Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Nov 2012
Review[Extracorporeal gas exchange procedures. Differentiated therapy when conventional ventilation reaches the limits].
In recent years the range of products for extracorporeal lung support has substantially expanded. In principle systems generating high blood flow and thus enabling oxygenation and decarboxylation, corresponding to classical extracorporeal membrane oxygenation (ECMO), can be distinguished from low-flow systems, enabling decarboxylation only. ⋯ Indications for extracorporeal decarboxylation, initially thought to enable most protective ventilator settings, have been extended to forms of hypercapnic lung failure and towards avoidance of intubation and mechanical ventilation itself in patients with isolated hypercapnia and failure of non-invasive ventilation. It has to be emphasized however, that due to a still sparse amount of literature and potentially deleterious complications associated with extracorporeal lung support, these kinds of therapies should be reserved for specialized and experienced centers.
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Med Klin Intensivmed Notfmed · Oct 2012
Review[Indirect laryngoscopy/video laryngoscopy. A review of devices used in emergency and intensive care medicine in Germany].
Airway management in intensive care or emergency medicine is particularly challenging and is often associated with life-threatening complications. An innovation in the field of airway management is the use of indirect laryngoscopy by means of video laryngoscopes. ⋯ However, the successful use in challenging intubations requires experience and regular use in daily practice. This review gives an overview of indirect laryngoscopes commonly used in Germany and also presents new study results for these novel devices.
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Med Klin Intensivmed Notfmed · Oct 2012
Review[Preventable mistakes during endotracheal intubation. Overview and concepts].
Endotracheal intubation is a standard procedure in anesthesiology as well as in intensive care medicine in many forms of assisted spontaneous breathing or controlled ventilation. In addition it continues to be the gold standard for airway protection in prehospital and in-hospital emergency medicine settings. Approaches will have to be considered to help prevent errors before they occur not only in the non-elective use of endotracheal intubation. The most common preventable situations are summarized in this paper.
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Med Klin Intensivmed Notfmed · Oct 2012
Review[Echocardiography in emergency admissions. Recognition of cardiac low-output failure].
Detection of acute cardiac dysfunction and differential diagnosis of low cardiac output syndrome is challenging for emergency physicians. For the critical ill patient it is essential to rapidly identify the underlying disease to initiate the correct therapy and optimize patient outcome. ⋯ The differentiation in preserved versus reduced left ventricular ejection fraction as a first assessment is helpful, particularly for physicians not well trained in echocardiography. The structured and focused approach to evaluate or exclude differential diagnoses of cardiac dysfunction is the key for optimal management of acute and critically ill patients with low cardiac output.
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Optimal timing of extubation following intubation substantially impacts on the prognosis of intensive care unit (ICU) patients whereby both early extubation with the risk of reintubation and delayed extubation with prolongation of mechanical ventilation need to be avoided. In most cases extubation is easy; in some cases, however, extubation may be extremely difficult or even impossible with two major reasons being responsible for this: firstly, laryngeal edema, where the cuff leak test and steroid treatment are well established procedures aimed at diagnosing and treating potential laryngeal complications and secondly, the presence of (chronic) respiratory failure despite sufficient treatment of acute respiratory failure. This can result in post-extubation failure following extubation or weaning failure and noninvasive ventilation has been increasingly used in both scenarios. Currently, specialised weaning centres are being established and certified in Germany aimed at managing the complex tasks for patients with prolonged weaning.