Download Use of a Loading Dose of Levetiracetam or Not?

Volume 14 Issue 4
Dec 2014
Clinical Pharmacy and Pharmacology
Section Newsletter
Society of Critical Care Medicine
Section Officers
Chair
Karen McAllen, PharmD,
FCCM
([email protected])
Past-Chair
Lance Oyen, PharmD, FCCM
([email protected])
Chair-Elect
Ishaq Lat, PharmD, BCPS,
FCCM
([email protected])
Secretary/Treasurer
Russ Roberts, PharmD
(rroberts@tuftsmedicalcenter.
org)
Members-at-Large
Seth Bauer, PharmD
([email protected];
[email protected])
Amy Dzierba, PharmD,
FCCM
([email protected])
Ty Kiser, PharmD, FCCM
([email protected])
MESSAGE FROM THE CHAIR
Karen J. McAllen, PharmD, FCCM
As I write my last message from the Chair, I am surprised at
how quickly this year went and all of the people who have
contributed to such a productive year. I would like to extend my
sincere appreciation for all the members of our section
committees. In addition, I would like to recognize the CPP
Section Committee Chairs and Chair-Elects as they have done
an outstanding job this year. I also would like to thank the
members of the CPP Steering Committee: Lance Oyen, Ishaq
Latt, Russ Roberts, Amy Dzierba, Seth Bauer, Ty Kiser, Sandra
Kane-Gill, and Steve Martin for their guidance and support this
year.
I would like to welcome the 2015 CPP Committee Chairs and
Chair-Elects. The Chairs are Simon Lam (Communications),
Jeff Gonzales (Education), John Allen (Membership), Marilyn
Bulloch (Program), Mitch Daley (Research) and Elizabeth
Sinclair (Patient Safety).
Keep in mind several deadlines that will arrive shortly after
Congress. The submission for proposed educational sessions
at the 2016 Annual Congress in Orlando, Florida, is March 3,
2015. More information can be found at
http://www.sccm.org/Education-Center/AnnualCongress/Pages/Past-Future.aspx.
The applications for SCCM committee and task force
appointments for 2016 are due May 1, 2015. More information
can be found in the iRooms under “My Involvement.”
It has been a privilege serving as the 2014 CPP Section Chair
and I look forward to seeing everyone in Phoenix in January.
CPP COMMITTEE CORNER
Communications Committee
Deepali Dixit, PharmD (Chair), and Simon Lam, PharmD (Chair-Elect)
The CPP Communications Committee members will be compiling highlights from some of the
educational sessions at the 2015 SCCM Congress. These will be published in our April 2015
CPP newsletter. If anyone is interested in helping with educational session summaries at
Congress, please email Simon Lam at the email address provided below.
Congratulations to all members of the CPP Section who had abstracts accepted for
Volume 14 Issue 4
Dec 2014
presentation at the upcoming Congress. The abstracts information is included in this issue of
the newsletter. Our section has close to 200 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 Sunday, January 18 (12:30 pm to 1:30
pm) at room 127B in the Phoenix Convention Center. 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 Deepali Dixit at
[email protected] or Simon Lam at [email protected].
Education Committee
Jorie Frasiolas, PharmD (Chair), and Jeff Gonzales, PharmD (Chair-Elect)
The CPP Education Committee continues to partner with the Society on several key initiatives,
including educational modules, a tool kit for protocol implementation, recertification education
for board certification in critical care pharmacotherapy, electronic posters, and journal club.
The webcast on spontaneous awakening and spontaneous breathing trials has been
rescheduled for early 2015. An email announcement will be distributed with additional
information.
Electronic posters presented at the 2014 SCCM Annual Congress are available in the CPP
Section iRoom and LearnICU eCommunity. To view the posters in the iRoom, please access
the committee documents along the left menu. The posters can also be found in the LearnICU
eCommunity at http://community.sccm.org/p/fo/si/topic=47 or by visiting the LearnICU
Pharmacology Knowledge Area.
Journal Club continues to be held the third Friday of every month at 2 PM EST. Upcoming dates
include December 19, January 16, and February 20. If you would like to receive the monthly
notification and link to access the journal club session, please contact Karen Berger at
[email protected] or [email protected].
Membership Committee
Laura Aykroyd, PharmD (Chair), and John Allen, PharmD (Chair-elect)
Mentor-Mentee Program
The Mentor-Mentee Program provides CPP pharmacist members with guidance in a variety of
areas such as clinical practice, research, teaching and SCCM/CPP involvement. Members are
matched based on mentoring need, specialty practice area (e.g., emergency medicine,
pediatrics, trauma, burn), practice model (e.g., clinical specialist, consultant, academia), and
experience level. We continue to expand the demographics used to match individuals to make
the pairing as beneficial as possible. All CPP Section members are welcome to participate in a
mentor or mentee capacity.
Members interested in being mentored are encouraged to contact us at any point. Matching will
resume at the end of January following the 2015 Annual Congress Meeting. Please contact me
([email protected]) or John Allen ([email protected]) if you have any questions
Volume 14 Issue 4
Dec 2014
regarding the program or are interested in participating. We look forward to working with our
current and prospective mentors and mentees and to the continued success of the program.
SCCM CPP Congress Orientation for New Members and First-time Attendees
The CPP Membership Committee would like to invite all new members or first-time Congress
attendees to the new member reception and orientation. It will be held on Saturday, January 17
from 5:00 pm to 6:00 pm in the Sheraton Phoenix Downtown Hotel, Encanto A, preceding the
CPP reception. The new member reception is a great way to learn about the different CPP
Section activities and meetings held during Congress, and it offers an opportunity to network
with other new members, the CPP Advisory Board, and committee chairs. We look forward to
seeing all the new members and first-time Congress attendees at this orientation. Thank you to
Kristine Parbuoni and Serena Harris for their planning efforts!
Patient Safety Committee
Lisa Harinstein, PharmD (Chair), and Elizabeth Sinclair, PharmD (Chair-Elect)
Thank you to those members who submitted applications for the 2014 CPP Patient Safety
Awards. The submissions have been reviewed and the winners will be announced at the 2015
Annual Congress CPP Section business meeting.
We know that many CPP members are implementing novel programs into clinical practice to
improve patient and medication safety, and we would like to recognize you for this great work.
Stay tuned after Congress 2015 for CPP Patient Safety Awards application information.
Additionally, the committee is working on a proposal for the 2016 Annual Congress. We plan on
submitting a proposal discussing safety issues with off-label use of medications in pediatric and
adult patients. If you are interested in speaking or know of other healthcare professionals who
would be interested in contributing to the proposal, please email Lisa Harinstein
([email protected]).
Program Committee
Moo Sultan, PharmD (Chair), and Marilyn Bulloch, PharmD (Chair-Elect)
The CPP Programming Committee has been coming together to complete the charges for the
year. As mentioned, the committee has decided on the topics for the session, Year in Review:
Pharmacy , which will be fluid resuscitation, burns, and infectious disease in critically ill. The
speakers have access to previous speakers and a guidance document developed by the
committee.
The committee is also planning for the Pre-Congress Symposium, Member Reception, and
Recruitment Exchange. The Pre-Congress Symposium, “Phoenix Rising – Transforming Your
Practice at any Stage” has been set for Saturday, January 17, 2015, from 2:00 pm to 4:00 pm.
The committee is working on finalizing speakers. We learned a lot from the Recruitment
Exchange this past year and are working on making it a successful event that would benefit
both employers and job seekers. Below is more information regarding this year’s Recruitment
Exchange. If anyone has any suggestions for the this or the Pre-Congress Symposium, please
let me know. Finally, the Visiting Clinical Professor Program is excited to send Stephanie
Mallow-Corbett to Vidant Medical Center on November 17, 2014. More updates to come on the
visit in the near future.
If you have any questions or suggestions for the above charges, please email Moo Sultan
([email protected]) or Marilyn Bulloch ([email protected])
Volume 14 Issue 4
Dec 2014
2015 CPP Recruitment Exchange
Location: 2015 SCCM Annual Congress, Phoenix, AZ
Room 103, Phoenix Convention Center
Date and Time: Sunday January 18, 2015, 10:00 – 11:00 am
The Clinical Pharmacy and Pharmacology Section is proud to announce the second annual
CPP Recruitment Exchange, to be held at the 2015 Society of Critical Care Medicine’s
Congress in Phoenix, AZ.
