Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Review[Simulation training for German anesthesiologists--case scenarios and training results].
Training of medical personnel using simulation techniques is an acknowledged measure of process optimization and quality assurance in a clinical setting. In 2006, a simulator-based training of anaesthesiologists was introduced in the University Medical Centre of Schleswig-Holstein, Campus Kiel, Germany. The training was performed on a human patient simulator (Meti, Sarasota, USA) and the course was conducted by instructors and engineers from the Simulation Centre Mainz in an operation room equipped with common anaesthesia devices. ⋯ The training was offered to the anaesthesia personnel of whole Schleswig-Holstein, Germany. A higher and more balanced overall performance of the participants was determined by the instructor teams in comparison to the training results in their own simulation centre. This improved performance was ascribed to the special circumstances of this training namely the familiar surroundings and team members.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Review[Lung protective ventilation - protective effect of adequate supported spontaneous breathing].
Based on available data, it can be suggested that spontaneous breathing during ventilator support has not to be suppressed even in patients with severe pulmonary dysfunction if no contraindications are present. Experimental data do not support the contention that spontaneous breathing aggravates ventilator-induced lung injury. ⋯ This should result in a lung protective effect of adequate supported spontaneous breathing. Clinical data supported this belief demonstrating improvement in pulmonary gas exchange, systemic blood flow, and oxygen supply to the tissue and a decrease in days on ventilator support and duration of stay in the intensive care unit.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Review[Lung protective ventilation - pathophysiology and diagnostics].
Mechanical ventilation may lead to lung injury depending on the ventilatory settings (e.g. pressure amplitudes, endexpiratory pressures, frequency) and the length of mechanical ventilation. Particularly in the inhomogeneously injured lungs of ARDS patients, alveolar overextension results in volutrauma, cyclic opening and closure of alveolar units in atelectrauma. ⋯ These side effects are reduced, but not eliminated with the currently recommended ventilation strategy with a tidal volume of 6 ml/kg idealized body weight. It is our hope that in the future optimization of ventilator settings will be facilated by bedside monitoring of novel indices of respiratory mechanics such as the stress index or the Slice technique, and by innovative real-time imaging technologies such as electrical impedance tomography.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Review[Lung protective ventilation. Ventilatory modes and ventilator parameters].
Mechanical ventilation has a considerable potential for injuring the lung tissue. Therefore, attention has to be paid to the proper choice of ventilatory mode and settings to secure lung-protective ventilation whenever possible. ⋯ The adjustment of inspiration and expiration time should consider the actual breathing mechanics and anticipate the generation of intrinsic PEEP. Ventilatory modes with the possibility of supporting spontaneous breathing should be used as soon as possible.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Review[Lung protective ventilation - supportive and adjunctive therapies in acute lung injury].
Various supportive and adjunctive therapies to conventional mechanical ventilation have been evaluated in patients with acute lung injury and acute respiratory distress syndrome (e.g. nitric oxide, prone position, surfactant, glucocorticoids). Although some investigations have shown promising improvements in oxygenation and physiological variables, large randomized trials of adjunctive and supportive therapies showed no impact on survival.