1
|
Gaetani M, Parshuram CS, Redelmeier DA. Furosemide in pediatric intensive care: a retrospective cohort analysis. Front Pediatr 2024; 11:1306498. [PMID: 38293664 PMCID: PMC10824983 DOI: 10.3389/fped.2023.1306498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Furosemide is the most commonly used medication in pediatric intensive care. Growing data indicates improved hemodynamic stability and efficacy of furosemide infusions compared to intermittent injections, thereby suggesting furosemide infusions might be considered as first line therapy in critically ill, paediatric patients. The objective of this study is to examine furosemide treatment as either continuous infusions or intermittent injections and subsequent patient outcomes. Methods This is a retrospective cohort analysis of patients treated in a pediatric intensive care unit (ICU) over a nine year period (July 31st 2006 and July 31, 2015). Eligible patients were admitted to either the general pediatric or cardiac specific ICU for a duration of at least 6 hours and who received intravenous furosemide treatment. Results A total of 7,478 patients were identified who received a total of 118,438 furosemide administrations for a total of 113,951 (96%) intermittent doses and 4,487 (4%) infusions running for a total of 1,588,750 hours. A total of 5,996 (80%) patients received exclusively furosemide injections and 1,482 (20%) patients received at least one furosemide infusion. A total of 193 patients died during ICU admission, amounting to 87 (6%) of the 1,482 patients who received an infusion and 106 (2%) of the 5,996 who received intermittent injections. Multivariable regression analysis showed no statistically significant decrease in adjusted mortality for patients who received furosemide injections compared to furosemide infusions (aOR 1.20, CI 0.76-1.89). Discussion This retrospective study observed similar mortality for patients who received furosemide infusions compared to furosemide injections. More research on furosemide in the ICU could provide insights on fluid management, drug effectiveness, and pharmacologic stewardship for critically ill children.
Collapse
Affiliation(s)
- Melany Gaetani
- Child Health Evaluative Sciences, The Research Institute Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Center for Safety Research, Toronto, ON, Canada
| | - Christopher S. Parshuram
- Child Health Evaluative Sciences, The Research Institute Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Center for Safety Research, Toronto, ON, Canada
- Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donald A. Redelmeier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| |
Collapse
|
2
|
Roumeliotis N, Pullenayegum E, Taddio A, Rochon P, Parshuram C. Liver enzymes after short-term acetaminophen error in critically ill children: a cohort study. Eur J Pediatr 2022; 181:2943-2951. [PMID: 35585255 DOI: 10.1007/s00431-022-04502-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/07/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
UNLABELLED Drug-associated harm is common but difficult to detect in the hospital setting. In critically ill children, we sought to evaluate drug-associated hepatic injury following enteral acetaminophen error, defined as acetaminophen dosing that exceeds daily maximum recommendations. This retrospective cohort study took place in two pediatric intensive care units within a pediatric hospital center. The included patients are children (< 18 years of age) admitted to the pediatric and cardiac intensive care unit between January 2008 and January 2018, and receiving enteral acetaminophen. We defined acetaminophen dosing error as exceeding daily acetaminophen dosing by > 10% the upper limit of maximum recommended dose for weight and age (> 82.5 mg/kg/day or > 4400 mg/day). We included 14,146 admissions, who received 147,485 doses of acetaminophen. Acetaminophen dosing errors occurred 1 in every 9.5 patient-days on acetaminophen. ALT and AST decreased significantly over the course of ICU admission (p < 0.0001). In patients with acetaminophen errors, ALT and AST measured in the 24 to 96 h post error were not significantly different than when measured outside this window. A sensitivity analysis using > 100 mg/kg/day as the upper daily acetaminophen error cut-off did not reveal any subsequent significant increase in ALT or ALT in the 24 to 96-h post-error window, compared to measurements taken outside the window. CONCLUSION Although the administration of acetaminophen in critically ill children frequently exceeds the daily recommended limit and vigilance is needed, we did not find any associated increase in liver transaminases following acetaminophen errors. WHAT IS KNOWN • Acetaminophen dosing errors are common in pediatric outpatients. • Excessive acetaminophen dosing can be associated with harm, including hepatic injury. WHAT IS NEW • Exceeding daily acetaminophen dosing limit occurs 1 in every 9.5 patient-days in children admitted to the critical care unit. • In patients with daily dose excess of acetaminophen, we did not find a significant increase in the measured liver enzymes in the 24 to 96 h following the overdosing.