Institutions
 Advertise your position to the largest
gathering of critical care pharmacy
specialists in the country
 Meet individually or in small groups with
potential candidates
 Follow up with potential candidates from
the ASHP Midyear Meeting or other
conferences
Potential Candidates
 Network
 Learn about potential employment
opportunities
 Follow up with institutions from the ASHP
Midyear Meeting or other conferences
There is NO CHARGE for this event. We do request that all institutions pre-register by
December 31, 2014. On-site registrations for institutions or potential candidates will be
welcome.
Institutions unable to attend the SCCM Annual Congress can still participate by sending position
information. This information will be posted for prospective candidates to view during the
Recruitment Exchange.
------------------------------------------------------------------------------------------------------------------------------Please email the following information to:[email protected] by December
31, 2014







Position type – critical care, emergency department, academia, internal medicine, other
Number of available positions
Institution name
Institution address
Contact name, address, phone, and email
Name of representative at SCCM Annual Congress
Other pertinent information
o Position schedule (e.g., days, nights, weekends, 7 on/7 off)
o Salary/benefits
o Requirements for hire
Volume 14 Issue 4
Dec 2014
o Other as applicable.
Research Committee
Erin Frazee, PharmD (Chair), and Mitch Daley, PharmD (Chair-Elect)
We’re in the home stretch of 2014 and the CPP Research Committee has had a lot of
successes so far this year, and we are looking forward to many new and ongoing opportunities
for 2015!




Three new research projects developed by CPP investigators, with the support of the
Research Committee, will launch in 2015. The investigators will likely be reaching out to
section members for support in the coming months, so look for this opportunity to
collaborate with colleagues across the country and help promote research within our
section.
The committee also continues to support the work of the Critical Care Pharmacotherapy
Trials Network and would like to recognize their recent publication in Critical Care
Medicine, “A Multicenter Study of the Point Prevalence of Drug-Induced Hypotension in
the ICU” by Sandy Kane-Gill and colleagues.
Look for an updated list of grant funding opportunities in the iRoom before SCCM Annual
Congress. The link to “Non-SCCM Funding” allows you to access a list of potential
funding opportunities from multiple extramural sources, including federal funding,
pharmacy foundations, private foundations, and industry.
We continue to receive very positive feedback about the experiences our members have
with the Research Consult Service (available at [email protected]) and
the Peer Pre-Review Service for research proposals, grant submissions, and
manuscripts. Please let us know how we can help with your project, whether with
questions of methodology, analytic techniques, or scientific writing. We can connect you
with individuals in the section who have expertise tailored to your specific subject matter
or need.
If you would like further information about any of these activities or the other services the CPP
Research Committee provides, please contact the chair Erin Frazee ([email protected]) or
chair-elect Mitch Daley ([email protected]).
Pharmacotherapy Article
Use of a loading dose of levetiracetam or not?
Tudy Hodgman, PharmD, BCPS, FCCM
As our understanding of the pathogenesis of seizures has increased, it has become apparent
that the treatment of seizures should be considered emergent. As the duration of seizures is
prolonged, the likelihood of poor outcomes increases dramatically. In view of this, the most
recent practice guidelines for the treatment of status epilepticus (SE) suggest that SE be
defined as 5 minutes or more of (i) continuous clinical and/or electrographic seizure activity or
(ii) recurrent seizure activity without recovery (returning to baseline) between seizures.1
The pharmacotherapy of seizures with the use anti-epileptic drug (AED) therapy is far from
ideal. Numerous issues plague both emergent and long-term treatments. Patsalos2 suggested
a rating system to evaluate AEDs by scoring their characteristics. The ideal factors suggested
are good oral absorption, two or fewer doses per day, linear kinetics, lack of significant hepatic
metabolism (specifically cytochrome P-450 enzyme system or glucuronidation), and lack of
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Dec 2014
substantial drug interactions.3 Interestingly levetiracetam and vigabatrin scored the closest to
“perfect” for an AED.2 Other problems cited with commonly used AEDs include drug withdrawal
upon discontinuation, tolerance, narrow therapeutic index, high plasma protein binding (leading
to drug interactions), and adverse events (cardiovascular depression, bradycardia, hypotension,
and decreased level of consciousness). In the context of these issues compared with other
AEDs, levetiracetam (LEV) offers what some may consider an ideal AED. LEV provides nondose–dependent absorption near 100% with peak serum concentration within 1 hour of oral
ingestion and attainment of steady state within 48 hours. Plasma protein binding is only 10%
with a half-life of 6-8 hours; 66% of the drug is eliminated renally unchanged with the remainder
metabolized to an inactive metabolite which is renally cleared.4 Intravenous (IV) LEV can be
administered rapidly over 15 minutes. Unfortunately no specific serum concentration response
relationship is accepted, though a therapeutic range of 6-20 mcg/mL has been suggested.5
Oral LEV was initially approved in the late 1990s, while the IV formulation was introduced in
2006 with labeling “as an adjunctive therapy, as an alternative when oral administration is
temporarily not feasible, for the treatment of: partial onset seizures in patients ≥1 month of age
with epilepsy, myoclonic seizures in patients ≥12 years of age with juvenile myoclonic epilepsy,
and primary generalized tonic-clonic seizures in patients ≥6 years of age with idiopathic
generalized epilepsy.”6 Although IV LEV has been used increasingly in the treatment of SE as
well as prophylaxis for seizures, LEV is not approved for the treatment of SE.
We know that a loading dose should be administered to quickly achieve a therapeutic
concentration; however, since LEV was not intended for the treatment of SE, the manufacturer
does not recommend a loading dose. Because the use of LEV has expanded into SE and acute
prophylaxis, our pharmacokinetic background would suggest the need to give a loading dose to
achieve a rapid therapeutic concentration. The goal of this paper is to evaluate what data exist
for initiating treatment with an IV loading dose.
Knake et al retrospectively evaluated 18 episodes of focal convulsive and non-convulsive status
epilepticus (NCSE) in patients with liver failure, elevated liver enzymes, those who were on
medications that had drug interactions with other AEDs or who had cardiac arrhythmias.7 The
definition of SE was continuous seizure activity or a series of seizures without return to full
consciousness between seizures lasting ≥30 minutes. All patients initially received a
benzodiazepine before levetiracetam. The mean LEV loading dose (administered over 30
minutes) was 944 mg (SD +/- 396 mg) with mean maintenance of 2166 mg (SD +/- 1280 mg).
Two patients required additional AED to control seizures. No patients experienced adverse
events other than sedation in two patients.7
Gamez-Leyva and colleagues retrospectively evaluated patients with SE who had received
LEV.8 Their SE definition was seizures lasting ≥30 minutes, lack of return to consciousness
between seizures, or SE on electroencephalography (EEG). The median loading dose was
1000 mg and their response rate was 71%. They reported no significant adverse effects with
LEV.8
The recommended loading dose of IV LEV in Thailand is 20-25 mg/kg over 30 minutes, followed
by 20-25 mg/kg maintenance continuous infusion over 24 hours. Thongplew et al9
retrospectively reported LEV use in patients >15 years old in the treatment of SE, defined as a
persistent seizure longer than 5 minutes of either generalized convulsive SE (recurrent
convulsive seizures that may be overt or subtle, symmetric or asymmetric, and associated with
profound coma and bilateral, although often has asymmetric, ictal discharges on EEG) or NCSE
(defined as SE with a change in behavior and/ or mental processes from baseline, associated
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Dec 2014
with continuous epileptiform discharges on EEG, or in response to treatment). They attempted
to identify characteristics between those who were discharged home versus those who died.
“Seizure control” was lack of recurrent seizures with no additional AED. Renal dysfunction was
defined by serum creatinine >1.5 mg/dL. They described 34 treatments with LEV for SE with a
mean loading dose of 1545 mg (SD +/- 1015 mg) and mean maintenance of 1128 mg (SD +/538.53 mg). Control was reported at 61.8%, and patients with worse outcomes had more
comorbidities (median, 3; P=0.036).
Using a 30-minute SE definition and prior AED failure, Moddel and colleagues treated 36 SE
patients with IV LEV.10 Response evaluated by 48 hours was resolved in 69%. Thirty patients
received a bolus of 500 –2000 mg over 30-60 minutes with daily maintenance of 2000-3000 mg.
Efficacy was higher if a bolus was administered compared with continuous infusions without a
bolus (P =0-.002), but with no difference in the loading doses used (500-1000 mg vs 1500-2000
mg; P=0.136).
