Comparative Effectiveness of Midazolam-Based Sedation on the Need for Intracranial Pressure Lowering Therapies in Traumatic Brain Injury
Sedatives play an important role in the management of patients with severe traumatic brain injury (sTBI) in the intensive care unit (ICU). Benzodiazepines are common for sedation (midazolam-based) but have been discouraged for non-brain-injured patients in the ICU. This study aimed to investigate th...
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Mary Ann Liebert
2025-01-01
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| Series: | Neurotrauma Reports |
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| Online Access: | https://www.liebertpub.com/doi/10.1089/neur.2024.0077 |
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| author | Rianne G.F. Dolmans Giovanni Russo James Anstey Ewout W. Steyerberg Fabio S. Taccone Andrew Udy Giuseppe Citerio Carole Ichai Rafael Badenes John Prowle Ari Ercole Mauro Oddo Antoine Schneider Stefan Wolf Raimund Helbok David Nelson D. Jamie Cooper Mathieu van der Jagt |
| author_facet | Rianne G.F. Dolmans Giovanni Russo James Anstey Ewout W. Steyerberg Fabio S. Taccone Andrew Udy Giuseppe Citerio Carole Ichai Rafael Badenes John Prowle Ari Ercole Mauro Oddo Antoine Schneider Stefan Wolf Raimund Helbok David Nelson D. Jamie Cooper Mathieu van der Jagt |
| author_sort | Rianne G.F. Dolmans |
| collection | DOAJ |
| description | Sedatives play an important role in the management of patients with severe traumatic brain injury (sTBI) in the intensive care unit (ICU). Benzodiazepines are common for sedation (midazolam-based) but have been discouraged for non-brain-injured patients in the ICU. This study aimed to investigate the effect of midazolam-based sedation versus non-midazolam-based sedation on the need for intracranial pressure (ICP) lowering therapies in patients with sTBI in the ICU. We studied patients with sTBI (Glasgow Coma Sale ≤8) from 14 ICUs in Europe and Australia, who received ICP monitoring and continuous instrumental variable (IV) sedation for at least 24 h. We analyzed the association between sedation strategy and the need for ICP lowering therapies during the first 7 ICU days using a multivariable logistic regression model, adjusted for clinical markers of injury severity. We also analyzed the center as an IV in a random effects model to address potentially unmeasured confounding. Among 227 patients with sTBI, 152 (67%) received midazolam-based sedation. These patients had a lower age and higher median Glasgow Coma Scale on admission compared with 75 patients in the non-midazolam-sedated group. In logistic regression analyses, patients with midazolam-based sedation had higher odds of receiving hyperosmolar therapy (odds ratio [OR]: 3.4, 95% confidence intervals [CI]: 1.6–7.7). This effect could not be confirmed in the instrumental variable analysis (hyperosmolar therapy: OR: 1.3, 95% CI: 0.1–13.1). The mean ICU length of stay was significantly longer in the midazolam-based sedation group compared with the non-midazolam-based sedation group (19 vs. 13 days, hazards ratio 0.6, 95% CI: 0.4–0.8). Midazolam-based sedation was common for patients with sTBI without a significantly increased need for ICP therapies but an association with longer ICU stay. Larger prospective comparative effectiveness studies are needed regarding sedation strategies in critically ill patients with TBI. |
| format | Article |
| id | doaj-art-fb61121dd7ca41ecabf2fd2973f28ea4 |
| institution | OA Journals |
| issn | 2689-288X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Mary Ann Liebert |
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| series | Neurotrauma Reports |
| spelling | doaj-art-fb61121dd7ca41ecabf2fd2973f28ea42025-08-20T01:49:57ZengMary Ann LiebertNeurotrauma Reports2689-288X2025-01-016124225010.1089/neur.2024.0077Comparative Effectiveness of Midazolam-Based Sedation on the Need for Intracranial Pressure Lowering Therapies in Traumatic Brain InjuryRianne G.F. Dolmans0Giovanni Russo1James Anstey2Ewout W. Steyerberg3Fabio S. Taccone4Andrew Udy5Giuseppe Citerio6Carole Ichai7Rafael Badenes8John Prowle9Ari Ercole10Mauro Oddo11Antoine Schneider12Stefan Wolf13Raimund Helbok14David Nelson15D. Jamie Cooper16Mathieu van der Jagt17Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia.Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.Department of Intensive Care, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia.School of Medicine and Surgery, Fondazione IRCCS San Gerardo dei Tintori, University Milano Bicocca - Neurointensive Care, Monza, Italy.Center Hospitalier Universitaire de Nice, Service de Réanimation polyvalente, Université Côte d’Azur, Nice, France.Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de Valencia, University of Valencia, Valencia, Spain.Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.Neurosciences and Trauma Critical Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.Direction of Innovation and Clinical Research, Centre Hospitalier Universitaire Vaudois (CHUV) Direction, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Center Hospitalier Universitaire, Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.Department of Neurosurgery, Charité Universitätsmedizin Neuro Intensive Care Unit, Berlin, Germany.Department of Neurology, Neurocritical Care Unit, Medical University of Innsbruck, Innsbruck, Austria.Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia.Department of Intensive Care Adults, Erasmus Medical Center, Rotterdam, The Netherlands.Sedatives play an important role in the management of patients with severe traumatic brain injury (sTBI) in the intensive care unit (ICU). Benzodiazepines are common for sedation (midazolam-based) but have been discouraged for non-brain-injured patients in the ICU. This study aimed to investigate the effect of midazolam-based sedation versus non-midazolam-based sedation on the need for intracranial pressure (ICP) lowering therapies in patients with sTBI in the ICU. We studied patients with sTBI (Glasgow Coma Sale ≤8) from 14 ICUs in Europe and Australia, who received ICP monitoring and continuous instrumental variable (IV) sedation for at least 24 h. We analyzed the association between sedation strategy and the need for ICP lowering therapies during the first 7 ICU days using a multivariable logistic regression model, adjusted for clinical markers of injury severity. We also analyzed the center as an IV in a random effects model to address potentially unmeasured confounding. Among 227 patients with sTBI, 152 (67%) received midazolam-based sedation. These patients had a lower age and higher median Glasgow Coma Scale on admission compared with 75 patients in the non-midazolam-sedated group. In logistic regression analyses, patients with midazolam-based sedation had higher odds of receiving hyperosmolar therapy (odds ratio [OR]: 3.4, 95% confidence intervals [CI]: 1.6–7.7). This effect could not be confirmed in the instrumental variable analysis (hyperosmolar therapy: OR: 1.3, 95% CI: 0.1–13.1). The mean ICU length of stay was significantly longer in the midazolam-based sedation group compared with the non-midazolam-based sedation group (19 vs. 13 days, hazards ratio 0.6, 95% CI: 0.4–0.8). Midazolam-based sedation was common for patients with sTBI without a significantly increased need for ICP therapies but an association with longer ICU stay. Larger prospective comparative effectiveness studies are needed regarding sedation strategies in critically ill patients with TBI.https://www.liebertpub.com/doi/10.1089/neur.2024.0077intracranial pressureneurocritical caresedationtraumatic brain injury |
| spellingShingle | Rianne G.F. Dolmans Giovanni Russo James Anstey Ewout W. Steyerberg Fabio S. Taccone Andrew Udy Giuseppe Citerio Carole Ichai Rafael Badenes John Prowle Ari Ercole Mauro Oddo Antoine Schneider Stefan Wolf Raimund Helbok David Nelson D. Jamie Cooper Mathieu van der Jagt Comparative Effectiveness of Midazolam-Based Sedation on the Need for Intracranial Pressure Lowering Therapies in Traumatic Brain Injury Neurotrauma Reports intracranial pressure neurocritical care sedation traumatic brain injury |
| title | Comparative Effectiveness of Midazolam-Based Sedation on the Need for Intracranial Pressure Lowering Therapies in Traumatic Brain Injury |
| title_full | Comparative Effectiveness of Midazolam-Based Sedation on the Need for Intracranial Pressure Lowering Therapies in Traumatic Brain Injury |
| title_fullStr | Comparative Effectiveness of Midazolam-Based Sedation on the Need for Intracranial Pressure Lowering Therapies in Traumatic Brain Injury |
| title_full_unstemmed | Comparative Effectiveness of Midazolam-Based Sedation on the Need for Intracranial Pressure Lowering Therapies in Traumatic Brain Injury |
| title_short | Comparative Effectiveness of Midazolam-Based Sedation on the Need for Intracranial Pressure Lowering Therapies in Traumatic Brain Injury |
| title_sort | comparative effectiveness of midazolam based sedation on the need for intracranial pressure lowering therapies in traumatic brain injury |
| topic | intracranial pressure neurocritical care sedation traumatic brain injury |
| url | https://www.liebertpub.com/doi/10.1089/neur.2024.0077 |
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