Vasopressor utilization in septic shock patients receiving propofol versus midazolam.

Purpose: The purpose of this study was to evaluate the effect of propofol versus midazolam on vasopressor requirements in patients with septic shock to better guide sedative selection.

Methods: This was a multicenter, retrospective, observational, IRB-approved, non-inferiority cohort study. Included individuals were ≥ 18 years of age, had a diagnosis of septic shock, and exclusive administration of propofol or midazolam for at least 12 h. The primary outcome was maximum increase in vasopressor requirements within the first 12 h following sedative initiation.

Results: For the primary outcome of maximum increase in norepinephrine equivalents (NEE) within 12 h, propofol was non-inferior to midazolam (0.09 vs. 0.129 μg/kg/min, p = 0.002). No difference was seen between the propofol and midazolam groups for the secondary outcome of maximum increase in NEE within 3 h (0.02 vs 0.04 μg/kg/min, p = 0.208), however, the propofol group had a significantly lower increase within 6 h (0.06 vs 0.086 μg/kg/min, p = 0.043) and 24 h (0.11 vs 0.25 μg/kg/min, p = 0.013).

Conclusion: In patients with septic shock, vasopressor requirement increases with propofol were non-inferior to midazolam within the first 12 h.