본문 바로가기
KERD
논문KCI 등재

The Optimal Dose of Midazolam for Promoting Sleep in Critically Ill Patients: A Pilot Study

2

조회

0

다운로드

1

인용

0

참고문헌

키워드

초록

Background: Many critically ill patients treated in the intensive care unit (ICU) experience sleep disruption. Midazolam is commonly used for the sedation of critically ill patients. This pilot study is aimed to identify the optimal dose of midazolam for achieving sound sleep in critically ill patients. Methods: This prospective study was conducted in the medical ICU of a tertiary referral hospital. Polysomnography recording was performed over 24 hours to assess the quantity and quality of sleep in patients sedated with midazolam. Results: A total of five patients were enrolled. Median total sleep time was 494.0 (IQR: 113.5-859.0) min. The majority of sleep was stage 1 (median 82.0 [IQR 60.5-372.5] min) and 2 (median 88.0 [60.5-621.0] min) with scant REM (median 10.0 [6.0-50.5] min) and no stage 3 (0.0 min) sleep. The median number of wakings in 1 hour was 16.1 (IQR: 7.6-28.6). The dose of midazolam showed a positive correlation with total sleep time (r = 0.975, p = 0.005). Conclusions: The appropriate quantity of sleep in critically ill patients was achieved with a continuous infusion of 0.02-0.03 mg/kg/h midazolam. However, the quality of sleep was poor. Further study is required for the promotion of quality sleep in such patients.

Abstract

Background: Many critically ill patients treated in the intensive care unit (ICU) experience sleep disruption. Midazolam is commonly used for the sedation of critically ill patients. This pilot study is aimed to identify the optimal dose of midazolam for achieving sound sleep in critically ill patients. Methods: This prospective study was conducted in the medical ICU of a tertiary referral hospital. Polysomnography recording was performed over 24 hours to assess the quantity and quality of sleep in patients sedated with midazolam. Results: A total of five patients were enrolled. Median total sleep time was 494.0 (IQR: 113.5-859.0) min. The majority of sleep was stage 1 (median 82.0 [IQR 60.5-372.5] min) and 2 (median 88.0 [60.5-621.0] min) with scant REM (median 10.0 [6.0-50.5] min) and no stage 3 (0.0 min) sleep. The median number of wakings in 1 hour was 16.1 (IQR: 7.6-28.6). The dose of midazolam showed a positive correlation with total sleep time (r = 0.975, p = 0.005). Conclusions: The appropriate quantity of sleep in critically ill patients was achieved with a continuous infusion of 0.02-0.03 mg/kg/h midazolam. However, the quality of sleep was poor. Further study is required for the promotion of quality sleep in such patients.

참고문헌 (34)

