Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
-
Acute respiratory failure is still one the main problems in surgical intensive care. Unknown pathophysiological mechanisms permit only symptomatic therapy. Today ventilatory strategies by using PEEP und IRV are established to improve gas exchange and FRC by recruiting collapsed alveoli, decreasing intrapulmonary shunting and returning V/Q matching to normal. ⋯ Posture changing depends on blood gas analysis, specifically on decreasing PaO2 after previous increment. Patients remained in prone and supine position at a mean of 6.3 (4.5-20) h and posture changing was proceeded over a period of 15.4 (7-32) days. No problems recording to blood pressure or mechanical ventilation appeared during prone position. 11 of 16 patients survived (68.8%), 5 died of cardiac (2) and multi organic failure (3) in connection with sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)
-
The dorsal approach for reposition and stabilisation of dorsal and lumbal spine fractures is widely accepted. It is much easier for the surgeon and with lower risk for the patient. For placement of the pedicle screws 3 steps with X-ray fluoroscopy in transversal and anteroposterior direction are necessary: K-wire placement in the pedicle, drill for opening the pedicle and finally screw placement. With the use of two fluoroscopes and a central cannulated drill which is placed over the K-wire the operation gets much shorter, easier and the fluoroscopy time can be reduced significantly.