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  1. Article ; Online: Comment on "Hydrocortisone versus vasopressin for the management of adult patients with septic shock refractory to norepinephrine: A multicenter retrospective study".

    Wieruszewski, Patrick M / Bauer, Seth R

    Pharmacotherapy

    2023  Volume 43, Issue 10, Page(s) 1094

    MeSH term(s) Humans ; Adult ; Norepinephrine/therapeutic use ; Hydrocortisone ; Retrospective Studies ; Shock, Septic/drug therapy ; Vasopressins/therapeutic use
    Chemical Substances Norepinephrine (X4W3ENH1CV) ; Hydrocortisone (WI4X0X7BPJ) ; Vasopressins (11000-17-2)
    Language English
    Publishing date 2023-10-12
    Publishing country United States
    Document type Multicenter Study ; Letter
    ZDB-ID 603158-4
    ISSN 1875-9114 ; 0277-0008
    ISSN (online) 1875-9114
    ISSN 0277-0008
    DOI 10.1002/phar.2870
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  2. Article ; Online: Optimizing Vasopressin Use and Initiation Timing in Septic Shock: A Narrative Review.

    Sacha, Gretchen L / Bauer, Seth R

    Chest

    2023  Volume 164, Issue 5, Page(s) 1216–1227

    Abstract: Topic importance: This review discusses the rationale for vasopressin use, summarizes the results of clinical trials evaluating vasopressin, and focuses on the timing of vasopressin initiation to provide clinicians guidance for optimal adjunctive ... ...

    Abstract Topic importance: This review discusses the rationale for vasopressin use, summarizes the results of clinical trials evaluating vasopressin, and focuses on the timing of vasopressin initiation to provide clinicians guidance for optimal adjunctive vasopressin initiation in patients with septic shock.
    Review findings: Patients with septic shock require vasoactive agents to restore adequate tissue perfusion. After norepinephrine, vasopressin is the suggested second-line adjunctive agent in patients with persistent inadequate mean arterial pressure. Vasopressin use in practice is heterogeneous likely because of inconsistent clinical trial findings, the lack of specific recommendations for when it should be used, and the high drug acquisition cost. Despite these limitations, vasopressin has demonstrated price inelastic demand, and its use in the United States has continued to increase. However, questions remain regarding optimal vasopressin use in patients with septic shock, particularly regarding patient selection and the timing of vasopressin initiation.
    Summary: Experimental studies evaluating the initiation timing of vasopressin in patients with septic shock are limited, and recent observational studies have revealed an association between vasopressin initiation at lower norepinephrine-equivalent doses or lower lactate concentrations and lower mortality.
    MeSH term(s) Humans ; United States ; Vasoconstrictor Agents/therapeutic use ; Shock, Septic/drug therapy ; Vasopressins/therapeutic use ; Norepinephrine/therapeutic use ; Arterial Pressure
    Chemical Substances Vasoconstrictor Agents ; Vasopressins (11000-17-2) ; Norepinephrine (X4W3ENH1CV)
    Language English
    Publishing date 2023-07-20
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, N.I.H., Extramural
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2023.07.009
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  3. Article ; Online: Precision fluid and vasoactive drug therapy for critically ill patients.

    Bauer, Seth R / Gellatly, Rochelle M / Erstad, Brian L

    Pharmacotherapy

    2023  Volume 43, Issue 11, Page(s) 1182–1193

    Abstract: There are several clinical practice guidelines concerning the use of fluid and vasoactive drug therapies in critically ill adult patients, but the recommendations in these guidelines are often based on low-quality evidence. Further, some were compiled ... ...

    Abstract There are several clinical practice guidelines concerning the use of fluid and vasoactive drug therapies in critically ill adult patients, but the recommendations in these guidelines are often based on low-quality evidence. Further, some were compiled prior to the publication of landmark clinical trials, particularly in the comparison of balanced crystalloid and normal saline. An important consideration in the treatment of critically ill patients is the application of precision medicine to provide the most effective care to groups of patients most likely to benefit from the therapy. Although not currently widely integrated into these practice guidelines, the utility of precision medicine in critical illness is a recognized research priority for fluid and vasoactive therapy management. The purpose of this narrative review was to illustrate the evaluation and challenges of providing precision fluid and vasoactive therapies to adult critically ill patients. The review includes a discussion of important investigations published after the release of currently available clinical practice guidelines to provide insight into how recommendations and research priorities may change future guidelines and bedside care for critically ill patients.
    MeSH term(s) Adult ; Humans ; Fluid Therapy ; Critical Illness/therapy ; Crystalloid Solutions/therapeutic use
    Chemical Substances Crystalloid Solutions
    Language English
    Publishing date 2023-01-19
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603158-4
    ISSN 1875-9114 ; 0277-0008
    ISSN (online) 1875-9114
    ISSN 0277-0008
    DOI 10.1002/phar.2763
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  4. Article ; Online: The authors reply.

