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7/30/2020 1 ASHP/SCCM COVID-19 Pharmacology Debates: Steroid and Antiviral Use Control Panel Audience Participation
Transcript of ^,W l^ D Ks/ r í õ W Z u } o } P Ç W ^ } ] v v ] À ] o h · Z u ] À ] t dd r í d ] o ] P o:,...
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ASHP/SCCM COVID-19 Pharmacology Debates: Steroid and
Antiviral Use
Control Panel
Audience Participation
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Webcast Recording
This webcast is being recorded. The recording will be available in early August.
To access go to: covid19.sccm.org/webcast or https://www.ashp.org/COVID-19
The Society of Critical Care Medicine (SCCM)
and the American Society of Health-System
Pharmacists (ASHP)partnered to
produce this webinar on COVID-19.
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Today’s Moderator
Moderator:
Mojdeh Heavner, Pharm.D., BCPS, BCCCP, FCCMAssociate Professor and Vice Chair of Clinical ServicesDepartment of Pharmacy Practice and ScienceUniversity of Maryland School of PharmacyBaltimore, Maryland, USA
No disclosures
ASHP/SCCM COVID-19 Pharmacology Debates: Antiviral Use
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Polling Question: If you were to utilize remdesivir in a patient with COVID-19, who do you feel is the most appropriate patient?
A. All patients with COVID-19 should receive remdesivir at any time point after diagnosis
B. Only patients on supplemental O2 should receive remdesivir within 10-14 days of diagnosis
C. Only patients requiring mechanical ventilation should receive remdesivir within 10-14 days of diagnosis
D. I would not give remdesivir to any patient with COVID-19 at any time point after diagnosis
Debate 1- Antiviral Use in COVID-19 PatientsGretchen Sacha, Pharm.D., BCCCPCritical Care Pharmacy SpecialistCleveland ClinicCleveland, Ohio, USA
No disclosures
Krutika N. Mediwala, Pharm.D., BCPS, BCIDPClinical Pharmacy SpecialistInfectious Diseases/Antimicrobial StewardshipResidency Program DirectorPGY2 Infectious Diseases ResidencyAffiliate Assistant ProfessorMedical University of South Carolina (MUSC)College of Pharmacy MUSC Health
Disclosure: Speakers Bureau for Cepheid
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Pro: Remdesivir Use In COVID-19 Patients
Gretchen Sacha, Pharm.D.Critical Care Clinical Pharmacy Specialist
Cleveland ClinicCleveland, Ohio, USA
@krutu8
• Hydroxychloroquine (Plaquenil®) / Chloroquine• Lopinavir/Ritonavir (Kaletra®)• Favipiravir (Avigan®)• Baloxavir• Umifenovir (Arbidol®)• Remdesivir
Antivirals in COVID-19
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• Broad spectrum anti-viral agent• Adenosine analogue – inhibits viral RNA polymerase• In vitro and in vivo activity against Ebola, SARS-CoV, and MERS-CoV• Demonstrated in vitro and in vivo activity against SARS-CoV-2 in Vero
E6 cells and Rhesus macaques• Compassionate use: 68% of patients experienced improvement in
oxygen-support class after remdesivir initiation
Remdesivir
Gordon CJ, et al. J Biol Chem. 2020;295(20):6785-6797.Wang N, et al. Cell Res. 2020;30(3):269-271.Williamson BN, et al. Nature. 2020. doi: 10.1038/s41586-020-2423-5.Grein J, et al. N Engl J Med. 2020;382(24):2327-2336.
• April 29th 2020: Publication of placebo-controlled RCT – Hubei, China• Adults, 12 days of sx onset, SpO2 ≤94% on RA or P/F <300 mmHg• Remdesivir IV 200 mg x 1 then 100 mg daily x 10 days total
Remdesivir – Clinical Efficacy
Wang Y, et al. Lancet. 2020; doi: 10.1016/S0140-6736(20)31022-9.
