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Vol. 47. Núm. 9.
Páginas 552-553 (septiembre 2023)
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Vol. 47. Núm. 9.
Páginas 552-553 (septiembre 2023)
Letter to the Editor
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Critical patient’s healing walks and photoprotecion: the dark side of the sun
Paseos curativos en pacientes críticos y fotoprotección: el lado oscuro del sol
Marta de Antonio-Cuscóa,
Autor para correspondencia

Corresponding author.
, Purificación Pérez-Teránb,c,d,1, Javier Mateu-de Antonioa,1, Joan Ramon Masclans-Envizb,c,d
a Pharmacy Department, Hospital del Mar, Barcelona, Spain
b Intensive Care Unit, Hospital del Mar, Barcelona, Spain
c Critical Illness Research Group (GREPAC), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Spain
d Department of Medicine, Universitat Pompeu Fabra (UPF), Spain
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Dear Editor:

A prolonged stay in an intensive care unit (ICU) could have detrimental consequences for patients and their families, causing both long-term physical and psychological sequelae.1 In this regard, we read with interest the article by Igeño-Cano concerning about benefits of transfer patients outside the ICU to an open area.2

However, the impact of solar radiation (SR) on drugs had not been a consideration in the treatment of critical patients up till now, underestimating the risks of adverse reactions (AR) (Supplementary Fig. S1) and photoinstability of drugs administered at that time (Supplementary Table S1). These risks will be even greater in the coming years due to climate change.

For all these reasons, during critically ill patients’ walks, it is advisable to protect the patient against SR as well as the drugs administered, specially avoiding sun exposure during strongest radiation according to the climatic zone (Supplementary Fig. S2).

For patients, it is essential to consider, the night administration of photosensitizing drugs to reduce drug concentrations during the day for drugs with short-medium half-lives, use of a hat, UV protection sunglasses, opaque clothing, keeping the application site of photosensitizing topical or transdermal drugs covered, and the application of a SPF50 cream without photosensitizers.

Likewise, it is important to apply also the pertinent preventive measures to those discontinued drugs with long half-life or prolonged-release formulations administered on previous days, such as azithromycin or depot intramuscular antipsychotics.

It is essential to correctly protect photosensitive medications with opaque or light-protected bags and photo-protected infusion lines to maintain their physical, chemical and pharmacological properties.3

The implementation of measures such avoiding times of maximum SR or prioritizing intermittent intravenous infusions over continuous administration could also be useful. Drugs requiring bolus administration could be better administered before going outside to avoid the increase in the patient's body temperature, a factor of drug stability, due to the SR during the walk.

In front of relatively high environmental temperatures (>25 °C/77 °F), refrigerating infusions by wrapping of infusion pumps in cold pouch between 2 freezer packs4 throughout their administration outside or storing the drug-filled device in the refrigeration before critical patients’ walks could be a strategies to bear in mind for thermolabile drugs. Nevertheless, it is necessary to evaluate the impact of refrigeration on the stability of each specific drug, diluent, and formulation; to avoid the formation of precipitation or crystallization or any other physicochemical instability.

Transdermal drug delivery should also be considered due to drug diffusion into the skin is a temperature-dependent process. Therefore, an optimal strategy could be to maintain the application area covered during administration and for days after removal.

Both enteral and parenteral nutrition must be discontinued due to lipid peroxidation and vitamins degradation.5 Because hypoglycemia may occur, glycaemia monitoring or dextrose 5% in water administration is required.

Intensive care medicine faces the challenge of adapting clinical practices to new scenarios to humanize ICU, but this brings also new challenges. In the organization of patients’ walks, it is essential to include a photoprotection protocol adjusted to routine clinical practice.

Authors’ contributions

All authors have contributed to the manuscript and have read and approved the final manuscript.

Appendix A
Supplementary data

The following are Supplementary data to this article:

M.E. Wilson, S. Beesley, A. Grow, et al.
Humanizing the intensive care unit [Internet].
J.C. Igeño-Cano.
Beneficios de los paseos por jardines exteriores del hospital en el paciente crítico, familia y profesionales. #paseosquecuran.
Med Intensiva, 44 (2020), pp. 446-448
I. Sánchez-Quiles, M.D. Nájera-Pérez, A. Espuny-Miró, et al.
Review of the stability of photosensitive medications [Internet].
J.L. Kuti, C.H. Nightingale, R.F. Knauft, et al.
Pharmacokinetic properties and stability of continuous-infusion meropenem in adults with cystic fibrosis.
Clin Ther, 26 (2004), pp. 493-501
D.T. Robinson, P. Ayers, B. Fleming, et al.
Recommendations for photoprotection of parenteral nutrition for premature infants: an ASPEN position paper [Internet].

P. Pérez-Terán and J. Mateu-de Antonio contributed equally to this work.

Copyright © 2023. Elsevier España, S.L.U. y SEMICYUC
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