Brian L Erstad

Brian L Erstad

Department Head, Pharmacy Practice-Science
Professor, Pharmaceutical Sciences
Member of the Graduate Faculty
Professor, BIO5 Institute
Primary Department
Contact
(520) 626-4289

Work Summary

Brian Erstad’s research interests pertain to critical care medicine with an emphasis on patient safety and related outcomes research.

Research Interest

Brian L. Erstad, PharmD, FCCM, is currently a tenured professor and head of the Department of Pharmacy Practice and Science. He is also a center investigator for the Center for Health Outcomes and PharmacoEconomics Research and a co-director for the Arizona Clinical and Translational Research Graduate Certificate Program. His clinical responsibilities are performed at Banner-University Medical Center Tucson.Dr. Erstad’s research interests pertain to critical care medicine with an emphasis on patient safety and related outcomes research. He has authored more than 150 peer-reviewed articles and book chapters.Dr. Erstad has served on the board of directors of the American Society of Health-System Pharmacists and on numerous committees and task forces for other organizations including AHRQ, USP, Society of Critical Care Medicine and the American College of Chest Physicians. He is currently an ad hoc member of the FDA’s Drug Safety and Risk Management Advisory Committee, a steering committee member of the United States Critical Illness and Injury Trials (USCIIT) Group, and treasurer of the American College of Clinical Pharmacy.

Publications

Barletta, J. F., Erstad, B. L., & Fortune, J. B. (2002). Stress ulcer prophylaxis in trauma patients. Critical Care, 6(6), 526-530.

PMID: 12493075;PMCID: PMC153440;Abstract:

Introduction. A number of issues concerning stress ulcer prophylaxis remain unresolved despite numerous randomized, controlled trials and several meta-analyses. The role of stress ulcer prophylaxis, particularly in trauma patients, is further complicated by the lack of trials utilizing clinically important bleeding as an endpoint. Given the lack of consensus regarding stress ulcer prophylaxis in trauma patients, prescribing practices at Level I trauma centers in the United States were assessed. Materials and methods. A survey was developed that contained questions related to institutional prescribing and evaluation of stress ulcer prophylaxis. The survey was intended to delineate these practices at the 188 Level I trauma centers (at the time of the present survey) in the United States. Results. One hundred and nineteen surveys were returned, yielding a response rate of 63%. Eighty-six percent stated that medications for stress ulcer prophylaxis are used in a vast majority of trauma patients admitted to the intensive care unit. Sixty-five percent stated that there is one preferred medication. For these institutions, histamine-2-blockers were the most popular at 71%. Thirty-nine percent stated that greater than 50% of patients remain on stress ulcer prophylaxis following discharge from the intensive care unit. Conclusion. The lack of consensus with regards to appropriate stress ulcer prophylaxis is apparent in this survey of Level I trauma centers. For those institutions with a preferred agent, histamine-2-blockers were most common.

Patanwala, A. E., Barletta, J. F., & Erstad, B. L. (2012). Pharmacoepidemiology and patient safety in the critically ill. Pharmaceuticals Policy and Law, 14(1), 93-104.

Abstract:

Critically ill patients are at the greatest risk of experiencing preventable and non-preventable adverse drug events (ADEs) compared to other patient populations. Information on ADEs concerning these patients is derived from a wide spectrum of sources such as surveillance studies involving large databases to landmark clinical investigations. Historically there has been a lack of consistency with regard to definitions of commonly used terms such as medication error, ADE, and preventability, which is a fundamental to appropriately conduct and interpret results of epidemiological investigations in this setting. However, attempts have been made to standardize this terminology by national organizations. The increased risk of ADEs in the critically ill patient population is due to a variety of reasons, which include the routine use of the intravenous route of drug administration, medications with a low therapeutic index and high complexity, 'off-label' use and an environment that may be conducive to errors. Reporting of ADEs is largely voluntary and is generally underreported and skewed towards the most serious events. Other methods for surveillance of ADEs in the critical care setting include medical record review and direct observation. Each of these methods has their own limitations and the data obtained can vary depending on the method used. A combination of data from all of these methods is likely to produce the most comprehensive information to improve patient safety. © 2012 - Network of Centres for Study of Pharmaceutical Law. All rights reserved.

