• Melany Gaetani, Helena Frndova, Winnie Seto, and Christopher Parshuram.
• Child Health Evaluative Sciences, The Research Institute Hospital for Sick Children, Toronto, ON, Canada.
• Pediatr Crit Care Me. 2020 Apr 1; 21 (4): e170-e176.

ObjectivesDespite the ubiquitous role of pharmacotherapy in the care of critically ill children, descriptions of the extent of pharmacotherapy in critical illness are limited. Greater understanding of drug therapy can help identify clinically important associations and assist in the prioritization of efforts to address knowledge gaps. The objectives of this study were to describe the diversity, volume, and patterns of pharmacotherapy in critically ill children.DesignA retrospective cohort study was performed with patient admissions to the ICU between July 31, 2006, and July 31, 2015.SettingThe study took place at a single, free-standing, pediatric, quaternary center.PatientsEligible patient admissions were admitted to the ICU for more than 6 hours and received one or more drug administration. There were a total 17,482 patient-admissions and after exclusion of 283 admissions (2%) with no documented enteral or parenteral drug administration, 17,199 eligible admissions were studied.InterventionsNone.Measurements And Main ResultsThe 17,199 eligible admissions were admitted to the ICU for 2,208,475 hours and received 515 different drugs. The 1,954,171 administrations were 894,709 (45%) enteral administrations, 998,490 (51%) IV injections and 60,972 (3%) infusions. Infusions were administered for 4,476,538 hours. Twelve-thousand two-hundred seventy-three patients (71%) were administered five or more different drugs on 80,943 of patient days (75%). The 10 most commonly administered drugs comprised of 834,441 administrations (43%).ConclusionsDrug administration in the ICU is complex, involves many medications, and the potential for drug interaction and reaction is compounded by the volume and diversity of therapies routinely provided in ICU. Further evaluation of polytherapy could be used to improve outcomes and enhance the safety of pharmacotherapy in critically ill children.

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