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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 Volume 14 Issue 4 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 Volume 14 Issue 4 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. Volume 14 Issue 4 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. Volume 14 Issue 4 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 1003 1005 1030 1037 1039 1048 1050 1056 1057 1062 1063 1066 1072 1077 1088 1090 1096 1105 1148 1155 1161 1173 1199 1200 1205 1212 1262 1266 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