Diazepam or midazolam for orotracheal intubation in the
               ICU?

patients admitted to the Central ICU of the Santa Casa Hospital Complex in Porto Alegre, over the age of 18 years, undergoing urgent intubation during 6 months were eligible. Patients were randomized in a single-blinded manner to either intravenous diazepam or midazolam. Diazepam was given as a 5 mg intravenous bolus followed by aliquots of 5 mg each minute. Midazolam was given as an intravenous bolus of 5 mg with further aliquots of 2.5 mg each minute. Ramsay sedation scale 5-6 was considered adequate sedation. We recorded time and required doses to reach adequate sedation and duration of sedation.

Results:

thirty four patients were randomized, but one patient in the diazepam group was excluded because data were lost. Both groups were similar in terms of illness severity and demographics. Time for adequate sedation was shorter (132 ± 87 sec vs. 224 ± 117 sec, p = 0.016) but duration of sedation was similar (86 ± 67 min vs. 88 ± 50 min, p = 0.936) for diazepam in comparison to midazolam. Total drug dose to reach adequate sedation after either drugs was similar (10.0 [10.0-12.5] mg vs. 15.0 [10.0-17.5] mg, p = 0.248). Arterial pressure and sedation intensity reduced similarly overtime with both drugs. Cost of sedation was lower for diazepam than for midazolam (1.4[1.4-1.8] vs. 13.9[9.4-16.2] reais, p <0.001).

Conclusions:

intubation using intravenous diazepam and midazolam is effective and well tolerated. Sedation with diazepam is associated to a quicker sedation time and to lower costs.

deep sedation; drug costs; intubation; randomized controlled trial; diazepam; midazolam

Parameters	Midazolam (n=17)	Diazepam (n=16)	P value
Age (years)	62 ± 13	60 ± 18	0.698
Apache II	23 ± 7	25 ± 10	0.633
Sex (male/female)	9/8	8/8	1.000
Glasgow coma scale	13 ± 4	12 ± 3	0.462
Weight (kg)	67 ± 18	65 ± 13	0.611
Height (cm)	164 ± 8	166 ± 8	0.454
BMI	25 ± 6	23 ± 3	0.431
Causes of intubation
Hypoxemia	8	8	1.000
Hypercapnia	4	3	1.000
Mixed respiratory failure	2	4	0.398
Coma	3	1	0.601
Diagnosis on study admission
Renal failure	2	3	0.656
Diabetes	1	4	0.175
Ischemic heart disease	0	1	0.485
Arterial hypertension	6	7	0.728
Ischemic stroke	5	3	0.688

		Basal	Bolus	15 min	30 min	60 min
Heart rate (beats/min)	Midazolam Diazepam	105 ± 16 107 ± 25	103 ± 15 108 ± 28	103 ± 16 105 ± 31	99 ± 15 99 ± 26	99 ± 14 98 ± 23
Systolic pressure (mmHg)	Midazolam Diazepam	127 ± 31 129 ± 39	107 ± 37 116 ± 42	93 ± 23^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time. 107 ± 37^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time.	93 ± 20^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time. 97 ± 33^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time.	110 ± 30 112 ± 35
Diastolic pressure (mmHg)	Midazolam Diazepam	67 ± 14 70 ± 20	58 ± 156 64 ± 20	58 ± 20 57 ± 20	55 ± 13^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time. 56 ± 21^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time.	63 ± 18 60 ± 19
Respiratory rate (breaths/min)	Midazolam Diazepam	29 ± 11 27 ± 9	27 ± 7 25 ± 8	21 ± 4^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time. 22 ± 6^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time.	20 ± 3^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time. 22 ± 3^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time.	22 ± 3^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time. 22 ± 4^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time.
Arterial oxygen saturation (%)	Midazolam Diazepam	91 ± 5 89 ± 16	92 ± 5 86 ± 19	96 ± 2 90 ± 16	95 ± 3 90 ± 20	95 ± 4 95 ± 6
Ramsay scale	Midazolam Diazepam	1.0[1.0-2.0] 2.0[1.0-2.5]	2.0[1.0-5.5] 2.0[1.0-5.0]	5.0[4.5-6.0]^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time. 6.0[5.0-6.0]^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time.	5.0[4.5-6.0]^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time. 5.0[5.0-6.0]^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time.	5.0[4.0-5.5]^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time. 5.0[4.0-5.7]^* * p <0.05 vs. baseline. No significance differences were observed between groups for each time.

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
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[1] *Correspondence: Address: Rua Fernandes Vieira, 181/601, Postal Code: 90035-091, Porto Alegre – RS – Brazil. beto_gremio@hotmail.com