human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: It is often necessary to adjust a patient ’s sedation level while they are in the intensive care unit . The purpose of this study was to compare propofol with midazolam for controlling short-term alterations in sedation .  Twenty-three patients undergoing an interactive procedure , physiotherapy , during mechanical ventilation of the lungs were studied . The patients were r and omly assigned to receive infusions of propofol or midazolam for sedation . Sedation was assessed using the method of Ramsay , where 3 is drowsy responding only to comm and s ; and 5 is asleep with a slow response to light glabellar tap . Prior to physiotherapy sedation was deepened from 3 to 5 by increasing the sedative infusion rate , and level 5 was maintained during physiotherapy by adjusting the infusion rate whenever necessary . After physiotherapy , the sedative dose was reduced until level 3 was again achieved . During physiotherapy , sedation level 5 was achieved for 53.9 % of the time with propofol but for only 25.7 % with midazolam ( P < 0.01 ) . After physiotherapy , those patients se date d with propofol  re-awakened to level 3 faster ( 8.3 ± 2.3 min , mean ±SE ) than those receiving midazolam ( 92.8 ± 35.0 min , P < 0.05 ) . After physiotherapy , a further 1.8 ± 0.5 dose adjustments were required to the  midazolam  infusion while only 0.4 ± 0.2 adjustments were required to the propofol infusion ( P < 0.05 ) . During physiotherapy 3.0 ± 0.5 dose adjustments to the propofol dose were required compared with 3.6 ± 0.5 adjustments to the midazolam dose ( NS ) . It is concluded that , during a st and ardized stimulus , physiotherapy , propofol infusion allowed a desired sedation score to be maintained for more of the time than did infusion of midazolam . Subsequently , when the infusion rates were reduced , less time was taken to re-awaken to baseline levels after physiotherapy , with fewer adjustments to the infusion rate , in those patients receiving propofol than midazolam . RésuméAux soins intensifs , il faut fréquemment modifier le niveau de sédation ; cette étude compare le propofol au midazolam pour contrôler ces changements de courte durée . Vingt-trois patients sous ventilateur mécanique soumis à des manoeuvres de physiothérapie interactive sont inclus dans l’étude . Ils reçoivent au hasard en sédation une perfusion de profopol ou de midazolam . La sédation est évaluée selon l’échelle de Ramsey ; on accorde 3 pour la somnolence avec réponse aux ordres et 5 au sommeil avec réponse lente à la légère percussion de la glabelle . Avant la physiothérapie , la sédation est approfondie du niveau 3 au niveau 5 en augmentant la perfusion au besoin . Après la physiothérapie , on réduit la perfusion jusqu’au retour au niveau 3 . Pendant la physiothérapie , le niveau 5 est atteint pendant 53,9 % de la durée du traitement avec le propofol contre seulement 25,7 % avec le midazolam ( P < 0,01 ) . Après la physiothérapie , les patients sous propofol reviennent au niveau 3 plus rapidement ( 8,3 ± 2,3 min , moyenne ± SD ) que ceux qui reçoivent du midazolam ( 92,8 ± 35,0 min , P < 0,05 ) . Après la physiothérapie , le dosage de midazolam nécessite 1,8 ± 0.5 ajustements comparativement à 0,4 ± 0,2 pour le propofol ( P < 0,05 ) . Pendant la physiothérapie , la posologie du propofol doit être ajustée 3,0 ± 0,5 fois comparativement à 3,6 ± 0,5 pour celle du midazolam ( NS ) . En conclusion , pendant une stimulation st and ardisée , la perfusion de propofol permet de maintenir le niveau de sédation désiré plus souvent que la perfusion de midazolam . Par la suite , lorsqu’on diminue la perfusion , le temps requis pour le retour à la ligne de base nécessite moins d’ajustements pour le propofol que pour le midazolam UNLABELLED It was the aim of this study to compare two regimens for sedation and analgesia during ventilator treatment in intensive care patients . Special regard was given to endocrine stress response , neuro-monitoring , hemodynamic parameters and clinical practicability . METHODS A total number of 16 patients of an operative ICU were r and omly allocated to the following groups : ( 1 ) Fentanyl-group , approximately 0.2 mg/h fentanyl , 2.5 mg/h midazolam and 2 mg/h