Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: a centre randomised, cross-over, open-label study in the Netherlands

Objective Compare duration of mechanical ventilation (MV), weaning time, ICU-LOS (ICU-LOS), efficacy and safety of remifentanil-based regimen with conventional sedation and analgesia. Design Centre randomised, open-label, crossover, ‘real-life’ study. Setting 15 Dutch hospitals. Patients Adult medical and post-surgical ICU patients with anticipated short-term (2–3 days) MV. Interventions Patient cohorts were randomised to remifentanil-based regimen ( n = 96) with propofol as required, for a maximum of 10 days, or to conventional regimens ( n = 109) of propofol, midazolam or lorazepam combined with fentanyl or morphine. Measurements and main results Outcomes were weaning time, duration of MV, ICU-LOS, sedation- and analgesia levels, intensivist/ICU nurse satisfaction, adverse events, mean arterial pressure, heart rate. Median duration of ventilation (MV) was 5.1 days with conventional treatment versus 3.9 days with remifentanil (NS). The remifentanil-based regimen reduced median weaning time by 18.9 h ( P = 0.0001). Median ICU-LOS was 7.9 days versus 5.9 days, respectively (NS). However, the treatment effects on duration of MV and ICU stay were time-dependent: patients were almost twice as likely to be extubated ( P = 0.018) and discharged from the ICU ( P = 0.05) on day 1–3. Propofol doses were reduced by 20% ( P = 0.05). Remifentanil also improved sedation-agitation scores ( P