Pneumologie
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The initiation of and weaning from mechanical ventilation with extubation cause significant changes in intrathoracic pressures and have profound consequences for the cardiovascular function. However, in spite of the known pathophysiological relationships, frequently little attention is paid to the cardiovascular situation during the weaning period. The currently available guidelines concerning weaning and extubation/reintubation are based on only limited evidence and are thus rather general. ⋯ On the contrary, many intensive care patients have subclinical or undiagnosed cardiac disease, and cardiovascular compensation mechanisms are frequently hampered by the underlying critical illness. Therefore, in a significant proportion of patients, weaning and extubation attempts fail due to the patient's limited cardiovascular reserves. This review summarises the relevant information for a successful weaning and extubation with special respect to the cardiovascular function.
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Palliative care should be part of respiratory medicine for two reasons: first, many respiratory diseases--besides thoracic tumours--need palliative care in the late stages of the disease. Second, dyspnoea is a common symptom in advanced, primary extrapulmonary diseases and the knowledge of respiratory specialists can be beneficial in the treatment of this symptom. In this paper we describe frequent symptoms of advanced pulmonary diseases and their treatment. Moreover, we focus on the structure of palliative care in Germany.
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The strongly pronounced obstructive sleep apnoea syndrome can lead to serious traffic accidents if the driver falls asleep at the wheel. This article deals with the insurance law consequences, especially with the problem if the insurer raises the objection that the sleep apnoea sufferer acted grossly negligent. Since the new German Insurance Contract Act of 1 (st) January 2008 paragraph 81 regulates a benefit reduction in cases of gross negligence by the insurant. ⋯ The jurisdiction is aware of the fact that in the case of sleep apnoea fatigue does not necessarily need to precede the act of falling asleep. In the opinion of the author it has to be distinguished between medicated and not medicated sleep apnoea and further if the sufferer knows about his disease. If the sleep apnoea sufferer has known of the risk of sudden microsleep, for example, after being warned by his doctor who discovered the disease, gross negligence cannot be dismissed and assurance benefit has to be reduced by about 65 %.
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Sarcoidosis is a multifactorial and polygenic disorder. The current knowledge of its genetics will be presented and discussed in the context of other granulomatous disorders of known and unknown aetiology. The differing and common features of these disorders lead to the perspective that in near future it will be possible to establish genotype-phenotype correlations which will predict the course and therapy response in an individual case.
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The aim of the present study was to evaluate anew scale for assessing COPD-related disability. The scale is an adaptation of the pain disability index (PDI), which is a standard instrument in diagnosing disability in chronic pain patients. An 11-point rating scale is used to assess disability in seven different areas of life. ⋯ The scale further demonstrated high correlations with questionnaires assessing related constructs [St. George's Respiratory Questionnaire (SGRQ): Pearson's correlation coefficients r=0.59 to 0.83, p