Advanced Modes of Mechanical Ventilation: Introduction for the Critical Care Pharmacist

Cawley, Michael J.

doi:10.1177/0897190017734766

Cited by 3 publications

(3 citation statements)

References 56 publications

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“…In this activity, there is the responsibility of intervention regarding potential drug interactions, dosage adjustments, dilution and reconstitution adjustments, de nition with the nurse and physician of the best time for administration, drug substitution, analysis of the route of administration, always ensuring patient safety 22 . The clinical pharmacist in ICU is also instigated to monitor laboratory test changes, as well as to assist in the care of patients on mechanical ventilation 23 . This professional can also perform discharge orientation, answering questions the patient may have about other drugs that help in treatment and how they should be used at home, after discharge 24,25 , or during transitions from the ICU to other units, or from other units to the ICU 13 .…”

Section: Activities Pertinent To the Hospital Clinical Pharmacist In ...mentioning

confidence: 99%

Clinical Pharmacy in the ICU: A Qualitative View of Healthcare Professionals

Nascimento

Marques

Vieira

et al. 2023

Preprint

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Objective: To evaluate the opinion of professionals working in intensive care units (ICU) regarding expectations of the Clinical Pharmacy service. Methods: Data were obtained by the focus group technique and interpreted by content analysis. The group included one physician, two nurses, one nutritionist, one physiotherapist and ten pharmacists. The discussions were led by a psychologist, in which the participants were asked to consider aspects about their experience and professional life in relation to the Intensive Care Clinical Pharmacy service. Results: Analysis of the discussion resulted in four different themes: Activities pertinent to the hospital clinical pharmacist in the Brazilian reality; Existing difficulties in the development of pharmaceutical assistance in ICU; The expectations of the work team regarding the performance of the intensive care clinical pharmacist and Improvements in the provision of the Intensive Care Clinical Pharmacy service. The multidisciplinary team and the clinical pharmacists see the Clinical Pharmacy service as vital for critically ill patients and as a guarantee of patient safety, but they question to what extent communication between the pharmacist and other professionals is adequate, as well as whether undergraduate and graduate courses prepare pharmacists to assist in decisions about patients. Conclusion: Through this research, pertinent questions were raised to be discussed in the literature and analyzed in future studies regarding the perceptions of health professionals, including pharmacists, considering the current moment of modification in the process of providing the Clinical Pharmacy service in Brazil.

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Section: Activities Pertinent To the Hospital Clinical Pharmacist In ...mentioning

confidence: 99%

Clinical Pharmacy in the ICU: A Qualitative View of Healthcare Professionals

Nascimento

Marques

Vieira

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Mechanical ventilation (MV) is a frequently encountered supportive care modality in critically ill patients. (1) While life-saving, mechanical ventilation predisposes patients to notable sequalae that can adversely affect patient-centered outcomes including ventilator induced lung injury (VILI), infection, intensive care unit (ICU) acquired muscle weakness, etc. that make the decision to intubate, daily evaluation of extubation potential, and need for tracheostomy essential bedside assessments.…”

Section: Introductionmentioning

confidence: 99%

“…); however, mechanical ventilation cannot be viewed as an isolated intervention but is deeply intertwined with a patient’s overall clinical status and associated pharmacotherapy regimen. (1,5–11) Indeed, associated pharmacotherapy regimens are complex with over 30% of patients in the ICU setting having greater than 20 medications prescribed. (12,13) This same study showed that 70% of patients had more than 13 medications at any given point.…”

Section: Introductionmentioning

confidence: 99%

Machine learning based prediction of prolonged duration of mechanical ventilation incorporating medication data

