Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0185212
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dc.titleAge related inverse dose relation of sedatives and analgesics in the intensive care unit
dc.contributor.authorMukhopadhyay A.
dc.contributor.authorTai B.C.
dc.contributor.authorRemani D.
dc.contributor.authorPhua J.
dc.contributor.authorCove M.E.
dc.contributor.authorKowitlawakul Y.
dc.date.accessioned2019-11-01T07:49:03Z
dc.date.available2019-11-01T07:49:03Z
dc.date.issued2017
dc.identifier.citationMukhopadhyay 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
dc.identifier.issn19326203
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/161175
dc.description.abstractSedative 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.
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceUnpaywall 20191101
dc.subjectfentanyl
dc.subjectpropofol
dc.subjectanalgesic agent
dc.subjectfentanyl
dc.subjecthypnotic sedative agent
dc.subjectpropofol
dc.subjectadult
dc.subjectage
dc.subjectaged
dc.subjectanalysis of variance
dc.subjectanesthesia
dc.subjectArticle
dc.subjectartificial ventilation
dc.subjectbody weight
dc.subjectcohort analysis
dc.subjectdrug dose titration
dc.subjectdrug infusion
dc.subjectextubation
dc.subjectfemale
dc.subjecthospital mortality
dc.subjecthuman
dc.subjectintensive care unit
dc.subjectlogistic regression analysis
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectobservational study
dc.subjectprospective study
dc.subjectvery elderly
dc.subjectadolescent
dc.subjectanalgesia
dc.subjectdemography
dc.subjectdose response
dc.subjectmiddle aged
dc.subjecttreatment outcome
dc.subjectyoung adult
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAge Factors
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAnalgesia
dc.subjectAnalgesics
dc.subjectDemography
dc.subjectDose-Response Relationship, Drug
dc.subjectFemale
dc.subjectFentanyl
dc.subjectHumans
dc.subjectHypnotics and Sedatives
dc.subjectIntensive Care Units
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectPropofol
dc.subjectTreatment Outcome
dc.subjectYoung Adult
dc.typeArticle
dc.contributor.departmentDEPT OF MEDICINE
dc.contributor.departmentSAW SWEE HOCK SCHOOL OF PUBLIC HEALTH
dc.contributor.departmentALICE LEE CENTRE FOR NURSING STUDIES
dc.description.doi10.1371/journal.pone.0185212
dc.description.sourcetitlePLoS ONE
dc.description.volume12
dc.description.issue9
dc.description.pagee0185212
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