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Volume 15 Issue 4 December 2015 Clinical Pharmacy and Pharmacology Section Newsletter Society of Critical Care Medicine Section Officers Chair Ishaq Lat, PharmD ([email protected]) Past Chair Karen McAllen, PharmD, ([email protected]) Chair-Elect Russ Roberts, PharmD (rroberts@tuftsmedicalcenter. org) Secretary/Treasurer Amy Dzierba, PharmD ([email protected]) Members-at-Large Seth Bauer, PharmD ([email protected]) Erin Frazee, PharmD ([email protected]) Ty Kiser, PharmD ([email protected]) MESSAGE FROM THE CHAIR Ishaq Lat, PharmD, FCCM, FCCP, BCPS “Do not let what you cannot do interfere with what you can do.” —John Wooden This newsletter marks my last message to the section. In what has been an extremely productive year, I want to take this opportunity to extend my appreciation to all the committee volunteers who contributed their free time to section activities. Moreover, our committee chairs and chair-elects have been key to the success of section initiatives. Their time and dedication are the greatest reasons for many of the initiatives available to section members. Quite simply, nothing of substance would have been accomplished without their commitment. Here is a brief listing of the committee activities this past year that have benefited the membership: Providing a monthly online journal club Providing a monthly update of critical care pharmacotherapy literature Publication of newsletter articles in relevant pharmacy journals (e.g., Pharmacotherapy, American Journal of Health-System Pharmacy) Development of the Congress Pre-Meeting Symposium Development of the Congress CPP Section Year-in-Review session Coordination of the CPP Section Recruitment Exchange Development of resources and providing review to facilitate member research endeavors Promotion of a multicenter project evaluating transitions of care processes relating to critical care Fostering career development by pairing interested members seeking mentorship with experienced mentors Offering a Visiting Clinical Professorship to promote critical care pharmacy activities and exchange of ideas Facilitation of discounted membership for resident trainees and recent graduates Archiving section member poster presentations Your section officers have embodied the principle of servant leadership. All through the past year, they have all sacrificed time Volume 15 Issue 4 December 2015 from personal endeavors to serve on behalf of the membership. Underlying all of the conversations at the Steering Committee level has been the attitude of “How does this best serve our section and future critical care pharmacists?” My deep gratitude to Russel Roberts (chair-elect), Amy Dzierba (secretary/treasurer), Kerstin McAllen (past chair), Seth Bauer (member-at-large), Erin Frazee (member-at-large), Ty Kiser (member-at-large), Sandy Kane-Gill (Council member), and Steve Martin (Council member). There will be a number of activities in the coming years that will broadly impact the section membership. If you are interested in participating in committee activities, please feel free to contact Russel ([email protected]) and join. Additionally, anyone is welcome to attend CPP committee meetings at Congress and to participate. Committee participation is open to all members of the section and we are collectively better with an engaged and active membership. It has been my privilege to serve as your Chair for the past year. I look forward to meeting you at Congress. CPP COMMITTEE CORNER Communications Committee Simon Lam, PharmD, BCPS, FCCM (chair), and Joanna Stollings, PharmD, BCPS (chair-elect) The CPP Communications Committee members will be compiling highlights from some of the educational sessions at the 2016 SCCM Congress. These will be published in our April 2016 CPP newsletter. If anyone is interested in helping with educational session summaries at Congress, please email Joanna Stollings at [email protected]. Congratulations to all members of the CPP Section who had abstracts accepted for presentation at the upcoming Congress. The abstracts information is included in this issue of the newsletter. Our section has 275 accepted abstracts, with many abstracts achieving high scores, warranting awards and recognition. Great job to all on your hard work! The production of this newsletter and other important CPP communication resources does not happen without a dedicated team of volunteers. If you are interested in joining the CPP Communications Committee or have any questions regarding the activities of the committee, I encourage you to join us at the committee meeting on Tuesday, Volume 15 Issue 4 December 2015 February 23, 2016 from 9:30 to 10:30 a.m. In addition, if you have any questions regarding membership in the Communications Committee or contributions you would like to make to the CPP Section newsletter, please email either Simon Lam at [email protected] or Joanna Stollings at [email protected]. Education Committee Jeffrey Gonzales, PharmD, BCPS, FCCM (chair), and Diana Mulherin, PharmD, BCPS (chair-elect) The CPP Education Committee continues to partner with the Society on several key initiatives, including Journal Club, educational modules, and a toolkit for protocol implementation. Journal Club continues to be held the third Friday of every month at 1:00 p.m. Central Time. We are pleased to announce a new Journal Club format, which has expanded to include three speakers per session. If you would like to receive the monthly notification and link to access the Journal Club sessions, please contact Karen Berger at [email protected] or [email protected]. The CPP Education Committee has also collaborated with the Graduate and Resident Education Committee on three modules for Virtual Critical Care Rounds this year, including antimicrobial therapy, anticoagulants, and delirium management. Additionally, members of the Education Committee are evaluating the implementation of the Critical Care Protocol Toolkit across multiple institutions. The Critical Care Protocol Toolkit can be accessed at: http://www.sccm.org/News/Pages/New-LearnICU.org-ResourcesAvailable.aspx. These are just a few of the notable accomplishments made possible by our members! If you would like to become involved in the Education Committee, please contact Jeff Gonzales ([email protected]) or Diana Mulherin ([email protected]). Membership Committee Susan Hamblin, PharmD, BCPS (chair), and Serena Harris, PharmD, BCPS (chair-elect) Mentor-Mentee Program The CPP Section mentor-mentee program connects pharmacists at all levels of training, with the goal of furthering clinical practice, research, teaching skills, and SCCM/CPP involvement. Mentees are able to identify their desired areas of mentorship and are matched based on this information, along with practice area and years of experience. This program has grown significantly during the past year, and we look forward to continued growth. However, we continue to need mentors of all levels and areas of practice. If you are interested in joining as a mentor or mentee, please contact Susan Hamblin ([email protected]) or Serena Harris ([email protected]). SCCM/CPP Congress Orientation for New Members and First-Time Attendees The CPP Membership Committee would like to invite all new CPP members and firsttime Congress attendees to the new member orientation and reception. The orientation will be Saturday, February 20, 2016 from 6:30 to 7:30 p.m., location TBD. This Volume 15 Issue 4 December 2015 orientation is a good way for residents, new members, or experienced practitioners to learn more about CPP involvement, navigating Congress, and the resources available through the section. New members are able to learn more about the section leadership and are provided with networking opportunities. We look forward to seeing all new members and first-time attendees at the orientation! Thank you to Serena Harris and Kristine Parbuoni for their planning efforts! Membership Database The membership database contains practice information, research interests, speaking interests, and mentor-mentee program interest for the CPP Section. As we prepare for 2016 Congress, please take a few moments to complete the CPP Member Profile Update link on the home page of the iRoom if you have not updated this information in the past year. Patient Safety Committee Elizabeth Sinclair, PharmD, BCPS (chair), and Rachel Kruer, PharmD, BCPS (chair-elect) The Patient Safety Committee has chosen winners for the Innovations in Patient and Medication Safety Award and the SCCM Excellence in Patient Safety Young Pharmacist Investigator Award. The winners will be notified soon and will be announced publicly at the CPP business meeting at Congress. We hope that interest and enthusiasm for these awards continues to grow in the coming years. If you have any feedback on the awards or the submission process, please send it to Elizabeth Sinclair Goswami ([email protected]). Members of the committee are continuing to work to organize safety-related research. Current projects include a study on adverse drug event-related admissions to the ICU and an evaluation of medication errors occurring during transitions of care. A section subcommittee is also working on a review paper on alcohol withdrawal. If you have any ideas related to patient safety research with which you would like to get involved, reach out to Elizabeth Sinclair Goswami to learn how to join the Patient Safety Committee. We are beginning to work on ideas to submit for patient safety-related programming for 2017 Congress. There are several ideas for proposals at this time, and we look forward to seeing the final results of the committee’s work on this. If you have any ideas that you would like the committee to consider, please reach out to Rachel Kruer ([email protected]). Program Committee Marilyn Bulloch, PharmD (chair), and Michaelia Cucci, PharmD (chair-elect) The SCCM CPP Program Committee has been working hard throughout 2015. The committee would like to think all of the members who have been instrumental in helping us work toward all of our charges. CPP Reception at 2016 Congress Volume 15 Issue 4 December 2015 Our annual CPP reception at 2016 Congress will be held Saturday February 20, 2016 from 8:00 to 10:00 pm. We are still working with SCCM on the exact venue and will be announcing the location soon. Please join us and take the opportunity to connect with your colleagues and friends in critical care pharmacy. Year-in-Review The CPP Program Committee would like to encourage all CPP members to attend the Pharmacy Year-in-Review at Congress on Monday, February 22, 2016 at 4:30 p.m. The theme for the 2016 Year-in-Review will be Critical Care Pharmacy 2020: Looking Forward to the Future of Critical Care Pharmacy. The topics will focus on areas of interest identified by committee members as those that are shaping the future of critical care pharmacy. Topics include: (1) “Emerging Infectious Diseases,” by Stephanie Bass; (2) “Pharmacologic Considerations for Machines and Devices in Intensive Care,” by Michaelia Dunn; and (3) “Advances in Nutrition Support,” by Diana Mulherin. The program committee has matched each speaker with a mentor who has presented at the Year-in-Review at past Congresses. The committee has also started proactively planning for the 2017 Year-in-Review in July and is in the process of developing the program. Pre-Congress Update Formally known as the Pre-Congress Symposium, the CPP will be hosting the PreCongress Update at Congress on Saturday February 20, 2016 at 5:00 p.m. The location will be announced soon by SCCM. The event has undergone a name change as mandated by SCCM, but will still follow the same format as in previous years. The Eevolution of Critical Care Pharmacy to 2020 and Beyond. Topics include: (1) “Training Models for Critical Care Pharmacy in 2020,” by Seth Bauer; (2) “The ICU Pharmacy Matrix: Technology for Patient Care in 2020 and Beyond,” by Gourang Patel; and (3) “Optimal Critical Care Services in 2020,” a roundtable discussion