OBJECTIVE:Remifentanil has a unique metabolic pathway that holds potential benefits for long-term sedation. We compared remifentanil-midazolam to sufentanil-midazolam in 41 critically ill adults requiring mechanical ventilation. STUDY DESIGN: Randomized double-blind trial. PATIENTS AND METHODS: Infusion rates were titrated every 4 hours to achieve the desired Ramsay score. Five fold increases in dose requirement was considered as the development of tolerance. Drugs requirement, development of tolerance and weaning time of ventilation were compared. RESULTS: The study was stopped after an interim analysis. The remifentanil and sufentanil groups were comparable regarding IGS II: 56+/-22 vs 64+/-26, mean+/-SD, ICU length of stay: 26 (8-45) vs 19 (11-34) days, and sedation duration: 6 (4-19) vs 6 (3-16)days, median [interquartile range, IQR]). There was a shorter weaning time in the remifentanil group as compared to sufentanil group: 22 h (12-53) vs 96 (47-142) h, median [IQR], p=0.04). The daily opioid infusion rate needed to be decreased over time only in sufentanil group, p < 0.001. Tolerance occurred in 6 (30%; CI(95), 10 to 40%) remifentanil and no sufentanilpatients (P=0.02). CONCLUSION:Sufentanil infusion needed to be reduced over time and prolonged the weaning time when compared to remifentanil.
RCT Entities:
OBJECTIVE:Remifentanil has a unique metabolic pathway that holds potential benefits for long-term sedation. We compared remifentanil-midazolam to sufentanil-midazolam in 41 critically ill adults requiring mechanical ventilation. STUDY DESIGN: Randomized double-blind trial. PATIENTS AND METHODS: Infusion rates were titrated every 4 hours to achieve the desired Ramsay score. Five fold increases in dose requirement was considered as the development of tolerance. Drugs requirement, development of tolerance and weaning time of ventilation were compared. RESULTS: The study was stopped after an interim analysis. The remifentanil and sufentanil groups were comparable regarding IGS II: 56+/-22 vs 64+/-26, mean+/-SD, ICU length of stay: 26 (8-45) vs 19 (11-34) days, and sedation duration: 6 (4-19) vs 6 (3-16)days, median [interquartile range, IQR]). There was a shorter weaning time in the remifentanil group as compared to sufentanil group: 22 h (12-53) vs 96 (47-142) h, median [IQR], p=0.04). The daily opioid infusion rate needed to be decreased over time only in sufentanil group, p < 0.001. Tolerance occurred in 6 (30%; CI(95), 10 to 40%) remifentanil and no sufentanilpatients (P=0.02). CONCLUSION:Sufentanil infusion needed to be reduced over time and prolonged the weaning time when compared to remifentanil.
Authors: Claudia Spies; Martin Macguill; Anja Heymann; Christina Ganea; Daniel Krahne; Angelika Assman; Heinrich-Rudolf Kosiek; Kathrin Scholtz; Klaus-Dieter Wernecke; Jörg Martin Journal: Intensive Care Med Date: 2010-12-17 Impact factor: 17.440
Authors: Jörg Martin; Anja Heymann; Katrin Bäsell; Ralf Baron; Rolf Biniek; Hartmut Bürkle; Peter Dall; Christine Dictus; Verena Eggers; Ingolf Eichler; Lothar Engelmann; Lars Garten; Wolfgang Hartl; Ulrike Haase; Ralf Huth; Paul Kessler; Stefan Kleinschmidt; Wolfgang Koppert; Franz-Josef Kretz; Heinz Laubenthal; Guenter Marggraf; Andreas Meiser; Edmund Neugebauer; Ulrike Neuhaus; Christian Putensen; Michael Quintel; Alexander Reske; Bernard Roth; Jens Scholz; Stefan Schröder; Dierk Schreiter; Jürgen Schüttler; Gerhard Schwarzmann; Robert Stingele; Peter Tonner; Philip Tränkle; Rolf Detlef Treede; Tomislav Trupkovic; Michael Tryba; Frank Wappler; Christian Waydhas; Claudia Spies Journal: Ger Med Sci Date: 2010-02-02
Authors: F Willem Rozendaal; Peter E Spronk; Ferdinand F Snellen; Adri Schoen; Arthur R H van Zanten; Norbert A Foudraine; Paul G H Mulder; Jan Bakker Journal: Intensive Care Med Date: 2008-10-24 Impact factor: 17.440
Authors: Arthur Kwizera; Jane Nakibuuka; Lameck Ssemogerere; Charles Sendikadiwa; Daniel Obua; Samuel Kizito; Janat Tumukunde; Agnes Wabule; Noeline Nakasujja Journal: Crit Care Res Pract Date: 2015-04-05