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Prophylactic Regimens in the Intensive Care Unit

  • Walter A. Wynkoop
  • Gilbert E. D’Alonzo

Abstract

After studying this chapter, you should be able to:
  • Identify risk factors associated with the development of deep vein thrombosis and its consequence, pulmonary embolism.

  • Understand the indications for medical, mechanical, and inferior vena cava filter prophylaxis and describe the available methods for each.

  • Identify the major physiologic mechanism associated with stress-induced gastritis and ulceration and identify the risk factors associated with this condition.

  • Know the methods used for prophylaxis of stress-induced gastritis and ulceration and the potential complications of the medical therapies used for this condition.

  • Identify the nosocomial infections common in the intensive care unit and the causative organisms responsible.

  • Discuss the various risk factors associated with the development of infection in critically ill patients.

  • Employ a variety of effective prophylactic regimens to prevent pneumonia, line sepsis, and urinary tract infection in critically ill patients.

Keywords

Deep Vein Thrombosis Nosocomial Pneumonia Mucosal Blood Flow Prophylactic Regimen Danaparoid Sodium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Suggested Reading

Deep Venous Thrombosis

  1. Becker DM, Philbrick JT, Selby B. Inferior vena cava filters. Indications, safety, effectiveness. Arch Intern Med 1992; 152: 1985–1994.PubMedCrossRefGoogle Scholar
  2. Clagett GP, Anderson FA, Heit JA, et al. Prevention of venous thromboembolism. Chest 1998; 114: 5315–5605.CrossRefGoogle Scholar
  3. Thromboembolic Risk Factors (THRIFT) Consensus Group. Risk of and prophylaxis for venous thromboembolism in hospitalized patients. Br Med J 1992; 305: 567–574.Google Scholar

Stress-Induced Gastritis and Ulceration

  1. Ben-Menachem T, Fogel R, Patel RV, et al. Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit. Ann Intern Med 1994; 121: 568–575.PubMedGoogle Scholar
  2. Binder HJ. Selective summaries: stress erosive gastritis: what is optimal thrapy and who should undergo it? Gastroenterology 1995; 109: 626–632.CrossRefGoogle Scholar
  3. Cook DJ, Fuller MB, Guyatt GH. Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med 1994; 330: 377–381.PubMedCrossRefGoogle Scholar
  4. Cook DJ, Reeve BK, Guyatt GH. Stress ulcer prophylaxis in critically ill patients. JAMA 1996; 275: 308–314.PubMedCrossRefGoogle Scholar
  5. Cook DJ, Laine LA, Guyatt GH, et al. Nosocomial pneumonia and the role of gastric pH. Chest 1991; 100: 7–13.PubMedCrossRefGoogle Scholar
  6. Heyland DK, Cook DJ, Jaeschke R, et al. Selective decontamination of the digestive tract. An overview. Chest 1994; 105: 1221–1229.PubMedCrossRefGoogle Scholar
  7. Maier RV, Mitchell D, Gentiello L. Optimal therapy for stress gastritis. Ann Surg 1994; 220: 353–363.PubMedCrossRefGoogle Scholar
  8. Martin LF, Booth FV, Reines HD, et al. Stress ulcers and organ failure in intubated patients in surgical intensive care units. Ann Surg 1992; 215: 332–337.PubMedCrossRefGoogle Scholar
  9. O’Keefe GE, Gentilb LM, Maier RV. Incidence of infectious complications associated with the use of H2-receptor antagonists in critically ill trauma patients. Ann Surg 1998; 227: 120–125.PubMedCrossRefGoogle Scholar