on the critical care pharmacy position paper with Chris Paciullo, Mitch Daley, and Scot Bolesta. Recruitment Exchange The 3rd annual Recruitment Exchange will be held at the 2016 SCCM Congress in Orlando, Florida. This is a no-charge, informal event that allows institutions with available critical care pharmacy or related positions to meet with prospective candidates. The committee asks all CPP members to share this information with their institutions. The committee’s goal is to continue to increase participation by members who seek quality candidates. This is a wonderful recruiting forum for institutions to recruit top candidates. The event will be held Sunday, February 21, 2016 from 11:30 a.m. to 12:30 p.m. The location will be announced soon by SCCM. Potential candidates are not required to register for the event. The committee does request that institutions send position information to [email protected] by December 31, 2015. However, onsite registrations will be welcome. All CPP members are encouraged to share information regarding the event with institutions and potential candidates. Questions about the event can be sent to [email protected] or [email protected]. Volume 15 Issue 4 December 2015 Visiting Clinical Professor The Visiting Clinical Professor (VCP) Program application deadline has been changed to a rolling deadline. There are still some older applications circulating with the April 2015 deadline, but this has changed. Applications are included with this newsletter and can also be found in the CPP iRoom by clicking on the Committee Documents link on the left side of the page and then on the VCP folder. VCP is a great program, designed to advance critical care pharmacy practice and teaching, particularly for those establishing new services or adjusting current services in their institutions. Additional information can be found within the VCP application or obtained by emailing Michaelia Dunn at [email protected] Research Committee Mitch Daley, PharmD (Chair), and Heather Personett, PharmD (Chair-Elect) The CPP Research Committee has exciting accomplishments to share. At the upcoming SCCM Congress, our members will be presenting three abstract research presentations on behalf of the CPP Section: Hira Shafeeq and colleagues will present a survey on barriers to resident publications from the resident perspective. Joe Swanson and colleagues will present a survey on barriers to resident publications from the preceptor perspective. Abby Antigua and Stacy Voils will present an SCCM survey on the practices of venous thromboembolism (VTE) prophylaxis in obese, critically ill patients. In addition, we would like to congratulate Sarah Day, Megan Rech and the Critical Care Pharmacotherapy Literature Update Team for the third consecutive publication of “Major Publications in the Critical Care Pharmacotherapy Literature,” 2014 edition, in American Journal of Health-System Pharmacy (AJHP). This review can be found published ahead of print on the AJHP website. In addition, we continue to consistently offer fundamental services and resources to assist you in conducting research, including: Recently updated funding opportunities (found in the iRoom under Non-SCCM Funding) Research consultation for any aspect of your study design (e-mail your inquiry to [email protected]) Critical Care Pharmacotherapy Literature Updates (published on a monthly basis in the iRoom under Committee Documents > Literature Updates) Feedback for your manuscript or grant proposal (Contact Bryan Lizza ([email protected]) for more information or to submit a document for review) Volume 15 Issue 4 December 2015 If you would like further information about any of these activities or would like to get involved in the Research Committee, please contact Chair Mitch Daley ([email protected]) or Chair-Elect Heather Personett ([email protected]). Pharmacotherapy Article Tenecteplase for Thrombolysis in Pulmonary Embolism John Hammer, PharmD, MBA, BCPS and Lauren A. Igneri, PharmD, BCPS Pulmonary embolism (PE) is a common condition that has the potential to cause significant morbidity and mortality. Patients with acute PE have varied clinical presentations, ranging from asymptomatic to cardiac arrest. The bleeding risks associated with thrombolytic therapy must be weighed against the benefits of lysing the thromboembolism. Patients with acute PE and hemodynamic instability, referred to as massive PE, or high-risk PE in the European guidelines, have a 30-day mortality greater than 15% and should receive thrombolytic therapy unless contraindicated. The use of thrombolytic therapy in patients with right ventricular dysfunction (RVD) or cardiac injury without hemodynamic instability, referred to as submassive PE, which is similar to the European category of intermediate-risk PE, is controversial because 30day mortality ranges from 3% to 15%. Guidelines do not recommend the use of systemic thrombolytic therapy in low-risk PE without hemodynamic instability, RVD or cardiac injury because 30-day mortality is generally less than 1% when treated with standard anticoagulation.1, 2 Tenecteplase is a recombinant tissue plasminogen activator (tPA) that has been FDA approved for the indication of acute myocardial infarction since 2000. 3 While currently not approved in the United States for PE, tenecteplase has gained increased attention following the 2014 PE Thrombolysis study (PEITHO), which is the largest, randomized controlled trial to date evaluating the use of a thrombolytic for PE. Tenecteplase, like alteplase, is a fibrin-specific tPA that preferentially activates plasminogen located on the clot’s surface, forming plasmin that lyses the fibrin clot. Selectively activating plasminogen bound to fibrin, rather than free plasminogen, could lead to greater efficacy and safety than a nonselective tPA; however, this theory has never been proven.3, 4 Tenecteplase is given as a weight-based dose ranging from 30 mg to 50 mg, which is the same as the acute myocardial infarction dose given in the package insert. The entire dose of tenecteplase is administered as an IV push over a period of 5 seconds, which is faster than the standard infusion time of any other thrombolytic for PE.5 Literature review: Although thrombolytic therapy has been proposed for use during cardiac arrest as a means to treat both life-threatening PE and coronary thrombosis, current cardiopulmonary resuscitation (CPR) guidelines recommend consideration of adjunctive thrombolytic therapy only when cardiac arrest is secondary to known or suspected PE.6 This recommendation is made based on the findings from two large, prospective clinical trials that failed to show benefit in outcomes when thrombolytic Volume 15 Issue 4 December 2015 therapy was administered during CPR.7, 8 Bottiger et al performed a double-blind, multicenter trial in Europe in which 1,050 patients with witnessed out-of-hospital cardiac arrests were randomized to receive weight-based tenecteplase or placebo during prehospital CPR. Treatment with open-label thrombolytic therapy was permitted if PE was suspected. The trial was terminated early after a futility analysis showed nearly identical rates of survival between groups. No significant difference in 30-day survival was seen in the tenecteplase (14.7%) versus placebo (17.0%) groups (RR of survival 0.87; 95% CI, 0.65 to 1.15; p = 0.36) or with any secondary endpoints including return of spontaneous circulation, hospital admission, 24-hour survival, survival to hospital discharge, or neurologic outcome.7 These findings are consistent with those of a prospective study that randomized 233 patients to receive either alteplase (100 mg IV over 15 min) or placebo if unresponsive to one minute of standard therapy for out-ofhospital cardiac arrest with pulseless electrical activity.8 Enrollment was stopped early in the aforementioned tenecteplase study; it is possible that no difference in outcomes was found because the study was underpowered. However, those who received tenecteplase had a significant increase in intracranial hemorrhage (ICH) compared to placebo (2.7% vs. 0.4%), (RR of ICH 6.95; 95% CI, 1.59 to 30.41; p = 0.006; number needed to harm [NNH] = 44). Low enrollment of patients with suspected PE (6.0% in tenecteplase group, 11.0% in placebo group) ultimately limits the generalizability of the findings to this population.7 Thus, thrombolysis may be attempted when all other standard resuscitative measures have failed during cardiac arrest if there is confirmation of, or high suspicion for, PE. In patients without a high risk of bleeding, systemically administered thrombolytic therapy is suggested for acute PE associated with hypotension (e.g., systolic blood pressure [SBP] < 90 mm Hg) or when the clinical course after starting anticoagulation suggests a high risk of developing hypotension. These recommendations are based on low-level evidence (Grade 2C) from alteplase, streptokinase, urokinase, reteplase, and desmoteplase administration in these populations.9 In a prospective study, eight patients with massive PE were randomized to receive 1,500,000 IU streptokinase, IV, over a period of 1 hour followed by unfractionated heparin (UFH) (n = 4) or UFH alone (n = 4). The trial was terminated after all patients in the UFH-only group died within 1 to 3 hours of randomization compared to 0 deaths in the streptokinase-plus-UFH group (p = 0.02).10 Although prospective, controlled trials assessing tenecteplase for the management of massive PE without cardiac arrest are lacking, numerous case reports and cohort studies have detailed good patient outcomes with the use of a weight-based bolus in conjunction with UFH or low-molecular-weight heparin (LMWH).11, 12 Due to the high mortality associated with massive PE without thrombolytic intervention and the pharmacokinetic advantages of tenecteplase, off-label use of tenecteplase may be considered for this indication. Tenecteplase has been studied in patients presenting with submassive PE causing significant RVD. TIPES, a phase II, double-blind, multicenter study in Italy, randomized 58 patients with PE, SBP > 100 mm Hg, and RVD to weight-based tenecteplase or placebo with UFH. The study was terminated early in order to have results available before the PEITHO international study began at the end of 2006. The primary endpoint was reduction in RVD 24 hours after randomization. The mean absolute reduction in right/left ventricle end-diastolic dimension (R/LV EDD) at 24 hours was 0.31±0.08 in the Volume 15 Issue 4 December 2015 tenecteplase group versus 0.10±0.07 in the placebo group (p = 0.04). No significant difference in R/LV EDD was seen between groups at day 7.13 Limitations of this study include the use of a surrogate endpoint as a marker of clinical efficacy, although normotensive patients with RVD are known to have a higher probability of progressing to shock.14 Two patients receiving tenecteplase and 1 receiving placebo developed major, nonfatal bleeding, and 13 patients receiving tenecteplase and 1 receiving placebo developed minor bleeding. The small sample size may limit interpretation of major bleeding outcomes with tenecteplase in this population. A similar population was evaluated in the multicenter, double-blinded, randomized controlled study, Tenecteplase or Placebo: Cardiopulmonary Outcomes at Three Months (TOPCOAT), in the United States. Eighty-three patients with SBP ≥ 90 mm Hg and evidence of RVD were randomized to receive weight-based tenecteplase or placebo in addition to LMWH for management of PE. Primary composite endpoint included (i) death, circulatory shock requiring vasopressor infusion, need for intubation, and major bleeding within 5 days, or (ii) recurrent PE, poor functional capacity, or an SF-36 Physical Component Summary score < 30 at 90-day follow-up. Three patients in the placebo group developed an adverse outcome within 5 days (1 cardiac arrest secondary to PE; 2 required intubation, vasopressor support, and catheter-directed thrombectomy) and 1 patient in the tenecteplase group died