Pneumologie
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Respiratory failure as a result of overload and/or reduced capacity of the respiratory muscles is the most common cause of unsuccessful weaning and the need for long term mechanical ventilation. Chronic obstructive pulmonary disease (COPD) is the most common underlying cause leading into long term mechanical ventilation. The most important clinical parameter for fatigue of the respiratory muscles is the rapid shallow breathing index. ⋯ However, NIV should only be applied under close monitoring and in cooperative patients, always considering the limits of the method. Dying under mechanical ventilation in the end stage illness is still a challenge for all involved persons. In the end stage of their disease for some patients it is possible to discontinue mechanical ventilation so they can spend the last period of their lives on a normal ward or even at home.
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Comparative Study
[Ultrasound in pulmonary embolism: killing three birds with one stone].
Pulmonary embolism remains a great diagnostic challenge. The value of different ultrasound methods is presented in this review. Regarding the accuracy of echocardiography, it shows a sensitivity of 41 - 50 % and a specifity of 90 % for unselected patients with suspicion of PE as a result. ⋯ Colour Doppler sonography with compression is a save modality ensuring the source of embolism in deep vein thrombosis. With suspicion of deep vein thrombosis the median sensitivity made up 95 % (38 - 100 %) and median specifity was 97 % (81 - 100 %). The combination of chest sonography, echocardiography and compression sonography of leg vein thrombosis enhances the sensitivity of sonography to 92 %, while this accuracy can not be reached with any other method.