Pharmacy to Dose: The Critical Care Podcast

Trial of the Week: Rivers EGDT in SepsisSpecial Guest: Rob Maclaren, PharmD, MPH, MCCM, FCCPI’m joined by Rob Maclaren to discuss the 2001 NEJM study “Early goal-directed therapy in the treatment of severe sepsis and septic shock.”We discuss the historical care of sepsis, mortality rates prior to this study, and use of critical care bundles before highlighting all the findings from the Rivers EGDT in sepsis trial. Then we review if one component is more important than others, break down the bundle, is EGDT still recommended, and much, much more. Reference list: https://pharmacytodose.files.wordpress.com/2023/11/rivers-egdt-tow-references.pdfPharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

2023 North American Congress of Clinical Toxicology (NACCT)Pharmacist-featured Research Highlights02:36 –  “Association between daily high temperature and copperhead envenomations reported to a regional poison center” ft. Jimmy Leonard, PharmD, DABAT18:22 – “Persistent complications following snake envenomation: results of a specialized snake post-discharge clinic” ft. Erin Ryan, PharmD31:56 – “Evaluation of large-scale, interactive simulation in poison management & drug abuse course” ft. Kristin Reinaker, PharmD, DABAT44:43 – “A systematic review of phenibut withdrawal with a focus on complications, treatment strategies, and phenibut alone or polysubstance withdrawal” ft. Ryan Feldman, PharmD, BCPS, DABAT61:33 – “Evaluation of the carbapenem-valproate interaction” ft. Nick Petrucelli, PharmD70:40 – “The use of ertapenem for reducing toxic valproic acid concentrations” ft. Patrick Dougherty, PharmD, BCPS, BCEMPLink to view research poster PDFs: https://pharmacytodose.com/2023/11/03/2023-nacct-pharmd-research-highlights/@PharmacyToDosePharmacyToDose.comPharmacyToDose@gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

CRRT Trials of the Week: RENAL & IDEAL-ICU Special Guest: Linda Awdishu, PharmD, MASLinda Awdishu joins me to highlight two landmark studies related to the use of continuous renal replacement therapy (CRRT) in the critically ill.We discuss renal replacement therapy, compare modalities, and review the history of CRRT as an introduction. Then we review two studies: “Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients: RENAL study” published in 2009 and “Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis: IDEAL-ICU study” published in 2018, both in the New England Journal of Medicine. Would these findings be replicated in other populations, do we have answers about the most appropriate effluent rate and when to initiate CRRT in the critically ill, findings from both studies, future research priorities, and much, much more!References list: https://pharmacytodose.files.wordpress.com/2023/10/crrt-tow-references.pdfPharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Pulmonary Hypertension Part IISpecial Guest: Zach Smith, PharmD, BCPS, BCCCP, FCCP04:03 – Intro/Diagnosis/Classification14:30 – Treatment overview24:00 – CCB30:30 – PDE5i/ERA/GCS40:00 – Prostacyclins 46:40 – RV failure in the ICU64:30 – Role of PharmD/Take-home pointsReference List: https://pharmacytodose.files.wordpress.com/2023/10/pulmonary-hypertension-part-ii-references.pdfPharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Trial of the Week: AID-ICUSpecial Guest: Grace Erdman, PharmDGrace Erdman, 2023 Pharmacy to Dose Award Winner, joins to discuss “Haloperidol for the treatment of delirium in ICU patients: AID-ICU trial” published in NEJM in 2022.We review studies that led to the AID-ICU study, discuss difficulties with delirium research, deep-dive into the AID-ICU trial, compare treatment in hyper-, and hypoactive delirium, research priorities moving forward, and much more. Reference list: https://pharmacytodose.files.wordpress.com/2023/10/aid-icu-tow-references.pdfPharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Trial of the Week: SPLITSpecial Guest: Anthony Hawkins, PharmD, FCCM, BCCCPAnthony Hawkins joins me to highlight the “Effect of a Buffered Crystalloid Solution vs. Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit: The SPLIT Randomized Clinical Trial” published in JAMA. We compare the composition of different crystalloids, review pertinent trials published prior to this study, discuss the findings from the SPLIT RCT, what is the best primary outcome in these studies, research on the horizon, questions to be answered, and much more. Reference list: https://pharmacytodose.files.wordpress.com/2023/10/split-tow-references.pdfPharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Trial of the Week: CRASH-3Special Guest: Ruben Santiago, PharmD, BCPS, BCCCPRuben Santiago joins me to discuss the landmark article “Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients withacute traumatic brain injury (CRASH-3)” published in Lancet.We review the history of TXA use in trauma, what the CRASH-3 study ultimately found, how does this compare to previous studies, what are guideline recommendations, applying this info in the viscoelastic testing era, and much more.Reference list: https://pharmacytodose.files.wordpress.com/2023/10/crash3-tow-references.pdfPharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Literature Review SeriesJuly 2023Special Guests: Chris Bollinger, PharmD, MBAHannah Davis, PharmD04:05 – Featured Articles44:35 – Cardiology60:30 – Hematology65:20 – Pulmonary76:00 – PharmD82:27 – Grab BagReference List: https://pharmacytodose.files.wordpress.com/2023/10/july-lrs-2023-references.pdfPharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Trial of the Week: UFH v. LMWH for Trauma VTE ProphylaxisSpecial Guest: Brandon Hobbs, PharmD, BCPS, BCCCP, FCCMBrandon Hobbs joins to discuss the landmark article “A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma” published in the New England Journal of Medicine. We review the history of VTE prophylaxis in trauma, what this study ultimately found, how long did it impact practice, what regimen is guideline-recommended today, practices from other centers across the country, and much, more.Reference list: https://pharmacytodose.files.wordpress.com/2023/09/vte-ppx-tow-references.pdfPharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Extracorporeal Cardiopulmonary Resuscitation (ECPR) Special Guests: Caitlin Brown, PharmD, BCCCP, FCCMPatrick Wieruszewski, PharmD, BCCCP04:22 – Definition/History of use06:48 – ECPR vs. ACLS11:40 – ECPR research22:00 –VA ECMO overview24:02 – Ideal patients/Contraindications30:52 – ECPR overview from presentation to cannulation41:15 – Pharmacotherapy in longer ECPR cardiac arrests49:00 – ECPR post-resuscitation care50:42 – Guideline recommendations52:50 – Post-cannulation acute complications56:10 – ECMO-induced PK/PD changes59:07 – Advice for new ECPR programs62:20 – Pharmacist’s role/Take-home pointsECPR: A Primer for Pharmacists https://pubmed.ncbi.nlm.nih.gov/37070401/Reference List: https://pharmacytodose.files.wordpress.com/2023/09/ecpr-references.pdfCurious Boxwood Etsy Shop: https://www.etsy.com/shop/curiousboxwoodPharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices