Nurse and Doctoral Student, Hospital Universitário (HU), Universidade de São Paulo (USP), São Paulo (SP), Brazil.
PhD. Nurse and Assistant Professor, Universidade Federal de São João Del Rei (UFSJ), Divinópolis (MG), Brazil.
Sao Paulo Med J. 2023 Jul 31;142(1):e2022666. doi: 10.1590/1516-3180.2022.0666.R1.190523. eCollection 2023.
The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use.
To estimate the incidence and factors associated with PIMs use in intensive care units.
Historical cohort study was conducted in a high-complexity hospital in Brazil.
A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%.
According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43).
Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.
危重病护理单元中潜在不适当药物（PIM）的流行病学仍然有限，特别是在与药物使用相关的因素方面。
评估重症监护病房中 PIM 使用的发生率和相关因素。
这是在巴西一家高复杂度医院进行的历史队列研究。
对在巴西一家高复杂度医院重症监护病房（ICU）住院的 314 名年龄≥60 岁的患者进行了回顾性病历审查。这些数据来自一个“患者安全项目”数据库。采用卡方检验、学生 t 检验和多变量逻辑回归分析来评估哪些因素与 PIM 相关。统计显著性设定为 5%。
根据 Beers 标准，所确定的药物中有 12.8%被认为不适合老年人群。PIM 使用的发生率为 45.8%。最常使用的 PIM 是甲氧氯普胺、胰岛素、抗精神病药、非甾体抗炎药和苯二氮䓬类药物。与 PIM 使用相关的因素是药物数量（比值比 [OR] = 1.17）、住院时间（OR = 1.07）和潜在药物相互作用过多（OR = 2.43）。
大约一半的 ICU 老年患者接受了 PIM。使用 PIM 的患者 ICU 住院时间更长、用药数量更多、潜在药物相互作用更多。在 ICU 中，使用明确的方法结合临床判断可以提高药物处方的安全性和质量。
