Page 241 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology ICU pharmacists and clinical outcomes

critically ill patients with chronic kidney disease (CKD), resource utilization in ICUs, aligning with broader evidence
demonstrating their significant impact on medication supporting their integration into critical care teams.
safety. The study identified 273 DDIs in 76 patients (83.5% Mohammad et al. evaluated the role of clinical
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of participants), with 63.7% requiring close monitoring pharmacists in an interprofessional ICU recovery clinic,
and 30% necessitating therapy modification or drug demonstrating their effectiveness in addressing MRPs
discontinuation. Pharmacist interventions, including among ICU survivors. The study found that pharmacist
dosage adjustments (19.4%), drug discontinuation interventions led to a significant reduction in MRPs
(17.2%), and enhanced monitoring (41%), were highly between initial and six-month follow-up visits (from 3.5
accepted by prescribers (92%). Notably, 22% of DDIs ± 1.7 to 2.4 ± 1.3 per patient, p=0.025), with common
caused temporary harm or prolonged hospitalization, interventions including patient education (91.3%),
but pharmacist involvement mitigated severe outcomes, medication changes (73.9%), and care coordination
such as life-threatening hypotension from contraindicated (73.9%). Although no significant difference in MRPs was
combinations (e.g., nitroglycerine-sildenafil). The study observed between the intervention and control groups,
also highlighted that advanced CKD stages (e.g., stage the high acceptance of pharmacist recommendations (e.g.,
5) and polypharmacy significantly increased DDI risk addressing safety-related issues, drug interactions, and
(p<0.05). These findings underscore the critical role of adherence) underscores their value in post-ICU care. The
pharmacists in preventing ADEs through proactive DDI authors emphasized the pharmacist’s role in comprehensive
management, particularly in high-risk CKD populations, medication management, particularly for complex sepsis or
though their impact on mortality remains unexplored. respiratory failure survivors, highlighting potential long-
Dilokpattanamongkol et al. evaluated the impact of term benefits in reducing preventable readmissions and
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pharmacist-led pharmaceutical care on pain and agitation optimizing recovery. These findings align with broader
management in a Thai medical ICU, demonstrating evidence supporting pharmacist integration in critical care
significant improvements in clinical outcomes. The study transitions to mitigate ADEs and improve patient outcomes.
found that pharmacist involvement in analgesic/sedative The study by Oxman et al. evaluated the impact
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selection reduced median ICU length of stay (from 10.00 to of pharmacist-driven interventions on antibiotic
6.50 days, p=0.002), hospital stay (from 30.50 to 17.50 days, de-escalation in suspected ventilator-associated
p<0.001), and ventilator days (from 14.00 to 8.50 days, pneumonia cases. Pharmacist involvement significantly
p=0.008). Pharmacists optimized therapy by promoting improved the rate of appropriate antibiotic targeting
opioid-based regimens over benzodiazepines, which based on culture results (59% pre-intervention vs. 91%
decreased adverse events like prolonged sedation (from post-intervention, p=0.003), demonstrating their role
24.44% to 4.55%, p=0.001) and hemodynamic instability in optimizing antimicrobial stewardship. However, the
(from 18.89% to 3.03%, p=0.003). However, mortality intervention did not significantly increase early antibiotic
rates remained unchanged (53.03% vs. 46.67%, p=0.432), discontinuation in low-risk patients (19% vs. 23%,
likely due to the multifactorial nature of ICU mortality. p=0.767), suggesting physician reluctance to stop empiric
The study highlights the role of CCPs in protocol-driven therapy despite clinical indicators. While mortality rates
sedation management to enhance recovery and resource remained unchanged (14% vs. 16.7%, p=0.72), the study
utilization, though their impact on survival may require highlights the pharmacist’s ability to enhance evidence-
broader multidisciplinary interventions. based antibiotic use in critical care, particularly in tailoring
The study by Louzon et al. demonstrated the significant therapy to microbiological data.
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impact of CCPs in managing pain, agitation, and delirium The study by Jiang et al. highlights the role of CCPs in
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through multidisciplinary ABCDE bundle rounds. Their optimizing antimicrobial dosing for patients undergoing
two-phase initiative showed that pharmacist-directed continuous venovenous hemofiltration (CVVH),
sedation management reduced continuous sedation demonstrating significant reductions in ADEs and cost
exposure by 46%, decreased ICU length of stay by 5 days, savings. Pharmacist interventions, including daily dosing
and lowered hospital costs by $1.2 million. In addition, adjustments based on dynamic CVVH parameters, led to
the expanded ABCDE bundle program further improved a 2.36-fold decrease in antimicrobial-related ADEs (11 vs.
outcomes, including a reduction in mean ventilator days 26 events, p=0.002) and cost savings of £1637.7 per patient.
from 5.6 to 4.0 days and a significant decline in mortality Notably, β-lactams accounted for 51.2% of dosing errors,
Acute Physiology and Chronic Health Evaluation ratios underscoring the complexity of antimicrobial management
from 1.26 to 0.75. These findings underscore the role of in renal replacement therapy. While mortality and ICU
pharmacists in optimizing clinical outcomes and reducing length of stay remained unchanged, the study emphasizes

Volume 9 Issue 3 (2025) 233 doi: 10.36922/EJMO025150116