Pneumologie
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Patients undergoing mechanical ventilation are usually treated in the intensive care unit. Monitoring of these patients is challenging for all members of the medical staff. ⋯ Furthermore, knowledge about oxygen supply and oxygen consumption as well as respiratory muscle capacities and workload is important. The current article presents an overview of these issues and evaluates different diagnostic tools to monitor ventilator-dependent patients.
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Biography Historical Article
[Prof. Dr. med. Joachim Schauer on the occasion of his 75th birthday].
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This review presents the potential indications for different airway devices in the intensive care unit (ICU). Since the interface during noninvasive ventilation is located outside the body, sedation is not regularly needed. Therefore, selection of a fitting mask is essential to avoid mask intolerance which is one of the biggest problems during noninvasive ventilation. ⋯ Endotracheal intubation remains the gold standard procedure for airway management. However, this procedure is associated with a number of complications. Tracheostomy is the airway access of choice when long-term mechanical ventilation is necessary.
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Comparative Study
A comparison of percutaneous dilatational tracheostomy versus conventional surgical tracheostomy.
Percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) are widely accepted techniques and frequently performed in clinical practice. We compared PDT with ST tracheostomies in view of the benefits and drawbacks, time of duration, indication and complication rate of the respective procedures. ⋯ Although both interventions are safe and achieve comparable results, PDT can be applied in a shorter time. PDT is easier to perform and seems particularly suitable for physicians in postgraduate training.
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Based on the tremendous impact of impaired respiratory muscle function, tests on their function play a significant role in respiratory and intensive care medicine. Besides differential diagnosing e.g. during prolonged weaning and quantification of impaired respiratory muscle function, e.g. in COPD, neuro-muscular diseases or ventilator-induced diaphragmatic dysfunction, those tests qualify for follow-up assessment, e.g. phrenic nerve lesions or specific respiratory muscle training. In general, (simple) volitional and (complex) non-volitional tests are available. ⋯ Several tests are complementary or additive to each other. Complete assessment for respiratory muscle function, therefore, frequently requires the combination of different test regimes. The current recommendations include in-depth description and practical guidelines for the different tests and approaches to assess respiratory muscle function.