Ruegg and coworkers retrospectively evaluated SE in 50 patients treated with IV LEV at an
initial dose of 20 mg/kg within 15 minutes of presentation.3 The maintenance dose of 15 mg/kg
BID was started 6 fours after the load, with doses adjusted to renal dysfunction. Intravenous
LEV was used as an add-on or a first-line agent, with efficacy being cessation of SE or
prevention of seizures (if used for therapeutic or prophylactic use). Patients underwent EEG to
exclude NCSE. The success rate was 82% (patient becoming or remaining free of seizures)
during the 7-day observation. Cessation of their presenting seizure occurred in 67% of SE
patients.
Spencer and colleagues characterized pharmacokinetics in 12 neurocritical care patients to
determine what dose regimen would achieve a serum concentration in the 6-20 mcg/mL range.5
All patients received 500 mg IV q12h, with post-dose (fourth or more doses) serum
concentrations at 0.167, 0.25, 0.5, 1, 2, 3, 6, 9,and 12 hours determined by liquid
chromatography and mass spectrometry. Peak serum concentrations were rapidly attained at 1
hour. Kinetic parameters were estimated by compartmental and non-compartments models and
fitted to nonlinear least square regression. Serum concentration time profiles were simulated at
various dosing regimens (all infused over 15 minutes). The mean dose was 5.8 +/- 1.3 mg/kg
(using total body weight) with a range of 4.4-9.5 mg/kg/dose. Based upon the Monte Carlo
simulations done, regimens of 1000 mg every 8 hours or 1500-2000 mg q12h provided the
highest probability (57.1%) of achieving a trough concentration >6 and <20 mcg/mL. They
noted significantly shorter half-life and increased clearance in their patient population of critical
care patients.
An open-label trial tried to evaluate IV LEV as first line therapy for SE (≥30 minutes without
consciousness recovered) in the elderly population. Fattouch et al looked at 9 patients with a
mean age of 76 years (65-91 years) who had concurrent medical diseases which precluded the
use of the “older” AED.11 Patients received a loading dose of 1500 mg (mean, 20 mg/kg) over
15 minutes, followed by an infusion of 2500 mg over 24 hours with at least 2 hours of video
EEG monitoring. Epileptic activity disappeared in 7 of 8 patients or was reduced in 1 of 8
within 15-30 minutes. One patient had no response.
Using a definition of SE of ≥5 minutes seizing or two or more seizures without return to
consciousness, Uges et al performed a prospective single-center open-label evaluation of a
single dose of IV LEV 2500 mg IV over 5 minutes as second-line therapy in 12 patients with
any type SE who received a benzodiazepine first.12 The median time to administration was 36
minutes (15-90 minutes) with a median seizure duration of 60 minutes (10-240 minutes). Serum
Volume 14 Issue 4
Dec 2014
concentrations were collected at 1, 5, and 20 hours post-dose with a measured peak serum
concentration of 76 mg/L (SD +/-17 mg/dL).
Berning and coworkers retrospectively assessed 27 patients with SE (convulsive seizures >5
minutes, recurrent seizures without regaining consciousness or partial seizures 20-30 minutes
in duration) who received IV LEV.13 Response was cessation of neurologic exam changes or
EEG. Patients were divided into four groups based on treatment prior to LEV (group I: none;
group II: low- to medium-dose benzodiazepine [ lorazepam 1-2 mg IV + no other AED]; group
III: lorazepam ≥3 mg without any additional AED; group IV: extensive treatment including
general anesthesia); 69% of patients received a medium to high dose prior to LEV. The time to
any treatment ranged from 6 minutes to 72 hours (median, 3 hours) with a median time to LEV
of 6 hours (range, 0.3-96 hours). The median bolus was 2000 mg (range, 1000-3000) over 1030 minutes. The median dose in first 24 hours was 3500 mg (1000-6000 mg). SE termination
rate was 94% with median time of 10 hours (0.5 hours – 21 days). In 15 patients, SE was
stopped within 6 hours after LEV, in 10 patients within 30 min. There was no change in
morbidity at discharge.
A randomized open-label pilot study of 79 patients (ages 1-75 years) with convulsive or subtle
convulsive SE (>5 minutes) was conducted by Misra et al.14 Those with NCSE were excluded.
Patients were randomized to IV lorazepam (0.1 mg/kg) over 2-4 minutes or LEV 20 mg/kg over
15 minutes to achieve an endpoint of cessation within 30 minutes. If seizures continued >10
minutes, patients were crossed over to the alternative therapy. The agents were equally
effective as first choice (LEV 76.3% vs. lorazepam 75.6%; P=1)or second choice (88.9% vs.
70%, P=1). The lorazepam group had more hypotension and need for mechanical ventilation
(p=0.03), but there was no difference in mortality.
In work by Aiguabella et al,15 results in 40 SE patients suggested that efficacy is based upon the
timing of the LEV. When LEV was used as add-on therapy, 57% patient responded in a mean
of 14 hours, whereas efficacy was 78.5% with early treatment in 14 patients. They concluded
that IV LEV may be effective as a first-line agent and that refractory SE is more difficult to treat.
In a prospective, open-label single-center study of patients with generalized epilepsy or partial
seizures already on one AED, Wheless and coworkers16 gave groups of 15 patients each a
loading dose of 20, 40, and 60 mg/kg (with maximum doses of 1, 2, and 3 g, respectively) over
5-6 minutes. The mean doses were 26.1 and 51.3 mg/kg in the 5- and 6-minute infusion
groups, respectively. The authors monitored subjects with electrocardiography and safety
assessments during the infusion. Serum concentrations post-infusion ranged from 14 to 189
mcg/mL without significant adverse events reported.
There are many issues with interpretation of these studies. Most are retrospective
nonrandomized, nonblinded, and have very small sample size. Some studies did not include
seizure type, objective measure of seizure resolution (e.g., EEG; therefore, they may have
missed NCSE), different underlying etiologies (some modifiable, some not), concurrent AED
with unknown serum concentrations, the indication for IV LEV, serum LEV concentrations, renal
function, hepatic function, weight, termination of seizures based upon first documented
cessation, selection bias, and lack of continuous EEG monitoring. Because the therapeutic
range for LEV is not defined, it would be difficult to routinely suggest a loading dose. However,
knowing that seizure duration is associated with both increased morbidity and mortality, and
coupled with the realization that rapid IV LEV is without significant adverse events, the benefit of
giving a “loading” dose outweighs the potential risks. This postulate should be tested in a formal
manner with a randomized, multicenter blinded trial.
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Dec 2014
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of
status epilepticus. Neurocrit Care. 2012;17:3-23.
Patsalos PN. Pharmacokinetic profile of levetiracetam: toward ideal characteristics.
Pharmacol Ther. 2000;85:77-85.
Ruegg S, Naegelin Y, Hardmeier M, et al. Intravenous levetiracetam: treatment
experience with the first 50 critically ill patients. Epilepsy Behav. 2008;12:477-480.
Radtke RA. Pharmacokinetics of levetiracetam. Epilepsia. 2001;42(suppl 4):24-27.
Spencer DD, Jacobi J, Juenke JM, et al. Steady-state pharmacokinetics of intravenous
levetiracetam in neurocritical care patients. Pharmacotherapy. 2011;31:934-941.
UCB, Inc. Keppra® injection package insert. © 2014. Smyrna, GA: UCB, Inc.
Knake S, Gruener J, Hattemer K, et al. Intravenous levetiracetam in the treatment of
benzodiazepine refractory status epilepticus. J Neurol Neurosurg Psychiatry.
2008;79(5):588-589.
Gamez-Leyva G, Aristin JL, Fernandez E, Pascual J. Experience with intravenous
levetiracetam in status epilepticus. CNS Drugs. 2009;23(11):983-987.
Thongplew S, Chawsamtong S, Sawanyawisuth K, Tiamkao S. Intravenous levetiracetam
treatment in Thai adults with status epilepticus. Neurol Asia. 2013;18(20):167-175.
Moddel G, Bunten S, Dobis C, et al. Intravenous levetiracetam: a new treatment alternative
for refractory status epilepticus. J Neurol Neurosurg Psychiatry. 2009;80:689-692.
Fattouch J, DiBonaventura C, Casciato S, et al. Intravenous levetiracetam as first line
treatment of status epilepticus in the elderly. Acta Neurol Scand. 2010;121:418-421.
Uges JWF, van Huizen MD, Engelsman J, et al. Safety and pharmacokinetics of
intravenous levetiracetam infusion as add-on in status epilepticus. Epilespsia.
2009;50(3):415-421.
