Ma. Smythe et al., AN EXPLORATORY ANALYSIS OF MEDICATION UTILIZATION IN A MEDICAL INTENSIVE-CARE UNIT, Critical care medicine, 21(9), 1993, pp. 1319-1323
Objectives. To evaluate patterns of medication use in a medical intens
ive care unit (ICU) and to explore relationships between drug use, pat
ient age, admitting diagnosis, Acute Physiology and Chronic Health Eva
luation (APACHE II) scores, length of stay, and survival. Design: Comb
ination prospective and retrospective study. Setting. Medical ICU in a
large teaching institution. Patients: Patient admissions (n = 191) to
a medical ICU during a 4-month study period. Interventions: The follo
wing data were collected: age, length of stay, diagnosis, physiologic
variables necessary for APACHE II scores, medications administered, an
d survival. Measurements and Main Results. The mean length of stay of
the study patients was 5.2 +/- 9.8 days. Overall mortality rate was 33
%. The mean age of survivors, 62.7 yrs, was significantly (p < .05) lo
wer than that value for nonsurvivors (68.6 yrs). Postcardiopulmonary r
esuscitation (CPR) or -stroke patients had a mortality rate that was h
igher than the overall mortality rate (p < .05). APACHE II scores of >
19 were associated with a reduced survival rate when compared with the
overall mortality rate. The mean daily and mean total number of medic
ations administered per patient were 7.5 +/- 3.4 and 12.1 +/- 7.6, res
pectively. Antihypertensives/vasodilators and gastrointestinal prophyl
axis medications were administered most commonly in 69% and 65% of pat
ients, respectively. The median total drug use per patient was signifi
cantly greater in nonsurvivors vs. survivors (13 and 10, respectively,
p < .02). There was a positive linear relationship between total medi
cation use and log length of stay (r2 = .62). Patients admitted post-C
PR or with seizures received the highest number of medications (p < .0
5). Conclusions. Patients admitted to the medical ICU receive multiple
medications from a variety of pharmacologic classes. Prolonged length
of stay, certain admitting diagnoses, and death are associated with i
ncreased medication administration. Age, certain admitting diagnoses,
and APACHE II scores are significantly related to survival.