Department of Surgical Sciences, Division of Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
Ups J Med Sci. 2024 May 9;129. doi: 10.48101/ujms.v129.10560. eCollection 2024.
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.
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).
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.
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.
在重症监护病房中，给患者使用标准剂量的镇痛和镇静药物。需要更好地检查由此产生的血液浓度范围和相应的临床反应。本研究的目的是描述重症监护患者的日常剂量、测量的血液浓度和临床反应。目的还在于为所研究药物的全血浓度参考值的建立做出贡献。
这是一项在一所大学医院的普通重症监护病房（ICU）前瞻性收集数据的描述性研究。研究了 10 种药物（可乐定、芬太尼、吗啡、右美托咪定、氯胺酮、酮咯酸、咪达唑仑、对乙酰氨基酚、丙泊酚和硫喷妥钠），并记录了每日剂量。每天采集两次血样，并测量药物浓度。使用 Richmond 躁动镇静量表（RASS）和数字评分量表（NRS）记录临床反应。
药物剂量在推荐剂量范围内。所有 10 种药物的血液浓度在队列中均表现出广泛的差异，但只有 3%的药物浓度超过治疗区间，其中可乐定（122 例中的 57 例）和咪达唑仑（122 例中的 38 例）占主导地位。RASS 和 NRS 与药物浓度无关。
在 ICU 环境中使用镇痛和镇静药物的推荐剂量间隔，并定期监测 RASS 和 NRS 等临床反应，可使 97%的浓度低于治疗区间的上限。本研究为这 10 种药物的全血药物浓度参考值做出了贡献。
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