ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The liver, as the major metabolizing organ in the body, plays a major role in the elimination of many drugs. The metabolic function of the liver is affected in liver disease, and this alters the elimination of many drugs, which may consequently require dosage adjustment to avoid toxicities owing to drug accumulation. This effect is determined by the type and severity of the disease, the specific enzyme metabolizing a drug, and how the disease affects the factors that control metabolism. This effect and the factors that determine it are not well understood, and there is no good test to assess degree of hepatic metabolic dysfunction. Consequently, dosage adjustment in liver disease cannot be done adequately, and studies focused on specific areas are needed to improve our understanding of the disease and ability to predict its effect and estimate dosage requirement.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The potential for drug reactions and interactions in critically ill patients is great. In addition to all the problems related to the administration of drugs to a “normal” patient population, the risks are greatly increased by the large number of drugs needed for critically ill patients. Seriously ill patients frequently require more than 20 different drugs at once. Moreover, this polypharmacy is imposed on people who are seriously ill with at least one (if not more than one) organ functioning suboptimally. This is likely to result in abnormal metabolism and excretion, with resulting unpredictable effects on the patient. Furthermore, there is commonly a chronic illness that exacerbates the risk of unexpected drug effects seen in an acute, severe illness.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The consequences of nutritional failure in the critically ill are profound. What can be done continues to be the focus of much research. The profound changes in body composition that occur in the very sick are now well described, but the implications of these changes for whole body and individual organ function and survival are still to be understood. The pivotal importance of promoting a normal functional gastrointestinal tract is the focus of current therapy. Pharmacology has entered the world of nutrition (nutriceuticals), but also the effects of drugs and on drugs of the consequences of nutritional failure are starting to be appreciated.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Brain failure or encephalopathy is common in the critically ill and often occurs early in the disease process. Cerebral dysfunction can usually be reversed by promptly treating the underlying cause. Early recognition of brain failure may facilitate prompt treatment, with possible reduction in the incidence of multiple-organ failure and improved survival.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The concept of remote organ failure or multiple organ failure was developed in a surgical intensive care unit over 20 years ago. There have been amazing advances in intensive care since then. Many patients who would have developed organ failure and died now survive; however, when multiple organ failure develops, the mortality remains high. Thus, the answer to this problem of multiple organ failure, multiple organ dysfunction syndrome, and systemic inflammatory response syndrome is prevention of organ failure by support of organ function. A number of new surgical concepts are introduced to support this approach. The principles of prevention of organ failure are emphasized in this editorial review and in the reviews to follow.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Organ failure continues to be a major cause of mortality in critically ill patients. Fundamental to appropriate treatment is adequate volume resuscitation based on conventional parameters. The advent of the pulmonary artery catheter led to the introduction of resuscitation protocols based on oxygen transport parameters. Despite intensive investigation of the use of oxygen transport parameters as resuscitative endpoints, controversy concerning these parameters remains. Central to this issue are the physiologic relationship of oxygen consumption to delivery and the role of tissue hypoxia in the development of organ failure in critically ill patients. Recent randomized trials designed to achieve supranormal oxygen parameters have yielded conflicting results. Currently, there are no clinical data to support nonselective patient management aimed at elevating oxygen delivery and consumption in patients who have been appropriately volume resuscitated based on conventional parameters.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID