Compatibilidad de los fármacos administrados en «Y» en las unidades de cuidados intensivos: revisión sistemática / Compatibility of drugs administered as Y-site infusion in intensive care units: A systematic review

Objetivos: Recopilar la información publicada sobre estabilidad de los fármacos usados en el paciente crítico, evaluar la calidad de los datos publicados y generar una tabla de compatibilidad con información actualizada. Diseño: 1) Se realizó una búsqueda sistemática en las bases de datos Medline, Stabilis, Handbook on Injectable Drugs y Micromedex, para completar y actualizar la información disponible. Se incluyeron los estudios publicados entre 1990 y 2017 redactados en inglés, español y francés; 2) se analizó la calidad de los artículos según los criterios indicados en las guías de práctica para estudios de estabilidad; 3) se construyó una tabla de compatibilidades con los datos hallados para las combinaciones binarias de 44 fármacos de uso frecuente en unidades de cuidados intensivos (UCI). Ámbito: UCI de hospitales españoles e internacionales. Resultados: La revisión sistemática incluyó 29 artículos (27 originales y 2 revisiones). Ningún estudio cumplió todos los criterios de calidad establecidos, aunque el 93% garantizaba una correcta reproducibilidad. La tabla final aporta datos de compatibilidad fisicoquímica de 475 de las 945 combinaciones posibles (50,3%), de las cuales 366 (77,1%) son compatibles y 80 (16,8%) son incompatibles. Conclusiones: Se proporciona una actualización de las compatibilidades entre los fármacos habitualmente empleados en las UCI, con la intención de contribuir a la administración segura de medicamentos en pacientes críticos

Objectives: To gather all published information about the stability of drugs commonly used in Intensive Care Units (ICU); evaluate the methodology of published data; and generate a compatibility table. Design: i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex. Articles published from 1990 to 2017 in English, Spanish and French were included. ii) Article quality was analyzed according to the stability studies practice guidelines. iii) A compatibility table was produced with data for 44 binary combinations of drugs frequently used in the ICU. Scope: Spanish and international hospital ICU. Results: The systematic review included 29 studies (27 originals, 2 reviews). None of the included studies followed all the methodological requirements. However, 93% guaranteed correct reproducibility. Accordingly, drug stability knowledge was available for 50.3% of the studied admixtures, in which 77.1% of the binary combinations proved compatible and 16.8% proved incompatible. Conclusions: This review provides new reliable evidence about the physicochemical stability of drugs commonly used in the critical care setting. The study contributes to the safe administration of intravenous drugs in critical patients with a view to avoiding adverse events in this frail population

Compatibility of drugs administered as Y-site infusion in intensive care units: A systematic review. / Compatibilidad de los fármacos administrados en «Y¼ en las unidades de cuidados intensivos: revisión sistemática.

OBJECTIVES: To gather all published information about the stability of drugs commonly used in Intensive Care Units (ICU); evaluate the methodology of published data; and generate a compatibility table. DESIGN: i) A systematic review was conducted searching the following databases: Medline, Stabilis, Handbook of Injectable Drugs and Micromedex. Articles published from 1990 to 2017 in English, Spanish and French were included. ii) Article quality was analyzed according to the stability studies practice guidelines. iii) A compatibility table was produced with data for 44 binary combinations of drugs frequently used in the ICU. SCOPE: Spanish and international hospital ICU. RESULTS: The systematic review included 29 studies (27 originals, 2 reviews). None of the included studies followed all the methodological requirements. However, 93% guaranteed correct reproducibility. Accordingly, drug stability knowledge was available for 50.3% of the studied admixtures, in which 77.1% of the binary combinations proved compatible and 16.8% proved incompatible. CONCLUSIONS: This review provides new reliable evidence about the physicochemical stability of drugs commonly used in the critical care setting. The study contributes to the safe administration of intravenous drugs in critical patients with a view to avoiding adverse events in this frail population.

Microstructural effects on the wear behavior of a biomedical as-cast Co-27Cr-5Mo-0.25C alloy exposed to pulsed laser melting.

In this work, the effect of pulsed laser melting on the exhibited microstructure and properties of a cast Co-27Cr-5Mo-0.25C alloy was investigated. In particular, properties such as surface hardness and wear behavior of the laser modified microstructure were determined as a function of the implemented laser melting parameters. It was found that laser melting promotes significant grain refinement while preventing the precipitation of coarse carbide phases. Apparently, a refined dendritic grain structure develops which is surrounded by a fine carbide distribution in the interdendritic regions. Moreover, the high-temperature face centered cubic (FCC) phase remains untransformed at room temperature. Hardness measurements and wear testing using a Pin-On-Disk tribological machine indicate that the modified laser surfaces exhibit both, high wear resistance and high microhardness when compared with the untreated as-cast Co-27Cr-5Mo-0.25C alloy. In particular, it was found that the laser modified surfaces exhibit improved wear and friction properties comparable to the ones found in Co-Cr-Mo alloys with a predominantly hexagonal closest packed (HCP) matrix. However, surface defects associated with the laser process can be detrimental for the improved wear performance and they should be considered in identifying the proper laser parameters in alloy melting.