title: Physiological modelling of agitation-sedation dynamics.
abstract: Agitation-sedation cycling in critically ill patients, characterized by oscillations between states of agitation and over-sedation, damages patient health and increases length of stay and cost. A model that captures the essential dynamics of the agitation-sedation system and is physiologically representative is developed, and validated using data from 37 critical care patients. It is more physiologically representative than a previously published agitation-sedation model, and captures more realistic and complex dynamics. The median time in the 90% probability band is 90%, and the total drug dose, relative to recorded drug dose data, is a near ideal 101%. These statistical model validation metrics are 5-13% better than a previously validated model. Hence, this research provides a platform to develop and test semi-automated sedation management controllers that offer the significant clinical potential of improved agitation management and reduced length of stay in critical care.
authors.affiliation: Centre for Bioengineering, Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, New Zealand. a.rudge@mech.canterbury.ac.nz
authors.forename: A D
authors.initials: AD
authors.lastname: Rudge
authors.forename: J G
authors.initials: JG
authors.lastname: Chase
authors.forename: G M
authors.initials: GM
authors.lastname: Shaw
authors.forename: D
authors.initials: D
authors.lastname: Lee
mesh_terms: D016292:Procedural Sedation; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D008954:Models, Biological; D015233:Models, Statistical; D008991:Monitoring, Physiologic; D017711:Nonlinear Dynamics; D011595:Psychomotor Agitation / Q000188:drug therapy*; D013997:Time Factors