Skip to main content
SpringerLink
Log in

The Intensive Care Unit

  • Chapter
  • First Online:
Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care

  • 4681 Accesses

Abstract

Caring for patients in the intensive care unit demands constant, meticulous thought and consideration while implementing every aspect of their management. Among the many life-sustaining therapies provided for those in the intensive care unit (ICU), the use of an individually tailored pharmacologic regimen has the potential to dramatically improve the overall health of the patient as well as to do great harm. Severe derangements in the physiologic responses and homeostatic mechanisms of critically ill patients often times result in challenges in constructing a durable therapeutic regimen. At times, these alterations in function can be difficult to detect, and their effects on the intended action of pharmacologic substances are often impossible to quantify. Knowledge of these specific disease processes, their potential effects on pharmacodynamics and pharmacokinetics, as well as an intimate familiarity with the pharmacologic agents most often used in the intensive care unit can lead to an optimized approach to improving the health of the critically ill patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Mihic SJ, Harris RA. Chapter 17: Hypnotics and sedatives. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s The pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill; 2011.

    Google Scholar 

  2. Oldenhof H, et al. Clinical pharmacokinetics of midazolam in intensive care patients, a wide interpatient variability[quest]. Clin Pharmacol Ther. 1988;43(3):263–9.

    Article  CAS  PubMed  Google Scholar 

  3. Malacrida R, et al. Pharmacokinetics of midazolam administered by continuous intravenous infusion to intensive care patients. Crit Care Med. 1992;20(8):1123–6.

    Article  CAS  PubMed  Google Scholar 

  4. Shafer A. Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens. Crit Care Med. 1998;26(5):947–56.

    Article  CAS  PubMed  Google Scholar 

  5. Bray RJ. Propofol infusion syndrome in children. Pediatr Anesth. 1998;8(6):491–9.

    Article  CAS  Google Scholar 

  6. Wolf A, et al. Impaired fatty acid oxidation in propofol infusion syndrome. Lancet. 2001;357(9256):606–7.

    Article  CAS  PubMed  Google Scholar 

  7. Kam PCA, Cardone D. Propofol infusion syndrome. Anaesthesia. 2007;62(7):690–701.

    Article  CAS  PubMed  Google Scholar 

  8. DeChicco R, et al. Contribution of calories from propofol to total energy intake. J Am Diet Assoc. 1995;95(9):A25.

    Article  Google Scholar 

  9. Laulin J-P, et al. The role of ketamine in preventing fentanyl-induced hyperalgesia and subsequent acute morphine tolerance. Anesth Analg. 2002;94(5):1263–9.

    Article  CAS  PubMed  Google Scholar 

  10. Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301(5):489–99.

    Article  CAS  PubMed  Google Scholar 

  11. Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012;307(11):1151–60.

    Article  CAS  PubMed  Google Scholar 

  12. Mukhtar AM, Obayah EM, Hassona AM. The use of dexmedetomidine in pediatric cardiac surgery. Anesth Analg. 2006;103(1):52–6.

    Article  CAS  PubMed  Google Scholar 

  13. Shehabi Y, et al. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM study). Anesthesiology. 2009;111(5):1075–84. doi:10.1097/ALN.0b013e3181b6a783.

    Article  CAS  PubMed  Google Scholar 

  14. Dellinger RP, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165–228.

    Article  CAS  PubMed  Google Scholar 

  15. Russell JA, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358(9):877–87.

    Article  CAS  PubMed  Google Scholar 

  16. Zewail AM, et al. Intravenous milrinone in treatment of advanced congestive heart failure. Tex Heart Inst J. 2003;30(2):109–13.

    PubMed Central  PubMed  Google Scholar 

  17. Barker FG, Ogilvy CS. Efficacy of prophylactic nimodipine for delayed ischemic deficit after subarachnoid hemorrhage: a metaanalysis. J Neurosurg. 1996;84(3):405–14.

