Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1997
Randomized Controlled Trial Comparative Study Clinical Trial[Effects of various feeding regimens in multiple trauma patients on septic complications and immune parameters].
The aim of this study was to investigate the incidence of septic complications, the immunological changes by the course of lymphocyte subsets and metabolic parameters on polytraumatised patients when given nutritional support in form of early enteral and total parenteral nutrition. Furthermore, we looked for differences between a standard enteral diet and a diet supplemented with arginine, omega-3-fatty acids, nucleotide, and selenium. ⋯ Early enteral nutrition seems to stabilise the immunosuppression of polytraumatised patients in an earlier phase. There is a consolidation of the lymphocyte counts, and of T(CD3+)- and T-helper-cells (CD4+). This could be the immunological correlate for the number of septic complications in the enteral fed groups. Therefore polytraumatised patients should be fed rather early enteral than parenteral when possible. In the initial phase after the trauma the way of nutritional support has more importance on the immune system as nutritional contents. So, in this form of studying, there is no advantage of immunonutrition.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1997
Case Reports[Diagnosis and therapy of tracheal rupture after blunt thoracic trauma].
Tracheobronchial ruptures are rare but potentially lifethreatening events. We report on the case of a 34-year-old suicidal unrestrained car driver, who developed subcutaneous and mediastinal emphysema and right-sided haematothorax following blunt thoracic trauma. Fibreoptical inspection of the tracheobronchial system revealed a rupture (approximately 2 cm in length) of the pars membranacea of the trachea ending shortly above the carina. ⋯ The clinical and radiological signs of tracheobronchial ruptures are discussed (respiratory distress, haemoptysis, cyanosis, localised pain, hoarseness, coughing, dysphagia, stridor, subcutaneous emphysema and pneumothorax, tension pneumothorax, mediastinal emphysema). Fibreoptic bronchoscopy is the present gold standard for confirming the diagnosis. The surgical and anaesthesiological approach to the management of tracheobronchial ruptures is described reviewing the current literature.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1997
Review[Mild and moderate hypothermia as a new therapy concept in treatment of cerebral ischemia and craniocerebral trauma. Pathophysiologic principles].
Hypothermia protects the brain and other vital organs during periods of ischaemia. We differentiate between mild (36-34 degrees C), moderate (33-29 degrees C), deep (28-17 degrees C) and profund (16-4 degrees C) hypothermia. During hypothermia, cerebral metabolic rate and cerebral blood flow decrease dependent on temperature. ⋯ In most instances, deep hypothermia renders neurologic outcome worse, which is most likely related to the generation of toxic metabolites and inadequate myocardial function during rewarming. The neuroprotective effects of hypothermia are related to several mechanisms along the ischaemic cascade: prevention of postischaemic hypoperfusion, reduction of functional and basal metabolism, decreased accumulation of lactic acid and oedema formation, inhibition of excitatory neurotransmitter release, prevention of Ca(++)- and Na(+)-influx, inhibition of lipid peroxidase activity, and free radical formation, stimulation of regenerative immediate early genes. The side effects of hypothermia include myocardial ischaemia, cardiac arrhythmias, decreased left ventricular contractility, coagulation abnormalities, and suppression of metabolic and immunological processes.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 1997
Comparative Study[Comparison between continuous and intermittent thermodilution measurement of cardiac output during coronary artery bypass operation].
Continuous recording of cardiovascular parameters ranks high in cardioanaesthesia. Various methods to measure the cardiac output have been developed within a period of a few years. We compared the bolus thermodilution method (COI), which has been internationally adopted as "gold standard" method, with the continuous thermodilution method (CCO) for measuring the cardiac output by means of the CCO Vigilance Monitor. Our aim was to find out whether cardiac output can be determined with valid results during coronary artery bypass surgery when using CCO. ⋯ Literature references show that the continuous thermodilution method is not only valid for intensive-care long-term measurement of cardiac output with approximately stationary haemodynamics, but also-as our results prove-valid if haemodynamics are not usually stationary, such as during coronary artery bypass surgery. The pros of the continuous thermodilution method are that no additional equipment is required apart from the standard equipment used in intensive-care medicine and cardio-anaesthesiology: that there is no stress caused by volume; and that manipulation is safe because no calibration routine is needed and also because measurement and analysis techniques are fully automated. Hence, we are of the opinion that the intraoperative use of this cardiac output measurement technique during open heart surgery is clinically indicated.