Seth Bauer

@nickmmark Two that are top of mind: 1. “We can stop the antihypertensives since the patient is on pressors.” 2. “We can stop midodrine since we are resuming the patient’s home antihypertensives.” I’m happy to share others if needed.

To be clear I’m looking for specific examples: “The dose of Ativan for seizures is 4 mg not 2” “Always put a stop at discharge on midodrine” Etc

Hey ICU pharmD friends - I’m thinking about doing a @CritCareTime episode about the importance of ICU clinical pharmacists. Specifically I’m looking for top 10 pearls & pet peeves. Got any good ones to share?

@SethRBauer next up on vasopressor choice after norepinephrine (NE) failure- #CHEST2024 NE dose at which vasopressin should be started @gretchensacha ‘s paper journals.lww.com/ccmjournal/abs… Vasopressin response: arterial PH and NE dose europepmc.org/article/pmc/88… Cardiac function and vasopressor response ncbi.nlm.nih.gov/pmc/articles/P… Angiotensin II @KhannaAshishCCM refresher on ATHOS nejm.org/doi/full/10.10… Renin and angiotensin II response: renin could be used as a bio marker pubmed.ncbi.nlm.nih.gov/32609011/

Don’t miss out on downloading this great article before it goes behind the paywall

My current thinking is: 1️⃣We should consider angiotensin II for this rationale particularly if renin is “high” (atsjournals.org/doi/10.1164/rc…) 2️⃣🤷🏻‍♂️ but we probably should be titrating vasopressin and treating it as a vasopressor, not “endocrine replacement”😜 What do you think?

This has me pondering for shock: 1️⃣Why do we use exogenous vasopressin for a “relative deficiency” but not angiotensin II for the same rationale? 2️⃣If we use angiotensin II for a “relative deficiency” why do we titrate the dosage instead of using a fixed dosage like vasopressin?

Framing I didn’t previously consider (inspired by @pwierusz): When the kidneys sense hypoperfusion they release renin to activate the RAS. Since the downstream effect of renin is to increase angiotensin II, the kidneys interpret hypoperfusion as a deficiency of angiotensin II.

@pwierusz @ImBigPharma @AndreaSikora Thanks @pwierusz for using better verbiage than me to express similar thinking.

@ImBigPharma @SethRBauer @AndreaSikora I would argue this is distinctly different when something is started as a means to substitute the existing treatment. For example this study that replaced metaraminol with NE once a central line obtained sciencedirect.com/science/articl…

Thinking about vasopressor verbiage in light of a recent discussion with @pwierusz. Our thinking is aligned but I’m curious about your opinion. If a patient is on norepinephrine, vasopressin is added, then norepinephrine titrated off, is the vasopressin adjunctive or monotherapy?

@AndreaSikora @pwierusz Thanks @AndreaSikora for continuing this conversation. My view is based on intent - in this case vasopressin was intended as adjunctive therapy when started. The fact that vasopressin ended up as the sole agent doesn’t change the intention. But apparently I’m in the minority. 🙃

@pwierusz @SethRBauer For the non-expert audience (me), how do you all see adjunctive v. monotherapy distinction affecting study design or care decisions?

@devlinpharmd @doctorShawniqua @NIDUS_Delirium @AmerDelirium @sharon_inouye Awesome! Congrats @KP_ICURN and others!

@gbosslet Thanks!

@SethRBauer @SICUPharmD @lisa_burry Great #BetterPoster design Seth!!

Thanks @lisa_burry! Poster can be reviewed/downloaded with the link below. Stay tuned for the manuscript - in peer review now. drive.google.com/file/d/1zRaVqP…

This article from the Mayo pharmacy group (co-authored by @erin_barreto and @pwierusz) is downright amazing. 🔥 They have accomplished incredible things! After reading I immediately sent to our team as a model to emulate.

@CarliLehrMDPhD @ClevelandClinic Congrats! Applause from Dumbledore is only fitting with your title.

@GeorgeICUrias I’m not sure if titrated will be better, but note it’s the strategy used in the large vasopressin trials (VASST and VANISH). The mortality effect is small (if any) and predictive enrichment is likely necessary. We discussed dosing on @PharmacyToDose here: podcasts.apple.com/us/podcast/pha…

How should we dose vasopressin in septic shock pts? @SethRBauer et al. tackled this question in a retrospective study which found that 0.03U/min should be good enough. 🎩 tip to the authors. This paper is cited in ‘The Vasopressor & Inotrope Handbook’ 👍🏼 eddyjoemd.com/foamed/

@HeavnerPharmD @umsop Awesome! Huge congrats to you!

🚨NEW POD ALERT🚨 🧂Norepinephrine Position Paper & Sepsis Research Priorities 🥇 Ft. Brittany Bissell Turpin @BissellTurpin Patrick Wieruszewski @pwierusz @mayoanesthesia @curiousboxwood Seth Bauer @SethRBauer History of norepinephrine formulation reporting 📜 Clinical & research implications ⚔️ Management in the drug shortage era 😬 Top 5 clinical sepsis research priorities 5⃣ Why this matters for more than just researchers ⭐️ Important basic science questions 🧑‍🔬 & much more! (Listen to the intros for a surprise or two) podcasts.apple.com/us/podcast/pha… open.spotify.com/show/4zYbVRHrS…

@BissellBrittany @PharmacyToDose

SWEET SIXTEEN aka Third Round Voting 8 games, 8 votes, 1 thread. Vote in each matchup below! Preview Pod: podcasts.apple.com/us/podcast/pha…

@BissellBrittany @PharmacyToDose And yes, I voted for Rivers over VASST 🤣

@BissellBrittany @PharmacyToDose 🙋🏻‍♂️It fundamentally changed how we treat patients with septic shock (flaws and all)