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Hospital Pharmacy 55(6)

Figure 1.  Admission diagnosis. Hemorrhage: gastrointestinal bleed, cerebral bleeds; infection: abscess, cellulitis, febrile neutropenia,
meningitis, osteomyelitis, pneumonia, sepsis, urosepsis; oncology; respiratory: pulmonary embolism, pneumothorax, respiratory distress,
trauma; surgery: abdominal surgery; neurology: altered mental status, seizures, stroke; other: angioedema, cardiac arrest, cirrhosis,
diabetic ketoacidosis, hyperkalemia, pancreatitis, congestive heart failure exacerbation.

Figure 2.  ICU LOS and MV days.

Note. ICU = intensive care unit; LOS = length of stay; MV = mechanical ventilation.

groups having similar average number of days on these infusions-4.0 days (interquartile range [IQR] = 2-5) vs 3.9 days
(IQR = 1-6) in the actual vs adjusted group, respectively.
Percentage of oral benzodiazepine given for further sedation
was 23% in the actual group and 10% in the adjusted group.
Figure 2 provides additional secondary endpoints of
ICU LOS and MV days throughout the hospital course.
Intensive care unit LOS was 10.6 days (IQR = 6-14 days)
in the actual group vs 9.4 days (IQR = 5-12 days) in the
adjusted group (P = .1241). Mechanical ventilation days
was 8.2 (IQR = 4-10 days) in the actual group and 7.1 (IQR
= 4-9 days) in the adjusted group (P = .1435).
Sedation scoring with use of SAS and RASS were similar
between groups (average SAS score range 2.1-4.5 vs 2.2-
4.8, average RASS score range −3.1 to 0.8 vs −2.2 to 0.6 in
the actual group and adjusted group, respectively) as seen in
Table 4. Self-extubation rates were higher in the actual group
as compared with the adjusted group (18 vs 7 days).

Discussion
The management of sedation and agitation has progressed
throughout the past few decades with the discovery of neuropsychological sequelae in patients associated with higher
sedation and longer LOS in the ICU. Therefore, current sedation-agitation guidelines recommend light sedation practices
and avoiding benzodiazepines in hopes to decrease rates of
ICU-delirium in our patients.1,2
Pharmacokinetic (PK) evaluation of propofol found the
volume of distribution can drastically affect sedation in morbidly obese patients based on the lipophilic nature of the drug
that may cause oversedation and risk of drug accumulation.7
Cortinez et al evaluated blood samples from 20 obese patients
receiving propofol during elective laparoscopic bariatric surgery. The average propofol dose used was 6.53 ± 1.11 mg/
kg/h to achieve 4 µg/mL plasma concentrations and a bispectral index (BIS) was measured to assess hypnotic effect (goal



