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Clinical Pharmacological and Therapeutic Considerations in General Intensive Care: A Review

The application of clinical pharmacological concepts and therapeutic standards in intensive care settings presents particularly difficult problems due to the lack of adequately controlled background information and the highly variable and rapidly evolving clinical conditions where drugs must be admi...

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Autores principales: Farina, Maria Luisa, Bonati, Maurizio, Iapichino, Gaetano, Pesenti, Antonio, Procaccio, Francesco, Boselli, Luigi, Langer, Martin, Graziina, Augusta, Tognoni, Gianni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101565/
https://www.ncbi.nlm.nih.gov/pubmed/3322782
http://dx.doi.org/10.2165/00003495-198734060-00003
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author Farina, Maria Luisa
Bonati, Maurizio
Iapichino, Gaetano
Pesenti, Antonio
Procaccio, Francesco
Boselli, Luigi
Langer, Martin
Graziina, Augusta
Tognoni, Gianni
author_facet Farina, Maria Luisa
Bonati, Maurizio
Iapichino, Gaetano
Pesenti, Antonio
Procaccio, Francesco
Boselli, Luigi
Langer, Martin
Graziina, Augusta
Tognoni, Gianni
author_sort Farina, Maria Luisa
collection PubMed
description The application of clinical pharmacological concepts and therapeutic standards in intensive care settings presents particularly difficult problems due to the lack of adequately controlled background information and the highly variable and rapidly evolving clinical conditions where drugs must be administered and their impact evaluated. In this review, an attempt has been made to discuss the available knowledge within the framework of a problem-oriented approach, which appears to provide a more clinically useful insight than a drug-centred review. Following a brief discussion of the scanty data and the most interesting models to which reference can be made from a pharmacokinetic point of view (the burn patient being taken as an example), the review concentrates on the main general intervention strategies in intensive care patients. These are based mainly on non-pharmacological measures (correction of fluid and electrolyte balance, total parenteral nutrition, enterai nutrition, oxygenation and ventilatory management) and are discussed with respect to the specific challenge they present in various clinical conditions and organ failure situations. In addition, 4 major selected clinical conditions where general management criteria and careful use of prophylactic and therapeutic drug treatments must interact to cope with the variety of presentations and problems are reviewed. These include: acute cerebral damage; anti-infective prophylaxis and therapy; cardiovascular emergencies; and problems of haemostasis. Each problem is analysed in such a way as to frame the pharmacological intervention in its broader context of the underlying (established or hypothesised) pathophysiology, with special attention being paid to those methodological issues which allow an appreciation of the degree of reliability of the data and the recommendations which appear to be practiced (often haphazardly) in intensive care units. The thorough review of the published literature provided (up to mid-1986) clearly shows that in this field the quality of randomised controlled and epidemiological studies is rather unsatisfactory. It would be highly beneficial to research and to clinical care if larger multicentric protocols and prospective epidemiological comparative investigations could be carried out to investigate more timely and adequately the variables which determine drug action, and the final outcome in the many subgroups of patients which must be considered in a proper stratification of intensive care unit populations.
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spelling pubmed-71015652020-03-31 Clinical Pharmacological and Therapeutic Considerations in General Intensive Care: A Review Farina, Maria Luisa Bonati, Maurizio Iapichino, Gaetano Pesenti, Antonio Procaccio, Francesco Boselli, Luigi Langer, Martin Graziina, Augusta Tognoni, Gianni Drugs Review Article The application of clinical pharmacological concepts and therapeutic standards in intensive care settings presents particularly difficult problems due to the lack of adequately controlled background information and the highly variable and rapidly evolving clinical conditions where drugs must be administered and their impact evaluated. In this review, an attempt has been made to discuss the available knowledge within the framework of a problem-oriented approach, which appears to provide a more clinically useful insight than a drug-centred review. Following a brief discussion of the scanty data and the most interesting models to which reference can be made from a pharmacokinetic point of view (the burn patient being taken as an example), the review concentrates on the main general intervention strategies in intensive care patients. These are based mainly on non-pharmacological measures (correction of fluid and electrolyte balance, total parenteral nutrition, enterai nutrition, oxygenation and ventilatory management) and are discussed with respect to the specific challenge they present in various clinical conditions and organ failure situations. In addition, 4 major selected clinical conditions where general management criteria and careful use of prophylactic and therapeutic drug treatments must interact to cope with the variety of presentations and problems are reviewed. These include: acute cerebral damage; anti-infective prophylaxis and therapy; cardiovascular emergencies; and problems of haemostasis. Each problem is analysed in such a way as to frame the pharmacological intervention in its broader context of the underlying (established or hypothesised) pathophysiology, with special attention being paid to those methodological issues which allow an appreciation of the degree of reliability of the data and the recommendations which appear to be practiced (often haphazardly) in intensive care units. The thorough review of the published literature provided (up to mid-1986) clearly shows that in this field the quality of randomised controlled and epidemiological studies is rather unsatisfactory. It would be highly beneficial to research and to clinical care if larger multicentric protocols and prospective epidemiological comparative investigations could be carried out to investigate more timely and adequately the variables which determine drug action, and the final outcome in the many subgroups of patients which must be considered in a proper stratification of intensive care unit populations. Springer International Publishing 2012-10-23 1987 /pmc/articles/PMC7101565/ /pubmed/3322782 http://dx.doi.org/10.2165/00003495-198734060-00003 Text en © ADIS Press Limited 1987 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Review Article
Farina, Maria Luisa
Bonati, Maurizio
Iapichino, Gaetano
Pesenti, Antonio
Procaccio, Francesco
Boselli, Luigi
Langer, Martin
Graziina, Augusta
Tognoni, Gianni
Clinical Pharmacological and Therapeutic Considerations in General Intensive Care: A Review
title Clinical Pharmacological and Therapeutic Considerations in General Intensive Care: A Review
title_full Clinical Pharmacological and Therapeutic Considerations in General Intensive Care: A Review
title_fullStr Clinical Pharmacological and Therapeutic Considerations in General Intensive Care: A Review
title_full_unstemmed Clinical Pharmacological and Therapeutic Considerations in General Intensive Care: A Review
title_short Clinical Pharmacological and Therapeutic Considerations in General Intensive Care: A Review
title_sort clinical pharmacological and therapeutic considerations in general intensive care: a review
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101565/
https://www.ncbi.nlm.nih.gov/pubmed/3322782
http://dx.doi.org/10.2165/00003495-198734060-00003
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