Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: a centre randomised, cross-over, open-label study in the Netherlands

Intensive Care Med. 2009 Feb;35(2):291-8. doi: 10.1007/s00134-008-1328-9. Epub 2008 Oct 24.


Objective: Compare duration of mechanical ventilation (MV), weaning time, ICU-LOS (ICU-LOS), efficacy and safety of remifentanil-based regimen with conventional sedation and analgesia.

Design: Centre randomised, open-label, crossover, 'real-life' study.

Setting: 15 Dutch hospitals.

Patients: Adult medical and post-surgical ICU patients with anticipated short-term (2-3 days) MV.

Interventions: Patient cohorts were randomised to remifentanil-based regimen (n = 96) with propofol as required, for a maximum of 10 days, or to conventional regimens (n = 109) of propofol, midazolam or lorazepam combined with fentanyl or morphine.

Measurements and main results: Outcomes were weaning time, duration of MV, ICU-LOS, sedation- and analgesia levels, intensivist/ICU nurse satisfaction, adverse events, mean arterial pressure, heart rate. Median duration of ventilation (MV) was 5.1 days with conventional treatment versus 3.9 days with remifentanil (NS). The remifentanil-based regimen reduced median weaning time by 18.9 h (P = 0.0001). Median ICU-LOS was 7.9 days versus 5.9 days, respectively (NS). However, the treatment effects on duration of MV and ICU stay were time-dependent: patients were almost twice as likely to be extubated (P = 0.018) and discharged from the ICU (P = 0.05) on day 1-3. Propofol doses were reduced by 20% (P = 0.05). Remifentanil also improved sedation-agitation scores (P < 0.0001) and intensivist/ICU nurse satisfaction (P < 0.0001). All other outcomes were comparable.

Conclusions: In patients with an expected short-term duration of MV, remifentanil significantly improves sedation and agitation levels and reduces weaning time. This contributes to a shorter duration of MV and ICU-LOS.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Over Studies
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Piperidines / administration & dosage*
  • Propofol / administration & dosage*
  • Psychomotor Agitation / epidemiology
  • Psychomotor Agitation / prevention & control
  • Remifentanil
  • Respiration, Artificial / methods*
  • Respiratory Insufficiency / epidemiology*
  • Respiratory Insufficiency / therapy*
  • Ventilator Weaning / statistics & numerical data*


  • Hypnotics and Sedatives
  • Piperidines
  • Remifentanil
  • Propofol