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18 citations found

1: Am J Respir Crit Care Med 2002 Nov 15;166(10):1338-44

The richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients.

Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP, Elswick RK.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine; School of Nursing and Nursing Service; Department of Pharmacy; and Department of Biostatistics, Virginia Commonwealth University Health System, Richmond, Virginia.

Sedative medications are widely used in intensive care unit (ICU) patients. Structured assessment of sedation and agitation is useful to titrate sedative medications and to evaluate agitated behavior, yet existing sedation scales have limitations. We measured inter-rater reliability and validity of a new 10-level (+4 "combative" to -5 "unarousable") scale, the Richmond Agitation-Sedation Scale (RASS), in two phases. In phase 1, we demonstrated excellent (r = 0.956, lower 90% confidence limit = 0.948; kappa = 0.73, 95% confidence interval = 0.71, 0.75) inter-rater reliability among five investigators (two physicians, two nurses, and one pharmacist) in adult ICU patient encounters (n = 192). Robust inter-rater reliability (r = 0.922-0.983) (kappa = 0.64-0.82) was demonstrated for patients from medical, surgical, cardiac surgery, coronary, and neuroscience ICUs, patients with and without mechanical ventilation, and patients with and without sedative medications. In validity testing, RASS correlated highly (r = 0.93) with a visual analog scale anchored by "combative" and "unresponsive," including all patient subgroups (r = 0.84-0.98). In the second phase, after implementation of RASS in our medical ICU, inter-rater reliability between a nurse educator and 27 RASS-trained bedside nurses in 101 patient encounters was high (r = 0.964, lower 90% confidence limit = 0.950; kappa = 0.80, 95% confidence interval = 0.69, 0.90) and very good for all subgroups (r = 0.773-0.970, kappa = 0.66-0.89). Correlations between RASS and the Ramsay sedation scale (r = -0.78) and the Sedation Agitation Scale (r = 0.78) confirmed validity. Our nurses described RASS as logical, easy to administer, and readily recalled. RASS has high reliability and validity in medical and surgical, ventilated and nonventilated, and sedated and nonsedated adult ICU patients.

PMID: 12421743 [PubMed - in process]

2: Am J Respir Crit Care Med 2002 Nov 15;166(10):1310-9 Related Articles, Links: Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit.

Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F.

Medical Intensive Care Unit, and Department of Cardiology, University Hospital Ambroise Pare, Assistance Publique Hopitaux de Paris, Boulogne, France.

PMID: 12421740 [PubMed - in process]

3: Anaesth Intensive Care 2002 Oct;30(5):628-32 Related Articles, Links: Outcome of stroke patients admitted to intensive care: experience from an Australian teaching hospital.

Fanshawe M, Venkatesh B, Boots RJ.

Department of Anaesthesia and Critical Care Medicine, Royal Brisbane Hospital, Queensland.

The objective of this study was to determine the mortality rate and the functional outcomes of stroke patients admitted to the intensive care unit (ICU) and to identify predictors of poor outcome in this population. The records of all patients admitted to the ICU with the diagnosis of stroke between January 1994 and December 1999 were reviewed. Patients with subarachnoid haemorrhage were excluded. Data were collected on clinical and biological variables, risk factors for stroke and the presence of comorbidities. Mortality (ICU, in-hospital and three-month) and functional outcome were used as end-points. In the six-year-period, 61 patients were admitted to the ICU with either haemorrhagic or ischaemic stroke. Medical records were available for only 58 patients. There were 23 ischaemic and 35 haemorrhagic strokes. The ICU, in-hospital and three-month mortality rates were 36%, 47% and 52% respectively. There were no significant differences in the prevalence of premorbid risk factors between survivors and non-survivors. The mean Barthel score was significantly different between the independent and dependent survivors (94+/-6 vs 45+/-26, P<0.001). A substantial number of patients with good functional outcomes had lower Rankin scores (92% vs 11%, P<0.001). Only 46% of those who were alive at three months were functionally independent. Intensive care admission was associated with a high mortality rate and a high likelihood of dependent lifestyle after hospital discharge. Haemorrhagic stroke, fixed dilated pupil(s) and GCS <10 during assessment were associated with increased mortality and poor functional outcome.

