title: Parameter identification and sedative sensitivity analysis of an agitation-sedation model.
abstract: Sedation administration and agitation management are fundamental activities in any intensive care unit. A lack of objective measures of agitation and sedation, as well as poor understanding of the underlying dynamics, contribute to inefficient outcomes and expensive healthcare. Recent models of agitation-sedation dynamics have enhanced understanding of the underlying dynamics and enable development of advanced protocols for semi-automated sedation administration. In this research, the agitation-sedation model parameters are identified using an integral-based fitting method developed in this work. Parameter variance is then analysed over 37 intensive care unit patients. The parameter identification method is shown to be effective and computationally inexpensive, making it suited to real-time clinical control applications. Sedative sensitivity, an important model parameter, is found to be both patient-specific and time-varying. However, while the variation between patients is observed to be as large as a factor 10, the observed variation in time is smaller, and varies slowly over a period of days rather than hours. The high fitted model performance across all patients show that the agitation-sedation model presented captures the fundamental dynamics of the agitation-sedation system. Overall, these results provide additional insight into the system and clinical dynamics of sedation management.
authors.affiliation: Centre for Bioengineering, Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand. a.rudge@mail.com
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Rudge
authors.forename: J Geoffrey
authors.initials: JG
authors.lastname: Chase
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Shaw
authors.forename: Dominic
authors.initials: D
authors.lastname: Lee
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Hann
mesh_terms: D003198:Computer Simulation; D003422:Critical Care; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000493:pharmacokinetics; D008874:Midazolam / Q000008:administration & dosage / Q000493:pharmacokinetics; D008954:Models, Biological; D015233:Models, Statistical; D009020:Morphine / Q000008:administration & dosage / Q000493:pharmacokinetics; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000378:metabolism
chemical_list: D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam