ИСТИНА

INTRODUCTION. Sedation is a first-line therapy used in intensive care unit (ICU) to control raised intracranial pressure in severe traumatic brain injury (TBI) patients. However, it remains unclear what the effect of different sedative drugs is on outcome. This analysis of the CENTER-TBI study uses comparative effectiveness research to fill this knowledge gap. METHODS. The CENTER-TBI study (clinicaltrials.gov registration NCT02210221) is a prospective observational longitudinal cohort study including patients with TBI from 65 centers across Europe. Data were extracted from the CENTER-TBI database v1.1 with Neurobot v2.6. We included all patient who were admitted to the ICU with ICP monitoring and who had more than one day of mechanical ventilation. For every patient, the primary sedative (the sedative that the patient received most of the days) was selected. We focused on midazolam and propofol, since these were the most frequently used. RESULTS. 4509 patients were included in the CENTER-TBI study: we selected 611 patients who received propofol, and 451 patients who received midazolam. There was a large variation between centers in choice of sedative drugs and length of sedation. The length of ICU stay was 0.84 time shorter (95% CI: 0.81 - 0.87) before adjustment, and 0.83 (95% CI: 0.80 - 0.86) after adjustment for major confounders compared to midazolam. Total adjusted hospital length of stay was similarly 0.97 time shorter (95% CI: 0.95 - 1.00) for propofol versus midazolam patients. The OR of propofol for a better functional outcome was 1.10 (95% CI: 0.83 - 1.45) before adjustment, and 0.93 (95% CI: 0.69 - 1.26) after adjustment. CONCLUSION. There is large variation in length of sedation and choice of sedative drugs among European neurotrauma centers. Propofol is associated with a shorter ICU and hospital length of stay but similar functional outcome as midazolam.