Propofol and remifentanil versus midazolam and fentanyl for sedation during therapeutic hypothermia after cardiac arrest: a randomised trial
Intensive Care Medicine,
Bjelland TW et al. – Time to offset was significantly shorter in patients treated with propofol and remifentanil. However, the clinical course in 40 % of patients prevented discontinuation of sedation and potential benefits from a faster recovery. The propofol and remifentanil group required norepinephrine twice as often, but both protocols were tolerated in most patients.
This was an open, randomised, controlled trial on 59 patients treated with therapeutic hypothermia (33–34 °C for 24h) after cardiac arrest in two Norwegian university hospitals between April 2008 and May 2009.
The intervention was random allocation to sedation and analgesia with propofol/remifentanil or midazolam/fentanyl.
Twenty–nine patients received propofol and remifentanil, and 30 midazolam and fentanyl.
Baseline characteristics were similar.
Sedation and analgesia were stopped in 35 patients, and extubation was performed in 17 of these.
Sedation had to be continued for 24 patients.
Time to offset was significantly lower in patients given propofol and remifentanil [mean (95 % confidence intervals) 13.2 (2.3–24) vs. 36.8 (28.5–45.1)h, respectively, p<0.001].
Patients given propofol and remifentanil needed norepinephrine infusions twice as often (23 vs. 12 patients, p=0.003).
Incidence of pneumonia and 3–month neurological outcome were similar in the two groups.
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