Effect of Remimazolam Sedation on Outcomes of Mechanically Ventilated Patients in the ICU
Southeast University, China
80 participants
Apr 1, 2025
INTERVENTIONAL
Conditions
Summary
The goal of this clinical trial is to evaluate the effect of remimazolam sedation on outcomes of mechanically ventilated ICU patients through a single-center, prospective, randomized controlled, pilot study.
Eligibility
Inclusion Criteria4
- Age ≥ 18 years;
- Endotracheal intubation and mechanical ventilation for 24-96 hours before enrollment Expected need for continued invasive ventilation and sedation for at least 24 hours;
- Target sedation depth on the Richmond Agitation-Sedation Scale (RASS) between 0 and -3;
- Informed consent obtained from the patient's family
Exclusion Criteria13
- Body mass index (BMI) > 30 kg/m²
- Severe central nervous system disease (e.g., acute stroke, uncontrolled seizures, or severe dementia) or any other condition that precludes RASS assessment
- Mean arterial pressure (MAP) < 55 mmHg despite intravenous fluid resuscitation and vasopressors
- Heart rate < 50 beats per minute, or second-degree or third-degree atrioventricular block in the absence of a pacemaker
- Acute myocardial infarction or severe heart failure (New York Heart Association \[NYHA\] class IV)
- Left ventricular ejection fraction < 30%
- Any contraindication or allergy to benzodiazepines
- Substance dependence, alcohol abuse, or psychiatric/psychological disorders. Alcohol abuse was defined as regular consumption of > 14 drinks per week (1 drink = 150 mL wine, 360 mL beer, or 45 mL liquor)
- Acute hepatitis or severe hepatic dysfunction (Child-Pugh class C)
- Chronic kidney disease with a glomerular filtration rate (GFR) < 60 mL/min/1.73 m²
- Neuromuscular disease
- Patients on extracorporeal membrane oxygenation (ECMO)
- Pregnancy or breastfeeding
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Interventions
In the intervention group, patients with a Richmond Agitation-Sedation Scale (RASS) score of -3 to 0 were given remimazolam besylate for injection at a loading dose of 0.08 mg/kg infused intravenously over 10 min, followed by a continuous infusion at a rate of 0.2 mg/kg/h. When dose adjustment was required, each step was 0.1-0.2 mg/kg/h, with a dose range of 0-2 mg/kg/h, until the target sedation level (RASS: -3 to 0) was achieved. If the target sedation level was not reached, an additional bolus dose of 0.08 mg/kg remimazolam besylate could be administered.
In the control group, patients received propofol emulsion injection at a loading dose of 0.3 mg/kg/h injected over 1 min, followed by a continuous infusion at a rate of 0.3 mg/kg/h. Dose adjustments were made in increments of 0.3-0.6 mg/kg/h, within a dose range of 0.3-4 mg/kg/h, to achieve the target sedation level (RASS: -3 to 0).
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT07596589