Berning S, Boesbeck F, van Baalen A, Kellinghous C. Intravenous levetiracetam as
treatment for status epilepticus. J Neurol. 2009;256(10):1634-1642.
Misra UK, Kalita J, Maurya PK. Levetiracetam versus lorazepam in status epilepticus: a
randomized, open labeled pilot study. J Neurol. 2013;259:645-648.
Aiguabella M, Falpi M, Villanueva V, et al. Efficacy of intravenous levetiracetam as add-on
treatment in status epilepticus: a multicentric observational study. Seizure. 2011;20(1):6064.
Wheless JW, Clarke D, Hovinga CA, et al. Rapid infusion of a loading dose of
intravenous levetiracetam with minimal dilution: a safety study. J Child Neurol. 2009;24(8):
946-951.
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Dec 2014
Member Spotlight
By John Hammer, PharmD, MBA, BCPS
Said “Moo” Sultan, PharmD, BCPS
(Pharmacy Clinical Specialist in Critical Care)
Said “Moo” Sultan, PharmD, BCPS, is a pharmacy clinical
specialist in critical care at University of North Carolina (UNC)
Healthcare. Dr. Sultan earned his Doctor of Pharmacy degree at
Virginia Commonwealth University – Medical College of Virginia in
Richmond. He completed his PGY1 and PGY2 critical care
specialty residencies at UNC Medical Center. After completion of
his residency, Dr. Sultan was a clinical team leader in the medical
ICU at Carolinas Medical Center for 2 years, before returning to
UNC Medical Center. He currently practices in the NC Jaycee
Burn Center located at UNC Medical Center. Dr. Sultan also
holds an appointment as Adjunct Assistant Professor in Clinical
Education at UNC Eshelman School of Pharmacy.
Dr. Sultan enjoys being involved in the growth of the profession and the development of the next
generation of pharmacists. He has served as education coordinator for the UNC Medical
Center Pharmacy Residencies and is currently the PGY1 Pharmacy Practice Program
Coordinator. Dr. Sultan has been actively involved with the development of the Research in
Education and Practice Symposium. In its inaugural year, this symposium offered pharmacy
residents and fellows across North Carolina a venue to present and receive feedback on their
research projects. In the second year of this meeting, the symposium looks to expand and
include participants from across the region.
Dr. Sultan is an active member of the Society of Critical Care Medicine (SCCM). He is the
current chair of the Clinical Pharmacy and Pharmacology (CPP) Program Committee and a
member of the SCCM Drug Shortage Task Force. While on the Program Committee, he has
submitted topics and presented the Year in Review: Clinical Pharmacy and Pharmacology
session at the SCCM Critical Care Congress. He has also assisted with preparing speaker
guidance documents and developing a process for assigning previous presenters as mentors
for the subsequent Year in Review session. In addition he has assumed leadership roles within
the SCCM Carolinas Virginias Chapter serving as the current chapter secretary and, before that,
on the Board of Directors. Dr. Sultan is also involved with the American College of Clinical
Pharmacy (ACCP) as a member of the Critical Care PRN Communications and Recognition
Committees. I asked Dr. Sultan if he had any advice for those looking to become more active in
professional organizations, including SCCM. He replied that showing interest by volunteering for
committees and assignments is important. Asking to work on additional initiatives after
completing tasks can be an effective way to demonstrate persistence and a desire to be
involved. He has found that taking an active membership role within a committee or
organization is an essential first step in transitioning to a leadership role. Dr. Sultan also
discussed the value of having mentors and seeking advice from those with more experience.
He believes the mentorship and advice he received has contributed greatly to both his desire to
be involved and his progression into leadership roles within SCCM and other professional
organizations.
In his free time Dr. Sultan likes CrossFit workouts and running; he is currently preparing for his
eighth half marathon.
Volume 14 Issue 4
CPP-Specific Itinerary at Congress
Saturday, January 17
CPP Section Strategic Planning Committee Meeting
8:00 am to 1:00 pm
Room: Ahwatukee A - Sheraton Phoenix Downtown
CPP Section Pre-Congress Symposium
2:00 pm to 4:00 pm
Room: Encanto A - Sheraton Phoenix Downtown
CPP Section New Members and First Congress Attendees Orientation
5:00 pm to 6:00 pm
Room: Encanto A - Sheraton Phoenix Downtown
CPP Section Reception
7:00 pm to 10:00 pm
Room: Valley of the Sun C - Sheraton Phoenix Downtown
Sunday, January 18
CPP Section Recruitment Exchange Meeting
10:00 am to 11:00 am
Room: 103 - Phoenix Convention Center
CPP Section Business Meeting
11:00 am to 12:30 pm
Room: 132 - Phoenix Convention Center
CPP Section Communications Committee Meeting
12:30 pm to 1:30 pm
Room: 127B - Phoenix Convention Center
CPP Section Program Committee Meeting
2:45 pm to 3:45 pm
Room: 223 - Phoenix Convention Center
Monday, January 19
CPP Section Education Committee Meeting
9:00 am to 1:00 pm: Room: 127B - Phoenix Convention Center
CPP Section Patient Safety Committee Meeting
10:00 am to 11:00 am: Room: 128A - Phoenix Convention Center
CPP Section Research Committee Meeting
11:00 am to 12:00 pm: Room: 128 - Phoenix Convention Center
CPP Section Membership Committee Meeting
12:00 pm to 1:00 pm: Room: 127C - Phoenix Convention Center
Dec 2014
Volume 14 Issue 4
Dec 2014
44th Critical Care Congress
Clinical Pharmacy and Pharmacology Section Meeting Guide
January 17-21, 2015
**Please check the Program and Exhibition guide at Congress for locations and the most up-to-date schedule**
Friday, January 16, 2015 (Pre-Congress Education Session)
8:00 am - 5:00 pm
Current Concepts in Adult Critical Care
9:30 am - 10:15 am ICU Pharmacology in Special Populations
Saturday, January 17, 2015 (Pre-Congress Education Session)
8:00 am - 5:00 pm
Critical Care Pharmacotherapy:
Challenges and Controversies
8:00 am – 8:45 pm
Management of Neuroemergencies: What’s
Changed in the Last 10 Years?
Pain, Agitation and Delirium: Beyond the
Guidelines
Novel Antidotes for the Poisoned ICU Patient
8:45 am – 9:15 am
9:15 am – 10:15
am
10:30 am – 11:15
am
11:15 am – 12:00
pm
1:00 pm – 1:45 pm
1:45 pm – 2:15 pm
Brian L. Erstad, PharmD, BCPS, MCCM
Co-Moderators: John Papadopoulos,
PharmD, BCNSP, FCCM; Jeffrey Barletta,
PharmD, FCCM
Denise H. Rhoney, PharmD, FCCM, FNCS
John W. Devlin, PharmD, FCCM
John Papadopoulos, PharmD, BCNSP, FCCM
Challenges with Drug Therapy During
Therapeutic Hypothermia
Strategies for Drug Therapy During
Extracorporeal Membrane Oxygenation
How I Manage Excessive Anticoagulation
Managing Medication Therapy When the Liver
Is Failing
2:30 pm – 3:15 pm
Protecting the Tenuous Kidney
3:30 pm – 4:15 pm
The Future of Antimicrobial Therapy in the
Critically Il
4:15 pm – 5:00 pm
The Use of Biomarkers in the Care of the
Critically Ill Patient
Sunday, January 18, 2015
Diana Esaian, PharmD, BCPS
10:30 am – 12:30
pm
New Antimicrobial Utilization Strategies in
the ICU
One Is Good, But Is Two Better?
Inhaled Antimicrobials
Antimicrobial Stewardship in the ICU
10:30 am – 12:30
Systems Biology in Critical Illness and
pm
Injury: From Mechanistic Insights to Drug
Discovery
Quantitative Lipidomics in Aneurysmal
Subarachnoid Hemorrhage
Monday, January 19, 2015
Moderator: John Papadopoulos, PharmD,
BCNSP, FCCM
Douglas N. Fish, PharmD, BCPS, FCCM
G. Christopher Wood, PharmD, FCCM, FCCP
Elizabeth Coyle, PharmD, BCPS, FCCM
10:00 am - 12:00
pm
Moderator: William E. Dager, PharmD, BCPS,
FCCM
William E. Dager, PharmD, BCPS, FCCM
10:00 am - 12:00
pm
Soup-to-Nuts Renal Failure: Caring for the
Patient with Kidney Injury
Pharmacotherapy in Acute Kidney Injury
Enhancing the Quality and Safety of Care
for Older Adults with Critical Illness
Reducing Adverse Drug Events in Critically Ill
Older Adults
Amy L. Dzierba, PharmD, BCPS, FCCM
William E. Dager, PharmD, BCPS, FCCM
Tyree H. Kiser, PharmD, BCPS, FCCM
Michael L. Bentley, PharmD, FCCM
Jeffrey Barletta, PharmD, FCCM
Steven E. Pass, PharmD, BCPS, FCCM
Samuel M. Poloyac, PharmD, PhD, FCCM
John W. Devlin, PharmD, FCCM
Volume 14 Issue 4
Dec 2014
3:15 pm – 4:15 pm
Glucose Control in the Critically Ill: Still
Relevant After All These Years?