pancuronium in intermittent doses , ( 2 ) ketamine-group , about 50 mg/h ketamine and 2.5 mg/h midazolam by syringe pump , in addition 2 mg/h pancuronium . During a period of 2 days and in intervalls of 6 h , plasma levels of epinephrine and norepinephrine ( by HPLC/ECD ) , ADH , ACTH and cortisol ( by RIA ) , ketamine ( by GC ) and stress-metabolites ( glucose , lactate , free glycerol ) were determined . Hemodynamic parameters were investigated in intervalls of 12 h , EEG ( Compressed Spectral Array , CSA ) in intervalls of 24 h. In addition , routine laboratory data , vigilance and adaptation to the respirator were observed . RESULTS Plasma levels of adrenaline , noradrenaline , dopamine , ADH , ACTH , cortisol and stress-metabolites were comparable in both groups . Levels of ADH , ACTH , cortisol and free glycerol did not leave the normal range . In three patients , in which epinephrine- or norepinephrine-infusions were necessary to improve cardiocirculatory stability , this treatment could be finished after beginning of the ketamine application . In both groups , CSA showed a dominant delta- und theta-activity according to the clinical aspects of sufficient sedation and analgesia . Hemodynamic parameters were comparable in both groups . ( ABSTRACT TRUNCATED AT 250 WORDS A 2 % solution of propofol has been compared with the 1 % formulation for sedation in patients whose lungs were being mechanically ventilated in an intensive care unit following coronary artery bypass surgery . There were no significant differences in the amount of  propofol  used in the two groups , the rate of  propofol infusion or the number of changes made to the infusion rate to maintain the desired level of sedation . Recovery times and times to tracheal extubation were similar . The mean heart rates of those receiving 2 % propofol were significantly higher throughout the period of the study for no apparent reason . Propofol 2 % was found to be safe , easy to administer and a practical alternative to the 1 % solution for sedating cardiac surgical patients A r and omised crossover study was undertaken to compare the quality and cost of controlled versus empirical sedation with midazolam in critically ill patients . Patients ( n = 40 ) entering the ICU were enrolled provided they satisfied the strict entry criteria . During 90 hours of midazolam sedation , patients received r and omly allocated 10-hour periods of controlled or empirical sedation . With empirical sedation , the mean dose of midazolam  and the cost of sedation were almost double those with controlled sedation . The quality of sedation was superior with the controlled method . In a separate study on 352 patients , a cost-benefit analysis of controlled sedation with midazolam or propofol infusion or bolus injections of morphine plus diazepam showed that the quality of sedation achieved with propofol was superior to the other two regimens and that , with morphine plus diazepam , the quality of sedation was unacceptably poor . Although the direct purchase price of propofol was higher than that of other agents , the total cost of sedation with propofol was lower than that for midazolam for short-term intensive care ( less than 24 hours ) and comparable to midazolam for longer-term use . However , indirect benefits of sedation with propofol include a much shorter ICU stay with the attendant reduced nursing costs and greater throughout the patients , and this more than compensates for the higher purchase price of the agent Objective : The assessment of propofol to produce diurnal sedation in critically ill patients Design : Prospect i ve clinical study Setting : Intensive Care Unit , University Hospital Patients and participants : Thirty consecutive patients admitted to the Intensive Care Unit older than 18 years who were expected to be se date d for more than 50 h Interventions : The patients were r and omised into two groups . All received sedation with a constant background infusion of morphine and a variable infusion rate of propofol , which was altered hourly to maintain the intended sedation score . The first group received constant light sedation ( CLS ) over 50 h aim ing for a Ramsay score of 2–3 . The second group received CLS between 0600 h and 2200 h and additional