Remdesivirn=158
Placebon=78
Difference
Time to clinical improvement, days
21.0 (13.0-28.0) 23.0 (15.0-28.0) HR 1.23 (95% CI 0.87-1.75)
28 day mortality, n (%) 22 (14%) 10 (13%) 1.1% (95% CI -8.1 to 19.3)
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Remdesivir – ACTT-1 Trial
Beigel JH, et al. N Engl J Med. 2020; doi: 10.1056/NEJMoa2007764
Remdesivir n=541 Placebo n=522
Patient status, n (%)No supplemental O2
Supplemental O2
NIPPV or HFIPPV or ECMO
67 (12.4)222 (41.0)98 (18.1)
125 (23.1)
60 (11.5)199 (38.1)99 (19.0)
147 (28.2)
-
Clinical Outcomes Remdesivir n=541 Placebo n=522 RR or HR* (95% CI)
Number of recoveries, n (%) 334 (62.1) 273 (52.4) -
Time to recovery, daysSupplemental O2 (n=421)
NIPPV or HF (n=197)MV or ECMO (n=272)
11 (9-12)7 (6-8)
16 (NE-10)-
15 (13-19)9 (7-11)
22 (NE-12)28 (NE-22)
RR: 1.32 (1.12-1.55)RR: 1.47 (1.17-1.84)RR: 1.20 (0.79-1.81)RR: 0.95 (0.64-1.42)
14 day mortality, n (%)Supplemental O2 (n=421)
NIPPV or HF (n=197)MV or ECMO (n=272)
32 (5.9)4 (1.8)
13 (13.3)13 (10.4)
54 (10.4)19 (9.5)
13 (13.1)19 (12.9)
HR: 0.70 (0.47-1.04)HR: 0.22 (0.08-0.58)HR: 1.12 (0.53-2.38)HR: 1.06 (0.59-1.92)
• May 22nd 2020• Adults, 72 hours
from diagnosis,radiographic infiltratesOR clinical assessmentAND SpO2 ≤94% on RA OR supplemental O2
• Remdesivir x 10 days
*Recovery rate ratio or hazard ratio based on Cox model for time to event
Remdesivir – Clinical Efficacy
Goldman JD, et al. N Engl J Med. 2020; doi: 10.1056/NEJMoa2015301. Gilead Sciences. Press release. 2020 June 1Olender SA. Clin Infect Dis. 2020; doi: 10.1093/cid/ciaa1041.
June 1, 2020 – SIMPLE-Moderate Study Press Release
Remdesivir x5dn=191
Remdesivir x 10dn=193
Standard of Caren=200
≥2 point improvement in ordinal scale, n (%) 134 (70) 126 (65) 121 (61)
≥1 point improvement in ordinal scale, n (%) 146 (76) 135 (70) 132 (66)
Death, n (%) 0 (0) 2 (1) 4 (2)
July 24, 2020 – SIMPLE-Severe vs Retrospective Cohort – IPTW Matching
Remdesivir(SIMPLE-Severe)
n=312
Standard of Care(Retrospective)
n=818
Adjusted Odds Ratio (95% CI)
Clinical recovery by day 14 74.4% 59.0% aOR 2.03 (1.34-3.08)
14 day mortality 7.6% 12.5% aOR 0.38 (0.22-0.68)
• SIMPLE-Severe study: no difference 5 days vs. 10 days remdesivir
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• Not currently FDA approved• Approved in Japan, Taiwan, India, Singapore, UAE – Veklury®• Conditional marketing authorization in Europe Union
• Available through FDA Emergency Use Authorization • Requirements: SpO2 ≤94% on RA, supplemental O2, mech vent, or ECMO
• NIH COVID-19 treatment guidelines recommend remdesivir• Remdesivir should be considered in patients hospitalized for COVID-
19 requiring with SpO2 ≤94% on RA or supplemental oxygen• 200 mg IV once followed by 100 mg IV x 5 -10 days (10d if intubated)
Clinical Recommendations
COVID-19 Treatment Guidelines Panel. 2020. National Institutes of Health.
