Der Stellenwert von Midazolam als Komponente in einem modernen Sedierungskonzept von postoperativ nachbeatmeten, allgemeinchirurgischen Patienten

Background. Analgesia and sedation, much used in critical care, are associated with immobilization, increased morbidity, prolonged ventilation, hospital stay and increased healthcare costs. Most sedation protocols are based on benzodiazepines with a medium or long half time, which prolongs the weaning period. The aim of our study was to propose a benzodiazepine-free sedation protocol. Material and methods. In 2008, 134 patients were treated with our conventional protocol using benzodiazepine and propofol (cohort2008>72+). In 2009, we introduced a new sedation strategy based on sufentanil, non-steroidal anti-inflammatory drugs, neuroleptics and antidepressants, which was applied in 140 consecutive patients (cohort2009>72-). The depth of sedation, duration of mechanical ventilation, duration of ICU and hospital stay was retrospectively analysed. Statistical calculations were performed using Log-Rank-Test and Wald-Chi-Quadrat-Test. Results. Cohort2008 had both a longer duration of deep sedation (18.7±2.5 days vs 12.6±1.85 days, p=0.031) and a longer duration of controlled ventilation (311.35±32.69 vs 143.96±20.76 hours, p<0.0001) than cohort2009. Ventilator days in cohort2008 tended also to be longer than in cohort2009 (653.66±98.37 hours vs 478.89±68.92 hours, p=0.128). The mean duration of ICU stay was 35.30±4.26 days in 2008 and 33.24±2.93 days in 2009 (n.s.). The mean duration of hospital stay was 57.0±9.8 days in cohort2008 and 64.3±8.1 days in cohort2009 (n.s.). Conclusions. A benzodiazepine-free sedation protocol significantly reduces the depth of sedation and controlled ventilation. Larger studies are needed to investigate whether this protocol could significantly reduce ventilator days.