ventilator (84.4% vs. 75.1%; 84.3% vs. 78.8%; P < 0.001) when compared with rnidazolam- and lorazepam-treated patients, respectively.Conclusions: In this large, propensity-matched ICU population, patients treated with propofol had a reduced risk of mortality and had both an increased likelihood of earlier ICU discharge and earlier discontinuation of mechanical ventilation.