Effect of Remimazolam Sedation on Outcomes of Mechanically Ventilated Patients in the ICU

Inclusion Criteria: * Age ≥ 18 years; * Endotracheal intubation and mechanical ventilation for 24-96 hours before enrollment Expected need for continued invasive ventilation and sedation for at least 24 hours; * Target sedation depth on the Richmond Agitation-Sedation Scale (RASS) between 0 and -3; * Informed consent obtained from the patient's family Exclusion Criteria: * Body mass index (BMI) \> 30 kg/m² * Severe central nervous system disease (e.g., acute stroke, uncontrolled seizures, or severe dementia) or any other condition that precludes RASS assessment * Mean arterial pressure (MAP) \< 55 mmHg despite intravenous fluid resuscitation and vasopressors * Heart rate \< 50 beats per minute, or second-degree or third-degree atrioventricular block in the absence of a pacemaker * Acute myocardial infarction or severe heart failure (New York Heart Association \[NYHA\] class IV) * Left ventricular ejection fraction \< 30% * Any contraindication or allergy to benzodiazepines * Substance dependence, alcohol abuse, or psychiatric/psychological disorders. Alcohol abuse was defined as regular consumption of \> 14 drinks per week (1 drink = 150 mL wine, 360 mL beer, or 45 mL liquor) * Acute hepatitis or severe hepatic dysfunction (Child-Pugh class C) * Chronic kidney disease with a glomerular filtration rate (GFR) \< 60 mL/min/1.73 m² * Neuromuscular disease * Patients on extracorporeal membrane oxygenation (ECMO) * Pregnancy or breastfeeding