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Doctoral Thesis
DOI
https://doi.org/10.11606/T.7.2020.tde-25022021-101807
Document
Author
Full name
Sandro Ritz Alves Bezerra
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2020
Supervisor
Committee
Secoli, Silvia Regina (President)
Nogueira, Lilia de Souza
Reis, Adriano Max Moreira
Trevisan, Danilo Donizetti
Title in Portuguese
Interações Medicamentosas Prolongadoras do Intervalo QT em Unidade de Terapia Intensiva: Coorte de idosos
Keywords in Portuguese
Enfermagem
Farmacoepidemiologia
Idoso
Interações Medicamentosas
Morte
Síndrome do QT Longo
Unidade de Terapia Intensiva
Abstract in Portuguese
Em Unidades de Terapia Intensiva (UTI), a ocorrência de interações medicamentosas representa um dos motivos precipitantes do prolongamento do intervalo QT, o qual pode contribuir para a Síndrome do Intervalo QT Prolongado Adquirida (ALQTS), que pode resultar em desfechos clínicos potencialmente catastróficos como síncope, parada cardíaca e morte súbita. Deste modo, o objetivo deste estudo foi determinar a incidência de interações medicamentosas prolongadoras de intervalo QT (IMP QT) e as variáveis clínicas e terapêuticas preditoras de IMP QT, e identificar associação entre a ocorrência de IMP QT e óbito. Analisaram-se prescrições médicas de pacientes idosos internados em UTI do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. As IMP QT foram identificadas segundo DRUG-REAX® da base de dados Micromedex. Na análise dos dados utilizaram-se os testes Pearson's Chi-squared test, Wilcoxon-Mann-Whitney test e Welch Two Sample t-test e regressão logística, com significância de p 0,05. A incidência de IMP QT foi de 43,9%. Foram identificadas 86 IMP QT cuja maioria (93,0%) foi de gravidade Maior. Os preditores para IMP QT foram potássio sérico 3.5 mEq/L (p=0,044), uso de antipsicóticos (p<0.001), de antidepressivos (p=0,003), de antiarrítmicos (p=0,006), ocorrência de IMP geral de gravidade Maior (p=0,002) e IMP geral de gravidade Contraindicada (p=0,004). A frequência de óbitos entre pacientes expostos a IMP QT foi 38,5% e cujos preditores foram a ocorrência de choque séptico (p<0,001), o uso de diurético de alça (p=0.048), o uso de antibióticos (p=0.049), a ocorrência de IMP QT Contraindicada (p=0.006). No contexto da UTI, os estudos farmacoepidemioilógicos podem trazer informações acerca do risco e do impacto das IMP, contribuindo assim na elaboração de práticas de cuidado que visem o uso seguro de medicamentos em pacientes idosos gravemente enfermos.
Title in English
QT Interval Prolonging Drug - Drug Interactions in an Intensive Care Unit: Elderly cohort.
Keywords in English
Death
Drug Interactions
Elderly
Intensive Care Units
Long QT Syndrome
Nursing
Pharmacoepidemiology
Abstract in English
In Intensive Care Units (ICU), the occurrence of drug-drug interactions (DDI) represents one of the precipitating reasons for the prolongation of the QT interval, which can contribute to the Acquired Long QT Interval Syndrome (ALQTS), which can result in potentially catastrophic clinical outcomes such as syncope, cardiac arrest and sudden death. Thus, the aim of this study was to determine the incidence of QT interval-prolonging drug-drug interactions (QT DDI) and the clinical and therapeutic variables that predict QT DDI, and to identify an association between the occurrence of QT DDI and death. Medical prescriptions of elderly patients admitted to the ICU of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo were analyzed. QT DDI were identified according to DRUG-REAX® from the Micromedex database. Pearson's Chi-squared test, Wilcoxon-Mann-Whitney test and Welch Two Sample t-test and logistic regression were used in the data analysis, with significance of p 0.05. The incidence of QT DDI was 43.9%. 86 QT DDI were identified, the majority (93.0%) of which was Major in severity. Predictors for QT DDI were serum potassium 3.5 mEq / L (p = 0.044), use of antipsychotics (p <0.001), antidepressants (p = 0.003), antiarrhythmics (p = 0.006), occurrence of general severity IMP Major (p = 0.002) and general IMP of severity Contraindicated (p = 0.004). The frequency of deaths among patients exposed to QT DDI was 38.5% and whose predictors were the occurrence of septic shock (p <0.001), the use of loop diuretics (p = 0.048), the use of antibiotics (p = 0.049) ), the occurrence of Contraindicated QT DDI (p = 0.006). In the context of the ICU, pharmacoepidemioilogical studies can bring information about the risk and impact of PPIs, thus contributing to the elaboration of care practices aimed at the safe use of medicines in seriously ill elderly patients.
 
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Publishing Date
2021-03-09
 
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