Medizinische Klinik, Intensivmedizin und Notfallmedizin
-
Med Klin Intensivmed Notfmed · May 2013
Review[Chronic critically ill patients from the perspective of hematologists/oncologists].
Many factors contribute to making critically ill patients with underlying hematological or oncological diseases into a special collective on intensive care units, such as an often incurable or at least doubtfully curable underlying disease, therapy associated complications and a commonly present immunosuppression. The prognosis of these patients has clearly improved in recent years so that a general reluctance in deciding to treat these patients in intensive care units can no longer be justified. ⋯ In the therapy of respiratory failure non-invasive ventilation is of great importance for a reduction in mortality if used early and contraindications, such as termination criteria are considered. Considerations on long-term prognosis, quality of life and palliative care are increasingly becoming topics in intensive care medicine.
-
Med Klin Intensivmed Notfmed · May 2013
Comparative Study Observational StudyComparison of three different commercial PCR assays for the detection of pathogens in critically ill sepsis patients.
The high mortality rate associated with sepsis necessitates a timely identification of the causative organism in order to optimize antimicrobial therapy. PCR assays are increasingly being used for this purpose. The aim of this study was to compare three commercially available PCR systems for the diagnosis of systemic infections. ⋯ There was some variability between the three PCR assays tested and the corresponding blood cultures with regards to the type of pathogen detected. The three PCR assays appeared to be less susceptible to false-positive results than blood cultures.
-
Med Klin Intensivmed Notfmed · May 2013
Review[Chronic critically ill patients from a pneumological perspective].
Epidemiological estimates predict an increase in patients with chronic lung diseases, such as chronic obstructive pulmonary disease (COPD) or asthma; therefore, increasing numbers of patients with preexisting lung diseases who require intensive care treatment are to be expected. These patients tend to have complex disease patterns and are difficult to wean from mechanical ventilation after intubation. It is not uncommon for these patients to need permanent mechanical ventilation after an acute illness. Also the question of limiting therapy, the need for treatment with a palliative objective and supervision of patients as well as their relatives at the end of life is a challenge for intensive care physicians when treating acutely ill patients with chronic pulmonary diseases.
-
Med Klin Intensivmed Notfmed · May 2013
Review[Chronic critically ill patients from a gastroenterological perspective].
From a gastroenterological point of view, for chronic critically ill patients a differentiation has to be made between general gastroenterological problems, which are important in many or all chronic critically ill patients and patients with gastroenterological diseases which are the reason for the chronic critically ill status. General gastroenterological problems are, for example the nutrition of these patients and also considerations about ulcer prophylaxis or gastroenterological complications, such as antibiotic-associated colitis. ⋯ Diseases which should be taken into consideration are advanced liver cirrhosis and short bowel syndrome. This manuscript is intended to discuss gastroenterological problems in this selected group of patients and to show possible solutions and treatment options.
-
Med Klin Intensivmed Notfmed · Apr 2013
Review[Hematooncology patients in intensive care management].
Critically ill cancer patients on intensive units with hematological or oncological underlying diseases are a special situation: the underlying disease may be incurable, acute problems are often therapy associated and immunosuppression is regularly present. Due to evolving knowledge about special aspects of these patients and optimized supportive therapy, the prognosis has substantially improved during the last decades. General reluctance to admit cancer patients to an intensive care unit is therefore no longer justified. ⋯ Extensive diagnostic measures, causal and supportive therapy of sepsis according to current guidelines has led to improved outcome even in cancer patients. In respiratory failure, non-invasive ventilation is the key to improved prognosis if used early enough and indications, contraindications and break-off criteria are strictly followed. The prognosis of critically ill cancer patients is determined by the severity of the acute problem and not by the underlying disease.