Emerging Clinical Pharmacy Practice in Critical Care: Insights from Vietnam

Background: Patients with critical illness are highly vulnerable to medication-related problems caused by rapid physiological changes, complex pharmacotherapy, and intensive use of high-risk medications.Globally, evidence supports the integration of clinical pharmacists into intensive care units (ICUs); however, low-and middle-income countries including Vietnam face systemic and workforce barriers that limit the development of ICU pharmacy services.This review synthesizes contemporary clinical pharmacy interventions, their clinical and economic effects, existing workforce and competency models, and contextual barriers to implementation in Vietnam. Methods: A structured narrative review was conducted using the Elicit platform, covering literature published between 2010 and 2025.Four predefined research domains guided the search: (1) types of ICU clinical pharmacy interventions; (2) workforce models and competency expectations; (3) barriers to implementation in Vietnam.Eligible articles included original studies, observational studies, randomized trials, mixed-methods research, program evaluations, and reviews addressing adult ICU practice.Data extraction and domain-based synthesis were performed manually to ensure contextual accuracy.Results: Seventy-nine studies met the inclusion criteria.The most frequently reported interventions were medication review/optimization and medication-related problem prevention (75.9%), followed by antimicrobial stewardship (24.1%) and therapeutic drug monitoring or pharmacokinetic-/pharmacodynamic-guided dosing (19%).Across diverse systems, ICU pharmacists have consistently reduced prescribing errors, enhanced regimen appropriateness, supported high-risk therapy management, and contributed to clinically and economically meaningful outcomes.Although workforce models varied widely, core competencies converged on medication safety, advanced pharmacotherapy in critical care, and interprofessional collaboration.However, in Vietnam, implementation remains limited because of workforce shortages, inconsistent training, inadequate AMS infrastructure, misaligned policies, and cultural and economic barriers. Conclusion:ICU clinical pharmacy services deliver substantial clinical and operational benefits; however, the capacity to implement such models in Vietnam is constrained by systemic, workforce, and educational limitations.Strengthening competency development, establishing ICU-specific training pathways, and improving policy-institutional alignment are critical for advancing ICU pharmacy practice in Vietnam.