Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · May 2014
Review[Shock liver and cholestatic liver in critically ill patients].
Liver dysfunction is frequently observed in critically ill patients. Its occurrence is associated with high morbidity and mortality. The most frequent entities of hepatic dysfunction in the intensive care unit are shock liver and cholestatic liver dysfunction with incidence rates up to 10 and 30 %, respectively. ⋯ However, several other potential contributors have been identified especially for cholestatic liver dysfunction. Apart from chronic liver diseases and malignancies, iatrogenic factors such as total parenteral nutrition, high pressure ventilation, surgical procedures, drugs and blood transfusions promote its occurrence. In shock liver and in cholestatic liver disease, early detection and therapy of the underlying disease is the only established treatment.
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In-hospital emergencies represent an increasing challenge with regard to risk management in hospitals and until now, no binding recommendations for in-hospital emergency management are available in Germany. Time delays in the detection and treatment of critically ill patients on the wards often lead to serious adverse events. The concept of traditional resuscitation teams is not adequate, because they are initiated only after acute deterioration or cardiac arrest has already occurred. ⋯ For a hospital with an already established resuscitation team, this represents a fundamental paradigm shift to a sustainable, interdisciplinary, and institutionalized process of rethinking and reorganizing. A clear commitment and ongoing joint efforts of the hospital management and all hospital staff are prerequisite for this.