Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Apr 2015
Review[Choice of crystalloids in interventions and surgery].
Fluid therapy is daily routine in the perioperative setting; however, high quality guidelines are lacking. The S3-guideline Intravasal Fluid Therapy in the Adult Patient gives evidence- and consensus-based recommendations for the use of fluids in perioperative and critically ill patients. In addition to identifying hypovolemia and guiding volume replacement, the type of fluid that should be used is addressed. ⋯ In this review the recommendations and their rationale in the perioperative setting are presented. Crystalloids are the basis of fluid therapy. Instead of isotonic saline, buffered solutions are recommended. Regarding the type of buffer (lactate, acetate, malate), no preferences based on outcome data can be made.
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Med Klin Intensivmed Notfmed · Apr 2015
Review[Dos and don'ts for crystalloids in intensive care medicine. Can too much water be bad?].
Notwithstanding the use of colloids, crystalloids have a firm position in today's intensive care: In addition to the substitution as a basic requirement of the human organism or drug carriers, they are primarily used for volume replacement. A common complication is the development of interstitial edema, which is due to the composition of these solutions and the permeability of the glycocalyx. ⋯ The use of 0.9% saline solution is regarded as obsolete. With low cost and a good safety profile, a few relevant aspects, e.g., the risk of hypervolemia and electrolyte imbalance, must be taken into account in the use of crystalloids.
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Med Klin Intensivmed Notfmed · Apr 2015
Review[Noninvasive ventilation in patients with persistent hypercapnia].
Chronic respiratory failure is caused by insufficiency of the inspiratory muscles, i.e. mainly the diaphragm, which represents the so-called "respiratory pump". Insufficiency of the respiratory pump causes hypercapnia. ⋯ Strong evidence supports the use of domiciliary NIV already in mild degrees of chronic respiratory failure caused by neuromuscular diseases, thoracic restrictions and obesity hypoventilation. In these diseases long-term NIV improves both physiological parameters (such as blood gases) and clinical outcome, e.g. exercise capacity, right heart dysfunction, sleep quality, disease-specific aspects of health-related quality of life (HRQL) and survival rate. In contrast, its influence on long-term survival in chronic obstructive pulmonary disease (COPD) patients is not clearly proven. Prescription of home NIV in COPD should therefore be restricted to severe degrees of chronic respiratory failure. Finally, there is an indication for domiciliary NIV in patients after prolonged weaning from mechanical ventilation. This paper elaborates underlying pathophysiology, diseases and how NIV works in chronic hypercapnic respiratory failure.
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Med Klin Intensivmed Notfmed · Apr 2015
Review[Indication and control of volume therapy. First things first].
Fluid therapy is a core concept in the management of perioperative and critically ill patients for maintenance of intravascular volume and organ perfusion. The clinical determination of the intravascular volume can be extremely difficult. Indication and control for intravascular volume therapy are among the most difficult aspects of intensive care. ⋯ Case history, clinical examinations, bedside ultrasonography, and invasive hemodynamic monitoring complete the assessment and allow clinicians to assess volume responsiveness.
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Med Klin Intensivmed Notfmed · Apr 2015
[Influence of ECMO and IABP on coronary blood flow. Valuable combination or waste of resources?].
The treatment of patients in severe cardiogenic shock with an intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) is a common procedure to achieve stabilization. Only limited data are available on the simultaneous use of both systems. The aim of the present study was to assess the effect of the concomitant use of IABP and ECMO on coronary blood flow. In addition, the influence of antegrade and retrograde perfusion was evaluated. ⋯ In antegrade perfusion the simultaneous use of IABP and ECMO is useful. In retrograde perfusion IABP impairs the mean arterial pressure and consequently the perfusion of the coronary arteries.