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Sedation in intensive care: morphine and renal function.

J F Bion, B K Logan, P M Newman

    Intensive Care Medicine
    |January 1, 1986
    PubMed
    Summary
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    In critically-ill patients with renal failure, morphine clearance is reduced. Hemofiltration helps prevent morphine accumulation, with conscious level more related to illness severity than drug levels.

    Area of Science:

    • Critical Care Medicine
    • Pharmacology
    • Nephrology

    Background:

    • Intravenous morphine is used for pain management in critically-ill patients.
    • Oliguric renal failure complicates morphine pharmacokinetics.
    • Assessing sedation and physiological disturbance is crucial in these patients.

    Purpose of the Study:

    • To investigate morphine pharmacokinetics and its effect on sedation in critically-ill patients with renal failure.
    • To evaluate the role of hemofiltration in managing morphine levels.
    • To determine the relationship between physiological disturbance, morphine levels, and conscious level.

    Main Methods:

    • 12 critically-ill patients on mechanical ventilation received IV morphine infusions.
    • 4 patients had acute oliguric renal failure and underwent hemofiltration/hemodialysis.

    Related Experiment Videos

  • APACHE Score, linear-analogue sedation scale, and HPLC for blood morphine levels were used.

    • Main Results:

    • Morphine clearance was impaired in renal failure and dependent on hemofiltration volumes.
    • Morphine accumulation did not occur with hemofiltration.
    • Conscious level correlated more closely with physiological disturbance than morphine blood levels.
    • Greater physiological disturbance amplified morphine's sedative effect at similar blood concentrations.

    Conclusions:

    • Hemofiltration reduces the risk of morphine accumulation in critically-ill patients with renal failure.
    • Clinical monitoring of sedation is vital, considering the interplay between physiological disturbance and morphine levels.
    • Physiological sickness scores may aid in understanding factors affecting cerebral function during critical illness.