Collapse
Affiliation(s)
- Nadia Roumeliotis
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada. .,Child Health Evaluative Sciences, and Center for Safety Research, SickKids Research Institute, Toronto, ON, USA. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, USA. .,Department of Pediatrics, CHU Sainte-Justine, 3175 chemin de la Cote-Sainte-Catherine, Montreal, Qc, H3T 1C5, Canada.
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, and Center for Safety Research, SickKids Research Institute, Toronto, ON, USA
| | - Anna Taddio
- Child Health Evaluative Sciences, and Center for Safety Research, SickKids Research Institute, Toronto, ON, USA.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, USA
| | - Paula Rochon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, USA.,Women's College Research Institute, Women's College Hospital, Toronto, ON, USA.,Department of Medicine, University of Toronto, Toronto, ON, USA
| | - Chris Parshuram
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, and Center for Safety Research, SickKids Research Institute, Toronto, ON, USA.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, USA
| |
Collapse
|
3
|
Fernández-Peña A, Katsumiti A, De Basagoiti A, Castaño M, Ros G, Sautua S, De Miguel M, Campino A. Drug compatibility in neonatal intensive care units: gaps in knowledge and discordances. Eur J Pediatr 2021; 180:2305-2313. [PMID: 33738517 DOI: 10.1007/s00431-021-04028-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
In this work, we reviewed the compatibility data of drug combinations frequently administrated in nine Spanish neonatal intensive care units (NICUs) and analyzed the degree of agreement among three highly used databases (Micromedex, King Guide to Parenteral Admixtures, and Stabilis) through Cohen's kappa coefficient statistical analysis. Among 1945 drug combinations analyzed, 283 were compatible, 421 were potentially compatible, 216 were incompatible, 139 were controversial, and there was no data for 886 combinations. In general, the three databases showed a strong degree of agreement: Micromedex vs. King Guide (κ = 0.746; p < 0.001), King Guide vs. Stabilis (κ = 0.743; p < 0.001), and Micromedex vs. Stabilis (κ = 0.691; p < 0.001). However, in 6 of 648 (Micromedex vs. King Guide), 3 of 357 (King Guide vs. Stabilis), and 32 of 606 (Micromedex vs. Stabilis) comparisons, drug pairs were compatible according to the first database and incompatible according to the second, indicating discordances among databases.Conclusion: There is a gap in knowledge about physical compatibility of a great number of drug combinations commonly used in NICUs. Although the three databases showed strong concordance, for some drug combinations, important discrepancies were found. Thus, there is a need for further studies on drug compatibility to increase safety of intravenous administration. What is Known: • Y site-administration in NICUs is very common and some administration errors are related to the lack of information on the compatibility of intravenous drugs. • Physical compatibility data of drugs frequently used in NICUs is still very limited. What is New: • Physical compatibility data of drug combinations commonly used in Spanish NICUs was reviewed in three highly used admixture databases: Micromedex, King Guide to Parenteral Admixtures and Stabilis, and our results showed a strong degree of agreement between them, however for some drug combinations, important discrepancies were found. • Our results indicated that there is still a large gap in knowledge about physical compatibility of a great number of drug combinations commonly used in NICUs..
Collapse
Affiliation(s)
- Alba Fernández-Peña
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | | | - Amaya De Basagoiti
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Mikel Castaño
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | - Goizane Ros
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | - Saioa Sautua
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain
| | - Monike De Miguel
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ainara Campino
- Osakidetza Basque Health Service, Cruces University Hospital, Department of Hospital Pharmacy, Barakaldo, Spain. .,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
| |
Collapse
|
4
|
Garcia JH, Crespo JCL, Handa AY, Padilha KG, Secoli SR. In(compatibility) of intravenous drugs in critical units: adult cohort. Rev Bras Enferm 2021; 74:e20200501. [PMID: 34076220 DOI: 10.1590/0034-7167-2020-0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To analyze potential (in)compatibilities of intravenous drugs based on the scheduling prepared by the nursing team. METHODS historic cohort (retrospective) with 110 adults in critical units. Intravenous medications were identified concomitantly, whose pairs were analyzed for (in) compatibility using the screening system Trissel's™ 2 Compatibility IV-Micromedex 2.0. Parametric and non-parametric statistic were used according to the nature of the variable. RESULTS 565 pairs of drugs were identified. Of these, 44.9% were compatible; and 8.8%, potentially incompatible. Most potentially incompatible pairs involved substances with alkaline pH such as phenytoin (32%) and sodium bicarbonate (8%) and weak acids such as midazolam (12%) and dobutamine (6%), which could result in precipitate formation. CONCLUSIONS almost half of the mixtures simultaneously administrated was compatible, which indirectly reflects in the organized work between the nursing team and the clinical pharmaceutic in the discussions and decisions related to time scheduling.
