Background Currently, a lack of pharmaceutical care exists concerning pain and agitation in medical intensive care units (MICU) in Thailand. Pharmaceutical care focusing on analgesics/sedatives would improve clinical outcomes. Objective To investigate the impact of pharmaceutical care of pain and agitation on ICU length of stay (LOS), hospital LOS, ventilator days and mortality. Setting The MICU of a university hospital. Method A before/after study was conducted on mechanically ventilated patients receiving analgesics/sedatives. Medical chart reviews and data collection were conducted in the retrospective group (no pharmacists involved). In the prospective group, pharmacists involved with the critical care team helped select analgesics/sedatives for individual patients. Main outcome measure ICU LOS Results In total, 90 and 66 patients were enrolled in retrospective and prospective groups, respectively. The median duration of ICU LOS was reduced from 10.00 (2.00–72.00) in the retrospective group to 6.50 days (2.00–30.00) in the prospective group (p = 0.002). The median hospital stay was reduced from 30.50 days (2.00–119.00) in the retrospective group to 17.50 days (2.00–110.00) in the prospective group (p < 0.001). Also, the median ventilator days was reduced from 14.00 days (2.00–90.00) to 8.50 days (1.00–45.00), p = 0.008. Mortality was 53.03% in the prospective group and 46.67% in the retrospective group (p = 0.432). Conclusion Pharmacist participation in a critical care team resulted in a significant reduction in the duration of ICU LOS, hospital LOS and ventilator days, but not mortality.
Agitation Analgesics Critically ill patients Medical intensive care unit Pain Pharmaceutical care Sedatives Thailand
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We give special thanks to: the Critical Care Department, nurses and staff at the MICU, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; the Pharmacy Department at Ramathibodi Hospital; the Dilokpattanamongkol and Sornsunthorn family; Jiradej Vatanutanon, Amaraporn Wongrakpanich and all of the critical care residents for their support. Special thanks go to Christopher C. Salisbury and Thomas MC Manamon for English editing. We also wish to thank Dr. Sunthiti Morakul and Dr. Cherdkiat Karnjanarachata for their advices throughout the study.
This study was funded by the Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok.
Conflicts of interest
The authors declare that they have no conflict of interest.
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