Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Acute respiratory distress syndrome (ARDS) is characterized by the formation of a protein-rich alveolar edema caused by increased permeability of the alveolocapillary membrane. The key clinical feature is refractory arterial hypoxemia, which in severe cases necessitates the application of extracorporeal membrane oxygenation. ⋯ In this context, modern and individualized nutritional regimens are of special importance; however, their prognostic impact, especially of immunonutrition, for ARDS patients is controversial. In this review, basic features of nutrition in intensive care medicine and ARDS-specific aspects (e.g., immunonutrition) are presented and discussed.
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In the critically ill liver patient, nutrition support is not very different from that given for other illnesses. In hyperacute liver failure, nutrition support is of less importance than in the other subtypes of acute liver failure that take a more protracted course. ⋯ Enteral nutrition ensuring an adequate provision of energy and protein should be preferred. Particular care should be taken to avoid refeeding syndrome and to treat vitamin and trace element deficiency.
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In Germany nearly 11,300 patients are on the waiting list for a donor organ. The process of organ donation should be known at every hospital and in particular the prerequisites for confirmation of brain death which can only take place in the intensive care unit. The consultation with the family of a deceased is of utmost importance because only few people have a signed organ donor card. ⋯ Retrieval of organs can be done at every operating theatre by specially trained surgeons. The transport of the specially packed retrieved organs is carried out considering the individual ischemic time. The donor hospital and the relatives receive a letter informing them about the course of events.
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Med Klin Intensivmed Notfmed · Jun 2013
[End-of life decisions in intensive care units. Influence of patient wishes on therapeutic decision making].
Among the ethical principles in medicine, respect for patient autonomy has gained the highest revaluation in recent decades. In Germany this was fostered by new legal regulations which came into effect in 2009 and clarified issues regarding end-of-life (EOL) decisions. In this study the influence of direct or mediated wishes of patient wills on EOL decisions in a medical intensive care unit (ICU) were investigated. ⋯ In a high percentage of the patients (81 %) who died during the course of intensive care treatment EOL policies were in place. The patients or their relatives were almost always involved in the decision making process. The current German law is in concordance with the established EOL practice in this intensive care unit.
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Med Klin Intensivmed Notfmed · Jun 2013
[Glucose control in the critically ill. Innovations and contemporary strategies].
Glucose control should be part of standard therapy in intensive care units (ICU) due to the proven association of hyperglycemia with increased morbidity and mortality. Due to the results of the latest randomized controlled multicentre trials blood glucose target levels of 140-180 mg/dl are currently recommended. In critically ill patients glucose monitoring should not be performed using point of care (POC) devices because of inacceptable inaccuracies. ⋯ Besides mean glucose levels, glucose variability and glucose complexity are also associated with outcome in critically ill patients and might therefore be future target parameters. Critically ill diabetic patients might benefit from different glucose target levels depending on the preadmission glucose control. Hypoglycemic events <80 mg/dl should be avoided because of the association with poor outcome.