Collapse
|
5
|
Aghili A, Thomovsky EJ, Johnson PA, Brooks AC, Pierce TJ, Gochenauer AE. Assessment of the physical compatibility of injectable enrofloxacin with commonly used intravenous fluids and drugs during simulated Y-port administration. Am J Vet Res 2021; 82:358-366. [PMID: 33904804 DOI: 10.2460/ajvr.82.5.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate physical compatibility of small animal (SAE) and large animal (LAE) injectable formulations of enrofloxacin with select IV fluids and drugs. SAMPLE 162 admixtures containing SAE or LAE with saline (0.9% NaCl) solution, lactated Ringer solution (LRS), Plasma-Lyte A (PLA), 6% hydroxyethylstarch 130/0.4 (HES), metoclopramide, or ampicillin-sulbactam. PROCEDURES In the first of 2 simultaneously conducted experiments, admixtures containing enrofloxacin (10 mg/kg) and a volume of IV fluid that would be administered over a 20-minute period when dosed at the maintenance infusion rate (40 mL/kg/d for saline solution, LRS, and PLA and 20 mL/kg/d for HES) were created. In the second experiment, enrofloxacin (10 mg/kg) was admixed with saline solution (40 mL/kg/d) and metoclopramide (2 mg/kg/d) or ampicillin-sulbactam (30 mg/kg). In both experiments, admixture components were infused into a flask over 20 minutes assuming patient weights of 5, 10, and 20 kg. Admixtures were created by use of undiluted SAE and SAE diluted 1:1 with saline solution and undiluted LAE and LAE diluted 1:1 and 1:10 with saline solution. Admixtures were assessed for physical incompatibility at 0, 15, 30, and 60 minutes after completion of mixing. Physical incompatibility was defined as gross precipitation, cloudiness, Tyndall effect, or change in turbidity. RESULTS Admixtures containing undiluted SAE or LAE were physically incompatible with saline solution, PLA, LRS, and HES. Because saline solution was used to dilute SAE and LAE, all admixtures containing diluted SAE or LAE were also physically incompatible. Physical compatibility of enrofloxacin with metoclopramide or ampicillin-sulbactam could not be assessed because those admixtures also contained saline solution. CONCLUSIONS AND CLINICAL RELEVANCE Enrofloxacin was physically incompatible with all tested solutions.
Collapse
|
6
|
Abstract
OBJECTIVES Despite the ubiquitous role of pharmacotherapy in the care of critically ill children, descriptions of the extent of pharmacotherapy in critical illness are limited. Greater understanding of drug therapy can help identify clinically important associations and assist in the prioritization of efforts to address knowledge gaps. The objectives of this study were to describe the diversity, volume, and patterns of pharmacotherapy in critically ill children. DESIGN A retrospective cohort study was performed with patient admissions to the ICU between July 31, 2006, and July 31, 2015. SETTING The study took place at a single, free-standing, pediatric, quaternary center. PATIENTS Eligible patient admissions were admitted to the ICU for more than 6 hours and received one or more drug administration. There were a total 17,482 patient-admissions and after exclusion of 283 admissions (2%) with no documented enteral or parenteral drug administration, 17,199 eligible admissions were studied. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The 17,199 eligible admissions were admitted to the ICU for 2,208,475 hours and received 515 different drugs. The 1,954,171 administrations were 894,709 (45%) enteral administrations, 998,490 (51%) IV injections and 60,972 (3%) infusions. Infusions were administered for 4,476,538 hours. Twelve-thousand two-hundred seventy-three patients (71%) were administered five or more different drugs on 80,943 of patient days (75%). The 10 most commonly administered drugs comprised of 834,441 administrations (43%). CONCLUSIONS Drug administration in the ICU is complex, involves many medications, and the potential for drug interaction and reaction is compounded by the volume and diversity of therapies routinely provided in ICU. Further evaluation of polytherapy could be used to improve outcomes and enhance the safety of pharmacotherapy in critically ill children.
