A Multicenter Study of the Point Prevalence of Drug-Induced Hypotension in the ICU

作者：Kane Gill Sandra L^*; LeBlanc Jaclyn M; Dasta Joseph F; Devabhakthuni Sandeep

来源：Critical Care Medicine, 2014, 42(10): 2197-2203.

DOI：10.1097/CCM.0000000000000499

• critical care
• drug-induced abnormalities
• drug toxicity
• hypotension
• intensive care
• medication error

Objective: To determine the point prevalence of drug-induced hypotension episodes in critically ill patients, to assess the episodes resulting from error, and to describe how episodes are treated.
Design: Multicenter observational, 24-hour snapshot study.
Setting: Forty-seven ICUs in 27 institutions located in the United States, Canada, and Singapore.
Patients: A total of 688 ICU patients were evaluated.
Interventions: None.
Measurements and Main Results: Patients were included in the study if they had an episode of hypotension in the 24 hours prior to the clinical pharmacists' evaluation. The definition for a hypotensive episode is either a systolic blood pressure less than 90 mm Hg or a decrease in systolic blood pressure of 30 mm Hg over a 2-hour period. Each episode of unintentional hypotension was assessed for suspected drug-related causes. When a drug-related cause was suspected, an objective assessment tool, the modified Kramer, was used to determine causality. A score of at least "possible" was considered drug induced, referred to as a "drug-related hazardous condition." A drug-related-hazardous condition is the temporal gap (intermediate stage) between the identification of an adverse drug reaction and the subsequent onset of drug-induced injury, known as an "adverse drug event." Drug-induced episodes were evaluated for medication errors and treatment. One hundred fifty-eight patients experienced 204 hypotensive episodes that were considered unintentional and drug related. Common drugs implicated included propofol, fentanyl, metoprolol, lorazepam, hydralazine, and furosemide. A total of 54 episodes (26.5%) resulted from medication errors. Common error types were improper dose/quantity (46%) and prescribing (25%). A total of 56.9% episodes were treated.
Conclusions: Many hypotensive episodes in the ICU are drug related and require treatment. A substantial portion of these episodes result from errors and are therefore preventable. This presents opportunities to improve prescribing including optimizing drug dosing to avoid possible patient harm from drug-induced hypotension.

• 出版日期2014-10