Background: Remimazolam is a new benzodiazepine with fast onset and offset and a metabolism independent of hepato-renal function. Several studies evaluated the efficacy of remimazolam for procedural sedation and general anesthesia; however, there are limited data on its use for sedation in intensive care unit (ICU). During coronavirus disease 2019 (COVID-19) pandemic, the high demand for mechanical ventilation led to significant and dramatic drug shortages. We therefore decided to use remimazolam for sedation in critically ill patients. Case Description: We report on the use of remimazolam as a sedative agent in five critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) admitted to an ICU in a large Italian hospital. The initial infusion rate was 0.05 mg/kg/h, titrated up to 2 mg/kg/h according to clinical condition and processed electroencephalogram [quantium counsciousness index (qCON) on CONOX]. Feasibility was defined as maintenance of target sedation level without additional hypnotics. We tried to maintain a moderate sedation in patients with spontaneous breathing [−3 target score according to Richmond Agitation-Sedation Scale (RASS)] and a qCON value on CONOX between 40 and 60 in intubated patients. Of the five patients, three received noninvasive respiratory support, and two were on invasive mechanical ventilation with norepinephrine. The median duration of remimazolam administration was 8 hours. In all patients, target sedation was reached without rescue sedatives. Vital signs and gas exchange remained stable, and no abnormalities in blood tests or episodes of agitation were observed after sedation withdrawal. Notably, in one patient, the use of remimazolam allowed progressive reduction in the dosage of norepinephrine. Conclusions: The use of remimazolam was found to be safe and effective in five ICU patients. Future randomized trials are needed to confirm these preliminary data and to better clarify the role of remimazolam for long-term ICU sedation.
Turi, S., Belletti, A., Marmiere, M., Faustini, C., Campugiani, A., D'Amico, F., et al. (2025). Feasibility of remimazolam use for sedation in critically ill patients with respiratory failure: a case series, 9, 14-14 [10.21037/jeccm-24-123].
Feasibility of remimazolam use for sedation in critically ill patients with respiratory failure: a case series
Monaco F.;
2025
Abstract
Background: Remimazolam is a new benzodiazepine with fast onset and offset and a metabolism independent of hepato-renal function. Several studies evaluated the efficacy of remimazolam for procedural sedation and general anesthesia; however, there are limited data on its use for sedation in intensive care unit (ICU). During coronavirus disease 2019 (COVID-19) pandemic, the high demand for mechanical ventilation led to significant and dramatic drug shortages. We therefore decided to use remimazolam for sedation in critically ill patients. Case Description: We report on the use of remimazolam as a sedative agent in five critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) admitted to an ICU in a large Italian hospital. The initial infusion rate was 0.05 mg/kg/h, titrated up to 2 mg/kg/h according to clinical condition and processed electroencephalogram [quantium counsciousness index (qCON) on CONOX]. Feasibility was defined as maintenance of target sedation level without additional hypnotics. We tried to maintain a moderate sedation in patients with spontaneous breathing [−3 target score according to Richmond Agitation-Sedation Scale (RASS)] and a qCON value on CONOX between 40 and 60 in intubated patients. Of the five patients, three received noninvasive respiratory support, and two were on invasive mechanical ventilation with norepinephrine. The median duration of remimazolam administration was 8 hours. In all patients, target sedation was reached without rescue sedatives. Vital signs and gas exchange remained stable, and no abnormalities in blood tests or episodes of agitation were observed after sedation withdrawal. Notably, in one patient, the use of remimazolam allowed progressive reduction in the dosage of norepinephrine. Conclusions: The use of remimazolam was found to be safe and effective in five ICU patients. Future randomized trials are needed to confirm these preliminary data and to better clarify the role of remimazolam for long-term ICU sedation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