Collapse
|
7
|
Häni C, Vonbach P, Fonzo-Christe C, Russmann S, Cannizzaro V, Niedrig DF. Evaluation of Incompatible Coadministration of Continuous Intravenous Infusions in a Pediatric/Neonatal Intensive Care Unit. J Pediatr Pharmacol Ther 2019; 24:479-488. [DOI: 10.5863/1551-6776-24.6.479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to evaluate and quantify incompatible coadministrations of continuous intravenous medication in the daily clinical practice of a PICU/NICU.
METHODS We conducted a retrospective, observational study in the setting of an 18-bed PICU/NICU. All concurrently administered continuous infusions, including blood products and parenteral nutrition, were analyzed for 2 months. Raw electronic data were retrieved and subjected to quality controls. Infusion combinations were classified as compatible, incompatible, no data, or variable according to the internal hospital charts, Trissel's database, and the Swiss summary of product characteristics. For situations with incompatible coadministrations, we assessed alternative distributions of infusions among the currently available lumen.
RESULTS Data for 100 patients were analyzed. Patients were exposed to a mean of 6.9 ± 3.6 individual continuous infusions administered through 3.8 ± 1.8 lumina. Among the 1447 coadministered continuous infusions, we detected 146 incompatible combinations (10%), resulting in 105 individually relevant incompatible situations. Furthermore, 185 combinations (13%) were not covered by internal compatibility charts, and for 207 combinations (15%) no data on compatibility were available. We found that 58% of the incompatible situations could have been avoided by a redistribution of the infusions among the available lumina.
CONCLUSIONS Most infusion combinations in the studied PICU/NICU were compatible and covered by the internal compatibility charts. However, we also identified concurrent administrations of incompatible infusions or for which compatibility data are not available. A significant reduction of coadministrations of incompatible infusions could be achieved through optimal use of available lumina.
Collapse
|
8
|
O'Brien F, Clapham D, Krysiak K, Batchelor H, Field P, Caivano G, Pertile M, Nunn A, Tuleu C. Making Medicines Baby Size: The Challenges in Bridging the Formulation Gap in Neonatal Medicine. Int J Mol Sci 2019; 20:E2688. [PMID: 31159216 PMCID: PMC6600135 DOI: 10.3390/ijms20112688] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022] Open
Abstract
The development of age-appropriate formulations should focus on dosage forms that can deliver variable yet accurate doses that are safe and acceptable to the child, are matched to his/her development and ability, and avoid medication errors. However, in the past decade, the medication needs of neonates have largely been neglected. The aim of this review is to expand on what differentiates the needs of preterm and term neonates from those of the older paediatric subsets, in terms of environment of care, ability to measure and administer the dose (from the perspective of the patient and carer, the routes of administration, the device and the product), neonatal biopharmaceutics and regulatory challenges. This review offers insight into those challenges posed by the formulation of medicinal products for neonatal patients in order to support the development of clinically relevant products.
Collapse
Affiliation(s)
- Fiona O'Brien
- School of Pharmacy, Royal College of Surgeons in Ireland, 111 St Stephens Green Dublin 2, Ireland.
| | | | - Kamelia Krysiak
- School of Pharmacy, Royal College of Surgeons in Ireland, 111 St Stephens Green Dublin 2, Ireland.
| | - Hannah Batchelor
- College of Medical and Dental Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Peter Field
- University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
| | - Grazia Caivano
- Chiesi Farmaceutici S.p.A. Largo Francesco Belloli 11/A-43122 Parma, Italy.
| | - Marisa Pertile
- Chiesi Farmaceutici S.p.A. Largo Francesco Belloli 11/A-43122 Parma, Italy.
| | - Anthony Nunn
- Department of Women's and Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool L8 7SS, UK.
