Background: The prevalence of adverse drug reactions is reported to be high in critical care
units. We conducted a systematic review to study the prevalence, drugs implicated, preventability,
predictability, severity and determinants of adverse drug reactions in critical care settings.
Methods: We searched MEDLINE, EMBASE, PROQUEST and OVID (January 1995 to June 2015)
using pre-specified appropriate medical subject heading terms. Of 1552 studies, 34 studies were
included for data extraction and synthesis.
Results: Overall, the prevalence of adverse drug reactions was 0.3% to 17% in paediatric intensive care
units and 4.5% to 34.1% in adult intensive care units. The highest prevalence reported among critical
care settings was 117.4 per 1000 patient days. The most common drug classes implicated were
antimicrobials in the medical intensive care units, cardiovascular drugs and anticoagulants in the
coronary care units, and analgesics and sedatives in the surgical care units. The prevalence of fatal and
severe adverse drug reactions ranged from 0.9 to 19% and 5.7 to 28.6% respectively. The predictable
and preventable adverse drug reactions ranged from 74.3 to 90.2% and 8.6 to 62.8% respectively. Only
8 studies reported patient outcomes. About 5.6% to 25.5% of patients died.
Conclusion: There is wide variation in prevalence, characteristics and drug classes implicated in the
occurrence of adverse drug reactions by type of intensive care unit. Findings of this study would help
health care professionals to optimise pharmacotherapy in critical care settings.