Con: Remdesivir Use In COVID-19 PatientsKrutika N. Mediwala, PharmD, BCPS, BCIDP
MUSC Health
@krutu8
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Notable Data
• Compassionate Use RDV
Grein et al
• RDV in severe COVID-19• RCT from China• Concommitant use of
LPV/r, interferons, corticosteroids
Wang et al
• Adaptive COVID-19 Treatment Trial
• NIH-sponsored• Multinational,
randomized, placebo-controlled trial
ACTT-1
• Manufacturer-sponsored
• Multinational, randomized, open-label
SIMPLE-1
LPV/r: lopinavir/ritonavir
Davis MR, et al. Infect Dis Ther. 2020;doi: 10.6084/m9.figshare.12563738
Baseline Score: 4 (Room-Air)
• ACTT-1: improved ordinal score at day 15 (OR 1.51; 95%CI 0.76–3.00) vs. placebo• ↑ # of pts discharged or able to be discharged (90% vs. 78%)• ↓ # of pts with severity of disease progression (8% vs. 16%)
• SIMPLE-1: 25% of pts with disease progression (n=52)• SIMPLE-2: modest benefit in improvement in d11 status • Small benefit in clinical improvement, no difference in progression of disease
severity/death• Low incidence of end points in mild-moderate illness
Clinical outcomes on day 14 or 15 by baseline clinical status
Beigel JH, et al. N Engl J Med. 2020; doi: 10.1056/NEJMoa2007764Goldman JD, et al. N Engl J Med. 2020; doi: 10.1056/NEJMoa2015301
Davis MR, et al. Infect Dis Ther. 2020;doi: 10.6084/m9.figshare.12563738
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Baseline Score: 5 (Low-flow O2)
• ACTT-1: mortality benefit (HR 0.22 [95% CI 0.08–0.58]) vs. placebo• ↓ me to recovery (RR 1.47 [95% CI 1.17–1.84])
• SIMPLE-1: rate of discharge (70.2%), disease progression (12.9%), and death (3.3%)• Wang et al: NO benefit in this pt population (majority)• Benefit in mortality, clinical improvement, and disease progression
Clinical outcomes on day 14 or 15 by baseline clinical status
Beigel JH, et al. N Engl J Med. 2020; doi: 10.1056/NEJMoa2007764Goldman JD, et al. N Engl J Med. 2020; doi: 10.1056/NEJMoa2015301
Davis MR, et al. Infect Dis Ther. 2020;doi: 10.6084/m9.figshare.12563738
Baseline Score: 6 (High-flow/NIMV)
NIMV: non-invasive mechanical ventilation
• ACTT-1: recovery rate ratio of 1.20 (0.79-1.81) vs. placebo• ↑ propor on of pts discharged (58% vs 44%) and ↘ rate of progression (25% vs 34%) at
d15• SIMPLE-1: 32% discharged and 43% progressed to MV or death
• Subgroup: no improvement with additional 5d of therapy at d14• Similar death rates to placebo• No clinically meaningful benefit in mortality, clinical improvement, and disease progression
Clinical outcomes on day 14 or 15 by baseline clinical status
Beigel JH, et al. N Engl J Med. 2020; doi: 10.1056/NEJMoa2007764Goldman JD, et al. N Engl J Med. 2020; doi: 10.1056/NEJMoa2015301
Davis MR, et al. Infect Dis Ther. 2020;doi: 10.6084/m9.figshare.12563738.
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Baseline Score: 7 (Invasive MV)
MV: mechanical ventilation
• ACTT-1: recovery rate ratio of 0.95 (0.64-1.42) vs. placebo• NO reduction in mortality (11.3% vs. 14.1%; HR 1.06 [95% CI 0.59–1.92])
• SIMPLE-1: ↓mortality rate with addi onal 5 days of therapy• ↑ mortality vs. placebo group in ACTT-1 (41.7% vs. 16.5%) • ↓ discharge vs. placebo group in ACTT-1 (8.3% vs. 15.7%) by d14 or d15
• Numerical mortality benefit in SIMPLE-1, but NO benefit over placebo at d15 in ACTT-1. No clinically meaningful benefit in mortality, clinical improvement, and disease progression
Clinical outcomes on day 14 or 15 by baseline clinical status
Beigel JH, et al. N Engl J Med. 2020; doi: 10.1056/NEJMoa2007764Goldman JD, et al. N Engl J Med. 2020; doi: 10.1056/NEJMoa2015301
Davis MR, et al. Infect Dis Ther. 2020;doi: 10.6084/m9.figshare.12563738.
Allocation Timeline
Jan 25th 2020 Compassionate Use
May 1st, 2020EUA donated supply
June 29th, 2020 DHHS secures 500K
EUA commercial courses
July 13th, 2020 EUA Commercial product
via Amerisource Bergen
September 2020 ?!?
https://www.phe.gov/emergency/events/COVID19/investigation-MCM/Pages/factsheet.aspx
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Allocation Process
https://www.phe.gov/emergency/events/COVID19/investigation-MCM/Pages/factsheet.aspx
• Non-standardized allocation practices between states• Centralized vs. lottery vs. hospital status
• Leftover donated supply and geographic distribution• “First-wave” supply
Payment and Reimbursement
Payment• Wholesale acquisition cost (WAC)
of ~$520 per 100mg vial• Discounted price for federal
facilities• Typical 5-day course of
remdesivir(total of 6 vials) $3,120 per course
Reimbursement• CARES Act Provider Relief Fund to
reimburse for uninsured patients• Private Insurers
• Committed to wave cost-sharing payments for members
https://www.phe.gov/emergency/events/COVID19/investigation-MCM/Pages/factsheet.aspx
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#FiveForFive - A Stewardship Mantra
Davis MR, et al. Infect Dis Ther. 2020;doi: 10.6084/m9.figshare.12563738#FiveForFive – Jason Pogue, PharmD
*10-14d from PCR-
positivity**
Duration –5 days
Category 5 –on low-flow
supplemental O2
Limited Resource
Looking ahead….
