Comparison of the effect of protocol-directed sedation with propofol vs. midazolam by nurses in intensive care: Efficacy, haemodynamic stability and patient satisfaction

Aim. The aim of this study was to compare the effect of protocol-directed sedation propofol vs. midazolam by nurses in intensive care on efficacy, haemodynamic stability and patient satisfaction. Background. Protocols represent one method potentially to reduce treatment delays and ensure that medical care is administered in a standardised manner. Propofol and midazolam are often used for sedation in intensive care units. Method. A randomised, prospective cohort study and data were collected in 2003. The subjects were randomised either into propofol (n = 32) or into midazolam (n = 28) group. Efficacy of sedation, haemodynamic stability, pulse oximetry saturation, Acute Physiology and Chronic Health Evaluation II (APACHE II score), weaning time from mechanical ventilation, duration of mechanical ventilation, length of stay at intensive care unit, sedative drugs cost and patient satisfaction were measured. Results. The nursing staff were able to maintain patients at Ramsay sedation scale (RSS) 3-4 during the sedative period. The efficacy of sedation was 74·2% and 66·9% of time in propofol and midazolam group respectively. Both sedatives reduced the arterial blood pressure and heart rate, but did not alter haemodynamic stability. The mean score of satisfactory sedation was not significantly different between the two groups (propofol: 11·4 SEM 0·2 vs. midazolam: 11·5 SEM 0·7). Conclusion. Protocol-directed sedation with propofol vs. midazolam by nurses were similar in quality during the sedative period. Relevance to clinical practice. This sedation practice for titration of propofol and midazolam by nurses was of similar quality and able to achieve an appropriate depth of sedation during the sedative period. Furthermore, they should provide care for patients' needs during the sedative period.