Brian L Erstad
Department Head, Pharmacy Practice-Science
Professor, BIO5 Institute
Professor, Pharmaceutical Sciences
Primary Department
Department Affiliations
(520) 626-4289
Work Summary
Brian Erstad’s research interests pertain to critical care medicine with an emphasis on patient safety and related outcomes research.
Research Interest
Brian L. Erstad, PharmD, FCCM, is currently a tenured professor and head of the Department of Pharmacy Practice and Science. He is also a center investigator for the Center for Health Outcomes and PharmacoEconomics Research and a co-director for the Arizona Clinical and Translational Research Graduate Certificate Program. His clinical responsibilities are performed at Banner-University Medical Center Tucson.Dr. Erstad’s research interests pertain to critical care medicine with an emphasis on patient safety and related outcomes research. He has authored more than 150 peer-reviewed articles and book chapters.Dr. Erstad has served on the board of directors of the American Society of Health-System Pharmacists and on numerous committees and task forces for other organizations including AHRQ, USP, Society of Critical Care Medicine and the American College of Chest Physicians. He is currently an ad hoc member of the FDA’s Drug Safety and Risk Management Advisory Committee, a steering committee member of the United States Critical Illness and Injury Trials (USCIIT) Group, and treasurer of the American College of Clinical Pharmacy.

Publications

Herout, P. M., & Erstad, B. L. (2004). Medication errors involving continuously infused medications in a surgical intensive care unit. Critical Care Medicine, 32(2), 428-432.

PMID: 14758159;Abstract:

Objective: To document the incidence of medication errors related to medications administered by continuous infusion. Design: Observational study. Setting: Sixteen-bed surgical intensive care unit. Measurements and Main Results: All continuous infusions in the surgical intensive care unit were evaluated at least once daily for correct flow-sheet charting, concentration, infusion rate, and dose administered, as well as patients' heights and weights (actual, ideal, and "dry"). Collected information was examined to determine the error rate, types of errors occurring, and weight used for dose calculation. Variations inpatient weight measures were compared. Seventy-one patients with 202 total infusions were observed. Errors involving continuously infused medications in our surgical intensive care unit occurred at a rate of 105.9 per 1,000 patient days. For nonweight-based infusions, 94% of doses were delivered correctly. Slightly >10% of the doses administered for weight-based infusions (dose based on dry body weight) were incorrect. Significant differences were found between the weight measurements recorded, but this did not translate into statistically significant differences in the apparent calculated doses delivered. Conclusions: Medications delivered by continuous infusion, particularly those that are weight based, can contribute to medication errors in the intensive care unit. A large proportion (87.6%) of doses for weight-based infusions was calculated based on estimated or unreliable admission weights. There were no severe consequences resulting from the errors observed in this 1 month investigation; however, depending on the pharmacokinetic characteristics of the drug being administered, there is a potential to deliver artificially low or high doses resulting in subtherapeutic or adverse effects.

Traylor, B. R., Patanwala, A. E., Sakles, J. C., & Erstad, B. L. (2013). Under-dosing of etomidate for rapid sequence intubation in the emergency department. Current Clinical Pharmacology, 8(4), 253-256.

Abstract:

Objective: The objective of this study was to determine if patients who weigh ≥100 kg are more likely to receive under-dosing of etomidate compared to those who weigh

Erstad, B., Patanwala, A. E., Warholak, T. L., Sanders, A. B., & Erstad, B. L. (2010). A prospective observational study of medication errors in a tertiary care emergency department. Annals of emergency medicine, 55(6).

We determine the rate and severity of medication errors, as well as factors associated with error occurrence in the emergency department (ED).

Puntillo, K., Pasero, C., Denise, L. i., Mularski, R. A., Grap, M. J., Erstad, B. L., Varkey, B., Gilbert, H. C., Medina, J., & Sessler, C. N. (2009). Evaluation of pain in ICU patients. Chest, 135(4), 1069-1074.

PMID: 19349402;Abstract:

Pain is a common and distressing symptom in ICU patients. Yet a major challenge exists in assessing and evaluating the pain. Although the patient's self-report of pain is the "gold standard" for pain assessment, other methods must be considered when patients are unable to self-report. Currently only two pain behavior instruments have been tested for their reliability, validity, and feasibility of use in ICUs: the pain behavior scale and the Critical-Care Pain Observation Tool. Other tools, albeit with less validity testing, include the pain assessment, intervention, and notation (PAIN) algorithm and a pain behaviors checklist. When established tools are insufficient to evaluate a patient's pain, alternative methods of augmenting a pain evaluation should be considered. These can include the completion of a pain risk profile, use of surrogates, or performance of an analgesic trial. Meticulous attention to the evaluation of a critically ill patient's pain provides the basis for selection of pain interventions and the subsequent assessment of the intervention's effectiveness. Copyright © 2009 American College of Chest Physicians.

Doungngern, T., Huckleberry, Y., Bloom, J. W., & Erstad, B. (2012). Effect of albumin on diuretic response to furosemide in patients with hypoalbuminemia. American Journal of Critical Care, 21(4), 280-286.

PMID: 22751371;Abstract:

Background Albumin is broadly prescribed for critically ill patients although it does not have a mortality benefit over crystalloids. One common use of albumin is to promote diuresis. Objectives To compare urine output in patients treated with furosemide with and without albumin and to assess other variables possibly associated with enhanced diuresis. Methods A retrospective study was conducted on patients in a medical intensive care unit who received furosemide therapy as a continuous infusion with and without 25% albumin for more than 6 hours. Primary end points were urine output and net fluid loss. Results A total of 31 patients were included in the final analysis. Mean urine output in patients treated with furosemide alone did not differ significantly from output in patients treated with furo -semide plus albumin at 6, 24, and 48 hours: mean output, 1119 (SD, 597) mL vs 1201 (SD, 612) mL, P= .56; 4323 (SD, 1717) mL vs 4615 (SD, 1741) mL, P = .42; and 7563 mL (SD, 2766) vs 7432 (SD, 2324) mL, P = .94, respectively. Additionally, net fluid loss did not differ significantly between the 2 groups at 6, 24, and 48 hours. Higher concentrations of serum albumin did not improve urine output. The only independent variable significantly associated with enhanced urine output at 24 and 48 hours was increased fluid intake. Conclusion Addition of albumin to a furosemide infusion did not enhance diuresis obtained with furosemide alone in critically ill patients. © 2012 American Association of Critical-Care Nurses.