TAILIEUCHUNG - Update to 2017 about critical care: Part 2

(BQ) Continued part 1, part 2 of the document Update to 2017 about critical care has contents: Aerosolized antibiotic, biomarkers in invasive fungal infections, optimum dose of colistin in intensive care unit, perioperative dysnatremia, hypophosphatemia in intensive care unit,. and other contents. Invite you to refer. | Acid Suppression in Critically III Is It Really Necessary Samir Sahu I INTRODUCTION Gastric mucosa is sensitive to changes in hemodynamics such as hypotension resulting in reduced perfusion and cytokine-mediated inflammation. This results in stress-related mucosal disease SRMD which endoscopically may range from superficial erosions to multiple ulcers and can lead to clinically important bleeding episodes requiring blood Prophylaxis of such lesions is nowadays available both as proton pump inhibitors PPI and histamine-2 receptor antagonists H2RA . Both of these agents are well tolerated and are able to decrease incidence of bleeding In spite of these pharmacological agents stress ulcer prophylaxis SUP measures and decrease in bleeding episode has not been ttanslated into mortality benefit in prospective studies. Thus recently some intensivists have expressed concerns about the safety of SUP especially with respect to infectious complications. g EPIDEMIOLOGY _____ Stress-related mucosal disease is present in most critically ill patients but only a few patients experience overt bleeding complications. Only around 1 of them develop SMRD-related gastrointestinal GI 3 g PATHOPHYSIOLOGY___________________________ Both systemic hypotension due to absolute or relative hypovolemia cardiogenic or obsttuctive shock use of vasopressors and local splanchnic hypoperfusion due to positive end expiratory pressure in patients on mechanical ventilation may lead to decrease in gastric mucosal blood flow. Hypoperfusion leads to a reduced production of several protective mechanisms that exist in a healthy stomach. These mechanisms can cause mucosal damage but need the presence of gastric acid to cause major ulcerations and gasttic bleeding. Without acid mucosal damage is only minimal. This is the rationale for the use of acid-suppressive drugs such as PPI or H2RA for pharmacological Recent studies report a very low incidence of stress .

• Y khoa - Dược
• Critical care update 2017
• Aerosolized antibiotic
• Invasive fungal infections
• Intensive care unit
• Furosemide stress test
• Blunt chest trauma
• Postcardiac arrest status
• Heart lung interactions
• Carbon dioxide