| | - Catherine Tuleu
- University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
| |
Collapse
|
9
|
Chemali D, Roumeliotis N, Cater C, Dulsrud L, Jeffs L, Taddio A, Frndova H, Parshuram C. Describing drug and fluid therapy in the paediatric intensive care unit: A pilot study. J Crit Care 2019; 52:53-57. [PMID: 30974315 DOI: 10.1016/j.jcrc.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Care in the paediatric intensive care unit (PICU) involves many clinical activities. The objectives of this study were to evaluate the feasibility of a novel observation method, the reliability of data abstraction, and to report the initial findings from application of this approach. MATERIALS AND METHODS Bedside activities of patients and clinical staff were recorded by direct observational study using video recording and audio annotation. Data were abstracted into 9 broad clinical activities and 12 specific drug-fluid activities. Enrolment rates, agreement between abstractors, clinical activity durations and interruptions are reported. RESULTS We enrolled 42 healthcare professionals, 12 family members of 13 patients, and recorded 12 patients (consent rates of 70%-92%). There were 884 clinical activity episodes. Each hour was comprised of a median (IQR) of 11.9 (4.8-16.5) minutes of drug and fluid related tasks. The 682 drug and fluid related activities were mainly preparation and administration. Interruptions occurred on average 7 times per hour. Data abstraction for 8 h had intra-class correlation co-efficient (95% CI) of 0.91 (079-0.96). CONCLUSIONS Real-time recording of clinical tasks in the PICU using a direct observation model combined with video recording is feasible. Preliminary results suggest abundant and diverse activity is routine.
Collapse
Affiliation(s)
- Dana Chemali
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Nadia Roumeliotis
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Caitlyn Cater
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Lianne Dulsrud
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Lianne Jeffs
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Anna Taddio
- Child Health Evaluative Sciences, The Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Helena Frndova
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Christopher Parshuram
- Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada; Child Health Evaluative Sciences, The Research Institute, Hospital for Sick Children, Toronto, ON, Canada.
| |
Collapse
|
10
|
Leopoldino RW, Costa HT, Costa TX, Martins RR, Oliveira AG. Potential drug incompatibilities in the neonatal intensive care unit: a network analysis approach. BMC Pharmacol Toxicol 2018; 19:83. [PMID: 30522525 PMCID: PMC6282361 DOI: 10.1186/s40360-018-0265-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/01/2018] [Indexed: 01/08/2023] Open
Abstract
Background There is little information on the frequency of drug incompatibilities in neonatal intensive care units (NICU) and the agents most commonly involved in them. The objective of the study was to characterize potential Drug Incompatibilities (DI) in the NICU by frequency, type and combination of drugs. Methods Between August 2015 and December 2016, all neonates admitted for more than 24 h and who received any drug treatment were included in this cohort study conducted in the NICU of a teaching maternity hospital in Brazil. Patient data were collected from patient records and prescription orders, and the compatibilities of all drug pairs were classified using the Trissel’s™ 2 IV Compatibility tool. Network analysis was performed in order to visualize the drug pairs commonly involved in potential DI. Results The study population consisted of 281 neonates with a median NICU length of stay of 11 days (range 2–184) and received 1343 intravenous medications. A total of 1114 potential DI were identified, 469 (42.1%) were restricted compatibilities, 348 (31.2%) unknown compatibilities and 297 (26.7%) documented incompatibilities. The incidence of documented incompatibilities in the NICU was 25.0% patient-days (95% confidence interval (CI) 19.4–30.7% patient-days). Incompatible potential DI affected 46.3% (95%CI 40.3–52.3%) of the neonates. Ampicillin (408 of 1114 pairs), gentamicin (216 of 1114 pairs) and aminophylline (197 of 1114 pairs) were the main medicines involved in potential DI. Conclusion Potential DI are extremely common in NICU, with half of the population susceptible to simultaneous administration of incompatible medications. More research is needed to understand the actual drug incompatibilities and their clinical outcomes.
Collapse
Affiliation(s)
- Ramon Weyler Leopoldino
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil.
| | - Haline Tereza Costa
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil
| | - Tatiana Xavier Costa
- Maternity School Januário Cicco, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha, 259. Petrópolis, Natal, RN, 59012-310, Brazil
| | - Rand Randall Martins
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil
| | - António Gouveia Oliveira
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Av. General Gustavo Cordeiro de Farias, s/n. Petrópolis, Natal, RN, 59012-570, Brazil
| |
Collapse
|