Comparison of Remifentanil Sedation with Conventional Regimen in ICU Care

Critically ill patients in intensive care unit (ICU) regularly experience nervousness and agitation and are at risk of reacting to numerous stressful and pain stimuli. Consequently, ICU patients normally require a combination of analgesia and sedation to alleviate their state of nervousness, enhance safety of the endotracheal tube, and facilitate mechanical ventilation (MV). Studies have proposed that analgesia-based sedation using remifentanil reduces the duration of MV and period of stay in the ICU compared to a conventional regimen.

Purpose and introduction

The aim of this study is to compare an analgesic sedation regimen with remifentanil against a conventional regimen using midazolam or morphine in patients requiring postoperative mechanical ventilation in the ICU.

A literature research was conducted in EBSCOhost (all databases), OvidSP and Science Direct. Keywords were Analgesia, Mechanical, ventilation, Remifentanil Sedation, Weaning and ICU.

Use of evidence

  • Results showed three randomized studies had been conducted in the ICU setting.
  • A summary of studies compared the safety and efficacy of the two procedures under study.
  • These randomized studies focused on patients between 19-75 years.
  • Each patient received either of the two treatments according to their individual body weights.
  • The randomization procedure was based on a computer generated list.
  • Patients were not informed of the sedation option used.
  • Median duration of MV was 5.1 days with conventional treatment versus 3.9 days with remifentanil.
  • The remifentanil-based regimen reduced median weaning time by 18.9 h.
  • Remifentanil also improved sedation-agitation scores.

Interpretation of evidence

In patients with an expected short-term duration of MV, remifentanil significantly improves sedation and agitation levels and reduces weaning time.

Counter Arguments

  • A conventional regimen using midazolam or morphine is important when a long ICU stay is anticipated
  • Analgesic drugs such as Remifentanil are relatively expensive
  • Evidence shows that Remifentanil can cause hypotension


  • Remifentanil significantly improves sedation and agitation levels
  • Remifentanil also reduces weaning time
  • Consequently, analgesic sedation using remifentanil reduces the duration of MV and ICU stay as compared to conventional regimen using midazolam with morphine
  • However, ICU costs per patient for the two sedation options is similar

Implications for practice

  • Clinicians should start patients on a remifentanil-based regimen whenever short-term MV is anticipated
  • Treatment should be assessed after 2–3 days


Battershill, A. J. and Keating G. M. (2006). Remifentanil: A Review of its Analgesic and Sedative Use in the Intensive Care Unit. Drugs 2006; 66 (3): 365-385.

Breen, D. et al. (2005). Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients: a randomised trial. Critical Care 2005, 9:R200-R210.

Dahaba,A. A. et al. (2004). Remifentanil versus Morphine Analgesia and Sedation for Mechanically Ventilated Critically Ill Patients. Anesthesiology, V 101, No 3, 640-6.

Muellejans, B. et al. (2006). Sedation in the intensive care unit with remifentanil/propofol versus midazolam/fentanyl: a randomised, open- label, pharmacoeconomic trial. Critical Care 2006, 10:R91.

Rozendaal, F.W. et al. (2009). 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 Medicine, volume 35, issue 2 pp 291-298.

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