Medizinische Klinik, Intensivmedizin und Notfallmedizin
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The dosing of drugs in critically ill patients remains challenging. While increased volume of distribution after fluid resuscitation and increased cardiac output can increase clearance of antibiotics, liver failure and renal failure can decrease the clearance of drugs. If an extracorporeal device is used, the dosing of drugs becomes even more difficult. Even in intensive care patients with intact renal function, pharmacokinetics and pharmacodynamics are significantly altered. ⋯ The importance of therapeutic drug monitoring is discussed. Global initiatives to increase quantity and quality of pharmacokinetic studies in this patient population through incentives and guidance of the regulatory agencies, as well as the major unmet educational need to integrate basic knowledge in this field into residency and fellowship programs as well as CME are briefly mentioned.
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Med Klin Intensivmed Notfmed · May 2014
Review[Shock liver and cholestatic liver in critically ill patients].
Liver dysfunction is frequently observed in critically ill patients. Its occurrence is associated with high morbidity and mortality. The most frequent entities of hepatic dysfunction in the intensive care unit are shock liver and cholestatic liver dysfunction with incidence rates up to 10 and 30 %, respectively. ⋯ However, several other potential contributors have been identified especially for cholestatic liver dysfunction. Apart from chronic liver diseases and malignancies, iatrogenic factors such as total parenteral nutrition, high pressure ventilation, surgical procedures, drugs and blood transfusions promote its occurrence. In shock liver and in cholestatic liver disease, early detection and therapy of the underlying disease is the only established treatment.
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In-hospital emergencies represent an increasing challenge with regard to risk management in hospitals and until now, no binding recommendations for in-hospital emergency management are available in Germany. Time delays in the detection and treatment of critically ill patients on the wards often lead to serious adverse events. The concept of traditional resuscitation teams is not adequate, because they are initiated only after acute deterioration or cardiac arrest has already occurred. ⋯ For a hospital with an already established resuscitation team, this represents a fundamental paradigm shift to a sustainable, interdisciplinary, and institutionalized process of rethinking and reorganizing. A clear commitment and ongoing joint efforts of the hospital management and all hospital staff are prerequisite for this.