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Investigating the Relationship Between Midazolam Serum Concentrations and Paediatric Delirium in Critically Ill

Sabrina Marongiu1,2, Mathieu S Bolhuis1, Daan J Touw1,2

  • 1Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.

Pediatric Reports
|January 23, 2025
PubMed

Insights

Paediatric delirium (PD) in critically ill children may be linked to sudden drops in midazolam serum concentration. This pilot study suggests that reduced midazolam levels, not just dose, might trigger PD, warranting further research.

Area of Science:

  • Pediatric Intensive Care
  • Pharmacology
  • Neuroscience

Background:

  • Intravenous midazolam is a common sedative for critically ill children.
  • Paediatric delirium (PD) is a potential complication in these patients.
  • The relationship between midazolam levels and PD is not fully understood.

Purpose of the Study:

  • To investigate the association between midazolam serum concentration and the development of new paediatric delirium (PD) in critically ill children.
  • To explore if changes in midazolam levels correlate with PD onset.

Main Methods:

  • Prospective observational pilot study conducted in a Paediatric Intensive Care Unit (PICU).
  • Included 28 critically ill children receiving continuous midazolam.
  • Monitored midazolam serum concentrations and used the Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) score to assess for PD.

Main Results:

  • Twenty-five percent (7/28) of children developed new PD, often after midazolam dose reduction.
  • Patients with PD had a lower median midazolam concentration on the day of PD detection compared to the previous day.
  • Similar trends were observed for active midazolam metabolites.

Conclusions:

  • A sudden and significant reduction in midazolam concentration may be associated with the development of PD in critically ill children.
  • Further research in larger cohorts is needed to confirm these findings and understand the underlying mechanisms.
Abstract

Keywords:
deliriummidazolampaediatric intensive carepharmacology

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