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Risk reduction in the intensive care unit

  • Sanjay Saint
    Correspondence
    Requests for reprints should be addressed to Sanjay Saint, MD, MPH, University of Michigan Medical Center, 3116 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109-0376
    Affiliations
    Robert Wood Johnson Clinical Scholars Program (SS), University of Washington, Seattle, Washington, USA
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  • Michael A. Matthay
    Affiliations
    Department of Medicine and Anesthesia (MAM), Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
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      Abstract

      Many potentially preventable complications occur in patients who receive intensive care. We have reviewed the epidemiology of three important complications (venous thromboembolism, stress-related upper gastrointestinal bleeding, and vascular catheter-related infection) and evaluated common preventive treatments to provide evidence-based recommendations for prevention. We used English language articles located by MEDLINE or cross-citation, giving preference to articles published in the last 10 years, meta-analyses, and clinical trials that were randomized, double-blinded, and used intention-to-treat analysis. We recommend prophylaxis against venous thromboembolism in most patients, whereas those without respiratory failure or coagulopathy may not require prophylaxis against stress-related upper gastrointestinal hemorrhage. Chlorhexidine gluconate is the preferred antiseptic for disinfecting the skin prior to and during intravascular catheterization. Central venous catheters impregnated with antibacterial or antiseptic agents should be considered in patients at high risk for vascular catheter-related infection. Finally, central venous, pulmonary arterial, and systemic arterial catheters should be changed only when clinically indicated.
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