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Differentiating midazolam over-sedation from neurological damage in the intensive care unit

INTRODUCTION: Midazolam is used routinely to sedate patients in the intensive care unit (ICU). We suspected that midazolam over-sedation was occurring in the ICU of the Guy's and St. Thomas' Trust and that it could be difficult to differentiate this from underlying neurological damage. A s...

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Autores principales: McKenzie, Catherine A, McKinnon, William, Naughton, Declan P, Treacher, David, Davies, Graham, Phillips, Gary J, Hilton, Philip J
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2005
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065106/
https://www.ncbi.nlm.nih.gov/pubmed/15693964
http://dx.doi.org/10.1186/cc3010
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author McKenzie, Catherine A
McKinnon, William
Naughton, Declan P
Treacher, David
Davies, Graham
Phillips, Gary J
Hilton, Philip J
author_facet McKenzie, Catherine A
McKinnon, William
Naughton, Declan P
Treacher, David
Davies, Graham
Phillips, Gary J
Hilton, Philip J
author_sort McKenzie, Catherine A
collection PubMed
description INTRODUCTION: Midazolam is used routinely to sedate patients in the intensive care unit (ICU). We suspected that midazolam over-sedation was occurring in the ICU of the Guy's and St. Thomas' Trust and that it could be difficult to differentiate this from underlying neurological damage. A sensitive assay for detecting midazolam and 1-hydroxymidazolam glucuronide (1-OHMG) in serum was developed and applied in the clinical setting. METHODS: In the present study we evaluated a series of cases managed in a mixed medical, surgical and trauma ICU. Serum was collected from 26 patients who received midazolam, were 'slow to wake' and in whom there was suspicion of neurological damage. Patient outcome was followed in terms of mortality, neurological recovery and neurological damage on discharge. RESULTS: Out of 26 patients, 13 had detectable serum levels of midazolam and/or 1-OHMG after a median of 67 hours (range 36–146 hours) from midazolam cessation. Of these 13 patients in whom midazolam/1-OHMG was detectable, 10 made a full neurological recovery. Of the remaining 13 patients with no detectable midazolam/1-OHMG, three made a full neurological recovery; 10 patients were subsequently found to have suffered neurological damage (P < 0.002), eight of whom died and two were discharged from the ICU with profound neurological damage. CONCLUSION: These findings confirm that prolonged sedation after midazolam therapy should be considered in the differential diagnosis of neurological damage in the ICU. This can be reliably detected by the assay method described. The effects of midazolam/1-OHMG persist days after administration of midazolam has ceased. After prolonged sedation has been excluded in this patient group, it is highly likely that neurological damage has occurred.
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spelling pubmed-10651062005-03-16 Differentiating midazolam over-sedation from neurological damage in the intensive care unit McKenzie, Catherine A McKinnon, William Naughton, Declan P Treacher, David Davies, Graham Phillips, Gary J Hilton, Philip J Crit Care Research INTRODUCTION: Midazolam is used routinely to sedate patients in the intensive care unit (ICU). We suspected that midazolam over-sedation was occurring in the ICU of the Guy's and St. Thomas' Trust and that it could be difficult to differentiate this from underlying neurological damage. A sensitive assay for detecting midazolam and 1-hydroxymidazolam glucuronide (1-OHMG) in serum was developed and applied in the clinical setting. METHODS: In the present study we evaluated a series of cases managed in a mixed medical, surgical and trauma ICU. Serum was collected from 26 patients who received midazolam, were 'slow to wake' and in whom there was suspicion of neurological damage. Patient outcome was followed in terms of mortality, neurological recovery and neurological damage on discharge. RESULTS: Out of 26 patients, 13 had detectable serum levels of midazolam and/or 1-OHMG after a median of 67 hours (range 36–146 hours) from midazolam cessation. Of these 13 patients in whom midazolam/1-OHMG was detectable, 10 made a full neurological recovery. Of the remaining 13 patients with no detectable midazolam/1-OHMG, three made a full neurological recovery; 10 patients were subsequently found to have suffered neurological damage (P < 0.002), eight of whom died and two were discharged from the ICU with profound neurological damage. CONCLUSION: These findings confirm that prolonged sedation after midazolam therapy should be considered in the differential diagnosis of neurological damage in the ICU. This can be reliably detected by the assay method described. The effects of midazolam/1-OHMG persist days after administration of midazolam has ceased. After prolonged sedation has been excluded in this patient group, it is highly likely that neurological damage has occurred. BioMed Central 2005 2004-12-14 /pmc/articles/PMC1065106/ /pubmed/15693964 http://dx.doi.org/10.1186/cc3010 Text en Copyright © 2004 McKenzie et al., licensee BioMed Central Ltd.
spellingShingle Research
McKenzie, Catherine A
McKinnon, William
Naughton, Declan P
Treacher, David
Davies, Graham
Phillips, Gary J
Hilton, Philip J
Differentiating midazolam over-sedation from neurological damage in the intensive care unit
title Differentiating midazolam over-sedation from neurological damage in the intensive care unit
title_full Differentiating midazolam over-sedation from neurological damage in the intensive care unit
title_fullStr Differentiating midazolam over-sedation from neurological damage in the intensive care unit
title_full_unstemmed Differentiating midazolam over-sedation from neurological damage in the intensive care unit
title_short Differentiating midazolam over-sedation from neurological damage in the intensive care unit
title_sort differentiating midazolam over-sedation from neurological damage in the intensive care unit
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1065106/
https://www.ncbi.nlm.nih.gov/pubmed/15693964
http://dx.doi.org/10.1186/cc3010
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