Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Cardiac biomarkers in intensive care medicine are an excellent complement to existing clinical and diagnostic information in specific diseases. Due to their lack of specificity, the diagnostic properties of common cardiac biomarkers, such as natriuretic peptides and cardiac troponins, remain ambiguous, while their prognostic value has already been proven. In addition, there are several promising new biomarkers that might contribute to a "multimarker strategy" in the critically ill patient in the future, but further evaluation is still required.
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Patients suffering from septic shock often present with not only severe reduction of afterload induced by vasodilation but are also affected by sepsis-induced cardiac dysfunction. Elevated troponin levels, which are typically not caused by coronary ischemia, may indicate septic cardiomyopathy which is characterized both by altered systolic function as well as by disturbances in the regulation of heart rate and heart rate variability. The latter findings are based not only on the dysfunction of the autonomous nervous system but are also the result of the direct interaction of endotoxins with cardiac pacemaker cells. ⋯ Therapy of septic shock (and thereby septic cardiomyopathy) is based on the well-known causative, supportive, and adjunctive strategies. Stabilization of cardiac function is assured by volume resuscitation (including blood transfusion) and inotropic support (dobutamine). Further specific therapeutic approaches have not yet been established.
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Med Klin Intensivmed Notfmed · Nov 2011
Review[Blood, blood components and plasma derivatives. Guideline-based implementation].
The transfusion act authorized the German Medical Association to provide "guidelines for therapy with blood components and plasma derivatives" by a working party for the critical use of blood products to help to protect patients from avoidable risks. Responsible and carefully considered use of blood products is mandatory, particularly because obtaining them requires the willingness of numerous volunteers to donate blood. The individual recommendations were evaluated by evidence-based criteria and for many medical interventions so that they will serve to provide comprehensive operational procedures for transfusion personnel in clinics.