Hyperglycemia: Stress and Iatrogenesis;
What Do I Do?
3:15 pm – 4:15 pm The Hangover, Part IV: Dealing with
Alcohol Withdrawal and Recreational
Drugs
Management of Alcohol Withdrawal: Benzos
or Beer?
Management of Club Drug Overdoses
Management of Opioid Intoxication
4:30 pm – 5:30 pm Year in Review: Clinical Pharmacy and
Pharmacology
Burns
Resuscitation for Shock Syndrome
Infectious Disease in the ICU
4:30 pm – 5:30 pm Your Patient Is Positive for Clostridium
difficile: “Oh Feces!”
Treatment of C. difficile: Is There More Than
Vancomycin and Metronidazole?
4:30 pm – 5:30 pm Pro/Con Debate: Is a Short Duration of
Antimicrobial Therapy Appropriate for
Ventilator-Associated Pneumonia?
A Short Duration of Therapy Is Appropriate
Tuesday, January 20, 2015
8:15 am – 9:00 am
(Plenary Session)
10:00 am – 12:00
pm
3:15 pm – 4:15 pm
3:15 pm – 4:15 pm
4:30 pm – 5:30 pm
Drug Shortages: Economic Explanation of
Manufacturing Failure and Buying
Monopolies
Short or Tall, Broad or Narrow? Balancing
Appropriate Sepsis Coverage with
Immunologic Function
Antibiotics in Sepsis: The Good, The Bad and
What Might Be Really Bad
Reconciling Immune Status and Antibiotics:
Making Practical Choices in the Critically Ill
Drug Dosing in Challenging ICU
Populations
The Geriatric Patient
The Morbidly Obese Patient
Acute Kidney Injury, CRRT, SLED
Drug-Induced Gastrointestinal Disease
Drug-Induced Diarrhea
Drug-Induced Constipation
Improving Medication Safety Strategies in
the ICU
Maximizing Adverse Drug Event Surveillance
with Automation
Making Clinical Decision Support Work for
You
Med Rec or Med Wreck? Multidisciplinary
Solutions on Getting It Done
Prasad E. Abraham, PharmD
Moderator: John Papadopoulos, PharmD,
BCNSP, FCCM
Amy L. Dzierba, PharmD, BCPS, FCCM
Asad E. Patanwala, PharmD
Jerry Altshuler, PharmD, BCPS
Moderator: Karen McAllen, PharmD, FCCM
Claire V. Murphy, PharmD
Jeremiah J. Duby, PharmD, BCPS
Kathryn R. Matthias, PharmD, BCPS, AQ-ID
Moderator: Jeffrey Barletta, PharmD, FCCM
Scott Bolesta, PharmD, BCPS, FCCM
Moderator: Elizabeth Coyle, BCPS, FCCM
Keith M. Olsen, PharmD, FCCM
Margaret Dempsey Clapp, RPH, MS, MDiv
Tyree H. Kiser, PharmD, BCPS, FCCM
Keith M. Olsen, PharmD, FCCM
Moderator: Michael L. Bentley, PharmD,
FCCM
Brad E. Cooper, PharmD, FCCM
Jeffrey Barletta, PharmD, FCCM
Michael L. Bentley, PharmD, FCCM
Moderator: John Papadopoulos, PharmD,
BCNSP, FCCM
Diana Esaian, PharmD, BCPS
Pamela L. Smithburger, PharmD, MS, BCPS
Moderator: Sandra L. Kane-Gill, PharmD,
MS, FCCM
Sandra L. Kane-Gill, PharmD, MS, FCCM
Pamela L. Smithburger, PharmD, MS, BCPS
Mitchell S. Buckley, PharmD, BCPS, FCCM
Volume 14 Issue 4
Dec 2014
4:30 pm – 5:30 pm
Medication Management in the
Neuroscience ICU
Seizure Prophylaxis: Still Necessary?
Coagulation Reversal in Neurological Patients
4:30 pm – 5:30 pm Hot Topics in Nutrition
What Is the Value of Using “Trophic Feeds” in
a Critically Ill Patient?
Wednesday, January 21, 2014
9:30 am – 11:30
am
9:30 am – 11:30
am
9:30 am – 11:30
am
Why Is My Platelet Count Dropping?
Evaluation of the Patient with
Thrombocytopenia
HIT in the Grey Zone: How to Manage the
Patient with an Uncertain Diagnosis
ICU Team: Show Me the Money
The Clinical Pharmacist Perspective
Geriatrics in the ICU: Old, New, Black and
Blue
Polypharmacy in the Geriatric ICU Patient
Amber Castle, PharmD, BCPS
John J. Lewin III, PharmD, MBA
John Papadopoulos, PharmD, BCNSP, FCCM
William E. Dager, PharmD, BCPS, FCCM
Lance J. Oyen, PharmD, BCPS, FCCM
Pamela L. Smithburger, PharmD, MS, BCPS
Volume 14 Issue 4
Dec 2014
Clinical Pharmacy and Pharmacology Section Member Abstracts
2015 SCCM Congress
Abstract
Number
1
2
3
4
18
20
23
28
32
117
126
141
151
152
178
179
190
191
194
200
247
250
263
280
Title
Correlation of CHADS2 with New Onset Atrial Fibrillation in Thoracic
and Vascular Surgical Patients
Fluid Overload Costs in Cardiovascular Patients: Are Small Volume
Infusions a Proactive Solution?
Mortality risk factors with carbapenem-resistant bacteremia: Impact of
combination therapy
RCT of Chlorhexidine vs. Soap & Water Bathing for Prevention of
Hospital-Acquired Infections in SICU
ADR surveillance using a multicenter clinical database: Propofol related
infusion syndrome incidence
Heterogeneous treatment effect of red blood cell transfusion (RBCT) in
the critically ill patients
The obesity paradox is not observed in critically ill patients on early
enteral nutrition
Platelet Dysfunction on Thromboelastogram Is Associated with
Increased Mortality in Head Trauma
Giving your patients M.O.R.E: Implementing of a non-pharmacologic
protocol to prevent ICU delirium
Impact of macrolide antibiotics on outcomes in ICU patients with acute
exacerbations of COPD
Glycemic variability with temperature changes during therapeutic
hypothermia after cardiac arrest
Effect of Delirium Motoric Subtypes on ICD-9 Documentation of
Delirium in the Intensive Care Unit
Impact of computerized physician order entry on sedation depth and
related outcomes in the ICU
Evaluation of SAS-Based Symptom-Triggered Treatment of Alcohol
Withdrawal in Critically Ill Patients
Continuation of Amiodarone at Discharge for New-Onset Atrial
Fibrillation in Critically Ill Patients
Efficacy of Chemical Pleurodesis with Doxycycline for Chylous Pleural
Effusion after Cardiac Surgery
Short-course of ranolazine prevents post-operative atrial fibrillation
following cardiac surgeries
Effect of dexmedetomidine on postoperative tachyarrhythmias after
valvular surgery
Risk Factors for Dexmedetomidine-associated Hemodynamic Instability
in Non-cardiac ICU Patients
Evaluation of pulmonary vasodilators in pediatric congenital
cardiovascular care
Seizure incidence in therapeutic hypothermia patients post cardiac
arrest
Evaluation of a Therapeutic Hypothermia Protocol at a Community
Hospital in Alabama
Impact of induced hypothermia on cardiac arrest survival and
associated initial rhythm
External versus Internal Cooling for Therapeutic Hypothermia: Does the
method matter?
Authors
Kirstin J. Kooda
Debra Child
Stephanie Bass, Seth R.
