Interactions In Intensive Care Unit Research Articles

Assessment of frequency and types of drug interactions in intensive care units: a cross-sectional study.

Drug interactions can cause adverse reactions, from treatment inefficiency to serious treatment complications in the patient. Due to the complexity of drug therapy and the simultaneous use of several drugs and different drug groups, patients hospitalized in intensive care units are exposed to more drug interactions. Therefore, this study was conducted to investigate the frequency of drug interactions in patients hospitalized in the ICU. In this cross-sectional study, the files of 300 patients hospitalized in the ICU were examined. Drug interactions were determined using Lexicomp software and the book drug iteration facts. Data analysis was done using SPSS 21 software. The findings showed that there were a total of 1121 cases of interference. Two hundred thirty-one (77%) patients had moderate interference, 94 (31.3%) patients had mild interference, and 67 patients (22.3%) had severe interference. One hundred eight patients had B-type interference, 223 C-type interference, 116 D-type interference, and 6 X-type interference, so most of the interactions are C-type interference. One hundred eighty-six patients had pharmacokinetic interference and 201 patients had pharmacodynamics interference. The highest interaction was between two drugs, heparin and aspirin with 58 cases. This study highlights the alarming frequency and types of drug interactions observed in ICU. The high prevalence of drug interactions emphasizes the need for improved medication management and vigilance in these critical care settings. Polypharmacy and certain drug combinations were identified as major contributing factors to the occurrence of drug interactions, which calls for regular medication reviews and cautious prescribing practices.

Potential Drug-drug Interactions in Intensive Care Units in Turkey: A Point Prevalence Study

Potential Drug-drug Interactions in Intensive Care Units in Turkey: A Point Prevalence Study

Drug Utilization and Potential Drug-Drug Interactions within an Intensive Care Unit at a University Tertiary Care Hospital in Egypt.

There are few reports on drug utilization and drug-drug interactions in Intensive Care Units (ICUs) in Egypt. A total of 94 patients participated in this retrospective observational study. Patient’s medical records were used to collect demographics, medical history, admission and discharge dates and medications used. The mean ± SD of the Glasgow Coma Scale (GCS) scores was 9.9 ± 4.4 and the median length of stay was 7 days (range 1–47 days). The total number of prescribed medications ranged from 4–29 with a mean ± SD of 14.1 ± 5.5 medications per patient. The top three most prescribed categories belonged to (1) anti-infective agents (23.9%); (2) electrolyte, caloric and water balance agents (14.6%); and (3) blood formation, coagulation and thrombosis (11.3%). The proton pump inhibitor, esomeprazole, was the most frequently prescribed medication accounting for 6.5% of total prescriptions, followed by clindamycin and magnesium sulfate each accounting for 3.5% of total prescriptions. The potential Drug-Drug Interactions (pDDIs) showed a total of 968 pDDIs with a mean ± SD (range) of 10.2 ± 9.4 (0–43) pDDIs per patient: severe (contraindicated) (3), major (178), moderate (618) and minor (169). Overall, the drug utilization patterns in this study were consistent with ICU drug utilization from other countries in the region. The implementation of clinical decision support systems and the involvement of clinical pharmacists may help improve medication safety.

Evaluation of potential drug-drug interactions in intensive care unit.

Potential drug-drug interactions (pDDIs) and adverse drug reactions (ADRs) may be frequently observed in critically ill patients because of multiple drug use. It is important to identify pDDIs before their progression to ADRs. This study aimed to determine the prevalence and effect of pDDIs and possible ADRs in intensive care patients. In this retrospective cross-sectional study, the medical records of patients in the intensive care unit (ICU) of Bursa Uludag University Faculty of Medicine Hospital between January 1, 2018, and December 31, 2018, were examined. Medication orders were recorded on days 2, 5, and 10. pDDIs, defined using the lexi-interact (UpToDate, 2020), were classified based on the significance level. A total of 144 patients were included in this study, and from the 395 medication orders, 1,776 had pDDIs. Of these interactions, 23.5% were major (n = 418), 71.4% were moderate (n = 1268), and 5.1% (n = 90) were minor. The majority of patients (96.9%) had at least one pDDI. There was a strong correlation between the number of drugs on days 2, 5, and 10 and the number of pDDIs (p < 0.001, ρ = 0.7; p < 0.001, ρ = 0.72; p < 0.001, ρ = 0.73, respectively). No significant correlation was found among the number of pDDIs, the APACHE II score, and the duration of ICU stay. The prevalence of pDDIs was high and there was a strong correlation between the number of drugs and pDDIs. Detection of potential interactions through clinical decision support systems and checker tools should be used to increase patient safety.

