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Critically ill patients are often vulnerable to the occurrence of hypotension.  Causes are often multifactorial including severity of illness, medication administration, etc. The occurrence of drug-induced hypotension could be prevented by optimizing the choice of drug therapy with regard to selection and dosing. This is often potentially disabling leading to organ hypoperfusion and resulting in ischemia and/or infarction.1,2 The prevalence of hypotension in the ICU could be as high as 81%.3-6

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This is a retrospective, multicenter, observational study.7 Pharmacists from the Clinical Pharmacy and Pharmacology (CPP) Section of the Society of Critical Care Medicine were recruited to participate in the study. The University of Pittsburgh was the study-coordinating site.  The primary objective of this study is to determine the point prevalence of drug-induced hypotension in critically ill patients. Secondary objectives include determining which episodes of drug-induced hypotension resulted from medication errors since these are preventable and to describe the resulting treatment. To be included in the study, ICU patients had to have an episode of hypotension in the 24 hours before the pharmacists’ evaluation. Hypotension was defined as a systolic blood pressure (SBP) less than 90mm Hg or a decrease in SBP of 30mm Hg over a 2-hour period. Patients were excluded from the study if they had 1) a SBP less than 90mm Hg at the start of the 24-hour data collection period or 2) a transient elevation in SBP due to pain or suctioning. Each episode of hypotension was evaluated for suspected drug-related causes. If suspected, the modified Kramer (objective assessment tool) was used to determine causality. A hypotensive episode could have more than one drug cause, so each drug was evaluated. If the modified Kramer indicated a score of possible, probable, or definite for the hypotension being caused by a drug, then the episode was considered drug induced. Episodes were also evaluated to whether they were intentional or not. An episode of hypotension was considered unintentional if it met the previous definition for hypotension or exceeded targeted SBP. Only unintentional episodes were analyzed further. The treatment was to discontinue causative agent, reduce dose of causative agent, administer colloid, administer crystalloid or to administer vasopressor indicating and others.  A total of 158 patients had 204 hypotensive episodes that were considered unintentional and drug related. Propofol, fentanyl, lorazepam, metoprolol, hydralazine and furosemide were the most common causative agents. Out of the total hypotensive episodes, 26.5% resulted from medication errors. Errors identified were improper dose (46%) and prescribing (25%). A total of 56.9% episodes were treated. Various treatment options were used with the most common being the administration of a crystalloid.7

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In conclusion, drug-induced hypotensive episodes in the ICU could be preventable. Protocol implementation and respective adherence may be a consideration for the management of hypotension in the ICU. Technology should be utilized to promote patient safety. Limitations of this study include: the fact that it was only a 24-hour snapshot of the ICU stay, the possibility ...

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