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Báo cáo y học: "Opioid-induced constipation in intensive care patients: relief in sigh"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Opioid-induced constipation in intensive care patients: relief in sight? | Available online http ccforum.eom content 12 4 161 Commentary Opioid-induced constipation in intensive care patients relief in sight Daniel Chappell Markus Rehm and Peter Conzen Clinic of Anaesthesiology Ludwig-Maximilians University Nussbaumstrasse 20 80336 Munich Germany Corresponding author Daniel Chappell daniel.chappell@med.uni-muenchen.de Published 1 July 2008 This article is online at http ccforum.com content 12 4 161 2008 BioMed Central Ltd Critical Care 2008 12 161 doi 10.1186 cc6930 Abstract Constipation is the most common gastrointestinal complication associated with opioid therapy in chronic pain patients and also frequently occurs in sedated intensive care unit patients. Conventional therapy may not provide sufficient relief from constipation which can be severe enough to limit opioid use or the dose. In a recent study on terminally ill patients suffering from laxativeresistant opioid-induced constipation Thomas and colleagues demonstrated subcutaneous methylnaltrexone to rapidly induce defecation. This appealing result might also have favourable prospects for intensive care patients as their outcome is often codetermined by recovery of bowel functioning. Gastrointestinal complications are very common in patients on intensive care units 1 . The highest occurrence of delayed gastric emptying is observed in patients with head injuries burns multisystem trauma and sepsis 2 . The aetiology of bowel dysfunctions in some cases progressing to a paralytic ileus is certainly complex and major contributing factors on the intensive care unit include parenteral nutrition mechanical ventilation hypoperfusion shock dehydration secretion of inflammatory mediators as well as endogenous and exogenous opioids 3 . Opioids are commonly used on the intensive care unit to treat pain or for sedation their efficacy is accompanied by burdensome side effects however the most frequent being nausea respiratory depression impaired cognition urinary retention and bowel dysfunction