The
benzodiazepine,
midazolam, is one of the most frequently used
sedatives in
intensive care medicine, but it has an unfavorable pharmacokinetic profile when continuously applied. As a consequence, patients are frequently prolonged and more deeply sedated than intended. Due to its distinct pharmacological features, including a
cytochrome P450-independent metabolization, intravenous
lormetazepam might be clinically advantageous compared to
midazolam. In this retrospective cohort study, we compared patients who received either intravenous
lormetazepam or
midazolam with respect to their survival and sedation characteristics. The cohort included 3314 mechanically ventilated,
critically ill patients that received one of the two drugs in a tertiary medical center in Germany between 2006 and 2018. A Cox proportional hazards model with mortality as outcome and APACHE II, age, gender, and admission mode as covariates revealed a hazard ratio of 1.75 [95% CI 1.46-2.09; p < 0.001] for in-hospital mortality associated with the use of
midazolam. After additionally adjusting for sedation intensity, the HR became 1.04 [95% CI 0.83-1.31; p = 0.97]. Thus, we concluded that excessive sedation occurs more frequently in
critically ill patients treated with
midazolam than in patients treated with
lormetazepam. These findings require further investigation in prospective trials to assess if
lormetazepam, due to its ability to maintain light sedation, might be favorable over other
benzodiazepines for sedation in the ICU.