No abstract

SummaryWe retrospectively compared the changes in serum albumin concentration and colloid osmotic pressure between survivors and nonsurvivors of prolonged (Ն7 days) critical illness over a 2-year period from 1 July 1995. All patients had serum albumin measured daily, and colloid osmotic pressure measured 5 days a week, throughout their ICU admission. (survivors); p < 0.01]. Analysis of colloid osmotic pressure results showed no difference between the groups in mean, minimum or recovery mean. Regression analysis of mean colloid osmotic pressure and albumin revealed that albumin only contributed 17% of the colloid osmotic pressure in these patients. The similar decrease in albumin in nonsurvivors and survivors may reflect the acute inflammatory response and/or haemodilution. However, survivors showed an ability to increase serum albumin concentrations, possibly owing to resumption of synthesis. The colloid osmotic pressure varied little between or within either group of patients, possibly because of the use of artificial colloids. There was no relationship between death and colloid osmotic pressure.

Summary The pharmacokinetics of midazolam and its metabolite, I-OH

The critically ill patient occupies an increasing amount of time and bed space in modern hospital practice, and also commands increasing expenditure. Drug therapy in these patients has, in the past, been based on data derived from healthy volunteers, fit anaesthetised patients undergoing minor operative procedures, or patients with single organ failure. Alterations in pharmacokinetics and pharmacodynamics have not been studied in depth in critically ill patients who often have multisystem failure. This paper reviews the currently available information on drugs in common usage in these patients. The studies that have been performed have usually shown delayed drug clearance, altered volumes of distribution and prolonged elimination half-lives. The sedative and analgesic drugs, in particular, have shown marked accumulation which may confuse the clinical picture, and prolonged periods of assisted ventilation may be required until the drugs are eliminated.