Brian L Erstad

Brian L Erstad

Department Head, Pharmacy Practice-Science
Professor, Pharmaceutical Sciences
Member of the Graduate Faculty
Professor, BIO5 Institute
Primary Department
Contact
(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

Baggs, J. H., Patanwala, A. E., Williams, E. M., & Erstad, B. L. (2012). Dosing of 3-factor prothrombin complex concentrate for international normalized ratio reversal. Annals of Pharmacotherapy, 46(1), 51-56.

PMID: 22190253;Abstract:

Background: Three-factor prothrombin complex concentrate (PCC) is commonly used for reversal of international normalized ratio (INR) in patients who are bleeding or require emergency surgery. However, there is little information regarding the optimal dosing strategy for achieving adequate INR reversal. Objective: To determine whether patients with higher initial INR levels are less likely to achieve adequate INR reversal after receiving 3-factor PCC. Methods: A retrospective cohort study was conducted in a tertiary care medical center in the US. Patients who received 3-factor PCC were grouped into 2 categories based on degree of INR reversal after PCC infusion: (1) adequate reversal (final INR 21.5) or (2) inadequate reversal (final INR >1.5). Initial INR was compared between the 2 groups using the Wilcoxon rank-sum test. A multivariate logistic regression analysis was used to adjust for confounders and determine predictors of adequate INR reversal. Results: Fifty patients met criteria for inclusion in the final analyses. Of these, 58% achieved adequate reversal after PCC. There were no significant differences in patient demographics or in vitamin K or fresh frozen plasma (FFP) use between the 2 groups. Median PCC dose was also similar between the adequate and inadequate reversal groups (25.2 vs 24.5 units/kg, respectively; p = 0.2). The group that did not achieve adequate reversal had a significantly higher initial INR (3.5 vs 2.5, p = 0.012) prior to PCC administration. In the multivariate logistic regression analysis, initial INR was a significant predictor of adequate INR reversal (ie, reversal less likely as INR increases) after adjusting for PCC dose and concurrent use of vitamin K or FFP (OR = 0.38; 95% CI 0.17 to 0.87; p = 0.02). Conclusions: Patients with a higher initial INR are less likely to achieve adequate INR reversal after receiving 3-factor PCC and may require higher doses than were used in the study.

Erstad, B. L. (2001). Octreotide for acute variceal bleeding. Annals of Pharmacotherapy, 35(5), 618-626.

PMID: 11346068;Abstract:

OBJECTIVE: To review the use of octreotide for acute variceal bleeding. DATA SOURCES: Articles were obtained through computerized searches involving MEDLINE (from 1997 to October 2000). Additionally, several textbooks containing information on the diagnosis and management of acute variceal bleeding were reviewed. The bibliographies of retrieved publications and textbooks were reviewed for additional references. STUDY SELECTION: All randomized studies and pharmacoeconomic evaluations that used octreotide therapy for acute variceal bleeding were considered. Randomized controlled trials and meta-analyses involving other therapies for treating variceal bleeding were also reviewed for possible inclusion. DATA EXTRACTION: The primary outcomes extracted from the literature were persistent or recurrent bleeding, need for endoscopic intervention or balloon tamponade, and mortality. DATA SYNTHESIS: Although both endoscopic therapies and medications are used to control bleeding and rebleeding episodes, the endoscopic approach has the additional goal of obliterating the varix. Since rebleeding episodes are common as long as the varix is present, endoscopic and medication therapies cannot be considered interchangeable based on bleeding control alone. However, octreotide by continuous intravenous infusion has demonstrated effectiveness in reducing blood loss and transfusion requirements as both an initial intervention (until definitive sclerotherapy can be performed) or as adjunctive therapy to endoscopic measures. Octreotide can be started quickly, has a relatively rapid onset of action, and does not require someone with endoscopy training to initiate. Additionally, octreotide is relatively free of significant adverse effects. CONCLUSIONS: While additional investigations are needed, particularly in the area of pharmacoeconomics, there is substantial evidence that octreotide is an efficacious therapy with relatively few adverse effects when used in the management of acute variceal bleeding.

Erstad, B. L., Witte, C. L., & Talkington, D. F. (1992). Toxic shock-like syndrome. Pharmacotherapy, 12(1), 23-27.

PMID: 1549535;Abstract:

Invasive group A streptococcal infection has important diagnostic and therapeutic implications in patients with necrotizing fasciitis. We cared for a man with the full-blown syndrome in whom many features of toxic shock syndrome were present, including profound hypotension and renal failure. The diagnostic similarities of toxic shock syndrome and the toxic shock-like syndrome caused by group A Streptococcus could have led to inappropriate treatment. Successful therapy in our patient included high doses initially of broad-spectrum antibiotics, repeated operative debridement of the lower leg (the affected limb), and ultimately, reconstructive surgery consisting primarily of split-thickness skin grafts. The reemergence of invasive streptococcal infections may relate to changes either in virulence factors of the causative streptococcus or in exotoxins elaborated by this microorganism. A causative relationship between an exotoxin produced by group A Streptococcus and the toxic shock-like syndrome has not yet been established.

Camamo, J. M., McCoy, R. H., & Erstad, B. L. (2005). Retrospective evaluation of inhaled prostaglandins in patients with acute respiratory distress syndrome. Pharmacotherapy, 25(2), 184-190.

PMID: 15767234;Abstract:

Study Objectives. To determine whether use of inhaled alprostadil (PGE 1) or epoprostenol (PGI2) significantly improved oxygenation in patients with acute respiratory distress syndrome (ARDS), and to determine whether differences between the two drugs exist with regard to oxygenation, duration of mechanical ventilation and hospitalization, adverse effects, and survival. Design. Retrospective chart review. Setting. A 360-bed tertiary care teaching facility with medical and surgical intensive care units. Patients. Twenty-seven patients admitted to the hospital who received either PGI2 or PGE1 for a primary or secondary diagnosis of ARDS. Measurements and Main Results. Seventeen patients received inhaled PGE 1 and 10 received inhaled PGI2. There were no significant changes in the ratio of arterial partial pressure of oxygen (PaO 2):fraction of inspired oxygen (FiO2) and in the PaO 2, from baseline to any time point that was analyzed during treatment, for patients receiving either PGE1 (p=0.2120 and 0.3399, respectively) or PGI2 (p=0.1655 and 0.0784, respectively). Conclusion. No statistically significant improvement in oxygenation was observed in patients receiving either PGE1 or PGI2. In addition, no significant differences were found between the two prostaglandins for the variables studied. Until positive results from large, prospective studies are available, we recommend that these inhaled prostaglandins not be used to treat ARDS.

Camamo, J. M., Weibel, K., O'Keeffe, T., Huckleberry, Y., Kopp, B. J., Diven, C., & Erstad, B. L. (2014). Cost savings with interventions to reduce aerosolized bronchodilator use in mechanically ventilated patients. Journal of critical care, 29(5), 814-6.

The purpose of this evaluation is to describe the cost savings associated with multimodal interventions aimed at reducing aerosolized bronchodilator use in mechanically ventilated patients without adversely affecting costs associated with length of stay (LOS).