Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2008
Review[Techniques of extracorporeal lung support].
For patients with severe acute respiratory distress syndrome techniques of extracorporeal lung support have been established thirty years ago. In the beginning of such a strategy a roller-pump-driven veno-venous extracorporeal membrane oxygenation (ECMO) was used, which was characterized by high complication rate. ⋯ While ECMO enables a complete extrapulmonary gas exchange, iLA provides effective CO(2)-elimination. In this review, technical basements, results from clinical studies, incidence of complications and algorithms for clinical use of extracorporeal lung support systems are discussed.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2008
[Alveolar ventilation and recruitment under lung protective ventilation].
Goal of mechanical ventilation is to improve gas exchange and reduce work of breathing without contributing to further lung injury. Besides providing adequate EELV and thereby arterial oxygenation PEEP in addition to a reduction in tidal volume is required to prevent cyclic alveolar collapse and tidal recruitment and hence protective mechanical ventilation. Currently, there is no consensus if and if yes at which price alveolar recruitment with high airway pressures should be intended ("open up the lung"), or if it is more important to reduce the mechanical stress and strain to the lungs as much as possible ("keep the lung closed"). ⋯ Based on available data neither high PEEP nor other methods used for alveolar recruitment could demonstrate a survival benefit in patients with ARDS. These results may support an individualized titration of PEEP or other manoeuvres used for recruitment taking into consideration the regional effects. Bedside imaging techniques allowing titration of PEEP or other manoeuvres to prevent end-expiratory alveolar collapse (tidal recruitment) and inspiratory overinflation may be a promising development.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2008
[Epidemiology and Pathophysiology of the acute respiratory distress syndrome (ARDS)].
Despite the implementation of a multimodal concept of treatment, the acute respiratory distress syndrome (ARDS) is still afflicted with high mortality rates. A reasonable application and combination of possible treatment strategies, such as prone position, positive end-expiratory pressure (PEEP), restrictive volume therapy or nitric oxide (NO), requires pathophysiological and epidemiological knowledge. In the following article we describe basic pathophysiological parameters in development, progression and therapy of ARDS. Furthermore, we try to elucidate possible reasons for considerable limitations of multicentric studies in this field.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2008
[Inhaled nitric oxide for rescue treatment of refractory hypoxemia in ARDS patients].
The acute respiratory distress syndrome (ARDS) is characterized by a maldistribution of pulmonary blood flow towards non-ventilated atelectatic lung areas being the main reason for intrapulmonary right-to-left shunt with the consequence of severe arterial hypoxemia. The application of inhaled nitric oxide (iNO) is a therapeutic option to selectively influence pulmonary blood flow in order to improve arterial oxygenation and to decrease pulmonary artery pressure without relevant systemic side effects. Although randomized controlled trials demonstrated no survival benefit in patient populations covering the entire severity range of acute lung injury, iNO represents a feasible rescue treatment for ARDS patients with severe refractory hypoxemia and is, therefore, an important option for ARDS therapy in specialized centers.