Minimize Benzodiazepine Use for Sedation in the ICU

Team, I’ll get to making this whole post prettier in the AM when I have some rest under my belt. I saw everyone chiming in on bedsideroundz’ page how they provide versed/midazolam for sedation in their critically ill patients and I had no choice but to put off my bedtime for a few hours and work on this post instead. A 🎩 tip to bedsideroundz for shining some indirect light to this conversation. Here are the official 2018 guideline statements regarding utilizing a benzodiazepine such as midazolam/versed for sedation in the ICU.

“The 2013 guidelines suggested targeting light levels of sedation or using daily awakening trials, and minimizing benzodiazepines to improve short-term outcomes (e.g., duration of mechanical ventilation and ICU LOS).”
“…sedation with benzodiazepines, which are no longer recommended for sedation in critically ill patients”
“The 2013 PAD guidelines suggest (in a conditional recommendation) that nonbenzodiazepine sedatives (either propofol or dexmedetomidine) are preferable to benzodiazepine sedatives (either midazolam or lorazepam) in critically ill, mechanically ventilated adults because of improved short-term outcomes such as ICU LOS, duration of mechanical ventilation, and delirium”
“We suggest using propofol over a benzodiazepine for sedation in mechanically ventilated adults after cardiac surgery”
“…shorter time to extubation with propofol versus a benzodiazepine”
“Overall, the panel judged that the desirable consequences of using propofol probably outweigh the undesirable consequences, and thus issued a conditional recommendation favoring propofol over a benzodiazepine.”
“We suggest using either propofol or dexmedetomidine over benzodiazepines for sedation in critically ill, mechanically ventilated adults”
“the study by Xu et al also showed reduced delirium with dexmedetomidine use”
“the Dexmedetomidine Versus Midazolam for Continuous Sedation in the ICU (MIDEX) study demonstrated a shorter duration of mechanical ventilation with dexmedetomidine over a benzodiazepine infusion”

I’ll post some more later. Please read the article for yourself. Don’t trust what I post.


Link to abstract

Link to PDF

Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, Agitation/Sedation, delirium, immobility, and sleep disruption in adult patients in the ICU.Crit Care Med 2018;46:e825–73.

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