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

Video Transcription

Video Summary

The webcast presented three pharmacy resident-led journal club reviews pertinent to critical care pharmacy practice. Steven Sloan discussed a large multicenter target trial emulation assessing sodium bicarbonate use in ICU metabolic acidosis. The study found a modest 2% absolute reduction in 30-day ICU mortality associated with bicarbonate use, particularly in subgroups with severe acidosis, acute kidney injury, or vasopressor support. Despite robust statistical methods, limitations included its retrospective design and lack of dosing detail, prompting calls for large randomized trials.<br /><br />Lauren Finch reviewed peripheral vasopressor administration in early sepsis-induced hypotension, analyzing a secondary cohort from the Clover trial across 60 US hospitals. Peripheral vasopressor initiation was common (~84%) and enabled faster therapy start with lower doses, with very low rates of complications (0.6%). Mortality was not increased with peripheral use, supporting its safety and practical benefits, though institutional practices varied widely and randomized studies are needed to confirm findings.<br /><br />Jonathan Uribe summarized the BRIDGE-TNK trial from China comparing tenecteplase plus thrombectomy versus thrombectomy alone for acute ischemic stroke. The combination modestly improved 90-day functional independence (NNT=11) without significant safety differences. Limitations include modest effect size, open-label design, and limited generalizability outside China. Nevertheless, findings support cautious adoption of tenecteplase bridging in appropriate patients.<br /><br />Overall, these studies highlight evolving pharmacotherapeutic strategies in critical illness, balancing modest benefits with safety and operational considerations, and underscore the need for further large randomized controlled trials to inform clinical guidelines.

Asset Subtitle

Pharmacology, Shock Non-Sepsis, Sepsis

Meta Tag

Content Type Webcast

Knowledge Area Pharmacology

Knowledge Area Sepsis

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Shock

Tag Anticoagulation

Year 2025

Keywords

Webcast

Pharmacology

Sepsis

Shock

Anticoagulation

2025

Associate

Professional

Select

critical care pharmacy

sodium bicarbonate

ICU metabolic acidosis

peripheral vasopressors

sepsis-induced hypotension

tenecteplase

acute ischemic stroke

randomized controlled trials

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