The review presents literature data and focuses on the acclaimed need for transition from general to dedicated Neurosurgical/Νeurological or Neuroscience Intensive Care Units (NSICU). There are solid data from well designed metanalyses showing that at least in the United States, the wider implementation of intensivists in the ICUs, led to significant reductions in ICU and hospital mortality and patient’s length of stay (LOS). Given the variation in ICU physician staffing plans and the potential for reduced mortality implied by these studies, a more rigorous evaluation of the optimal ICU organization is essential. Highly specialized vs. less specialized ICU physician staffing is associated with reduced hospital and ICU mortality and LOS.
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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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