Special populations• Pregnancy• Pediatrics• Renal and liver
dysfunction• Mechanical
ventilation and ECMO
Trials • ACTT-1 d28• ACTT-2• SIMPLE-2• SOLIDARITY• DisCoVeRy• Case Series
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Polling Question: If you were to utilize remdesivir in a patient with COVID-19, who do you feel is the most appropriate patient?
A. All patients with COVID-19 should receive remdesivir at any time point after diagnosis
B. Only patients on supplemental O2 should receive remdesivir within 10-14 days of diagnosis
C. Only patients requiring mechanical ventilation should receive remdesivir within 10-14 days of diagnosis
D. I would not give remdesivir to any patient with COVID-19 at any time point after diagnosis
Question and Answer
Speaker:Gretchen Sacha
Pharm.D., BCCCP
Speaker:Krutika N. Mediwala
Pharm.D., BCPS, BCIDP
Moderator:Mojdeh Heavner
Pharm.D., BCPS, BCCCP, FCCM
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ASHP/SCCM COVID-19 Pharmacology Debates: Steroid Use
Polling Question: Do you recommend the use of corticosteroids for the treatment of all hospitalized patients with COVID-19?
A. YesB. NoC. Unsure/Undecided
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Polling Question: In which group of hospitalized patients with COVID-19 do you recommend the use of corticosteroids?
A. Receiving invasive mechanical ventilation onlyB. Receiving supplemental oxygen (not mechanically ventilated) onlyC. Receiving any supplemental oxygen (invasive and non-invasive
ventilation)D. On room air (no supplemental oxygen)E. All of the aboveF. Unsure/Undecided
Debate 2- Steroid Use in COVID-19 PatientsMitchell Buckley, Pharm.D., FASHP, FCCM, FCCP, BCCCP, BCPSClinical Pharmacy SpecialistBanner University Medical Center Phoenix, Arizona, USA
Disclosures: No relevant disclosures
Amy L. Dzierba, Pharm.D., FCCM, FCCP, BCCCPClinical Pharmacy Manager, Adult Critical CarePGY2 Pharmacy Residency Program Director Critical CareNew York-Presbyterian HospitalColumbia University Irving Medical CenterNew York, New York, USA
Disclosures: No relevant disclosures
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Mitchell Buckley, PharmD, FASHP, FCCM, FCCP, BCPS, BCCCP
Pro: Steroid Use for COVID-19
Objectives
• Evaluate clinical data on corticosteroid use in COVID-19
• Review clinical practice guideline recommendations
• Recommend an evidence-based strategy employing the use corticosteroids in COVID-19 patients
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Disclosure
• No relevant conflict of interest related to the content of the presentation
Results From June 24th PRO/CONDebate on Immunomodulator Use
27
39
5247
21
14
0
10
20
30
40
50
60
Pre-debate Post-debate
Perc
ent
Do you recommend the use of corticosteroids for the treatment of patients with COVID-19?
Yes No Unsure/Undecided
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Adapted from Siddiqi HK. J Heart and Lung Transplant. 2020;39(5):405-407.
Seve
rity
of Il
lnes
s
Time
Viral response phase
Host inflammatory response phase
Early Infection Pulmonary Phase Hyperinflammatory Phase
Reduce immunosuppression Careful use of immunomodulators
Randomized Clinical Trials
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GLUCOCOVID TrialPatient Eligibility
• Symptom duration ≥ 7 days• Radiologic evidence lung disease• Moderate-Severe disease• Laboratory evidence of hyper-inflammation
Methylprednisolone Regimen• 40mg IV q12h x 3 days, then
• 20mg IV q12h x 3 days
Corral-Gudino L. Eprint doi: https://doi.org/10.1101/2020.06.17.20133579.
GLUCOCOVID Trial
Corral-Gudino L. Eprint doi: https://doi.org/10.1101/2020.06.17.20133579.
