I don’t have experience using it, but terlipressin was approved by the FDA in September 2022 for treatment of HRS in adults with rapid reduction in kidney function and has been on our formulary for a couple years now.

My understanding is that it can be an alternative to Golytely for bowel prep in patients who cannot tolerate the large fluid volume. Haven’t actually seen it used, but I do know it is an option on our formulary.

We used PRN bolus vec 10 mg or roc 50-100 mg for vent dyssynchrony. Usually trialed a couple doses before committing to a drip. Really depended on patient specific scenario, but anecdotally I think it’s worthwhile strategy for some folks to reduce drug exposure.

This is common practice for trauma patients at both hospitals I have worked at in NC when there are rib fractures. Anecdotally, I think it helps facilitate IS and prevent derecruitment for non-intubated patients. Outside of rib fractures, I don’t see it used routinely.

Great thread, thanks for sharing. I would also add the pharmacokinetics of glycopyrrolate in this situation just make more sense. Pick the drug that will reliably work more quickly instead of choosing a patch that will take up to 24 hours to reach maximum effect.