Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2012
[Percutaneous tracheostomy in intensive care medicine - Update 2012].
Percutaneous tracheostomy has become an established procedure in airway management of critically ill patients. It offers advantages over prolonged tracheal intubation. To date, there is no evidence of the optimal timing of the procedure. ⋯ Provided that specific contraindications are observed (e.g. difficult tracheal intubation, inability to identify anatomic landmarks, severe coagulopathy etc.), all techniques have low complication rates. The use of ultrasound may further enhance perioperative safety. Finally it must be noted that percutaneous tracheostomy is an elective procedure that requires informed consent from the patient or an attorney of law.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2012
Review[Anaesthesia in endoscopic and percutaneous procedures in cardio-thoracic and cardiovascular interventions, part 2 - endoscopic thoracic interventions and endovascular percutaneous aortic aneurysm repair (EVAR)].
Despite the ongoing further development of high definition imaging techniques (CT, MRI), mediastinoscopy and thoracoscopy remain essential instruments e.g. for extracting mediastinal lymph nodes allowing further histological diagnostics, or increasingly complex thoracoscopic procedures. Furthermore, in the course of the development of endoscopic thoracic and percutaneous interventions, the therapy of thoracic aortic aneurysms is increasingly the domain of endovascular procedures. In the second part of this review the anaesthesiological procedure and specialties concerning endoscopic thoracic interventions and percutaneous aortic aneurysm repair (EVAR) will be described.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2012
Review[If the extracorporeal lung assist comes to its limit: use and management of extracorporeal membrane oxygenation in severe acute respiratory distress syndrome].
In patients with the most severe forms of acute respiratory distress syndrome (ARDS) refractory to conventional mechanical ventilation and adjunctive or rescue therapies like kinetic therapy, inhaled vasodilators or extracorporeal CO2-elimination (extracorporeal lung assist), the use of the extracorporeal membrane oxygenation (ECMO) can secure gas exchange. Due to technical improvements and miniaturization, the new ECMO system is safer and simpler. ⋯ Recent data suggests, that outcome of patients with severe ARDS treated with ECMO may improve. This review describes the function and the management of ECMO-therapy in ARDS-patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2012
[Which kind of therapy for which patient? Choosing the ventilator strategy in ARDS].
Ventilator-induced lung injury (VILI) contributes to the high mortality of ALI/ARDS. Lung protective ventilation with a tidal volume of 6 ml / kgIBW (Ideal Body Weight) and a plateau pressure <30 cm H2O has shown to reduce mortality and was thus selected as one of ten quality indicators for critical care in Germany. ⋯ Measurements of transpulmonary pressure by an oesophageal probe or electrical impedance tomography (EIT) are promising approaches, but still need to proof their superiority. Until then, every clinician must aim to translate the recommendations of lung protective ventilation into daily practice.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2012
[If mechanical ventilation comes to its limits: extracorporeal lung assist].
Extracorporeal lung assist can be performed pumpless by using the arterio-venous driving pressure or pumpdriven in a veno-venous mode. Oxygenation is maintained via the native lungs and depends mainly on mean airway pressure during mechanical ventilation. ⋯ It aims at a further reduction of the applied tidal volume and peak pressures in order to reduce the intensity of the pulmonary and systemic inflammatory response which is the main factor for the development of multi-organ failure in this group of patients. Eventually patients with acute exacerbation of a chronic pulmonary disease might also benefit from extracorporeal ventilation.