RESUMO
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.
Assuntos
Cuidados Críticos , Preparações Farmacêuticas , Interações Medicamentosas , Humanos , Unidades de Terapia Intensiva , Estudos RetrospectivosAssuntos
Aneurisma/complicações , Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Tronco Braquiocefálico/patologia , Síndrome de Marfan/complicações , Estenose Traqueal/etiologia , Adulto , Broncoscopia , Humanos , Intubação Intratraqueal , Masculino , Complicações Pós-Operatórias , Desmame do RespiradorRESUMO
We present a 49-y-old male, with a history of Marfan's disease and aortic and mitral valve replacement surgery, who was operated for a type III thoracoabdominal aneurysm. The postoperative course was compromised by a Staphylococcus epidermidis mitral valve endocarditis, which was successfully treated only after intravenous linezolid was included in the therapy.
Assuntos
Acetamidas/uso terapêutico , Anti-Infecciosos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Próteses Valvulares Cardíacas/microbiologia , Oxazolidinonas/uso terapêutico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus epidermidis/efeitos dos fármacos , Acetamidas/administração & dosagem , Anti-Infecciosos/administração & dosagem , Quimioterapia Combinada , Endocardite Bacteriana/microbiologia , Humanos , Linezolida , Masculino , Pessoa de Meia-Idade , Valva Mitral/microbiologia , Valva Mitral/cirurgia , Oxazolidinonas/administração & dosagem , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/microbiologia , Falha de Tratamento , Resultado do TratamentoRESUMO
A 55-year-old female patient is described who had recurrent retroperitoneal infections without an apparent focus. After a protracted period of illness the infection proved to be caused by actinomycosis. An unusual feature of the inflammatory process consisted of obstruction of the ureters, ultimately resulting in destruction of the left kidney. Hydronephrosis resulting from inflammatory fibrosis has not been reported in the literature before.