(1238) Evaluation of Duration of Mechanical Ventilation With Short-Course Midazolam in the Emergency Room

Introduction: Long-term sedation of critically ill patients with benzodiazepines (BZDs) is associated with worse outcomes including longer mechanical ventilation duration, increased delirium, and increased mortality. While non-BZDs such as propofol are associated with superior long-term outcomes, its effects on hemodynamics may cause concern in certain scenarios such as shock. At our institution, BZDs initiated in the emergency department (ED) are commonly rotated to non-BZDs following admission to the ICU. The aim of this study is to evaluate ICU outcomes associated with short-term BZD use.

Methods: This was a retrospective cohort study of mechanically ventilated patients in the ED who received either continuous midazolam or propofol infusions and admitted to the medical ICU from 1/2020-3/2022. Patients with status epilepticus, acute pancreatitis, status post-cardiac arrest, or continuous midazolam for >24 hours in the ED were excluded. Data collection included patient demographics, documented indication for midazolam, concomitant vasopressor requirements, change in sedation within 60 minutes of ICU admission, and incidence of delirium. The primary outcome was the duration in mechanical ventilation. Secondary outcomes included incidence of delirium and in-hospital mortality. Statistical analyses were performed using R (version 4.2.1).

Results: A total of 137 patients were included. Median age was higher in the midazolam group, compared to propofol (65 vs. 59 years, p=0.03). Median APACHE II score was similar between groups (p=0.92). Midazolam was most often initiated due to concomitant vasopressors (n=25.6%), with a median norepinephrine equivalent of 0.15 mcg/kg/min. In the midazolam group, 36.6% were changed to propofol within 60 minutes of ICU admit. There was no significant difference in duration of mechanical ventilation between the groups (p=0.53), nor significant differences in the incidence of delirium at 24 or 48 hours, or in-hospital mortality.

Conclusions: Short-term use of midazolam did not result in a longer duration of mechanical ventilation. There were no statistically significant differences regarding the incidence of delirium or in-hospital mortality. Further research is warranted to confirm these findings and ensure their validity.