Intensive care drug therapy and its potential adverse effects on blood pressure and heart rate in critically ill children  

作　　者：Lisa Marie Kiesel Astrid Bertsche Wieland Kiess Manuela Siekmeyer Thilo Bertsche Martina Patrizia Neininger 

机构地区：[1]Drug Safety Center and Clinical Pharmacy,Institute of Pharmacy,Medical Faculty,Leipzig University,Bruederstr.32,04103 Leipzig,Germany [2]Division of Neuropediatrics,University Hospital for Children and Adolescents,Fleischmannstr.8,17475 Greifswald,Germany [3]Department of Women and Child Health,Hospital for Children and Adolescents and Center for Pediatric Research,University Hospital of Leipzig,Liebigstr.20a,04103 Leipzig,Germany

出　　处：《World Journal of Pediatrics》2023年第9期902-911,共10页世界儿科杂志（英文版）

摘　　要：Background Owing to complex treatment,critically ill children may experience alterations in their vital parameters.We investigated whether such hemodynamic alterations were temporally and causally related to drug therapy.Methods In a university pediatric intensive care unit,we retrospectively analyzed hemodynamic alterations defined as values exceeding the limits set for heart rate(HR)and blood pressure(BP).For causality assessment,we used the World Health Organization–Uppsala Monitoring Center(WHO–UMC)system,which categorizes the probability of causality as“certain,”“probable,”“possible,”and“unlikely.”Results Of 315 analyzed patients with 43,200 drug prescriptions,59.7%experienced at least one hemodynamic alteration;39.0%were affected by increased HR,19.0%by decreased HR,18.1%by increased BP,and 16.2%by decreased BP.According to drug information databases,83.9%of administered drugs potentially lead to hemodynamic alterations.Overall,88.3%of the observed hemodynamic alterations had a temporal relation to the administration of drugs;in 80.2%,more than one drug was involved.Based on the WHO–UMC system,a drug was rated as a“probable”causing factor for only 1.4%of hemodynamic alterations.For the remaining alterations,the probability ratings were lower because of multiple potential causes,e.g.,several drugs.Conclusions Critically ill children were frequently affected by hemodynamic alterations.The administration of drugs with potentially adverse effects on hemodynamic parameters is often temporally related to hemodynamic alterations.Hemodynamic alterations are often multifactorial,e.g.,due to administering multiple drugs in rapid succession;thus,the influence of individual drugs cannot easily be captured with the WHO–UMC system.

关 键 词：Adverse drug reaction Drug therapy Hemodynamic monitoring Multifactorial causality Pediatric intensive care unit 

分 类 号：R57[医药卫生—消化系统]