This feature examines the impact of pharmacologic interventions on the treatment of the critically ill patient—an area of health care that has become increasingly complex. It will review recent advances (including evolving and controversial data) in drug therapy for adult ICU patients and assess these new modalities in terms of clinical, humanistic, and economic outcomes.
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References
1.
AlbaneseJ., ViviandX., PotieF.Sufentanil, fentanyl, and alfentanil in head trauma patients: A study on cerebral hemodynamics.Crit Care Med.1999; 27: 407–11.
2.
SperryR.J., BaileyP.L., ReichmanM.V.Fentanyl and sufentanil increase intracranial pressure in head trauma patients.Anesthesiology.1992; 77: 416–20.
3.
de NadalM., MunarF., PocaM.A.Cerebral hemodynamic effects of morphine and fentanyl in patients with severe head injury.Anesthesiology.2000; 92: 11–9.
4.
HamaokaN., OdaY., HaseI.Propofol decreases the clearance of midazolam by inhibiting CYP3A4: An in vivo and in vitro study.Clin Pharmacol Ther.1999; 66: 110–7.
5.
AhonenJ., OlkkolaK.T., TakalaA.Interaction between fluconazole and midazolam in intensive care patients.Acta Anaesthesiol Scand.1999; 43: 509–14.
6.
OdaY., MizutaniK., HaseI.Fentanyl inhibits metabolism of midazolam: Competitive inhibition of CYP 3A4 in vitro.Br J Anaesth.1999; 82: 900–3.
7.
BauerT.M., RitzR., HaberthurC.Prolonged sedation due to accumulation of conjugated metabolites of midazolam.Lancet.1995; 346: 145–7.
8.
CarrascoG., MolinaR., CostaJ.Propofol versus midazolam in short-, medium-, and long-term sedation of critically ill patients.Chest.1993; 103: 557–64.
9.
PohlmanA.S., SimpsonK.P., HallJ.B.Continuous intravenous infusions of lorazepam versus midazolam for sedation during mechanical ventilatory support: A prospective, randomized study.Crit Care Med.1994; 22: 1241–7.
10.
Barrientos-VegaR., Sanchez-SoriaM.M., Morales-GarciaC.Prolonged sedation of critically ill patients with midazolam or propofol: Impact on weaning and costs.Crit Care Med.1997; 25: 33–40.
11.
Sanchez-Izquierdo-RieraJ.A., Caballero-CubedoR.E., Perez-VelaJ.L.Propofol versus midazolam: Safety and efficacy for sedating the severe trauma patient.Anesth Analg.1998; 86: 1219–24.
12.
JacobiJ., FraserG.L., CoursinD.B.Clinical practice guidelines for the use of sedatives and analgesics in the critically ill adult.Crit Care Med.2002; 30: 119–41.
13.
D'AmbrosioJ.A., PhelpsP.B., NolenJ.G.Propylene glycol-induced lactic acidosis secondary to a continuous infusion of lorazepam.Pharmacotherapy.1993; 13: 274.
14.
ReynoldsH.N., TeikenP., ReganM.E.Hyperlactatemia, increased osmolar gap, and renal dysfunction during continuous lorazepam infusion.Crit Care Med.2000; 28: 1631–4.
15.
ArbourR.B.Propylene glycol toxicity related to high dose lorazepam infusion: Case report and discussion.Am J Crit Care.1999; 5: 499–506.
16.
SeayR.E., GravesP.J., WilkinM.K.Comment: Possible toxicity from propylene glycol in lorazepam infusion.Ann Pharmacother.1997; 31: 647–8.
17.
EzidinmaN.P., FishJ.T., WandschneiderH.L.Propylene glycol associated renal toxicity from lorazepam infusions.Crit Care Med.1999; 27: A123.
18.
ArbourR., EsparisB.Osmolar gap metabolic acidosis in a 60-year-old man treated for hypoxemic respiratory failure.Chest.2000; 118: 545–6.
19.
EzidinmaN.P., FishJ.T., WandschneiderH.L.Propylene glycol associated renal toxicity from lorazepam infusions.Crit Care Med.1999; 27: A123.
20.
ParkerM.G., FraserG.L., WatsonD.M.Removal of propylene glycol and correction of increased osmolar gaps by hemodialysis in a patient on high dose lorazepam infusion therapy.Intensive Care Med.2002; 28: 81–4.