Primary Composite Endpoint• In-hospital all-cause mortality
• Higher level of care (ICU admission)• Progression of respiratory failure that required NIV
Study Analysis GroupsMethylprednisolone
(n=56)Control(n=29) Relative Risk (95% CI)
All patients (ITT) 34% 48% 0.70 (0.41-1.18)
≤72 years (ITT) 16% 40% 0.40 (0.14-1.14)
>72 years (ITT) 48% 67% 0.66 (0.66-1.11)
All patients (Per-Protocol) 24% 48% 0.50 (0.27-0.94)
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RECOVERY Trial – Preliminary Report
Horby P. N Engl J Med 2020. doi: 10.1056/NEJMoa2021436. Online ahead of print.
6425 patients randomized Dexamethasone 6mg PO/IV daily (n=2104) – up to 10 days
vs. usual care alone (n=4321)
Horby P. N Engl J Med 2020. doi: 10.1056/NEJMoa2021436. Online ahead of print.
RECOVERY Trial – Preliminary Report
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Horby P. N Engl J Med 2020. doi: 10.1056/NEJMoa2021436. Online ahead of print.
RECOVERY Trial – Preliminary Report
Horby P. N Engl J Med 2020. doi: 10.1056/NEJMoa2021436. Online ahead of print.
RECOVERY Trial – Preliminary Report
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RECOVERY Trial – Preliminary Report
Horby P. N Engl J Med 2020. doi: 10.1056/NEJMoa2021436. Online ahead of print.
Clinical Practice Guidelines
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Guideline RecommendationsSource Recommendations
NIH (updated July 17, 2020)
• Recommends using dexamethasone 6 mg / day for up to 10 days... in patients who are…• Mechanically ventilated (AI)• Requiring supplemental oxygen but who are not mechanically ventilated (BI)
• Recommends against using dexamethasone in patients who DO NOT require supplemental oxygen (AI).
IDSA (updated June 25, 2020)
• Among hospitalized patients with severe* COVID-19, the IDSA guideline panel suggestsglucocorticoids rather than no glucocorticoids. (Conditional recommendation, Moderate certainty of evidence)
• Among hospitalized patients with COVID-19 without hypoxemia requiring supplemental oxygen, the IDSA guideline panel suggests against the use of glucocorticoids. (Conditional recommendation, Low certainty of evidence)
Surviving Sepsis Campaign (updated March 20, 2020)
• In mechanically ventilated adults with COVID-19 and ARDS, we suggest using systemic corticosteroids, over not using corticosteroids.
• In mechanically ventilated adults with COVID-19 and respiratory failure (without ARDS), we suggest against the routine use of systemic corticosteroids.
Supporting Evidence for Steroids
COVID-19 associated with pro-inflammatory response
RECOVERY Trial• Strength in numbers…. large sample size• Survival benefit
Previous corticosteroid ARDS trials ≠ COVID-19 ARDS• DEXA-ARDS trial• Single pathogen disease state
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Con: Steroid Use for COVID-19Amy L. Dzierba, PharmD, FCCM, FCCP, BCCCP
Guideline Recommendations• In mechanically ventilated adults with COVID-19 and respiratory failure (without ARDS),
we suggest against the routine use of systemic corticosteroids.
• In mechanically ventilated adults with COVID-19 and ARDS, we suggest using systemic corticosteroids, over not using corticosteroids.
• Among hospitalized patients with COVID-19 pneumonia, the IDSA guideline panel suggests against the use of corticosteroids.
• Among hospitalized patients with ARDS due to COVID-19, the IDSA guideline panel recommends the use of corticosteroids in the context of a clinical trial.
• Recommends against the routine use of systemic corticosteroids for the treatment of mechanically ventilated patients with COVID-19 without ARDS.
• In mechanically ventilated adults with COVID-19 and ARDS, there are insufficient data to recommend either for or against corticosteroid therapy in the absence of another indication.
Alhazzani W, et al. Crit Care Med. 2020;48:e440-e469; Bhimraj A, et al. Clin Infect Dis. 2020; Apr 27;ciaa478. doi: 10.1093/cid/ciaa478; NIH Guidelines https://www.covid19treatmentguidelines.nih.gov.
Surviving Sepsis
Campaign COVID-19 Guidelines
IDSA COVID-19 Guidelines
NIH COVID-19 Treatment Guidelines
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All Roads Lead to RECOVERY…
Horby P, et al. N Engl J Med. 2020. doi: 10.1056/NEJMoa2021436.
Should corticosteroids be used in allhospitalized patients with COVID-19?
