Articles: critical-care.
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To determine the clinical benefits of selective decontamination of the digestive tract in patients treated in intensive care units. ⋯ The findings strongly indicate that selective decontamination significantly reduces infection related morbidity in patients receiving intensive care. They also highlight why definite conclusions about the effect of prophylaxis on mortality cannot be drawn despite the large number of trials available. Based on the most favourable results obtained by pooling data from trials in which combined topical and systemic treatment was used it may be estimated that 6 (range 5-9) and 23 (13-139) patients would need to be treated to prevent one respiratory tract infection and one death respectively.
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Neuromuscular blocking agents are powerful drugs that are being used with increasing frequency in critical care medicine. The choice of a particular muscle relaxant is influenced by the patient's underlying condition and the side-effects of the drugs. ⋯ Prolonged paralysis for days to weeks after the discontinuation of neuromuscular blocking agents is an uncommon but devastating complication, the etiology of which is poorly understood. Physicians in critical care medicine should receive formal training in the use of neuromuscular blocking drugs.