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Indian J Crit Care Med. 2017 May;21(5):274-280. doi: 10.4103/ijccm.IJCCM_67_17.

The Benefit of Benzodiazepine Reduction: Improving Sedation in Surgical Intensive Care.

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Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Germany.
Department of Anaesthesiology and Intensive Care Therapy, Philipps University Marburg, Germany.
Clinic of Anesthesiology and Intensive Care Medicine, University of Cologne, Germany.



Sedation, as it is often required in critical care, is associated with immobilization, prolonged ventilation, and increased morbidity. Most sedation protocols are based on benzodiazepines. The presented study analyzes the benefit of benzodiazepine-free sedation.


In 2008, 134 patients were treated according to a protocol using benzodiazepine and propofol (Group 1). In 2009, we introduced a new sedation strategy based on sufentanil, nonsteroidal anti-inflammatory drugs, neuroleptics, and antidepressants, which was applied in 140 consecutive patients (Group 2). Depth of sedation, duration of mechanical ventilation, duration of Intensive Care Unit, and hospital stay were analyzed.


Group 1 had both a longer duration of deep sedation (18.7 ± 2.5 days vs. 12.6 ± 1.85 days, P = 0.031) and a longer duration of controlled ventilation (311, 35 ± 32.69 vs. 143, 96 ± 20.76 h, P < 0.0001) than Group 2. Ventilator days were more frequent in Group 1 (653, 66 ± 98.37 h vs. 478, 89 ± 68.92 h, P = 0.128).


The benzodiazepine-free sedation protocol has been shown to significantly reduce depth of sedation and controlled ventilation. Additional evidence is needed to ascertain reduction of ventilator days which would not only be of benefit for the patient but also for the hospital Management.


Analgesia; benzodiazepine; critical care; intensive care unit; midazolam; sedation

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