night sedation ( ANS ) with propofol between 2200 h and 0600 h , aim ing for a sedation score of 4–5 . Measurements and results : Patients were studied for 50 h from 1800 h on the first day of admission . Recordings of heart rate , blood pressure , sedation scores and propofol and morphine infusion rates were made hourly . An APACHE II score was recorded for each patient . Sedation scores were analysed by blind visual assessment and cosinor analysis , which is used in chronobiology to examine the correlation of data with a cosine curve . Patients in the ANS group had significantly better rhythmicity of sedation levels using cosinor analysis ( r = 26 % v 8 % ) p < 0.01 . There was no difference between the CLS and ANS groups with respect to age , sex or APACHE II scores . Nine out of 15 patients in the ANS group achieved diurnal sedation . Three patients in the CLS group showed diurnal rhythmicity of sedation , which can be attributed to natural sleep , and had a median APACHE II score of 12 . Five patients in the CLS group and three in the ANS group showed a deep constant sedation pattern . They had high APACHE II scores ( median 21.5 ) and an obtunded conscious level on admission due to severe sepsis . Conclusion : Propofol can safely provide diurnal sedation in the critically ill when titrated against the Ramsay score . Sedation levels can not be manipulated in some severely ill patients Sedation was studied in 30 patients requiring overnight ventilation in the intensive therapy unit ( ITU ) . Patients received an infusion of either alfentanil or pethidine , supplemented with midazolam . The infusion rates were adjusted to provide optimal sedation as judged by a nurse , and measurements were made of quality of sedation , recovery and serum cortisol concentration . In addition , blood concentrations of alfentanil were measured to permit pharmacokinetic and pharmacodynamic analysis . Satisfactory sedation was achieved in both groups . The required infusion rate for alfentanil was between 0.4 and 0.5 micrograms kg-1 min-1 . Recovery was good in both groups , apart from one patient in the alfentanil group , in whom recovery was greatly prolonged and alfentanil pharmacokinetics were abnormal . A difference was found in the metabolic response to surgery between the two groups , the response in the alfentanil group being significantly less marked Propofol ( P ) and midazolam ( M ) are frequently given by continuous infusion for sedation in critically ill , mechanically ventilated patients . We compared these drugs with regard to : ( 1 ) time-to-awaken ; ( 2 ) reproducibility of bedside assessment s of level of sedation ; ( 3 ) time-to-sedation ; and ( 4 ) change in oxygen consumption ( V O2 ) from awake to se date d state . Seventy-three patients were prospect ively r and omized to receive either P ( n=37 ) or M ( n=36 ) . Wake-up times after stopping the drug were assessed by blinded and unblinded observers , by asking patients to perform simple tasks . Times to se date were assessed by consensus agreement among nurses and investigators . Demographics and APACHE II scores were not different between P and M. The P group had a significantly narrower range of wake-up times with a higher likelihood of waking in less than 60 min . Blinded versus unblinded observations had excellent correlation . Average time to se date and decrease in V O2 were not different . We conclude that in this patient population : ( 1 ) both P and M achieved optimal sedation in a large fraction of patients when administered by specified dosing protocol s ; ( 2 ) P had a faster , more reliable , wake-up time ; ( 3 ) assessment s of time-to-awaken were objective and reproducible ; ( 4 ) time to sedation was not significantly different ; ( 5 ) V O2 decreased similarly with both Purpose The purpose of this r and omized , double-blind study was to evaluate the efficacy of midazolam and propofol for postoperative sedation and early extubation following cardiac surgery . Methods ASA physical status II-III patients scheduled to undergo elective first-time cardiac surgery with an ejection fraction > 45 % were eligible . All patients received a st and ardized sufentanil/isoflurane anaesthesa . Dunng cardiopulmonary bypass 100 μg · kg−1 · mm 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: It is often necessary to adjust a patient ’s sedation level while they are in the intensive care unit . The purpose of this study was to compare propofol with midazolam for controlling short-term alterations in sedation .  