Page 235 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology ICU pharmacists and clinical outcomes

improving patient recovery and minimizing excessive they largely encompassed individuals from general medical
consumption of healthcare resources. Among the essential, and surgical wards. This broader scope limits the direct
yet sometimes underappreciated, members of these teams relevance of the findings to critically ill populations, where
are critical care pharmacists (CCPs). Their integration clinical dynamics and pharmacotherapeutic challenges
2
into ICU care has increasingly been recognized as an differ substantially.
indispensable strategy to enhance therapeutic outcomes Furthermore, the aforementioned meta-analysis
14
and reduce medication-related risks. Moreover, the faced limitations related to small sample sizes, study
3-5
evolving landscape of intensive care presents increasingly heterogeneity, and a high risk of bias, which called into
complex pharmacotherapeutic challenges, driven by the question the strength and generalizability of its conclusions.
rapid development of new drugs, emerging antimicrobial In addition, these earlier evaluations lacked a focus on
resistance patterns, and high rates of comorbidities mortality outcomes and did not disaggregate results by
among ICU patients. CCPs are uniquely positioned to clinical setting. As a result, the true impact of CCPs in the
6-8
address these dynamics by ensuring the implementation ICU remains inadequately quantified, particularly with
of up-to-date medication practices, assessing evolving regard to patient survival and the incidence of medication-
pharmacokinetics in critically ill patients, and managing related problems (MRPs).
drug-related toxicities. Their expertise in emergency
9,10
drug resuscitation protocols and knowledge of high-alert Beyond reducing ADEs, CCPs are also believed to
medications further reinforces their critical contribution contribute indirectly to lowering ICU mortality rates. 3,17,18
to ICU safety. 11 Their recommendations often lead to more appropriate
and timely initiation of therapies such as antibiotics,
CCPs possess specialized training and clinical expertise vasopressors, or anticoagulants, which are critical in
in pharmacotherapy, particularly in high-acuity settings. managing life-threatening conditions. For example,
Their roles transcend traditional pharmacy duties, inappropriate antimicrobial therapy has been linked to
encompassing real-time decision-making, participation in increased mortality in sepsis patients; thus, pharmacist-led
multidisciplinary rounds, individualization of medication antimicrobial stewardship can be life-saving. Moreover,
15
regimens, dose adjustments based on organ function, by assuming responsibilities related to medication safety
management of drug interactions, and oversight of and efficacy, CCPs allow intensivists and nurses to focus
medication safety protocols. 12,13 This allows for a more
proactive approach to patient care in the ICU, where more on other aspects of patient care, potentially reducing
the risk of oversight and burnout among ICU staff.
2,19
complex drug regimens and rapid physiological changes
demand constant monitoring and adjustment. 2 Despite these potential benefits, the extent of CCPs’
influence on clinical outcomes such as ADEs and mortality
Evidence suggests that the involvement of CCPs leads
to a higher implementation rate of pharmacotherapeutic has not been thoroughly evaluated in a comprehensive,
ICU-specific meta-analysis. Previous studies have either
recommendations. These interventions include dosage
14
adjustments, therapeutic drug monitoring, and the lacked adequate statistical power, failed to isolate the
prevention or resolution of adverse drug events (ADEs). In ICU as a unique clinical environment, or focused only on
surrogate outcomes like cost savings or error rates rather
addition, CCPs serve as valuable resources in formulating than clinically significant endpoints.
and adhering to institutional guidelines, conducting staff
education, and contributing to antimicrobial stewardship This knowledge gap underscores the need for more
initiatives, all of which are vital in managing critically ill rigorous evaluation. To date, no meta-analysis has been
patients, particularly those with sepsis, multi-organ failure, exclusively dedicated to assessing the influence of CCPs on
or polypharmacy. 15,16 both mortality and ADEs in ICU populations. Therefore,
the current study aims to address this gap by conducting
A growing body of literature supports the contribution
of CCPs to improved patient outcomes in the ICU. Previous a comprehensive meta-analysis focused specifically on the
studies have shown that their participation reduces inclusion of CCPs in ICU teams and their impact on these
preventable ADEs, medication errors, and overall hospital two critical outcomes.
costs. For example, a frequently referenced meta-analysis The objective of this meta-analysis is to systematically
conducted by Wang et al. reported a significant decrease assess and quantify the impact of CCPs on clinical
14
in ADEs following pharmacist-led interventions. However, outcomes among ICU patients, with a primary focus
the study did not find a definitive impact on the incidence on mortality and ADEs. In addition to these primary
of medication errors. It is worth noting that the patient endpoints, the study also explores secondary outcomes
populations analyzed were not limited to the ICU; instead, where data are available, including ICU length of stay,

Volume 9 Issue 3 (2025) 227 doi: 10.36922/EJMO025150116