Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0185212
Title: Age related inverse dose relation of sedatives and analgesics in the intensive care unit
Authors: Mukhopadhyay A. 
Tai B.C. 
Remani D.
Phua J. 
Cove M.E. 
Kowitlawakul Y. 
Keywords: fentanyl
propofol
analgesic agent
fentanyl
hypnotic sedative agent
propofol
adult
age
aged
analysis of variance
anesthesia
Article
artificial ventilation
body weight
cohort analysis
drug dose titration
drug infusion
extubation
female
hospital mortality
human
intensive care unit
logistic regression analysis
major clinical study
male
observational study
prospective study
very elderly
adolescent
analgesia
demography
dose response
middle aged
treatment outcome
young adult
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Analgesia
Analgesics
Demography
Dose-Response Relationship, Drug
Female
Fentanyl
Humans
Hypnotics and Sedatives
Intensive Care Units
Male
Middle Aged
Propofol
Treatment Outcome
Young Adult
Issue Date: 2017
Citation: Mukhopadhyay A., Tai B.C., Remani D., Phua J., Cove M.E., Kowitlawakul Y. (2017). Age related inverse dose relation of sedatives and analgesics in the intensive care unit. PLoS ONE 12 (9) : e0185212. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0185212
Abstract: Sedative and analgesic practices in intensive care units (ICUs) are frequently based on anesthesia regimes but do not take account of the important patient related factors. Pharma-cologic properties of sedatives and analgesics change when used as continuous infusions in ICU compared to bolus or short-term infusions during anesthesia. In a prospective observational cohort study, we investigated the association between patient related factors and sedatives/analgesics doses in patients on mechanical ventilation (MV) and their association with cessation of sedation/analgesia. We included patients expected to receive MV for at least 24 hours and excluded those with difficulty in assessing the depth of sedation. We collected data for the first 72 hours or until extubation, whichever occurred first. Multivariate analysis of variance, multivariate regression as well as logistic regression were used. The final cohort (N = 576) was predominantly male (64%) with mean (SD) age 61.7 (15.6) years, weight 63.4 (18.2) Kg, Acute Physiology and Chronic Health Evaluation II score 28.2 (8) and 30% hospital mortality. Increasing age was associated with reduced propofol and fentanyl doses requirements, adjusted to the weight (p<0.001). Factors associated with higher propofol and fentanyl doses were vasopressor use (Relative mean difference (RMD) propofol 1.56 (95% confidence interval (CI) 1.28–1.90); fentanyl 1.48 (1.25–1.76) and central venous line placement (CVL, RMD propofol 1.64 (1.15–2.33); fentanyl 1.41 (1.03–1.91). Male gender was also associated with higher propofol dose (RMD 1.27 (1.06–1.49). Sedation cessation was less likely to occur in restrained patients (Odds Ratio, OR 0.48 (CI 0.30–0.78) or those receiving higher sedative/analgesic doses (OR propofol 0.98 (CI 0.97–0.99); fentanyl 0.99 (CI 0.98–0.997), independent of depth of sedation. In conclusion, increasing age is associated with the use of lower doses of sedative/analgesic in ICU, whereas CVL and vasopressor use were associated with higher doses. © 2017 Mukhopadhyay et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/161175
ISSN: 19326203
DOI: 10.1371/journal.pone.0185212
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