Background and Objectives: Pharmacotherapy is an under-evaluated element of critical care medicine. In order to better understand pharmacotherapy in pediatric critical illness, we evaluated a cohort of emergency admissions to a university-affiliated pediatric intensive care unit (PICU).
Methods: A prospective, observational study was performed. Eligible patients were admitted to this medical-surgical ICU for at least 24 hours. The primary outcomes were the number of drug orders written, the number of different medications ordered, and the number of drug administrations. Multiple regression analyses were used to identify factors independently associated with each primary outcome.
Results: We studied 100 patients with a median age of 40 months (interquartile range [IQR] 9–82), who were admitted for a total of 851 ICU days. These patients received 4419 drug orders and 11 911 intermittent dose-administrations of 241 different medications. Each patient received a median of 29.5 (IQR 16.5–48.5) drug orders, 14 (IQR 9–18.5) different medications, and 58 (IQR 28–129) drug administrations while in the ICU. The most frequent orders were for morphine 457 (10.6%), furosemide (frusemide) 337 (7.8%), potassium 237 (5.5%), lorazepam 226 (5.2%), and albuterol (salbutamol) 158 (3.7%). The duration of PICU stay and severity of illness were independently associated with all primary outcomes.
Conclusions: Pharmacotherapy is an active component in the practice of pediatric critical care medicine. We demonstrated that increasing numbers of ordered medications, drug orders, and drug administrations were associated with increasing duration of ICU therapies and the length of ICU stay. These data underscore the potential importance of improved safety and efficacy of medicines used to treat critically ill children.
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No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study. The authors would like to thank Emma Perreira (data entry) and Rosemarie Farrell (study co-ordination).
Dr Parshuram is a Career Scientist of the Ministry of Health and Long-Term Care, Ontario, Canada, and is a recipient of an Early Researcher Award of the Ontario Ministry of Research and Innovation.
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McDonnell, C., Hum, S., Frndova, H. et al. Pharmacotherapy in Pediatric Critical Illness. Pediatr-Drugs 11, 323–331 (2009). https://doi.org/10.2165/11310670-000000000-00000
- Intensive Care Unit
- Intensive Care Unit Admission
- Pediatric Intensive Care Unit
- Intensive Care Unit Stay
- Regular Medication