Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Apr 2015
Review[Noninvasive ventilation in patients with persistent hypercapnia].
Chronic respiratory failure is caused by insufficiency of the inspiratory muscles, i.e. mainly the diaphragm, which represents the so-called "respiratory pump". Insufficiency of the respiratory pump causes hypercapnia. ⋯ Strong evidence supports the use of domiciliary NIV already in mild degrees of chronic respiratory failure caused by neuromuscular diseases, thoracic restrictions and obesity hypoventilation. In these diseases long-term NIV improves both physiological parameters (such as blood gases) and clinical outcome, e.g. exercise capacity, right heart dysfunction, sleep quality, disease-specific aspects of health-related quality of life (HRQL) and survival rate. In contrast, its influence on long-term survival in chronic obstructive pulmonary disease (COPD) patients is not clearly proven. Prescription of home NIV in COPD should therefore be restricted to severe degrees of chronic respiratory failure. Finally, there is an indication for domiciliary NIV in patients after prolonged weaning from mechanical ventilation. This paper elaborates underlying pathophysiology, diseases and how NIV works in chronic hypercapnic respiratory failure.
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Med Klin Intensivmed Notfmed · Apr 2015
Review[Indication and control of volume therapy. First things first].
Fluid therapy is a core concept in the management of perioperative and critically ill patients for maintenance of intravascular volume and organ perfusion. The clinical determination of the intravascular volume can be extremely difficult. Indication and control for intravascular volume therapy are among the most difficult aspects of intensive care. ⋯ Case history, clinical examinations, bedside ultrasonography, and invasive hemodynamic monitoring complete the assessment and allow clinicians to assess volume responsiveness.
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Med Klin Intensivmed Notfmed · Apr 2015
[Influence of ECMO and IABP on coronary blood flow. Valuable combination or waste of resources?].
The treatment of patients in severe cardiogenic shock with an intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) is a common procedure to achieve stabilization. Only limited data are available on the simultaneous use of both systems. The aim of the present study was to assess the effect of the concomitant use of IABP and ECMO on coronary blood flow. In addition, the influence of antegrade and retrograde perfusion was evaluated. ⋯ In antegrade perfusion the simultaneous use of IABP and ECMO is useful. In retrograde perfusion IABP impairs the mean arterial pressure and consequently the perfusion of the coronary arteries.
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Med Klin Intensivmed Notfmed · Feb 2015
Review[Sepsis - Knowledge of non-physician personnel in Africa. A cross-sectional study in Malawian district hospitals].
Malawi has one of the worst human resource situations in the world and each clinically working doctor has to serve around 50,000 patients. There are almost no Malawian specialists physicians so that in the district hospitals it is usually non-medical staff (e.g. anesthesia clinical officer) who have the responsibility for severely sick patients with sepsis. At the Queen Elizabeth Central Hospital we have organized different courses over the years to support these colleagues. ⋯ Healthcare workers in Malawi are not aware of key recommendations of the Surviving Sepsis Campaign. Guidelines have to be adapted to the specific healthcare structures in underdeveloped countries. We realized the wish and the desire of the participants for more training and more courses in Malawi. In order to be able to support these needs we would like to invite cooperation from interested institutions and colleagues for a special sepsis course on the occasion of the annual World Sepsis Days.
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The primary aim of cardiopulmonary resuscitation after cardiac arrest is to achieve the return of spontaneous circulation (ROSC). However, following ROSC the clinical and neurologic outcome is mainly influenced by adequate treatment in the postresuscitation period. There are several novel recommendations in the current 2010 guidelines of the European Resuscitation Council (ERC) concerning advanced life support (ALS). ⋯ Major aspects concerning the therapy of the postcardiac arrest syndrome include temperature management with therapeutic hypothermia, mechanical ventilation and the extent of oxygenation and blood glucose control. Thus, the initial cardiopulmonary resuscitation and the following postresuscitation treatment have to be considered as merging therapy concepts. Only a standardized therapeutic approach in these different phases of treatment will result in successful resuscitation with high rates of survival and good neurologic outcome.