  1. Gallicchio L, "Sleep duration and mortality: a systematic review and meta-analysis", J Sleep Res, 18, pp.148~158 (2009)
  2. Grandner MA, "Mortality associated with short sleep duration: The evidence, the possible mechanisms, and the future", Sleep Med Rev, 14, pp.191~203 (2010)
  3. Cooper AB, "Sleep in critically ill patients requiring mechanical ventilation", Chest, 117, pp.809~818 (2000)
  4. Hardin KA, "Sleep in critically ill chemically paralyzed patients requiring mechanical ventilation", Chest, 129, pp.1468~1477 (2006)
  5. Elliott R, "Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study", Crit Care, 17, pp.R46~ (2013)
  6. Aaron JN, "Environmental noise as a cause of sleep disruption in an intermediate respiratory care unit", Sleep, 19, pp.707~710 (1996)
  7. Meyer TJ, "Adverse environmental conditions in the respiratory and medical ICU settings", Chest, 105, pp.1211~1216 (1994)
  8. Bosma K, "Patient-ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation", Crit Care Med, 35, pp.1048~1054 (2007)
  9. Figueroa-Ramos MI, "Sleep and delirium in ICU patients: a review of mechanisms and manifestations", Intensive Care Med, 35, pp.781~795 (2009)
  10. Friese RS, "Sleep and recovery from critical illness and injury:a review of theory, current practice, and future directions", Crit Care Med, 36, pp.697~705 (2008)
  11. Roche Campo F, "Poor sleep quality is associated with late noninvasive ventilation failure in patients with acute hypercapnic respiratory failure", Crit Care Med, 38, pp.477~485 (2010)
  12. Oto J, "Sleep quality of mechanically ventilated patients sedated with dexmedetomidine", Intensive Care Med, 38, pp.1982~1989 (2012)
  13. Riker RR, "Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial", JAMA, 301, pp.489~499 (2009)
  14. Beigmohammadi MT, "Pharmacokinetics Alterations of Midazolam Infusion versus Bolus Administration in Mechanically Ventilated Critically Ill Patients", Iran J Pharm Res, 12, pp.483~488 (2013)
  15. Michalk S, "Midazolam infusion for basal sedation in intensive care: absence of accumulation", Intensive Care Med, 15, pp.37~41 (1988)
  16. Sleigh JW, "The bispectral index: a measure of depth of sleep?", Anesth Analg, 88, pp.659~661 (1999)
  17. Lydic R, "Sleep, anesthesiology, and the neurobiology of arousal state control", Anesthesiology, 103, pp.1268~1295 (2005)
  18. Keil A, "Committee report: publication guidelines and recommendations for studies using electroencephalography and magnetoencephalography", Psychophysiology, 51, pp.1~21 (2014)
  19. Hori T, "Sleep Computing Committee of the Japanese Society of Sleep Research Society: Proposed supplements and amendments to 'A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects', the Rechtschaffen & Kales (1968) standard", Psychiatry Clin Neurosci, 55, pp.305~310 (2001)
  20. Berry RB, "American Academy of Sleep Medicine: Rules for scoring respiratory events in sleep: update of the 2007AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine", J Clin Sleep Med, 8, pp.597~619 (2012)
  21. Martin J, "Sedation and an algesia in German intensive care units: how is it done in reality? Results of a patient-based survey of analgesia and sedation", Intensive Care Med, 32, pp.1137~1142 (2006)
  22. Shehabi Y, "Sedation and delirium in the intensive care unit: an Australian and New Zealand perspective", Anaesth and intensive care, 36, pp.570~578 (2008)
  23. Rhoney DH, "National survey of the use of sedating drugs, neuromuscular blocking agents, and reversal agents in the intensive care unit", J Intensive Care Med, 18, pp.139~145 (2003)
  24. Barr J, "Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit", Crit Care Med, 41, pp.263~306 (2013)
  25. Drouot X, "Sleep in the intensive care unit", Sleep Med Rev, 12, pp.391~403 (2008)
  26. Buxton OM, "Sleep disruption due to hospital noises: a prospective evaluation", Ann Intern Med, 157, pp.170~179 (2012)
  27. Freedman NS, "Abnormal sleep", wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit, 2001, pp.163, 451~457
  28. Walder B, "Sleep disturbances in critically ill patients", Der Anaesth, 56, pp.7~17 (2007)
  29. Chen HI, "Sleep loss impairs inspiratory muscle endurance", The Am rev of respir dis, 140, pp.907~909 (1989)
  30. Schiffman PL, "Sleep deprivation decreases ventilatory response to CO2 but not load compensation", Chest, 84, pp.695~698 (1983)
  31. Monti JM, "Midazolam and sleep in insomniac patients", British journal of clinical pharmacology, 16(Suppl 1), pp.87S~88S (1983)
  32. Treggiari-Venzi M, "Overnight sedation with midazolam or propofol in the ICU: effects on sleep quality, anxiety and depression", Intensive Care Med, 22, pp.1186~1190 (1996)
  33. Bonafide CP, "Remifentanil inhibits rapid eye movement sleep but not the nocturnal melatonin surge in humans", Anesthesiology, 108, pp.627~633 (2008)
  34. Kamdar BB, "The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU", Crit Care Med, 41, pp.800~809 (2013)

관련 논문AI추천

이 간행물의 다른 논문 (19건)