Medizinische Klinik, Intensivmedizin und Notfallmedizin
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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.
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Med Klin Intensivmed Notfmed · Oct 2012
Comparative StudyOutcome prediction using clinical scores and biomarkers in patients with presumed severe infection in the emergency department.
Severe infections play an important role in the emergency department (ED) and early risk stratification is essential. We compared the prognostic value of APACHE II, SOFA, and MEDS scores, and the biomarkers C-reactive protein (CRP), procalcitonin (PCT), and interleukin 6 (IL-6). ⋯ All investigated parameters have a predictive value in patients with an infection in the ED. According to the trend observed, the APACHE II score seems to have the best discriminative power. Use of the APACHE II score already at the time of admission to the ED may be useful for stratifying patients at risk for ICU treatment, thereby using the same score in the ED and the ICU.
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Med Klin Intensivmed Notfmed · Oct 2012
Case Reports[Severe organic dysphagia after long-term ventilation in a patient with sepsis and multiorgan failure].
A case of severe chronic dysphagia lasting more than 1 year after long-term ventilation due to sepsis is presented. Fiber optic endoscopic examination of swallowing (FEES) revealed retention of food on both sides of the base of the tongue and in both valleculae combined with severe penetration and postglutitive aspiration into the larynx. ⋯ The adhesion was resected using a CO(2) laser. The final examination 3 months later showed complete recovery of normal swallowing function.
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Med Klin Intensivmed Notfmed · Oct 2012
[Ethic rounds in intensive care. Possible instrument for a clinical-ethical assessment in intensive care units].
Ethical problems, such as medical end-of-life decisions or withdrawing life-sustaining treatment are viewed as an essential task in intensive care units. This article presents the ethics rounds as an instrument for evaluation of ethical problems in intensive care medicine units. The benchmarks of ethical reflection during the ethics rounds are considerations of ethical theory of principle-oriented medical ethics. ⋯ In contrast to the clinical ethics consultation, the ethicist in the ethics rounds model is integrated as a member of the ward round team. Therefore ethical problems may be identified and analyzed very early before the conflict escalates. This preventive strategy makes the ethics rounds a helpful instrument in intensive care units.