SCCM Resource Library-July Journal Club: Spotlight on Pharmacy (2025)

Video Transcription

Video Summary

The webcast featured three pharmacy residents presenting recent critical care studies. <br /><br />Grace Zhang reviewed the A2B trial comparing dexmedetomidine or clonidine-based sedation versus propofol in mechanically ventilated ICU patients. The open-label multicenter UK trial found no significant difference in time to successful extubation or mortality among groups, though alpha-2 agonists increased bradycardia and agitation risks. The study suggested dexmedetomidine remains an alternative for light sedation but does not clearly improve outcomes over propofol.<br /><br />Becky Mann presented a meta-analysis comparing norepinephrine versus epinephrine for post-cardiac arrest shock. Including six mostly retrospective studies of 3,458 patients, norepinephrine was associated with fewer recurrent cardiac arrests, especially in out-of-hospital arrests and shockable rhythms, but no mortality or neurological outcome differences. The analysis highlighted heterogeneity and limited randomized data, stressing need for standardized definitions and further research. Norepinephrine is generally favored as first-line vasopressor.<br /><br />Hollyann Brown discussed a multicenter retrospective study comparing andexanet alfa versus four-factor prothrombin complex concentrate (PCC) for reversal of factor Xa inhibitor–related intracranial hemorrhage. Andexanet showed slightly better hemostatic efficacy but higher thrombotic events, with no mortality or discharge outcome differences. Given high cost and safety concerns, PCC remains widely used despite guideline endorsements of andexanet as first-line.<br /><br />Overall, these recent trials emphasize the complexity of critical care pharmacotherapy, balancing efficacy, safety, and cost, while underlining gaps for future research to optimize sedation, vasopressor choice, and anticoagulant reversal.

Asset Subtitle

Pharmacology, Neuroscience, Cardiovascular, 2025

Meta Tag

Content Type Webcast

Knowledge Area Pharmacology

Knowledge Area Neuroscience

Knowledge Area Cardiovascular

Membership Level Professional

Membership Level Select

Membership Level Associate

Tag Vasoactive Agents

Tag Analgesia and Sedation

Tag Anticoagulation

Year 2025

Keywords

Webcast

Pharmacology

Neuroscience

Cardiovascular

Vasoactive Agents

Analgesia and Sedation

Anticoagulation

2025

Professional

Select

Associate

critical care pharmacotherapy

dexmedetomidine

propofol sedation

norepinephrine vs epinephrine

post-cardiac arrest shock

andexanet alfa

prothrombin complex concentrate

factor Xa inhibitor reversal

multicenter clinical trials

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