Remifentanil-midazolam compared to sufentanil-midazolam for ICU long-term sedation

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%; CI95, 10 to 40%) remifentanil and no sufentanil patients (P = 0.02). Conclusion. - Sufentanil infusion needed to be reduced over time and,prolonged the-weaning time when compared to remifentanil. (c) 2005 Elsevier SAS. Tons droits reserves.