ISSN:1070-5295    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Intensive care clinicians prescribe sedatives to ensure patients are comfortable, cooperative, and can tolerate the delivery of critical care with minimum risk of oversedation and side effects. It is important to monitor the level of sedation and to be aware of the many pharmacokinetic and pharmacodynamic changes that occur in the critically ill patient with the various drug groups. Drugs used for sedation during intensive care include benzodiazepines, propofol, &agr;2-agonists (clonidine), neuroleptic agents (haloperidol, droperidol, phenothiazines), and ketamine. Few novel approaches to sedation of critically ill patients have been described recently, but none of the intravenous sedatives currently available is ideal.

ISSN:1070-5295    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Inhalational agents have been used in general anaesthesia for almost 150 years and have been used in the intensive care unit to provide sedation intermittently over the last 40 years. Their main advantage over intravenous agents is that they are excreted via the lungs, allowing a rapid and predictable recovery. Because the agents are minimally metabolized and quickly eliminated, the depth of sedation can be precisely controlled.This review summarizes the inhaled sedative agents which are currently available, concentrating mainly on isoflurane, which is the only agent that can be recommended for long-term use in critically ill patients. Nitrous oxide causes bone marrow depression, halothane is hepatotoxic, and enflurane is nephrotoxic. No research has been performed with the newer agents, desflurane and sevoflurane, in the intensive care unit, but it is doubtful that they will be of value in the critically ill patient.

ISSN:1070-5295    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The authors discuss the pharmacodynamics and pharmacokinetics of the new neuromuscular blocking drugs in the critically ill. In the last 18 months, publications on the use of these drugs in this patient group have centered on two controversial topics, tachyphylaxis and polyneuromyopathy, which manifests as muscle weakness after prolonged use of neuromuscular blocking drugs. The incidence of these problems and their avoidance are considered.

ISSN:1070-5295    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Sedation monitoring falls into two distinct categories. Subjective observation of the patient has lead to sedation scores that are labor intensive, difficult to replicate, and yet easy to implement. Objective scoring using automated monitoring is in the early stages of development, and is relatively expensive. The relative merits of the methods currently available are discussed.

ISSN:1070-5295    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Opioids are important drugs in modern medicine. They are widely used as antitussive, antidiarrhoeal, sedative, and analgesic agents and they are well established for treating the critically ill patient. The central effects of opioids are well documented, but opioids have other important effects. This article will examine some new developments in the field of opioid pharmacology. The relevance of endogenous opioids is highlighted, followed by a description of some important peripheral effects of opioids. These include some effects the importance of which is unknown.

ISSN:1070-5295    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A number of exciting developments in the field of surgery and its relation to science, in general, and particularly to intensive care are reviewed in the following pages of this editorial review and in the papers that follow on related surgical topics. The importance of molecular biology and its actual and potential impact on the operative disciplines are compared. This includes the problem of why there have been no magic bullets so far. The clinical relevance of research has been stretched to a point where claims seemed to be promissory notes that test the credibility of what is otherwise good science. Prolonged intensive care unit (ICU) care in itself, and when necessary, results in increasing complications, particularly nosocomial infections and increased morbidity and mortality. Much can be done to control such problems. I raise the question as to whether we need a new concept in ICUs: short-term conventional ICUs for overnight or 2-day to 3-day postoperative, postinjury monitoring, and long-term units which are more like operating rooms. There are many biologic puzzles in our mediator studies — too much of a mediator is bad but none is worse, or vice versa. Can we ever understand such complexities? Also, there are factors, substances, or occurrences which predict disaster. I have called these “harbingers of doom” and they may be markers, but not necessarily causes, of the impending disaster. Finally, I suggest that integrated biology and chaos theory will help us understand and treat injury, illness, inflammation, sepsis, and ICU problems in the future.

ISSN:1070-5295    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Translocational endotoxemia has been blamed for the development of multi-system organ failure and death after major burns. Endotoxin exerts its biological effects by the induction of a large number of cells to produce cytokines, prostanoids, and other biological products which are actually responsible for cell and organ damage. It now seems that physiologic changes following the injury can trigger these cascades independently of endotoxin. Endotoxin, which enters the portal system by translocation, is still an important source of induction, but probably not the only one. Efforts at intervention must therefore now take into consideration control of cytokine release as well as a reduction in endotoxemia.

ISSN:1070-5295    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Hyperosmotic solutions (HS) and hyperosmotic–hyperoncotic solutions (HHS) containing 7.2 -7.5 % NaCl have proven beneficial for the resuscitation of patients suffering from hypovolemic shock, especially after trauma. In recent years they have also been used perioperatively for fluid replacement in patients undergoing cardiopulmonary bypass, aortic aneurysm surgery, and those with sepsis.Nearly all investigators infused HS/HHS more slowly (typically over 20 minutes) than during the resuscitation from hemorrhagic shock (5 minutes). Nevertheless they still could demonstrate that application of HS/HHS is efficient. It was shown that an infusion of HS/HHS results in an rapid increase in cardiac filling pressures with a concomitant increase in cardiac output and oxygen delivery. In some high risk patients it seems advisable to closely monitor the cardiac response to fluid loading with HS/HHS and best to titrate the infused volume against the changes in pulmonary capillary wedge pressure. Perioperative fluid balance was less positive than after conventional fluid resuscitation, an effect that often lasted into the postoperative period. Some studies could show an improvement in pulmonary function; however, others found no change. In septic patients filling pressures, cardiac output, and oxygen delivery were increased. These effects were, however, of short duration. The recently demonstrated positive effects of HS/HHS on the immune function may be of particular interest for this patient population, but they still must be confirmed in a clinical trial. This also holds true for the positive microcirculatory effects of HS/HHS, which is nearly always impaired after both cardiopulmonary bypass and in sepsis. Ultimately, however, demonstrated improvement in morbidity and mortality, yet to be shown, will promote the widespread clinical use of these solutions.

ISSN:1070-5295    

出版商:OVID    

年代:1999

数据来源: OVID