Target controlled infusion in the intensive care unit: a scoping review

Area of Science:

• Pharmacology
• Critical Care Medicine
• Pharmacokinetics/Pharmacodynamics

Background:

• Target-controlled infusion (TCI) systems precisely deliver drugs using pharmacokinetic-pharmacodynamic (PKPD) models, primarily in operating rooms.
• Their use in intensive care units (ICUs) is limited despite complex dosing needs for critically ill patients.

Purpose of the Study:

• To evaluate the existing evidence on TCI system application in ICU settings.
• Focus on sedation, analgesia, and antibiotic administration.

Main Methods:

• Systematic literature search of Medline and Cochrane Library up to August 2024.
• Inclusion of studies on adult ICU patients receiving TCI for any drug.
• Data extraction on study design, PKPD models, performance, and clinical endpoints.

Main Results:

• 14 studies focused on sedatives (propofol, remifentanil) using Marsh and Minto models, showing stable sedation and fewer adverse events.
• Limited evidence exists for dexmedetomidine and midazolam.
• Three studies explored antibiotic TCI (vancomycin, cefepime) with potential but lacking validation.

Conclusions:

• TCI shows promise for sedation and analgesia in ICUs, improving drug titration and patient outcomes.
• Evidence for TCI with antibiotics and newer PKPD models is insufficient.
• Broader ICU application requires further clinical research and model validation.