Erstad, B. L., Snyder, B. A., & Kramer, T. H. (1993). Epidural, intrathecal, and patient-controlled analgesic use in a University Medical Center. Journal of Pharmacy Technology, 9(4), 141-143.
PMID: 10171510;Abstract:
Objective: To determine the number and profile of surgical patients receiving epidural, intrathecal, and patient-controlled analgesia. Design: Two-month audit of epidural, intrathecal, and patient-controlled analgesia. Setting: A 300-bed, tertiary care, university medical center. Patients: All patients undergoing surgery and receiving epidural, intrathecal, or patient- controlled analgesia. Results: Of 1123 operations performed during the two- month audit, 185 patients (16 percent) received one of the three forms of analgesia studied. Sixty-three percent of the 185 patients received patient- controlled analgesia and 33 percent received epidural injections for pain control. The most common types of surgery associated with the use of these specialized pain-control techniques were obstetric/gynecologic, orthopedic, general, urologic, and cardiothoracic. Conclusions: Specialized forms of analgesia are becoming increasingly common. Our audit defined the number of patients receiving such therapies according to type of surgery. Collection of such information by other institutions should allow for targeted evaluations of cost-effectiveness (e.g., drug use evaluations).
Erstad, B. L., Mayersohn, M., & Nix, D. E. (2017). Should estimates of glomerular filtration rate and Creatinine Clearance be Indexed to Body Surface Area for drug dosing?. American Journal of Health-Systems Pharmacists, 74(21), 1814-19. doi:https://doi.org/10.2146/ajhp160467
Under consideration - Revisions submitted 10/2016
Erstad, B. L. (1994). Oxygen transport goals in the resuscitation of critically ill patients. Annals of Pharmacotherapy, 28(11), 1273-1284.
PMID: 7849343;Abstract:
OBJECTIVE: To discuss the limitations of conventional monitoring techniques of shock and examine more recent monitoring techniques that are used to titrate therapies to attain supranormal oxygen transport goals. DATA SOURCES: Review articles and investigations published since 1973. STUDY SELECTION: Articles were selected if they examined the monitoring or treatment of shock. Emphasis was placed on finding investigations involving humans that used innovative methods to assess and treat inadequate tissue perfusion. DATA EXTRACTION: Data were extracted primarily from original investigations and review articles published in or translated into English. DATA SYNTHESIS: The conventional monitoring of shock often fails to detect inadequate tissue perfusion, which may lead to inadequate resuscitation of patients, resulting in increased morbidity and mortality. Attainment of supranormal values for oxygen transport variables has been associated with improved outcomes, especially in patients with hypovolemic shock or septic shock. Additionally, interventions used to increase these variables to supranormal values have resulted in improved survival in high-risk preoperative patients with hypovolemic or septic shock, but not in severely ill postoperative patients with multiple complications. CONCLUSIONS: Efforts to increase oxygen transport variables to supranormal values cannot be recommended routinely for all critically ill patients. Preoperative patients in early stages of hypovolemic or septic shock may benefit from therapies titrated to achieve supranormal goals, but patients in later stages of illnesses may be harmed by such attempts. Questions remain regarding how quickly and how long the oxygen transport variables should be elevated. The most effective and least toxic therapeutic interventions for increasing the variables need to be determined.
Radosevich, J. J., Patanwala, A. E., Frey, P. D., Paddock, H., & Erstad, B. L. (2015). Higher insulin infusion rate but not 24-hour insulin consumption is associated with hypoglycemia in critically ill patients.. Diab Res Clin Pract, 110, 322-327.
Patanwala, A. E., Acquisto, N. M., & Erstad, B. L. (2011). Prothrombin complex concentrate for critical bleeding. Annals of Pharmacotherapy, 45(7-8), 990-999.
PMID: 21730276;Abstract:
OBJECTIVE: To review the evidence supporting the use of prothrombin complex concentrate (PCC) as a hemostatic agent in individuals without hemophilia. DATA SOURCES: Articles were identified through a search of Ovid/MEDLINE (up to April 2011) and Cochrane Central Register of Controlled Trials (up to April 2011). The search terms used were prothrombin complex concentrate, hemorrhage, and bleeding. STUDY SELECTION AND DATA EXTRACTION: The search was limited to comparative studies. Bibliographies of retrieved articles were reviewed to obtain additional articles. The intent of the search was to identify original research comparing PCC to fresh frozen plasma (FFP) or recombinant factor VIIa for the management of bleeding in patients without hemophilia. DATA SYNTHESIS: PCCs are recommended as an alternative to FFP and recombinant factor VIIa for the treatment of serious or life-threatening bleeding related to vitamin K antagonist therapy. Studies in this setting have shown that PCCs are safe and effective and provide prompt reduction of international normalized ratio (INR) compared to FFP. However, most trials are uncontrolled, and the primary outcomes in these studies have been INR reduction rather than hemostatic effect. Other common off-label uses include coagulopathy due to hepatic failure and traumatic hemorrhage; however, there is insufficient evidence to support use of PCC in these settings. Advantages of PCC include the low drug volume required compared to FFP. The use of PCC may be associated with thrombo-embolic complications. CONCLUSIONS: PCC is a safe and effective alternative to FFP and provides rapid reversal of INR in patients on vitamin K antagonist therapy. These agents may be advantageous compared to FFP in patients with volume restrictions. Comparative trials are needed to compare the various PCC products, FPP, and recombinant factor VIIa with regard to clinically significant outcomes such as hemostatic effect.
