Effect of remimazolam besylate on elderly patients with mechanical ventilation: a single-center randomized controlled study.

Objective: To compare the clinical prognosis and offline strategy differences between remimazolam besylate and propofol for sedation in elderly patients undergoing mechanical ventilation.

Methods: This single-center prospective randomized controlled study included elderly patients requiring invasive mechanical ventilation in the Emergency Intensive Care Unit (EICU) at The Second Hospital & Clinical Medical School of Lanzhou University from October 2021 to October 2023. Patients were randomly assigned to the remimazolam group (experimental) or propofol group (control) using respective sedation treatments. Clinical treatments remained uninfluenced. After improvement and meeting offline conditions, a cluster offline strategy guided evaluation and treatment. Data on patient demographics, vital signs, clinical outcomes, and adverse events were recorded.

Results: There were no significant differences in invasive mechanical ventilation time (107.50 vs. 104.50 h, P = 0.969), ICU stay (7 days for both groups, P = 0.603), in-hospital mortality (22.5% vs. 15.0%, P = 0.39), or 28-day survival rate (69.57% vs. 69.23%, P = 0.98) between the control and experimental groups. Tracheotomy was performed in 5 control group patients and 2 experimental group patients (P = 0.235). Sedation-related delirium rates were 7.5% (control) and 5.0% (experimental) (P = 0.613).

Conclusions: Remimazolam besylate and propofol showed no significant differences in safety or effectiveness for elderly patients undergoing mechanical ventilation when using the clustered offline strategy.