A small group of children admitted to the PICU requires prolonged MV. The elevated mortality rate is associated with higher ventilatory parameters and vasoactive drug support on the 21st day of MV. Stable children requiring prolonged MV in the PICU potentially prevent additional admissions of a large number of acute and unstable patients.

Objective: To assess the extent of use of drugs not appropriate for children in prescriptions issued in a tertiary pediatric intensive care unit (PICU), according to FDA standards. Methods:Observational cross-sectional study. The prescriptions issued to all patients admitted to the PICU at Hospital de Clínicas de Porto Alegre, Brazil, over a six-week period were assessed. Patients' age, sex, weight, prior disease, reason for admission to the PICU and pediatric index of mortality (PIM) were recorded, as were all drugs prescribed, their indications, presentations, doses, frequencies and means of administration. Adequacy for prescription of drugs in three pediatric age ranges was defined according to USA Food and Drug Administration (FDA) approval classification, based on the USP DI 2001 drug reference database.Results: Data were obtained in the months of July and August 2002, on different days, for six consecutive weeks, based on prescriptions issued to 51 patients in 54 admissions to the PICU. Median patient age was 10.5 months; 61% of patients were male. Two thirds of patients (65%) presented prior disease. 87% of admissions were due to clinical reasons, of which 57% were respiratory complaints. A total of 747 prescription items were registered, with prevalence of 10.5% for nonapproved uses and 49.5% for off-label uses. No statistically significant difference was found in the distribution of prevalence of irregular prescription either by the three age ranges or by level of severity of disease at admission (according to PIM risk categories). Conclusion:The high prevalence of prescription of drugs not appropriate for children confirms, in the Brazilian context, the inadequate and inadvertent use of drugs either not approved or offlabel for PICU use. This demonstrates the need to encourage further studies on the quality, efficacy and safety of drugs for pediatric use. ResumoObjetivo: Avaliar a extensão do uso de medicamentos não apropriados para crianças em prescrições de uma unidade de tratamento intensivo pediátrica (UTIP) terciária, de acordo com os padrões estabelecidos pela FDA.Métodos: Estudo transversal, observacional, baseado na avaliação das prescrições de todos os pacientes admitidos na UTIP do Hospital de Clínicas de Porto Alegre, no período de seis semanas consecutivas. Foram considerados idade, sexo, peso, doença prévia, motivo de admissão na UTIP, e PIM (pediatric index of mortality) dos pacientes, e todos os medicamentos prescritos e suas indicações, com as respectivas apresentações, doses, freqüências e vias de administração. O critério de adequação na prescrição dos medicamentos seguiu a classificação de aprovação da FDA, baseada no catálogo de informações de medicamentos USP DI 2001, em três faixas etárias pediátricas.Resultados: Os dados foram obtidos nos meses de julho e agosto de 2002, em diferentes dias, de seis semanas consecutivas, baseados nas prescrições de 51 pacientes em 54 admissões de UTIP. A mediana de idade dos pacientes foi 10,5 meses, sendo 61% do sexo masculino. Dois terç...

The prevalence rate of patients with systemic inflammatory response syndrome upon admission to HCPA pediatric intensive care unit was elevated, with a predominance of infectious syndromes, responsible for longer stays, increased risk of mortality and increased mortality of patients during the period evaluated.