Marongiu Sabrina, Bolhuis Mathieu S, Touw Daan J, Kneyber Martin C J
Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
Department of Pharmaceuticals Analysis, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, 9713 AV Groningen, The Netherlands.
Pediatr Rep. 2025 Jan 14;17(1):7. doi: 10.3390/pediatric17010007.
Intravenous midazolam is widely used for sedation in critically ill children. Sometimes, these children develop a paediatric delirium (PD). Our aim was to determine the relationship between midazolam serum concentration and the development of new PD in critically ill children.
Prospective observational pilot study.
Paediatric Intensive Care Unit (PICU), Groningen, the Netherlands.
All children admitted to the PICU from October-December 2019 who received continuous midazolam administration.
None.
Twenty-five percent (n = 7) of the included patients (n = 28) developed new PD. In most patients, PD occurred following midazolam dose reduction. The median cumulative midazolam dose was higher in patients who developed PD compared to those without PD. We analysed 104 blood samples to determine the midazolam concentrations. To determine whether patients had PD, the Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) score was used. Patients suffering PD (n = 7) had a lower median midazolam concentration on that day compared with the day prior to PD detection. Analysis of the active metabolites, 1-hydroxymidazolam and 1-hydroxymidazolam glucuronide, showed similar results.
PD may be linked to a sudden and significant reduction in the midazolam concentration in critically ill children. Further investigation in larger patient populations is necessary to validate our findings.
静脉注射咪达唑仑广泛用于危重症儿童的镇静。有时，这些儿童会发生小儿谵妄（PD）。我们的目的是确定咪达唑仑血清浓度与危重症儿童新发PD之间的关系。
前瞻性观察性试点研究。
荷兰格罗宁根的儿科重症监护病房（PICU）。
2019年10月至12月入住PICU且接受持续咪达唑仑治疗的所有儿童。
无。
纳入的患者中25%（n = 7）（n = 28）发生了新发PD。在大多数患者中，PD发生在咪达唑仑剂量减少之后。发生PD的患者中位累积咪达唑仑剂量高于未发生PD的患者。我们分析了104份血样以测定咪达唑仑浓度。为确定患者是否患有PD，使用了索菲亚观察戒断症状 - 小儿谵妄（SOS - PD）评分。与PD检测前一天相比，发生PD的患者（n = 7）当天的咪达唑仑中位浓度较低。对活性代谢物1 - 羟基咪达唑仑和1 - 羟基咪达唑仑葡萄糖醛酸苷的分析显示了类似结果。
PD可能与危重症儿童咪达唑仑浓度的突然大幅降低有关。有必要在更大的患者群体中进行进一步研究以验证我们的发现。