secondary to ICH. At 90 days, the composite endpoint was met in 37% of the placebo group versus 15% of the tenecteplase group (p = 0.017).15 Quality of life (QOL) was included in the primary endpoint because patients with PE are known to experience a poor functional capacity for up to three months after initiation of anticoagulation.16 The significant difference between groups was primarily driven by functional capacity and QOL at 90 days rather than acute outcomes within 5 days of randomization. Therefore, hemodynamically stable patients with RVD may report improved QOL if they receive fibrinolysis as part of PE management. PEITHO was an international, multicenter, double-blind trial that randomized 1,006 patients with PE, RVD, and elevated troponin to either weight-based tenecteplase or placebo with UFH. The primary endpoint of death or hemodynamic compromise occurring within 7 days of randomization was seen in 2.6% of the tenecteplase group versus 5.6% of the placebo group (OR 0.44; 95% CI, 0.23 to 0.87; p = 0.02; NNT = 34). Of note, death within the first 7 days and first 30 days was not statistically different between groups, indicating that the difference in the primary outcome was due to hemodynamic decompensation. Patients who received tenecteplase experienced more major extracranial bleeding within 7 days versus placebo (6.3% vs. 1.2%), (OR 5.55; 95% CI, 2.3 to 13.39; p < 0.001; NNH = 20) and stroke (2.4% vs. 0.2%), (OR 12.10; 95% CI, 1.57 to 93.39; p = 0.003; NNH = 46).5 Long-term results from patient follow-up 180 days after study randomization are forthcoming.17 Although patients with PE and evidence of RVD may have improved hemodynamics from tenecteplase administration, an increased risk of major bleeding, including ICH, was identified. This is in contrast to the findings of a prospective, controlled study that randomized 256 hemodynamically stable patients with PE and RVD to alteplase, 100 mg (10 mg IV bolus, followed by 90 mg IV over 2 hours) plus UFH versus UFH only. No significant difference in mortality or major bleeding was seen between groups, but the need for escalation of treatment was significantly lower in patients who received alteplase.18 It is unclear why differences in Volume 15 Issue 4 December 2015 bleeding outcomes were seen when evaluating these two studies, but notably, nearly one-third of patients in the PEITHO study received a dose of LMWH or fondaparinux before randomization. Another difference was the added inclusion criteria of elevated troponin as part of the RVD definition in PEITHO, which may indicate that a higher-risk population was studied. Based on current literature, tenecteplase may be considered for thrombolysis in hemodynamically stable patients with PE and significant RVD who are at high risk for developing hypotension and at low risk for bleeding. There is a paucity of high-quality, prospective, randomized controlled trials comparing tenecteplase to other thrombolytics for PE. Additionally, there are no prospective studies evaluating the use of tenecteplase in massive PE with the exception of those who present in cardiac arrest. It is unlikely that a future randomized, controlled trial comparing thrombolysis plus anticoagulation to anticoagulation alone will be conducted in massive PE. This study design would be unethical based on the findings from the previously discussed streptokinase study and expert opinion from guidelines recommending thrombolytics in massive PE unless contraindications are present. 1, 9, 10 Despite the lack of prospective data demonstrating benefit in clinical outcomes, it is reasonable to generalize the effectiveness of tenecteplase with submassive PE to massive PE. Tenecteplase is a fibrin-specific thrombolytic that has the advantage of faster and more convenient administration compared to other thrombolytics since it is given as an IV push. It has not yet been shown whether rapid administration leads to better clinical outcomes. Currently, there is insufficient data to guide the decision to prescribe tenecteplase over alternative thrombolytics, including alteplase, which has FDA approval for use in PE. Given the administration advantages compared to other thrombolytics, tenecteplase may be a reasonable alternative for the management of PE. References: 1. Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008 Sep;29(18):2276-2315. 2. Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011 Apr 26;123(16):1788-1830. 3. TNKase (tenecteplase) [package insert]. South San Francisco, CA: Genentech, Inc; 2000 June. Revised 2011 May. 4. Todd JL, Tapson VF. Thrombolytic therapy for acute pulmonary embolism: a critical appraisal. Chest. 2009 May;135(5):1321-1329. 5. Meyer G, Vicaut E, Danays T, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med. 2014 Apr 10;370(15):1402-1411. 6. Neumar RW, Otto CW, Link MS, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 2;122(18 Suppl 3):S729-767. Volume 15 Issue 4 December 2015 7. Bottiger BW, Arntz HR, Chamberlain DA, et al. Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med. 2008 Dec 18;359(25):2651-2662. 8. Abu-Laban RB, Christenson JM, Innes GD, et al. Tissue plasminogen activator in cardiac arrest with pulseless electrical activity. N Engl J Med. 2002 May 16;346(20):1522-1528. 9. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e419S-e494S. 10. Jerjes-Sanchez C, Ramírez-Rivera A, de Lourdes García M, et al. Streptokinase and heparin versus heparin alone in massive pulmonary embolism: a randomized controlled trial. J Thromb Thrombolysis. 1995;2(3):227-229. 11. Caldicott D, Parasivam S, Harding J, Edwards N, Bochner F. Tenecteplase for massive pulmonary embolus. Resuscitation. 2002 Nov;55(2):211-213. 12. Shukla AN, Thakkar B, Jayaram AA, Madan TH, Gandhi GD. Efficacy and safety of tenecteplase in pulmonary embolism. J Thromb Thrombolysis. 2014 Jul;38(1):2429. 13. Becattini C, Agnelli G, Salvi A, et al. Bolus tenecteplase for right ventricle dysfunction in hemodynamically stable patients with pulmonary embolism. Thromb Res. 2010 Mar;125(3):e82-e86. 14. Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000 Jun 20;101(24):2817-2822. 15. Kline JA, Nordenholz KE, Courtney DM, et al. Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter double-blind, placebo-controlled randomized trial. J Thromb Haemost. 2014 Apr;12(4):459-468. 16. Kline JA, Hernandez J, Hogg MM, et al. Rationale and methodology for a multicentre randomised trial of fibrinolysis for pulmonary embolism that includes quality of life outcomes. Emerg Med Australas. 2013 Dec;25(6):515-526. 17. Konstantinides S, Meyer G, Lang I, et al. Single-bolus tenecteplase plus heparin compared with heparin alone for normotensive patients with acute pulmonary embolism who have evidence of right ventricular dysfunction and myocardial injury: rationale and design of the Pulmonary Embolism Thrombolysis (PEITHO) trial. Am Heart J. 2012 Jan;163(1):33-38.e1. 18. Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med. 2002 Oct 10;347(15):1143-1150. Member Spotlight: Suprat Saely Wilson, PharmD, BCPS by Jessica Jones, PharmD, BCPS Suprat Saely Wilson, PharmD, BCPS, is the pharmacy coordinator and a clinical specialist for emergency medicine services at Detroit Receiving Hospital (DRH)/Detroit Medical Center (DMC). She is also the director of the DMC PGY2 Emergency Medicine Volume 15 Issue 4 December 2015 Pharmacy Residency Program. The Emergency Department (ED) at Detroit Receiving Hospital is a 92bed, level I trauma center with more than 110,000 patient visits each year. The Department of Pharmacy Services is an integral part of the emergency medicine (EM) multidisciplinary team, providing 24-hour clinical services, including medical and trauma resuscitation. Additionally, Dr. Wilson serves as adjunct clinical faculty for University of Michigan College of Pharmacy, Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, and the Raabe College of Pharmacy at Ohio Northern University. Dr. Wilson received her doctor of pharmacy degree from the University of Michigan in 2008. She completed her PGY1 and PGY2 residencies at the Detroit Medical Center, PGY1 at Sinai-Grace Hospital and PGY2 in emergency medicine at Detroit Receiving Hospital. After completion of her residency, Dr. Wilson became a clinical specialist in the DRH ED in 2010, and expanded her role to residency director in 2012 and pharmacy coordinator in 2014. She continues to practice as a clinical specialist, writing policies and protocols for pharmacy emergency medicine services. Dr. Wilson is passionate about pharmacy integration into emergency medicine services and ensuring excellent education of residents and students. She precepts both students and residents on clinical rotations year-round, and also provides didactic lectures and facilitates several courses. She received the American Society of Health-System Pharmacists (ASHP) New Preceptor Award in 2015. Dr. Wilson is the founding editor of the DMC pharmacy newsletter, The Receptor, to which residents contribute. She also plans the annual programming for the Michigan Society of Health-System Pharmacists meetings, including the Michigan Pharmacists Association Annual Convention & Exposition, residency meetings, and the DMC Annual Infectious Diseases and Critical Care Symposium. In addition to her local and regional committee involvement, Dr. Wilson is an active member in several national organizations, including the American College of Clinical Pharmacy (ACCP), the ASHP, and the Society of Critical Care Medicine (SCCM). She is currently the member-at-large for the Emergency Medicine Section of SCCM, as well as a member of the Clinical Pharmacy and Pharmacology (CPP) Patient Safety and Education Committee. She has served on the Programming Committee, Travel Award Committee, Code Committee, and Media Committee for the American College of Clinical Pharmacy (ACCP) Emergency Medicine Practice and Research Network, as well as serving on the ASHP section advisory groups on emergency care and education. Additionally, Dr. Wilson is an ASHP guest surveyor for emergency medicine residency. As evidenced by her extensive involvement, Dr. Wilson is a well-respected clinician who contributes greatly to the profession of pharmacy. Research Pearl Formulating Research Questions and Hypotheses: Control of Confounding to Reduce Bias in Research Volume 15 Issue 4 December 2015 by Todd Miano, PharmD, MSCE Confounding is a potential source of bias in virtually every research study. Defined as a confusion of effects, confounding arises when the effect of a risk factor is mistaken for the effect of the exposure of interest.1 Confounding is created when risk factors are imbalanced across treatment groups. For example, consider a study that examines the rate of acute kidney injury (AKI) in patients treated with vancomycin monotherapy compared to vancomycin plus piperacillin/tazobactam (VPT). In this scenario, you might expect higher aminoglycoside use in the VPT group, because those patients may have an indication for broad gram-negative coverage. In this scenario, aminoglycoside exposure is a confounding variable—any difference in AKI rate between groups may not be the result of piperacillin/tazobactam exposure, but instead the result of more frequent aminoglycoside use in the VPT group. If we want to accurately measure the effect of VPT combination therapy, we must control for the effect of aminoglycoside exposure. Control of confounding can be achieved during the design and data analysis stages of research. Study design features that control confounding include randomization, restriction, and matching.1 The gold standard for control of confounding is randomization. Indeed, removal of confounding is the sole benefit of randomization. 