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Critical care pharmacotherapy. A review
1Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Bergmannsheil, Bochum, Federal Republic of Germany.
Drugs
|March 1, 1993
Summary
Preventing nosocomial pneumonia in ventilated patients is possible by preserving gastric acidity and using topical antibiotics. Stress ulcer bleeding is linked to tissue hypoxemia, not gastric acidity, with new treatments showing promise.
Area of Science:
- Critical care medicine
- Gastroenterology
- Infectious disease
Background:
- Gastrointestinal tract plays a key role in multiple organ failure and nosocomial infections.
- Gram-negative bacterial overgrowth in the oropharynx and stomach causes nosocomial pneumonia.
- Gastric alkalinization is no longer considered necessary for preventing stress ulcer bleeding in critically ill patients.
Purpose of the Study:
- To review current research on gastrointestinal tract's role in critical care.
- To evaluate preventive measures for nosocomial infections and organ failure.
- To discuss new findings on stress ulcer bleeding and sedation in ventilated patients.
Main Methods:
- Review of recent studies on gastrointestinal prophylaxis in critical care.
- Analysis of mechanisms underlying stress ulcer bleeding.
- Evaluation of sedative agents in mechanically ventilated patients.
Main Results:
- Preserving gastric acidity and topical antibiotics are effective for preventing pneumonia in ventilated patients.
- Tissue hypoxemia, not gastric acidity, causes stress ulcer bleeding; pirenzepine and sucralfate show efficacy.
- Clonidine is effective for managing sympathetic overshoot during withdrawal.
Conclusions:
- New strategies for gastrointestinal prophylaxis in critical care are emerging.
- Understanding the pathophysiology of stress ulcer bleeding has led to improved treatments.
- Sedation strategies for ventilated patients continue to evolve, with clonidine showing specific benefits.