Evaluating Healthcare Worker Movements and Patient Interactions Within ICU Rooms

Background: Contamination of healthcare workers and patient environments likely play a role in the spread of antibiotic-resistant organisms. The mechanisms that contribute to the distribution of organisms within and between patient rooms are not well understood, but they may include movement patterns and patient interactions of healthcare workers. We used an innovative technology for tracking healthcare worker movement and patient interactions in ICUs. Methods: The Kinect system, a device developed by Microsoft, was used to detect the location of a person’s hands and head over time, each represented with 3-dimensional coordinates. The Kinects were deployed in 2 intensive care units (ICUs), at 2 different hospitals, and they collected data from 5 rooms in a high-acuity 20-bed cardiovascular ICU (unit 1) and 3 rooms in a 10-bed medical-surgical ICU (unit 2). The length of the Kinect deployment varied by room (range, 15–48 days). The Kinect data were processed to included date, time, and location of head and hands for all individuals. Based on the coordinates of the bed, we defined events indicating bed touch, distance 30 cm (1 foot) from the bed, and distance 1 m (3 feet) from the bed. The processed Kinect data were then used to generate heat maps showing density of person locations within a room and summarizing bed touches and time spent in different locations within the room. Results: The Kinect systems captured In total, 2,090 hours of room occupancy by at least 1 person within ~1 m of the bed (Table 1). Approximately half of the time spent within ~1 m from the bed was at the bedside (within ~30 cm). The estimated number of bed touches per hour when within ~1 m was 13–23. Patients spent more time on one side of the bed, which varied by room and facility (Fig. 1A, 1B). Additionally, we observed temporal variation in intensity measured by person time in the room (Fig. 1C, 1D). Conclusions: High occupancy tends to be on the far side (away from the door) of the patient bed where the computers are, and the bed touch rate is relatively high. These results can be used to help us understand the potential for room contamination, which can contribute to both transmission and infection, and they highlight critical times and locations in the room, with a potential for focused deep cleaning.Funding: NoneDisclosures: None

Frequency and risk factors of polypharmacy and drug interactions among patients in general intensive care unit of Golestan Hospital, Ahvaz, southwest of Iran

&lt;abstract&gt;&lt;sec&gt; &lt;title&gt;Objective&lt;/title&gt; &lt;p&gt;This study was aimed to evaluate polypharmacy and drug interactions in intensive care units.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Materials and methods&lt;/title&gt; &lt;p&gt;This epidemiologic-descriptive study was performed on the records of 80 patients admitted to the intensive care unit with a duration of more than 48 hours from 2018-10-23 to 2019-01-21. The patients' records, including polypharmacy, type and number of drug interactions as well as factors such as age, gender, hospitalization duration, number of drug-prescribing physicians were investigated. To determine drug interactions, Free &lt;italic&gt;Lexi-Comp&lt;/italic&gt; &lt;italic&gt;iOS&lt;/italic&gt; software version 4.0.1 was used.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Findings&lt;/title&gt; &lt;p&gt;Of 80 participants in this study, 58, and 22 patients (72.5%, and 27.5%) were respectively male and female, with a mean age of 39.9 years; besides, 46.2%, and 25.3% of patients were hospitalized due to trauma, and non-traumatic cerebral hemorrhage, respectively. The average hospitalization was six days. The average number of drug-prescribing physicians and medications received was 5 and 10, respectively. The majority of patients (91.2%) received over five drugs. The majority of drug interactions (70%) were in C-Class, and 1.2% were in X-Class. Also, 85% of the studied samples had at least one drug interaction.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Conclusion&lt;/title&gt; &lt;p&gt;Polypharmacy and drug interactions were common in patients hospitalized in the intensive care unit ward. Risk factors for increasing drug interactions were the length of stay and number of medications prescribed, and for polypharmacy, length of stay, number of medications-prescribing physicians, and number of prescription medications.&lt;/p&gt; &lt;/sec&gt;&lt;/abstract&gt;

Prevalence of Drug-Drug Interactions in Intensive Care Unit of a Multispecialty Hospital at Hyderabad, South India

Prevalence of Drug-Drug Interactions in Intensive Care Unit of a Multispecialty Hospital at Hyderabad, South India

The prevalence of potentially beneficial and harmful drug-drug interactions in intensive care units.

