scholarly journals The effect of opioids on gastrointestinal function in the ICU

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Yun Yan ◽  
Yu Chen ◽  
Xijing Zhang
Keyword(s):  
Critical Care ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Potential Risk ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critical Care Setting ◽  
Gastrointestinal Function ◽  
Opioid Antagonists

AbstractGastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.

Anticonvulsants: Pharmacotberapeutic Issues in the Critically Ill Patient

1991 ◽  
Vol 2 (4) ◽  
pp. 639-656 ◽  
Author(s):  
Robert E. Dupuis ◽  
Jorge Miranda-Massari
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Critical Care Setting ◽  
Critically Ill Patient ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Epilepsy Treatment

Critically ill patients often have or develop conditions that make them susceptible to seizures and epilepsy. Treatment frequently involves the use of anticonvulsants. In order to use these effectively, the critical care nurse must be aware of the indications and controversies surrounding their use, the pathophysiologic conditions that impact on the disposition, and appropriate dosing and monitoring of these agents in the critical care setting

scholarly journals Updates in Nutrition Support for Critically III Adult Patients

2017 ◽  
Vol 52 (1) ◽  
pp. 17-26 ◽  
Author(s):  
Diana Wells Mulherin ◽  
Sarah V. Cogle
Keyword(s):  
Critical Care ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Hospital Pharmacist ◽  
Critical Care Medicine ◽  
Critical Care Setting ◽  
Nutrition Support ◽  
American Society

Specialized nutrition support is often employed in critically ill patients who are unable to maintain volitional intake. The Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recently updated guidelines for the provision of nutrition support in critically ill patients. The purpose of this review is to summarize key changes from the previous guidelines as they relate to recently published literature, which will aid the hospital pharmacist in optimizing nutrition support therapies in the critical care setting.

Academic education. Creating a laboratory that simulates the critical care environment

1996 ◽  
Vol 16 (6) ◽  
pp. 76-81 ◽  
Author(s):  
PG Morton
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Teaching Method ◽  
Critical Care Setting ◽  
Academic Education ◽  
Clinical Experiences ◽  
Care Environment ◽  
Excellent Teaching

Educating students and practicing nurses for the complexities and demands of critical care is a challenge. Training in a laboratory that simulates the critical care setting is an excellent teaching method that can be used to supplement lectures and clinical experiences. Developing such a laboratory is an exciting and rewarding process that will promote learning and ultimately benefit the care of critically ill patients.

Psychopharmacology in the Critical Care Setting

2021 ◽  
pp. 235-250
Author(s):  
Sandeep Nayak ◽  
Jonathan Brigham ◽  
Ted Avi Gerstenblith ◽  
Elizabeth Prince
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Psychotropic Medications ◽  
Oral Medication ◽  
Critical Care Setting ◽  
Confounding Factors

Psychotropic medications can be a powerful tool for enabling treatment of critically ill patients. However, a careful approach to psychopharmacology is necessary in the critical care setting. Special considerations include interactions with other medications and treatments, high levels of physiologic stress that alter metabolism, and the challenges of obtaining diagnostic clarity due to limitations in assessment and confounding factors during critical illness. This chapter outlines common consult questions posed by intensive care teams to psychiatry consultation teams, including management of agitation and sedation, poor participation in care, anxiety, continuation of outpatient medication regimens, and alternatives to oral medication.

scholarly journals Anticoagulation strategies in critical care for the treatment of atrial fibrillation: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037591
Author(s):  
Brian Johnston ◽  
Alexandra Nelson ◽  
Alicia C Waite ◽  
Gedeon Lemma ◽  
Ingeborg Welters
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Critical Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Critical Care Setting

