Altering Routine Intensive Care Unit Practices to Support Commensalism

Hamilton, Leslie A.; Behal, Michael L.

doi:10.1002/ncp.10484

Cited by 4 publications

(2 citation statements)

References 74 publications

(213 reference statements)

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“…Morphine-induced changes in the GI microbiome occur in a receptor-dependent manner and can be inhibited by opioid antagonists [ 51 , 55 ]. The impact of morphine administration on pathogen virulence has been well studied, but the effect of other opioids on virulence is unclear [ 59 ].…”

Section: Resultsmentioning

confidence: 99%

The effect of opioids on gastrointestinal function in the ICU

2021

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Gastrointestinal (GI) dysfunction is common in the critical care setting and is highly associated with clinical outcomes. Opioids increase the risk for GI dysfunction and are frequently prescribed to reduce pain in critically ill patients. However, the role of opioids in GI function remains uncertain in the ICU. This review aims to describe the effect of opioids on GI motility, their potential risk of increasing infection and the treatment of GI dysmotility with opioid antagonists in the ICU setting.

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Section: Resultsmentioning

confidence: 99%

The effect of opioids on gastrointestinal function in the ICU

2021

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“…stroke patients) cannot be ruled out as a trigger for pulmonary complications. The absence of an explanatory pathogenic mechanism has led to controversy in clinical practice and the consideration of alternatives [30][31][32][33][34][35].…”

Section: Problem Outline: Is Chlorhexidine Oral Care Harmful?mentioning

confidence: 99%

Antiseptic mouthwash, the nitrate–nitrite–nitric oxide pathway, and hospital mortality: a hypothesis generating review

Blot

2020

Intensive Care Med

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Meta-analyses and several large cohort studies have demonstrated that antiseptic mouthwashes are associated with mortality in hospitalized patients. A clear pathogenic mechanism is lacking, leading to controversy and a reluctance to abandon or limit the use of antiseptic mouthwashes. Here, we generate the hypothesis that a disturbance in nitric oxide homeostasis by antiseptic mouthwashes may be responsible for the observed increase in mortality risk. Nitric oxide is essential in multiple physiological processes, and a reduction in nitric oxide bioavailability is associated with the occurrence or worsening of pathologies, such as atherosclerosis, diabetes, and sepsis. Oral facultative anaerobic bacteria are essential for the enterosalivary nitrate-nitrite-nitric oxide pathway due to their capacity to reduce nitrate to nitrite. Nitrate originates from dietary sources or from the active uptake by salivary glands of circulating nitrate, which is then excreted in the saliva. Because antiseptic mouthwashes eradicate the oral bacterial flora, this nitric oxide-generating pathway is abolished, which may result in nitric oxide-deficient conditions potentially leading to life-threatening complications such as ischaemic heart events or sepsis.

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