Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1993
Review[Indications for the use of human albumin in anesthesia and intensive care medicine].
The plasmatic albumin concentration (3.5-4.5 g/dl) represents about 60% of the total plasma protein. Only 25-40% of whole albumin belongs to the intravascular pool, the majority is distributed in the interstitial space especially of the skin. Main physiological effects of plasmatic albumin are the control of the plasmatic volume by preservation of the colloid oncotic pressure (COP) and the plasmatic transport including the binding of drugs. ⋯ For prevention of interstitial pulmonary oedema, a COP of 15-20 mmHg should be achieved. Up to now, no clinical study verified a positive effect of albumin substitution regarding outcome or incidence of complications in intensive-care patients. Thus, an albumin therapy to maintain a COP of 15-20 mmHg in intensive-care patients is only recommended if a capillary leak is unlikely and the dose limits of synthetic colloids are attained.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1993
[The effect of intermittent prone position on pulmonary gas exchange in acute lung failure].
In a clinical trial, the influence of repeated intermittent prone position on pulmonary gas exchange was investigated in 6 patients with severe ARDS. Despite various intra- and interindividual differences, oxygenation index (calculated by the paO2:FiO2 ratio) was improved significantly by change from supine to prone position in the first two days of treatment, whereas paCO2 remained unchanged. Later on, a significant improvement of oxygenation could not be verified. In patients with proven or presumed densities of dorsal lung regions, body position changes from supine to prone position in the early phase of treatment may improve arterial oxygenation and may be regarded as a therapeutic principle in conventional ARDS treatment.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1993
[Dying and death in a surgical intensive care unit from the viewpoint of close relatives--a questionnaire survey].
No studies are available so far on the way dying and death in the ICU are perceived by relatives of the patients. It is also not clear in how far the current criticism of intensive care medicine stems from these relatives. These problems were investigated by sending a self-developed 48-item questionnaire to relatives of patients who had died in the ICU. ⋯ However, the treatment was not perceived as an artificial prolongation of life. Although death loses dignity in the ICU according to those questioned, dying in peace does seem possible in this situation. The high response rate, the positive general assessment and the critical view of death in the ICU are discussed in the following.