Patients Requiring No Oxygen Support
Horby P, et al. N Engl J Med. 2020. doi: 10.1056/NEJMoa2021436.Adapted from Siddiqi HK and Mehra MR. J Heart Lung Transplant. 2020;39:405-407.
Seve
rity
of Il
lnes
s
Time
Viral response phase
Host inflammatory response phase
Early Infection Pulmonary Phase Hyperinflammatory Phase
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Patients Requiring Invasive Mechanical Ventilation
Seve
rity
of Il
lnes
s
Time
Viral response phase
Host inflammatory response phase
Early Infection Pulmonary Phase Hyperinflammatory Phase
Horby P, et al. N Engl J Med. 2020. doi: 10.1056/NEJMoa2021436.Adapted from Siddiqi HK and Mehra MR. J Heart Lung Transplant. 2020;39:405-407.
Patients Requiring Oxygen Support (not mechanical ventilation)
32-year-old woman requiring 3 liters/min nasal cannula
65-year-old woman with diabetes mellitus requiring 5 liters/min nasal cannula
55-year-old obese man with diabetes requiring high flow nasal cannula at 60
liters/min on 100% FiO2
Horby P, et al. N Engl J Med. 2020. doi: 10.1056/NEJMoa2021436.
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• Right Time• Balance between preventing collateral damage from immune response
and interrupting the immune system
• Right Patient• 17% of RECOVERY patients were not deemed eligible• Concomitant medications• SARS-CoV-2 versus COVID-19
• Right Drug/Dose/Duration• Dexamethasone 6 mg daily up to 10 days or clinical improvement
Should corticosteroids be used in all hospitalized patients with COVID-19 requiring oxygen support
(not mechanical ventilation)?
Horby P, et al. N Engl J Med. 2020. doi: 10.1056/NEJMoa2021436.
Guideline Recommendations
Bhimraj A, et al. Clin Infect Dis. 2020; Apr 27;ciaa478. doi: 10.1093/cid/ciaa478.NIH Guidelines https://www.covid19treatmentguidelines.nih.gov.
• Among hospitalized patients with COVID-19 without hypoxemia requiring supplemental oxygen, the IDSA guideline panel suggests against the use of glucocorticoids.
• Among hospitalized patients with severe* COVID-19, the IDSA guideline panel suggests glucocorticoids rather than no glucocorticoids.
• Recommends using dexamethasone 6 mg / day for up to 10 days in patients who are
• Mechanically ventilated (AI)• Requiring supplemental oxygen but who are not mechanically
ventilated (BI)• Recommends against using dexamethasone in patients who DO NOT
require supplemental oxygen.
IDSA COVID-19 Guidelines
NIH COVID-19 Treatment Guidelines
*Severe illness is defined as patients with SpO2 ≤94% on room air, and those who require supplemental oxygen, mechanical ventilation, or ECMO.
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Supporting Evidence Against Routine Corticosteroid UseCOVID-19 associated with pro-inflammatory response❌All patients will not have the same dysregulated response
RECOVERY Trial❌Not all patient populations may benefit
Polling Question: Do you recommend the use of corticosteroids for the treatment of all hospitalized patients with COVID-19?
A. YesB. NoC. Unsure/Undecided
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Polling Question: In which group of hospitalized patients with COVID-19 do you recommend the use of corticosteroids?
A. Receiving invasive mechanical ventilation onlyB. Receiving supplemental oxygen (not mechanically ventilated) onlyC. Receiving any supplemental oxygen (invasive and non-invasive
ventilation)D. On room air (no supplemental oxygen)E. All of the aboveF. Unsure/Undecided
Question and Answer
Speaker:Mitchell Buckley
Pharm.D., FASHP, FCCM, FCCP, BCCCP, BCPS
Speaker:Amy L. Dzierba, Pharm.D.
FCCM, FCCP, BCCCP
Moderator:Mojdeh Heavner
Pharm.D., BCPS, BCCCP, FCCM
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• The recording of this webcast will be available in August 2020, to access go to: covid19.sccm.org/webcast or https://www.ashp.org/COVID-19
• To register for additional COVID-19 related webcasts, visit: sccm.org/disaster or www.ashp.org/COVID-19
• To sign up for additional webinars on COVID-19 visit ashp.org/COVID-19/Stay-Informed
• Visit sccm.org/COVID19RapidResources for more resources• For more information on ASHP’s COVID-19 resources visit
ASHP.org/COVID-19
Thank You for Attending
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