Bauer, Simon W. Lam
Joshua T. Swan
Ashleigh Lowery, Omar
Badawi, Erkan Hassan
Omar Badawi
Kimberley A. Harris, Omar
Badawi, Erkan Hassan
Mitchell J. Daley
Pamela L. Smithburger, Ryan
Rivosecchi
Tyree H. Kiser
Krystal K. Haase
Joshua T. Swan
Joel Feih, William J. Peppard
Phil Grgurich
Robert Nietupski
Jeffrey J. Cies
Drayton A. Hammond
Mona K. Patel, Daryl Glick
Calvin J. Ice
Caitlin M. Aberle
Ruchi Patel
Christen A. Freeman
Lesly Jurado
Harminder Sikand
Volume 14 Issue 4
282
289
294
308
336
340
343
348
349
356
360
362
371
410
416
423
426
429
430
431
435
436
437
438
439
441
442
443
Anti-Shivering Medication Requirements in Therapeutic Normothermia:
Surface vs. Endovascular Cooling
Efficacy of a Streamlined Education Program for Nursing Transition into
Critical Care Areas
Implementation and expansion of an online critical care pharmacy
journal club
Reinforcing ABCDE Bundle Concepts through Interprofessional
Simulation and Team STEPPS Training
Evaluation of glucose management software in critically ill patients with
hyperglycemic crises
Increasing weight-based dosing of insulin is associated with
hypoglycemia in critically ill patients
Efficacy and safety of insulin glargine versus insulin infusions in
intensive care unit patients
Efficacy of a nurse-driven, electronic, diabetic ketoacidosis protocol – A
comparative analysis
Evaluation of hypoglycemia with 2 different insulin protocols in the
neuro intensive care unit (NICU)
All-terrain Vehicle Accidents: Nine Years of Experience at a Level 1
Trauma Center
Long-term intensive care unit (ICU) outcome trends among a
nationwide cohort of tele-ICU patients
Characteristics and outcomes of cancer patients admitted to the
intensive care unit: a 5-year study
The Incidence of Ventilator-associated Pneumonia in the United States
from 2008 to 2011
Proton pump inhibitors and the risk for hospital-acquired Clostridium
difficile in ICU patients
Evaluation of the use of steroids in cirrhotic patients with shock
Use of PCC in patients with variceal bleeding requiring massive
transfusion
Impact of a stress ulcer prophylaxis guideline and education on acid
suppressive therapy in the ICU
Evaluation of Rifaximin Therapy for Hepatic Encephalopathy in the
Medical Intensive Care Unit
The Economic Impact of a Stress Ulcer Prophylaxis Pharmacy Program
Targeting Inappropriate Therapy
Efficacy and Safety of 4-Factor Prothrombin Complex Concentrate in
Patients with Liver Disease
Evaluation of IgG versus IgG/IgM/IgA PF4 ELISA for diagnosis of HIT
and argatroban usage
Prothrombin complex concentrate plus low-dose factor VIIa for bleeding
and reversal of coagulopathy
A Comparison of INR Reversal Between 4-Factor and 3-Factor
Prothrombin Complex Concentrates
Prospective evaluation of a bivalirudin dosing nomogram for heparininduced thrombocytopenia
Thrombocytopenia Associated with Continuous Renal Replacement
Therapy in Critically Ill Patients
Safety and effectiveness of 3- vs 4-factor PCC in patients requiring
emergent warfarin reversal
Consequences of Treating False Positive Heparin-Induced
Thrombocytopenia
Evaluation of Heparin Resistance in Patients Outside of the Operating
Room
Dec 2014
Andrew B. Kirk, Cara
McDaniel
Maresa D. Glass
Karen Berger, Aimee
Christine LeClaire
Cara McDaniel
Kevin T. Ferguson, Maresa
D. Glass
John J. Radosevich
Christina M. Rose
Marybeth Boudreau
Brittany Pelsue
John A. Bethea
Omar Badawi, Erkan Hassan
Lama Nazer
Bryan D Lizza
Jeffrey F. Barletta
Kevin R. Donahue
Cassandra Baker
Deepali Dixit
Ittiporn Chuatrisorn
Jeffrey F. Barletta, Mitchell
Buckley
William Cang, Wan-Ting
Huang
Kevin T. Ferguson, Maresa
D. Glass
Mark Anthony Baje
William Cang
Wes Zemrak, Kathryn E.
Smith
Jason Ferreira
Stacy Alan Voils
Jacob Marler
Scott D. Nei
Volume 14 Issue 4
448
449
459
460
461
463
464
465
Evaluation of epoetin alfa for prevention of blood transfusions in a
pediatric intensive care unit
Obesity and Risk of Thromboembolism in Critically Ill Medical Patients
Receiving Chemoprophylaxis
Dose-adjusted enoxaparin for venous thromboembolism prophylaxis in
trauma patients
Elevated risk of thomboembolic events after novel anticoagulation
reversal protocol
Four Factor Prothrombin Complex Concentrate: One Year Experience
Evaluation of the use of novel oral anticoagulants in a medical intensive
care unit
Venous thromboembolism prophylaxis in patients post liver transplant
Heparin induced thrombocytopenia in extracorporeal life support: a
systematic review of argatroban
468
High-dose versus standard dose oseltamivir for treatment of severe
influenza in adult ICU patients
469
Impact of antibiotic setting of procalcitonin ordering on provider actions
in medical intensive care
476
479
481
484
490
494
500
501
505
507
Colistin: The safety and efficacy of a loading dose, high dose
maintenance regimen
MRSA-coverage de-escalation practices in patients with ventilatorassociated pneumonia
Evaluation of Procalcitonin Utilization in Septic Patients in an Academic
Intensive Care Unit
Characteristics and outcomes of critically ill cancer patients infected
with Acinetobacter baumannii
Impact of the Joint Commission pneumonia core measures on antibiotic
use in the Emergency Department
Providers' perceptions of an antimicrobial stewardship program at an
academic institution
Management of Staphylococcus aureus bacteremia through pharmacist
prospective evaluation
A Community Hospital's Experience with Procalcitonin: Reduction in the
Use of Antibiotics
Clinical pharmacist interventions with procalcitonin while performing
antibiotic stewardship
Efficacy of Extended-Infusion Cefepime and Meropenem in Trauma
and Burn Intensive Care Unit Patients
508
Influence of Colistin Dose on Global Cure in Patients with GramNegative Bacteremia
512
Factors influencing antibiotic actions after procalcitonin result: a case
control study.
514
516
524
530
550
Management of severe, resistant alcohol withdrawal with or without the
addition of propofol
ABCG2 rs2231142 c.421C>A is Associated with Outcomes Following
Severe Traumatic Brain Injury
Factors associated with elevated vancomycin dosing in neurocritical
care patients
Quantitative imaging biomarkers of brain edema after 23% saline in
liver failure
Can Adjusted Phenytoin Concentration Accurately Predict Free
Dec 2014
Cindy Zoeller
Gabriel Fontaine
Janise B. Phillips
Cassie A. Barton
Matthew J. Korobey
Julie Kalabalik
Mona K. Patel
Zachary R. Smith
Stephanie Bass, Sarah
Welch, Seth R. Bauer, Simon
W. Lam
Stephanie Bass, Abdalla
Ammar, Seth R. Bauer,
Simon W. Lam
Jessica Elefritz
Anthony Jaworski
Megan Austin
Lama Nazer
Marilyn N. Bulloch
Vanessa M. Gleason
Sarah Klemm
Martha J. Roberts
Gourang P. Patel
Christina Wong
Stephanie Bass, Gabrielle A.
Gibson, Seth R. Bauer,
Simon W. Lam
Stephanie Bass, Abdalla
Ammar, Seth R. Bauer,
Simon W. Lam
Adrian Wong
Solomon M Adams
Kimberley A. Harris
Bryan D. Lizza
Brittany Kaufman, Jeffrey F.
Volume 14 Issue 4
553
554
559
560
565
571
585
587
590
592
594
597
598
617
619
620
622
624
626
629
630
631
632
634
635
636
637
Concentration?
