Daily interruption of sedation in intensive care unit patients with renal impairment: remifentanil-midazolam compared to fentanyl-midazolam

Objective.-We compared extubation time following daily interruption of sedation in intensive care unit patients with renal impairment with two sedation regimes remifentanil-midazolam and fentanyl-midazolam. Study design. Prospective, randomized double-blind trial. Patients and methods.-Patients with renal impairment needing mechanical ventilation for more than 48 hours. Two groups: remifentanil (R) and, fentanyl (F), Infusion rates were titrated to achieve the desired Ramsay score. The two groups received midazolam (2.5 mg then 0.1 mg/kg/h). Results.-Nineteen patients were included. Patient's characteristics, mean sedation time and sedation quality were comparable. Extubation time was significantly shorter in R group (1480 +/- 980 versus 2880 +/- 1280 min, P = 0.04). Weaning time was also shorter in R group (220 +/- 164 versus 720 +/- 480 min)., Agitation on weaning was comparable in the two groups. Group R received significantly more morphine than group F after interruption of sedation. Conclusion.-Daily interruption of sedation with remifentanil is associated with shorter weaning and extubation time in patients with renal impairment. However further studies are necessary to determine if this issue is associated with lower rate of ventilation induced complications. (C) 2007 Elsevier Masson SAS. Tons droits reserves.