Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Apr 2020
[Out-of-hospital airway management with a laryngeal tube or endotracheal intubation for out-of-hospital cardiac arrest : Influence on in-hospital mortality].
Endotracheal (ET) intubation has been the gold standard in out-of-hospital airway management for a long time. Recent guidelines suggest an alternative airway management with supraglottic airway devices like the laryngeal tube (LT) especially for less experienced rescue personnel. However, scientific evidence on the prognostic impact of the laryngeal tube in the setting of cardiopulmonary resuscitation is limited. ⋯ Preclinical airway management with LT shows similar mortality outcomes in direct comparison to intubation with ET in OHCA patients. Further randomized studies are warranted.
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Med Klin Intensivmed Notfmed · Apr 2020
Review[CARs, CRS and neurotoxicity: severe complications after administration of immunotherapy : Essentials for intensivists].
The development of chimeric antigen receptor (CAR) T‑cells has shown promising results in relapsed/refractory B‑cell acute lymphoblastic leukemia/lymphoma (B-ALL) and diffuse large cell B‑cell lymphoma. Complications, especially cytokine release syndrome (CRS) and CAR T‑cell related encephalopathy syndrome (CRES), can be life threatening. The management of both plays a key role in CAR T‑cell therapy. ⋯ Using a therapy algorithm in the treatment with CAR T‑cells allows safe management of toxicities and can be helpful in recognizing them in time.
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Med Klin Intensivmed Notfmed · Apr 2020
Review[Multidrug-resistant bacteria in animals and humans].
The increasing burden of antimicrobial-resistant bacteria causes morbidity and mortality, especially among patients affected by healthcare-associated infections. Limited treatment options challenge clinicians in both human and veterinary medicine. ⋯ Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β‑lactamase (ESBL) producing Enterobacteriaceae are frequently transmitted between animals and humans. The rates of asymptomatic carriage are increased among persons with livestock contact compared with the general population. The occurrence of carbapenemase-producing Enterobacteriaceae has been documented on German pig and chicken farms, but investigations into their prevalence and zoonotic importance are pending. Colistin is frequently used in veterinary medicine to treat diarrhoea and causes selection pressure for colistin-resistant Gram-negative bacteria harbouring mcr genes. Vancomycin-resistant enterococci (VRE), oxazolidinone-resistant Gram-positive bacteria and multiresistant staphylococci are further antimicrobial-resistant microorganisms, which might have a zoonotic potential. Besides human healthcare and livestock, the problem of antimicrobial-resistant bacteria also affects companion animals (e. g. dogs, cats and horses), wildlife and the environment, which underlines the need to prevent antimicrobial resistance in a One Health approach.