IntroductionAtrial fibrillation (AF) is the most common cardiac arrhythmia in critically ill patients and is associated with an increased risk of thromboembolic events and mortality. Oral anticoagulation for thromboembolism prophylaxis is a key component of managing AF in the general population and is recommended by National Institute for Health and Care Excellence guidelines. However, assessment tools used to aid decision making about anticoagulation have not yet been validated in the critical care setting. There is a paucity of data assessing the impact of anticoagulation strategies on clinical outcomes in critically ill patients with AF. We present a protocol for a systematic review and meta-analysis to evaluate the effectiveness of anticoagulation strategies for AF used specifically in critical care.Methods and analysisWe will conduct a systematic review of the literature by searching MEDLINE, EMBASE, CENTRAL and PubMed databases for articles published from January 1990 to October 2019. Studies reporting anticoagulation strategies for AF in adults (>18 years) admitted to a general critical care setting will be assessed for inclusion. Outcomes of interest will include (1) percentage of patients started on anticoagulation in critical care for AF, (2) incidence of thromboembolism, (3) incidence of bleeding events, (4) intensive care unit (ICU) mortality, (5) hospital mortality, (6) ICU length of stay and (7) hospital length of stay. We will conduct a meta-analysis of trials. Risk of bias will be assessed using the Cochrane Risk of Bias tool for randomised trials or the Newcastle-Ottawa Risk of Bias assessment tool for non-randomised studies. This protocol and subsequent systematic review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.Ethics and disseminationThis proposed systematic review will include data extracted from published studies; therefore, ethical approval is not required. The results of this review will be published in clinical specialty journals and presented at international meetings and conferences.Trial registration numberCRD42020158237.

scholarly journals COVID 19 CRITICAL CARE TRAINING SURGE EXPERIENCE FOR PHYSICIANS IN RIYADH HEALTH CLUSTER ONE, SAUDI ARABIA

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
AF Mady ◽  
O Ramdan ◽  
R Al Yousef ◽  
A Ishag ◽  
G Bakirova ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Basic Knowledge ◽  
The World ◽  
Medical City ◽  
Care Training ◽  
Icu Physicians

As the COVID-19 pandemic spreads, the number of critically ill patients is expected to surge in hospitals across the world. This may result in non-ICU clinicians being needed to care for critically ill patients, In line with Pandemic COVID – 19 situations that we are facing currently; the Critical Care Department Training Committee of King Saud Medical City in collaboration with the Riyadh Health Cluster One, Saudi Arabia conducted a series of training projects. Its goal is to help non – ICU Physicians to be equipped and be more competent to handle critically ill patients when the situation will have the need for it. We aim to provide basic knowledge and skills to successfully manage critically ill patients with suspected or confirmed COVID – 19 cases in a critical care setting.

scholarly journals Optimal Role of the Nephrologist in the Intensive Care Unit

2016 ◽  
Vol 43 (1-3) ◽  
pp. 68-77 ◽  
Author(s):  
D.J. Askenazi ◽  
Michael Heung ◽  
Michael J. Connor Jr. ◽  
Rajit K. Basu ◽  
Jorge Cerdá ◽  
...  
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Health Care Team ◽  
Quality Initiatives ◽  
Team Members ◽  
Delivery Of Care ◽  
Multi Disciplinary Team

As advances in Critical Care Medicine continue, critically ill patients are surviving despite the severity of their illness. The incidence of acute kidney injury (AKI) has increased, and its impact on clinical outcomes as well as medical expenditures has been established. The role, indications and technological advancements of renal replacement therapy (RRT) have evolved, allowing more effective therapies with less complications. With these changes, Critical Care Nephrology has become an established specialty, and ongoing collaborations between critical care physicians and nephrologist have improved education of multi-disciplinary team members and patient care in the ICU. Multidisciplinary programs to support these changes have been stablished in some hospitals to maximize the delivery of care, while other programs have continue to struggle in their ability to acquire the necessary resources to maximize outcomes, educate their staff, and develop quality initiatives to evaluate and drive improvements. Clearly, the role of the nephrologist in the ICU has evolved, and varies widely among institutions. This special article will provide insights that will hopefully optimize the role of the nephrologist as the leader of the acute care nephrology program, as clinician for critically ill patients, and as teacher for all members of the health care team.

scholarly journals Gastrointestinal complications are associated with a poor outcome in non-critically ill pneumonia patients