PMID: 12413265 [PubMed - in process]

4: Crit Care Clin 2002 Oct;18(4):915-29, x Related Articles, Links: Neuromuscular disorders in the intensive care unit.

Marinelli WA, Leatherman JW.

Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415, USA. marin005@tc.umn.edu

Neuromuscular disorders encountered in the ICU can be categorized as muscular diseases that lead to ICU admission and those that are acquired in the ICU. This article discusses three neuromuscular disorders can lead to ICU admission and have a putative immune-mediated pathogenesis: the Guillian-Barre syndrome, myasthenia gravis, and dermatomyositis/polymyositis. It also reviews critical care polyneuropathy and ICU acquired myopathy, two disorders that, alone or in combination, are responsible for nearly all cases of severe ICU acquired muscle weakness.

PMID: 12418447 [PubMed - in process]

5: Crit Care Clin 2002 Oct;18(4):897-914 Related Articles, Links: Central nervous system vasculitis in the intensive care unit.

Hajj-Ali RA, Ghamande S, Calabrese LH, Arroliga AC.

Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue-G62, Cleveland, OH 44195, USA.

Intensivists are sometimes faced with unexplained neurologic defects in ICU patients. A subacute presentation over weeks or months characterized by headache and mental status change with focal deficits in the absence of evidence of secondary vasculitis or other diseases mentioned in the differential diagnosis should arouse suspicion of PACNS. Delay in diagnosis of this rare condition may lead to additional morbidity and prolong ICU stay. There is also a risk of permanent cognitive dysfunction with untreated PACNS. A reactive CSF picture, ischemic changes on MR imaging, and alterations in vessel caliber on cerebral angiography are not diagnostic but strengthen the evidence for PACNS. A brain biopsy may be required to confirm the diagnosis. High-dose steroid therapy with a prolonged course and gradual taper controls the disease in most cases. Additional immunosuppressive therapy is needed in some patients.

PMID: 12418446 [PubMed - in process]

6: Crit Care Clin 2002 Oct;18(4):881-95, x Related Articles, Links: Pulmonary-renal syndromes in the intensive care unit.

Rodriguez W, Hanania N, Guy E, Guntupalli J.

Division of Renal Diseases and Hypertension, Department of Internal Medicine, University of Texas Medical School, 6431 Fannin, MSB 4.126, Houston, TX 77030, USA.

Renal disease associated with pulmonary hemorrhage is seen in a variety of clinical disorders and is a common cause of admission to intensive care units. Recent advances in the understanding of the pathogenesis of these disorders have improved the therapeutic options significantly and have favorably influenced the course of many of these disorders. This article discusses rheumatologic diseases that involve both the kidney and lungs, with emphasis on pathogenesis and therapeutic options. Common pulmonary-renal syndromes including anti-glomerular basement membrane disease and anti-neutrophil cytoplasmic autoantibodies-associated vasculitis.

PMID: 12418445 [PubMed - in process]

7: Crit Care Clin 2002 Oct;18(4):805-17 Related Articles, Links: Catastrophic antiphospholipid syndrome in the intensive care unit.

Westney GE, Harris EN.

Pulmonary/Critical Care Section, Department of Medicine, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA 30310, USA. westneg@msm.edu

CAPS is characterized by development of widespread microvascular thrombosis. Patients at risk are those with positive aCL or LA factor. Precipitating events, such as infection, trauma, surgical procedures, or reduction in anticoagulation therapy, may contribute to the development of CAPS. Presentation to the ICU can be dramatic, with progressive multiorgan failure and need for rapid institution of life-supporting measures. Cardiopulmonary failure has been the major contributor to mortality. A variety of therapeutic modalities have been used in an attempt to offset the widespread thrombosis and organ damage from high aCL levels. Anticoagulation therapy and high dosages of steroids seem to have a positive effect on survival.

PMID: 12418442 [PubMed - in process]

8: Crit Care Clin 2002 Oct;18(4):781-803 Related Articles, Links: Systemic lupus erythematosus in the intensive care unit.

Raj R, Murin S, Matthay RA, Wiedemann HP.

Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Desk A-90, 9500 Euclid Avenue, Cleveland, OH 44195, USA.

