Manual de orientações para administração de medicamentos injetáveis em pacientes pediátricos e adultos com restrição hídrica em unidades de terapia intensiva

Abstract

Sepsis and septic shock are among the main causes of death in Intensive Care Units, requiring fluid management through volume replacement to avoid tissue hypoperfusion, but on the other hand, when done inappropriately, it can generate adverse effects. In patients with acute lung injury, a restrictive fluid strategy resulted in fewer days of mechanical ventilation. In acute kidney injury, positive fluid balance may not be protective, resulting in worse outcomes. In general, in patients admitted to Intensive Care Units, positive water balance is associated with a higher incidence of complications such as pulmonary congestion and cardiovascular overload. In critically ill patients, broadspectrum antimicrobials are often used, such as polymyxin B, which must be diluted in 300 to 500 mL of 5% glucose saline or 0.9% saline, which limits its use in patients who are at risk of developing states of volume overload. In these cases, it is necessary to adopt minimum dilutions, following the recommendations for maximum infusion concentration of the medicine. Patients admitted to the Intensive Care Unit are complex, requiring constant reassessment by the multidisciplinary team, with quick measures to be taken. To this end, it is essential that reliable information is readily available, contributing to evidence-based health practice. It is believed that a manual with standardized medications will facilitate the safe management of these patients. Furthermore, the need for an approach aimed at the pediatric population is justified due to the greater risk of adverse drug reactions, given the high number of off-label drug prescriptions, lack of form and pharmaceutical presentation suitable for use in pediatrics, combined with physiological, pharmacokinetic and pharmacodynamic aspects in children, making this group more susceptible to harmful effects. The clinical pharmacist has the role of conveying safety to medication users, being a reference for multidisciplinary teams, as one of their duties is providing safe information. The objective was to develop a medication dilution manual for the adult and pediatric Intensive Care Units of a teaching hospital, in which the most used classes of medications were listed, based on the hospital's list of standardized medications. The research was carried out in the Lexicomp and PDR Drug Information databases, with a description of the diluents and minimum volumes for each medicine, establishing the dilution procedure, with determination of the maximum concentrations allowed in accordance with the literature