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Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients

BACKGROUND: Analgosedation is a cornerstone therapy for mechanically ventilated patients in intensive care units (ICU). To avoid inadequate sedation and its complications, monitoring of analgosedation is of great importance. The aim of this study was to investigate whether monitoring of analgosedati...

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Autores principales: Nies, Richard J., Müller, Carsten, Pfister, Roman, Binder, Philipp S., Nosseir, Nicole, Nettersheim, Felix S., Kuhr, Kathrin, Wiesen, Martin H. J., Kochanek, Matthias, Michels, Guido
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137863/
https://www.ncbi.nlm.nih.gov/pubmed/30302254
http://dx.doi.org/10.1186/s40560-018-0331-7
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author Nies, Richard J.
Müller, Carsten
Pfister, Roman
Binder, Philipp S.
Nosseir, Nicole
Nettersheim, Felix S.
Kuhr, Kathrin
Wiesen, Martin H. J.
Kochanek, Matthias
Michels, Guido
author_facet Nies, Richard J.
Müller, Carsten
Pfister, Roman
Binder, Philipp S.
Nosseir, Nicole
Nettersheim, Felix S.
Kuhr, Kathrin
Wiesen, Martin H. J.
Kochanek, Matthias
Michels, Guido
author_sort Nies, Richard J.
collection PubMed
description BACKGROUND: Analgosedation is a cornerstone therapy for mechanically ventilated patients in intensive care units (ICU). To avoid inadequate sedation and its complications, monitoring of analgosedation is of great importance. The aim of this study was to investigate whether monitoring of analgosedative drug concentrations (midazolam and sufentanil) might be beneficial to optimize analgosedation and whether drug serum concentrations correlate with the results of subjective (Richmond Agitation-Sedation Scale [RASS]/Ramsay Sedation Scale) and objective (bispectral (BIS) index) monitoring procedures. METHODS: Forty-nine intubated, ventilated, and analgosedated critically ill patients treated in ICU were clinically evaluated concerning the depth of sedation using RASS Score, Ramsay Score, and BIS index twice a day. Serum concentrations of midazolam and sufentanil were determined in blood samples drawn at the same time. Clinical and laboratory data were statistically analyzed for correlations using the Spearman’s rank correlation coefficient rho (ρ). RESULTS: Average age of the population was 57.8 ± 16.0 years, 61% of the patients were males. Most frequent causes for ICU treatments were sepsis (22%), pneumonia (22%), or a combination of both (25%). Serum concentrations of midazolam correlated weakly with RASS (ρ = − 0.467) and Ramsay Scores (ρ = 0.476). Serum concentrations of sufentanil correlated weakly with RASS (ρ = − 0.312) and Ramsay Scores (ρ = 0.295). Correlations between BIS index and serum concentrations of midazolam (ρ = − 0.252) and sufentanil (ρ = − 0.166) were low. CONCLUSION: Correlations between drug serum concentrations and clinical or neurophysiological monitoring procedures were weak. This might be due to intersubject variability, polypharmacy with drug-drug interactions, and complex metabolism, which can be altered in critically ill patients. Therapeutic drug monitoring is not beneficial to determine depth of sedation in ICU patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40560-018-0331-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-61378632018-10-09 Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients Nies, Richard J. Müller, Carsten Pfister, Roman Binder, Philipp S. Nosseir, Nicole Nettersheim, Felix S. Kuhr, Kathrin Wiesen, Martin H. J. Kochanek, Matthias Michels, Guido J Intensive Care Research BACKGROUND: Analgosedation is a cornerstone therapy for mechanically ventilated patients in intensive care units (ICU). To avoid inadequate sedation and its complications, monitoring of analgosedation is of great importance. The aim of this study was to investigate whether monitoring of analgosedative drug concentrations (midazolam and sufentanil) might be beneficial to optimize analgosedation and whether drug serum concentrations correlate with the results of subjective (Richmond Agitation-Sedation Scale [RASS]/Ramsay Sedation Scale) and objective (bispectral (BIS) index) monitoring procedures. METHODS: Forty-nine intubated, ventilated, and analgosedated critically ill patients treated in ICU were clinically evaluated concerning the depth of sedation using RASS Score, Ramsay Score, and BIS index twice a day. Serum concentrations of midazolam and sufentanil were determined in blood samples drawn at the same time. Clinical and laboratory data were statistically analyzed for correlations using the Spearman’s rank correlation coefficient rho (ρ). RESULTS: Average age of the population was 57.8 ± 16.0 years, 61% of the patients were males. Most frequent causes for ICU treatments were sepsis (22%), pneumonia (22%), or a combination of both (25%). Serum concentrations of midazolam correlated weakly with RASS (ρ = − 0.467) and Ramsay Scores (ρ = 0.476). Serum concentrations of sufentanil correlated weakly with RASS (ρ = − 0.312) and Ramsay Scores (ρ = 0.295). Correlations between BIS index and serum concentrations of midazolam (ρ = − 0.252) and sufentanil (ρ = − 0.166) were low. CONCLUSION: Correlations between drug serum concentrations and clinical or neurophysiological monitoring procedures were weak. This might be due to intersubject variability, polypharmacy with drug-drug interactions, and complex metabolism, which can be altered in critically ill patients. Therapeutic drug monitoring is not beneficial to determine depth of sedation in ICU patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40560-018-0331-7) contains supplementary material, which is available to authorized users. BioMed Central 2018-09-14 /pmc/articles/PMC6137863/ /pubmed/30302254 http://dx.doi.org/10.1186/s40560-018-0331-7 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Nies, Richard J.
Müller, Carsten
Pfister, Roman
Binder, Philipp S.
Nosseir, Nicole
Nettersheim, Felix S.
Kuhr, Kathrin
Wiesen, Martin H. J.
Kochanek, Matthias
Michels, Guido
Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients
title Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients
title_full Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients
title_fullStr Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients
title_full_unstemmed Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients
title_short Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients
title_sort monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? a prospective observation study of medical intensive care patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137863/
https://www.ncbi.nlm.nih.gov/pubmed/30302254
http://dx.doi.org/10.1186/s40560-018-0331-7
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