Table 5 Results of clinical studies comparing different sedative agents with regard to cytokine levels, infection rate, and duration of mechanical ventilation
From: Intensive care unit-acquired infection as a side effect of sedation
Outcome | First author [Reference] | Year of publication/country | Study design/Number of patients | Main results* |
|---|---|---|---|---|
Cytokine responses | von Dossow [143] | 2008/Germany | Randomized controlled study comparing fentanyl with remifentanil/40 patients | IFNγ/IL-10 after concanavalin A stimulation, and SOCS-3 gene expression significantly lower in remifentanil group |
|  | Helmy [145] | 2001/Egypt | Randomized controlled study comparing propofol with midazolam/40 patients | Both agents suppressed IL-8 production Midazolam suppressed production of IL-1β, IL-6, and TNF-α Propofol inhibited IL-2 production and stimulated IFNγ production |
|  | Memis [111] | 2007/Turkey | Randomized controlled study comparing dexmedetomidine vs midazolam/40 patients | Significant decreases in TNF-α, IL-1β, and IL-6 in dexmedetomidine group |
Infection and other outcomes | Arya [144] | 2001/India | Randomized controlled study comparing midazolam and morphine with midazolam/33 newborn babies | Comparable rate of infection (6%) in the two groups |
| Â | Muellejans [14] | 2006/Germany | Randomized controlled study comparing remifentanil and propofol with fentanyl and midazolam/80 patients | Mean time intervals from arrival at the ICU until extubation (20.7 vs 24.2 hours) and from arrival until eligible discharge from the ICU (46.1 vs 62.4 hours) were significantly (P < 0.05) shorter in the remifentanil/propofol group |
| Â | Rozendaal [15] | 2009/Neatherlands | Randomized controlled study comparing remifentanil and propofol with propofol, midazolam or lorazepam combined with fentanyl or morphine/215 patients | The remifentanil-based regimen reduced median weaning time by 18.9 hours (P = 0.0001), increased the likelihood to be extubated (P = 0.018), and the discharge from the ICU (P = 0.05) |
| Â | Kress [146] | 1996/USA | Randomized controlled study comparing propofol with midazolam/73 patients | Narrower range of wake-up times with a higher likelihood of waking in less than 60 minutes in propofol group |
| Â | Riker [148] | 2009/USA | Randomized controlled double-blind study comparing dexmedetomidine with midazolam/375 patients | Reduced rate of infection (10.2 vs 19.7%, P = 0.02), and shorter time to extunation (median 3.7 vs 5.6 days, P = 0.01) in the dexmedetomidine group |
| Â | Nadal [149] | 1995/Spain | Retrospective cohort comparing patients with thiopental with those without thiopenthal | Higher rate of VAP in patients who received thiopenthal (53 vs 35%) |