1 Random treatment allocation ensures balance of both measured and unmeasured risk factors across treatment groups, removing potential sources of confounding. In many clinical situations, however, randomization may be unfeasible or unethical. Thus, alternative methods for confounding control are often needed. Restriction refers to the exclusion of patients with a given risk factor. If no patients in the population have a given risk factor, researchers can be sure that confounding from that risk factor is removed. Matching involves finding control patients that match the exposed patients on particular risk factors. In the AKI example above, researchers could match VPT patients to vancomycin patients on age, presence of hypotension, and baseline serum creatinine concentration. Matching on these factors ensures balance in those variables across groups, thereby removing confounding. The most common data analysis technique to control confounding is multivariable modeling (e.g., multiple linear regression, multiple logistic regression, and proportional hazards regression).2 Confounding is controlled by simultaneously including important risk factors with the exposure of interest in the multivariable model. This modeling isolates the effect of the exposure while holding all risk factors constant. Another popular approach is the use of propensity scores. The propensity score for an individual is the probability of being treated based on the individual’s background characteristics and risk factors.3 Confounding can be removed by matching on the propensity score. In our example, each VPT patient would be matched with a vancomycin patient who has a similar propensity score. Matching on treatment probability balances all risk factors included in the propensity score model, which can be thought of as mimicking the randomization process.3 Unlike randomization, however, propensity score analysis can control confounding only from measured risk factors. Volume 15 Issue 4 December 2015 References: 1. Rothman KJ. Epidemiology: An Introduction. 2nd ed. New York, NY: Oxford University Press; 2012. 2. Katz MH. Multivariable analysis: a primer for readers of medical research. Ann Intern Med. 2003 Apr 15;138(8):644-650. 3. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70(1):41-55. CPP-Specific Itinerary at Congress Saturday, February 20, 2016 CPP Section Pre-Congress Update 5:00 p.m. – 6:30 p.m. CPP Section New Members and First Congress Attendees Orientation 6:30 p.m. – 7:30 p.m. CPP Section Reception 8:00 p.m. – 10:00 p.m. Sunday, February 21, 2016 CPP Section Recruitment Exchange Meeting 11:30 a.m. – 12:30 p.m. CPP Section Program Committee Meeting 4:30 p.m. – 5:30 p.m. Monday, February 22, 2016 CPP Section Education Committee Meeting 9:00 a.m. – 10:00 a.m. CPP Section Patient Safety Committee Meeting 10:00 a.m. – 11:00 a.m. CPP Section Research Committee Meeting 11:00 a.m. – 12:00 p.m. CPP Section Membership Committee Meeting 12:00 p.m. – 1:00 p.m. Tuesday, February 23, 2016 CPP Section Communications Committee Meeting 9:30 a.m. – 10:30 a.m. CPP Business Meeting Volume 15 Issue 4 December 2015 12:30 p.m. – 2:00 p.m. 45th Annual Critical Care Congress Clinical Pharmacy and Pharmacology Section Meeting Guide February 20-24, 2016 **Please check the Program and Exhibition guide at Congress for locations and the most up-to-date schedule.** Friday, February 19, 2016 (Pre-Congress Educational Session) 8:00 AM - 9:30 AM Current Concepts in Adult Critical Care – Day 1 Early Recognition of Unusual Medication Emergencies and Drug Shortages Current Concepts in Pediatric Critical Care – Day 1 Pharmacologic Optimization in Unique Circumstances Panel Discussion Critical Care Pharmacy Preparatory Review and Recertification Course – Day 1 Shock Syndromes and Sepsis 9:30 AM - 10:15 AM Supportive and Preventive Medicine 10:30 AM - 11:30 AM Practice Management: Medication Safety and Protocol Development 11:30 AM - 12:30 PM 1:30 PM - 3:00 PM Cardiovascular Critical Care Fluids, Electrolytes, Acid-Base Disorders and Nutrition Support 3:00 PM - 3:45 PM Principles of Estimating Renal Clearance, Acute Kidney Injury, and Renal Replacement in the Critically Ill Patient Pulmonary Disorders 8:00 AM - 5:00 PM 11:15 AM - 12:00 PM 8:00 AM - 5:00 PM 8:35 AM - 9:05 AM 9:40 AM - 10:15 AM 8:00 AM - 5:30 PM 4:00 PM - 5:30 PM Saturday, February 20, 2016 (Pre-Congress Educational Session) 8:00 AM - 5:30 PM Critical Care Pharmacy Preparatory Review 8:00 AM - 9:30 AM and Recertification Course – Day 2 Neurocritical Care Mitchell J. Daley, PharmD, BCPS Jennifer L. Morris, PharmD, BCPS Jennifer L. Morris, PharmD, BCPS Moderator: Amy Dzierba, PharmD, FCCM, BCPS Ishaq Lat, PharmD, FCCM, FCCP, BCPS Seth R. Bauer, PharmD, FCCM, BCPS Amy L. Dzierba, PharmD, FCCM, BCPS Lisa G. Hall Zimmerman, PharmD, FCCM, BCPS, BCNSP Henry Cohen, BS, MS, PharmD, FCCM, BCPP, CGP Erik E. Abel, PharmD, BCPS Roland N. Dickerson, PharmD, FCCM, FCCP, FASHP, FASPEN, BCNSP Michael L. Bentley, PharmD, FCCM Ishaq Lat, PharmD, FCCM, FCCP, BCPS Amy L Dzierba, PharmD, FCCM, BCPS Moderator: Simon W. Lam, PharmD, BCPS Gretchen M. Brophy, PharmD, FCCP, FCCM, BCPS Aaron M. Cook, PharmD, BCPS Volume 15 Issue 4 9:30 AM - 10:30 AM 10:45 AM - 11:45 AM 11:45 AM - 12:45 PM 1:45 PM - 2:30 PM Sedation, Pain, Analgesia, Delirium, and Neuromuscular Blockers Research Design and Literature Evaluation 2:30 PM - 3:15 PM Acute Cardiac Care Hepatic Failure/Gastrointestinal/Endocrine Emergencies Toxicology 3:30 PM - 4:30 PM 4:30 PM - 5:30 PM Infectious Diseases I Infectious Diseases II December 2015 Kimberly L. Varney, PharmD, BCPS Ishaq Lat, PharmD, FCCM, FCCP, BCPS Scott T. Benken, PharmD, BCPS Seth R. Bauer, PharmD, FCCM, BCPS Steven Pass, PharmD, FCCP, FCCM, FASHP, BCPS Eric W. Mueller, PharmD, FCCM, FCCP Simon W. Lam, PharmD, BCPS Sunday, February 21, 2016 10:30 AM - 11:30 AM Resuscitation 11:30 AM - 12:30 PM 11:30 AM - 12:30PM Fluid Controversies Albumin: Has Anything Changed Since the SAFE Study? De-resuscitation: Reversal When the Fluid Comes Back Diuresis in Deresuscitation Ketamine Use in the ICU: Re-Emergence of Special K Antiepileptic Uses of Ketamine Pros and Cons of Ketamine Use for ICU Sedation Susan E. Hamblin, PharmD, BCPS Michael L. Bentley, PharmD, FCCM Hira Shafeeq, PharmD, BCPS Chris A. Droege, PharmD Monday, February 22, 2016 6:00 AM - 8:00 AM Improving 10:00 AM - 11:00 AM 10:00 AM - 12:00 PM 10:00 AM - 12:00 PM Clinical Outcomes and Pathogen-Directed Therapy for Serious Bacterial Infections in the Critical Care Setting New and Emerging Therapeutic Options for Treatment Bench-Pressing in the ICU: Which Vasopressor Agent Should I Choose for My Patient? Which Box Does Your Patient Fit In? The Method Behind the Madness Controversies in Neurocritical Care Seizure Prophylaxis Conversing with the Experts: Panel Discussion The Difficult Task of Treating MultidrugResistant Acinetobacter baumannii An Old Drug Revisited: The Role of Colistin Emerging Antibiotic Treatments Jason M. Pogue, PharmD Gourang P. Patel, PharmD, MSc, BCPS Gretchen M. Brophy, PharmD, FCCP, FCCM, BCPS Gretchen M. Brophy, PharmD, FCCP, FCCM, BCPS Lama H. Nazer, PharmD, BCPS Steven Pass, PharmD, FCCP, FCCM, FASHP, BCPS Volume 15 Issue 4 10:00 AM - 12:00 PM 10:00 AM - 12:00 PM 3:15 PM - 4:15 PM 3:15 PM - 4:15 PM 4:30 PM - 5:30 PM 4:30 PM - 5:30 PM New American College of Critical Care Medicine Guidelines Guidelines for Stress Ulcer Prophylaxis in Adult Critically Ill Patients Pediatric Pulmonary Hypertension: The Changing Landscape Medications and Novel Therapies for Shortand Long-Term Management Precision Pharmacodelivery in the PICU: Role of Kinetics Analysis and Modeling Pathophysiologic Mechanisms of Variability to Drug Response in Critical Ill Conditions Pharmacokinetics and Pharmacodynamics Modeling in Pediatrics Assessing and Reversing Coagulopathy in the ICU Reversal of Novel Anticoagulants A Ninja in the ICU: Novel Methods for the Prevention of Drug-Associated Acute Kidney Injury Risk Factors and Predictors of DrugAssociated AKI Striving for Early Detection of DrugAssociated AKI Year in Review: Clinical Pharmacology and Pharmacy Emerging Infectious Diseases Pharmacologic Considerations for Machines and Devices in Intensive Care Advances in Nutrition Support December 2015 Henry Cohen, BS, MS, PharmD, FCCM, BCPP, CGP Eric E. Abel, PharmD, BCPS Moderator: Elizabeth Farrington, PharmD, FCCM, FCCP, FPPAG, BCPS Elizabeth Farrington, PharmD, FCCM, FCCP, FPPAG, BCPS Jennifer L. Morris, PharmD, BCPS Moderator: William Dager, PharmD, FCCM, FCCP, FCSHP, BCPS Mitchell J. Daley, PharmD, BCPS Moderator: Sandra L Kane-Gill, PharmD, MSc, FCCM, FCCP Brian L. Erstad, PharmD, BCPS, MCCM Sandra L. Kane-Gill, PharmD, MSc, FCCM, FCCP Moderator: Ishaq Lat, PharmD, FCCM, FCCP, BCPS Stephanie Bass, PharmD Michaelia Dunn, PharmD, BCPS Diana Wells Mulherin, PharmD, BCPS Tuesday, February 23, 2016 10:00 AM - 12:00 PM Advancing 11:00 AM - 12:00 PM 2:00 PM - 2:45 PM 3:15 PM - 4:15 PM Nutrition Therapies in the ICU Malnutrition, Metabolomics, Muscles and Metabolism: Getting the Most out of Nutrition Therapy Training the Next Generation of Critical Care Practitioners: State of the (Critical Care) Union Pharmacist Perspective Plenary Session: Value-Based Medicine: Dollars and Sense Aerosolized Antibiotics in the ICU: Where Do They Fit? Brian L. Erstad, PharmD, BCPS, MCCM Michael W. Sirimaturos, PharmD, BCNSP Brian L. Erstad, PharmD, BCPS, MCCM Volume 15 Issue 4 4:30 PM - 5:30 PM December 2015 Bioavailability: Pharmacokinetics of Aerosolized Antibiotics It’s Hot! Not Every Fever Is an Infection Eric W. Mueller, PharmD, FCCM, FCCP Moderator: Gretchen M Brophy, PharmD, FCCP, FCCM, BCPS Aaron M. Cook, PharmD, BCPS Neuroleptic Malignant Syndrome Wednesday, February 24, 2016 9:30 AM - 10:30 AM This Is Jeopardy: Questions and Answers with Anticoagulation Reversal Bleeding Jeopardy 10:30 AM - 11:30 AM Immunomodulation in the Critically Ill 10:30 AM - 11:30 AM Management of the Acute Care Surgical Patient When to Stop the Antibiotics: The Feces Are Everywhere Moderator: Jeffrey Barletta, PharmD, FCCM William Dager, PharmD, FCCM. FCCP, FCSHP, BCPS Gourang P. Patel, PharmD, MSc, BCPS Moderator: Gretchen M Brophy, PharmD, FCCP, FCCM, BCPS Simon W. Lam, PharmD, BCPS Clinical Pharmacy and Pharmacology Section Member Abstracts at 2016 Congress Abstract Number Title 20 Four-Factor Prothrombin Complex Concentrate for Life-Threatening Bleeds or Emergent Surgery EEG Suppression Ratio 6 Hours After Cardiac Arrest - Accurate Biomarker of Severity of Brain Injury Apoptotic Pathway Mediates the Neuroprotective Effect of IRL-1620 in Focal Cerebral Ischemia Levetiracetam is as effective as phenytoin for status epilepticus with less adverse events in the ED 30 Pain Assessment in Critically Ill Patients with Delirium: Self-reported Pain versus Behavioral Pain 4 15 19 42 43 45 49 52 53 Telecritical care implementation in community hospitals decreased ICU and hospital mortality Desaturation during tracheal intubations in PICUs is pervasive and associated with adverse outcomes Influence of withholding pharmacologic prophylaxis doses on venous thromboembolism occurrence Outcomes of hyperoncotic albumin exposure and risk of ICU organ dysfunction in shock Long term outcome of patients with liver cirrhosis admitted to a general intensive care unit Safety and effectiveness of weight-based activated PCC for warfarin-induced life-threatening bleeding CPP Authors Christine Lesch, PharmD Jonathan Sin, PharmD Richard R. Riker, MD, FCCM Anil Gulati, MD, PhD Jaclyn O’Connor, BCPS, PharmD Suprat Saely Wilson BCPS, PharmD, PharmD Rima Bouajram PharmD Jeremiah J. Duby, BCPS, PharmD Erin Nagle, PharmD Sean D. Firth, MPH, PhD Pradip P. Kamat, MBA, MD Seth R. Bauer, BCPS, PharmD, FCCM Belinda L. Udeh, PhD, MPH Matthew R. Wanek, BCPS, PharmD John Kinsella, MD Suprat Saely Wilson BCPS, PharmD Volume 15 Issue 4 Abstract Number 54 57 58 71 75 79 82 90 98 100 104 111 120 123 130 132 134 144 145 151 December 2015 Title Daily vancomycin dose requirements as a continuous infusion in obese vs. non-obese SICU patients Reducing time to antibiotic administration in septic SICU patients: pre and post intervention A Feasibility Trial to Detect Sepsis in the ED Based Upon Blood Monocyte Volume Variability Cardiac Hemodynamic Changes During Weaning From Mechanical Ventilation Using NICOM: Pilot