RESUMO
Any patient suffering from critical life-threatening illnesses in most cases require hospitalization, in the care unit (ICU) where they can receive essential life-sustaining treatments. This has created an impact including more than 50 million individuals world-wide. Although advancements, in technology and healthcare have increased survival rates many individuals who survive these illnesses experience long-term impairments known as post-intensive care syndrome (PICS). PICS encompasses cognitive and emotional challenges that significantly affect patients' quality of life and ability to return to their normal routines. Caregivers may also face similar emotional hurdles, a condition referred to as PICS-family (PICS-F). The prevalence of PICS varies but can affect up to 50% of ICU survivors. Cognitive difficulties can be noticed in, around 70% of instances impacting abilities like memory, focus, and decision-making. These difficulties can lead to emotions such, as sadness worry, and a condition known as traumatic stress disorder (PTSD). Multiple factors, such as delirium, sedation, and pre-existing health conditions play a role, in the emergence and severity of PICS. Diagnosing PICS involves comprehensive assessments covering physical, cognitive, and emotional dimensions. Screening should ideally commence during the ICU stay and continue post-discharge. Assessment tools such as the Montreal cognitive assessment (MoCA) and emotional functioning screenings aid in identifying PICS. This manifests physically through muscle weakness and fatigue, impacting mobility and daily activities. Effectively managing ICUs requires the implementation of models and strategies that optimize resource utilization. However, these strategies may entail challenges such as data integration and stakeholder involvement. Preventing PICS involves proactive measures like reducing sedation, promoting early mobility, and offering rehabilitation services. Addressing PICS necessitates a proactive approach, comprehensive patient care, and collaboration among multidisciplinary teams. The successful implementation of these strategies depends on thorough evaluation and active engagement with all stakeholders involved in ICU management.
RESUMO
Vasopressors and inotropes are often administered to critically ill patients in intensive care unit for the management and treatment of haemodynamic impairment, heart failure, septic and cardiogenic shock, trauma among certain other diseases. In patients with shock, vasopressors and inotropes are used to induce vasoconstriction or enhance cardiac contractility. Vasopressors induces vasoconstriction, which causes systemic vascular resistance, leading to increase in mean arterial pressure and elevates organ perfusion. While inotropes raise cardiac output, which helps maintain mean arterial pressure and body perfusion. Due to a decreased risk of side effects compared to other catecholamine vasopressors, norepinephrine is considered a first-line vasopressor titrated to attain an optimal arterial pressure. An inotrope such as dobutamine may be given to raise cardiac output to a sufficient level to fulfil tissue demand if tissue and organ perfusion still is not enough. Due to their strengthening effect on cardiac contractility, inotropes have been utilized in the care of patients with heart failure for decades, particularly for patients with systolic dysfunction, or heart failure with reduced ejection fraction. Along with their beneficial inotropic impact, they also have chronotropic and peripheral vascular effects. For patients with severely reduced cardiac output and peripheral organ hypoperfusion, they are most frequently employed in intensive care unit. Along with their benefits they are also associated with certain considerate side-effects. The purpose of this research is to review the available information about role of inotropes and vasopressors therapy in the intensive care unit.