Universität zu Köln

Nies, Richard J., Mueller, Carsten, Pfister, Roman, Binder, Philipp S., Nosseir, Nicole, Nettersheim, Felix S., Kuhr, Kathrin, Wiesen, Martin H. J., Kochanek, Matthias and Michels, Guido (2018). Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients. J. Intensive Care, 6. LONDON: BMC. ISSN 2052-0492

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Abstract

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 (rho). 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 (rho = - 0.467) and Ramsay Scores (rho = 0.476). Serum concentrations of sufentanil correlated weakly with RASS (rho = - 0.312) and Ramsay Scores (rho = 0.295). Correlations between BIS index and serum concentrations of midazolam (rho = - 0.252) and sufentanil (rho = - 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Nies, Richard J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED Binder, Philipp S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Nosseir, Nicole UNSPECIFIED UNSPECIFIED UNSPECIFIED Nettersheim, Felix S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhr, Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Wiesen, Martin H. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kochanek, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Michels, Guido UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-172937
DOI:	10.1186/s40560-018-0331-7
Journal or Publication Title:	J. Intensive Care
Volume:	6
Date:	2018
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	2052-0492
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CRITICALLY-ILL PATIENTS; BISPECTRAL INDEX; ICU PATIENTS; MIDAZOLAM; SUFENTANIL; PROPOFOL; PHARMACOKINETICS; ALFENTANIL; AGITATION; FAILURE Multiple languages Critical Care Medicine Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/17293