    Sacha, Gretchen L / Kiser, Tyree H / Wright, Garth C / Bauer, Seth R

    Critical care medicine

    2023  Volume 51, Issue 2, Page(s) e69–e70

    Language English
    Publishing date 2023-01-20
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005763
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  5. Article ; Online: The authors reply.

    Sacha, Gretchen L / Wang, Lu / Bauer, Seth R

    Critical care medicine

    2022  Volume 50, Issue 10, Page(s) e776–e777

    Language English
    Publishing date 2022-09-12
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005643
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  6. Article ; Online: Physical and Chemical Compatibility of Medications Commonly Used in Critically Ill Patients With Balanced Crystalloids: A Systematic Review.

    Buckley, Christopher T / Farrar, Julie E / Schleicher, Mary / Stollings, Joanna L / Duggal, Abhijit / Bauer, Seth R

    The Annals of pharmacotherapy

    2023  Volume 58, Issue 3, Page(s) 322–332

    Abstract: Objective: Evaluate available evidence of physical and/or chemical compatibility of commonly used medications in critically ill patients with balanced crystalloids.: Data sources: Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ... ...

    Abstract Objective: Evaluate available evidence of physical and/or chemical compatibility of commonly used medications in critically ill patients with balanced crystalloids.
    Data sources: Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were queried from inception to September 2022.
    Study selection and data extraction: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English-language studies reporting physical and/or chemical compatibility data between 50 selected medications and balanced crystalloids were included. A previously designed tool to assess risk of bias was adapted for use.
    Data synthesis: Twenty-nine studies encompassing 39 (78%) medications and 188 unique combinations with balanced crystalloids were included. Combinations included 35 (70%) medications with lactated Ringer's, 26 (52%) medications with Plasma-Lyte, 10 (20%) medications with Normosol, and one (2%) medication with Isolyte. Studies commonly evaluated physical and chemical compatibility (55.2%). More medications were evaluated via Y-site than admixture. Incompatibilities were identified in 18% of combinations comprising 13 individual drugs.
    Relevance to patient care and clinical practice: This systematic review evaluates the compatibility of select critical care medications with balanced crystalloid solutions. Results may be used as a tool to guide clinicians on balanced crystalloid compatibility, potentially increasing ubiquitous use and reducing patient exposure to normal saline.
    Conclusion and relevance: Data are limited regarding chemical/physical compatibility of commonly used medications in critically ill patients with balanced crystalloids. Additional compatibility studies are warranted, particularly methodologically rigorous studies assessing Plasma-Lyte, Normosol, and Isolyte. Of the evaluated medications, there was a low frequency of incompatibilities with balanced crystalloids.
    MeSH term(s) Humans ; Fluid Therapy/methods ; Critical Illness/therapy ; Crystalloid Solutions/therapeutic use ; Magnesium Chloride ; Electrolytes ; Gluconates ; Sodium Acetate ; Potassium Chloride ; Sodium Chloride
    Chemical Substances Plasma-lyte 148 ; Crystalloid Solutions ; Plasmalyte A (97397-05-2) ; Magnesium Chloride (02F3473H9O) ; Electrolytes ; Gluconates ; Sodium Acetate (4550K0SC9B) ; Potassium Chloride (660YQ98I10) ; Sodium Chloride (451W47IQ8X)
    Language English
    Publishing date 2023-06-21
    Publishing country United States
    Document type Systematic Review ; Journal Article ; Review
    ZDB-ID 1101370-9
    ISSN 1542-6270 ; 1060-0280
    ISSN (online) 1542-6270
    ISSN 1060-0280
    DOI 10.1177/10600280231179999
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  7. Article ; Online: Baricitinib versus tocilizumab in critically ill COVID-19 patients: A retrospective cohort study.

    Conroy, Grace M / Bauer, Seth R / Pallotta, Andrea M / Duggal, Abhijit / Wang, Lu / Sacha, Gretchen L

    Pharmacotherapy

    2023  Volume 44, Issue 1, Page(s) 28–38

    Abstract: Objectives: The immunomodulators tocilizumab and baricitinib improve outcomes in severely ill patients with coronavirus disease 2019 (COVID-19); however, comparative analyses of clinical outcomes related to these agents are lacking. A tocilizumab ... ...

