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Paige M Garber, Christopher A Droege, Kristen E Carter, Nicole J Harger, Eric W Mueller
OBJECTIVE: Ketamine is an N-methyl-D-aspartate (NMDA) antagonist with emerging evidence assessing its use as a continuous infusion agent to provide concomitant analgesia and sedation. The role of ketamine as adjunctive therapy in mechanically ventilated patients is unclear. This study sought to investigate the impact of adjunctive continuous infusion ketamine on concomitant analgesic and sedative dosing while providing goal comfort in mechanically ventilated patients. METHODS: This retrospective, two-center, intrapatient comparison study included mechanically ventilated, adult ICU patients who received continuous infusion ketamine with at least one other analgesic or sedative infusion...
February 11, 2019: Pharmacotherapy
Lina Meng, Tiffany Wong, Sharon Huang, Emily Mui, Vinhkhoa Nguyen, Gabriela Espinosa, Janjri Desai, Marisa Holubar, Stan Deresinski
STUDY OBJECTIVE: The optimal pharmacodynamic parameter for prediction of efficacy of vancomycin is the area under the concentration-time curve (AUC), and current published data indicate that dosing based on vancomycin trough concentrations is an inaccurate substitute. In this study, our objective was to compare the achievement of therapeutic target attainment after switching from a trough-based to an AUC-based dosing strategy as a part of our institution's vancomycin-per-pharmacy protocol...
February 10, 2019: Pharmacotherapy
Caroline Der-Nigoghossian, Kimberly Levasseur-Franklin, Jason Makii
Optimal blood pressure management is controversial in neurocritically ill patients due to conflicting concerns of worsening ischemia with decreased blood pressure versus cerebral edema and increased intracranial pressure with elevated blood pressure. In addition, there is a lack of high-quality evidence regarding optimal blood pressure goals in patients with most of these conditions. This review summarizes guideline recommendations and examines the literature for blood pressure management in patients with ischemic stroke, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, traumatic brain injury, and spinal cord injury...
February 7, 2019: Pharmacotherapy
Jordi Navarro, José Ramón Santos, Ana Silva, Joaquin Burgos, Vicenç Falcó, Esteban Ribera, Arkaitz Imaz, Adrian Curran
STUDY OBJECTIVE: Dual therapy with once-daily dolutegravir (DTG) plus boosted darunavir (DRV/b) may be a suitable and effective strategy with a high genetic barrier to resistance in human immunodeficiency virus (HIV)-infected patients. Our aim was to evaluate the effectiveness of DTG plus DRV/b (DTG+DRV/b) as a switch strategy in HIV-infected patients, irrespective of their history of virologic failure (VF). DESIGN: Multicenter, retrospective cohort study. SETTING: HIV outpatient treatment clinics at three university hospitals in Spain...
February 5, 2019: Pharmacotherapy
Salia Farrokh, Michael Erdman, John Bon, Eljim Tesoro
Status Epilepticus (SE) has a high mortality rate and is one of the most common neurological emergencies. Fast progression of this neurological emergency and lack of response to traditional antiepileptic drugs (AEDs) in most cases has challenged clinicians to use new agents. The objective of this paper was to evaluate the efficacy and safety of AEDs released to the market after 2000 for SE, refractory SE (RSE), and super refractory SE (SRSE). The PubMed database was searched for clinical trials published between January 2000 and July 2018 using the search terms status epilepticus, refractory status epilepticus, super refractory status epilepticus, brivaracetam, clobazam, cannabidiol, eslicarbazepine, lacosamide, perampanel, rufinamide, stiripentol, and zonisamide...
February 5, 2019: Pharmacotherapy
Megan E Barra, Karen Berger, Eljim P Tesoro, Gretchen Brophy
Patients undergoing neuroendovascular procedures such as cerebral aneurysm coiling and intracranial stent deployment are frequently treated with antiplatelet agents to prevent thrombotic complications. The combination of aspirin and a P2Y12 inhibitor such as clopidogrel is often initiated days prior to elective procedures or as loading doses for emergent procedures; however, some patients may still experience thrombotic complications. Patients identified as clopidogrel hyporesponders are more likely to experience poor outcomes and may require changes to their regimens...
