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This issue of Critical Care Nursing Quarterly focuses on the pharmacological management of critically ill patients. Literature and guideline recommendations are continuously changing and being updated, especially for patients in the intensive care unit. It is essential for all members of the multidisciplinary team to be familiar with current therapies and recommendations.


Critically ill patients are particularly susceptible to the adverse effects of medications. Frequently, these drug-induced effects result in changes to the cardiovascular system, including blood pressure, heart rate and rhythm, and heart function. Kennelly and Esaian provide a review of the most prominent drug-induced effects on the cardiovascular system. Patients may also be admitted to the intensive care unit for the treatment of medication overdoses or poisoning, and critical care providers should be familiar with the mechanisms of toxicity and the treatment options for these situations. In the article by Patel, the most prevalent toxicological emergencies encountered in the critical care environment are reviewed, including treatment and reversal with specific antidotes.


The ever-increasing prevalence of infections caused by multidrug-resistant organisms has become a serious concern for health care providers. Treatment options for these infections are often limited and can be a significant challenge for critical care providers. Guervil and Chau examine the mechanisms of resistance and discuss treatment options for these patients, including the role of extended infusions for selected antimicrobial agents and the impact this can have on the treatment of these challenging infections.


Earlier this year, updated treatment guidelines were released by the Society of Critical Care Medicine for the management of pain, agitation, and delirium.1 Two articles, one by Altshuler and Spoelhof and the other by Desai, Chau, and George, review the pharmacological options, mechanisms, and other considerations for the treatment of agitation, pain, and delirium as recommended in these updated guidelines.


New medications are constantly being approved by the Food and Drug Administration, challenging providers to stay updated on new treatment options. Nowhere is this more apparent than with the novel therapies for oral anticoagulation, which have been recently approved. The article by Gass and Weeks weighs the pros and cons of the 3 new oral anticoagulants that are now available and examines key considerations for the use of these new agents, including the all-important issue of reversibility.


The ongoing drug shortage situation continues to be a challenge for all health care providers. The number and frequency of drug shortages continue to increase and most frequently involve medications used in the treatment of critically ill patients. Gulbis, Ruiz, and Denktas discuss the reasons behind drug shortages and the recommended steps for dealing with these shortages. The authors also examine the impact drug shortages have on the pharmacy, nursing, and medical staff's ability to provide optimal care to the critical care population.


In many institutions, the approach to caring for critically ill patients has evolved beyond just the physician and bedside nurses to a true multidisciplinary team of practitioners. A critical care pharmacist is a valuable member of this team and can provide a significant contribution to the overall care of patients. Jurado and Steelman provide readers with an in-depth discussion of the role of the pharmacist in the critical care setting and demonstrate how pharmacists can provide much more to an institution than just dispensing medications.


With this issue, we hope to provide critical care nurses, physicians, and other critical care providers with a thorough review of the pharmacotherapies commonly used in the treatment of critically ill patients. We hope that this will allow all providers to increase their depth of knowledge on these issues and improve the care provided to their patients.


-Brian E. Gulbis, PharmD, BCPS


Issue Editor




1. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41:263-306. [Context Link]