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Outcomes in Critically Ill Patients Sedated with Intravenous Lormetazepam or Midazolam : A Retrospective Cohort Study

  • The benzodiazepine, midazolam, is one of the most frequently used sedatives in intensive care medicine, but it has an unfavorable pharmacokinetic profile when continuously applied. As a consequence, patients are frequently prolonged and more deeply sedated than intended. Due to its distinct pharmacological features, including a cytochrome P450-independent metabolization, intravenous lormetazepam might be clinically advantageous compared to midazolam. In this retrospective cohort study, we compared patients who received either intravenous lormetazepam or midazolam with respect to their survival and sedation characteristics. The cohort included 3314 mechanically ventilated, critically ill patients that received one of the two drugs in a tertiary medical center in Germany between 2006 and 2018. A Cox proportional hazards model with mortality as outcome and APACHE II, age, gender, and admission mode as covariates revealed a hazard ratio of 1.75 [95% CI 1.46–2.09; p < 0.001] for in-hospital mortality associated with the use of midazolam. After additionally adjusting for sedation intensity, the HR became 1.04 [95% CI 0.83–1.31; p = 0.97]. Thus, we concluded that excessive sedation occurs more frequently in critically ill patients treated with midazolam than in patients treated with lormetazepam. These findings require further investigation in prospective trials to assess if lormetazepam, due to its ability to maintain light sedation, might be favorable over other benzodiazepines for sedation in the ICU.

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Author:Björn WeissORCiD, David HilfrichORCiD, Gerald VorderwülbeckeORCiD, Maria HeinrichORCiD, Julius J. GrunowORCiD, Nicolas PaulORCiD, Jochen Kruppa-ScheetzORCiD, Bruno NeunerORCiD, Berthold DrexlerORCiD, Felix BalzerORCiD, Claudia SpiesORCiD
Title (English):Outcomes in Critically Ill Patients Sedated with Intravenous Lormetazepam or Midazolam : A Retrospective Cohort Study
Parent Title (English):Journal of Clinical Medicine (JCM)
Document Type:Article
Year of Completion:2021
Release Date:2024/04/23
Tag:Benzodiazepines; Intensive care; Lormetazepam; Midazolam; Mortality; Sedation; Sedation index; Survival
Article Number:4091
Page Number:11
Faculties:Fakultät AuL
DDC classes:600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin, Gesundheit
Review Status:Veröffentlichte Fassung/Verlagsversion
Licence (German):License LogoCreative Commons - CC BY - Namensnennung 4.0 International