Minerva anestesiologica
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It is increasingly apparent that organ dysfunction in sepsis is caused, at least in part, by an acquired intrinsic derangement in cellular oxidative adenosine triphosphate (ATP) production. We have termed this phenomenon "cytopathic hypoxia". Although several different but mutually compatible mechanisms might account for the development of cytopathic hypoxia in sepsis, recent data from our laboratory point to activation of the nuclear enzyme, poly-ADP-ribosyl polymerase (PARP), as being the most important.
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Minerva anestesiologica · Apr 2001
Selective decontamination of the digestive tract as infection prevention in the critically ill. Does it lead to resistance?
Several meta-analysis showed the efficacy of selective decontamination of the digestive tract (SDD) in the reduction of infections in critically ill patients, particularly for ventilator associated pneumonia and bloodstream infections, thereby reducing mortality and morbidity. The principle of SDD is that by means of application of non-absorbable antibiotics in the intestinal canal and oropharyngeal cavity, potentially pathogenic microorganisms are eliminated, thereby reducing the incidence of organ site infections. The endogenous anaerobic flora is preserved as a factor contributing to defence against colonization. ⋯ The results of a recent meta-analysis and of several studies, which confirmed the virtual absence of any reported AR with SDD and that did not find AR after stopping SDD, are presented. The eradication of the reservoir of abnormal bacteria located in the gut by topical non-absorbable antibiotics appears to significantly reduce morbidity, mortality and resistance. Using only systemic antibiotics in ICU may contribute to maintain an abnormal population of bacteria among which AR is encouraged.
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Perioperative medicine starts with preoperative assessment and preparation of patients undergoing various procedures. It includes intraoperative care and continues postproceudral management, from recovery room to intensive care and step-down facilities. ⋯ Potential areas of anesthesia involvement, still unclear, include preoperative and postoperative ward management and complete preparation such as cardiology or pulmonary testing. Further steps to take in the direction of perioperative medicine are the development of a different model of resident training, and the improvement of information technology and medical record.
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The importance of sedation in the ICU. The authors shortly describe the use of sedation as useful tool to reduce patient discomfort and to modulate stress response, in critically ill patients.