(1344) Continuous-Infusion Sedation Lorazepam Versus Midazolam in Critically Ill Patients

Introduction: Non-benzodiazepine sedatives are preferred over benzodiazepines (BDZ), such as lorazepam (LZ) and midazolam (MZ), for ventilated patients. Guidelines do not make recommendations regarding choice of BDZ for continuous sedation. Limited sample sizes and failure to assess clinically significant outcomes restrict the current literature, leading to diverse patient management. We sought to evaluate sedation with continuous infusions LZ versus MZ in the ICU.

Methods: This was a retrospective multi-center cohort study (January 2016-June 2023) that evaluated mechanically ventilated ICU adult patients who received LZ or MZ for sedation (at least 12 hours). Patients on other BDZ, those receiving continuous BDZ infusion for specific indications (elevated intracranial pressures, status epilepticus, neuromuscular blocking agents, targeted temperature management post-cardiac arrest, and alcohol withdrawal management), those receiving ECMO or with positive SARS-CoV-2 tests were excluded. Patients were matched based on gender, SOFA score, ICU type, ethnicity, inclusion year, and type of institution. Outcomes evaluated include mechanical ventilation duration, ICU and hospital length of stay (LOS), and in-hospital mortality.

Results: Of the 1194 patients who met inclusion criteria and did not meet exclusion criteria, 62 LZ patients were identified and matched to 62 MZ patients (124 patients total). There were no differences in baseline characteristics between matched cohorts. There was no difference in median lorazepam equivalent doses administered [LZ, 35.2 mg (9.2-88.8 mg) vs. MZ, 17.5 mg (7.5-57.6 mg), p=0.17] and duration of use [LZ, 0.9 days (0.3–1.9 days) vs. MD, 0.9 days (0.4–1.4 days), p=0.60]. There were no significant differences in outcomes evaluated, including duration of ventilation [LZ, 3.6 days (1.5-10.8 days) vs. MZ, 2.2 days (1.2-11.2 days), adj-p=0.27], ICU LOS [LZ, 8.7 days (4.0-14.7 days) vs. MZ, 6.7 days (2.9-9.9 days), adj-p=0.17], hospital LOS [LZ, 12.9 days (8.9-24.1 days) vs. MZ, 10.6 days (7.1-20.4 days), adj-p=0.27] and in-hospital mortality [LZ, 27 (43.5%) vs. MZ, 25 (40.3%), adj-p=0.73].

Conclusions: In the selected patient population, there was no significant difference between LZ and MZ in any clinical outcomes evaluated.