Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Esophageal manometry has traditionally been utilized for respiratory physiology research, but clinicians have recently found numerous applications within the intensive care unit. Esophageal pressure (PEs) is a surrogate for pleural pressures (PPl), and the difference between airway pressure (PAO) and PEs provides a good estimate for the pressure across the lung also known as the transpulmonary pressure (PL). Differentiating the effects of mechanical ventilation and spontaneous breathing on the respiratory system, chest wall, and across the lung allows for improved personalization in clinical decision making. ⋯ Intrinsic PEEP (auto-PEEP) may be monitored using esophageal manometry, which may also improve patient comfort and synchrony with the ventilator. Finally, during weaning, PEs may be used to better predict weaning success and allow for rapid intervention during failure. Improved consistency in definition and terminology and further outcomes research is needed to encourage more widespread adoption; however, with clear clinical benefit and increased ease of use, it appears time to reintroduce basic physiology into personalized ventilator management in the intensive care unit.
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Med Klin Intensivmed Notfmed · Feb 2018
[The 40th anniversary of the German Interdisciplinary Association of Critical Care Medicine : A ceremonial address on the occasion of the anniversary].
During the 17th annual meeting, the German Interdisciplinary Association of Critical Care Medicine (DIVI) celebrated its 40th anniversary. On this occasion a speech was given with the following content. In 1977, the DIVI was founded as an umbrella association for medical societies involved in critical care. ⋯ The activities within the society are mostly done within the sections where members of the various disciplines (internists, anesthesiologists, neurologists, etc.) and professions (physicians, nurses) cooperate together on special topics. Currently, critical care in Germany has to overcome severe problems: rigorous economic pressure, critical lack of staff, missing professional long-term perspectives for intensivists, weak representation at international conferences. DIVI and its contributing societies must urgently join together in order to overcome these existential problems.
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Med Klin Intensivmed Notfmed · Nov 2017
Review[Structured bedside-ultrasound in intensive care medicine].
The so-called point-of-care ultrasound (POCUS) is of increasing importance for diagnostics and therapy control in intensive care medicine. Based on focused thorax sonography, echocardiography, and abdominal sonography, the most important working and differential diagnoses can be demonstrated or excluded depending on the leading symptom. Sonographic-based algorithms allow a structured evaluation especially of patients with the common leading symptoms dyspnea and thoracic pain.
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Med Klin Intensivmed Notfmed · Nov 2017
Case Reports[Severe accidental hypothermia : Treatment using an intravascular temperature management catheter].
Different techniques have been reported for the treatment of severe accidental hypothermia. In this case, we successfully used an intravascular catheter temperature management system which has been developed to induce reversible therapeutic hypothermia in patients following resuscitation. In our patient, the initial core temperature was 26.7 °C, and the temperature management system allowed for successful rewarming without complications with a maximum rate of about 1 °C/h.
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Med Klin Intensivmed Notfmed · Sep 2017
Review[Evaluation of care conditions in intensive care units : Results of an online questionnaire of critical care nurses].
In the following article, selected results of a descriptive study on personnel staffing and patients' care in intensive care units in Germany are presented and discussed. The main focus is laid on comparing features of personnel staffing with indicators of job satisfaction and patients' care. ⋯ The article represents the data of 2233 included German critical care nurses. The main results are the following: a low nurse patient ratio (≥1:3) in intensive care units has the tendency to cause higher risks in patients' care and shows lower job satisfaction than nurses with higher nurse-patient ratio (≤1:2).