Study Quetiapine-associated QTc prolongation in cardiac surgery patients with ICU delirium Standard versus low dose alteplase infusion for treatment of acute pulmonary embolism Mortality and Incidence of Acute Adverse Neurologic Events in the Cardiac Intensive Care Unit Pharmacologic Treatment of ICU Delirium is Not Associated with Increased Development of Arrhythmias Does DDAVP increase renal insufficiency and prolong mechanical ventilation in cardiac surgery? Impact of intraoperative continuous vs. intermittent cefazolin therapy on the incidence of SSIs Recombinant Activated Factor VII Use in Cardiac Surgery – A Single Center Experience Survey of Analgesia, Sedation, and Shivering Practice During Targeted Temperature Management Efficiency of Simple Hemofiltration with Concurrent Veno-Arterial Extra-Corporeal Life Support Predictors of response to insulin, glucagon, and lipid emulsion in antihypertensive overdose The Incidence Of Subglottic Stenosis Following Cardiac Surgery In Infants And Children Efficacy and Safety of Milrinone versus Dobutamine in Cardiogenic Shock Intravenous Chlorothiazide in Acute Heart Failure Refractory to Loop Diuresis and Adjunct Metolazone Knowledge Capture techniques to design a score of overall physiological state in Critical Illness Development of a Quantitative Clinical Instability Score weighted for the degree of support required Sensitivity and Specificity of a Pediatric Early Warning System Using Data-Driven Vital Signs CPP Authors Hsin Lin, PharmD Hsin Lin, PharmD Keri J. Bicking, BCPS, PharmD, BCNSP Antonio Saad, MD William D. Cahoon Jr, PharmD Amanda Kroll Duman, BCPS, PharmD Nicole Harger Lukas Martin, PharmD Yuliya A. Domnina, MD Claire V. Murphy, PharmD John Blackburn, MD Jessica R. Crow, BCPS, PharmD Stephanie L. Davis, BCPS Bethany Shoulders Mindee Sue Hite, PharmD Kevin M. Silinskie, PharmD Cassandra J. Bellamy, PharmD Christina L. Candeloro, PharmD Robert Nietupski, BCPS, PharmD Julia Weiner, PharmD Jeffrey J. Cies, PharmD, MPH, BCPS Nicole Harger Kristen E. Hillebrand, PharmD Prashant Purohit, MD, MD Diana Esaian, BCPS, PharmD Caitlin M. Aberle, BCPS, PharmD Tyler Lewis, PharmD John Papadopoulos, BS, PharmD, FCCM Maria Cardinale, PharmD BCPS John Kinsella, MD John Kinsella, MD Natalie Michelle Pageler, MD, MEd Volume 15 Issue 4 Abstract Number 165 December 2015 Title Novel Application of Tele-ICU Presence to Support Rapid Response Calls in a Community Hospital Adverse drug reactions during therapeutic hypothermia after cardiac arrest 173 187 195 200 211 219 221 An Evaluation of Sedation and Neurologic Outcome in Therapeutic Hypothermia Following Cardiac Arrest Implementing a competency program to improve pharmacist participation in code blue response The Effects of Miniaturized Chest Compressor on Quality and Outcome of CPR in ICU Patients Neuromuscular blockers for shivering prevention during therapeutic hypothermia post cardiac arrest The Dollar $ign Project: an innovative drug costawareness tool for medical providers Critical Care Pharmacy Resident Research Publication: Residency Directors Perceptions and Practices. Critical Care Pharmacy Resident Research Project Publication: Practices and Perceptions of Graduates 225 234 238 248 250 A degree course in critical care for undergraduate medical students - the student view Effect of simulation training on intubation practices of fellows in a training program The FOAM effect: use of smartphone-created videos to standardize resident orientation and education Evaluation of Pharmacy-Nursing Collaborative Education on the Critical Care Pain Observational Tool Management of diabetic ketoacidosis/hyperglycemic hyperosmolar state in patients on hemodialysis 262 264 Stress dose hydrocortisone use in pediatric septic shock varies and is associated with poor outcomes CPP Authors Belinda L. Udeh, PhD, MPH Amy L. Dzierba, PharmD, BCPS, FCCM Sandra L. Kane-Gill, PharmD, FCCM Pamela L. Smithburger, MS, PharmD, BCPS Robert Witcher, PharmD Cassandra Baker, PharmD Kerry E. Francis, PharmD Akta S. Patel, PharmD Wanchun Tang, MD, MCCM Basirat O. Sanuth, PharmD, BCPS Thomas J. Moran, BCPS, MS, PharmD John W. Devlin, PharmD, FCCM Drayton A. Hammond, BCPS, MBA, PharmD Hira Shafeeq, BCPS, PharmD Joseph M. Swanson, PharmD, BCPS John W. Devlin, PharmD, FCCM Drayton A. Hammond, BCPS, MBA, PharmD Hira Shafeeq, BCPS, PharmD Joseph M. Swanson, PharmD, BCPS John Kinsella, MD Phani C. Kantamneni, MD Aanchal Kapoor, MD Christa A. Lenzi, PharmD Huan Mark Nguyen PharmD, BCPS Christopher K. Finch, BCPS, PharmD, FCCM Ana Negrete, PharmD Caitlin M. Schaapveld-Davis BCPS, PharmD Megan A. Van Berkel, BCPS, PharmD Jennifer L. Hewlett, PharmD Volume 15 Issue 4 Abstract Number December 2015 Title Transition from Intravenous to Subcutaneous Insulin in Critically Ill Adult Patients 268 275 277 Hypoglycemic event rates with two different insulin protocols in adult intensive care unit patients Improved glycemic control with collaborative targeted interventions in a medical ICU Impact of Injectable Phosphate National Shortage on Mechanical Ventilation 281 282 290 293 299 304 312 316 317 320 325 338 351 352 358 366 Significance of lactic acidosis and glucose levels in diabetic ketoacidosis Comparison of 70/30 biphasic insulin versus insulin detemir during continuous enteral nutrition The impact of the cumulative caloric deficit in critically ill patients Intensive Care Unit length of stay is associated with insomnia in critical illness survivors Precipitating factors associated with Delirium: A Case-Control study in a UK Intensive Care Unit Effect of Race on ICU Mortality: A Multi-Center Retrospective Cohort Study Cancer patients requiring multiple admissions to the ICU: Incidence, risk factors, and outcomes Predictors of ICU admission in cancer patients: A 5year registry-based case-control study Local culture is a critical factor in adoption of evidenced based medicine Barriers and facilitators of high-quality RCTs in pediatric critical care: A survey of trialists Long-Stay Patients in Pediatric Intensive Care Units in Riyadh: A Cross-Sectional Descriptive Study Likelihood of Rapid Response Patients having Palliative Care Triggers The Disconnect Between Patients’ Values and Preferences for End of Life Care ICU Patients Receiving Prolonged Life Sustaining Treatments Ethical Issues in Critical Care Medicine: Uncovering the Common and Uncommon Issues CPP Authors Meagan Doolin, PharmD Andrew C. Fritschle Hilliard, PharmD, BCPS Serena Ann Harris, PharmD, BCPS Todd A. Walroth, BCPS, PharmD Jessica A. Whitten, BCPS Jeffrey J. Fong, BCPS, PharmD Katie Nault, MBA, PharmD Rebeca L. Halfon, PharmD Michael W. Sirimaturos, PharmD, BCNSP Abigail D. Antigua, PharmD Jessica M. Cope, PharmD Aimee J. Gowler, BCPS, PharmD Stephen J. Lemon Jr, PharmD Stacy Alan Voils, BCPS, MS, PharmD Stephanie Worrall, PharmD James A. Curtis, BCPS, PharmD Hal E. Richards, PharmD Tiffany White, BCPS, PharmD Katri Abraham, BCPS, PharmD Ali Paplaskas, PharmD Krista A. Wahby, PharmD Raymond J. Yost, PharmD John Kinsella, MD Ruth Wan Nandan Chirumamilla, Research Fellow Lama Nazer, BCPS, PharmD Lama Nazer, BCPS, PharmD Omar Badawi, PharmD, BCPS, FCCM Erkan Hassan, PharmD, FCCM Mark Duffett, MSc, RPh Dr. Mohamad-Hani Temsah, MD James Gasperino, MD Tasnim Sinuff, MD Mary H. Peterson, DNP, MSN, RN, NEABC Prasad E. Abraham, PharmD, BCPS, FCCM Marina Rabinovich, BCPS, PharmD Volume 15 Issue 4 Abstract Number December 2015 Title 378 A Description of Patients in Anhepatic Phase Post Primary Graft Non-function Cost-Effectiveness of H2RAs versus PPIs for Stress Ulcer Prophylaxis in Critically Ill Patients Organ support, readmission and aetiological factors in the management of critically ill cirrhotics Decreased airway complications with glycopyrrolate prophylaxis for endoscopy: A prospective trial Timing and utility of Child-Pugh score in patients with liver cirrhosis referred to ICU Risk factors for inappropriate stress ulcer prophylaxis in medical and surgical intensive care units The effectiveness of intravenous vitamin K in cirrhotic patients with coagulopathy in the ICU 379 Discontinuing PPI stress ulcer prophylaxis in the medical ICU when enteral feeds reach 30 ml/hr 369 370 373 375 376 377 385 390 Comparison of optical density ranges of IgG specific ELISA utilizing confirmatory results of SRA Does Early PCC Administration Influence Outcomes for Warfarin-Associated Intracranial Hemorrhage Effect of ECMO Use on the Incidence of Severe Thrombocytopenia during Severe ARDS 394 399 Activated prothrombin complex concentrate or plasma for reversal of warfarin-associated coagulopathy Off-label use of 4-factor prothrombin complex concentrate for direct oral anticoagulant reversal 401 408 409 411 Comparing three eras of hepatic coagulopathy normalization using coagulation factor concentrates Effectiveness and Safety of Four-Factor Prothrombin Complex Concentrate in Cirrhotic Patients Efficacy and Safety of 4-PCC for Coagulopathy Reversal Stratified by FDA Approval Status CPP Authors Vikram Dhawan, MD Drayton A. Hammond, BCPS, MBA, PharmD John Kinsella, MD Jordan E. Anderson, BCPS, PharmD Abdallah R. Dalabih, MBA, MD John Kinsella, MD Phillip Mohorn, BCPS, PharmD Sandra L. Kane-Gill, PharmD, FCCM Adam MacLasco, PharmD Ryan Rivosecchi, PharmD Nathan Cope, PharmD Nita F. Johnston, PharmD Jessica Brown Millen, PharmD Kevin T. Ferguson, BCPS, PharmD Maresa D. Glass, BCPS, PharmD Mitchell J. Daley, PharmD, BCPS Brady Helmink Manasa Murthy, PharmD Abdullah Alhammad, BCPS, PharmD John W. Devlin, PharmD, FCCM Amy L. Dzierba, PharmD, BCPS, FCCM Justin Muir, PharmD Russel J. Roberts, PharmD Leslie A. Hamilton, PharmD, BCPS Anthony Shaun Rowe, BCPS, PharmD Sandra L. Kane-Gill, PharmD, FCCM Ryan Rivosecchi, PharmD Pamela L. Smithburger, MS, PharmD, BCPS Cory Weaver, PharmD Cassie A. Barton, PharmD Jesse B. Bierman, PharmD Nathan Dominic Mah, PharmD Diana Esaian, BCPS, PharmD Audrey Johnson, PharmD Caitlin M. Aberle, BCPS, PharmD John Papadopoulos, BS, PharmD, FCCM Mitchell J. Daley, PharmD, BCPS Brady Helmink Manasa Murthy, PharmD Volume 15 Issue 4 Abstract Number 423 424 425 426 433 438 December 2015 Title Validation and Outcomes of Rapid Molecular Diagnostic Technology in Culture-Positive Sterile Fluids Attributable Risk and Time Course of Colistin Associated Acute Kidney Injury: Focus on Early Events Effect of seizure prophylaxis in LaCrosse encephalitis Ampicillin/Sulbactam versus Alternative BetaLactams for Severe Acinetobacter baumannii Infections Resistance patterns of uropathogens in patients with urinary tract infections presenting to the ED Evaluation of Clinical Trials Including Geriatrics in the Treatment of HAP Pathogen and risk factor variation for ventilatorassociated pneumonia in critically ill populations 439 440 447 450 451 452 456 457 459 464 466 Risk Factors for Developing an Early Space Pulmonary Isolate in Critically Ill Trauma Patients Incidence of AKI with concomitant vancomycin and beta-lactams in critically ill patients Empiric antibiotics for gram-negative bloodstream infections in ß-lactam allergic ICU patients The effect of vancomycin and linezolid on the treatment and outcomes of presumed MRSA pneumonia Comparison of High Dose Versus Standard Dose Oseltamivir in Critically Ill Patients with Influenza Antimicrobial Treatment and Mortality Risk for Carbapenem-Resistant Klebsiella pneumoniae pneumonia Association between pre-operative cefazolin dose and surgical site infection in obese patients Evaluation of a Standardized Antibiotic Desensitization Protocol Impact of higher target vancomycin trough levels on incidence of vancomycin-induced AKI Aneurysmal Subarachnoid Hemorrhage Patients with elevated 20-HETE have higher Lindegaard ratios CPP Authors Janelle J Juul, PharmD William J. Peppard, BCPS, PharmD Todd A. Miano, PharmD, MSCE Franklin Huggins, PharmD, BCPS Kirsten V. Busey, PharmD Jason Ferreira, PharmD, BCPS Sarah Albers, PharmD Elizabeth M. VanWert, PharmD Marilyn N. Bulloch, PharmD, BCPS Chris A. Droege, PharmD Neil E. Ernst, PharmD Kristen E. Hillebrand, PharmD