Dzierba Amy L, Stollings Joanna L, Devlin John W
Department of Pharmacy, New York-Presbyterian Hospital, New York, New York, USA.
Center for Acute Respiratory Failure, Columbia University College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, New York, USA.
Pharmacotherapy. 2023 Nov;43(11):1154-1165. doi: 10.1002/phar.2768. Epub 2023 Feb 3.
Precision medicine is a growing field in critical care. Research increasingly demonstrated pharmacogenomic variability to be an important determinant of analgesic and sedative drug response in the intensive care unit (ICU). Genome-wide association and candidate gene finding studies suggest analgesic and sedatives tailored to an individual's genetic makeup, environmental adaptations, in addition to several other patient- and drug-related factors, will maximize effectiveness and help mitigate harm. However, the number of pharmacogenetic studies in ICU patients remains small and no prospective studies have been published using pharmacogenomic data to optimize analgesic or sedative therapy in critically ill patients. Current recommendations for treating ICU pain and agitation are based on controlled studies having low external validity, including the failure to consider pharmacogenomic factors affecting response. Use of a precision medicine approach to individualize pharmacotherapy focused on optimizing ICU patient comfort and safety may improve the outcomes of critically ill adults. Additionally, benefits and risks of analgesic and/or sedative therapy in an individual may be informed with large, standardized datasets. The purpose of this review was to describe a precision medicine approach focused on optimizing analgesic and sedative therapy in individual ICU patients to optimize clinical outcomes and reduce safety concerns.
精准医学是重症监护领域中一个不断发展的领域。越来越多的研究表明，药物基因组变异性是重症监护病房（ICU）中镇痛和镇静药物反应的重要决定因素。全基因组关联研究和候选基因发现研究表明，根据个体的基因组成、环境适应性以及其他一些与患者和药物相关的因素量身定制的镇痛和镇静药物，将使疗效最大化并有助于减少危害。然而，针对ICU患者的药物遗传学研究数量仍然较少，且尚未发表使用药物基因组数据优化重症患者镇痛或镇静治疗的前瞻性研究。目前治疗ICU疼痛和躁动的建议基于外部效度较低的对照研究，包括未考虑影响反应的药物基因组因素。采用精准医学方法个体化药物治疗，专注于优化ICU患者的舒适度和安全性，可能会改善重症成年患者的治疗结果。此外，大型标准化数据集可为个体镇痛和/或镇静治疗的益处和风险提供参考。本综述的目的是描述一种精准医学方法，该方法专注于优化个体ICU患者的镇痛和镇静治疗，以优化临床结果并减少安全隐患。