21.
CawleyM.J.Short-term lorazepam infusion and concern for propylene glycol toxicity: Case report and review.Pharmacotherapy.2001; 21(9): 1140–4.
BennettS.N., McNeilM.M., BlandL.A.Postoperative infections traced to contamination of an intravenous anesthetic, propofol.N Engl J Med.1995; 333: 147–54.
24.
WebbS.A., RobertsB., BrehenyF.X.Contamination of propofol infusions in the intensive care unit: Incidence and clinical significance.Anaesth Intensive Care.1998; 26: 162–4.
25.
GalleyH.F., DiMatteoM.A., WebsterN.R.Immunomodulation by anesthetic, sedative, and analgesic agents: Does it matter?Int Care Med.2000; 26: 267–74.
26.
SaloM., PirttikangasC.O., PulkkiK.Effects of propofol emulsion and thiopentone on T helper cell type-1/type-2 balance in vitro.Anaesthesia.1997; 52: 341–4.
27.
HofbauerR., FrassM., SalfingerH.Propofol reduces the migration of human leukocytes through endothelial cell monolayers.Crit Care Med.1999; 27: 1843–7.
28.
KelbelI., KochT., WeberA.Alterations of bacterial clearance induced by propofol.Acta Anaesthesiol Scand.1999; 43: 71–6.
29.
KellyD.F., GoodaleD.B., WilliamsJ.Propofol in the treatment of moderate and severe head injury: A randomized, prospective double-blinded pilot trial.J Neurosurg.1999; 90: 1042–52.
BrayR.J.Propofol infusion syndrome in children.Paediatr Anaesth.1998; 8: 491–9.
32.
CremerO.L., MoonsK.G.M., BoumanE.A.C.Long-term propofol infusion and cardiac failure in adult head-injured patients.Lancet.2001; 357: 117–8.
33.
SharmaN.D., RosmanH.S., PadhiD.Torsades de pointes associated with intravenous haloperidol in critically ill patients.Am J Cardiol.1998; 81: 238–40.
34.
DouglasP.H., BlockP.C.Corrected QT interval prolongation associated with haloperidol in acute coronary syndromes.Catheter Cardiovasc Interv.2000; 50: 352–5.
35.
PerraultL.P., DenaultA.Y., CarrierM.Torsades de pointes secondary to intravenous haloperidol after coronary bypass grafting surgery.Can J Anaesth.2000; 47: 251–4.
36.
LawrenceK.R., NasrawayS.A.Conduction disturbances associated with administration of butyrophenone antipsychotics in the critically ill: A review of the literature.Pharmacotherapy.1997; 17: 531–7.
37.
HattaK., TakahashiT., NakamuraH.The association between intravenous haloperidol and prolonged QT interval.J Clin Psychopharmacol.2001; 21: 257–61.
38.
ReillyJ.G., AyisS.A., FerrierI.N.QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients.Lancet.2000; 355: 1048–52.
39.
EylesD.W., McLennanH.R., JonesA.Quantitative analysis of two pyridinium metabolites of haloperidol in patients with schizophrenia.Clin Pharmacol Ther.1994; 56: 512–20.
40.
UsukiE., PearceR., ParkinsonA.Studies on the conversion of haloperidol and its tetrahydropyridine dehydration product to potentially neurotoxic pyridinium metabolites by human liver microsomes.Chem Res Toxicol.1996; 9: 800–6.
41.
EylesD.W., McGrathJ.J., PondS.M.Formation of pyridinium species of haloperidol in human liver and brain.Psychopharmacology Berl.1996; 125: 214–9.
42.
IwahashiK., AnemoK., NakamuraK.Analysis of the metabolism of haloperidol (HP) and its neurotoxic pyridinium metabolites (HHP+) in patients with drug-induced parkinsonism.Clin Chim Acta.2000; 298: 193–5.
43.
UlrichS., NeuhofS., BraunV.Disposition of haloperidol pyridinium and reduced haloperidol pyridinium in schizophrenic patients: No relationship with clinical variables during short-term treatment.J Clin Psychopharmacol.2000; 20: 210–9.
44.
VennR.M., BryantA., HallG.M.Effects of dexmedetomidine on adreno-cortical function, and the cardiovascular, endocrine, and inflammatory responses in postoperative patients needing sedation in the intensive care unit.Br J Anaesth.2001; 86: 650–6.