Shaun P. Keegan, BCPS, PharmD Desiree Kosmisky, PharmD Eric W. Mueller, PharmD, FCCP, FCCM Aimee Christine LeClaire, PharmD, BCPS, FCCM Stephen J. Lemon Jr, PharmD Stacy Alan Voils, BCPS, MS, PharmD Drayton A. Hammond, BCPS, MBA, PharmD Melanie N. Smith, PharmD Alley J. Killian, PharmD, BCPS Nicholas Peters, PharmD, BCPS Justin Kinney, PharmD Alexander H. Flannery BCPS, PharmD Melissa Thompson Bastin, PharmD, BCPS Stephanie Bass, BCPS, PharmD Seth R. Bauer, BCPS, PharmD, FCCM Simon W. Lam, PharmD, BCPS, FCCM Sarah Welch, PharmD William J. Peppard, BCPS, PharmD Kelsey Aker Keith M. Olsen, PharmD, FCCM Marilyn N. Bulloch, PharmD, BCPS Stephen T. Eure, RPh Samuel M. Poloyac, PharmD, PhD, FCCM Volume 15 Issue 4 Abstract Number 468 474 477 478 482 483 484 485 487 490 491 492 493 497 498 503 508 516 531 536 541 December 2015 Title Delirium risk in surgical intensive care patients on chronic treatment with gabapentin or pregabalin Assessment of 23-Valent Pneumococcal Vaccine Response in Critically-ill Neurosurgical Patients Association of Osmolality, Brain Volume, and Clinical Neurologic Changes in Hepatic Encephalopathy Efficacy and Safety of Clevidipine and Nicardipine in Post-Neurosurgery Patients Pharmacists’ Impact on Door-to-Needle Time in Acute Ischemic Stroke Prothrombin complex concentrate vs. fresh-frozen plasma in warfarin-associated ICH Next generation gene expression analysis shows decreased expression of transporters following TBI Sleep in the ICU: An Analysis of Sleep Quality and Quantity in Mechanically Ventilated Patients IRL-1620 provides neuroprotection and enhances angiogenesis in diabetic rats with cerebral ischemia CSF concentration of Vancomycin compared to serum during continuous infusion in adult patients Glibenclamide reduces diffuse cerebral edema in a combined model of traumatic brain injury and shock Fever Control in Brain Injury with a Rapid Infusion of 4°C Normal Saline: Efficacy and Safety Trial Evaluation of prothrombin complex reversal strategies in patients with warfarin-associated ICH Multi-faceted approach to reducing delirium in a medical intensive care unit Lacosamide for Treatment of Status Epilepticus: A Safe and Effective Option Systolic Dysfunction Following Moderate-Severe Traumatic Brain Injury Comparison of lurasidone versus quetiapine for the treatment of delirium in critically ill patients Paroxysmal sympathetic hyperactivity after acquired brain injury in critically ill children Clevidipine Versus Nicardipine for Acute Blood Pressure Lowering in the Neuroscience ICU Initial Experience with 23% hypertonic saline for cerebral edema in Pediatric Intensive Care Risk of resistant microorganisms with prolonged antibiotic prophylaxis for intracranial devices CPP Authors Lisa M. Harinstein, BCPS, PharmD Douglas N. Fish, BCPS, PharmD, FCCM Tyree H. Kiser, PharmD, BCPS, FCCM Robert MacLaren, MPH, PharmD, FCCM Scott W. Mueller, BCPS, PharmD Bryan D. Lizza, BCPS, PharmD Ola Elnadoury, PharmD Joseph Samide, PharmD Joe Bodkin, PharmD Elisabeth Donahey, BCPS, PharmD Megan A. Rech, BCPS, PharmD Mindee Sue Hite, PharmD Kevin M. Silinskie, PharmD Solomon M. Adams, PharmD Philip E. Empey, PharmD, PhD, BCPS Raymonde Jean, MD Anil Gulati, MD, PhD Jessica Louie, PharmD Samuel M. Poloyac, PharmD, PhD, FCCM Matthew J. Korobey, BCPS, PharmD Sperry Kotsianas, PharmD Jennifer Cortes, BCPS Gregory M. Norris, MD Dennis Parker Jr, PharmD Vijay Krishnamoorthy, MD Jessica Elefritz, PharmD Jennifer L. Hewlett, PharmD Gretchen M. Brophy, BCPS, PharmD, FCCM Lisa M. Kurczewski, PharmD, BCPS Lois F. Parker, BS, RPh, FASHP Stephanie Chauv, PharmD Gabriel V. Fontaine BCPS, PharmD Quang P. Hoang, BCPS, PharmD Courtney B. McKinney, BCPS, PharmD Volume 15 Issue 4 Abstract Number 545 546 548 549 552 560 566 570 572 575 576 577 578 579 December 2015 Title Effects of vitamin D deficiency in aneurysmal subarachnoid hemorrhage. Retrospective Comparison of Alpha-2 Agonists for Alcohol Withdrawal in the MICU Evaluation of Outcomes Associated with Vasopressin Use in Aneurysmal Subarachnoid Hemorrhage Does the number of comorbidities before ICU admission influence quality of life after ICU? Provider and Family Perceptions of Family Involvement in Delirium Prevention in an ICU Carer Strain in Caregivers of ICU survivors Is there are relationship between perceived self efficacy and quality of life in ICU survivors? Precipitating causes associated with diabetic ketoacidosis in adult patients Characterization of Patient Referrals to a PostIntensive Care Syndrome (PICS) Recovery Center Drug history as a measure of comorbidity and predictor of long term outcome following ICU admission Comparison of hemodynamic ADEs associated with dexmedetomidine and propofol in ICU patients Impact of Intravenous Acetaminophen in Cardiothoracic Surgery Patients Population Pharmacokinetics (PK) of Vancomycin in Children on Extra-Corporeal Life Support (ECLS) Intravenous heparin calculation errors pre- and postimplementation of the Heparin NOCLOT Wizard International Survey of Pharmacologic VTE Prophylaxis Practice in Critically Ill Obese Patients 580 581 582 583 584 585 586 Clinical impact of hyperchloremia secondary to hypertonic sodium chloride administration Current Practices and Safety of Medication Use During Rapid Sequence Intubation (RSI) Population Pharmacokinetics (PK) of Vancomycin (VAN) in Neonates on Extra-Corporeal Life Support Thrombotic Complications after Prothrombin Complex Concentrate (Kcentra) Administration Evaluation of discontinuation of quetiapine and haloperidol prescribed for acute ICU delirium Ketamine infusion as adjunct sedation in mechanically ventilated critically ill patients CPP Authors Yarelis Alvarado, BCPS, PharmD Bryan D. Lizza, BCPS, PharmD Lisa L. Forsyth, PharmD Allycia Natavio, PharmD Kyle Schmidt, PharmD John Kinsella, MD Sandra L. Kane-Gill, PharmD, FCCM Pamela L. Smithburger, MS, PharmD, BCPS John Kinsella, MD John Kinsella, MD Katie Langley Sarah Bloom, ACNP, BSN, CCRN, MSN Joanna L. Stollings, PharmD, BCPS John Kinsella, MD Mallory A. Fiorenza, PharmD, BCPS Amy West, PharmD Seth R. Bauer, BCPS, PharmD, FCCM Matthew R. Wanek, BCPS, PharmD Jeffrey J. Cies, PharmD, MPH, BCPS Sarah Providence, BCPS, PharmD Abigail D. Antigua, PharmD Jessica M. Cope, PharmD Aimee J. Gowler, BCPS, PharmD Stephen J. Lemon Jr, PharmD Stacy Alan Voils, BCPS, MS, PharmD Chris A. Droege, PharmD Neil E. Ernst, PharmD Shaun P. Keegan, BCPS, PharmD Eric W. Mueller, PharmD, FCCP, FCCM Christine Marie Groth, BCPS, PharmD Jeffrey J. Cies, PharmD, MPH, BCPS Emily J. Owen, PharmD Rachel C. Stratman Wolfe PharmD Mallory A. Fiorenza, PharmD, BCPS Jonathan Girnys, PharmD Lara Groetzinger, BCPS, PharmD Ryan Rivosecchi, PharmD Volume 15 Issue 4 Abstract Number December 2015 Title A national evaluation of ICU delirium identification, prevention and treatment practices 587 588 Anti-Factor Xa Testing for Quantifying Anticoagulant Effect due to Oral Direct Xa Inhibitors 598 Effectiveness of an Algorithm for Glucose Management in Critical Care Vancomycin Dosing and Pharmacokinetics in PostOperative Pediatric Cardiothoracic Surgery Patients Sedation and neuromuscular blockade in adults receiving extracorporeal membrane oxygenation Ketamine use for sedation management in patients receiving extracorporeal membrane oxygenation The incidence of hypotension with continuous infusion atracurium compared to cisatracurium The Pharmacokinetics of Dexmedetomidine in Infants and Children following Isolated Orthotopic Liver The Persistence of ICU Delirium after Cessation of Sedatives and Analgesics 599 Evaluation of thromboelastography (TEG) for VTE prophylaxis in liver failure patients 600 Association Between Compliance to the Yale Alcohol Withdrawal Protocol and Outcomes 591 592 593 594 595 597 601 602 603 605 606 607 608 Propensity matched analysis comparing hypotension between etomidate and ketamine in septic patients Do antipsychotics improve ICU outcomes in patients with delirium ? High- versus Low-dose Recombinant Activated Factor VII Use in Cardiac Surgery Patients Association of insulin dose, diabetes, and dialysis with hypoglycemia in treatment of hyperkalemia Evaluation of antithrombin supplementation on heparin anticoagulation in pediatric ECMO patients Rivaroxaban vs. Standard of Care Post Ultrasound Accelerated Thrombolysis for Pulmonary Embolism Evaluation of a low-dose heparin nomogram for cardiac surgery patients with high bleeding risk CPP Authors John W. Devlin, PharmD, FCCM Amy L. Dzierba, PharmD, BCPS, FCCM Sandra L. Kane-Gill, PharmD, FCCM Pamela L. Smithburger, MS, PharmD, BCPS Joshua T. Swan, BCPS, PharmD Jake Beyer, BS, PharmD Tyree H. Kiser, PharmD, BCPS, FCCM Toby C. Trujillo, BCPS, PharmD, FCCP Lina Huang, BCPS, PharmD Peter N. Johnson, BCPS, PharmD Jeremy DeGrado, PharmD Amy L. Dzierba, PharmD, BCPS, FCCM Justin Muir, PharmD Anthony T. Gerlach, BCPS, PharmD, FCCM Felice Su, MD Timothy D. Girard, MD Michael Kenes, BCPS, PharmD Joanna L. Stollings, PharmD, BCPS Jeffrey T. Fish, PharmD Jennifer Garber, PharmD Chris Viesselmann, PharmD Maria Cardinale, PharmD BCPS Claire Y. Chan, BCPS, PharmD Mojdeh S. Heavner, BCPS, PharmD Bruce Allan Doepker, BCPS, PharmD Kari L. Cape, PharmD, BCPS Lindsay Pell Ryder, BCPS, BCPS Megan A. Van Berkel, BCPS, PharmD Juliane Jablonski, CCRN, CNS, DNP, RN Todd A. Miano, PharmD, MSCE Joel Feih, PharmD Markus Kaiser, MD Heather A LaRue PharmD Sharon Gordon PharmD Claudia Lynn Dubois, BCPS, PharmD Patricia R. Louzon, PharmD, BCPS Ashleigh Lowery, PharmD Mehrnaz Pajoumand, BCPS, PharmD Carla Williams, BCPS, PharmD Volume 15 Issue 4 Abstract Number December 2015 Title Are we providing adequate analgesia & sedation to critically ill, mechanically-ventilated patients? 609 610 612 614 615 Impact of improved sedation practices on positive outcomes in critically ill patients Vitamin D deficiency in a cardiac surgery intensive care unit: Standard doses are not enough Warfarin Reversal in ICH: activated versus inactivated four factor prothrombin complex concentrates Intrapleural fibrinolytic and DNAse therapy for pleural infection leads to surgical avoidance Clinical and Pharmacokinetic Evaluation of Oral Acetaminophen Absorption in Critically Ill Patients 616 617 618 619 620 621 622 623 624 625 626 Use of Intravenous Sildenafil in Pediatric Patients at an Academic Children’s Hospital Increased Neonatal Vancomycin Trough Levels and Incidence of Ototoxicity/Nephrotoxicity in the NICU Mechanically Ventilated ICU Patients’ Sedative Selfadministration: Impact on Medication Received Lack of Change in Oxygen Consumption following Albuterol compared to Levalbuterol in Healthy Adults An Evaluation of Norepinephrine Dosing Strategies in Morbidly Obese Patients with Septic Shock Evaluation of pharmacist vs nurse assessed confusion assessment method for the intensive care unit Impact of Variable Re-Dosing Strategies on INR after Prothrombin Complex Concentrate (Kcentra) The impact of early analgesia on outcomes in mechanically ventilated patients Weight-based Heparin Nomogram for Critically Ill Patients with High Bleeding Risk Drug Desensitization: Outcomes and Risk Factors for skin reactions in adults CPP Authors Lisa Hall Zimmerman, PharmD, BCPS, FCCM Lesly Jurado, PharmD Steven H. Nakajima, PharmD Joshua D. Steelman, PharmD Darowan Akajagbor, BCPS, PharmD William Darko, PharmD Kayla Kotch, PharmD Ashleigh Lowery, PharmD Kasey Greathouse, PharmD, BCPS Mary Lenefsky, PharmD Kimberly Elisabeth Levasseur-Franklin, BCPS, PharmD Michele Handzel, PharmD Cara McDaniel, BCPS, PharmD Chris A. Droege, PharmD Neil E. Ernst, PharmD Shaun P. Keegan, BCPS, PharmD Eric W. Mueller, PharmD, FCCP, FCCM Megan Welch, PharmD Kristine Parbuoni, BCPS, PharmD Elizna Van Zyl Anita Siu, PharmD, BS Sarah Maryon Hayes, BS, PharmD Debra J. Skaar, PharmD, FCCM Manpreet Virk, MD Alexander H. Flannery BCPS, PharmD Komal A. Pandya, PharmD Paul Wong, PharmD Jennifer S. Catlin, BCPS, PharmD Livia Mackley, PharmD Gabrielle A. Gibson, BCPS, PharmD Emily J. Owen, PharmD Rachel C. Stratman Wolfe PharmD Heath Oetken, PharmD Keith