SLE causes significant morbidity and mortality by multisystem organ involvement. Infections are the leading cause of morbidity and mortality in patients with SLE. Meticulous exclusion of infection is mandatory in patients with SLE, because infections may masquerade as exacerbation of underlying disease; and the immunosuppression used to treat severe forms of exacerbation of lupus can have catastrophic consequences in patients with infections. Corticosteroids are the first-line therapy for most noninfectious complications of SLE, with various adjuvant immunosuppressive agents such as cyclophosphamide being increasingly used in combination with plasmapheresis. Some recent series have shown an improved survival rate, but this improvement needs to be confirmed by further studies. Controlled trials comparing various therapeutic options are lacking, and optimal therapy has not been defined.

PMID: 12418441 [PubMed - in process]

9: Crit Care Clin 2002 Oct;18(4):767-80 Related Articles, Links: Arthritis in the intensive care unit.

Raj JM, Sudhakar S, Sems K, Carlson RW.

Mayo Graduate School of Medicine, 200 1st Street SW Siebens Building #5, Rochester, MN 55905, USA. jraj@speedchoice.com

Acute arthritis in critically ill patients may be caused by local or systemic infection, by a flare of chronic joint disease such as rheumatoid or crystal-associated arthritis, or by less common entities such as hemarthrosis. Diagnosis requires analysis of synovial fluid, and appropriate treatment is based on its findings. Prompt diagnosis and treatment are usually necessary to prevent the significant morbidity associated with these conditions.

PMID: 12418440 [PubMed - in process]

10: Crit Care Clin 2002 Oct;18(4):729-48 Related Articles, Links: Rheumatologic diseases in the intensive care unit: epidemiology, clinical approach, management, and outcome.

Janssen NM, Karnad DR, Guntupalli KK.

Immunology, Allergy and Rheumatology Section, Department of Medicine, Baylor College of Medicine, One Baylor Plaza 672E, Houston, TX 77030, USA.

Patients with systemic rheumatic diseases may be admitted to the ICU because of worsening of or development of a new manifestation of the rheumatic disease, infections caused by immunosuppression, or adverse effects of drugs used to treat rheumatic diseases. Sometimes an unrelated, acute disorder may become life threatening because of the underlying rheumatic disorder. Rheumatoid arthritis is the most common rheumatic disease seen in ICU patients, followed by systemic lupus erythematosus and scleroderma. These three conditions together account for up to 75% of rheumatic cases admitted to the ICU. The respiratory system is the organ system most commonly affected in the acute process, followed by the renal, gastrointestinal, and nervous systems. More than 50% of admissions result from infections, and 25% to 35% result from exacerbation of the underlying rheumatic condition. In about 20% of patients, the rheumatic disorder may be diagnosed for the first time in the ICU. An aggressive approach should be pursued to establish the diagnosis of either disease exacerbation or infection. Delay in instituting appropriate immunosuppressive or antimicrobial therapy may result in multiple organ system failure and a poor outcome. The mortality rate in patients with rheumatic disease exceeds that predicted by the APACHE II or SAPS II scores and is higher than that in nonrheumatologic ICU admissions. The mortality may exceed 50% in patients admitted for infection; the prognosis is comparatively better for patients with exacerbations of disease activity. Renal failure, coma, and acute abdomen are predictors of poor outcome. Early recognition of abdominal complications requiring surgical intervention may help reduce mortality.

PMID: 12418438 [PubMed - in process]

11: Intensive Care Med 2002 Nov;28(11):1661-3 Related Articles, Links: Top-down costing: problems in determining staff costs in intensive care medicine.

Brazzi L, Bertolini G, Arrighi E, Rossi F, Facchini R, Luciani D.

Istituto di Anestesia e Rianimazione, Ospedale Maggiore IRCCS, Milan, Italy.

OBJECTIVE. To describe the activities carried out by the staff of Italian ICUs and to quantify the amount of working time devoted to ICU patients. DESIGN AND SETTING. Prospective, observational, multicenter study in 110 ICUs to report the non-ICU-related activities performed by ICU staff, together with the time such activities require. Of the 110 ICUs 80 participated in the project. MEASUREMENTS AND RESULTS. We found substantial variation in the number of activities carried out and in the working time allocated to such activities. Considering the differences in the number of employees, their salaries, and the amount of time spent performing various activities, it was found that the personnel cost for ICU activity was 83.4% (range 55-100%) of the total personnel costs. CONCLUSIONS. Given the wide variation in the number of activities performed and in the proportion of working time spent performing non-ICU related activities, data comparing costs between different ICUs should be interpreted with caution.

