Brian Erstad, Recently Served as Co-Chair of a Guideline Development Committee for the Society of Critical Care Medicine

Brian Erstad, PharmD, interim dean and professor of pharmacy practice and science at the University of Arizona R. Ken Coit College of Pharmacy, recently served as the Co-Chair of a clinical practice guideline development committee for the Society of Critical Care Medicine (SCCM). 

The SCCM is the largest nonprofit medical organization dedicated to promoting excellence and consistency in the practice of critical care. With members in more than 80 countries, SCCM is the only organization that represents all professional components of the critical care team. The organization offers a variety of activities that ensure excellence in patient care, education, research, and advocacy.

“I was honored to be selected as co-chair of this clinical practice guideline intended to help clinicians ensure appropriate use of neuromuscular blocking agents in critically ill patients,” said Erstad. “Neuromuscular blocking agents are often used in the intensive care unit setting but are considered high-risk medications with potentially life-threatening complications if not used appropriately. These guidelines intend to ensure appropriate use in patients with acute respiratory distress syndrome (ARDS).”

The guidelines, “Society of Critical Care Medicine Guidelines for the Administration of Neuromuscular Blockade in Adults With Acute Respiratory Distress Syndrome,” are an update of previous guidelines on the use of neuromuscular blockers, medications that temporarily paralyze muscles, in critically ill patients. While past guidelines covered many topics, including when to use these drugs, how different types work, and how to prevent side effects, this update focuses specifically on ARDS. The panel chose ARDS because it is the most common reason these medications are used for longer periods in the ICU and because it carries a high risk of death. Studies also show that even patients who do not have ARDS when they are first placed on a ventilator can still develop it later, with about 30% of ventilated ICU patients being at risk.

The panel, chaired by Erstad, looked at how to treat patients with ARDS and suggested using certain muscle-paralyzing medications (called NMBAs) in adults with moderate to severe ARDS because these drugs can help the body work better with a ventilator.

For many of the other decisions, the experts essentially found that there isn’t enough strong evidence to recommend one approach over another. This includes questions like whether it’s better to adjust the drug dose based on the patient’s response or give a standard fixed dose, whether doctors should rely on monitoring tools to guide how deeply a patient is sedated when using these drugs, and whether these medications should be used when patients are placed face down (a position sometimes used to improve breathing). Overall, the takeaway is that while these drugs can be helpful in more severe cases, with the finer details still uncertain, doctors need to rely on their clinical judgment while keeping patient safety and comfort in mind.

Erstad additionally co-authored “Comparison of Histamine-2 Receptor Antagonists and Proton Pump Inhibitors for Stress Ulcer Prophylaxis in Patients With Septic Shock” with Asad Patanwala, PharmD, in the journal Critical Care Medicine. This study compared two types of medications, histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), used to prevent stress ulcers in hospitalized patients with septic shock. Erstad and Patanwala analyzed data from over 15,000 patients across 220 hospitals in the U.S. They found that PPIs were more effective than H2RAs in reducing the risk of upper gastrointestinal bleeding (UGIB), with an odds ratio of 0.78. However, there were no significant differences between the two groups in terms of mortality, ventilator-associated pneumonia, Clostridioides difficile infection, or length of hospital stay. These findings suggest PPIs may be preferable for stress ulcer prevention in these patients.

Erstad joined the College of Pharmacy faculty in 1988 and went on to lead the Department of Pharmacy Practice and Science for more than a decade, serving in that role until 2024, before becoming interim dean in July 2025. In addition to more than 350 peer‐reviewed publications and book chapters, he is the editor of the renowned textbook “Critical Care Pharmacotherapy”. He is an international expert who has made major contributions and held leadership roles in numerous professional organizations.