Current drug targets
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Acute severe asthma is characterized by a state of airway inflammation and increased bronchiolar smooth-muscle tone that leads to increased resistance to expiration and lung hyperinflation. Despite the better knowledge of its pathophysiology, the incidence and severity of asthma in the last twenty years is increased worldwide, although with significant age and geographic variation. As a result, the number of patients requiring more intensive medical therapy has also increased. ⋯ The use of inhalational anesthetic agents for treatment of severe status asthmaticus has been documented in case reports, case series and small uncontrolled studies. Their use may be considered in any mechanically ventilated patients whose severe bronchospasm failed to respond to maximal medical treatment. In the present review article, we aim to provide a brief description of the physio-pathological and clinical features of acute severe asthma, and of the principles of treatment, focusing our attention on the use of the inhalational anesthetics in severe patients requiring mechanical ventilation and not responding to conventional therapy.
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Current drug targets · Sep 2009
ReviewUse of corticosteroids in critically ill septic patients : a review of mechanisms of adrenal insufficiency in sepsis and treatment.
Adrenal insufficiency has being reported with increased frequency in critical ill patients with sepsis and other inflammatory states. Its incidence varies widely depending on the criteria used to define it and the patient population studied. Increased glucocorticoid action is essential in the stress response to acute injury and even minor degrees of adrenal insufficiency can be fatal. ⋯ Whether exogenous corticosteroid support may be beneficial in critical illness is still matter of debate: most international guidelines recommend that the decision to treat patients with corticosteroids should be based on clinical criteria (low blood pressure poorly responsive to vasopressor despite adequate fluid resuscitation) rather than on tests of the hypothalamic-pituitary-adrenal axis alone. As regards specifically the role of steroids in the treatment of sepsis and septic shock, at present there are no strong evidence-based recommendations. More studies are needed to reach consensus about several issues: which is the best target population, whether a cosyntropin test should be used to guide treatment, whether fludrocortisones should be given along with hydrocortisone, and how long treatment should continue.
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Current drug targets · Sep 2009
ReviewEffect of beta-blockers on perioperative myocardial ischemia in patients undergoing noncardiac surgery.
Myocardial ischemia remains a major cause of morbidity in patients undergoing noncardiac surgery. The purpose of the paper was to review the evidence of the use of perioperative beta-blockers for the reduction of myocardial ischemia in patients having noncardiac surgery. ⋯ The meta-analysis shows that the use of beta-blockers, both as premedication and postoperatively, in noncardiac surgery is associated with a significant reduction in perioperative myocardial ischemia.
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Statins are widely prescribed cholesterol lowering agents that exert their effects by inhibiting 3-hydroxy-3methylglutaryl co-enzyme A reductase. With their modulatory effects on the atherogenic lipid profile, the role of statin therapy is expanding amidst the growing obesity epidemic. The cholesterol lowering effects of statin therapy remains central in the long term management of coronary artery disease and cerebrovascular disease. ⋯ Clinical research into plaque histology, vulnerable high risk plaques and plaque rupture has improved our insight into the pathophysiology of these acute vascular events. Non lipid lowering effects of statin, the so called pleitrophic effects, have become the focal point of investigation. This review discusses recent experimental and clinical evidence supporting the role of statin in perioperative medicine.
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It has been estimated that nosocomial fever occurs in approximately one-third of hospitalized patients. The incidence is even higher in critically-ill patients in whom both infectious and noninfectious etiologies of fever are common. ⋯ There is widespread acceptance that in most if not all critically ill neurologic patients fever should be treated but still it is not clear if fever per se in nonneurologic critically ill patients should be treated too. We review physical and pharmacological methods presently utilized to treat fever in critically ill patients.