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World J Crit Care Med. May 4, 2015; 4(2): 139-151
Published online May 4, 2015. doi: 10.5492/wjccm.v4.i2.139
Designing drug regimens for special intensive care unit populations
Brian L Erstad
Brian L Erstad, Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ 85721-0207, United States
Author contributions: Erstad BL solely contributed to this work.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Brian L Erstad, PhD, MCCM, Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, 1295 N. Martin Ave., Tucson, AZ 85721-0207, United States. blerstad@hotmail.com
Telephone: +1-520-6264289 Fax: +1-520-6267355
Received: August 5, 2014
Peer-review started: August 6, 2014
First decision: August 28, 2014
Revised: September 6, 2014
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: May 4, 2015
Processing time: 261 Days and 7.9 Hours
Abstract

This review is intended to help clinicians design drug regimens for special populations of critically ill patients with extremes of body size, habitus and composition that make drug choice or dosing particularly challenging due to the lack of high-level evidence on which to make well-informed clinical decisions. The data sources included a literature search of MEDLINE and EMBASE with reviews of reference lists of retrieved articles. Abstracts of original research investigations and review papers were reviewed for their relevance to drug choice or dosing in the following special critically ill populations: patients with more severe forms of bodyweight or height, patients with amputations or missing limbs, pregnant patients, and patients undergoing extracorporeal membrane oxygenation or plasma exchange. Relevant papers were retrieved and evaluated, and their associated reference lists were reviewed for citations that may have been missed through the electronic search strategy. Relevant original research investigations and review papers that could be used to formulate general principles for drug choice or dosing in special populations of critically ill patients were extracted. Randomized studies with clinically relevant endpoints were not available for performing quantitative analyses. Critically ill patients with changes in body size, habitus and composition require special consideration when designing medication regimens, but there is a paucity of literature on which to make drug-specific, high-level evidence-based recommendations. Based on the evidence that is available, general recommendations are provided for drug choice or dosing in special critically ill populations.

Keywords: Drug dosage calculations; Pharmacokinetics; Critical care; Body composition; Obesity; Pregnancy

Core tip: Special populations of intensive care units patients with more severe alterations in body size, shape, and composition pose unique challenges to clinicians faced with drug choice or dosing decisions. Appropriate drug choice or dosing in these populations must take into account a variety of factors from altered pharmacokinetic parameters to concomitant therapeutic interventions and co-morbidities.