Pharmacokinetics of sedatives – Understanding a modifiable risk factor for pediatric delirium

项目摘要/摘要 在过去的十年里，精神错乱-被认为是由于以下原因导致的认知功能的不明原因的改变 另一种临床情况-已被公认为成人危重患者的公共卫生紧急情况 疾病。在这一患者群体中，精神错乱与死亡率、发病率、住院时间延长有关。 停留时间和增加的医疗保健费用。我们开发了一种精神错乱筛查工具来评估精神错乱 各个年龄段的孩子。这个分数，康奈尔儿童妄想症的评估，已经得到了几个 康奈尔大学的精神病学家，并开始被用作临床护理的一部分。在发展的同时， 精神错乱是多因素的，镇静剂是临床医生需要考虑的一个可改变的危险因素。到目前为止，有 没有药代动力学信息来指导临床医生哪些镇静剂与神志不清的发展有关。 根据广泛的初步证据，我们怀疑基于苯二氮卓类的镇静与 精神错乱的发展，可能会受到药物清除和血清浓度的影响。我们还将 确定其他常用的麻醉剂和其他药物是否与精神错乱的发展有关 不受苯二氮类药物影响。我们将在一项多中心(n=3)的研究中测试这两个具体目标 匹兹堡大学和布法罗大学进行了分析。

Project Summary/Abstract Over the past decade, delirium – identified as an unexplained alteration in cognitive function as a result of another clinical condition – has become recognized as a public health emergency for adults with critical illnesses. In this patient population, delirium is associated with mortality, morbidity, increased length of hospital stays and increased health care costs. We have developed a delirium screening tool to assess delirium in children of all ages. This score, the Cornell Assessment of Pediatric Delirium, has been validated with several psychiatrists at Cornell University and is starting to be used as a part of clinical care. While the development of delirium is multifactorial, sedatives represent a modifiable risk factor for clinicians to consider. To date, there is no pharmacokinetic information to guide clinicians on which sedatives are linked to delirium development. Based on extensive preliminary evidence, we suspect that benzodiazepine-based sedation is related to delirium development and may be affected by drug clearance and serum concentrations. We will also determine if other commonly used narcotics and other agents are associated with delirium development independent of benzodiazepine effects. We will test these two specific aims in a multi-centered (n = 3) study with analysis done at the University of Pittsburgh and University of Buffalo.