Drug-drug interactions in the intensive care unit: Do they really matter?

作者：Vanham D^*; Spinewine A; Hantson Ph; Wittebole X; Wouters D; Sneyers B^*

来源：Journal of Critical Care, 2017, 38: 97-103.

DOI：10.1016/j.jcrc.2016.09.014

• Drug-drug interactions
• Intensive care unit
• Prevalence
• Interrater reliability
• Adverse drug events

Purpose: To describe prevalence and patterns of potential drug-drug interactions (pDDIs) in the intensive care unit (ICU), occurrence of adverse drug events (ADEs), and agreement between different compendia and intensivists' perceptions.
Methods: A cross-sectional study. Drug profiles of all adult patients from 2 academic ICUs were screened on day 3 upon admission. We identified pDDIs using 3 compendia (Stockley's, Micromedex, and Epocrates) and documented their mechanism of action, clinical consequences, severity, level of evidence, and management. Medical records were searched to identify ADEs potentially related to major pDDls. Agreement between information sources (compendia, intensivists) was evaluated.
Results: We identified 1120 pDDIs among 275 patients. Median number of pDDls per patient was 3.0 (interquartile range, 1-6), with 79% of patients presenting with at least 1 pDDI. Major pDDIs were detected in 18% of patients, with potentially related to ADEs in 4% of patients. Only 13% of all pDDIs were documented simultaneously in all 3 compendia. Different information sources (compendia, clinicians) showed "no" to "fair" agreement.
Conclusions: Potential drug-drug interactions occurred in most ICU patients, contrasting with low rates of potentially related ADEs, which may have been underestimated. Sources of information are inconsistent, challenging the identification of pDDIs.

• 出版日期2017-4