Evaluation of Duration of Mechanical Ventilation Associated with Short-Course Midazolam Infusion in the Emergency...

Long-term benzodiazepine (BZD) use in the intensive care unit (ICU) is associated with negative patient outcomes, while data on short-term BZD use are limited.

This study evaluated ICU outcomes associated with short-term midazolam infusion (<24 h) compared to propofol in emergency department (ED) patients who were mechanically ventilated.

This was a retrospective cohort study of mechanically ventilated patients in the ED who received either midazolam or propofol infusions from 1/1/2020 to 3/15/2022. Patients with either status epilepticus, acute pancreatitis, or status postcardiac arrest, had continuous midazolam for >24 h, or concurrent midazolam and propofol use for >2 h, were excluded. The primary outcome was ventilator-free days (VFDs) at day 7. Secondary outcomes were duration of mechanical ventilation, incidence of delirium within 48 h, and in-hospital mortality.

A total of 137 patients were included (midazolam, n = 82; propofol, n = 55). Patients were older in the midazolam group (65 vs. 59 years), while baseline Acute Physiology and Chronic Health Evaluation II scores were comparable between the two groups. Midazolam was most often initiated due to need for vasopressors (25.6%), with a median norepinephrine equivalent of 0.15 mcg/kg/min (IQR 0.07-0.29) at initiation. In the midazolam group, 36.6% were changed to propofol within 60 minutes of ICU admission. No significant differences were observed in VFDs at day 7 between the propofol and midazolam groups (difference 0, 95% CI -0.69 to +0.58; p = 0.75). We also did not find differences in duration of mechanical ventilation (p = 0.53), incidence of delirium at 48 h (p = 0.85), or in-hospital mortality (p = 0.49).

Short-term midazolam use (i.e., <24 h) was not associated with longer VFDs at day 7 in this retrospective study. No significant differences were observed in duration of mechanical ventilation, delirium incidence, or in-hospital mortality. Further research is warranted to validate these findings.