Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2012
Review[Fluid management - which fluid for what type of patients?].
There is a renewed discussion about the role of crystalloids and natural as well as synthetic colloids in fluid resuscitation. Based on the currently available evidence the choice of fluid replacement does not influence mortality. However, there is increasing evidence that due to unwarranted organ effects of the specific replacement fluids, individual subgroups of patients may be preferentially treated either with cristalloids or colloids.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2012
Biography Historical Article[In Memoriam - Dr. Otto Heinrich Just (1922-2012)].
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2012
Review[Fluid management: estimation of fluid status].
Cardiac filling pressures alone are not appropriate to estimate the effect of a volume challenge on the corresponding change in stroke volume. Dynamic variables of fluid responsiveness have been shown to discriminate with acceptable sensitivity and specificity between responders and non-responders to a volume challenge. However, several clinical confounders have been indentified which potentially influence the predictive power of these variables. Sound knowledge of these confounders and the acknowledgement that there is no unique threshold value for volume optimisation but a considerable "gray zone" is necessary to fully exploit the advantages of functional haemodynamic monitoring.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jul 2012
Review[Fluid management: goal-directed therapy].
Goal-directed fluid therapy (GDT) is one important step in perioperative therapy as it improves complication rate and mortality by optimisation of oxygen delivery. There is a convincing evidence for GDT when used early, before organ failure occurs, and in high-risk patients. Moderne algorithms use goals derived from advanced haemodynamic monitoring and are based on the concept of fluid responsiveness and optimisation of global perfusion. Future investigations will have to prove the advantage of using the new less or non-invasive haemodynamic monitoring devices or automatic closed-loop fluid administration systems for GDT.