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Strategies to prevent drug incompatibility during simultaneous multi-drug infusion in intensive care units: a literature review

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Abstract

Purpose

Drug protocols in intensive care units may require the concomitant administration of many drugs as patients’ venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible drugs. Incompatibilities can lead to the formation of particles and inactivation of drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences.

Methods

This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities.

Results

All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, incompatibility tables and databases, and the use of standard operating procedures.

Conclusion

Although many strategies have been developed in recent years to address drug incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.

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Data Availability

All data analysed during this study is included in this manuscript.

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Acknowledgements

We thank Alexandra Tavernier (M.A., University of Glasgow, Professeur Agrégée, France) for English language and editing assistance.

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Authors and Affiliations

  1. Univ. Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France

    Laura Négrier, Anthony Martin Mena, Gilles Lebuffe, Pascal Odou, Stéphanie Genay & Bertrand Décaudin

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  1. Laura Négrier
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  2. Anthony Martin Mena
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  3. Gilles Lebuffe
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  4. Pascal Odou
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  5. Stéphanie Genay
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  6. Bertrand Décaudin
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Contributions

All authors contributed to the study conception and design. L.N. wrote the manuscript. B.D., S.G., and A.M.M. contributed to the supervision, the methodology, the validation, the reviewing, and editing. L.N., S.G., and A.M.M. performed the literature searches and the data analysis. P.O. and G.L. contributed to critically revise the work and editing.

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Correspondence to Laura Négrier.

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Négrier, L., Martin Mena, A., Lebuffe, G. et al. Strategies to prevent drug incompatibility during simultaneous multi-drug infusion in intensive care units: a literature review. Eur J Clin Pharmacol 77, 1309–1321 (2021). https://doi.org/10.1007/s00228-021-03112-1

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