Remifentanil vs morphine for patients in intensive care unit who need short-term mechanical ventilation

This randomized, double-blind study compared the safety and efficacy of remifentanil (9 microg/ kg/h) with morphine (0.045 mg/kg/h plus a bolus dose of 0.025 mg/kg). One hundred and eighty nine Intensive Care Unit (ICU) patients with normal renal function or mild renal impairment requiring mechanical ventilation were included in this study. A pre-defined dosing algorithm permitted initial titration of the opioids to predetermine the optimal level of sedation and pain score. Supplementary infusion of midazolam (0.03 mg/kg/h) was given when additional sedation was required. The duration of optimal sedation during the maintenance phase was 82.7 per cent and 84.3 per cent of the total time in the remifentanil and morphine groups respectively. There were no statistically significant differences in the between-subject variability in the duration of optimal sedation between the two treatment groups. Midazolam was not required in approximately 75 per cent of all patients. The patients in the morphine group required twice the amount of midazolam required by the remifentanil group. The dosing algorithm facilitated rapid extubation in both groups. Remifentanil provided comparable hemodynamic stability to morphine, and was not associated with an increase in cardiovascular adverse event. Remifentanil is therefore considered to be effective and well tolerated in ICU patients.