Twenty-three patients undergoing an interactive procedure , physiotherapy , during mechanical ventilation of the lungs were studied . The patients were r and omly assigned to receive infusions of propofol or midazolam for sedation . Sedation was assessed using the method of Ramsay , where 3 is drowsy responding only to comm and s ; and 5 is asleep with a slow response to light glabellar tap . Prior to physiotherapy sedation was deepened from 3 to 5 by increasing the sedative infusion rate , and level 5 was maintained during physiotherapy by adjusting the infusion rate whenever necessary . After physiotherapy , the sedative dose was reduced until level 3 was again achieved . During physiotherapy , sedation level 5 was achieved for 53.9 % of the time with propofol but for only 25.7 % with midazolam ( P < 0.01 ) . After physiotherapy , those patients se date d with propofol  re-awakened to level 3 faster ( 8.3 ± 2.3 min , mean ±SE ) than those receiving midazolam ( 92.8 ± 35.0 min , P < 0.05 ) . After physiotherapy , a further 1.8 ± 0.5 dose adjustments were required to the  midazolam  infusion while only 0.4 ± 0.2 adjustments were required to the propofol infusion ( P < 0.05 ) . During physiotherapy 3.0 ± 0.5 dose adjustments to the propofol dose were required compared with 3.6 ± 0.5 adjustments to the midazolam dose ( NS ) . It is concluded that , during a st and ardized stimulus , physiotherapy , propofol infusion allowed a desired sedation score to be maintained for more of the time than did infusion of midazolam . Subsequently , when the infusion rates were reduced , less time was taken to re-awaken to baseline levels after physiotherapy , with fewer adjustments to the infusion rate , in those patients receiving propofol than midazolam . RésuméAux soins intensifs , il faut fréquemment modifier le niveau de sédation ; cette étude compare le propofol au midazolam pour contrôler ces changements de courte durée . Vingt-trois patients sous ventilateur mécanique soumis à des manoeuvres de physiothérapie interactive sont inclus dans l’étude . Ils reçoivent au hasard en sédation une perfusion de profopol ou de midazolam . La sédation est évaluée selon l’échelle de Ramsey ; on accorde 3 pour la somnolence avec réponse aux ordres et 5 au sommeil avec réponse lente à la légère percussion de la glabelle . Avant la physiothérapie , la sédation est approfondie du niveau 3 au niveau 5 en augmentant la perfusion au besoin . Après la physiothérapie , on réduit la perfusion jusqu’au retour au niveau 3 . Pendant la physiothérapie , le niveau 5 est atteint pendant 53,9 % de la durée du traitement avec le propofol contre seulement 25,7 % avec le midazolam ( P < 0,01 ) . Après la physiothérapie , les patients sous propofol reviennent au niveau 3 plus rapidement ( 8,3 ± 2,3 min , moyenne ± SD ) que ceux qui reçoivent du midazolam ( 92,8 ± 35,0 min , P < 0,05 ) . Après la physiothérapie , le dosage de midazolam nécessite 1,8 ± 0.5 ajustements comparativement à 0,4 ± 0,2 pour le propofol ( P < 0,05 ) . Pendant la physiothérapie , la posologie du propofol doit être ajustée 3,0 ± 0,5 fois comparativement à 3,6 ± 0,5 pour celle du midazolam ( NS ) . En conclusion , pendant une stimulation st and ardisée , la perfusion de propofol permet de maintenir le niveau de sédation désiré plus souvent que la perfusion de midazolam . Par la suite , lorsqu’on diminue la perfusion , le temps requis pour le retour à la ligne de base nécessite moins d’ajustements pour le propofol que pour le midazolam UNLABELLED It was the aim of this study to compare two regimens for sedation and analgesia during ventilator treatment in intensive care patients . Special regard was given to endocrine stress response , neuro-monitoring , hemodynamic parameters and clinical practicability . METHODS A total number of 16 patients of an operative ICU were r and omly allocated to the following groups : ( 1 ) Fentanyl-group , approximately 0.2 mg/h fentanyl , 2.5 mg/h midazolam and 2 mg/h pancuronium in