TY - JOUR
T1 - ICU management of patients with Parkinson's disease or Parkinsonism
AU - Freeman, William D.
AU - Tan, K. Meng
AU - Glass, G. A.
AU - Linos, Konstantinos
AU - Foot, Carole
AU - Ziegenfuss, Marc
N1 - Funding Information:
Dr. Freeman acknowledges research funding provided in part by the Robert H. and Clarice Smith/M.L. Simpson Foundation Trust. The copyright for the figures is held by the Mayo Foundation. Permission has been obtained from the Mayo Foundation for Medical Education and Research to reproduce these figures-all rights reserved. We acknowledge the work of Mr. David Factor and Mr. Mike King in producing these illustrations.
PY - 2007
Y1 - 2007
N2 - Parkinson's disease (PD) is a common neurodegenerative disorder, occurring in at least 1% of patients older than 65 years of age and characterized by bradykinesia, rigidity, and tremor. Parkinsonism is a broad term for patients with PD and Parkinson's like disorders. Due to the aging population, the number of patients admitted to the intensive care unit (ICU) with PD or disorders with Parkinsonism is expected to rise in the future. For optimal ICU care, PD co-morbidities of memory impairment, aspiration, and dysautonomia require special attention. Withdrawal of dopaminergic medications in the perioperative state or ICU can lead to worsened PD symptoms, chest wall rigidity complicating ventilator management, and a severe hyperpyrexia, rigid, encephalopathic state termed neuroleptic malignant syndrome (NMS). PD patients are also sensitive to antipsychotic and antiemetic medications, which can exacerbate rigidity and aspiration. Elderly patients with PD are more sensitive to sedative medications and more susceptible to develop post-operative or ICU delirium, which has increased morbidity and mortality. PD patients are at increased risk of increased perioperative aspiration pneumonia and its associated morbidity and mortality. Specialized ICU management strategies for patients with PD are described.
AB - Parkinson's disease (PD) is a common neurodegenerative disorder, occurring in at least 1% of patients older than 65 years of age and characterized by bradykinesia, rigidity, and tremor. Parkinsonism is a broad term for patients with PD and Parkinson's like disorders. Due to the aging population, the number of patients admitted to the intensive care unit (ICU) with PD or disorders with Parkinsonism is expected to rise in the future. For optimal ICU care, PD co-morbidities of memory impairment, aspiration, and dysautonomia require special attention. Withdrawal of dopaminergic medications in the perioperative state or ICU can lead to worsened PD symptoms, chest wall rigidity complicating ventilator management, and a severe hyperpyrexia, rigid, encephalopathic state termed neuroleptic malignant syndrome (NMS). PD patients are also sensitive to antipsychotic and antiemetic medications, which can exacerbate rigidity and aspiration. Elderly patients with PD are more sensitive to sedative medications and more susceptible to develop post-operative or ICU delirium, which has increased morbidity and mortality. PD patients are at increased risk of increased perioperative aspiration pneumonia and its associated morbidity and mortality. Specialized ICU management strategies for patients with PD are described.
KW - Intensive care
KW - Parkinson's disease
KW - Parkinsonism
UR - http://www.scopus.com/inward/record.url?scp=36549084081&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=36549084081&partnerID=8YFLogxK
U2 - 10.1016/j.cacc.2007.09.007
DO - 10.1016/j.cacc.2007.09.007
M3 - Article
AN - SCOPUS:36549084081
SN - 0953-7112
VL - 18
SP - 227
EP - 236
JO - Current Anaesthesia and Critical Care
JF - Current Anaesthesia and Critical Care
IS - 5-6
ER -