A pharmacy-initiated electronic handoff tool may reduce the proportion of AAP-naive ICU survivors with an AAP continued at the time of ICU transfer. The handoff tool was not associated with a significant reduction in the discharge prescribing rates of AAPs for hospital survivors, but a clinically meaningful reduction was possibly achieved due to enhanced communication enabled by this tool.

Purpose Studies of critical care physicians and nursing personnel indicate a potentially high rate of burnout. To date there is a paucity of data in critical care pharmacists assessing burnout in this group. The purpose of this study was to assess the incidence of risk of burnout in critical care pharmacists. Methods Critical care pharmacists were solicited via email to complete an anonymous, electronic questionnaire regarding burnout. Subject demographic and employment characteristics were collected along with the validated, 22-item Maslach Burnout Inventory Health Services Survey in the study cohort. Burnout was assessed from 3 aspects, emotional exhaustion, depersonalization, and lack of personal accomplishment. High degree of burnout was defined as a score >27 in emotional exhaustion, or score >10 in depersonalization, or score <33 in personal achievement. Risk factors of burnout were evaluated using descriptive statistics and logistic regression. Results Out of 3,140 critical care pharmacists, 193 (6.1%) completed surveys. The mean scores were 25.3, 7.5, and 36.7 for emotional exhaustion, depersonalization, and reduced personal achievement, respectively. Overall, 123 pharmacists (64%) reported at least one syndrome of burnout, and 28 pharmacists (14.5%) reported burnout in all 3 scales. No single risk factor was identified to be associated with the risk of burnout. Conclusion Risk of burnout is high in critical care pharmacists, at 64%, and is comparable to the risk in other critical care practitioner groups. This emphasizes the importance of continuing to evaluate risk factors for burnout and providing resources for burnout prevention to high-risk practitioners.

Vasopressin initiated as an adjunct vasopressor, as opposed to first-line therapy, was associated with response.

OBJECTIVE The primary objective of this study was to determine whether an association exists between deep sedation from continuous infusion sedatives and extubation failures in mechanically ventilated children. Secondary outcomes evaluated risk factors associated with deep sedation. METHODS This was a retrospective cohort study conducted between January 1, 2009, and October 31, 2012, in the pediatric intensive care unit (PICU) at Duke Children's Hospital. Patients were included in the study if they had been admitted to the PICU, had been mechanically ventilated for ≥48 hours, and had received at least one continuous infusion benzodiazepine and/or opioid infusion for ≥24 hours. Patients were separated into 2 groups: those deeply sedated and those not deeply sedated. Deep sedation was defined as having at least one documented State Behavioral Scale (SBS) of −3 or −2 within 72 hours prior to planned extubation. RESULTS A total of 108 patients were included in the analysis. Both groups were well matched with regard to baseline characteristics. For the primary outcome, there was no difference in extubation failures in those who were deeply sedated compared to those not deeply sedated (14 patients [22.6%] versus 7 patients [15.2%], respectively; p = 0.33). After adjusting for potential risk factors, patients with a higher weight percentile for age (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00–1.03), lower Glasgow Coma Score (GCS) score prior to intubation (OR 0.85; 95% CI 0.74–0.97), and larger maximum benzodiazepine dose (OR 1.93; 95% CI 1.01–3.71) were associated with greater odds of deep sedation. A higher GCS prior to intubation was significantly associated with increased odds of extubation failure (OR 1.19; 95% CI 1.02–1.39). CONCLUSIONS While there was no statistically significant difference in extubation failures between the 2 groups included in this study, considering the severe consequences of extubation failure, the numerical difference reported may be clinically important.

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