Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2016
Review Meta Analysis[Postoperative acute kidney injury: confounder or causal link for surgical outcome?]
Demographic change and increase of complexity of diagnostic and surgical procedures lead to an increasing relevance of acute kidney injury as postoperative complication. Postoperative acute kidney injury is associated with higher mortality, morbidity and treatment costs. It has not yet been unequivocally proven that postoperative acute kidney injury is in fact causally linked with worse treatment outcome in surgical patients. This article aims to give an overview of the phenomenon postoperative acute kidney injury, to discuss problems of demonstrating causal relations in biomedical research, and to present arguments for and against the hypothesis that postoperative acute kidney injury is causally linked to worse surgical outcome.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2016
Review[Awake video laryngoscopy - an alternative to awake fiberoptic intubation?]
Awake video laryngoscopy is a novel option in airway management that is drawing more and more attention as an alternative to awake endoscopic guided intubation.Main issues: Intubation under preserved spontaneous breathing is the safest method to secure the expected difficult airway. In direct comparisons to awake flexible endoscopic intubation, awake video laryngoscopy achieves satisfactory intubation times and a high acceptance of patients and anesthesiologists. Specific cases, in particular very limited mouth opening or sub-glottic masses, require awake flexible endoscopic intubation. Sufficient topical anesthesia and a sophisticated sedation protocol are prerequisites for successful awake video laryngoscopy. ⋯ Awake video laryngoscopy cannot fully replace flexible endoscopic intubation. It is a useful option, but it must be considered that this technique is not suitable for all types of airways, patients or even anesthesiologists. Expertise and adequate practice is mandatory for both techniques. Careful planning, an appropriate blade design and a high expertise in video laryngoscopy are crucial for a successful intubation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2016
Review[Acute kidney injury - remote ischaemic preconditioning: a nephroprotective strategy?]
Acute kidney injury is a common and serious complication with a huge impact on morbidity and short- as well as long-term mortality. Sepsis and major surgeries, especially cardiac surgery, are the most common causes of acute kidney injury. ⋯ Remote ischaemic preconditioning is an intervention consisting of brief episodes of ischaemia and reperfusion at a remote site before subsequent ischaemic insults occur. This simple and uncomplicated method may offer an effective nephroprotective strategy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2016
Review[Acute kidney injury - status of biomarkers in perioperative and critically ill patients].
Acute kidney injury (AKI) impairs short- and long-term prognosis of affected patients even in case of apparantly mild course and 'full' recovery as measured by follow-up serum creatinine concentrations. Late or none intervention worsens prognosis. ⋯ Effective treatment is multifactorial and includes identification and reversal of AKI etiology and generation of a (micro)environment for optimal renal recovery. Available treatment options for AKI in perioperative and critically ill patients will be discussed in the setting of novel kidney biomarkers.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2016
Review[Transfer of critically ill patients between hospitals - fundamentals and requirements].
Due to the increasingly changed clinical landscape, which leads to a reduction of clinical facilities in rural regions. This also leads to a centralized clinical care, in addition to limited care options in the periphery. Therefore the interhospital transfer is becoming increasingly important. ⋯ Not only the number of transports, but also the transport distances have steadily increased in recent years. It is necessary to differentiate centripetal transports into the centers of the maximum and centrifugal transports back to peripheral clinics, weaning devices or rehabilitation facilities. Especially in the case of the latter, the number of patients still to be transported under intensive medical conditions has clearly increased.