Identifying essential medications for critical care: initial findings from US academic intensive care units

Low- and middle-income countries (LMICs) shoulder a disproportionately high amount of death and disability caused by both communicable and non-communicable diseases. As a result, there is a higher occurrence of serious illness in these countries. Intensive Care Units (ICUs) have emerged in the past twenty years in LMICs. However, the World Health Organization (WHO) Model List of Essential Medicines lacks many common medicines used in critical care, and the lack of necessary medications to treat critical illnesses has hindered the function of these ICUs. This study aimed to develop a list of commonly used essential medications in the ICU to serve as the foundation for a multi-phase project.

This was an observational cross-sectional survey of all the program directors of all the Critical Care fellowship training programs in the United States of America. The study surveyed a multidisciplinary group of critical care providers to assess the first, second, and third-line preferred medication use in 10 categories of medications: sedatives, vasopressors, inotropes, antiarrhythmics, intravenous antihypertensives, neuromuscular blocking agents, medications for the management of ICU delirium, stress ulcer prophylaxis (SUP), deep vein thrombosis prophylaxis, and analgesics, to create a list of 26 commonly used critical care medicines.

Of the 588 contacted programs, 133 completed the survey questionnaire, representing a 23% response rate with an over-representation from the East Coast and the Midwest. Seven medication categories had a clear first-line preference, while only three had clear second-line preference respondents.

This survey successfully identified the 26 most commonly used medications in the ICU grouped into 10 categories. This list will serve as a foundational reference for future phases of the research project, which will include engagement with stakeholders from LMICs to refine and adapt the list to regional realities.