M. Olsen, PharmD, FCCM Sai-Ho Jason Chui, BCPS, PharmD Mehrnaz Pajoumand, BCPS, PharmD Sharon Wilson, BCPS, PharmD Taryn Murray, PharmD Joanna L. Stollings, PharmD, BCPS Volume 15 Issue 4 Abstract Number December 2015 Title Three versus Four-Factor Prothrombin Complex Concentrate for Reversal of Warfarin-Induced Bleeding 628 629 630 631 632 633 634 635 637 642 643 644 645 646 647 648 649 650 The half-life of acetaminophen and its relationship to mortality after acetaminophen overdose Major Bleed Risk in Patients on Novel Oral Anticoagulants with PGP and/or CYP450 3A4 Inhibitors Tolerability of Subanesthetic Ketamine in the Surgical Intensive Care Unit Comparison of Neuromuscular Blockers in Early Acute Respiratory Distress Syndrome Do Norepinephrine Starting Rates Effect Outcomes in Septic Shock? Characterization Of Pharmacy Interventions In A Post Intensive Care Unit Recovery Center Efficacy and Safety of Intraventricular Antibiotics in Critically Ill Neurosurgical Patients Impact of Over-Sedation and Inadequate Pain Control on Duration of Intubation in Oncology Patients High vs. low dose sulfamethoxazole/trimethoprim for the treatment of Stenotrophomonas pneumonia Evaluation of propofol (Diprivan) monitoring practices in adult intensive care units Does dexmedetomidine reduce opioid requirements in brain injured patients Safety of Analgesia-based Sedation in the Trauma Intensive Care Unit (ICU) Improving Administration of Weight-Based Vancomycin Loading Doses in the ED Through PreBuilt Orders Evaluation of delirium monitoring in a medical ICU Evaluation of the Appropriateness of Initial Antibiotic Dosing in Severe Sepsis and Septic Shock Dexmedetomidine (DEX) Prescribing Patterns for Mechanically Ventilated (MV) Patients Insufficient use of analgesia and anxiolysis in postintubated patients in the ED CPP Authors Prasad E. Abraham, PharmD, BCPS, FCCM Tai Elder, PharmD Serena Ann Harris, PharmD, BCPS Tara R. Holt, BCPS, PharmD Wesley D. McMillian, BCPS, PharmD, FCCM Laura Hencken, PharmD Michael A. Peters, BCPS John Stine, PharmD, BCPS Caroline J. Girardeau, BCPS, PharmD Debbie Liang, PharmD Mona K. Patel, PharmD Leanne M. Current, BCPS, PharmD Charles J. Kramer, BCPS, PharmD Krista A. Wahby, PharmD Kara Zacholski, PharmD Sarah Bloom, ACNP, BSN, CCRN, MSN Joanna L. Stollings, PharmD, BCPS Colleen Barthol, BCPS, PharmD Molly Curran Trisha Patel, BCPS, PharmD Michelle Horng, BCPS, PharmD Lisa M. Kurczewski, PharmD, BCPS Kimberly L. Varney Gill, BCPS, PharmD Ali Paplaskas, PharmD Linda A. Park, BCPS, PharmD Dennis O. Parker Jr, PharmD Maria L. Pusnik, BCPS, PharmD Brandon P. Hobbs, PharmD Xi Liu-DeRyke, PharmD, FCCM Joseph Hai Trang, PharmD Colleen Teevan, BCPS, PharmD Amy L. Dzierba, PharmD, BCPS, FCCM Justin Muir, PharmD Phil Grgurich, PharmD, BCPS Laura M. Bosse, PharmD Suprat Saely Wilson BCPS, PharmD, PharmD Volume 15 Issue 4 Abstract Number 651 652 653 654 656 657 December 2015 Title Potential prolonged effects of argatroban in the critically ill Prothrombin Complex Concentrate (Kcentra) for Reversal of Oral Factor Xa Inhibitors Risk factors associated with elevated vancomycin trough concentrations in a Medical ICU Risk Factors for the Development of Hemodynamic Adverse Effects with Dexmedetomidine Efficacy of Sequential Nephron Blockade in Pediatric Cardiac Intensive Care Patients Continuous Sedation with Midazolam in Obese vs Non-Obese Critically Ill Patients Implementation and Perceptions of a Critical Care Pharmacists’ Mentor-Mentee Program 659 660 661 662 666 672 686 690 694 702 705 708 719 723 Using social media to increase the reach of SCCM’s Critical Care Congress Diversity in the Emerging Intensivist Workforce: Trends in Critical Care Fellows from 2004-2014 Impact of a Clinical Pharmacist Participating in Multidisciplinary rounds in an ICU Setting High-Flow Nasal Cannula Flow Titration and Effort of Breathing in the Pediatric Intensive Care Unit Derivation of a Bundle to Improve First Attempt Success at Intubation in the Intensive Care Unit Predictors of Difficult Intubation When Using Video Laryngoscopy in the Intensive Care Unit Thrombotic outcomes with an unfractionated heparin guideline in extracorporeal membrane oxygenation Fixed-Dose Cisatracurium in Acute Respiratory Distress Syndrome: Sedation and Analgesia Efficacy of High Flow/High Humidity Nasal Cannula Therapy in Viral Bronchiolitis Use of a common canister metered dose inhaler protocol in mechanically ventilated patients Steroid Dosing Relationship to Duration of Mechanical Ventilation in Acute COPD Exacerbations High Dose Oseltamivir and ARDS Adjunct Therapy in Severe Influenza: A Comparison of Two Outbreaks Pediatric Cystic Fibrosis (CF) Patients Requiring Endotracheal Intubation: National Mortality Trends CPP Authors Earnest Alexander Jr, PharmD, FCCM Uyen Diep Melissa M. Giarratano, PharmD Maresa D. Glass, BCPS, PharmD Emily J. Owen, PharmD Rachel C. Stratman Wolfe PharmD Steven E. Pass, PharmD, FCCM Alexander H. Flannery BCPS, PharmD Jeremy D. Flynn, PharmD, FCCP, FCCM Ahmed A. Mahmoud, PharmD Ronald A. Bronicki, MD, FCCM Erin E. Mancl, PharmD, BCPS Megan A. Rech, BCPS, PharmD Susan E. Hamblin, PharmD, BCPS Drayton A. Hammond, BCPS, MBA, PharmD Serena Ann Harris, PharmD, BCPS Brian J. Kopp, BCPS, PharmD, FCCM Elizabeth H. Mack, MD, MS Todd A. Miano, PharmD, MSCE Thomas Bushell, PharmD Nam Cho BCPS, PharmD Asavari Kamerkar, MD John W. Bloom, MD John W. Bloom, MD Amy L. Dzierba, PharmD, BCPS, FCCM Justin Muir, PharmD Amanda M. Ball, BCPS, PharmD Rebecca Bookstaver, BSN, PharmD Catherine A. Pierce, PharmD, FCCM Patricia A. Abboud, MD Jennifer Bushwitz, PharmD Mollie Gowan, PharmD Katherine Kielts, PharmD Jennifer McCann, PharmD, BCPS Jeffrey P. Gonzales, BCPS, PharmD, FCCM Steven D. Strausbaugh, MD, FCCP, CPI Volume 15 Issue 4 Abstract Number 747 750 751 758 768 773 784 787 797 799 802 805 810 818 822 826 834 840 841 847 850 858 862 December 2015 Title High vs. low dose corticosteroids in COPD exacerbations requiring mechanical ventilation Evaluating Methylprednisolone Doses in Intensive Care Unit Patients for Acute COPD Exacerbation Healthcare-associated pneumonia treatment characterization in medical intensive care unit patients Trend and outcomes of video laryngoscope use across pediatric ICUs Effect of an Audit and Feedback Process on Pain, Agitation, and Delirium Documentation in 15 ICUs Impact of a team initiative to reduce unplanned extubations in patients with difficult airways Interprofessional Collaboration on Delirium Management in a Pediatric Intensive Care Unit Multi-center validation of an ICU real-time prediction of mortality (RPM) model Experience with Propofol for Procedural Sedation in Infants under 6 months of Age. Reduction in Point-of-Care Blood Glucose Measurements in the Medical Intensive Care Unit Inappropriate Continuation of Acid Suppression Therapy in Intensive Care Unit Patients Increasing event reporting by residents in a pediatric intensive care unit Evaluation and Potential Impact of Critical Care Pharmacists’ Interventions in Singapore Incidence of Atypical Antipsychotic Prescription at Time of ICU and Hospital Discharge Using Physician Champions To Coordinate Spontaneous Awakening And Breathing Trials Effect of a “Re-invigorated” RRT on In-hospital Cardiopulmonary Arrest Rates and Mortality. Discrepancies in Measuring Bladder Volumes with Bedside Ultrasound and Bladder Scanning in the ICU Discharge Prescribing of Enteral Opiates After Use as a Weaning Strategy from Intravenous Opiates Experience with Implementation of Pain Agitation and Delirium Guidelines in MICU Prospective Evaluation of an Automated Severity Score’s ability to differentiate ICU patients High versus Standard Dose Dexmedetomidine for Sedation in Critically Ill Patients: The HI-DEX Study Structure and function of teams in the PICU: A social network analysis Economic Impact of Clinical Pharmacy Services at an Academic Teaching Hospital CPP Authors Jennifer Cortes, BCPS Richard Lawrence McKnight, PharmD Jeffrey M. Quedado, PharmD Jeffrey P. Gonzales, BCPS, PharmD, FCCM Eleanor Gradidge, MD Pradip P. Kamat, MBA, MD Stacey L. Folse, BCPS, MPH, PharmD Pradip P. Kamat, MBA, MD Allison Lardieri, PharmD Omar Badawi, PharmD, BCPS, FCCM Erkan Hassan, PharmD, FCCM Pradip P. Kamat, MBA, MD Seth R. Bauer, BCPS, PharmD, FCCM Kaitlin Pruskowski, PharmD Elizabeth H. Mack, MD, MS Simeon Tang, PharmD Matthew J. Korobey, BCPS, PharmD Frantz Hastrup, MD Samad Rasul, MD, FACP Warren Isakow, MD Marilyn Schallom, CCRN, PhD, FCCM Dan Gilstrap, MD Bridgette L. Kram, PharmD, BCPS Stacey L. Folse, BCPS, MPH, PharmD Omar Badawi, PharmD, BCPS, FCCM Erkan Hassan, PharmD, FCCM Rebecca L. Anderson, BCPS, PharmD Mark Duffett, MSc, RPh Martha A. Naber, PharmD Edward G. Timm, PharmD Volume 15 Issue 4 Abstract Number 864 872 876 891 892 893 896 902 903 904 905 906 911 912 919 920 924 925 927 932 934 December 2015 Title Reduction in S. aureus nasal screening in MICU reduces lab costs without increase in Lab ID events Experience and Satisfaction with Early Mobility in Mechanically Ventilated Cancer Patients Impact of Expanding Emergency Medicine Pharmacy Services in a Community Hospital Transport Risk Assessment in Pediatrics Score Predicts Clinical Course of Critically Ill Children Staff and family satisfaction with implementation of a safe pediatric sedation checklist Evaluation of azithromycin administration and QTcinterval prolongation in the critically ill The creation of the first ICU Patient and Family Advisory Council in the UK Standardization of anticoagulation management in extracorporeal membrane oxygenation Implementation of clinical decision support tool for the management of HIT in the ICU Improving Hand Hygiene Compliance In Hospital Care Characterization of Warfarin Major Bleeding Events in Real-World Clinical Practice Impact of pharmacists on transition of care from intensive care to progressive care units Evaluation of inappropriate unable-to-assess CAMICU documentations of critically ill patients Safety of the Peripheral Administration of Vasopressor Agents The Impact of Mobility and Sedation Protocols on Delirium in Mechanically Ventilated Patients Utility of an Osmolar Gap and Other Laboratory Values in the Diagnosis of Toxic Alcohol Ingestion Medication Utilization and Outcomes with Implementation of the Critical-Care Pain Observation Tool Evaluation of risk factors for high vancomycin troughs in pediatric patients Sedation and analgesia utilization following rapid sequence intubation in the emergency department Impact of reflex urine studies on antimicrobial use and healthcare costs in the intensive care unit Evaluation of Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic State Protocol at an Academic Center CPP Authors Seth R. Bauer, BCPS, PharmD, FCCM Louis P. Voigt, MD Darlene Chaykosky, PharmD, BCPS Rosa L. Haddock, MD Gilberto Puig, MD Elizabeth H. Mack, MD, MS Anna Fiorvento Linda A. Park, BCPS, PharmD Maria L. Pusnik, BCPS, PharmD John Kinsella, MD Chris Viesselmann, PharmD Marina Rabinovich, BCPS, PharmD Venkatesh Aiyagari, MD Maureen A. Smythe, PharmD, BCPS Patricia R. Louzon, PharmD, BCPS Paul M. Szumita, BCPS, PharmD Kimberly Terry, BCPS, PharmD Diana Esaian, BCPS, PharmD Tyler Lewis, PharmD Cristian Merchan, PharmD John Papadopoulos, BS, PharmD, FCCM James A. Curtis, BCPS, PharmD Neil Roe, PharmD Megan A. Van Berkel, BCPS, PharmD Alexis Luckey, PharmD Jodi L. Taylor, BCPS, PharmD Bethany Ann Wattles, PharmD Cindy Zoeller, PharmD, MBA Michele Handzel, PharmD Cara McDaniel, BCPS, PharmD Marian Gaviola, PharmD Wesley D. McMillian, BCPS, PharmD, FCCM Marina Rabinovich, BCPS, PharmD Volume 15 Issue 4 Abstract Number 941 949 953 955 963 968 973 975 976 995 998 1014 December 2015 Title Ventilator Weaning Protocol Reduces Duration of Ventilation in a Pediatric ICU Evaluation of neuroleptic utilization in the intensive care unit during transitions of care Developing a standardized OR to ICU handoff process Evaluation of Phenytoin Monitoring Practices in Adult Critically ill Patients Post-operative Acute Kidney Injury