Outcome of patients with systemic rheumatic disease admitted to medical intensive care units.

Background: The number of older adults admitted to cardiac intensive care units (CICU) have been increasing over the past decade, but it is not known if outcomes vary between CICU and medical intensive care units (MICU). We aimed to describe survival and length of stay (LOS) in older adults admitted to CICU and MICU. Methods: All patients admitted to the CICU or MICU at Beth Israel Deaconess Medical Center from 2001-2012 were identified from MIMIC-III, a large single-center critical care database containing deidentified clinical data for 38,597 patients. Our primary outcomes were ICU mortality and ICU LOS. Regression analyses were performed adjusting for age, gender, ICU setting and Oxford Acute Severity of Illness Score (OASIS), a severity score developed and validated in critically ill patients for ICU mortality. Results: We included 21,088 MICU patients (48.3% female) and 7,726 CICU patients (42% female). Unadjusted mortality was 13.7% in MICU and 12.5% in CICU (p=0.11). When adjusted for age, gender and OASIS, there was no difference in mortality between MICU and CICU (OR 0.62, 95% CI 0.34-1.13, p=0.15). However, we found a significant interaction between older age and type of ICU with mortality (p=0.03) but not with ICU LOS (p=0.15). In patients >75 years (6,837 in MICU and 3,161 in CICU), each 5-year interval of older age was associated with higher mortality when adjusted for gender and OASIS in the CICU (OR 1.05, 95% CI 1.02-1.08 p=0.002), but not in the MICU (OR 1.01, 95% CI 0.99-1.03, p=0.15, Figure). Conclusion: Older adults admitted to the CICU had higher adjusted mortality by age group after age 75, as opposed to older MICU patients in whom mortality was high but remained unchanged after age 75.

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A multicentered pharmacoepidemiological approach to evaluate clinically significant potential drug–drug interactions in medical intensive care settings in Pakistan

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918765510 ◽

2018 ◽

Vol 25 (4) ◽

pp. 190-195 ◽

Cited By ~ 1

Author(s):

Faisal Shakeel ◽

Jamshaid Ali Khan ◽

Muhammad Aamir ◽

Syed Muhammad Asim ◽

Irfan Ullah

Keyword(s):

Intensive Care ◽

Drug Interactions ◽

Intensive Care Units ◽

Potential Drug ◽

Significant Potential ◽

Significant Difference ◽

Tertiary Hospitals ◽

Medical Intensive Care ◽

Clinically Significant ◽

Multiple Drugs

Background: Iatrogenic injuries due to drug–drug interactions are particularly significant in critical care units because of the severely compromised state of the patient. The risk further increases with the use of multiple drugs, increasing age, and stay of the patient. Objective: The aim was to assess potential drug–drug interactions, evaluate clinically significant potential drug–drug interactions and their predictors in medical intensive care units of tertiary hospitals in Pakistan. Methods: Analysis of patient data collected from medical intensive care units of tertiary hospitals in Pakistan were carried out using Micromedex DrugReax. Various statistical tools were applied to identify the significance of associated predictors. Results: In a total of 830 patients, prevalence of potential drug–drug interactions was found to be 39%. These attributed to 190 drug combinations, of which 15.4% were clinically significant. A significant association of potential drug–drug interactions was present with number of prescribed drugs, age, and gender. In terms of clinically significant potential drug–drug interactions, the association was significant with increasing age. Moreover, one-way analysis of variance revealed a significant difference in the means of potential drug–drug interactions among the four hospitals. Conclusion: A prevalence of 39% potential drug–drug interactions was observed in patients of medical intensive care unit, with 22.8% being clinically significant. These attributed to nine drug pairs and could easily be avoided to reduce the risk of adverse effects from potential drug–drug interactions.

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