[Antibiotics and artificial nutrition in the cardiac intensive care unit].
Patients admitted to cardiac intensive care units are at high risk for infections, particularly nosocomial pneumonia, pacemaker's pocket and sternotomic wound infections. These complications delay recovery, prolong hospitalization, time on mechanical ventilation, and increase mortality. Both behavioral and pharmacological measures are needed to prevent and control infections in these patients, as well as specific antibiotic treatment and nutritional support. In infected critically ill patients, pathophysiological alterations modify distribution and clearance of antibiotics, and hypercatabolic state leads to malnutrition and immune paralysis, which both contribute to increased infectious risk and worsened outcome. A deep understanding of antibacterial agents pharmacology in the critically ill is essential in order to treat severe infections; moreover, it is necessary to know routes of administration and composition of artificial nutrition solutions. The aim of this review is to define main and specific aspects of antibiotic therapy and nutritional support in cardiac critical care patients in light of recent literature data.
De Gaudio
Raffaele
R
Cattedra di Anestesiologia e Rianimazione, Dipartimento di Area Critica Medico-Chirurgica, Università degli Studi, Firenze. araffaele.degaudio@unifi.it
Selmi
Valentina
V
Chelazzi
Cosimo
C
D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D003325:Coronary Care Units; D003422:Critical Care / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control; D003666:Decontamination; D004352:Drug Resistance, Microbial; D041981:Gastrointestinal Tract / Q000382:microbiology; D006331:Heart Diseases / Q000628:therapy*; D006801:Humans; D016867:Immunocompromised Host; D017053:Infection Control; D007668:Kidney / Q000503:physiopathology; D044342:Malnutrition / Q000276:immunology / Q000517:prevention & control; D018529:Nutritional Support; D011183:Postoperative Complications / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control
D000900:Anti-Bacterial Agents