intermittent doses , ( 2 ) ketamine-group , about 50 mg/h ketamine and 2.5 mg/h midazolam by syringe pump , in addition 2 mg/h pancuronium . During a period of 2 days and in intervalls of 6 h , plasma levels of epinephrine and norepinephrine ( by HPLC/ECD ) , ADH , ACTH and cortisol ( by RIA ) , ketamine ( by GC ) and stress-metabolites ( glucose , lactate , free glycerol ) were determined . Hemodynamic parameters were investigated in intervalls of 12 h , EEG ( Compressed Spectral Array , CSA ) in intervalls of 24 h. In addition , routine laboratory data , vigilance and adaptation to the respirator were observed . RESULTS Plasma levels of adrenaline , noradrenaline , dopamine , ADH , ACTH , cortisol and stress-metabolites were comparable in both groups . Levels of ADH , ACTH , cortisol and free glycerol did not leave the normal range . In three patients , in which epinephrine- or norepinephrine-infusions were necessary to improve cardiocirculatory stability , this treatment could be finished after beginning of the ketamine application . In both groups , CSA showed a dominant delta- und theta-activity according to the clinical aspects of sufficient sedation and analgesia . Hemodynamic parameters were comparable in both groups . ( ABSTRACT TRUNCATED AT 250 WORDS A 2 % solution of propofol has been compared with the 1 % formulation for sedation in patients whose lungs were being mechanically ventilated in an intensive care unit following coronary artery bypass surgery . There were no significant differences in the amount of  propofol  used in the two groups , the rate of  propofol infusion or the number of changes made to the infusion rate to maintain the desired level of sedation . Recovery times and times to tracheal extubation were similar . The mean heart rates of those receiving 2 % propofol were significantly higher throughout the period of the study for no apparent reason . Propofol 2 % was found to be safe , easy to administer and a practical alternative to the 1 % solution for sedating cardiac surgical patients A r and omised crossover study was undertaken to compare the quality and cost of controlled versus empirical sedation with midazolam in critically ill patients . Patients ( n = 40 ) entering the ICU were enrolled provided they satisfied the strict entry criteria . During 90 hours of midazolam sedation , patients received r and omly allocated 10-hour periods of controlled or empirical sedation . With empirical sedation , the mean dose of midazolam  and the cost of sedation were almost double those with controlled sedation . The quality of sedation was superior with the controlled method . In a separate study on 352 patients , a cost-benefit analysis of controlled sedation with midazolam or propofol infusion or bolus injections of morphine plus diazepam showed that the quality of sedation achieved with propofol was superior to the other two regimens and that , with morphine plus diazepam , the quality of sedation was unacceptably poor . Although the direct purchase price of propofol was higher than that of other agents , the total cost of sedation with propofol was lower than that for midazolam for short-term intensive care ( less than 24 hours ) and comparable to midazolam for longer-term use . However , indirect benefits of sedation with propofol include a much shorter ICU stay with the attendant reduced nursing costs and greater throughout the patients , and this more than compensates for the higher purchase price of the agent Objective : The assessment of propofol to produce diurnal sedation in critically ill patients Design : Prospect i ve clinical study Setting : Intensive Care Unit , University Hospital Patients and participants : Thirty consecutive patients admitted to the Intensive Care Unit older than 18 years who were expected to be se date d for more than 50 h Interventions : The patients were r and omised into two groups . All received sedation with a constant background infusion of morphine and a variable infusion rate of propofol , which was altered hourly to maintain the intended sedation score . The first group received constant light sedation ( CLS ) over 50 h aim ing for a Ramsay score of 2–3 . The second group received CLS between 0600 h and 2200 h and additional night sedation ( ANS ) with propofol between 2200 h and 0600 h , aim ing for a sedation score of 4–5 . Measurements and results : Patients were studied for 50 h from 1800 h on the first day of admission . Recordings of heart rate , blood pressure , sedation scores and propofol and morphine infusion rates were made hourly . An APACHE II score was recorded for each patient . Sedation scores were analysed by blind visual assessment and cosinor analysis , which is used in chronobiology to examine the correlation of data with a cosine curve . Patients in the ANS group had significantly better rhythmicity of sedation levels using cosinor analysis ( r = 26 % v 8 % ) p < 0.01 . There was no difference between the CLS and ANS groups with respect to age , sex or APACHE II scores . Nine out of 15 patients in the ANS group achieved diurnal sedation . Three patients in the CLS group showed diurnal rhythmicity of sedation , which can be attributed to natural sleep , and had a median APACHE II score of 12 . Five patients in the CLS group and three in the ANS group showed a deep constant sedation pattern . They had high APACHE II scores ( median 21.5 ) and an obtunded conscious level on admission due to severe sepsis . Conclusion : Propofol can safely provide diurnal sedation in the critically ill when titrated against the Ramsay score . Sedation levels can not be manipulated in some severely ill patients Sedation was studied in 30 patients requiring overnight ventilation in the intensive therapy unit ( ITU ) . Patients received an infusion of either alfentanil or pethidine , supplemented with midazolam . The infusion rates were adjusted to provide optimal sedation as judged by a nurse , and measurements were made of quality of sedation , recovery and serum cortisol concentration . In addition , blood concentrations of alfentanil were measured to permit pharmacokinetic and pharmacodynamic analysis . Satisfactory sedation was achieved in both groups . The required infusion rate for alfentanil was between 0.4 and 0.5 micrograms kg-1 min-1 . Recovery was good in both groups , apart from one patient in the alfentanil group , in whom recovery was greatly prolonged and alfentanil pharmacokinetics were abnormal . A difference was found in the metabolic response to surgery between the two groups , the response in the alfentanil group being significantly less marked Propofol ( P ) and midazolam ( M ) are frequently given by continuous infusion for sedation in critically ill , mechanically ventilated patients . We compared these drugs with regard to : ( 1 ) time-to-awaken ; ( 2 ) reproducibility of bedside assessment s of level of sedation ; ( 3 ) time-to-sedation ; and ( 4 ) change in oxygen consumption ( V O2 ) from awake to se date d state . Seventy-three patients were prospect ively r and omized to receive either P ( n=37 ) or M ( n=36 ) . Wake-up times after stopping the drug were assessed by blinded and unblinded observers , by asking patients to perform simple tasks . Times to se date were assessed by consensus agreement among nurses and investigators . Demographics and APACHE II scores were not different between P and M. The P group had a significantly narrower range of wake-up times with a higher likelihood of waking in less than 60 min . Blinded versus unblinded observations had excellent correlation . Average time to se date and decrease in V O2 were not different . We conclude that in this patient population : ( 1 ) both P and M achieved optimal sedation in a large fraction of patients when administered by specified dosing protocol s ; ( 2 ) P had a faster , more reliable , wake-up time ; ( 3 ) assessment s of time-to-awaken were objective and reproducible ; ( 4 ) time to sedation was not significantly different ; ( 5 ) V O2 decreased similarly with both Purpose The purpose of this r and omized , double-blind study was to evaluate the efficacy of midazolam and propofol for postoperative sedation and early extubation following cardiac surgery . Methods ASA physical status II-III patients scheduled to undergo elective first-time cardiac surgery with an ejection fraction > 45 % were eligible . All patients received a st and ardized sufentanil/isoflurane anaesthesa . Dunng cardiopulmonary bypass 100 μg · kg−1 · mm 
    Output:
    