PMID: 12415458 [PubMed - in process]

12: Intensive Care Med 2002 Nov;28(11):1656-60 Related Articles, Links: A randomized prospective trial of immediate vs. next-day feeding after percutaneous endoscopic gastrostomy in intensive care patients.

Stein J, Schulte-Bockholt A, Sabin M, Keymling M.

Medizinische Klinik II, Johann-Wolfgang-Goethe Universitat, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany, j.stein@em.uni-frankfurt.de

OBJECTIVE. To determine the effect of immediate vs. next-day feeding after percutaneous endoscopic gastrostomy in intensive care and intermediate care patients. DESIGN AND SETTING. A prospective, randomized, controlled trial of the clinical outcome in two German hospitals. PATIENTS. The study included 80 patients: 40 in group 1 who received enteral feeding within 1 h and 40 in group 2 in whom feeding was started 24 h after percutaneous endoscopic gastrostomy feeding. INTERVENTIONS. Patients were fed a polymeric iso-osmolar formula via pump 30 ml/h in 20 h on day 1, 70 on day 2, and l00 on day 3. Every 6 h for 72 h gastric residue was checked, and the patient was examined by a physician the first 3 days. MEASUREMENTS AND RESULTS. Comparing the maximum residual volumes for each group for each day as the major end-points, the immediate feeding group showed an increase of about 20-50% on each day, which, however, was significant only on day 2. Our study also failed to show any significant difference in complication rate or either short-term (1-3 days) or long-term (1-30 days) mortality. CONCLUSIONS. In acutely ill intensive and intermediate care patients immediate enteral feeding via a percutaneous endoscopic gastrostomy tube is as safe as next-day feeding.

PMID: 12415457 [PubMed - in process]

13: Intensive Care Med 2002 Nov;28(11):1644-8 Related Articles, Links: Acute lung injury and acute respiratory distress syndrome at the intensive care unit of a general university hospital in BrazilAn epidemiological study using the American-European Consensus Criteria.

Fialkow L, Vieira SR, Fernandes AK, Silva DR, Bozzetti MC.

Address for correspondence: Rua Henrique Dias 194, Apto 604, Bairro Bom Fim, Porto Alegre, Rio Grande do Sul, Brazil CEP:90035-100, e-mail: lfialkow@terra.com.br, mcb@famed.ufrgs.br, Tel.: +55-51-33111017, Fax: +55-51-33118883

OBJECTIVES. To determine: (1) the frequency of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); (2) the mortality associated with these syndromes and (3) the influence of risk factors, comorbidities and organ system dysfunction in the mortality of ALI patients. DESIGN. Prospective cohort study. SETTING. Intensive care unit (ICU) of a general university hospital in Brazil. PATIENTS AND PARTICIPANTS. All patients that remained in the ICU for more than 24 h were evaluated regarding the presence/development of ALI/ARDS according to the 1994 American-European Consensus Conference. INTERVENTIONS. None. MEASUREMENTS AND RESULTS. One thousand three hundred and one patients were studied and analyzed regarding mortality, risk factors, comorbidities and organ system dysfunction(s). The frequency of ALI was 3.8% (50), of which ARDS was 2.3% (30) and ALI/non-ARDS 1.5% (20) ( p=0.15). The ICU mortality of patients with ALI was 44.0%; in ALI/non-ARDS and ARDS patients it was 40.0% and 46.7%, respectively ( p=0.43). The hospital mortality of ALI patients was 48.0%; in ALI/non-ARDS and ARDS patients it was 50.0% and 46.7%, respectively ( p=0.21). A multivariate analysis demonstrated that renal (ICU and hospital: p=0.002) and hematological dysfunction (ICU: p=0.008; hospital: p=0.02) were independently associated with ICU and hospital mortality in ALI patients. CONCLUSIONS. (1) The frequency of ALI was 3.8%, of which the frequency of ARDS was 2.3% and of ALI/non-ARDS 1.5%; (2) The ICU and hospital mortality of ALI patients was 44.0% and 48.0%, respectively; mortality rates of ARDS and ALI/non-ARDS did not differ significantly; (3) Renal and hematological dysfunction were associated with mortality in ALI patients.

