PGY2 Critical Care Pharmacy Residency

Outcomes associated with bacteremia in patients with axillary mechanical circulatory support devices

Diane Dreucean, PharmD; Celia Morton, PharmD; Luma Succar, PharmD; Jill Krisl, PharmD; Katherine Perez, PharmD; Kevin Donahue, PharmD

PURPOSE Development of bloodstream infections (BSI) while on durable mechanical circulatory support (MCS) devices has been shown to negatively impact orthotopic heart transplantation (OHT) outcomes. However, this association has not been explored in patients on temporary MCS. The aim of this study was to assess the incidence of BSI in patients with axillary MCS devices and characterize patient outcomes following device removal.

METHODS

We retrospectively reviewed 194 patients that underwent axillary MCS device placement with an intra-aortic balloon pump (IABP), Impella® 5.0, or Impella® 5.5 from May 2016 through August 2020. The primary endpoint was the incidence of BSI during axillary device support, reported as the proportion of patients who developed a BSI and BSI per 1000-device days.

RESULTS

We retrospectively reviewed 194 patients that underwent axillary MCS device placement with an intra-aortic balloon pump (IABP), Impella® 5.0, or Impella® 5.5 from May 2016 through August 2020. The primary endpoint was the incidence of BSI during axillary device support, reported as the proportion of patients who developed a BSI and BSI per 1000-device days.

CONCLUSION

Incidence of BSI across axillary-placed MCS devices is not well defined. Our results demonstrate that unique factors, such as longer duration of MCS or prior femoral device use, can play a role in development of BSI and warrant further investigation. Strategies to prevent BSI, including use of peri-procedural antimicrobials, may have clinical utility in improving post-device outcomes. Larger studies are needed to fully elucidate risk factors associated with BSI development in this patient population, evaluate the BSI risk profile of femoral versus axillary MCS devices, and assess the impact of BSI on patient outcomes.

PGY2 CRITICAL CARE PHARMACY RESIDENCY

Diane Dreucean, PharmD

Diane completed her undergraduate coursework and earned her PharmD from the University of Houston in 2019. She completed her PGY1 at Houston Methodist Hospital. Following completion of her PGY2, Diane will be staying on at Houston Methodist Hospital as an overnight critical care clinical pharmacy specialist. Primary Project Preceptor: Kevin Donahue, PharmD, BCPS

Presented at 2020 Virtual ASHP Midyear Clinical Meeting; 2021 TMC Critical Care Virtual Research Forum

Evaluation of inhaled alprostadil in hospitalized adult patients

Hangil Seo, PharmD; Chelsea N. Lopez, PharmD; Luma Succar, PharmD; Kevin R. Donahue, PharmD

PURPOSE Intermittent inhaled alprostadil (iPGE1) represents a potential alternative to traditional inhaled pulmonary vasodilators, however there is limited evidence for its use in adult patients. The goal of this study was to describe the clinical characteristics of inpatients receiving iPGE1 and identify the populations most likely to benefit from its use.

METHODS

This was a single center, retrospective, descriptive analysis of all inpatient adult patients who received at least one dose of iPGE1 at a large academic medical center from May 2016 to July 2020. The primary objective of this study was to describe the patient characteristics and dosing strategies employed. Secondary outcomes included changes in respiratory support requirements, hemodynamics, and inotropic or vasoactive drug dosing. Outcomes were stratified and compared based on the primary indication for alprostadil initiation as either cardiac or pulmonary.

RESULTS

Fifty-four patients received iPGE1 and were included in the study. Indication for iPGE1 use was pulmonary (pHTN or ARDS) in 40 (75%) patients or cardiac in 14 (25%) patients. Overall, there was no difference between indications in the number of patients de-escalated from baseline level of respiratory (53% vs 57%, p = 0.76), inotropic (70% vs 57%, p=0.39), or vasopressor support (78% vs 57%, p=0.17). Furthermore, there was no significant improvement in partial pressure to fraction of inspired oxygen ratios, cardiac index, or pulmonary artery pressures in either of the groups at multiple time intervals after iPGE1 initiation.

CONCLUSION

This study represents the largest to date investigation on the use of intermittent iPGE1 in hospitalized patients. Alprostadil was utilized in novel populations; however, efficacy as evaluated by clinical or surrogate endpoints could not be demonstrated. Further investigation is needed in select subpopulations to evaluate for its optimal place in therapy.

PGY2 CRITICAL CARE PHARMACY RESIDENCY

Hangil Seo, PharmD, BCPS

Hangil earned his BS in Pharmaceutical Sciences in 2016 and PharmD from the University of Pittsburgh in 2018. He completed his PGY1 residency at NYU Langone Health in New York, New York. Following completion of his PGY2, Hangil will work as an overnight critical care clinical pharmacy specialist at Tufts Medical Center. Primary project preceptor: Chelsea Lopez, PharmD, BCCCP

Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Texas Medical Center PGY2 Critical Care Resident Research Virtual Forum.