Hospital Pharmacy - December 2020

Table of Contents for the Digital Edition of Hospital Pharmacy - December 2020

Drug Review Updated List of Light-Sensitive Oral Medications Scott Perkins, Adam Evans, and Allison King
Original Articles Prophylactic Enoxaparin Dosing in Obese Orthopedic Patients: A Literature Search Van N. Tran, Ilya Varfolomeev, and Geoff Hill
Significant Published Articles for Pharmacy Nutrition Support Practice in 2019 Roland N. Dickerson, Angela L. Bingham, Todd W. Canada, Lingtak N. Chan, M. Petrea Cober, Sarah V. Cogle, Anne M. Tucker, and Vanessa J. Kumpf
Effect of Therapeutic Interchange on Medication Changes Between Admission and Discharge Ryan A. Popp, Kathleen A. Lusk, Shelley S. Glaess, Donna Burkett, and Rebecca L. Attridge
Evaluating Six Commercially Available Closed-System Drug-Transfer Devices Against NIOSH’s 2015 Draft Vapor Protocol Shiraz Halloush, Ivan A. Reveles, and Jim Koeller
Adjusted vs Total Body Weight–Based Dosing of Sedation and Analgesia Used in the Intensive Care Unit Julianne Yeary, Alexandra Greco, Richard McKnight, Karen Petros, Gregory Schaefer, and Jeffrey Garavaglia
Medication Safety at Home: A Qualitative Study on Caregivers of Chronically Ill Children in Malaysia Chii-Chii Chew, Amar-Singh HSS, Huan-Keat Chan, and Mohamed Azmi Hassali
Hospital Pharmacy - December 2020 - Cover1
Hospital Pharmacy - December 2020 - Cover2
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Hospital Pharmacy - December 2020 - 348
Hospital Pharmacy - December 2020 - Drug Review Updated List of Light-Sensitive Oral Medications Scott Perkins, Adam Evans, and Allison King
Hospital Pharmacy - December 2020 - 350
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Hospital Pharmacy - December 2020 - 352
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Hospital Pharmacy - December 2020 - 365
Hospital Pharmacy - December 2020 - Original Articles Prophylactic Enoxaparin Dosing in Obese Orthopedic Patients: A Literature Search Van N. Tran, Ilya Varfolomeev, and Geoff Hill
Hospital Pharmacy - December 2020 - 367
Hospital Pharmacy - December 2020 - 368
Hospital Pharmacy - December 2020 - 369
Hospital Pharmacy - December 2020 - 370
Hospital Pharmacy - December 2020 - 371
Hospital Pharmacy - December 2020 - 372
Hospital Pharmacy - December 2020 - Significant Published Articles for Pharmacy Nutrition Support Practice in 2019 Roland N. Dickerson, Angela L. Bingham, Todd W. Canada, Lingtak N. Chan, M. Petrea Cober, Sarah V. Cogle, Anne M. Tucker, and Vanessa J. Kumpf
Hospital Pharmacy - December 2020 - 374
Hospital Pharmacy - December 2020 - 375
Hospital Pharmacy - December 2020 - 376
Hospital Pharmacy - December 2020 - 377
Hospital Pharmacy - December 2020 - 378
Hospital Pharmacy - December 2020 - 379
Hospital Pharmacy - December 2020 - 380
Hospital Pharmacy - December 2020 - 381
Hospital Pharmacy - December 2020 - Effect of Therapeutic Interchange on Medication Changes Between Admission and Discharge Ryan A. Popp, Kathleen A. Lusk, Shelley S. Glaess, Donna Burkett, and Rebecca L. Attridge
Hospital Pharmacy - December 2020 - 383
Hospital Pharmacy - December 2020 - 384
Hospital Pharmacy - December 2020 - 385
Hospital Pharmacy - December 2020 - 386
Hospital Pharmacy - December 2020 - 387
Hospital Pharmacy - December 2020 - 388
Hospital Pharmacy - December 2020 - 389
Hospital Pharmacy - December 2020 - 390
Hospital Pharmacy - December 2020 - Evaluating Six Commercially Available Closed-System Drug-Transfer Devices Against NIOSH’s 2015 Draft Vapor Protocol Shiraz Halloush, Ivan A. Reveles, and Jim Koeller
Hospital Pharmacy - December 2020 - 392
Hospital Pharmacy - December 2020 - 393
Hospital Pharmacy - December 2020 - 394
Hospital Pharmacy - December 2020 - 395
Hospital Pharmacy - December 2020 - 396
Hospital Pharmacy - December 2020 - 397
Hospital Pharmacy - December 2020 - 398
Hospital Pharmacy - December 2020 - 399
Hospital Pharmacy - December 2020 - Adjusted vs Total Body Weight–Based Dosing of Sedation and Analgesia Used in the Intensive Care Unit Julianne Yeary, Alexandra Greco, Richard McKnight, Karen Petros, Gregory Schaefer, and Jeffrey Garavaglia
Hospital Pharmacy - December 2020 - 401
Hospital Pharmacy - December 2020 - 402
Hospital Pharmacy - December 2020 - 403
Hospital Pharmacy - December 2020 - 404
Hospital Pharmacy - December 2020 - Medication Safety at Home: A Qualitative Study on Caregivers of Chronically Ill Children in Malaysia Chii-Chii Chew, Amar-Singh HSS, Huan-Keat Chan, and Mohamed Azmi Hassali
Hospital Pharmacy - December 2020 - 406
Hospital Pharmacy - December 2020 - 407
Hospital Pharmacy - December 2020 - 408
Hospital Pharmacy - December 2020 - 409
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