PMID: 12415455 [PubMed - in process]

14: Intensive Care Med 2002 Nov;28(11):1629-34 Related Articles, Links: Duration of life-threatening antecedents prior to intensive care admission.

Hillman KM, Bristow PJ, Chey T, Daffurn K, Jacques T, Norman SL, Bishop GF, Simmons G.

Department of Intensive Care, University of New South Wales, Sydney, Australia, ken.hillman@unsw.edu.au

OBJECTIVE. To document the characteristics and incidence of serious abnormalities in patients prior to admission to intensive care units. DESIGN AND SETTING. Prospective follow-up study of all patients admitted to intensive care in three acute-care hospitals. PATIENTS. The study population totalled 551 patients admitted to intensive care: 90 from the general ward, 239 from operating rooms (OR) and 222 from the Emergency Department (ED). MEASUREMENTS AND RESULTS. Patients from the general wards had greater severity of illness (APACHE II median 21) than those from the OR (15) or ED (19). A greater percentage of patients from the general wards (47.6%) died than from OR (19.3%) and ED (31.5%). Patients from the general wards had a greater number of serious antecedents before admission to intensive care 43 (72%) than those from OR 150 (64.4%) or ED 126 (61.8%). Of the 551 patients 62 had antecedents during the period 8-48 h before admission to intensive care, and 53 had antecedents both within 8 and 48 h before their admission. The most common antecedents during the 8 h before admission were hypotension ( n=199), tachycardia ( n=73), tachypnoea ( n=64), and sudden change in level of consciousness ( n=42). Concern was expressed in the clinical notes by attending staff in 70% of patients admitted from the general wards. CONCLUSIONS. In over 60% of patients admitted to intensive care potentially life-threatening abnormalities were documented during the 8 h before their admission. This may represent a patient population who could benefit from improved resuscitation and care at an earlier stage.

PMID: 12415452 [PubMed - in process]

15: Intensive Care Med 2002 Nov;28(11):1555-62 Related Articles, Links: Pyrexia in head-injured patients admitted to intensive care.

Stocchetti N, Rossi S, Zanier ER, Colombo A, Beretta L, Citerio G.

Terapia Intensiva Neuroscienze, Ospedale Maggiore, Policlinico IRCCS, Via S. Sforza, 3520 122 Milan, Italy.

OBJECTIVES. (a) To quantify the occurrence of pyrexia during the first week after head injury; (b) to elucidate the relationships between pyrexia and neurological severity, length of stay in the ICU, intracranial hypertension, and cerebral perfusion pressure (CPP); and (c) to describe the effects of antipyretic therapy on temperature, intracranial pressure (ICP) and CPP. DESIGN AND SETTING. Multicenter retrospective observational study in three ICUs in the Milan area. PATIENTS. 110 patients with traumatic brain injury. MEASUREMENTS AND RESULTS. Eighty patients suffered pyrexia, defined as an external temperature higher than 38 degrees C or internal temperature higher than 38.4 degrees C. Occurrence and duration of pyrexia were associated with the degree of neurological impairment and with prolonged ICU stay. In patients with normal perimesencephalic cisterns the episodes of increased ICP were more frequent in febrile cases. Various antipyretic therapies were used in 66 patients. Pharmacological treatment was slightly effective (mean temperature reduction 0.58+/-0.7 degrees C) but caused a significant drop in CPP (6.5+/-12.5 mmHg). CONCLUSIONS. Pyrexia is extremely frequent in the acute phase after head injury. Its incidence is higher in more severe cases and is correlated with a longer ICU stay. It may affect ICP, but its contribution is difficult to assess when other major causes of increased intracranial volume are present. Antipyretic therapy is poorly effective for controlling body temperature and may be deleterious for CPP.

PMID: 12415441 [PubMed - in process]

16: Intensive Care Med 2002 Nov;28(11):1512-20 Related Articles, Links: Position paper of the ESICM Working Group on Nutrition and MetabolismMetabolic basis of nutrition in intensive care unit patients: ten critical questions.

