Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · May 2015
Review Comparative Study[Acute kidney injury: choice of the initial modality for renal replacement therapy].
Continuous and intermittent renal replacement therapies are thought to be equally adequate approaches for the treatment of patients with acute kidney injury. Accordingly, current guidelines advocate the use of different modalities in a complementary fashion, i.e., to tailor therapy to the specific clinical situation. ⋯ Intermittent hemodialysis, on the other hand, remains the therapy of choice for the rapid correction of life-threatening electrolyte abnormalities or metabolic acidosis. During the further course of treatment, an individualized approach should be continued which may include a switch between modalities based on current therapeutic goals and potential risks for side effects of renal replacement therapy.
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The activation of multiple pro- and anti-inflammatory mediators is a key feature in the pathophysiology of sepsis. Many of these mediators may directly contribute to organ dysfunction and determine disease severity. So far our ability to modulate these upregulated mediator pathways is very limited. Therefore the adsorption of such mediators via an extracorporeal circuit may be a beneficial intervention during sepsis. ⋯ Whilst biochemical efficacy could be demonstrated by some of the systems, controlled and randomized studies demonstrating improved clinical endpoints are still lacking. Therefore the use of such therapies outside clinical studies cannot yet be recommended.
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Med Klin Intensivmed Notfmed · Apr 2015
Review[Indications and limitations for colloids in interventions and surgery].
Over the last few decades colloids have played an important part in the stabilisation of patients with acute need of intravascular volume replacement. After the 6S and the CHEST trials were published in 2012 and the subsequent recommendations of the European Medicines Agency (EMA) and the Food and Drug Administration (FDA) there has been some uncertainty about the current clinical relevance and routine use of colloids. ⋯ In situations of acute volume resuscitation colloids are still appropriate. Only colloids in balanced solutions should be used. Possible side effects, contraindications and the maximum daily dose have to be taken into consideration when administering colloids.
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Med Klin Intensivmed Notfmed · Apr 2015
Randomized Controlled Trial Comparative Study[Comparison of GlideScope® Cobalt and McGrath® Series 5 video laryngoscopes with direct laryngoscopy in a simulated regurgitation/aspiration scenario].
Video laryngoscopy has become increasingly important in airway management in the pre- and intrahospital settings. However, using video laryngoscopes in the presence of body fluids can make visualization of the airway difficult. A simulated regurgitation model was used to compare two video laryngoscopes (VL) with direct laryngoscopy. ⋯ Using a video laryngsocope with an "anti-fogging" system improved visualization in a simulated aspiration model. In this scenario, VL showed no advantage to direct laryngoscopy in terms of success rate and speed of intubation.