Der Internist
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Review Comparative Study
[Percutaneous mechanical circulatory support: options and importance].
In cases of low cardiac output and chronic cardiac failure despite conventional therapy, mechanical circulatory support may be the only option to ensure adequate organ perfusion and to save the life of the patient. In recent years, several conceptionally different methods of circulatory support have been developed for percutaneous application in interventional cardiology and intensive care. Indications range from elective use in complex cardiac interventions to long-term support as a bridge to recovery. ⋯ However, an increasing level of support is paralleled by greater invasiveness and complexity of the systems. Due to a lack of larger comparative trials, the benefits and risks of adverse events must be balanced against those of conventional therapy with inotropes and largely on an individual basis. This review summarizes the options for percutaneous circulatory support with special consideration to applications in the catheter laboratory and intensive care units in internal medicine.
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In recent years a rapid expansion of extracorporeal devices for support of severe lung failure has been witnessed. Systems for veno-venous extracorporeal membrane oxygenation (VV-ECMO) or for extracorporeal carbon dioxide elimination are distinguished depending on the indications. ⋯ Modern extracorporeal lung support devices allow an effective extracorporeal gas exchange and have become an inherent component of intensive care treatment of critically ill patients. Due to potentially severe complications the use should be restricted to specialized centers with experience in the treatment of severe acute respiratory distress syndrome (ARDS).
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Acute kidney injury is still one of the most common serious complications in critical ill patients and is associated with high mortality. Even small changes in renal function significantly influence survival and long-term prognosis. ⋯ Prophylactic measures as well as early diagnosis and therapy must be the goal of a modern intensive care treatment. Various treatment modalities for renal replacement therapy allow individualized treatment of each patient. The review summarizes the main aspects on prophylaxis and early diagnosis of acute kidney injury as well as the different treatment modalities for an individualized renal replacement therapy.
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In Germany about 200 patients suffer from acute liver failure each year. Due to its rare occurrence and the severity of the disease course only few evidence-based therapeutic strategies are available. ⋯ Current research in stem cell biology and tissue engineering suggest in initial animal studies the feasibility of stem cell-based artificial liver support systems for future treatment of acute liver failure.
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Case Reports
[Dyspnea on exertion, angina pectoris and loud buzzing in the right groin in an 82-year-old man].
We report on the case of an 82-year-old man who was suffering from chest pain and dyspnea. Acute cardiac ischemia could be excluded. ⋯ Apparently, these symptoms were caused by a high output heart failure with known coronary heart disease. The patient was treated by implantation of prosthesis and oversewing the fistula which led to full recovery.