Biolo G, Grimble G, Preiser JC, Leverve X, Jolliet P, Planas M, Roth E, Wernerman J, Pichard C.

Istituto di Clinico Medica, University of Trieste, Ospedale di Cattinara, 34100 Trieste, Italy.

The metabolic changes associated with critical illness involve several pathways acting at different steps of the utilization of nutritive substrates. The understanding of the role of these pathways and of their complex regulation has led to the development of new strategies for the metabolic and nutritional management of critically ill patients, including the development of new products for nutritional support. The rationale for changing the profile of nutritional support solutions by adding novel substrates is also discussed. This review focuses on the metabolic specificities of critically ill patients and also includes an analysis of the adequacy of tools to monitor the metabolic status and the adequacy of the nutritional support.

PMID: 12415440 [PubMed - in process]

17: J Hosp Infect 2002 Nov;52(3):212-8 Related Articles, Links: Environmental regulation of biofilm formation in intensive care unit isolates of Staphylococcus epidermidis.

Fitzpatrick F, Humphreys H, Smyth E, Kennedy CA, O'Gara JP.

Department of Microbiology, RCSI Education and Research Centre, Smurfit Building, Royal College of Surgeons in Ireland, Dubliq, Ireland.

Staphylococcus epidermidis is a common cause of prosthetic device-related infection in the intensive care unit (ICU). The environmentally regulated ica operon encodes a polysaccharide adhesin which is a key virulence determinant in the development of S. epidermidis biofilms. To evaluate the capacity of ICU S. epidermidis isolates to form biofilm, we measured biofilm production by 18 isolates associated with device-related infection and 20 contaminating isolates that were not associated with clinically diagnosed infection. Biofilm assays were performed in brain-heart infusion (BHI) medium and in BHI supplemented with salt, ethanol or subinhibitory tetracycline, all of which have the potential to promote biofilm formation. Polymerase chain reaction (PCR) was used to screen for the presence of the ica genes. A significant proportion of S. epidermidis strains associated with device-related infections (89%) were found to contain the ica locus compared with 50% of contaminating isolates (P = 0.01). However only four of 26 (15.3%) of all ica-positive isolates were biofilm-positive when grown in BHI medium, indicating that no significant association existed between the presence of the ica locus and biofilm-forming capacity, under standard growth conditions. In contrast the number of ica-positive isolates that were biofilm-positive under stress-inducing growth conditions or in the presence of subinhibitory tetracycline increased significantly to 73% (P = 0.02). These findings suggest that the presence of the ica locus alone is not sufficient for biofilm formation and that regulation of biofilm formation under altered growth conditions, which may exist in the in vivo environment, also plays a possible role in the pathogenesis of biomaterial-related S. epidermidis infections. Copyright 2002 The Hospital Infection Society

PMID: 12419274 [PubMed - in process]

18: Pediatrics 2002 Nov;110(5):e52 Related Articles, Links: Unlicensed and off-label drug use in an Australian neonatal intensive care unit.

O'Donnell CP, Stone RJ, Morley CJ.

Neonatal Unit, Royal Women's Hospital, Victoria, Australia.

OBJECTIVES: To determine the extent of unlicensed and off-label drugs prescribed in the level 3 neonatal intensive care unit (NICU) at the Royal Women's Hospital, Melbourne, Australia. METHODS: A prospective cohort study was conducted of all infants who were admitted to the NICU during a 10-week period. Each drug prescribed was evaluated in relation to the licensed approved uses to determine whether the drug was administered in a licensed manner or was unlicensed or used in an off-label manner. RESULTS: There were a total of 101 admissions involving 97 infants. A total of 1442 prescriptions were administered; 42% were licensed, 11% were unlicensed, and 47% were off-label. Twenty-one percent were off-label for 2 or more reasons. Eighty percent of infants received either an unlicensed or an off-label prescription or both; this proportion rose to 93% of extremely low birth weight infants. CONCLUSIONS: This is the largest study performed of unlicensed and off-label drug use in the NICU. This practice remains widespread despite clear recommendations to improve this undesirable situation. The attendant risks to infants and prescribers remain. It is time for legislation to be introduced to govern this area.

PMID: 12415058 [PubMed - in process]