Sikora,

Zhao,

Kong

et al. 2023

Preprint

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Rationale: Duration of mechanical ventilation is associated with adverse outcomes in critically ill patients and increased use of resources. The increasing complexity of medication regimens has been associated with increased mortality, length of stay, and fluid overload but has never been studied specifically in the setting of mechanical ventilation. Objective: The purpose of this analysis was to develop prediction models for mechanical ventilation duration to test the hypothesis that incorporating medication data may improve model performance. Methods: This was a retrospective cohort study of adults admitted to the ICU and undergoing mechanical ventilation for longer than 24 hours from October 2015 to October 2020. Patients were excluded if it was not their index ICU admission or if the patient was placed on comfort care in the first 24 hours of admission. Relevant patient characteristics including age, sex, body mass index, admission diagnosis, morbidities, vital signs measurements, severity of illness, medication regimen complexity as measured by the MRC-ICU, and medical treatments before intubation were collected. The primary outcome was area under the receiver operating characteristic (AUROC) of prediction models for prolonged mechanical ventilation (defined as greater than 5 days). Both logistic regression and supervised learning techniques including XGBoost, Random Forest, and Support Vector Machine were used to develop prediction models. Results: The 318 patients [age 59.9 (SD 16.9), female 39.3%, medical 28.6%] had mean 24-hour MRC-ICU score of 21.3 (10.5), mean APACHE II score of 21.0 (5.4), mean SOFA score of 9.9 (3.3), and ICU mortality rate of 22.6% (n=72). The strongest performing logistic model was the base model with MRC-ICU added, with AUROC of 0.72, positive predictive value (PPV) of 0.83, and negative prediction value (NPV) of 0.92. The strongest overall model was Random Forest with an AUROC of 0.78, a PPV of 0.53, and NPV of 0.90. Feature importance analysis using support vector machine and Random Forest revealed severity of illness scores and medication related data were the most important predictors. Conclusions: Medication regimen complexity is significantly associated with prolonged duration of mechanical ventilation in critically ill patients, and prediction models incorporating medication information showed modest improvement in this prediction.

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Assessing the impact of critical care training on pharmacy students in Egypt: a pre-post study

Moustafa,

Hamid,

Hassoub

et al. 2024

BMC Med Educ

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Background Transition to independent pharmacy practice is challenging. Undergraduate and postgraduate pharmacy students in low-to-middle-income countries (LMICs) currently receive minimal experiential learning in critical care. Objective To assess the critical care training course’s impact on pharmacy students’ knowledge, self-efficacy, and self-esteem, as well as their satisfaction with the course. Method In a pre-post interventional study, pharmacy students took a 10-day critical care training course with experiential learning. They completed a knowledge questionnaire covering various critical care topics, the 18 questions Pharmacy Self-efficacy and Self-esteem Study Questionnaire, and a satisfaction questionnaire. Data was analyzed using IBM SPSS version 20.0. Results A total of 72 trainees participated in the study. The average score for pre-course self-efficacy and self-esteem significantly increased post-course, with a median (IQR) of 3.75 (3.50–3.94) compared to 3.56 (3.28–3.78) pre-course, with a p-value of less than 0.05. Furthermore, their overall knowledge score significantly increased from baseline to post-course, with the median (IQR) rising from 0.53 (0.50–0.61) to 0.98 (0.97–1.0), with a p-value of less than 0.05. Their course satisfaction average total score was 45.08 (SD ± 5.41) (on a scale of 10–50). Conclusion The present study provides clear evidence that integrating this critical care training course into a structured curriculum for pharmacy students using experiential learning can act as a facilitator of knowledge enrichment, increase their self-esteem and self-efficacy, and make them satisfied with learning. Larger long duration studies are needed to support this evidence.

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Advanced Modes of Mechanical Ventilation: Introduction for the Critical Care Pharmacist

Cited by 3 publications

References 56 publications

Clinical Pharmacy in the ICU: A Qualitative View of Healthcare Professionals

Clinical Pharmacy in the ICU: A Qualitative View of Healthcare Professionals

Machine learning based prediction of prolonged duration of mechanical ventilation incorporating medication data

Assessing the impact of critical care training on pharmacy students in Egypt: a pre-post study

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