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Summary: Purpose:We compared propofol with high-dose barbiturates in the treatment of refractory status epilepticus (RSE) and propose a protocol for the administration of propofol in RSE in adults, correlating propofol's effect with plasma levels.Methods: Sixteen patients with RSE were included; 8 were treated primarily with high-dose barbiturates and 8 were treated primarily with propofol.Results: Both groups of patients had multiple medical problems and a subsequent high mortality. A smaller but not statistically significant fraction of patients had their seizures controlled with propofol (63%) than with high-dose barbiturate therapy (82%). The time from initiation of high-dose barbiturate therapy to attainment of control of RSE was longer (123 min) than the time to attainment of seizure control in the group receiving propofol (2.6 min, p = 0.002). Plasma concentrations of propofol associated with control of SE were 14 pM +. 4 (2.5 p,g/ml). Recurrent seizures were common when propofol infusions were suddenly discontinued but not when the infusions were gradually tapered.Conclusions: If used appropriately, propofol infusions can effectively and quickly terminate many but not all episodes of RSE. Propofol is a promising agent for use in treating RSE, but more studies are required to determine its true value in comparison with other agents.

We conducted a retrospective chart review of 193 patients admitted during a 3-month period to determine the frequency of and potential risk factors associated with thrombocytopenia, and the association of acquired thrombocytopenia with length of stay in a surgical-trauma intensive care unit (SICU) and mortality. All records were reviewed beginning 24 hours after admission. Patients were followed for the duration of SICU stay or until death. Data collected and analyzed as potential risk factors for thrombocytopenia were age, gender, admitting diagnosis, classification (trauma, surgical, medical), APACHE II score, medical history, all scheduled drugs with start and stop dates, select laboratory values, arterial or central line placement, and complications. Thrombocytopenia occurred in 25 (13%) patients. These patients were more likely (p<0.05) than those without thrombocytopenia to have the following potential risk factors: presence of a central or arterial line (76% vs 46%, p<0.025), nonsurgical diagnosis (60% vs 37%, p<0.05), diagnosis of sepsis (p<0.001), and administration of phenytoin (p<0.01), piperacillin (p<0.005), imipenem-cilastatin (p<0.001), and vancomycin (p<0.005). A longer SICU stay (mean 21 vs 4.5 days, p<0.05) and increased mortality (16% vs 4%, p<0.05) were significantly associated with thrombocytopenia. Cefazolin administration was significantly associated with nonthrombocytopenia (p<0.05). Factors not associated with thrombocytopenia were age, gender, and administration of histamine2-receptor antagonists, heparin, enoxaparin, penicillins, ceftazidime, ceftriaxone, chloramphenicol, and amphotericin B. A central or arterial line was the only factor associated with the development of thrombocytopenia in a multiple linear regression analysis (p=0.0003, multiple r=0.2580). Thrombocytopenia is not a common occurrence in the SICU, but is associated with a longer SICU stay and increased mortality.

Objective. To examine perceived motivating factors and barriers (MFB) to postgraduate training (PGT) pursuit among pharmacy students. Methods. Third-year pharmacy students at 13 schools of pharmacy provided demographics and their plan and perceived MFBs for pursuing PGT. Responses were characterized using descriptive statistics. Kruskal-Wallis equality-of-proportions rank tests determined if differences in perceived MFBs existed between students based on plan to pursue PGT. Results. Among 1218 (69.5%) respondents, 37.1% planned to pursue PGT (32.9% did not, 30% were undecided). Students introduced to PGT prior to beginning pharmacy school more frequently planned to pursue PGT. More students who planned to pursue PGT had hospital work experience. The primary PGT rationale was, "I desire to gain more knowledge and experience." Student debt was the most commonly cited barrier. Conclusion. Introducing pharmacy students early to PGT options and establishing work experiences in the hospital setting may increase students' desire to pursue PGT.

Background Sedation is common in critical care. It is unknown if sedative self-administration is a safe or acceptable intervention for mechanically ventilated (MV) patients. Objectives To evaluate whether patient self-administered sedation with dexmedetomidine (Precedex®) (PST-DEX) is safe and acceptable for self-management of anxiety during ventilatory support. Methods Randomized pilot trial in three ICUs. Intubated patients were randomly assigned to PST-DEX (n=17) or usual care (n=20). PST-DEX was administered via standard PCA pumps with a basal infusion (0.1–0.7 mcg/kg/hour) titrated by the number of patient-triggered doses (0.25 mcg/kg/dose). PST-DEX safety goals were heart rate > 40 bpm, systolic BP > 80 mm Hg, diastolic BP > 50 mm Hg. Acceptability was determined by patients’ self-reported satisfaction and ability to administer DEX. A 100-mm visual analog scale assessed patients’ anxiety daily (VAS-A). Results Patients (N = 37) were 60% male, 89% Caucasian. Mean age was 50.6 ±15 years; APACHE III 60.1 ± 32.6 and protocol duration 3.4 ± 1.6 days [median = 4]. Five PST-DEX patients had BP and/or HR readings below safety parameters necessitating short-term treatment. Nursing adherence to safety parameter reporting was 100%; adherence to PST-DEX titration algorithm was 73%. Overall baseline VAS-A was 38.4 ± 28.0 and did not change significantly over time [βday = 2.1((SE=2.5), p = 0.4)]. Most PST-DEX patients (92%) were satisfied/very satisfied with their ability to self-administer medication. Conclusions For select patients, PST-DEX is a safe and acceptable alternative to clinician-administered sedation. Additional research to determine the efficacy of PST DEX is warranted.