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

项目总结/摘要 在过去的十年里，谵妄-被确定为一种无法解释的认知功能改变， 另一种临床状况-已被公认为是一个公共卫生紧急情况的成年人与关键 疾病。在这一患者人群中，谵妄与死亡率、发病率、住院时间延长相关 增加医疗费用和医疗费用。我们已经开发了一种谵妄筛查工具来评估谵妄， 所有年龄段的儿童。这个评分，康奈尔评估小儿谵妄，已被验证与几个 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。尽管制订 谵妄是多因素的，镇静剂是临床医生考虑的一个可改变的风险因素。迄今为止， 没有药代动力学信息来指导临床医生镇静剂与谵妄发展有关。 基于广泛的初步证据，我们怀疑苯二氮卓类镇静剂与 谵妄的发展，并可能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谵妄的发展有关 与苯二氮卓类药物的作用无关。我们将在一项多中心（n = 3）研究中检验这两个具体目标 并在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.