Uso de fármacos em Unidade de Tratamento Intensivo e seu potencial iatrogênico

Abstract

Patient admissions to Intensive Care Unit (ICU) are related to differentiated monitoring and treatment demands. Among the therapeutic modalities, the pharmacological resources prevail; benefit and stabilization, on one side, they can mean iatrogeny, for another. This concern intensifies when it is contemplated the pharmacotherapy of the critically ill, and carrier of multiple organic dysfunctions. The objective of this work consisted of tracing a profile of the drugs use in adult patients' ICU, with particular interest in their iatrogenic potentials. A descriptive and retrospective analysis was done in 200 patients admitted in the ICUs of the Hospital Geral de Fortaleza - INSS (public institution) and Hospital São Mateus (private institution), in Fortaleza, Ceará, Brazil. The patients studied were equitably distributed, according to each institution and their evolution (survivors and non-survivors). Both ICUs admit clinical-surgical patients, being the public ICU of the closed type, and submitted to a drug formulary; already the private ICU, it is of the open type, with drugs’ choice and prescription without restrictions. Two-hundred-one generic drugs were prescribed, with significantly larger demand in the private ICU. There was a tendency to prescribe more drugs to the non-survivor patients, the elderly and carriers of APACHE II score higher than 14 points. The antibiotics were the more frequently prescribed drugs, followed by the vasoative/inotropics, and analgesics/sedatives/neuromuscular blockers. One-thousand-hundred-eighteen potential drug interactions were registered, with prevalence in private ICU, the patients non-survivors and the elderly. Regarding the gravity, there was a clear supremacy of the moderate intensity interactions (82,47 percent) over great intensity interaction one. The patients admitted to both ICUs underwent, therefore, polipharmacy and were exposed to the frequent risk of potential drug interactions. There was, however, a less accentuated tendency in the closed type ICU, endowed with drug formulary.