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Introduction: Angiotensin II (Ang-2) is a non-catecholamine vasopressor that targets the renin-angiotensin-aldosterone system by agonism of the angiotensin type 1 receptor. Its utility as a vasopressor and a catecholamine-sparing agent was demonstrated in the pivotal ATHOS-3 trial, and numerous post-hoc analyses have shown reduced mortality in certain subsets of the population. Methods: Consecutive adult patients at 5 centers who received Ang-2 from 2017-2020 were included in this multicenter, retrospective observational cohort study. Patient demographics, hemodynamics, and adverse events were collected. The primary outcomes of the study were the mean difference in MAP and norepinephrine (NEpi)-equivalent dose at hours 0 and 3 following initiation of Ang-2 therapy. Results: One hundred and sixty-two patients were included in this study. The primary outcomes of an increase in MAP (mean difference 9.3 mmHg, 95% CI 6.4-12.1, p < 0.001) and a reduction in NEpi equivalent dose (mean difference 0.16 µg/kg/min, 95% CI 0.10-0.22, p < 0.001) between hours 0 and 3 were statistically significant. The median time to reach a MAP ≥65 was 16 minutes (IQR 5-60 min). After stratifying patients by the NED dose and number of vasopressors administered prior to the initiation of Ang-2, those with a NED dose < 0.2 µg/kg/min, NED dose < 0.3 µg/kg/min, or those on ≤ 3 vasopressors had a significantly greater reduction in NED by hour 3 than those patients above these thresholds. Conclusion: Ang-2 is an effective vasopressor and reduces catecholamine dose significantly. Its effect is rapid, with target MAP obtained within 30 minutes in most patients. Given the critical importance of adequate blood pressure to organ perfusion, Ang-2 should be considered when target MAP cannot be achieved with conventional vasopressors. Ang-2 should be utilized early in the course of shock, before the NED dose exceeds 0.2-0.3 µg/kg/min and before the initiation of the fourth-line vasopressor. [ABSTRACT FROM AUTHOR]

Introduction: Pharmacists are widely recognized members of the critical care health care team. However, unlike other health care professions, critical care pharmacists do not have standardized pharmacist to patient ratios that establish maximal cost‐efficiency while maintaining optimal patient safety. Though many prior recommendations claim a ratio of 1:15 for safe pharmacy practice, recommendations have ranged as low as 1:8 to as high as 1:30. Objectives: To determine critical care pharmacists' perceptions of pharmacist to patient ratios within the intensive care unit (ICU) and qualitatively and quantitatively describe critical care pharmacist work environments. Methods: A cross‐sectional survey of pharmacists was conducted to identify current pharmacist to patient ratios and identify pharmacist perceptions of the safety of these ratios. Responses were presented using descriptive statistics. Multiple linear regression was conducted to determine factors associated with perceptions of workload and patient safety. Results: The response rate was 11% (n = 185). The majority of respondents reported participating in activities beyond patient care. The majority of pharmacists cared for more than 15 patients daily (n = 155, 84%), and 16% took care of 15 or fewer patients. About 30% of pharmacists did not feel the pharmacist to patient ratio optimized patient safety, and over half reported perceptions overwork. A majority of participants (n = 130, 76%) expressed a need for additional critical care pharmacists at their institutions. Higher pharmacist to patient ratios were associated with increased perception of unsafe patient care −.343 (−.507 to −.180, P <.001). Conclusions: Heterogeneity exists among critical care pharmacy activities that may influence pharmacists' perceptions of workload and patient safety. Critical care pharmacists report that their institutions should have more critical care pharmacists. Pharmacists' perceptions of workload vary based on differences in their activities outside of patient care. [ABSTRACT FROM AUTHOR]