Remimazolam Versus Midazolam for Sedation in Mechanically Ventilated Patients with Severe Pneumonia: A Randomized Controlled Trial
Abstract
PurposePatients with severe pneumonia in the intensive care unit often require mechanical ventilation and sedation. Midazolam, a common sedative, is limited by prolonged sedation and accumulation. Remimazolam besylate, a novel ultra-short-acting benzodiazepine, offers efficacy and safety. This study compared remimazolam and midazolam for sedation in mechanically ventilated patients with severe pneumonia.MethodsThis single-center, prospective, randomized controlled trial enrolled 68 adults with severe pneumonia requiring invasive mechanical ventilation, targeting a Richmond Agitation-Sedation Scale (RASS) score of -3 to 0. Patients were randomized 1:1 to receive either remimazolam (initial dose 0.2 mg/kg/h) or midazolam (initial dose 0.02 mg/kg/h), all receiving remifentanil for analgesia. The primary outcome was the proportion of time spent within the target RASS range without rescue sedation during the first 72 h after randomization. Secondary outcomes included hemodynamic parameters, oxygen saturation, duration of mechanical ventilation, ventilator-free days at day 28 +(VFD-28), and 28-day mortality.ResultsBaseline characteristics were comparable, and the median percentage of time within the target RASS range was 100% (p = 0.989) for both groups. Rescue sedation was required in 11.8% of the remimazolam group and 17.6% of the midazolam group (p = 0.734). No significant differences were observed in mean arterial pressure, heart rate, oxygen saturation, duration of mechanical…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 68 participants or records.
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