Fluid stewardship in intensive care: clinical pharmacist’s actions analysis

Abstract

Objective: To describe and analyze the pharmaceutical interventions performed by clinical intensivist pharmacists in the management of fluid therapy. Methods: This is an observational, retrospective, descriptive study conducted in a clinical ICU of a tertiary teaching hospital from January 2018 to December 2022. The study evaluated the classification according to the “four rights of fluid therapy” adapted from Hawkins14 (right drug, right dose, right route, and right patient); the acceptability of pharmaceutical interventions; the classification of interventions involving hidden fluids, and the medications involved in this classification. Results: The study included 415 patients, the majority of whom were male, 51% (213). The mean age was 57.4 ± 17.2 years. A total of 993 pharmaceutical interventions related to fluids were performed, comprising 12.2% of the interventions during the study period and corresponding to 2.4 per patient. The acceptability rate was 90% (894). Of the cited interventions, the majority (591) were related to the “right dose” (59.4%). The other interventions were: 167 (16.9%) related to the “right drug,” 163 (16.4%) to the “right route,” and 72 (7.2%) to the “right patient.” The management of hidden fluids was present in 722 (72.7%) interventions, with a focus on antimicrobials, totaling 256 (35.4%); followed by electrolytes and vitamins with 229 (31.7%), and antiulcer agents with 124 (17.2%). Conclusion: The pharmaceutical interventions analyzed were related to the “four rights of fluid therapy” and had high acceptability from the team. There was significant demand for pharmaceutical intervention in fluid management. The findings indicate the potential role of the clinical intensivist pharmacist as a key player in the fluid therapy management of critically ill patients.