A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients

Abstract

A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients Abstract Purpose: To compare the quality of analgesia provided by a remifentanil-based analgesia regime with that provided by a fentanylbased regime in critically ill patients. Methods: This was a registered, prospective, two-center, randomized, triple-blind study involving adult medical and surgical patients requiring mechanical ventilation (MV) for more than 24 h. Patients were randomized to either remifentanil infusion or a fentanyl infusion for a maximum of 30 days. Sedation was provided using propofol (and/or midazolam if required). Results: Primary outcome was the proportion of patients in each group maintaining a target analgesia score at all time points. Secondary outcomes included duration of MV, discharge times, and morbidity. At planned interim analysis (n = 60), 50% of remifentanil patients (n = 28) and 63% of fentanyl patients (n = 32) had maintained target analgesia scores at all time points (p = 0.44). There were no significant differences between the groups with respect to mean duration of ventilation (135 vs. 165 h, p = 0.80), duration of hospital stay, morbidity, or weaning. Interim analysis strongly suggested futility and the trial was stopped. Conclusions: The use of remifentanil-based analgesia in critically ill patients was not superior regarding the achievement and maintenance of sufficient analgesia compared with fentanyl-based analgesia.

Propofol and remifentanil versus midazolam and fentanyl for sedation during therapeutic hypothermia after cardiac arrest: a randomised trial

“…A change from different combinations of flunitrazepam, midazolam, sufentanil and fentanyl to propofol and remifentanil was also associated with a shorter time to extubation [25]. In contrast to Rozendaal et al [26], Spies et al [27] reported no difference in weaning time.…”

Remifentanil/midazolam versus fentanyl/midazolam for analgesia and sedation of mechanically ventilated neonates and young infants: a randomized controlled trial

“…Muellejans et al [17] compared remifentanil with fentanyl for analgesia and sedation of mechanically ventilated adult ICU patients and found quite similar extubation times of 1.1 h for remifentanil and 1.3 h for fentanyl. Spies et al [18] stopped their trial in mechanically ventilated adult patients ahead of time as a planned interim analysis could detect no advantage of remifentanil compared to fentanyl. The significant differences for remifentanil and fentanyl in our study demonstrate that neonates and young infants seem to benefit more than any other subgroup of patients from the unique pharmacokinetic properties of remifentanil.…”

Emergency Neurological Life Support: Airway, Ventilation, and Sedation

“…A recent mechanistic review suggests that remifentanil may be a cost effective sedative alternative when ICU length of stay is considered [91]. Superiority over fentanyl has not been demonstrated [92].…”