Nosocomial Infections

  1. Emori TG, Gaynes RP. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 1993; 6: 428–442.PubMedGoogle Scholar
  2. Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosoco- mial infections, 1988. Am J Infect Control 1988; 16: 128–140.PubMedCrossRefGoogle Scholar
  3. Haley RW, Culvar DH, White JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985; 121: 182–205.PubMedGoogle Scholar
  4. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) study. JAMA 1995; 274: 639–644.PubMedCrossRefGoogle Scholar
  5. Driks MR, Craven DE, Celli BR, et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type-2 blockers. N Engl J Med 1987; 317: 1376–1382.PubMedCrossRefGoogle Scholar
  6. Estes RI, Meduri GU. The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation. Intensive Care Med 1995; 21: 365–383.PubMedCrossRefGoogle Scholar
  7. Fiddian-Green RG, Baker S. Nosocomial pneumonia in the critically ill: product of aspiration or translocation? Crit Care Med 1991; 19: 763–769.PubMedGoogle Scholar
  8. Griffin JG, Meduri GU. New approaches in the diagnosis of nosocomial pneumonia. Surg Clin North Am 1994; 78: 1091–1122.Google Scholar
  9. Lode HM, Schaberg T, Raffenberg M, et al. Nosocomial pneumonia in the critical care unit. Crit Care Clin 1998; 14: 119–133.PubMedCrossRefGoogle Scholar
  10. Meduri GU, Johanson WG (eds) International Consensus Conference: clinical investigation of ventilator-associated pneumonia. Chest 1992; 102 (suppl 1): 551S - 588S.Google Scholar
  11. Meduri GU, Mauldin GL, Wunderink RG, et al. Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia. Chest 1994; 106: 221–235.PubMedCrossRefGoogle Scholar
  12. Bjornson HS. Pathogenesis, prevention, and management of catheter-associated infections. New Horiz 1993; 1: 271–278.PubMedGoogle Scholar
  13. Cunha BA. Intravenous line infections. Crit Care Clin 1998; 14: 339–346.PubMedCrossRefGoogle Scholar
  14. Eyer S, Brummit C, Crossley K, et al. Catheter related sepsis: prospective, randomized study of three methods of long term catheter maintenance. Crit Care Med 1990; 18: 1073–1079.PubMedCrossRefGoogle Scholar
  15. Intravenous Nurses Society. Intravenous Nursing Standards of Practice. Belmont, MA: Intravenous Nurses Society, 1990.Google Scholar
  16. Maki DG, Stolz SM, Wheeler S, et al. Prevention of central venous catheter related bloodstream infection by use of an antiseptic impregnated catheter. A randomized, controlled trial. Ann Intern Med 1997; 127: 257–266.PubMedGoogle Scholar
  17. Norwood S, Ruby A, Civetta J, Cortes V. Catheter-related infections and associated septicemia. Chest 1991; 99: 968–975.PubMedCrossRefGoogle Scholar
  18. Perucca R. Intravenous monitoring and catheter care. In: Terry J, Baranowski L, Lonsway RA, Hedrick C (eds) Intravenous Therapy. Philadelphia: Saunders, 1995: 392–399.Google Scholar
  19. Timsit JF, Brunell F, Cheval C, et al. Use of tunneled femoral catheters to prevent catheter-related infection. Ann Intern Med 1999; 130: 729–735.PubMedGoogle Scholar
  20. Amin M Antibacterial prophylaxis in urology: a review. Am J Med 1992;92(suppl 4A):114–117.Google Scholar
  21. Cunnin CM. Detection, Prevention and Management of Urinary Tract Infections, 4th Ed. Philadelphia: Lea and Febiger, 1987.Google Scholar
  22. Daifuku R, Stamm WE. Bacterial adherence to bladder uroepithelial cells in catheter-associated urinary tract infection. N Engl J Med 1986; 314: 1208–1213.PubMedCrossRefGoogle Scholar
  23. Paradisi F, Giampaolo C, Mangani V. Urosepsis in the critical care unit. Crit Care Clin 1998; 14: 165–180.PubMedCrossRefGoogle Scholar
  24. Sobel JD. Pathogenesis of urinary tract infections: host defenses. Infect Dis Clin North Am 1987; 1: 751–772.PubMedGoogle Scholar
  25. Tambyah P, Halverson KT, Maki DG. A prospective study of pathogenesis of catheter-associated urinary tract infections. Mayo Clin Proc 1999; 74: 131–136.PubMedCrossRefGoogle Scholar
  26. Warren JW. Catheter-associated urinary tract infections. Infect Dis Clin North Am 1987; 1: 823–854.PubMedGoogle Scholar
  27. Wong ES. New aspects of urinary tract infections. Clin Crit Care Med 1987; 12: 25–38.Google Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • Walter A. Wynkoop
  • Gilbert E. D’Alonzo

There are no affiliations available

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