Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Oct 1999
Review[High altitude headache: epidemiology, pathophysiology, therapy and prophylaxis].
Headache is known to be the predominant symptom in acute mountain sickness which is also frequently accompanied by nausea, vomiting and insomnia. Nowadays, every year millions of skiers and mountaineers are attracted to mountains all over the world. At altitudes between 2500 m and 5000 m about 20% to 90% of those who are not adapted to high altitude will experience high altitude headache (HAH). ⋯ Acetazolamide, dexamethasone, and aspirin were also found to prevent HAH. The most beneficial effects however, may be achieved by the combined application of acetazolamide and aspirin. This combination increases oxygenation and reduces prostaglandin synthesis.
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Non invasive ventilation is defined as mechanical ventilation without the use of endotracheal intubation and has been increasingly established within intensive care units during the last decades. Negative pressure ventilation and non invasive positive pressure ventilation have been successfully applied, first in chronic respiratory failure (CRF) due to various causes and later in acute respiratory failure (ARF). In this review ventilation modes, indications, contraindications and side effects of non invasive ventilation are analysed and the impact of non invasive ventilation on the physiology, pathophysiology and outcome of CRF and ARF, and possible applications in CRF (restrictive chest and pulmonary diseases, neuromuscular diseases and COPD) and ARF are discussed. It is concluded that non invasive ventilation should be included in the routine management of respiratory failure at all intensive care units.
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Wien. Klin. Wochenschr. · Oct 1999
Heavy chronic alcohol abuse has no additional adverse effect on the function of extrahepatic organs and ICU mortality in patients with liver cirrhosis.
We questioned whether heavy chronic alcohol abuse influences extrahepatic organ failure and ICU mortality in cirrhotic patients admitted to a medical intensive care unit. ⋯ The occurrence of extrahepatic organ failure and ICU mortality was not different between patients with liver cirrhosis secondary to heavy chronic alcohol abuse and patients with liver cirrhosis due to nonalcoholic causes. Cirrhotic patients should be admitted to a medical intensive care unit for extended intensive care treatment prior to the occurrence of extrahepatic multiple organ failure, independent of the underlying aetiology.
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Wien. Klin. Wochenschr. · Oct 1999
[Implementing limited therapy methods in intensive care units: discontinuing therapy, reducing therapy and withholding therapy in intensive care units of the Innsbruck University Clinics].
The intensive care physician is frequently confronted with the decision to withhold or withdraw therapy in patients with a poor prognosis. Apart from the legal implications, the practical management of withholding or withdrawing intensive care treatment continues to be indistinct. The subject has not been investigated in Austria or Germany. The aim of the study was to examine the different points of view of intensive care physicians and the various procedures to limit therapy in patients with a poor prognosis. ⋯ Before withholding or withdrawing intensive care therapy, a medical specialist must determine and document the futile prognosis of the patient. If the patient's wish is unknown, all further decisions should be made in agreement with all participants. The goal of the therapy is to provide the patient maximum comfort under minimal intensive care treatment.