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chun-Ta Huang ◽  
Chun-Ming Hong ◽  
Yi-Ju Tsai ◽  
Wang-Huei Sheng ◽  
Chong-Jen Yu
Keyword(s):  
Critical Care ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Care Setting ◽  
Negative Impact ◽  
Length Of Hospital Stay ◽  
Critical Care Setting ◽  
Bowel Distension ◽  
Gastrointestinal Complications ◽  
Prolonged Length

Abstract Background Development of gastrointestinal (GI) complications is adversely associated with prognosis in the critically ill. However, little is known about their impact on the outcome of non-critically ill patients. In this study, we aimed to investigate the incidence of GI complications and their influence on prognosis of hospitalized pneumonia patients. Methods Adult patients admitted with a diagnosis of pneumonia from 2012 to 2014 were included. Medical records were reviewed to obtain patients’ demographics, physical signs, comorbidities, laboratory results, clinical events, and the Confusion, Urea, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score was calculated to assess the severity of pneumonia. GI complications, including bowel distension, diarrhea, GI bleeding and ileus, were evaluated during the first 3 days of hospitalization and their association with patient outcomes, such as hospital mortality and length of stay, was analyzed. Results A total of 1001 patients were enrolled, with a mean age of 73.7 years and 598 (59%) male. Among them, 114 (11%) patients experienced at least one GI complication and diarrhea (5.2%) was the most common. The hospital mortality was 14% and was independently associated with an increase in the CURB-65 score (odds ratio [OR] 1.952 per point increase; 95% confidence interval [CI] 1.516–2.514), comorbid malignancy (OR 1.943; 95% CI 1.209–3.123), development of septic shock (OR 25.896; 95% CI 8.970–74.765), and the presence of any GI complication (OR 1.753; 95% CI 1.003–3.065). Conclusions Compared to a critical care setting, GI complications are not commonly observed in a non-critical care setting; however, they still have a negative impact on prognosis of pneumonia patients, including higher mortality and prolonged length of hospital stay.

Recombinant Human Erythropoietin Use in Intensive Care

2002 ◽  
Vol 36 (6) ◽  
pp. 1068-1074 ◽  
Author(s):  
Martin Darveau ◽  
Éric Notebaert ◽  
André Y Denault ◽  
Sylvain Bélisle
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Recombinant Human Erythropoietin ◽  
Cochrane Library ◽  
Optimal Dosage ◽  
Human Erythropoietin ◽  
The Impact

OBJECTIVE: To review the literature concerning the role of recombinant human erythropoietin (rHuEPO) in reducing the need for transfusion in critically ill patients. DATA SOURCES: Articles were obtained through searches of the MEDLINE database (from 1990 to June 2001) using the key words erythropoietin, epoetin alfa, anemia, reticulocytes, hemoglobin, critical care, intensive care, critical illness, and blood transfusion. Additional references were found in the bibliographies of the articles cited. The Cochrane library was also consulted. STUDY SELECTION AND DATA EXTRACTION: Controlled, prospective, and randomized studies on the use of rHuEPO in critically ill adults were selected. DATA SYNTHESIS: Anemia is a common complication in patients requiring intensive care. It is caused, in part, by abnormally low concentrations of endogenous erythropoietin and is mainly seen in patients with sepsis and multiple organ dysfunction syndrome, in whom inflammation mediator concentrations are often elevated. High doses of rHuEPO produce a rapid response in these patients, despite elevated cytokine concentrations. There have been 3 studies on rHuEPO administration in intensive care and 1 trial in acutely burned patients. Only 2 of these studies looked at the impact of rHuEPO administration on the need for transfusion. CONCLUSIONS: Few randomized, controlled trials explore the role of rHuEPO in critical care. Only 1 was a large, randomized clinical trial, but it presents many limitations. Future outcome and safety studies comparing rHuEPO with placebo must include clinical endpoints such as end-organ morbidity, mortality, transfusion criteria, and pharmacoeconomic analysis. rHuEPO appears to provide an erythropoietic response. Optimal dosage and the real impact of rHuEPO on the need for transfusion in intensive care remain to be determined. Currently, based on the evidence available from the literature, rHuEPO cannot be recommended to reduce the need for red blood cell transfusions in anemic, critically ill patients.

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