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Background and Importance Intravenous sedation (IS) is routinely used in critically ill patients (CIP) requiring invasive mechanical ventilation (IMV). Selecting an appropriate sedative regimen (SR) is essential to optimise ventilation and reduce complications. Evidence on which SR minimises adverse events and improves extubation success remains limited.Aim and Objectives This study aimed to evaluate the therapeutic use of intravenous SR in CIP undergoing IMV. Primary objective: to assess the association between intravenous SR and IMV duration. Secondary objectives: to evaluate the association between SR use and extubation success, as well as the incidence of SR related complications (agitation, delirium, hypotension and bradycardia).Material and Methods Retrospective, observational, and descriptive study from January-March 2025, including adult patients admitted to intensive care unit (ICU) who required IVM and received continuous IS. Sedation included midazolam (in combination with propofol, dexmedetomidine, or as monotherapy) and regimens without midazolam (propofol alone or with dexmedetomidine).Inclusion criteria were: treatment with one of the above intravenous SR, ICU stay longer than 48-hours, IVM, ability to discontinue sedation, and being candidates for extubation during the ICU stay, whether successful or not.The following variables were analysed: SR used, age, SAPS-III at admission, target sedation level, IVM duration, successful extubation (no-reintubation within 48-hours), complications during ICU stay (agitation, delirium, hypotension and bradycardia).Continuous variables were analysed using Mann–Whitney-U test and categorical variables by χ2-test (p< 0.05). Data were analysed using SPSSv27.Results 51 patients were included: 28 (55%) received midazolam-based SR and 23 (45%) without midazolam. The mean age (years) was 66.6 (SD 15.0), and 66.7% were aged ≥65. The overall mean SAPS-III score at admission was 48.8 (SD 12.1).Median IVM duration was statistically higher in midazolam group compared to non-midalozam group: 8.5 days [IQR 19,5–4]) vs 2 days[IQR 4–1];( p<0.001).Extubation success rate was higher in non-midazolam group (88.6% vs 63%).SR related complications were higher in the midazolam group: agitation (50% vs 47,8%), delirium (25% vs 4,3%), hypotension (53.6% vs 21, 7, 1%) and bradycardia (35.7% vs 26,1).Conclusion and Relevance Regimens including midazolam were associated with significantly longer IVM duration compared to regimens without midazolam and higher rate of complications.Our results support current recommendations regarding avoidance of benzodiazepines in CIP’s sedation as far as possible and implement new modalities such as inhaled sedation and other intravenous strategies.Conflict of Interest No conflict of interest