The Year in Review: Critical Care Medicine

Abstract

Background: There have been significant recent advances in the pharmacotherapeutic management of critically ill patients. The purpose of this article is to review and discuss the most pertinent published literature in the areas of neurology, cardiovascular diseases, infectious diseases, nephrology, hematology, and gastroenterology as it pertains to critical care in order to provide an update for the critical care practitioner.

Methods: We performed a Medline search from July 1999 to December 2000 utilizing terms relating to the pharmacotherapy of the specific aforementioned topics in critical care medicine. We focused on English-language clinical studies performed in adult intensive care unit (ICU) patients. From these articles we selected those that would have a practical impact on drug therapy in the ICU or the development of drug usage guidelines for critically ill patients. Review articles were generally not included.

Results: The following topics were found to be either new developments or of potentially significant impact in the management of adult critically ill patients. In the area of neurology, advances were found with respect to optimization of regimens for sedative and neuromuscular blocking agents, validation of sedation scales and tools, and in the treatment of head injury patients. In the cardiovascular diseases, most studies related to the hemodynamic support of septic shock. We focus on developments in fluid resuscitation, optimization of global and regional oxygen transport variables, the repositioning of vasopressor agents, and a return to the use of steroids. Given the high mortality rate associated with the development of acute renal failure in the ICU, there has been a consistent attempt to develop preventative and treatment strategies for these patients, including optimization of antimicrobial dosing methods. Several epidemiological and longitudinal studies document changes in multi-drug antimicrobial resistance patterns. The use of treatment guidelines for antimicrobials in the critically ill improves outcomes in most patients. Significant attention has focused on the characterization of anemia in the ICU and the development of alternative pharmacological strategies in its treatment. Finally, in gastroenterology, the main focus has been the investigation of methods to optimize the delivery of enteral nutrition given its proven benefits in critically ill patients.

Conclusions: Significant advances in the areas of neurological, cardiovascular, infectious diseases, renal, hematological, and gastrointestinal issues in the pharmacotherapy of critically ill patients have been published over the course of the past year. Many of these studies have yielded data that may be incorporated into the pharmacotherapeutic management of ICU patients, hence maximizing outcomes.