Critical Care and Shock

Hypertension remains the “silent killer”. Over 72 million Americans suffer from this condition and it is estimated that as many as 1 billion people worldwide may have it [1]. Critical care clinicians are likely to encounter patients with this malady. Indeed, one percent of patients with essential hypertension (HTN) will develop at some point in their life a hypertensive crisis [2].

A 54 year-old Caucasian gentleman with history of diabetes presented to emergency department with complaints of facial swelling for one week and left orbital pain of one day duration. The patient underwent computed tomography (CT) scan of head with intravenous contrast which revealed infl ammation of left medial rectus muscle and cellulites of medial left orbital coronal space deep to and surrounding the medial rectus muscle with some lateral deviation of the left eye. In addition, left maxillary sinus disease was noted.

Airway pressure release ventilation (APRV) is a relatively new mode of ventilation that became commercially available in the United States in the mid-1990s. APRV differs fundamentally from that of conventional positive-pressure ventilation. Whereas conventional modes of ventilation begin the ventilatory cycle at a baseline pressure and elevate airway pressure to accomplish tidal ventilation, APRV commences at an elevated baseline pressure and follows with a deflation to accomplish tidal ventilation (Figure 1) [1].

Objective: The primary objective of this study was to characterize how vasopressor and inotropic agents are prescribed and administered in the hemodynamic management of sepsis. Secondary objectives were 1) to evaluate adherence with published guidelines to identify areas of deviation and 2) to describe pharmacists’ perceived incidence of adverse drug reactions (ADRs) of vasopressors and inotropes.
Design and setting: Web-based survey.
Patients and participants: Critical care pharmacists.