Researchers analyzed data on 13,692 mechanically ventilated patients from 104 U.S. hospitals during the years 2003 - 2009.
They found that overall ICU mortality was 19.7 percent in propofol treated patients as compared to 28.8 percent in midazolam treated patients, and 19.3 percent for propofol compared to 25.2 percent for lorazepam treated patients. Those treated with benzodiazepines also spent significantly more time on mechanical ventilation, and a longer time in the ICU.
"Patients with renal failure and liver dysfunction have trouble clearing benzodiazepines and are more likely to be over-sedated," explains the principal author Nick Lonardo, Pharm.D. pharmacy clinical care coordinator for the SICU. "By staying on a ventilator longer, this puts patients at higher risk for developing ventilator-associated pneumonia and many of the other complications, including delirium, that come from being sedated for long periods in an ICU."
Although this is the first study to associate benzodiazepines with increased mortality, a number of smaller studies suggest that this class of drugs is associated with other adverse outcomes, especially delirium. Separate studies have linked delirium seen in the ICU to an increased risk for death. These smaller reports have already triggered a drop in the use of benzodiazepines over the last 10 years. This study found that within the data from the 104 intensive care units analyzed, there were nearly three times as many patients treated with propofol as compared to benzodiazepines.