Pharmacy to Dose: The Critical Care Podcast Nick Peters

Trial of the Week: Ketamine for EM Agitation
Special Guest: Justin Lin, PharmD, BCPS, BCCCP @jjlinpharmd
 
Justin Lin joins to review the May Trial of the Week “Efficacy of ketamine for initial control of acute agitation in the emergency department: a randomized study” published in the American Journal of Emergency Medicine in 2021.
We set the scene by discussing how this research idea started, review the classic agitation presentation at his institution, and highlight evidence comparing pharmacotherapy treatment options prior to this study. Then we dive into the Trial of the Week, discussing the study design and results. What was the biggest pushback from providers or the IRB? Any unique education strategies? Would results stay the same with increased IV push administration? What would the comparator arm be if this study was replicated today? Plus, the most challenging part of this project, Justin’s favorite agent, and so much more.
 
Reference list: https://pharmacytodose.com/wp-content/uploads/2024/05/ketamine-for-em-agitation-trial-of-the-week-references.pdf
 
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Sanford Guide Q&A
Special Guest: Doug Black, PharmD
 
04:40 – Doug’s background/Sanford guide introduction
14:20 – Print v. digital guide/included content
34:35 – Tables/tools highlights
41:55 – Doug’s favorites/conclusions
 
Sanford Guide Website: https://web.sanfordguide.com/
 
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Code ICH
Special Guest: Gabe Fontaine, PharmD, MBA, BCPS, BCCCP, FNCS, FCCM @gabe_fontaine
 
04:00 – Code ICH and history of ICU bundled care
15:15 – BP control
22:50 – Hemostasis
33:15 – Challenges & future directions
 
Reference List: https://pharmacytodose.com/wp-content/uploads/2024/05/code-ich-references.pdf
 
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Trial of the Week: MENDS2
Special Guest: John Devlin, PharmD, BCCCP, MCCM, FCCP @devlinpharmd
 
03:20 – PADIS background and research introduction
35:25 – MENDS2 discussion
 
John Devlin joins to review the May Trial of the Week “Dexmedetomidine or Propofol for Sedation in Mechanically Ventilated Adults with Sepsis” the MENDS2 study, published in NEJM in 2021.
We set the scene by discussing how John developed an interest with PADIS research, discussing PK/PD sedative properties and considerations, landmark trials prior to MENDS2, and how much background work is required for a large RCT.
Then we dive into the MENDS2 trial itself. Any significant findings? Biggest methodologic differences from MENDS2 and previous studies? Most challenging process of blinding? Any potential safety concerns? How to avoid unblinding study patients (and why that’s so important)? Plus, trial fun facts, seeing your name in a NEJM research article, applying MENDS2 findings into daily practice, and so much more.
 
Reference list: https://pharmacytodose.com/wp-content/uploads/2024/05/mends2-trial-of-the-week-references.pdf
 
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Rapid Reaction: ANNEXA-I
 
02:35 – Study design/results
18:30 – Considerations/questions
 
Reference List: https://pharmacytodose.files.wordpress.com/2024/05/annexa-i-references.pdf
 
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Trial of the Week: DESIRE & In-Flight Medical Emergencies References
Special Guests: Jim Miller, PharmD, BCCCP @millerjtm
Michael Liu, PharmD, MBA, BCCCP, BCNSP, BCPS
 
04:05 – DESIRE trial
31:15 – In-flight medical emergencies
 
The episode starts off with special guest, Jim Miller, helping review the DESIRE study as a Trial of the Week.
We set the scene reviewing dexmedetomidine pharmacokinetic advantages and landmark dexmedetomidine research. Then we highlight the DESIRE trial itself discussing the study methodology and results. What was considered usual care with regards to sedation? What is the external validity in this trial? What was the effect of changing the primary outcome measure mid-study? Are there anti-inflammatory properties with dexmedetomidine? What did Jim’s novel research show? What would Jim and I want for sedation if mechanically ventilated? And much more.
 
Then the episode closes with Michael Liu highlighting his experience assisting with an in-flight medical emergency.
We review his AJHP article describing his experience. Was this his first time in this situation? Biggest difference between in-hospital and out-of-hospital emergency response? What advice would he give others? And so much more.
 
Reference list: https://pharmacytodose.files.wordpress.com/2024/05/desire-trial-of-the-week-references.pdf
 
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