Decreased time on mechanical ventilation using remifentanil-based analgesia and sedation

Introduction

Remifentanil is a short acting mu-opioid agonist with a half-life of less than 10 min and organ-independent elimination. This study compared the safety and efficacy of remifentanil-based analgesia and sedation (RBA) with hypnotic-based sedation (HBS), in 105 ICU patients with medical conditions requiring long-term (up to 10 days) mechanical ventilation. The primary endpoint assessed whether the RBA could reduce time on mechanical ventilation.

Methods

Patients were randomised 1:1 to open treatment with either RBA or HBS (midazolam [MID] + fentanyl or morphine at investigator's choice). Remifentanil infusion started at 6–9 μg/kg/hour and was titrated to effect optimal analgesia and sedation. A supplemental MID bolus was introduced at a remifentanil rate of 12–18 μg/kg/hour. HBS was administered according to routine clinical practice. The time from the start of treatment to the start of the weaning process and extubation were recorded. The sedation agitation score and pain index were recorded throughout the study.

Results

Twenty-nine (51%) RBA patients and 16 (33%) HBS patients started weaning during the 10-day treatment period and were extubated. The median percentage time of appropriate analgesia/sedation was greater than 95% with both regimens. Table 1 presents the time from the start of study drug to the start of the weaning period and to extubation.

Table 1

Conclusions

Remifentanil-based analgesia and sedation significantly decreased time on mechanical ventilation. Remifentanil may be a useful agent in the cost-effective care of ICU patients.