    Article  PubMed  Google Scholar 

  18. McGarry L, Stokes M, Thompson D. Outcomes of thromboprophylaxis with enoxaparin vs. unfractionated heparin in medical inpatients. Thromb J. 2006;4(1):17.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Kakkar AK, et al. Low-molecular-weight heparin and mortality in acutely ill medical patients. N Engl J Med. 2011;365(26):2463–72.

    Article  CAS  PubMed  Google Scholar 

  20. Yoshida Rde A, et al. Systematic review of randomized controlled trials of new anticoagulants for venous thromboembolism prophylaxis in major orthopedic surgeries, compared with enoxaparin. Ann Vasc Surg. 2013;27(3):355–69.

    Article  PubMed  Google Scholar 

  21. Annane D, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288(7):862–71.

    Article  CAS  PubMed  Google Scholar 

  22. Sprung CL, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008;358(2):111–24.

    Article  CAS  PubMed  Google Scholar 

  23. Roth P, Wick W, Weller M. Steroids in neurooncology: actions, indications, side-effects. Curr Opin Neurol. 2010;23(6):597–602. doi:10.1097/WCO.0b013e32833e5a5d.

    Article  CAS  PubMed  Google Scholar 

  24. Bebawy JF. Perioperative steroids for peritumoral intracranial edema: a review of mechanisms, efficacy, and side effects. J Neurosurg Anesthesiol. 2012;24(3):173–7. doi:10.1097/ANA.0b013e3182578bb5.

    Article  PubMed  Google Scholar 

  25. Feigin VL, et al. Corticosteroids in patients with hemorrhagic stroke. Stroke. 2006;37(5):1344–5.

    Article  Google Scholar 

  26. Collaborators CT. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury? Outcomes at 6 months. Lancet. 2005;365(9475):1957–9.

    Article  Google Scholar 

  27. Cook DJ, et al. Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med. 1994;330(6):377–81.

    Article  CAS  PubMed  Google Scholar 

  28. Marik PE, et al. Stress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis. Crit Care Med. 2010;38(11):2222–8. doi:10.1097/CCM.0b013e3181f17adf.

    Article  PubMed  Google Scholar 

  29. Lin PC, et al. The efficacy and safety of proton pump inhibitors vs histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care patients: a meta-analysis. Crit Care Med. 2010;38(4):1197–205.

    Article  CAS  PubMed  Google Scholar 

  30. Alhazzani W, et al. Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis*. Crit Care Med. 2013;41(3):693–705. doi:10.1097/CCM.0b013e3182758734.

    Article  CAS  PubMed  Google Scholar 

  31. Sreedharan A, et al. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2010;(7):CD005415.

    Google Scholar 

  32. Wang C, Ma MH, Chou HC, et al. High-dose vs non-high-dose proton pump inhibitors after endoscopic treatment in patients with bleeding peptic ulcer: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2010;170(9):751–8.

    Article  CAS  PubMed  Google Scholar 

  33. Songür Y, et al. Comparison of infusion or low-dose proton pump inhibitor treatments in upper gastrointestinal system bleeding. Eur J Intern Med. 2011;22(2):200–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, Harvard Medical School, Boston, MA, 02215, USA

    Brian O’Gara MD & Shahzad Shaefi MD

  2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Brian O’Gara MD & Shahzad Shaefi MD

Authors
  1. Brian O’Gara MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shahzad Shaefi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shahzad Shaefi MD .

Editor information

Editors and Affiliations

  1. Departments of Anesthesiology and Pharmacology, LSU Health Sciences Center, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, Stockton, California, USA

    Adam M. Kaye

  3. Center for Perioperative Management and Medical Informatics, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

O’Gara, B., Shaefi, S. (2015). The Intensive Care Unit. In: Kaye, A., Kaye, A., Urman, R. (eds) Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8948-1_39

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-8948-1_39

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8947-4

  • Online ISBN: 978-1-4614-8948-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation