tailieunhanh - Báo cáo y học: "Intensive care unit-acquired infection as a side effect of sedation"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Intensive care unit-acquired infection as a side effect of sedation. | Nseir et al. Critical Care 2010 14 R30 http content 14 2 R30 c CRITICAL CARE RESEARCH Open Access Intensive care unit-acquired infection as a side effect of sedation Saad Nseir1 Demosthenes Makris2 Daniel Mathieu1 Alain Durocher1 Charles-Hugo Marquette3 Abstract Introduction Sedative and analgesic medications are routinely used in mechanically ventilated patients. The aim of this review is to discus epidemiologic data that suggest a relationship between infection and sedation to review available data for the potential causes and pathophysiology of this relationship and to identify potential preventive measures. Methods Data for this review were identified through searches of PubMed and from bibliographies of relevant articles. Results Several epidemiologic studies suggested a link between sedation and ICU-acquired infection. Prolongation of exposure to risk factors for infection microaspiration gastrointestinal motility disturbances microcirculatory effects are main mechanisms by which sedation may favour infection in critically ill patients. Furthermore experimental evidence coming from studies both in humans and animals suggest that sedatives and analgesics present immunomodulatory properties that might alter the immunologic response to exogenous stimuli. Clinical studies comparing different sedative agents do not provide evidence to recommend the use of a particular agent to reduce ICU-acquired infection rate. However sedation strategies aiming to reduce the duration of mechanical ventilation such as daily interruption of sedatives or nursing-implementing sedation protocol should be promoted. In addition the use of short acting opioids propofol and dexmedetomidine is associated with shorter duration of mechanical ventilation and ICU stay and might be helpful in reducing ICU-acquired infection rates. Conclusions Prolongation of exposure to risk factors for infection microaspiration gastrointestinal motility disturbances microcirculatory effects and .