Treatment with Hypertonic Saline Alternating with Mannitol in
Neurologic Emergencies
The Impact of Emergency Room Sedation on ICU Outcomes
A PCC-based reversal protocol is associated with reduced mortality in
warfarin-associated ICH
IV Acetaminophen Use and Associated Outcomes in Neurocritical Care
Patients
Optimization of clopidogrel loading dose in patients undergoing carotid
stent placement
Safety profile of desmopressin in patients with acute intracranial
hemorrhage
Evaluating the transition from dexmedetomidine to clonidine for PAD
management in the ICU
Delirium in mechanically-ventilated intensive care patients: effect of
sedation and risk factors
Evaluation of an ICU pain, agitation and delirium protocol in a large
academic health system
Sedation variability increases incidence of delirium in adult medical
intensive care unit patients
Supplemental Melatonin and Delirium in the Intensive Care Unit: A
Retrospective Study
Evaluation of the effectiveness of training for the CAM-ICU assessment
by the nurses in the ICU
Physician Order Entry Implementation Effects on Sedation/Analgesia
Assessment in Surgical Trauma ICU
Pharmacokinetics (PK) of Daptomycin (DAP) in Critically Ill Trauma
Patients
Proton Pump Inhibitors versus Histamine-2 receptors Blockers in
Preventing Gastrointestinal Bleeding
Antipsychotic Prescribing Patterns During and After Critical Illness in a
Tertiary Medical Center
Does QTc prolongation occur after initiation of haloperidol or quetiapine
in the critically ill?
Prevalence and Factors Associated with Absence of Venous
Thromboembolism Prophylaxis
Pharmacokinetic analysis of once-daily vancomycin dosing during
continuous renal replacement therapy
Evaluation of liposomal bupivacaine for pain management after total
knee arthroplasty
Assessing bleeding associated with combined use of SSRI and dual
antiplatelet therapy
Methylnaltrexone versus Naloxone for Opioid-Induced Constipation in
the Medical Intensive Care Unit
Pharmacologic control of subarachnoid hemorrhage headache:
Analysis of pain intensity difference
Implications of Atypical Antipsychotic Prescribing in the Intensive Care
Unit
Continuous Infusion Vancomycin via Instillation of Vancomycin into the
Dialysate Solution
Hemodynamic Disturbances in Emergent Rapid Sequence Intubation
Using Propofol or Etomidate
Assessment of medication associated hypotension requiring
intervention in the PICU
Dec 2014
Barletta, Mitchell Buckley
Nicole M. Grimmer
Michael Samarin
Wes Zemrak, Kathryn E.
Smith
Gretchen M. Brophy
Ginger Gamble
Karen Berger
Kimberly Terry
Marian Gaviola
Prasad E. Abraham
Heather Torbic
Jennifer Cole
Ruchi Patel
Lesly Jurado
Prasad E. Abraham
Omar Badawi, Mohammad
Aljawadi
Joanna L. Stollings
Michelle Horng
Prasad E. Abraham
Meghann Luc, Megan Austin,
William J. Peppard
Justin Kaplan, Zachariah
Thomas
Kayla Giang
Cristian Merchan
Elizabeth K. Glisic
Bridgette L. Kram
Jeffrey J. Cies
Bryan D Lizza, Rhynn Malloy
Mary Riedy, Kelli Crowley,
Sandra Kane-Gill, Rajesh
Aneja, Carol Vetterly
Volume 14 Issue 4
638
639
640
641
643
644
645
646
648
649
650
654
655
656
657
680
693
702
Evaluation of the use of ketamine for acute pain in the emergency
department
Clinical outcomes of adjunctive ketamine for managing alcohol
withdrawal syndrome
Comparison of continuous infusions of midazolam and pentobarbital for
refractory status epilepticus
Comparison of Two Guideline Based Pain and Agitation Protocols in
Mechanically Ventilated Patients
Pharmacoeconomic Analysis of Inhaled Epoprostenol vs Nitric Oxide
for Severe, Refractory ARDS
Thiocyanate accumulation in critically ill patients receiving nitroprusside
infusions
Continuation of Quetiapine Therapy at Transitions of Care in an
Academic ICU
A multicenter evaluation of evidence supporting ICU off-label
medication use
Efficacy of Redosing Prophylactic Antibiotics for Prolonged Surgeries
Population Pharmacokinetics of Meropenem in a Pediatric ICU
Population
Retrospective evaluation of dexmedetomidine to facilitate mechanical
ventilation extubation
Transition from Dexmedetomidine to Enteral Clonidine for ICU
Sedation: A Pilot Study
Extended interval fondaparinux for VTE prophylaxis in critically ill
patients with renal failure
Rise and Shine: Using a standardized sedation orderset to promote
ABCDE compliance
Risk Factors for Adverse Hemodynamic Effects with Dexmedetomidine
Risk Factors for Death from Ventilator-Associated Pneumonia in the
United States from 2008-2011
Inhaled Nitric Oxide versus Inhaled Epoprostenol for the Acute
Management of Pulmonary Hypertension
Angiotensin-Converting Enzyme Inhibitor (ACEI) Induced Angioedema
in the Intensive Care Unit (ICU)
713
Comparison of Inhaled Epoprostenol to Inhaled Nitric Oxide: A Noninferiority Study
733
Cisatracurium for Acute Respiratory Distress Syndrome: Patterns of
Utilization
742
Sildenafil for Acute Pulmonary Hypertension after Cardiac Surgery
743
745
759
768
770
774
818
Effect of extracorporeal membrane oxygenation use on sedative
requirements during severe ARDS
Assessment of a Sedation Titration Protocol for Patients Receiving
Mechanical Ventilation
Inhaled Flolan versus inhaled Veletri for refractory hypoxemia in
critically ill patients
Evaluation of Four Factor Prothrombin Concentrate Complex (PCC)
Usage and Safety at a Tertiary Care
Stress Ulcer Prophylaxis utilization and overutilization in Intensive Care
Units from 2008 to 2012
Clinical Outcomes of Neurocritical Care Patients Following a Bed
Triage Workflow
Optimization of intelligent infusion pump technology to minimize
vasopressor pump programing errors
Dec 2014
Nahal Beik
Adrian Wong
Melissa Chudow, Maresa D.
Glass, Melissa Giarratano
Vishal Ooka
Jennifer Wiedmar
Amanda Morris, Tyree H.
Kiser
Gregory J. Peitz, Michael
Samarin
Pamela L. Smithburger,
Mitchell Buckley
Jeffrey A. Endicott
Jeffrey J. Cies
Nicholas Peters
Elizabeth K. Glisic, David J.
Gagnon
Krista A. Wahby
Ashleigh Lowery
Ahmed A. Mahmoud
Bryan D Lizza
Jessica George
Scott A. Chapman
Stephanie Bass, Mahmoud A.
Ammar, Seth R. Bauer,
Simon W. Lam
Andrew B. Kirk, Cara
McDaniel
Justin J. Roth, Stacy Alan
Voils
Caroline Der-Nigoghossian
Serena Ann Harris
Heather Torbic
Rebecca L. Anderson,
Jennifer Montero
Omar Badawi, Mohammad
Aljawadi
Jessica Cowell, William J.
Peppard
Mitchell J. Daley
Volume 14 Issue 4
821
822
827
831
841
853
865
870
873
884
896
904
Implementation of a VTE risk assessment tool at a pediatric hospital
Missed Opportunities for Intervention in the Comprehensive
Management of Alcohol Withdrawal Syndrome
Effect of Patient Controlled Analgesia (PCA) order set templates on
safety events requiring naloxone
Safety of a pharmacy managed intravenous vancomycin loading dose
protocol
Hypoglycemia and adherence to an insulin infusion protocol in cardiac
surgery vs other ICU patients
Implementing Clinical Pharmacy Services in a Multidisciplinary Critical
Care Recovery Center
Effect of IV phosphate repletion guideline changes in ventilated patients
in an intensive care unit
Evaluation of prothrombin complex concentrate utilization at a large,
urban academic medical center
Assessment of parenteral nutrition appropriateness after
implementation of a qualification checklist
Evaluation of an updated insulin infusion protocol at a large academic
medical center
Venous Thromboembolism Prevention: Automating Risk Assessment &
Clinical Decision Support in the EHR
Implementation of daily multidisciplinary ABCDE bundle rounds in a
medical ICU
924
Association between higher colistin dose and nephrotoxicity
931
Loop Diuretic Infusions With and Without Continuous Albumin Infusions
in Acute Kidney Injury Patients
934
937
938
939
946
960
963
964
971
980
986
995
1001
Evaluation of vancomycin dosing and CVVH intensity on vancomycin
trough concentrations attainment
Use of Conivaptan and Tolvaptan for the Treatment of Hyponatremia in
Critically Ill Adults
Incidence and Characterization of Acute Renal Failure Following
Acetaminophen Overdose
Influence of 6% hydroxyethyl starch 130/0.4 on AKI and transfusion
requirements in CT surgery
Impact of hydrocortisone on atrial fibrillation in septic shock
Predicting the Progression to Septic Shock in Patients with a Candida
Bloodstream Infection
Tissue Dysoxia and Mortality in Septic Shock
Pharmacist Presence and Compliance with the 3 Hour Sepsis Bundle in
the ED
Pharmacist Impact On Time To Antibiotic Administration In Sepsis
Patients In An Emergency Department
Practices and Perceptions of ED and ICU RNs Regarding Initial IV
Antibiotic Therapy for Septic Shock
Outcomes in septic shock patients treated with continuous versus bolus
stress-dose hydrocortisone
A multidisciplinary educational approach to decreasing time to antibiotic
administration in sepsis
Impact of body mass index on norepinephrine requirements and
hemodynamics in septic shock
Dec 2014
Cindy Zoeller
Jessica L. Johnson
Rebecca Nashett
Darlene Chaykosky
Andrea Jeanne Passarelli
Andrew C. Fritschle Hilliard
Jennifer Garber
Emily M. Pavich
Stephen J. Lemon
Gabrielle A. Gibson, Seth R.
