Renal Insufficiency ICU sedation
Basic, Basic Sciences
Many patients in ICUs have some degree of renal impairment prior to their ICU stay. Perhaps more significantly, a substantial portion of patients without pre-existing renal insufficiency will develop it at some point during their ICU course, which is a well-known independent predictor of morbidity and mortality. It is important to consider renal function and protection.
Lorazepam - the preferred benzodiazepine as a continuous infusion for renal impairment, as its renally cleared metabolites are not active.
Propofol - no adjustment is needed in renal insufficiency. Compared to midazolam, propofol is also less likely to result in subsequent renal insufficiency in patients with previously normal kidney function.
Dexmedetomidine - studies have found no significant difference in plasma concentrations of dexmedetomidine following infusions in patients both with and without renal insufficiency.
Pharmacokinetics of dexmedetomidine administered to patients with end‐stage renal failure and secondary hyperparathyroidism undergoing general anaesthesia W. Zhong MD Y. Zhang PhD M.‐Z. Zhang PhD X.‐H. Huang PhD Y. Li MD R. Li MD Q.‐W. Liu PhD First published: 16 December 2017 https://doi.org/10.1111/jcpt.12652
Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam Tacyano Tavares Leite, Etienne Macedo, Izanio da Silva Martins, Fernanda Macedo de Oliveira Neves and Alexandre Braga Libório CJASN November 2015, 10 (11) 1937-1945; DOI: https://doi.org/10.2215/CJN.02330315