Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Acute and emergency physicians need to make rapid and far-reaching decisions on the basis of little diagnostic information. In patients with symptoms suggestive of a cardiopulmonary diagnosis, point-of-care lung ultrasound (LUS) is becoming increasingly used. In patients with acute dyspnea, chest pain and shock, LUS increases the diagnostic reliability. ⋯ LUS is also used for treatment follow-up. It is clearly superior to other diagnostic measures (auscultation, chest X‑ray). With ever smaller "handheld" ultrasound devices, the use of ultrasound is also being increasingly used in preclinical situations.
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Diaphragm function is crucial for patient outcome in the ICU setting and during the treatment period. The occurrence of an insufficiency of the respiratory pump, which is predominantly formed by the diaphragm, may result in intubation after failure of noninvasive ventilation. Especially patients suffering from chronic obstructive pulmonary disease are in danger of hypercapnic respiratory failure. ⋯ After intubation and the following inactivity the diaphragm is subject to profound pathophysiologic changes resulting in atrophy and dysfunction. Besides this inactivity-triggered mechanism (termed as ventilator-induced diaphragmatic dysfunction) multiple factors, comorbidities, pharmaceutical agents and additional hits during the ICU treatment, especially the occurrence of sepsis, influence diaphragm homeostasis and can lead to weaning failure. During the weaning process monitoring of diaphragm function can be done with invasive methods - ultrasound is increasingly established to monitor diaphragm contraction, but further and better powered studies are in need to prove its value as a diagnostic tool.
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Med Klin Intensivmed Notfmed · Oct 2018
[PROtocol-based MObilizaTION on intensive care units : Design of a cluster randomized pilot study].
Despite convincing evidence for early mobilization of patients on intensive care units (ICU), implementation in practice is limited. Protocols for early mobilization, including in- and exclusion criteria, assessments, safety criteria, and step schemes may increase the rate of implementation and mobilization. ⋯ Exploratory evaluation of study feasibility and estimation of effect sizes as the basis for a future explanatory study.
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Med Klin Intensivmed Notfmed · Oct 2018
[Diagnosis and stage-adapted treatment of acute pancreatitis].
Acute pancreatitis is a potentially life-threatening disease, which is morphologically classified into interstitial edematous or necrotizing pancreatitis. According to the revised Atlanta classification, mild, moderate and severe clinical courses are differentiated regarding local and systemic complications as well as concomitant organ failure. ⋯ Characteristic in the course of severe acute pancreatitis are abdominal necroses, which require individualized and interdisciplinary treatment with antibiotic therapy, drainage and definitive necrosectomy. Necrosectomy should be planned as a "step-up approach" using interventional-radiological, endoscopic and minimally invasive surgical procedures.
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Med Klin Intensivmed Notfmed · Sep 2018
Practice Guideline[Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR) : Consensus statement of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC].
Extracorporeal cardiopulmonary resuscitation (eCPR) may be considered as a rescue attempt for highly selected patients with refractory cardiac arrest and potentially reversible etiology. Currently there are no randomized, controlled studies on eCPR, and valid predictors of benefit and outcome which might guide the indication for eCPR are lacking. Currently selection criteria and procedures differ across hospitals and standardized algorithms are lacking. Based on expert opinion, the present consensus statement provides a proposal for a standardized treatment algorithm for eCPR.