Recommended dosages of analgesic and sedative drugs in intensive care result in a low incidence of potentially toxic blood concentrations.

Autor:	Lennborn U; Department of Surgical Sciences, Division of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden., Johansson A; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden., Lindgren E; Department of Surgical Sciences, Division of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden., Nielsen EI; Department of Pharmacy, Uppsala University, Uppsala, Sweden., Sandler H; Department of Surgical Sciences/Forensic Medicine, Uppsala University, Uppsala, Sweden., Bertilsson M; Uppsala Clinical Research Centre, Uppsala University, Uppsala Sweden., Kronstrand R; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.; Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden., Ahlner J; Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden., Kugelberg FC; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.; Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden., Rubertsson S; Department of Surgical Sciences, Division of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Jazyk:	angličtina
Zdroj:	Upsala journal of medical sciences [Ups J Med Sci] 2024 May 09; Vol. 129. Date of Electronic Publication: 2024 May 09 (Print Publication: 2024).
DOI:	10.48101/ujms.v129.10560
Abstrakt:	Background: Standard dosages of analgesic and sedative drugs are given to intensive care patients. The resulting range of blood concentrations and corresponding clinical responses need to be better examined. The purpose of this study was to describe daily dosages, measured blood concentrations, and clinical responses in critically ill patients. The purpose was also to contribute to establishing whole blood concentration reference values of the drugs investigated. Methods: A descriptive study of prospectively collected data from 302 admissions to a general intensive care unit (ICU) at a university hospital. Ten drugs (clonidine, fentanyl, morphine, dexmedetomidine, ketamine, ketobemidone, midazolam, paracetamol, propofol, and thiopental) were investigated, and daily dosages recorded. Blood samples were collected twice daily, and drug concentrations were measured. Clinical responses were registered using Richmond agitation-sedation scale (RASS) and Numeric rating scale (NRS). Results: Drug dosages were within recommended dose ranges. Blood concentrations for all 10 drugs showed a wide variation within the cohort, but only 3% were above therapeutic interval where clonidine (57 of 122) and midazolam (38 of 122) dominated. RASS and NRS were not correlated to drug concentrations. Conclusion: Using recommended dose intervals for analgesic and sedative drugs in the ICU setting combined with regular monitoring of clinical responses such as RASS and NRS leads to 97% of concentrations being below the upper limit in the therapeutic interval. This study contributes to whole blood drug concentration reference values regarding these 10 drugs. Competing Interests: The authors report no conflict of interest. (© 2024 The Author(s).)
Databáze:	MEDLINE
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