among Patients Admitted from the Emergency Room for Major Surgery Plasma resistin levels are associated with acute kidney injury in critically ill trauma patients Are There Differences in the Risk Factors for AKI in Young Adults as Compared to Older Adults? A Unique Application of the GRADE Criteria: DrugCombination Associated AKI Characteristics & Outcomes of severe hyponatremia (Na=125 meq/L) in the MICU: A retrospective study The Impact of Endocrine Supplementation on Adverse Events in Septic Shock Type 2/Th2 Inflammatory Responses Protect Against the Mortality of Staphylococcus aureus Infection ABO Blood Type A and Increased Severity of Sepsis Association between intravenous fluid chloride content and acute kidney injury in adults with sepsis 1027 1035 1043 1048 1051 1053 1057 Impact of hydrocortisone continuous infusion versus bolus dose on glycemic control Shock Index as a Predictor of ICU Transfer in Patients Admitted to the Medical Ward with Sepsis Vitamin D Supplementation and Mortality in Patients with Severe Sepsis and Septic Shock Efficacy of non-weight based vasopressor dosing in critically ill patients with severe sepsis Impact of Pharmacist Intervention on Timing of Appropriate Antimicrobial Therapy in Septic Shock Impact of Educational Interventions and Simulation Training on Mortality in a Busy Urban Hospital CPP Authors Sameer Kamath, MD Jason Ferreira, PharmD, BCPS Juliane Jablonski, CCRN, CNS, DNP, RN Nadia H. Ismail, BS, MS Joshua T. Swan, BCPS, PharmD Daniel N. Holena, MD Sandra L. Kane-Gill, PharmD, FCCM Joseph F. Dasta, MS, RPh, MCCM, MSc Sandra L. Kane-Gill, PharmD, FCCM Ryan Rivosecchi, PharmD Phani C. Kantamneni, MD Brittany Dawn Bissell, PharmD Michael J. Erdman, PharmD, BCPS Jason Ferreira, PharmD, BCPS Philip A. Verhoef, MD, PhD Megan A. Rech, BCPS, PharmD Bruce Allan Doepker, BCPS, PharmD Kari L. Cape, PharmD, BCPS Claire V. Murphy, PharmD Megan Perry, PharmD Lindsay Pell Ryder, BCPS, BCPS Christy C. Forehand, BCPS, PharmD April Miller Quidley, PharmD, BCPS, FCCM Laura Zane, PharmD Isaac Noble Biney, MD Megan A. Rech, BCPS, PharmD Bryan Allen, PharmD Alexander H. Flannery BCPS, PharmD Jeremy D. Flynn, PharmD, FCCP, FCCM Raymonde Jean, MD Volume 15 Issue 4 Abstract Number December 2015 Title Impact of prior antihypertensive therapy on outcomes for patients with circulatory shock 1059 1061 Impact of order set utilization for the treatment of patients with severe sepsis and septic shock 1077 Fluid Resuscitation in Septic Shock Patients Perceived At Risk for Volume Overload Patients metabolomic profile in intensive care unit. ECMO in H1N1 Pregnant and Postpartum Women with ARDS: A Systematic Review and Metaanalysis. Sepsis without Walls: A Quality Improvement Project The Influence of Sepsis on Sleep Architecture in the Intensive Care Unit Predictors of Outcomes with Endocrine Support in Septic Shock 1079 Evaluation of a Severe Sepsis Order Set in the Surgical Intensive Care Unit 1062 1063 1067 1069 1075 1084 Evaluation of Code Sepsis at a Urban Community Teaching Hospital Enoxaparin Versus Anti-Xa Adjusted Dalteparin for Venous Thromboembolism Prophylaxis in Trauma 1108 1109 1113 1116 1119 1126 1127 1131 1135 Empiric antibiotic selection for ventilator associated pneumonia in traumatically-injured patients Hypertonic saline and acute kidney injury in traumatic brain injury Dronabinol for Acute Pain Management in Burn Patients that Use Marijuana Predictors of Contrast Induced Nephropathy in Trauma Patients Antibiotic Evaluation Following Penetrating Abdominal Injury With and Without Orthopedic Injury Adjunct Ketamine Infusions Provide Improved Acute Traumatic and Post-Surgical Pain Management Comparison of tranexamic acid and aminocaproic acid in blood loss reduction in orthopedic surgeries Impact of a nursing-driven sedation protocol on mechanical ventilation in the surgical ICU CPP Authors Seth R. Bauer, BCPS, PharmD, FCCM Mitchell J. Daley, PharmD, BCPS Ishaq Lat, PharmD, FCCM Robert MacLaren, MPH, PharmD, FCCM Russel J. Roberts, PharmD Sarah S. Sokol, PharmD Lucretia C. Davis, PharmD Petra Grami, BSN, CCRN, NE-BC Chiamaka Ike, BCPS, PharmD Christa A. Schorr, RN, MSN, FCCM Dr. Patrick Biston, MD Antonio Saad, MD James Gasperino, MD Raymonde Jean, MD Brittany Dawn Bissell, PharmD Michael J. Erdman, PharmD, BCPS Jason Ferreira, PharmD, BCPS Andrew S. Jarrell, BCPS, PharmD, PharmD Rachel M. Kruer, BCPS, PharmD Alan Rozycki, PharmD Basirat O. Sanuth, PharmD, BCPS Chris A. Droege, PharmD Neil E. Ernst, PharmD Shaun P. Keegan, BCPS, PharmD Eric W. Mueller, PharmD, FCCP, FCCM Megan Welch, PharmD Melissa A. Reger, BCPS, PharmD, RPh Susan E. Hamblin, PharmD, BCPS Kelly Maguigan, PharmD Charles J. Foster, BCPS, PharmD Christopher Miller, PharmD Scott W. Mueller, BCPS, PharmD John A. Bethea, PharmD Lauren R. Jones, PharmD Eric W. Mueller, PharmD, FCCP, FCCM Madeline Foertsch BCPS, PharmD Meghann Luc, PharmD Caitlin F. Mulllins, PharmD William J. Peppard, BCPS, PharmD Bryan Allen, PharmD Justin Kaplan, PharmD Claire V. Murphy, PharmD Volume 15 Issue 4 Abstract Number 1140 1142 1145 1147 1149 1152 1158 1163 1164 1169 1172 1173 1179 1180 1182 1186 1188 1190 1199 1204 December 2015 Title Use of a Computerized Heparin Protocol Improves Patient Safety in the Surgical Intensive Care Unit Do Intracranial Pressure Monitors Improve Survival in Pediatric Traumatic Brain Injury Patients? Comparison of vancomycin dosing in hypermetabolic vs non-hypermetabolic patients with thermal injury Evaluation of tranexamic acid as part of a massive transfusion protocol at a Level 1 Trauma Center The Effect of Antipsychotic Use Post Traumatic Brain Injury on Duration of Post Traumatic Amnesia Serum sodium (sNa) response to hypertonic saline (HTS) in traumatic brain injury (TBI) Methicillin-resistant Staphylococcus aureus pneumonia in critically ill trauma patients Evaluation of Dose to INR response of PCC3 and PCC4 to INR Reduction in Emergent Warfarin Reversal Assessment of a Tranexamic Acid Protocol for Orthopedic Trauma Surgery Urine sodium excretion and serum sodium changes with hypertonic saline for traumatic brain injury Prophylactic Enoxaparin Dosing Strategies and Incidence of Venous Thromboembolism in Burn Patients Increased Red Cell Distribution Width is Associated with Mortality Following Burn Injury Early hypercoagulability in trauma ICU patients detected by calibrated automated thrombogram Respiratory depression in the intoxicated trauma patient: Are opioids to blame? Trauma patients admitted taking warfarin or dabigatran - A comparison of management and outcomes Reduction in Red Blood Cell Utilization Associated with a Blood Conservation Initiative in a SICU Outcomes of trauma patients not receiving antibiotics for polymicrobial growth of BAL Early VENous Thromboembolism prophylaxis in blunt trauma: The EVENT Study Ceftolozane-tazobactam pharmacokinetics in a patient on continuous veno-venous hemofiltration Activated PCC (FEIBA) for reversal of rivaroxabaninduced life-threatening bleeding - a case series CPP Authors Kelli Rumbaugh, PharmD Mathew Mathew Edavettal MD, PhD Brittainy Allen, PharmD Megan A. Rech, BCPS, PharmD Melissa A. Reger, BCPS, PharmD, RPh Ann W. Vu, BCPS, PharmD Kirstin J. Kooda, BCPS, PharmD Scott A. Chapman, PharmD Charles Andrew Adams Jr, MD, FCCM Kristen Bunnell, PharmD Scott A. Chapman, PharmD Meagan Doolin, PharmD Serena Ann Harris, PharmD, BCPS Todd A. Walroth, BCPS, PharmD Scott A. Chapman, PharmD David R. Foster, BS, PharmD Andrew C. Fritschle Hilliard, PharmD, BCPS Todd A. Walroth, BCPS, PharmD Jessica A. Whitten, BCPS Nam K. Tran, PhD Stephen J. Lemon Jr, PharmD Stacy Alan Voils, BCPS, MS, PharmD Cassie A. Barton, PharmD Nathan Dominic Mah, PharmD Carinda J. Feild, PharmD, FCCM Bao Anh Tran Keri J. Bicking, BCPS, PharmD, BCNSP James C. McMillen, BCPS, PharmD Eileen Shomo Jeffrey P. Gonzales, BCPS, PharmD, FCCM David Nicolau, PharmD Suprat Saely Wilson BCPS, PharmD Volume 15 Issue 4 Abstract Number 1206 1212 1217 1231 1241 1258 1260 1288 1293 1297 1313 December 2015 Title Adjunctive Use of Ketamine during Extracorporeal Membrane Oxygenation Methemoglobinemia in acetaminophen overdose and glucose-6-phosphate dehydrogenase deficiency Extracorporeal Membrane Oxygenation for Hemophagocytic Lymphohistiocytosis Secondary to Ehrlichiosis Lipid emulsion for inadvertent intrathecal administration of local anesthetics in the ED OTC sexual enhancement and poppers: a deadly combination unknown to the public Lipid rescue therapy and hyperinsulinemia/euglycemia for atenolol and zolpidem overdose Neurosarcoidosis induced panhypopituitarism Are children just little adults - the controversy of pediatric ischemic stroke treatment A System-wide Approach to Drug Price Inflation and Therapeutic Alternatives Cost Effectiveness of Intensive Care in the UK Screening Weeks: A pilot trial management metric CPP Authors Tanna Hassig, BCPS Joseph E. Mazur, PharmD, BCPS Cara McDaniel, BCPS, PharmD Pradip P. Kamat, MBA, MD Ruchi Jain BCPS, PharmD Scott W. Mueller, BCPS, PharmD Melissa Heim, PharmD Aanchal Kapoor, MD Paras B. Khandhar, MD Jennifer Anderson, ACNP John Kinsella, MD Jennifer Good, MD Volume 15 Issue 4 December 2015 Miscellaneous Section Technology Update by Mona Patel, PharmD The Society launched its first-ever Journal Club Twitter chat on October 29, 2015. Christopher Seymour, MD, discussed his Critical Care Medicine article, “County-Level Effects of Prehospital Regionalization of Critically Ill Patients: A Simulation Study.” Anthony Gerlach, PharmD, who is also the Social Media Task Force Co-Chair, moderated the session. The discussion generated 323 tweets and 472,644 impressions. The next Twitter chat will take place on December 15, 2015 at 2:00 p.m. Central Time, when Azra Bihorac, MD, and Chuck Hobson, MD, will discuss their Critical Care Medicine article, “Critical Care Delivery and ICU Structure: The Elephant in the Room.” To participate, simply create an account or log in to Twitter and search for #SCCMJC. Frequently Asked Questions by Justin Muir, PharmD What electronic resources are available to optimize my experience at Congress? Download the SCCM Events app from the Google Play Store (Android) or iTunes App Store (Apple) and take advantage of electronic schedules of presentations, abstracts, and exhibits. Add events to your schedule to keep track of all of the sessions and meetings you want to attend. Missed a session or poster? Log in to http://my.sccm.org and click on “My Learning”. Use the links under the 45th Annual Congress heading for “Speaker Presentations” and “Posters/Abstracts.” Electronic versions of posters, audio recordings and slides from the individual presentations are available to those who registered for Congress. On Demand resources will be posted shortly after Congress has concluded. Communications Committee members are charged with publishing the newsletter. Thanks to the following members: Simon Lam (chair) Joanna Stollings (chair-elect) Seth Bauer (member-at-large) Katarzyna Adamczhk Jerry Altshuler Mahmoud Ammar Abdalla Ammar Scott Benken Kim Berger Prachi Bhatt Aida ‘Rebecca’ Bickley Jessica Crow Deepali Dixit Chris Droege Diana Esaian Stacey Folse Marian Gaviola Amanda Giancarelli Gabrielle Gibson Payal Gurnani John Hammer Drayton Hammond Julie Kalabalik Michael Kenes Desiree Kosmisky Jason Makii Russell Mason Thomas Moran Justin Muir Mona Patel Natalie Prater Kelli Rumbaugh Abbi Smith Volume 15 Issue 4 December 2015 Marilyn Bulloch Tram Cat Darlene Chaykosky Tudy Hodgman Lauren Igneri Jessica Jones Tom Smoot Calvin Tucker Sarah Welch Patrick Welch Featured CPP Resources Are you stuck on a research-related question? Consider reaching out to the experts on the CPP Research Committee by e-mailing [email protected] Do you have a manuscript or grant that you would like to be reviewed by a content expert? If so, consider emailing the Research Committee chair at [email protected] Upcoming SCCM Congress Meetings—Save the Dates! 2016 2017 2018 February 20-24 January 21-25 February 24-28 Orlando, Florida Honolulu, Hawaii San Antonio, Texas