A standardized statistical score is not a pharmacological conversion factor.
A retrospective pediatric ICU study summarized multiple sedative and analgesic exposures, including midazolam, using scores relative to the study population. It described substantial variation in dosing and combined treatment burden.
The score depended on the sample’s drug distributions. It did not make different medicines biologically equivalent, and sedation scores were not prospectively confirmed for all observations. Illness severity and ventilation duration may influence requirements.
Do not convert a summed z-score into a specific midazolam dose or toxicity threshold. For an individual assessment, retain the original drug amounts, units and timing. Relative ranking can describe variation while not establishing whether one patient was appropriately sedated or unusually tolerant.
Source: PMC7877817, supplied full-text paper. Findings are paraphrased; forensic implications are an interpretation.
Related: Benzodiazepine Dose and ICU Restraints: Interpreting a Two-Way Clinical Relationship.