Pharmacologic issues in the critically ill

Pharmacotherapy of critically ill patients poses numerous challenges to the treating physician. Individualization of therapy is recommended for all Patients, using pharmacokinetic and pharmacodynamic principles to design an optimal regimen. In critically ill patients, the interplay between drug and patient, drug and disease, and drug-drug interactions causes alterations in drug disposition and effect, which must be accounted for in regimen design. The approach to pharmacotherapy in the ICU should also include alterations in response to dynamic physiologic changes, and a systematic approach to the prevention, reporting, and correction of adverse drug events, including errors.