We studied the circadian influences on cyclosporine pharmacokinetics in five recipients of pancreatic allografts. Results from these patients demonstrate a slightly increased area under the concentration-time curve (p = 0.156) resulting from decreased apparent clearance during the resting (PM) versus activity (AM) period (p = 0.199). A significant delay in mean residence time was observed after the PM dose (p = 0.039), and the PM area under the moment curve was larger than the AM value (p = 0.063). We propose three chronopharmacokinetic dosing methods that alter either the PM dose administration time or redistribute the daily dose to produce equal exposure to cyclosporine during the active and resting periods. These trends and differences suggest that more sophisticated time-dependent cyclosporine dosing methods are needed to balance AM and PM drug exposure and thereby improve immunosuppression.

Objective: 1) Outcomes of cardiac arrest in hospitalized patients with tracheostomies. 2) Disposition of patients at the time of hospital discharge. Method: A retrospective electronic chart review was performed of 1102 patients who had cardiac arrest (absence of pulse or non-perfusing rhythm) at a tertiary care academic medical center between Jan 2005-Dec 2009. Data was abstracted and summarized using descriptive statistics. Results: Twenty-six of 1102 (2%) had a tracheostomy at the time of arrest. Median age years = 61 years (range 24-83 years). A total of 18 out of 26 (69%) were male. A total of 18 out of 26 (69%) had return of spontaneous circulation following resuscitation. Fourteen out of 26 (54%) were on mechanical ventilation (MV) at the time of arrest. Twenty-two out of 26 (84%) patients had tracheostomy secondary to prolonged MV. Twelve out of 26 (46%) patients were alive at 3 months and 7 out of 26 (26%) patients were alive at 1 year. Of the 11 patients who survived to discharge, disposition included: 6 out of 11 (54%) home; 3 out of 11 (27%) long-term acute care hospital (LTAC); 2 out of 11 (18%) skilled nursing facility (SNF). Conclusion: The frequency of cardiac arrest in patients with a tracheostomy was 2.4%. Survival at 1 year was 26%. Of those who survived to discharge, 54% of patients went home and 45% were discharged to a LTAC or SNF.

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