Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Oct 2015
Review[Acute colonic pseudo-obstruction: Ogilvie syndrome].
Acute colonic pseudo-obstruction (ACPO) is characterized by marked colonic dilatation which develops over several days. ACPO is due to a motility disorder and is not caused by colonic obstruction and occurs in patients with severe, often acute underlying diseases or postoperatively. It is associated with a 25-30% mortality overall that increases to up to 50% in patients who develop complications (e.g. colonic ischemia and perforation). ⋯ If patients do not respond within 1-2 days or if ACPO has already reached a critical duration (>3-4 days) or extent (i.e. cecal diameter ≥12 cm), neostigmine should be administered and leads to durable success in approximately 3 out of 4 patients. Patients who are still refractory to treatment should receive endoscopic decompression. More invasive therapeutic options, such as cecostomy or (segmental) colonic resection should only be considered for patients who still do not respond to treatment or present with the abovementioned complications.
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Acute vascular occlusion within the mesenteric circulation leads to ischemic damage of the corresponding bowel segment, which starts on the mucosal level and progresses transmurally. ⋯ Even today, acute mesenteric ischemia is associated with a poor prognosis. To improve survival and to reduce long-term morbidity, a rapid and systematic diagnostic workup is mandatory.
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Med Klin Intensivmed Notfmed · Oct 2015
Comparative Study[Aspiration and pneumonia risk after preclinical invasive resuscitation : Endotracheal intubation and supraglottic airway management with the laryngeal tube S].
Laryngeal tubes (LT) have substantially facilitated emergency airway management. However, it remains unclear whether LTs provide comparable protection against aspiration or even higher rates of aspiration and pneumonia compared to endotracheal intubation (ET) as the former gold standard. ⋯ Airway management by LT was not associated with higher risk of aspiration. In contrast, higher rates of aspiration and pneumonia were observed after ET, especially in OHCA patients. However, a possible prognostic impact of supraglottic airway devices remains to be elucidated.
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Children who require mechanical ventilation represent a high-risk population with significant morbidity and mortality. Experienced handling of conventional therapies including high frequency oscillation ventilation and initiation of newer treatment options such as surfactant or nitric oxide has led to some improvements. Nevertheless, extracorporeal membrane oxygenation (ECMO) is a life-saving technology in patients with respiratory failure refractory to maximal medical therapy. ⋯ Despite limited evidence and relatively few randomized trials in children, ECMO remains the safety net for patients with severe respiratory failure. Experience as measured by the annual number of cases plays an important role for the quality of results.
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Med Klin Intensivmed Notfmed · Sep 2015
Review[Lung and kidney failure. Pathogenesis, interactions, and therapy].
The lungs and kidneys represent the most often affected organs (acute respiratory distress syndrome, ARDS or kidney failure) in multiple organ failure (MOF) due to shock, trauma, or sepsis with a still unacceptable high mortality for both organ failures. ⋯ The organ replacement therapies used in both organ failures have the potential to further injure the other organ (ventilator trauma, dialyte trauma). On the other hand, renal replacement therapy can have positive effects on lung injury by restoring volume and acid-base homeostasis. The new development of "low-flow" extracorporeal CO2 removal on renal replacement therapy platforms may further help to decrease ventilator trauma in the future.