Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Oct 2013
Review Case Reports[Abnormal liver function tests in the intensive care unit].
Abnormal liver biochemical and function tests are found in the majority of critically ill patients and are associated with increased mortality. Frequent causes for elevated liver function tests in the intensive care unit (ICU) are acute hepatic dysfunction due to acute hepatitis, acute liver failure (ALF), and drug-induced liver injury (DILI). ⋯ Elevated liver enzymes may also reflect a complication of ICU treatment measures like drug-related hepatotoxicity, secondary sclerosing cholangitis in critically ill patients (SC-CIP), or related to parenteral nutrition. Comprehensive diagnostic evaluation is essential to identify the underlying etiology of abnormal liver function tests and to initiate the appropriate therapeutic strategies.
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Mechanical ventilation (MV) is one of the most essential cornerstones of intensive care therapy. Although of pivotal importance for many patients suffering from respiratory insufficiency MV itself may further induce pathophysiological processes due to the mechanical stress exerted on the lungs. ⋯ Although MV is necessary for the treatment of severe hypoxemia it causes damage not only in the lungs but also in other organs due to a secondary inflammatory process in the lungs. To reduce these reactions an evidence-based concept of lung protective ventilation is essential.
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Med Klin Intensivmed Notfmed · Oct 2013
Review[Atrial fibrillation in the ICU. Distinct entity--special treatment?].
Atrial fibrillation (AF) is the single most frequent arrhythmia in the intensive care unit, occurring among 44-61 % of all patients with arrhythmias in the intensive care unit. The success rate of electrical cardioversion (DC-CV) early after surgery is as low as 10-35 % in postoperative AF but 6 weeks after discharge 90 % are in sinus rhythm (SR). ⋯ DC-CV is recommended in unstable and heart failure patients. The term resistant AF is suggested for that distinct situation of AF not amenable to cardioversion solely in the acute phase of critical illness.