C James Kirkpatrick, Hans Anton Lehr, Mike Otto, Fernando Bittinger, Ramzan Rangoonwala.
Clinical implications of Circulating Particulate Contamination of Parenteral Injections: A Review.
Infect Dis J Jan ;10(1):16-20.

In the field of intensive care medicine, not only large volumes of parenteral infusions but also numerous injections are required. The problems of quality control and patient safety in the context of complex therapeutic regimens demand constant attention. The expansion of the field of generic drugs, has highlighted the question of the possible deleterious effects of particulate contamination of parenterals. The present paper reviews the evidence that such contamination is indeed a risk to patients with a compromised microcirculation, Data are presented from clinical and experimental studies, the latter including both in vivo and in vitro approaches. Particular attention is focussed on the significance of the microcirculatory problems in multiple organ dysfunction syndrome, the major disease complex in contemporary intensive care medicine. The review concludes with a perspective on future areas of scientific endeavour necessary to further define the direct effects of particulates on the microcirculation.

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