Major Publications in the Critical Care Pharmacotherapy Literature: 2021

Abstract

OBJECTIVES: To summarize the most impactful articles relevant to the pharmacotherapy of critically ill adult patients published in 2021. DATA SOURCE: PubMed/MEDLINE. STUDY SELECTION: Randomized controlled trials, prospective studies, or systematic review/meta-analyses of adult critical care patients assessing a pharmacotherapeutic intervention and reporting clinical endpoints published between January 1, 2021, and December 31, 2021. DATA EXTRACTION: Candidate articles were organized by clinical domain based on the emerging themes from all studies. A modified Delphi process was applied to obtain consensus on the most impactful publication within each clinical domain based on overall contribution to scientific knowledge and novelty to the literature. DATA SYNTHESIS: The search revealed 830 articles, of which 766 were excluded leaving 64 candidate articles for the Delphi process. These 64 articles were organized by clinical domain including: emergency/neurology, cardiopulmonary, nephrology/fluids, infectious diseases, metabolic, immunomodulation, and nutrition/gastroenterology. Each domain required the a priori defined three Delphi rounds. The resultant most impactful articles from each domain included five randomized controlled trials and two systematic review/meta-analyses. Topics studied included sedation during mechanical ventilation, anticoagulation in COVID-19, extended infusion beta-lactams, interleukin-6 antagonists in COVID-19, balanced crystalloid resuscitation, vitamin C/thiamine/hydrocortisone in sepsis, and promotility agents during enteral feeding. CONCLUSIONS: This synoptic review provides a summary and perspective of the most impactful articles relevant to the pharmacotherapy of critically ill adults published in 2021.

A redução da morbimortalidade no choque séptico com o uso precoce de hidrocortisona

“…( SEVRANSKY et al, 2021;DALBY e EASTIN, 2020;GROSSESTREUER et al, 2020). Por sua vez, seis estudos trouxeram resultados inconclusivos (MOSKOWITZ et al, 2018;WIERUSZEWSKI et al, 2022;KRISHNAN et al, 2022;MOSKOWITZ et al, 2019;HAGER et al, 2019;LINDSELL et al, 2019) e, portanto, não foram capazes de reforçar o uso rotineiro dos corticoides como terapia fundamental no manejo do choque séptico. Esses achados corroboram uma visão de incerteza acerca do assunto.…”

“…Finalmente, constatou-se que 6 artigos obtiveram resultados inconclusivos quanto ao uso da hidrocortisona no manejo do paciente com sepse, devido à carência de evidências claras em relação à conduta (MOSKOWITZ, 2018;WIERUSZEWSKI, 2022;e KRISHNAN et al, 2022) e à não conclusão de alguns desses estudos (MOSKOWITZ et al, 2019;HAGER et al, 2019;LINDSELL et al, 2019).…”

Major Publications in the Critical Care Pharmacotherapy Literature: 2022

“…To mitigate information overload, strategies have been used to keep up with literature including journal surveillance, interaction with scientific and media communities, and services to journals including article review and editorial work (3). The Clinical Pharmacy and Pharmacology Literature Update (CPPLU) working group within the Society of Critical Care Medicine reviews major critical care journals, distributes a monthly summary to various sections of the Society, and reviews influential articles relevant to critical care pharmacotherapy annually (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Therefore, we aimed to summarize the most influential publications related to the pharmacotherapeutic care of critically ill patients in 2022.…”