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.


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Matt Cross, MD