Fecha de publicación: -- Fuente: PubMed "apis" J Am Coll Clin Pharm. 2026 Nov;9(11):e70321. doi: 10.1002/jac5.70321.ABSTRACTBACKGROUND: Pharmacist interventions (PIs) are vital for patient safety in pediatric intensive care units (PICUs). However, linking these recommendations to definitive outcomes like mortality remains limited by methodological challenges. This study evaluated the association of cumulative PIs and interprofessional team adherence with survival among patients requiring pharmacotherapeutic optimization who received at least one PI.METHODS: A retrospective cohort study was conducted with 565 patients admitted to a tertiary PICU (2019-2021) with a stay > 24 h who received at least one documented PI. To account for the time-varying nature of exposures and attenuate confounding, total PIs and accepted pharmacist interventions (aPIs) were modeled exploring their interaction with time using extended multivariable Cox proportional hazard models. Baseline clinical severity was adjusted using the Pediatric Index of Mortality-2 score (PIM-2). Data classification integrity was ensured through independent external validation (Cohen's kappa = 0.702).RESULTS: Overall mortality was 11.9%, and total PIs presented an acceptance rate of 72.2%. In extended multivariable models, among patients who received at least one PI, cumulative total PIs were significantly associated with a lower hazard of in-PICU mortality (hazard ratio [HR] = 0.989; p = 0.040), an association predominantly observed in non-surgical patients (HR = 0.951; p = 0.029). Interprofessional adherence was more strongly associated with survival; cumulative PIs had a significant association with survival across the entire cohort (HR = 0.983; p = 0.025), remaining consistent in both surgical (HR = 0.983; p = 0.041) and non-surgical strata (HR = 0.950; p = 0.043). Baseline clinical severity (PIM-2 > 30%) remained the strongest independent predictor of death (p < 0.001).CONCLUSION: Among patients requiring pharmacotherapeutic optimization who received at least one PI, cumulative pharmacist recommendations and interprofessional team adherence were independently associated with a lower time-dependent hazard of in-PICU mortality. Given the observational design, these findings reflect independent associations requiring prospective confirmation.PMID:43000161 | DOI:10.1002/jac5.70321