Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France.
Groupe de recherche sur les formes injectables et les technologies associées (GRITA), University Lille, EA 7365, 59000 Lille, France; Pharmacie, CHU de Lille, 59000 Lille, France.
Anaesth Crit Care Pain Med. 2019 Apr;38(2):173-180. doi: 10.1016/j.accpm.2018.04.003. Epub 2018 Apr 19.
The aim of this review is to analyse the clinical consequences of intravenous drug incompatibilities in critically ill patients, especially the incidence of organ dysfunctions and mortality.
A review of literature was conducted according to the PRISMA statement in June 2017, using Medline, ISI Web of Science and Clinicaltrials.gov.
Eligible studies were case reports and randomised controlled trials (RCTs) that assessed the effects of drug incompatibilities in critically ill patients on morbidity or mortality as primary or secondary outcomes, or adverse events. Two investigators independently reviewed the eligibility of the study from abstracts or manuscript data.
Twelve articles met the selection criteria. The six articles reporting RCTs concern only four RCTs. RCTs were single-centre studies comparing infusion with or without filter. One of them included adult patients. The others included paediatric and neonatal intensive care unit patients. Primary endpoints were SIRS, organ failure, overall complication rate, bacteraemia, sepsis, phlebitis and length of stay. The results are mixed with one RCT reporting a reduction in SIRS, organ failure and overall complication rate, two studies in disagreement over the occurrence of sepsis and one study reporting no impact on length of hospital stay. The six articles on case reports show different drug incompatibility situations. They report pulmonary toxicity.
Little data is available on this topic. Infused particles may induce organ failure, in particular pulmonary toxicity and SIRS. Further studies are needed to establish a link between the level of exposure to drug incompatibilities and clinical implication.
本综述旨在分析重症患者静脉药物不相容的临床后果，特别是器官功能障碍和死亡率的发生率。
根据 2017 年 6 月的 PRISMA 声明，我们对文献进行了回顾，使用了 Medline、ISI Web of Science 和 Clinicaltrials.gov。
合格的研究是病例报告和随机对照试验（RCT），评估了药物不相容性对重症患者发病率或死亡率的影响，作为主要或次要结局，或不良事件。两名研究人员独立审查了摘要或手稿数据的研究入选标准。
符合选择标准的文章有 12 篇。报告 RCT 的 6 篇文章仅涉及 4 项 RCT。RCT 是比较输注加或不加过滤器的单中心研究。其中一项研究包括成年患者。其他研究包括儿科和新生儿重症监护病房的患者。主要终点是 SIRS、器官衰竭、总并发症发生率、菌血症、败血症、静脉炎和住院时间。结果不一，一项 RCT 报告 SIRS、器官衰竭和总并发症发生率降低，两项研究对败血症的发生存在分歧，一项研究报告对住院时间无影响。6 篇病例报告文章显示了不同的药物不相容情况。它们报告了肺毒性。
关于这个主题的数据很少。输注的颗粒可能会导致器官衰竭，特别是肺毒性和 SIRS。需要进一步的研究来建立药物不相容与临床意义之间的联系。
