Pneumologie
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Although life-saving, mechanical ventilation is associated with numerous complications. Recently, it was shown in animal models that controlled mechanical ventilation (CMV) can cause the so-called ventilator-induced diaphragmatic dysfunction (VIDD). The decrease in diaphragmatic strength proceeds along with prolonged mechanical ventilation. ⋯ Since VIDD is particularly caused by comorbidity, a series of other factors may lead to diaphragmatic dysfunction. Whether or not VIDD causes weaning failure is difficult to decide since other reasons may also cause respiratory muscle weakness. However, based on pathophysiology, treatment options may be assisted mechanical ventilation, administration of antioxidative agents or stimulation of the phrenic nerve.
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Acute heart failure syndromes (AHFS) are a growing health problem in Western Countries. Standard treatment includes vasodilators and diuretics, however, the subgroup of patients with AHFS and low cardiac output state represents a special therapeutic challenge that is complicated by high in-hospital and post-discharge mortality and by requiring additional i. v. inotropic support. ⋯ While most inotropes yield short-term haemodynamic improvements, they are associated with increased myocardial oxygen consumption, (supra-) ventricular arrhythmias and possibly increased post-discharge mortality. This review highlights current inotropes used in the treatment of AHFS and introduces new drug developments including myosin activators and Na+/K+ ATPase inhibitors.
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Randomized Controlled Trial
[Patient education in COPD during inpatient rehabilitation improves quality of life and morbidity].
Pulmonary rehabilitation is recommended for the treatment of COPD in international guidelines. However, patient education as an important part of pulmonary rehabilitation has not been addressed sufficiently to show its benefit. The aim of this study was to find out whether education improves the effectiveness of rehabilitation with regard to quality of life (QoL) and morbidity in the year following rehabilitation. ⋯ Patient education for COPD has been shown to improve the effectiveness of an inpatient rehabilitation programme regarding quality of life. It also reduces morbidity and supports a change of lifestyle. Therefore, education should be an essential component of rehabilitation in COPD.