Effect and hemodynamics of remimazolam besylate on sedation of mechanically ventilated patients: a propensity score-matched study

Remimazolam besylate is a novel ultra-short-acting benzodiazepine sedative. This study aimed to evaluate its hemodynamics profiles during sedation in mechanically ventilated patients in the intensive care unit (ICU), compared with propofol. We conducted a single-center, retrospective, propensity score–matched observational study including patients who underwent mechanical ventilation and received either remimazolam or propofol for sedation. The primary outcome was change in mean arterial pressure (MAP) during sedation. Secondary outcomes included the incidence of hypotension and hypertension, norepinephrine requirements, bradycardia, tachycardia, volume of fluid resuscitation, post-sedation nausea and vomiting, duration of mechanical ventilation, ICU and hospital length of stay, and 28-day mortality. After matching, 366 patients (183 pairs) were analyzed. The median (IQR) age was 55.0 (43.3–67.0) years, and 64.2% were male. Compared with propofol, the remimazolam group had a smaller change in MAP [13 (9–17) vs. 14 (11–18) mmHg, p < 0.05], along with a lower incidence of hypotension and reduced need for high-dose norepinephrine (p < 0.05). No significant differences were observed in change in heart rate, hypertension, bradycardia, tachycardia, fluid resuscitation, nausea or vomiting, or major clinical outcomes including duration of mechanical ventilation, ICU and hospital stay, and 28-day mortality. In this retrospective matched analysis, remimazolam was associated with fewer blood pressure fluctuations and less hypotension compared with propofol, while overall clinical outcomes were similar. Prospective multicenter studies are needed to further confirm these findings. Chinese Clinical Trial Registry (ChiCTR2200063981).