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32 Rapid drop in midazolam concentration may be linked to paediatric delirium in critically ill children – an observational pilot study
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  1. Sabrina Marongiu1,
  2. Mathieu Bolhuis1,
  3. Daan Touw1,
  4. Martin Kneyber2
  1. 1Dept of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen
  2. 2Dept of Paediatrics, division of Paediatric Critical Care Medicine, University of Groningen, University Medical Center Groningen

Abstract

Introduction We sought to detect a relationship between midazolam concentration and development of new delirium in critically ill children who were on continuous midazolam administration.

Methods Delirium was detected using the Sophia Observation withdrawal Symptoms - Paediatric Delirium (SOS-PD) score and 104 left-over samples were available to measure midazolam concentrations.

Results Twenty-five percent of the included patients developed new delirium. Median cumulative midazolam dose was higher in patients who developed delirium compared to those without delirium but lower compared with the day preceding delirium detection, indicative of a rapid decline. Similar findings were made when active metabolites 1-hydroxymidazolam and 1-hydroxymidazolam glucuronide were considered.

Conclusions A sudden and significant reduction in midazolam concentration may contribute to the development of a delirium in critically ill children. 

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