The use of propofol for medium and long-term sedation in critically ill adult patients: a meta-analysis

Objective: To investigate the effects of using propofol for medium and long-term sedation on mortality and length of intensive care unit (ICU) stay of critically ill adult patients. Design: Randomised controlled studies comparing propofol with an alternative sedative agent in critically ill adult patients were included without language restriction from the Cochrane Controlled Trial Register (2007 issue 3), EMBASE, and MEDLINE databases (1966 to 1 December 2007). Two reviewers reviewed the quality of the studies and performed data extraction independently. Measurements and results: Sixteen randomised controlled studies with a total of 1,386 critically ill adult patients were considered. Nine of the pooled studies (56%) limited the doses of propofol infusion to < 6 mg/kg h(-1). Mortality was not significantly different between patients sedated with propofol, or an alternative sedative agent (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.80-1.38, P = 0.74; I-2 = 0%). Using propofol for medium and long-term sedation was associated with a significant reduction in length of ICU stay (overall weighted-mean-difference [WMD] in days -0.99, 95%CI -1.51 to -0.47, P = 0.0002; I-2 = 82.26%) when compared to an alternative sedative agent; however, this benefit became insignificant (overall WMD in days -0.98, 95%CI -2.86 to 0.89, P = 0.30; I-2 = 78.8%) when the comparison was limited to between propofol and midazolam. Conclusion: Using propofol for prolonged sedation in critically ill patients appears to be safe and may reduce duration of mechanical ventilation. It reduces the length of ICU stay when compared to long acting benzodiazepines, but not when compared to midazolam.