Erstad, B., & Erstad, B. L. (2002). Implications of prion-induced diseases for animal-derived pharmaceutical products. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 59(3).

The implications of prion-induced diseases for the use of medications that theoretically could harbor the infectious pathogens are discussed. Prions have been identified as protein particles that lack nucleic acids. There is evidence that prions cause the transmissible neurodegenerative diseases known as transmissible spongiform encephalopathies. Of these diseases, bovine spongiform encephalopathy (BSE) and the human spongiform encephalopathy to which it has been linked, new variant Creutzfeldt-Jakob disease (CJD), have generated the most attention. The first cases of new variant CJD appeared in Britain in the mid-1990s. Ingestion of prion-infected beef remains the only known cause of new variant CJD. No cases of BSE or new variant CJD have been documented in the United States. The time from exposure to the development of clinical sequelae appears to be about 10 years. The median duration of illness is 14 months, and the outcome is invariably death. There is no treatment; currently the only available approach is prevention. There is no reliable method of predicting the number of new cases that might occur because of lack of definitive information on the efficiency of transmission from animals to humans and the number of people currently infected and at risk for infection. The infectivity of medications and plasma fractionation products containing material from cattle with BSE is unknown, but the risk is believed to be very low. No cases of such transmission have been identified. Guidelines to keep the risk of transmission via medications low have been promulgated by FDA, and further research is warranted. There have been no reports of medications or plasma fractionation products being contaminated with the prions that cause new variant CJD. Ongoing vigilance and research are appropriate, however.

Keim, S. M., Erstad, B. L., Sakles, J. C., & Davis, V. (2002). Etomidate for procedural sedation in the emergency department. Pharmacotherapy, 22(5), 586-592.

PMID: 12013357;Abstract:

Study Objective. To review our experience with etomidate in nonintubated patients in the emergency department. Design. A 2-year retrospective chart review of consecutive patients receiving etomidate for sedation. Setting. Emergency department of a university-based teaching hospital. Patients. Forty-eight patients who underwent painful procedures in the emergency department. Measurements and Main Results. Demographics, dosing information, recovery times, and adverse events were abstracted using a standardized data collection form. Forty-eight nonintubated patients were sedated with etomidate. Mean age was 34 years (range 6-80 yrs); 38 were men and 10 women; two were children. The mean initial dose of etomidate was 13 mg. Adverse events occurred in 11 (21%) patients. None sustained any substantial morbidity as indicated by need for intubation, prolonged emergency department stay, or hospital admission. Conclusion. Although controversial, etomidate holds promise as a potent sedative agent for patients undergoing painful procedures in the emergency department. A large prospective evaluation is needed to document the performance and complications of this agent.

Erstad, B. L., & Barletta, J. F. (2000). Treatment of hypertension in the perioperative patient. Annals of Pharmacotherapy, 34(1), 66-79.

PMID: 10669188;Abstract:

OBJECTIVE: To review studies and drug therapy relating to the treatment of hypertension in perioperative patients. DATA SOURCES: Articles were selected from a MEDLINE search (1966-August 1998), and several textbooks on hypertension and surgery were reviewed. In addition, bibliographies of all articles and textbook chapters were studied for articles not found in the computerized searches. STUDY SELECTION: Clinical studies involving hypertension in the perioperative setting were included. The initial search was limited to studies conducted in humans and published in English. DATA EXTRACTION: Information regarding drug therapy was reviewed and guidelines were constructed for managing surgical patients with acute blood pressure elevations. DATA SYNTHESIS: Although nitroprusside and nitroglycerin, with their short onset of action and duration of effect, are indicated for hypertensive emergencies, a variety of agents are available for hypertensive urgencies. An algorithm that can be used as a template for the development of intrainstitutional guidelines is provided. CONCLUSIONS: Due to the scarcity of comparative trials, decisions involving agents for the treatment of perioperative hypertension must often be made based on combined efficacy, toxicity, cost, and convenience considerations.