2,833 publications from this institution
The use of corticosteroids in patients with septic shock remains controversial. Questions remain regarding the more appropriate dose, the optimal timing to initiate therapy, the selection of patients who will benefit most from the treatment and the exact mechanisms involved in their effectiveness. Recent studies have highlighted that, in critically ill patients, corticosteroid metabolism was reduced and associated with high circulating cortisol levels. Hence the required doses of hydrocortisone may be lower than the currently recommended doses in septic shock (i.e. 200 mg/day). However, altered expression and/or function of corticosteroid receptors may still suggest that higher hydrocortisone doses are necessary to overcome this so-called "steroid-resistance". In this article, we summarized these recent concepts and discussed how they could influence the administration of corticosteroids in such patients.
SUMMARy Anemia is one of the most commonly encountered abnormal laboratory findings in intensive care unit (ICU) patients, and many ICU patients will receive a blood transfusion during their ICU stay. However, the determinants of when and to whom transfusions should be given are not clear cut and have been the subject of considerable debate in recent years. Transfusion practice may vary considerably between institutions and across countries. The ABC (anemia and blood transfusion in critical care) study reported increased ICU and hospital mortality rates in patients who had received a transfusion. On the other hand, low hemoglobin levels are still associated with increased mortality and morbidity. The “traditional” transfusion trigger of 10 g/dL certainly no longer applies to all, but may well be relevant in certain groups, e.g., patients with cardiac disease. Transfusions should certainly be more restrictive than before, but applying this policy across the board cannot be recommended; each patient must be assessed individually on the basis of past and present clinical history, and in light of oxygenation and hemodynamic parameters. Clearly, further study is needed before we are able to determine the best transfusion strategies for our ICU patients.
info:eu-repo/semantics/published
This observational study suggests that dopamine administration may be associated with increased mortality rates in shock. There is a need for a prospective study comparing dopamine with other catecholamines in the management of circulatory shock.
Gastrointestinal motility is a complex process, which is often altered during critical illness, an effect that can lead to constipation. There is no consensus definition for constipation and it is therefore difficult to accurately assess incidence across studies. More recently, the term “paralysis of the lower gastrointestinal tract” has been suggested. Constipation can cause abdominal distension and discomfort, and reduce tolerance to enteral feeding. It can impair respiratory function and has been associated with worse patient outcomes including prolonged ICU length of stay and prolonged mechanical ventilation. The etiology of constipation in ICU patients is multifactorial and includes immobility, fluid and electrolyte disturbances, adverse effects of medication, and sepsis. Management must focus on treating the underlying cause and re-establishing regular bowel movements.