Bauer
Patricia L. Parker
Patricia R. Louzon
Stephanie Bass, Gabrielle A.
Gibson, Seth R. Bauer,
Simon W. Lam
Katherine Johnson, Rohini
Prashar, Imran Shafique,
Sandeep Vetteth, Celeste
Sejnowski, Mariann
Churchwell, Rose Jung
Abdullah Alhammad
Caroline Der-Nigoghossian
Joanna L. Stollings
Lauren A. Igneri
Sean P. Kane
Justin J. Roth
Matthew J. Korobey
Kara L. Birrer
Vitaliy Nikitenko
Russel J. Roberts, Abdullah
Alhammad
Amanda Liszewski
Lara Groetzinger, Ryan
Rivosecchi
Krista A. Wahby, Kara
Zacholski
Volume 14 Issue 4
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Risk Factors for Mortality in Septic Patients Who Received Multiple
Vasopressors
Impact of Grm+ vs. Grm- Antibiotic Initiation Sequencing on
Vasopressor Requirements in Septic Shock
Emergent warfarin reversal (EWR) comparing 3 coagulation factor
products: PCC3, PCC4, LDrFVIIa
Effect of Scheduled Acetaminophen on Intravenous Opioid Use in
Trauma Patients
Ketamine may increase the risk of PE in selected trauma patients
Analgesia and sedation in mechanically ventilated trauma patients with
a history of stimulant use
Venous Thromboembolism Prophylaxis in Critically Ill Surgical Patients
Efficacy of Intrapleural tPA for Retained Hemothorax in Trauma
Patients
Anti-factor Xa activity in non-weight based enoxaparin dosing for VTE
prophylaxis in trauma patients
Evaluation of anti-Xa Level Monitoring for Enoxaparin in Trauma
Patients
Comparison of Weight-based Dosing of 23.4% HTS Versus Fixed
Dosing for ICP Reduction in TBI Patients
The incidence of hypocalcemia in trauma patients receiving massive
transfusion protocol
Effectiveness and safety of enoxaparin prophylaxis dosed by a
predictive equation in burn patients.
Impact of ketamine on the ability to wean off fentanyl infusions in
critically ill trauma patients
Feasibility of early jejunal enteral nutrition for patients with severe
duodenal injuries
High-dose midazolam versus pentobarbital for intracranial hypertension
in traumatic brain injury
Evaluation of hemodynamic and adverse effects of ketamine versus
etomidate for RSI in trauma
Utilization of seizure prophylaxis in traumatic brain injury (TBI) patients
Digoxin toxicity associated with negative interference from digoxin-like
immunoreactive substances
Pharmacokinetics of Continuous Infusion Meropenem with ExtraCorporeal Life Support and CRRT
Delayed Multi-System Reaction with Fentanyl Infusion in a Critical Ill
Patient
QTc Prolongation Progressing to Torsade de Pointes Secondary to
Ibogaine Ingestion
Pulmonary Embolism Following Receipt of 4-Factor Prothrombin
Complex Concentrate in a Trauma Patient
Severe Hemoptysis Following Eptifibatide for Acute MI and Stent
Patency During ECMO
Conservative Management of Massive Rivaroxaban and Enoxaparin
Overdose
Daptomycin Resistant Endocarditis Treated With Ceftaroline
Intraventricular nicardipine every six hours is a safe alternative for
refractory cerebral vasospasm
Anaphylactic Reaction and QT prolongation Caused By Chinese Herbal
Medicine
Dec 2014
Bruce Hartman
Russel J. Roberts, Abdullah
Alhammad
Scott A. Chapman
Michael Kenes
Bradley D. Domonoske
Bridgette L. Kram
Megan Perry
Meghan Caylor
Scott A. Chapman
Ittiporn Chuatrisorn
Jason Ferreira, Kirsten V.
Busey
Amanda J. Giancarelli, Kara
L. Birrer
Sukhraj Mudahar
Natalie Ann Winings
Johnathan Voss
Tiffany VanDervort
Caitlin Pfaff
Rebecca L. Anderson,
Jennifer Montero
William J. Peppard
Jeffrey J. Cies
John A. Bethea
Stephanie Chauv
Zachariah Thomas
Michele Handzel
Farooq A. Bandali, Zachariah
Thomas
Melissa Fowler
Deb S. Sherman
Marcia L. Brackbill
Volume 14 Issue 4
Dec 2014
Miscellaneous Section
Frequently Asked Questions
By: Tom Moran, PharmD
What time is this presentation at? Where was that speaker presenting?
The Critical Care Congress has developed an app that will let you access the complete
schedule of events including a list of speakers and rooms. This would be a great tool to help you
plan out your day and keep track of things during the conference. It will be available for both
Android and iPhone.
Do you have a question about the Society of Critical Care Medicine’s Clinical Pharmacy and
Pharmacology Section that you have always wondered about? Let us know and we will try to
address it in future newsletters.
Other Announcements
The Board of Pharmacy Specialties (BPS) will be hosting a BPS Critical Care Item Writing
Workshop on January 17, 2015 (8:30 am – 4:30 pm) at the Sheraton Phoenix Downtown Hotel
(South Mountain Room), 340 N. 3rd Street, Phoenix, AZ, in conjunction with the 44th Critical
Care Congress Annual Meeting.
The purpose of the workshop is to review items for possible use in developing the Critical Care
Specialty Certification Examination. All participants are requested to write five items along with
references. Your contribution is very valuable and aligns with the BPS charge in working with
Board Certified Pharmacists to ensure that all BPS specialty certification exams reflect current
best practices. At the workshop, the Specialty Council on Critical Care Pharmacy will work
diligently alongside item writers and test development consultants to ensure that the entire
certification process, including item development, is psychometrically sound and defensible.
As an incentive, BPS will reimburse all workshop participants who write five questions and
attend the workshop to one night’s lodging (at the full rate of a single/double room + tax,
maximum $200) and a dinner (up to $25) in Phoenix, AZ. An expense report will be emailed to
you after the meeting for reimbursement.
Please see this link (CC Writing Workshop Participation Form) for more details. If you are
interested in participating, please contact Jacquelyn Kelly Marshall at [email protected].
Communications Committee members are charged with publishing the newsletter.
Thanks to the following members:
Deepali Dixit (Chair)
Simon Lam (Chair-Elect)
Amy L. Dzierba (Member-atLarge)
Kate Adamczyk
Farooq Bandali
Kim Berger
Aida Rebecca Bickley
Marilyn Bulloch
Chris Droege
Michaelia Dunn
Diana Esaian
Kirstin Kooda
Jim Landzinski
Xi Liu-Deryke
Stacey Folse
Amanda Giancarelli
Daryl Glick
Payal K. Gurnani
Susan Hamblin
Jason Makii
Tom Moran
Justin Muir
Aljuhani Ohoud
Mona K. Patel
Volume 14 Issue 4
Dec 2014
Darlene Chaykosky
Jessica Crow
Garrett Curtis
Stephanie Davis
Hammond Drayton
John Hammer
Angela Haskell
Tudy Hodgman
Julie Kalabalik
Tom Smoot
Joanna Stollings
Ed Sypniewski
Calvin Tucker
Featured CPP Resources
 Are you stuck on a research-related question? Consider
reaching out to the experts in the CPP Research Committee
by emailing [email protected].
 Do you have a manuscript or grant that you would like
reviewed by a content expert? If so, consider emailing the
Research Committee Chair at [email protected]
Upcoming SCCM Congress Meetings – Save the Date!
2015
2016
2017
January 17-21
February 20-24
January 21-25
Phoenix, Arizona
Orlando, Florida
Honolulu, Hawaii