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Description of Prescribing Practices of Intrapleural Tissue Plasminogen Activator and Intrapleural DNase Administration at a Tertiary Academic Medical Center

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Pharmacology & Pharmacy 2014年第9期5卷 890-894页

作者： Heather Torbic Gaspar Hacobian nahal beik Department of Pharmacy Brigham and Women’s Hospital Boston USA

Objectives: To describe the prescribing practices, preparation and administration techniques of intrapleural (IP) tissue plasminogen activator (t-PA) and IP DNase in patients at a tertiary academic medical center. Methods: Adult patients receiving IP t-PA and IP DNase between January 1-December 31, 2012 were retrospectively evaluated. Patients were included if they received IP t-PA and/or IP DNase for a pleural infection and were excluded if they received IP t-PA or IP DNase for chest tube clearance. Results: A total of 197 doses of IP t-PA and IP DNase received amongst 30 patients were included. The mean age of the patients included was 62 years old with 50% of the patients being female. Of the 30 patients included, 18 patients (60%) received both IP t-PA and IP DNase and 12 patients (40%) received only IP t-PA. The median dose of IP t-PA received was 4 mg (IQR 2-10) and the median dose of IP DNase received was 5 mg (IQR 5-5). Systemic antibiotics were administered to 77% of patients prior to IP t-PA or IP DNase administration. Improved pleural effusion drainage was reported in 70% of patients. Increased pain in the chest cavity during administration of IP t-PA or IP DNase was reported in 7% of patients. Conclusion: The majority of patients at our institution received concomitant IP t-PA and IP DNase after systemic therapy for treatment of pleural infections had been attempted. Administration of IP t-PA and IP DNase demonstrated improved drainage of pleural infections with minimal harm to patients.

关键词： Intrapleural Tissue Plasminogen Activator DNase Pleural Effusion

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Evaluation of the Use of Ketamine for Acute Pain in the Emergency Department at a Tertiary Academic Medical Center

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Pharmacology & Pharmacy 2016年第1期7卷 19-24页

作者： nahal beik Katelyn Sylvester Megan Rocchio Michael B. Stone Department of Pharmacy Brigham and Women’s Hospital Boston USA Department of Emergency Medicine Brigham and Women’s Hospital Boston USA

Introduction: At subdissociative doses of 0.1 - 0.5 mg/kg, ketamine provides effective analgesia when used alone or as an adjunct to opioid analgesics without causing cardiovascular or respiratory compromise. Ketamine is a beneficial analgesic agent in the emergency department (ED), particularly in patients with opioid-resistant pain or polytrauma patients who are hemodynamically unstable. Purpose: The purpose of this study was to evaluate current practice and describe clinical outcomes associated with the use of low-dose ketamine for acute pain in the ED. Methods: Adult patients receiving ketamine were retrospectively evaluated between March 1, 2012 and March 31, 2013. Patients were included if they were ordered for ketamine in the ED to treat acute pain. Outcomes included dose administered, cumulative doses, concurrent opioid administration, and any efficacy or adverse events documented after the administration of ketamine. Continuous variables are reported as mean (standard deviation [SD]) or median (interquartile range [IQR]). Results: A total of 46 patients were evaluated for inclusion. Of the 25 patients included, 38 doses of ketamine were documented. The mean age was 41 years old with 64% of the patients being female. The average initial ketamine dose was 0.12 ± 0.06 mg/kg and 8 (32%) patients received multiple doses of ketamine (1.5 ± 0.8 doses per patient). Ketamine was added to opioid therapy in 23 (92%) patients. Pain scores decreased post administration of ketamine from 10 (9 - 10) to 5 (4 - 7). Adequate pain relief was documented in 11 (44%) patients (felt comfortable going home);partial pain relief was noted in 5 (20%) patients;3 (12%) patients reported no pain relief;3 (12%) patients were able to have a procedure done, and efficacy was not documented in 3 (12%) patients. Anxiety and agitation were documented in 2 (8%) patients. No adverse outcomes were documented in 84% of patients. Conclusion: Administration of low-dose ketamine for acute pain in the

关键词： Ketamine Acute Pain Emergency Department

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Retrospective Review of Propofol versus Etomidate during Rapid Sequence Intubation in the Emergency Department at a Tertiary Academic Center

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Pharmacology & Pharmacy 2017年第7期8卷 231-241页

作者： Megan A. Rocchio Katelyn Sylvester nahal beik Nicole M. Glasser Paul M. Szumita Department of Pharmacy Brigham and Women’s Hospital MA USA Center for Drug Policy Partners Health Care MA USA Department of Pharmacy Crozer-Keystone Health System PA USA

Background: Etomidate is the standard induction agent used during rapid sequence intubation (RSI) in the emergency department (ED). Etomidate shortages require providers to utilize alternative agents. The purpose of this study is to compare the safety and procedural outcomes of propofol and etomidate for RSI in the ED. Methods: This was a retrospective chart review of adult patients in the ED who received propofol or etomidate for induction during RSI. The main endpoint was hypotension, defined as a systolic blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg, within the first hour of intubation. Time to intubation, intensive care unit length of stay, hospital length of stay, and in-hospital mortality were also evaluated. Results: Two hundred and seventy five patient charts were reviewed. Of the 98 patients included, 43 patients received propofol and 55 patients received etomidate. Propofol was associated with an increased incidence of hypotension within the first hour of intubation (65.1% vs. 25.5%, p < 0.001). No difference was found in the time to intubation: ≤5 minutes (51.2% vs. 34.6%, p = 0.83). The mortality rate was 11.6% in the propofol group and 27.3% in the etomidate group (p = 0.004). There was no difference in hospital or intensive care unit length of stay between the propofol and etomidate groups (7.7 vs. 9.2 days, p = 0.23;4.2 vs. 6.3 days, p = 0.31). Conclusion: Propofol was a safe and procedurally effective induction agent for RSI. Compared to etomidate, it was associated with an increased rate of hypotension within the first hour of intubation, with no difference in the percent of patients that required an intervention.

关键词： Rapid Sequence Intubation Etomidate Zropofol Safety Efficacy

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