• Sandra L Kane-Gill, Jaclyn M LeBlanc, Joseph F Dasta, Sandeep Devabhakthuni, and Critical Care Pharmacotherapy Trials Network.
• 1Pharmacy and Therapeutics, Clinical Translational Science Institute and Critical Care Medicine, Schools for Pharmacy and Medicine, University of Pittsburgh, Pittsburgh, PA. 2Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA. 3Department of Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada. 4Division of Pharmacy Practice and Administration, The Ohio State University, Columbus, OH. 5Division of Health Outcomes and Pharmacy Practice, University of Texas, Austin, TX. 6Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, College Park, MD.
• Crit. Care Med. 2014 Oct 1; 42 (10): 2197-203.

ObjectiveTo determine the point prevalence of drug-induced hypotension episodes in critically ill patients, to assess the episodes resulting from error, and to describe how episodes are treated.DesignMulticenter observational, 24-hour snapshot study.SettingForty-seven ICUs in 27 institutions located in the United States, Canada, and Singapore.PatientsA total of 688 ICU patients were evaluated.InterventionsNone.Measurements And Main ResultsPatients were included in the study if they had an episode of hypotension in the 24 hours prior to the clinical pharmacists' evaluation. The definition for a hypotensive episode is either a systolic blood pressure less than 90 mm Hg or a decrease in systolic blood pressure of 30 mm Hg over a 2-hour period. Each episode of unintentional hypotension was assessed for suspected drug-related causes. When a drug-related cause was suspected, an objective assessment tool, the modified Kramer, was used to determine causality. A score of at least "possible" was considered drug induced, referred to as a "drug-related hazardous condition." A drug-related hazardous condition is the temporal gap (intermediate stage) between the identification of an adverse drug reaction and the subsequent onset of drug-induced injury, known as an "adverse drug event." Drug-induced episodes were evaluated for medication errors and treatment. One hundred fifty-eight patients experienced 204 hypotensive episodes that were considered unintentional and drug related. Common drugs implicated included propofol, fentanyl, metoprolol, lorazepam, hydralazine, and furosemide. A total of 54 episodes (26.5%) resulted from medication errors. Common error types were improper dose/quantity (46%) and prescribing (25%). A total of 56.9% episodes were treated.ConclusionsMany hypotensive episodes in the ICU are drug related and require treatment. A substantial portion of these episodes result from errors and are therefore preventable. This presents opportunities to improve prescribing including optimizing drug dosing to avoid possible patient harm from drug-induced hypotension.

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