Cipepofol versus Conventional Sedation for Pneumonia Patients Receiving Mechanical Ventilation: A Real-World Retrospective Study of Effectiveness and Hemodynamic Safety.

PURPOSE: Severe pneumonia often necessitates invasive mechanical ventilation (MV) and prolonged sedation in the ICU. This real-world retrospective cohort study aimed to compare cipepofol vs conventional sedation regimens in this vulnerable population, with MV duration as the primary endpoint and hemodynamic safety as a key safety outcome.

PATIENTS AND

METHODS

This retrospective cohort study evaluated mechanically ventilated patients with severe pneumonia who received continuous sedation for more than 48 hours. Patients were classified into cipepofol or conventional sedation (propofol-, midazolam- or dexmedetomidine-based) groups. Propensity score matching (PSM) was performed at a 1:1 ratio based on age and APACHE II scores.

RESULTS

After PSM, 198 patients (99 per group) were analyzed. The primary endpoint-MV duration did not differ significantly between the cipepofol and conventional groups (median 218.23 vs 227.25 hours, P = 0.740). Subgroup analysis further confirmed that there was no significant difference in MV duration between propofol- and midazolam-based regimens compared to the cipepofol-regimen. Notably, cipepofol demonstrated superior hemodynamic safety, showing significantly lower incidences of early hypotension within the first hour (11.1% vs 27.3%, P=0.007) and overall bradycardia (19.1% vs 36.1%, P=0.014). Post-hoc subgroups analysis revealed that cipepofol reduced the risks of early hypotension and overall bradycardia compared to propofol- or midazolam-based regimens in hospital-acquired pneumonia patients. Multivariate analysis confirmed cipepofol use as an independent protective factor against early hypotension (adjusted OR 0.300, 95% CI: 0.136-0.665, P=0.003) and bradycardia (adjusted OR 0.414, 95% CI: 0.212-0.808, P=0.010). No significant differences were found regarding sedation success, length of ICU stay, 28-day ventilator-free days, 28-day mortality, vasopressor requirements, or organ function parameters (all P>0.05).

CONCLUSION

In mechanically ventilated patients with severe pneumonia requiring prolonged sedation, cipepofol did not shorten MV duration compared with propofol- or midazolam-based conventional regimens, but it significantly reduced risks for early hypotension and overall bradycardia events.

TRIAL REGISTRATION: ClinicalTrials.gov (NCT06514781).