The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Prevention of Complications in Critically Ill Patients

중환자의 합병증 예방

  • Lee, Won-Yeon (Department of Internal Medicine, Yonsei University Wonju College of Medicine)
  • 리원연 (연세대학교 원주의과대학 내과학교실 호흡기내과)
  • Published : 2011.02.01
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Abstract

Critically ill patients requiring treatment in intensive care unit (ICU) are increasing recently. The patients treating in intensive care unit have various catheter, device, antibiotics treatment, and decreased immunity, and are prone to get complications from those. Some complications are clinically insignificant, but some complications may be fatal. The serious complications are including ventilator associated pneumonia that is one type of hospital acquired pneumonia, venous thromboembolism that is a major risk factor of pulmonary embolism, and stress related ulcer that make clinically significant gastrointestinal bleeding. Those complications prolong ICU stay period, increase morbidity and mortality, and cost. Therefore we should try to decrease incidence of those complications. The methods to decrease the complications in ICU are including education of facility staffs including physicians, nurses, students, and other staffs, and daily formal routine evaluation of patients in ICU.

Keywords

References

  1. American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare- associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416. https://doi.org/10.1164/rccm.200405-644ST
  2. Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care associated pneumonia, 2003: recommendations of CDC and the healthcare infection control practices advisory committee. MMWR Recomm Rep 2004;53:1-36.
  3. Edwards JR, Peterson KD, Mu Y, et al. National healthcare safety network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783-805. https://doi.org/10.1016/j.ajic.2009.10.001
  4. Rello J, Ollendorf DA, Oster G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115-2121. https://doi.org/10.1378/chest.122.6.2115
  5. Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian critical trials group. Am J Respir Crit Care Med 1999;159:1249-1256. https://doi.org/10.1164/ajrccm.159.4.9807050
  6. Warren DK, Shukla SJ, Olsen MA, et al. Outcome and attributablee cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med 2003;31:1312-1317. https://doi.org/10.1097/01.CCM.0000063087.93157.06
  7. Kollef MH. The prevention of ventilator-associated pneumonia. N Engl J Med 1999;340:627-634. https://doi.org/10.1056/NEJM199902253400807
  8. Bonten MJ. Controversies on diagnosis and prevention of ventilator associated pneumonia. Diagn Microbiol Infect Dis 1999;34:199-204. https://doi.org/10.1016/S0732-8893(99)00040-1
  9. Cook D, Guyatt G, Marshall J, et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Cre Trials Group N Engl J Med 1998;338:791-797.
  10. Schuster DP, Rowley H, Feinstein S, McGue MK, Zuckerman GR. Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit. Am J Med 1984;76:623-630. https://doi.org/10.1016/0002-9343(84)90286-9
  11. Fabian TC, Boucher BA, Croce MA, et al. Pneumonia and stress ulceration in severely injured patients: a prospective evaluation of the effects of stress ulcer prophylaxis. Arch Surg 1993;12:185-191.
  12. Quenot JP, Thiery N, Barbar S. When should stress ulcer prophylaxis be used in the ICU? Curr Opin Crit Care 2009;15:139-143. https://doi.org/10.1097/MCC.0b013e32832978e0
  13. Cook DJ, Griffith LE, Walter SD, et al. The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care 2001;5:368-375. https://doi.org/10.1186/cc1071
  14. Cook DJ, Fuller HD, Guyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med 1994;330:377-381. https://doi.org/10.1056/NEJM199402103300601
  15. Ellison RT, Perez-Perez G, Welsh CH, et al. Risk factors for upper gastrointestinal bleeding in intensive care unit patients: role of helicobacter pylori. Federal Hyperimmune Immunoglobulin Therapy Study Group. Crit Care Med 1996;24:1974-1981. https://doi.org/10.1097/00003246-199612000-00008
  16. Lam NP, Le PD, Crawford SY, Patel S. National survey of stress ulcer prophylaxis. Crit Care Med 1999;27:98-103. https://doi.org/10.1097/00003246-199901000-00034
  17. Ali T, Harty RF. Stress-induced ulcer bleeding in critically ill patients. Gastroenterol Clin North Am 2009;38:245-265. https://doi.org/10.1016/j.gtc.2009.03.002
  18. Fennerty MB. Pathophysiology of the upper gastrointestinal tract in the critically ill patient: rationale for the therapeutic benefits of acid suppression. Crit Care Med 2002;30(6 Suppl):S351-S355. https://doi.org/10.1097/00003246-200206001-00002
  19. Geus WP. Are there indications for intravenous acid-inhibition in the prevention and treatment of upper GI bleeding? Scand J Gastroenterol Suppl 2000:S10-S20.
  20. Welage LS. Overview of pharmacologic agents for acid suppression in critically ill patients. Am J Health Syst Pharm 2005;62(10 Suppl 2):S4-S10.
  21. Spirt MJ. Stress-related mucosal disease. Curr Treat Options Gastroenterol 2003;6:135-145. https://doi.org/10.1007/s11938-003-0014-9
  22. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(6 Suppl):S381-S453. https://doi.org/10.1378/chest.08-0656
  23. Cook D, Crowther M, Meade M, et al. Deep venous thrombosis in medical-surgical critically ill patients: prevalence, incidence, and risk factors. Crit Care Med 2005;33:1565-1571. https://doi.org/10.1097/01.CCM.0000171207.95319.B2
  24. Crowther MA, Cook DJ, Griffith LE, et al. Neither baseline tests of molecular hypercoagulability nor D-dimer levels predict deep venous thrombosis in critically ill medical-surgical patients. Intensive Care Med 2005;31:48-55. https://doi.org/10.1007/s00134-004-2467-2
  25. Khouli H, Shapiro J, Pham VP, et al. Efficacy of deep venous thrombosis prophylaxis in the medical intensive care unit. J Intensive Care Med 2006;21:352-358. https://doi.org/10.1177/0885066606292880
  26. Bang SM, Jang MJ, Oh D, et al. Korean guidelines for the prevention of venous thromboembolism. J Korean Med Sci 2010;25:1553-1559. https://doi.org/10.3346/jkms.2010.25.11.1553
  27. Limpus A, Chaboyer W, McDonald E, Thaliib L. Mechanical thromboprophylaxis in critically ill patients: a systematic review and meta-analysis. Am J Crit Care 2006;15:402-410; discussion 411-412.