Patients admitted to Intensive Care Units (ICU) have the highest mortality rates among hospitalized patients. For those who survive, recovery is often a prolonged rehabilitation period with physical, cognitive and psychological dysfunction. The aim of the present narrative review was to identify in the existing literature articles providing information about the development of chronic pain after ICU stay. We performed a PubMed search for publications up to 22 March 2020. We identified 41 articles eligible to be included in the present review; 29 of them were original research articles. Pre-existing chronic pain, previous poor health- related quality of life (HRQoL), but also the critical illness itself and organ support with multiple interventions, predispose to the development of chronic pain in the post-critical period, making it difficult to return to the pre-disease functional status. Opioid administration during mechanical ventilation is a common practice, frequently without reliable and systematic assessment of pain or individualized titration of dosage. Continue reading
The study of mechanisms by which drugs can modify cellular and ultimately whole animal and human performance is still one of the most exciting branches of science. However and despite the fact that many physicians are frequently using some times more than 20 drugs simultaneously in critically ill patients, very few of them are able to understand the enormous complexity and variability of different therapeutic responses within patients and/or between patients suffering from critical illness.
Continue readingA majority of current pharmacokinetic and pharmacodynamic data are generated from studies in healthy volunteers and stable patients with single organ dysfunction. However, critically ill patients differ from other patients because of the complex and unstable nature of their illness. Critical illness results in multiple changes that alter drug disposition in the body. As organs fail, so the pharmacokinetic processes of absorption, distribution, and elimination are affected.
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