Uijtendaal Esther V, van Harssel Lieke L M, Hugenholtz Gerard W K, Kuck Emile M, Zwart-van Rijkom Jeannette E F, Cremer Olaf L, Egberts Toine C G
Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, the Netherlands.
Pharmacotherapy. 2014 Mar;34(3):213-9. doi: 10.1002/phar.1395. Epub 2014 Jan 4.
To describe the frequency and type of potential drug-drug interactions (pDDIs) in a general intensive care unit (ICU) and to make recommendations to improve the management of these pDDIs.
Retrospective observational study.
General ICU of a tertiary care hospital.
All patients admitted for more than 24 hours between May 2009 and December 2010 who were prescribed at least one medication.
Based on the G-Standaard, the Dutch national drug database, pDDIs were identified and classified into categories of potential clinical outcome and management advice. In total, 35,784 medication episodes were identified, resulting in 2887 pDDIs (8.1%). These 2887 pDDIs occurred in 1659 patients for a mean frequency of 1.7 (95% confidence interval [CI] 1.6-1.9) pDDIs per patient. Overall, 54% of the patients experienced at least one pDDI with pDDIs present during 27% of all ICU admission days. All pDDIs could be reconstructed using 81 of the 358 (23%) relevant unique pDDI pairs described in the G-Standaard. The most frequently occurring potential clinical consequence was an increased risk of side effects or toxicity (91% of the pDDIs) such as electrolyte disturbances and masking of hypoglycemia. The most important advised management strategy was monitoring (81%), consisting of monitoring of laboratory values (52%), clinical monitoring of toxicity or effectiveness (48%), or monitoring of physical parameters such as electrocardiogram and blood pressure (11%).
Potential drug-drug interactions occur in 54% of all ICU patients, which is two times more than the rate seen in patients on general wards. A limited set of 20 pDDI pairs is responsible for more than 90% of all pDDIs. Therefore, it is worthwhile to develop guidelines for the management of these specific pDDIs. As the vast majority of the interactions can be managed by monitoring, advanced clinical decision support systems linking laboratory data to prescription data may be an effective risk management strategy.
描述综合重症监护病房（ICU）中潜在药物相互作用（pDDI）的发生频率及类型，并提出改进这些pDDI管理的建议。
回顾性观察研究。
一家三级护理医院的综合ICU。
2009年5月至2010年12月期间入院超过24小时且至少开具了一种药物的所有患者。
基于荷兰国家药物数据库G-Standaard，识别出pDDI并将其分类为潜在临床结果类别及管理建议。总共识别出35784次用药事件，产生了2887次pDDI（8.1%）。这2887次pDDI发生在1659名患者中，每位患者的平均发生频率为1.7次（95%置信区间[CI]1.6 - 1.9）。总体而言，54%的患者经历了至少一次pDDI，pDDI出现在所有ICU住院日的27%期间。所有pDDI均可使用G-Standaard中描述的358个（23%）相关独特pDDI对中的81个进行重构。最常出现的潜在临床后果是副作用或毒性风险增加（占pDDI的91%），如电解质紊乱和低血糖的掩盖。最重要的建议管理策略是监测（81%），包括实验室值监测（52%）、毒性或有效性的临床监测（48%）或心电图和血压等物理参数监测（11%）。
所有ICU患者中有54%发生潜在药物相互作用，这是普通病房患者发生率的两倍。20对特定pDDI导致了超过90%的所有pDDI。因此，制定这些特定pDDI的管理指南是值得的。由于绝大多数相互作用可通过监测进行管理，将实验室数据与处方数据相连接的先进临床决策支持系统可能是一种有效的风险管理策略。
