Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Supraglottic airway devices are developed with increasing frequency following the overwhelming success of the laryngeal mask airway (LMA). In contrast to the first generation devices such as the 'classic' LMA and the laryngeal tube second generation devices usually offer an oesophageal drainage tube and/or an improved oropharyngeal leak pressure during positive pressure ventilation such as the laryngeal mask ProSeal and the laryngeal tube S. ⋯ Both the LMA and the PLMA have been shown to be perfectly suitable for routine anaesthesia and emergency airway management. While the lacking protection against aspiration is still considered a major limitation of the LMA, the value of airway devices with an oesophageal drainage tube in this respect remains untermined at present.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2011
Review[ICU delirium: Consequences for management of analgesia and sedation in the critically ill].
Monitoring and protocolized management for analgesia, sedation and delirium are key indicators for an evidence-based treatment of critically ill patients. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%). ⋯ Using data from 671 reference works, text, diagrams and recommendations were drawn up. The new 3rd Generation Guideline now includes evidence and consensus-based recommendations for the management of delirium in the intensive care unit.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2011
Review[Airwaymanagement: video-assisted airway management].
Endotracheal intubation remains the "goldstandard" in airway management. If with use of conventional techniques intubation of the patient fails, or if an anticipated difficult airway is present, video-assisted techniques may help to increase intubation success. ⋯ However, if Oxygenation and Ventilation can be established with bag-mask ventilation or supraglottic airways, the use of an endoscopic optical stylet or a videolaryngoscope may be alternatives. If the algorithm for the unanticipated difficult airway can be safely administered, the latter techniques may also be used as emergency intubation devices.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2011
Review[Invasive airway management update 2011].
Invasive airway management techniques are still challenging even for skilled anesthesiologists, intensivists and emergency physicians. All current percutaneous tracheostomy techniques are based on Seldinger's principle. ⋯ There is no data available to generally support performing early (<8 days) tracheostomy in intensive care patients requiring mechanical ventilation. Experimental data show promising results of supporting expiration through a small bore catheter using ejectors based on Bernoulli's principle in terms of minimizing risk of barotrauma during emergency transtracheal high frequency jet ventilation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2011
Review[Prevention of ventilator-associated pneumonia: what's evidence-based treatment?].
Patients who suffer from a ventilator-associated pneumonia (VAP) are ventilated longer, stay longer in the ICU and in hospital and therefore lead to higher costs. Despite the therapeutic potential of the VAP nowadays there is about 10% additional mortality observed. Although the clinical VAP diagnosis is limited (sensitivity/specificity) rapid diagnosis promotes treatment (calculated antibiotic therapy) and improves the survival rate. And in the course the review of the VAP diagnosis of unnecessary antibiotics reduces the resistance development in that area and also the selection pressure.