Background The present study was conducted with the aim of investigating the prevalence of potentially beneficial and harmful drug-drug interactions (DDIs) in intensive care units (ICUs). Methods The present cross-sectional prospective study was conducted in two ICUs in Shahr-e Kord city, Iran. The study sample was consisted of 300 patients. The Drug Interaction Facts reference text book [Tatro DS. Drug interaction facts. St Louis, MO: Walters Kluwer Health, 2010.] was used to determine the type and the frequency of the DDIs. Results The participants consisted of 189 patients men and 111 women. The mean age of patients was 44.2 ± 24.6 years. Totally, 60.5% of patients had at least one drug-drug interaction in their profile. The total number of DDIs found was 663 (the mean of the total number of drug-drug interactions was 2.4 interactions per patient). Of all the 663 interactions, 574 were harmful and others were beneficial. In terms of starting time, 98 of the potential interactions were rapid and 565 of them were delayed. In terms of severity, 511 of the potential interactions were moderate. Some of the drugs in the patients' medical records including phenytoin, dopamine, ranitidine, corticosteroid, dopamine, heparin, midazolam, aspirin, magnesium, calcium gluconate, and antibiotics, the type of ventilation, the type of nutrition and the duration of hospital stay were among the factors that were associated with high risk of potential DDIs (p < 0.05). Conclusions The prevalence of potentially beneficial and harmful DDIs, especially harmful drug-drug interactions, is high in ICUs and it is necessary to reduce these interactions by implementing appropriate programs and interventions.

Drug-drug interactions in intensive care units and potential clinical consequences of these interactions

Aim: Drug-drug interactions (DDIs) are an important factor that can lead to serious health problems by increasing or decreasing the effects of drugs. This study aimed to evaluate the frequency of DDIs in the intensive care unit (ICU). Material and Methods: All patients who were hospitalized for more than 24 h in the ICU of our hospital between January and September 2018 and received 2 or more medications were included in this retrospective study. Frequency and severity of the DDIs were detected using the Rx Mediapharma and Lexi-Interact programs. Results: Of the 972 patients enrolled in the study, 2742 incidences of DDIs were detected in 626 patients (64%). Of the different drug pairs administered, 422 had DDIs, and 64 of those had 10 or more DDIs, constituting 67% of all of the DDIs. The most common potential clinical consequences of DDIs were increased risk of bleeding (12.3%), hyperkalemia (8.2%), arrhythmia (7.9%), and CNS depression (6.6%). Conclusion: The results indicated that DDIs in the ICU were very common in our hospital. Moreover, these results indicated that patients should be closely monitored for the prevention of adverse effects, such as electrolyte disturbance, bleeding risk, and arrhythmia of drugs.

Prevalência de interações medicamentosas em unidades de terapia intensiva no Brasil

OBJETIVO: Determinar a prevalência de interações medicamentosas em unidades de terapia intensiva e analisar a significância clínica das interações identificadas. MÉTODOS: Estudo multicêntrico, transversal e retrospectivo desenvolvido com 1124 pacientes em sete unidades de terapia intensiva (UTI) de hospitais de ensino no Brasil. As informações sobre os medicamentos administrados com 24 horas e 120 horas de internação foram obtidas nas prescrições. RESULTADOS: Em 24 horas 70,6% dos pacientes apresentaram pelo menos uma interação medicamentosa. O número de interações medicamentosas detectadas em 24 horas foi 2299 e em 120 horas foi 2619. Midazolam, fentanil, fenitoína e omeprazol foram os fármacos com maior frequência de interações medicamentosas. CONCLUSÃO: Nesta amostra, interações medicamentosas moderadas e graves foram mais prevalentes. Diante desses resultados, todas as ações dos profissionais de saúde que prestam assistência ao paciente devem ser integradas visando identificar e prevenir possíveis eventos a medicamentos.

薬物相互作用 (24―ICUでの注意すべき薬物相互作用）

薬物相互作用 (24―ICUでの注意すべき薬物相互作用）

Ethical considerations at the end of life in the intensive care unit

Intensive care units (ICUs) confront the healthcare system with end-of-life situations and ethical dilemmas surrounding death. It is necessary for all providers who treat dying patients to have a working knowledge of the philosophical principles that are fundamental to biomedical ethics. Those principles, however, are insufficient for compassionate care. To function well in the intensive care unit, one also must appreciate the behaviors that surround mortality. Human conduct is not predicated solely on rules; complex, unpredictable interactions are the norm. Palliative care, moving forward as a discipline, will become the perfect complement to intensive medical care, rather than being seen as an embodiment of its failures. We need to be as aggressive about respecting patient dignity as we are about using the technology that is central to health care. This article will outline end-of-life ethical principles, explore the sociology that influences human interactions in intensive care units, and show how palliative care should guide behaviors to improve how we deal with death.