ICU sedation, delirium & recovery
Prolonged infusion of remimazolam in surgical and medical intensive care unit patients: a pilot pharmacokinetic study
Authors' conclusion
In this preliminary study, both the surgical ICU group (approximately 24 h) and the medical ICU group (beyond 24 h) showed no evidence of time-dependent accumulation of plasma remimazolam, indicating a generally stable pharmacokinetic profile under the examined conditions.
Study context
- Population
- Patients requiring mechanical ventilation receiving remimazolam 0.1 mg/kg/h for ≥ 24 hcompleted the study
- Participants
- 20 patients
- Comparison
- Prolonged remimazolam infusion in surgical vs medical intensive care unit (ICU) patients
- Surgicaln = 10
- Medical ICUn = 10
- Outcome
- Pharmacokinetics of remimazolam administered continuously
- Follow-up
- 24 h
Methodological detailsopen-label, pilot
- Open-label
- Pilot
Main finding
As reported in the abstract
Pharmacokinetics of prolonged remimazolam infusion
| Group | Value | Plasma concentration at end of infusion | Clearance | Volume of distribution at steady state | Median infusion duration |
|---|---|---|---|---|---|
| Surgical | 130.7 (95% CI 115.2–146.1) ng/mL | 130.7 ng/mL | 54.3 L/h (95% CI 47.6-61.8) | 284 L (95% CI 215-376) | 24.0 h |
| Medical ICU | 134.3 (95% CI 98.7–170.0) ng/mL | 134.3 ng/mL | 55.6 L/h (95% CI 42.8-72.1) | 316 L (95% CI 142-707) | 102.0 h |
Value
Surgical130.7 (95% CI 115.2–146.1) ng/mL
Medical ICU134.3 (95% CI 98.7–170.0) ng/mL
Plasma concentration at end of infusion
Surgical130.7 ng/mL
Medical ICU134.3 ng/mL
Clearance
Surgical54.3 L/h (95% CI 47.6-61.8)
Medical ICU55.6 L/h (95% CI 42.8-72.1)
Volume of distribution at steady state
Surgical284 L (95% CI 215-376)
Medical ICU316 L (95% CI 142-707)
Median infusion duration
Surgical24.0 h
Medical ICU102.0 h
- Surgical vs Medical ICU: P = 0.856 — no statistically significant difference
- Surgical vs Medical ICU: P = 0.780 — no statistically significant difference
- Steady-state plasma concentration intrasubject variability (modest)
- 4.46-32.73%
- Steady-state plasma concentration intersubject variability (moderate)
- 16.45-31.71%
Original publication
Prolonged infusion of remimazolam in surgical and medical intensive care unit patients: a pilot pharmacokinetic study. J Intensive Care. Published 11 December 2025. doi:10.
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