February 5, 2019: Pharmacotherapy
Aaron M Cook, Jimmi Hatton-Kolpek
Augmented renal clearance (ARC) is a phenomenon in critically ill patients characterized by increased creatinine clearance and elimination of renally-eliminated medications. Patients with severe neurologic injury, sepsis, trauma, and burn have been consistently identified as at risk for ARC, with mean creatinine clearances ranging from 170 ml/min to over 300 ml/min. Several potential mechanisms may contribute to the occurrence of ARC including endogenous responses to increased metabolism and solute production, alterations in neurohormonal balance, and therapeutic maneuvers such as fluid resuscitation...
February 5, 2019: Pharmacotherapy
Amy L Dzierba, Darryl Abrams, Justin Muir, Daniel Brodie
Extracorporeal life support (ECLS) can provide mechanical support for patients with severe, life-threating cardiac or respiratory failure. ECLS is a complex therapy that has increased in use over several decades owing to advances in technology. In concert with this growth, there is an increased need to understand the complexity of this technology to augment the effectiveness of ECLS and minimize complications such as ventilator-induced lung injury, bleeding, thrombosis, infections, and inadequate drug dosing...
February 5, 2019: Pharmacotherapy
Susan E Smith, Susan E Hamblin, Bradley M Dennis
INTRODUCTION: The appropriate level of sedation in patients with an open abdomen following damage control laparotomy (DCL) is debated. Chemical paralysis with neuromuscular blocking agents (NMBA) has been used to decrease time to abdominal closure. We sought to evaluate the effect of NMBA use on sedation requirements in patients with an open abdomen and to determine the effect of sedation on patient outcomes. METHODS: A retrospective cohort study was conducted at an American College of Surgeons-verified level one trauma center...
January 23, 2019: Pharmacotherapy
Drayton A Hammond, Payal K Gurnani, Alexander H Flannery, Keaton S Smetana, Jennifer C Westrick, Ishaq Lat, Megan A Rech
A framework for evaluating pharmacists' impact on cost avoidance in the intensive care unit (ICU) and emergency department (ED) has not been established. This scoping review was registered (CRD42018091217) and conducted to identify, aggregate, and qualitatively describe the highest quality evidence for cost avoidance generated by clinical pharmacists on interventions performed in an ICU or ED. Searches were conducted in PubMed, Scopus, CINAHL, Cochrane CENTRAL Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception until April 2018...
January 21, 2019: Pharmacotherapy
Tyree H Kiser, Paul M Reynolds, Marc Moss, Ellen L Burnham, P Michael Ho, R William Vandivier
STUDY OBJECTIVE: To assess whether a macrolide-based antibiotic treatment strategy reduces in-hospital mortality, decreases hospital readmissions, or improves other clinically important outcomes compared with a non-macrolide antibiotic treatment strategy in critically ill patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). DESIGN: Propensity score-matched pharmacoepidemiologic cohort study. DATA SOURCE: Premier's Perspective Hospital Database...
January 21, 2019: Pharmacotherapy
Laura Baumgartner, Kalvin Lam, Jonathan Lai, Mitch Barnett, Ashley Thompson, Kendall Gross, Amanda Morris
STUDY OBJECTIVE: Intensive care unit (ICU) delirium is an acute brain dysfunction that has been associated with increased mortality, prolonged ICU and hospital lengths of stay, and development of post-ICU cognitive impairment. Melatonin may help to restore sleep and reduce the occurrence of ICU delirium. The purpose of this study was to evaluate the effectiveness of melatonin for the prevention of ICU delirium in critically ill adults. DESIGN: Retrospective, observational cohort study...
