Key Articles and Guidelines Relative to Intensive Care Unit Pharmacotherapy: 2009 Update

Brian L. Erstad, Pharm.D., FCCM, FCCP, FASHP; Gretchen M. Brophy, Pharm.D., FCCP, FCCM; Steven J. Martin, Pharm.D., FCCP, FCCM; Curtis E. Haas, Pharm.D., FCCP; John W. Devlin, Pharm.D., FCCM, FCCP; Lynda S. Welage, Pharm.D., FCCP; William E. Dager, Pharm.D., FCSHP, FCCP, FCCM


Pharmacotherapy. 2009;29(10):1228-1269. 

In This Article

Abstract and Introduction


Compilations of key articles and guidelines in a particular clinical practice area are useful not only to clinicians who practice in that area, but also to all clinicians. We compiled pertinent articles and guidelines pertaining to drug therapy in the intensive care setting from the perspective of experienced critical care pharmacists. A broad assembly of practitioners with expertise in various areas of intensive care unit pharmacology were involved in the compilation of this update.


The original compilation of key articles and guidelines pertaining to intensive care unit (ICU) pharmacology was published in 2002.[1] That compilation was primarily from the perspective of the general ICU practice of the primary author (B.L.E.); therefore, certain topics were not covered to a significant degree. A subsequent revision in 2004[2] and this 2009 update were compiled by selected members of the Critical Care Practice and Research Network (PRN) of the American College of Clinical Pharmacy. These revisions contain a more diverse range of articles reflective of the authors' interest areas and practice settings. In addition, we evaluated research investigations by using an evidence-based classification system.[3] This classification system is as follows: class I, randomized controlled trials; class II, prospective trials and retrospective studies with reliable data (e.g., case-control studies); and class III, retrospective studies and expert opinion.

The information in this compilation should be particularly useful for trainees, relatively new practitioners, and experienced specialists seeking a broader understanding of critical care–related pharmacotherapy. We hope it also might serve as a useful template for experienced clinicians who have contemplated a similar undertaking in their practice areas.

Authors from the Critical Care PRN were invited to participate based on their recognized areas of expertise. Once written, the sections were compiled and reviewed by all authors to help ensure appropriate article selections and summaries. We could not include every published article we considered important to critical care pharmacotherapy; however, we compiled what we believed were the most representative articles addressing the selected critical care topics.

This bibliography is divided into four general sections. The first focuses on landmark and contemporary pivotal articles and guidelines pertaining to pharmacotherapy in the ICU setting. When these were not available in a specific clinical area, comprehensive reviews or articles were chosen that have generated substantial discussion among ICU practitioners. Some of the headings of this section have been changed since the previous revision.[2] The second section focuses on articles pertaining to medication errors and adverse drug events in the ICU. Since many of the interventions by ICU pharmacists pertain to patient safety, this section could include a large number of citations; however, the intent was to cite investigations that assessed medication errors and adverse drug events, or pharmacists' attempts to prevent or ameliorate them, from a broader system-wide perspective. The third section lists more general articles pertaining to critical care pharmacy services development and justification. The fourth section focuses on literature pertaining to the economic justification of ICU pharmacy services (both supporting and opposing) or, more specifically, the justification for pharmacists in the critical care setting.