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重症监护患者中具有临床意义的潜在药物-药物相互作用:一项大型回顾性观察性多中心研究。

Clinically relevant potential drug-drug interactions in intensive care patients: A large retrospective observational multicenter study.

机构信息

Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.

Amsterdam UMC (location AMC), Department of Intensive Care Medicine, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.

出版信息

J Crit Care. 2021 Apr;62:124-130. doi: 10.1016/j.jcrc.2020.11.020. Epub 2020 Dec 1.

Abstract

PURPOSE

Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting.

MATERIALS & METHODS: In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting.

RESULTS

The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when considering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs.

CONCLUSIONS

Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients.

摘要

目的

潜在的药物-药物相互作用(pDDI)可能会对入住重症监护病房(ICU)的患者造成伤害。由于患者的危急状况和在 ICU 上的持续监测,并非所有 pDDI 都具有临床相关性。针对不相关 pDDI 的临床决策支持系统(CDSS)警告可能会导致警报疲劳和忽略重要信号。因此,我们的目的是描述临床相关 pDDI(crpDDI)的频率,以便为 ICU 环境定制 CDSS。

材料与方法

在这项多中心回顾性观察研究中,我们使用药物管理数据来识别来自 13 个 ICU 的 ICU 入院患者中的 pDDI。临床相关性基于一项 Delphi 研究,其中重症监护医生和医院药剂师评估了 pDDI 在 ICU 环境中的临床相关性。

结果

每 1000 次药物管理中 pDDI 的平均数量为 70.1,当仅考虑 crpDDI 时降至 31.0。在 103871 名 ICU 患者中,38%的患者发生了 crpDDI。最常发生的 crpDDI 涉及延长 QT 间期的药物、地高辛或 NSAIDs。

结论

考虑 ICU 环境中 pDDI 的临床相关性很重要,因为只有一半的检测到的 pDDI 是 crpDDI。因此,为 ICU 定制 CDSS 可能会减少警报疲劳并提高 ICU 患者的用药安全性。

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