    Abstract Objectives: The immunomodulators tocilizumab and baricitinib improve outcomes in severely ill patients with coronavirus disease 2019 (COVID-19); however, comparative analyses of clinical outcomes related to these agents are lacking. A tocilizumab national shortage shifted treatment to baricitinib in critically ill patients, allowing for an outcome comparison in a similar population. The purpose of this study is to compare clinical outcomes in critically ill COVID-19 patients who received tocilizumab and those who received baricitinib.
    Design: Retrospective, observational cohort study using generalized estimating equation models, accounting for clustering by hospital and known confounders, to estimate the proportional odds of the ordinal World Health Organization Clinical Progression Scale (WHO-CPS) score at day 14, the primary outcome. Secondary outcomes included WHO-CPS score at day 7.
    Setting: Multiple hospitals within the Cleveland Clinic Health System.
    Patients: Adult patients admitted for COVID-19 between January 2021 and November 2021.
    Interventions: Receipt of tocilizumab, before its shortage, or baricitinib, during shortage.
    Measurements and main results: In total, 507 patients were included; 217 received tocilizumab and 290 received baricitinib. Over 96% of patients required ICU admission and 98% received concomitant dexamethasone. Tocilizumab recipients had higher (worse) baseline WHO-CPS scores. After adjustment, tocilizumab use was associated with higher odds of a worse day 14 WHO-CPS score compared with baricitinib (adjusted odds ratio [OR] 1.65 [95% confidence interval (CI) 1.10-2.48]). Similarly, after adjustment, tocilizumab use was associated with higher odds of a worse day 7 WHO-CPS score (adjusted OR 1.65 [95% CI 1.22-2.24]).
    Conclusions: Baricitinib use was associated with better WHO-CPS scores at day 14 and day 7 compared with tocilizumab in a cohort of critically ill patients with COVID-19. The odds of having a one unit increase in WHO-CPS score at day 14 was 71% higher with tocilizumab than baricitinib. No difference in mortality or adverse effects was noted.
    MeSH term(s) Adult ; Humans ; COVID-19 ; COVID-19 Drug Treatment ; Critical Illness ; Retrospective Studies ; Purines ; Pyrazoles ; Sulfonamides ; Antibodies, Monoclonal, Humanized ; Azetidines
    Chemical Substances baricitinib (ISP4442I3Y) ; tocilizumab (I031V2H011) ; Purines ; Pyrazoles ; Sulfonamides ; Antibodies, Monoclonal, Humanized ; Azetidines
    Language English
    Publishing date 2023-08-24
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 603158-4
    ISSN 1875-9114 ; 0277-0008
    ISSN (online) 1875-9114
    ISSN 0277-0008
    DOI 10.1002/phar.2867
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  8. Article ; Online: Critical care essentials for pharmacy trainees and new clinical practitioners.

    Erstad, Brian L / Kiser, Tyree H / Bauer, Seth R

    American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

    2020  Volume 78, Issue 13, Page(s) 1176–1183

    MeSH term(s) Community Pharmacy Services ; Critical Care ; Humans ; Interprofessional Relations ; Pharmacies ; Pharmacists ; Pharmacy ; Students, Pharmacy
    Language English
    Publishing date 2020-12-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 1224627-x
    ISSN 1535-2900 ; 1079-2082
    ISSN (online) 1535-2900
    ISSN 1079-2082
    DOI 10.1093/ajhp/zxaa417
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  9. Article ; Online: Feasibility of Converting Inhaled Epoprostenol Product From Flolan to Veletri in Critically Ill Patients.

    Torbic, Heather / Bauer, Seth R / Wanek, Matthew R

    American journal of therapeutics

    2020  Volume 28, Issue 6, Page(s) e781–e785

    MeSH term(s) Administration, Inhalation ; Antihypertensive Agents/adverse effects ; Critical Illness ; Epoprostenol ; Feasibility Studies ; Humans ; Hypertension, Pulmonary/drug therapy ; Vasodilator Agents/therapeutic use
    Chemical Substances Antihypertensive Agents ; Vasodilator Agents ; Epoprostenol (DCR9Z582X0)
    Language English
    Publishing date 2020-10-01
    Publishing country United States
    Document type Letter
    ZDB-ID 1280786-2
    ISSN 1536-3686 ; 1075-2765
    ISSN (online) 1536-3686
    ISSN 1075-2765
    DOI 10.1097/MJT.0000000000001142
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  10. Article ; Online: Author's Response: Abrupt Discontinuation Versus Down-Titration of Vasopressin in Patients Recovering from Septic Shock.

    Lam, Simon W / Sacha, Gretchen L / Bauer, Seth R

    Shock (Augusta, Ga.)

    2020  Volume 56, Issue 5, Page(s) 870

    MeSH term(s) Humans ; Shock, Septic/drug therapy ; Vasopressins
    Chemical Substances Vasopressins (11000-17-2)
    Language English
    Publishing date 2020-07-21
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1185432-7
    ISSN 1540-0514 ; 1073-2322
    ISSN (online) 1540-0514
    ISSN 1073-2322
    DOI 10.1097/SHK.0000000000001749
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