Objectives: To compare propofol and midazolam in adult intensive care patients in relation to length of ICU stay, length of mechanical ventilation (MV) and time until extubation. Methods: MEDLINE, EMBASE, LILACS and Cochrane databases were searched from inception until July 2019 to retrieve RCTs that compared propofol and midazolam use as sedatives in adult ICU patients. There was no language restriction. We extracted and combined data from studies that reported to length of ICU stay, length of MV and time until extubation. A random-effects, meta-analytic model was applied in all calculations. Cochrane collaboration tool and GRADE were used to assess bias and certainty of the outcomes of the included studies, respectively. Two groups of patients were analyzed: elective surgical patients and critically ill patients. Results: Elective surgical patients receiving propofol reduced ICU stay by 5.07 hours (MD -5.07; 95% CI -8.68 to -1.45; p ,0.006, I 2 = 41 %, 5 studies), MV time by 4.28 hours (MD -4.28; 95% CI -4.62 to -3.94 (p ,0.00001, I 2 = 0, 3 studies), extubation time by 1.92 hours (MD -1.92; 95% CI -2.71 to -1.13; p ,0.00001, I 2 = 89%, 9 studies) compared to patients receiving midazolam. Critically ill patients receiving propofol reduced extubation time by 32.68 hours (MD -32.68; 95% CI -48.37 to -16.98; p ,0.0001, I 2 = 97%, 7 studies) compared to patients receiving midazolam. GRADE was very low for all outcomes. Conclusions: We conclude that propofol is a safe sedation strategy for general and elective surgery patients in the ICU. It is associated with improved outcomes when compared to the use of midazolam. Our data is in accordance with the recent sedation guideline (PADIS) recommendations where propofol can be used as the first-line sedative in adult ICU patients.
CONTEXT: A high number of hospitalized children do not receive adequate sedation due to inadequate evaluation and use of such agents. With the increase in knowledge of sedation and analgesia in recent years, concern has also risen, such that it is now not acceptable that incorrect evaluations of the state of children's pain and anxiety are made. OBJECTIVE: A comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation. DESIGN: Prospective cohort study. SETTING: A pediatric intensive care unit with three beds at an urban teaching hospital. PATIENTS: Thirty simultaneous and independent observations were conducted by specialists on 18 patients studied. DIAGNOSTIC TEST: Comfort and Hartwig scales were applied, after 3 minutes of observation. MAIN MEASUREMENTS: Agreement rate (kappa). RESULTS: On the Comfort scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 20.28 (SD 2.78), 27.5 (SD 0.70), and 15.1 (SD 1.10), respectively, whereas on the Hartwig scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 16.35 (SD 0.77), 20.85 (SD 1.57), and 13.0 (SD 0.89), respectively. The observed agreement rate was 63% (p = 0.006) and the expected agreement rate was 44% with a Kappa coefficient of 0.345238 (z = 2.49). CONCLUSIONS: In our study there was no statistically significant difference whether the more complex Comfort scale was applied (8 physiological and behavioral parameters) or the less complex Hartwig scale (5 behavioral parameters) was applied to assess the sedation of mechanically ventilated pediatric patients.
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