January 21, 2019: Pharmacotherapy
Gretchen L Sacha, Seth R Bauer, Ishaq Lat
Septic shock is a life-threatening disorder associated with high mortality rates requiring rapid identification and intervention. Vasoactive agents are often required to maintain goal hemodynamics and preserve tissue perfusion. However, guidance regarding the proper administration of adjunct agents for the management of septic shock is limited in patients who are refractory to norepinephrine. This review will summarize vasopressor agents and describe the nuanced application of these agents in patients with septic shock, specifically focusing on clinical scenarios with limited guidance including patients who are nonresponsive to first-line agents and individuals with mixed shock states, tachyarrhythmias, obesity, valvular abnormalities, or other comorbid conditions...
January 15, 2019: Pharmacotherapy
Rajiv A Kabadi, Ilya M Danelich, John W Entwistle, Gregary D Marhefka, Gordon Reeves, Andrew J Boyle, Ataul Qureshi
Current guidelines emphasize the need for at least 6-12 months of oral dual antiplatelet therapy consisting of aspirin and a P2Y12 inhibitor following drug-eluting coronary artery stent implantation. In patients with recently implanted coronary artery stents who require urgent cardiac or noncardiac surgery, the benefits of maintaining oral dual antiplatelet therapy must be carefully weighed against the risks of excessive bleeding, and current practice is largely guided by individual surgeon preferences. When the effects of a second oral antiplatelet agent are undesirable during the perioperative period, the use of a short-acting intravenous antiplatelet agent as "bridge" therapy that can be discontinued shortly before surgery has been associated with a reduced occurrence of adverse clinical events in patients with recently implanted coronary stents requiring urgent coronary artery bypass graft surgery...
January 15, 2019: Pharmacotherapy
C Lindsay DeVane
No abstract text is available yet for this article.
January 13, 2019: Pharmacotherapy
Kasper Bruun Kristensen, Øystein Karlstad, Jaana E Martikainen, Anton Pottegård, Jonas W Wastesson, Helga Zoega, Morten Schmidt
STUDY OBJECTIVE: Evidence on the cardiotoxicity of nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs)-particularly diclofenac and the newer selective cyclooxygenase (COX)-2 inhibitors-has accumulated over the last decade. Our objective was to examine whether the use of NSAIDs in the Nordic countries changed with the emerging evidence, regulatory statements, and clinical guidelines advocating caution for use of specific NSAIDs. DESIGN: Drug utilization study...
January 13, 2019: Pharmacotherapy
Armando Silva Almodovar, Milap C Nahata
STUDY OBJECTIVES: To assess chronic potentially unsafe medication use among older adults using opioids chronically versus those who did not, to assess the likelihood of chronically using medications to treat adverse effects associated with chronic opioid use, and to characterize the differences in chronic potentially unsafe medication use at three morphine equivalent dose (MED) levels/day (<50MED, 50-90MED, and >90MED). DESIGN: Retrospective cross-sectional analysis...
January 13, 2019: Pharmacotherapy
Steven M Smith
A recent observational study published in Pharmacotherapy suggests that treatment with an angiotensin receptor blocker (ARB), compared to an angiotensin-converting enzyme (ACE) inhibitor, each combined with statin therapy, substantially reduces cardiovascular events and mortality in patients with newly-diagnosed coronary heart disease. This Alternative Viewpoint describes major biases introduced in the study design that likely contributed to this surprising finding This article is protected by copyright. All rights reserved...
January 11, 2019: Pharmacotherapy
Sara Alosaimy, Sarah C J Jorgensen, Michael J Rybak
No abstract text is available yet for this article.
January 8, 2019: Pharmacotherapy
Vaughn L Culbertson, Shaikh Emdadur Rahman, Grayson C Bosen, Matthew L Caylor, Dong Xu
STUDY OBJECTIVE: Numerous medications interact at serotonin (5-hydroxytryptamine [5-HT]) receptors directly or through off-target interactions, causing mild to severe serotonergic adverse drug events (ADEs), particularly among the elderly. Our objective was to develop a novel molecular-based toxicity scoring system to assess serotonergic burden resulting from concurrently administered drugs. Quantitative methods to assess serotonergic burden may provide a useful clinical tool for improving pharmacotherapy...
January 8, 2019: Pharmacotherapy
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