Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
Curr Opin Crit Care. 2010 Apr;16(2):128-35. doi: 10.1097/MCC.0b013e3283374e3c.
Various antiepileptics, sedative and anesthetic agents are used in the neurocritical care setting and therapeutic drug monitoring (TDM) has been proposed as a means to individualize dosing to ensure efficacy, avoid toxicity, and to account for drug-drug interactions. The purpose of this review is to highlight key articles relating to TDM published in the last 5 years with a focus on drug therapy for seizures, status epilepticus, and traumatic brain injury.
Current evidence supports TDM of first-generation antiepileptics, and free-level monitoring for phenytoin and valproic acid is recommended in the neurocritical care population. There are insufficient data to recommend routine TDM of second-generation antiepileptics at this time. In traumatic brain injury, routine TDM of barbiturate infusions appears to be of little value in guiding or evaluating patient response to therapy except to differentiate between drug-induced coma and brain death. Although TDM of sedative agents has been studied, the use of clinical sedation scales is preferred over TDM in evaluating a patient's level of sedation.
Therapeutic drug monitoring plays an important role in the care of patients in the neurocritical care setting but is applicable only to a limited number of drugs.
在神经危重症监护环境中，各种抗癫痫药、镇静和麻醉剂被广泛应用，治疗药物监测（TDM）被提议作为一种个体化给药的手段，以确保疗效、避免毒性，并考虑药物相互作用。本文的目的是重点介绍过去 5 年中与 TDM 相关的关键文献，主要关注癫痫发作、癫痫持续状态和创伤性脑损伤的药物治疗。
目前的证据支持第一代抗癫痫药物的 TDM，并且建议在神经危重症患者中监测苯妥英和丙戊酸的游离水平。目前还没有足够的数据推荐常规 TDM 第二代抗癫痫药物。在创伤性脑损伤中，除了区分药物诱导的昏迷和脑死亡外，常规 TDM 似乎对指导或评估患者对治疗的反应没有什么价值。尽管已经研究了镇静剂的 TDM，但在评估患者镇静水平方面，临床镇静评分比 TDM 更受欢迎。
治疗药物监测在神经危重症患者的治疗中起着重要作用，但仅适用于少数药物。
