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

Target-controlled infusion (TCI) systems, originally developed for intravenous drug administration of anesthetic drugs, enable precise drug delivery based on pharmacokinetic-pharmacodynamic (PKPD) models. While widely used in the operating room, their application in the intensive care unit (ICU) remains limited despite the complexity of drug dosing in critically ill patients. This scoping review evaluates existing evidence on the use of TCI systems in ICU settings, focusing on sedation, analgesia, and antibiotic administration. A systematic literature search was conducted in Medline and the Cochrane Library up to August 2024. Studies involving adult ICU patients receiving TCI for any drug were included. Data were extracted on study design, PKPD models, performance metrics, and clinical endpoints. A total of 281 studies were identified; 14 focused on sedatives, particularly propofol and remifentanil, using the Marsh and Minto models. TCI was associated with more stable sedation, improved titration, and fewer adverse events. Evidence on dexmedetomidine and midazolam was limited. Only three studies explored antibiotic TCI, mainly for vancomycin and cefepime, showing potential but lacking robust clinical validation. In conclusion, while current findings are promising, the evidence base supporting TCI-especially in the context of newer, generalized pharmacokinetic models and antibiotics-remains insufficient, and its broader application requires further clinical research and model validation.