Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2018
Review Guideline[SSC International Guideline 2016 - Management of Sepsis and Septic Shock].
The new guideline of the Surviving Sepsis Campaign was revised in 2016 and presented in 2017. Furthermore, "Sepsis-3" in 2016 completely changed the definition of Sepsis from inflammation plus infection to a "life-threatening organ dysfunction caused by a dysregulated host response". ⋯ The article summarizes the most important recommendations and additionally discusses some crucial amendments. This is intended to encourage the reader to incorporate the new guideline into clinical practice, thus improving the prognosis of patients suffering from sepsis or septic shock.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2018
Review Case Reports[ARDS - An Update - Part 1: Epidemiology, Pathophysiology and Diagnosis].
The Acute Respiratory Distress Syndrome (ARDS) is defined by hypoxemic respiratory failure caused by inflammatory response within the lung usually requiring invasive mechanical ventilation. Despite more than 50 years of research numerous issues regarding epidemiology, pathophysiology and diagnosis remain unclear until today: Due to rather unspecific clinical diagnostic criteria incidence of ARDS varies considerably in clinical trials with a range from 4 to 79 cases per 100 000 persons per year. Consequently, mortality is also highly variable from about 40 to 60% in severe ARDS. ⋯ However, it is unknown whether pulmonary and extrapulmonary causes and risk factors for ARDS are accompanied by different pathophysiologic processes due to primary endothelial and epithelial injury. Thus, possible benefits of corresponding biomarker panels for the differentiation of endothelial and epithelial lung injury are also speculative until today. Therefore, ARDS diagnosis is still based on clinical findings and radiological imaging.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2018
Review[Renal Replacement Therapy in Acute Kidney Injury - Indication and Implementation].
Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with a worse short- and long-term outcome. The KDIGO (Kidney Disease: Improving Global Outcomes) guidelines suggest to implement preventive strategies in high-risk patients. Definition and classification of acute kidney injury according to the KDIGO criteria are based on an increase in serum creatinine and/or a decrease in urinary output. ⋯ In hemodynamically instable patients and patients with increased intracranial pressures continuous renal replacement therapy is recommended. Although weak evidence exists, regional citrate anticoagulation is suggested for patients receiving continuous renal replacement therapy and systemic heparin anticoagulation is suggested for patients receiving intermittent renal replacement therapy. The KDIGO guidelines recommend to deliver an effluent volume of 20 - 25 ml/kg/h for CRRT in AKI.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2018
Review Case Reports[ARDS - An Update - Part 2: Therapy and Outcome].
The Acute Respiratory Distress Syndrome (ARDS) is defined by hypoxemic respiratory failure due to inflammatory response within the lung usually requiring invasive mechanical ventilation. Despite more than 50 years of scientific research numerous issues especially regarding mechanical ventilation as the most important treatment option remain unclear. ⋯ Because no specific pharmacological therapy revealed beneficial effects until today, adjunctive treatment is actually limited to prone positioning and restrictive fluid balance. Long-term outcome of ARDS survivors is often affected by anxiety and mental health disorders.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2018
Review[Respiratory Failure: Innovations in Diagnostics and Therapy].
Acute and chronic respiratory failures require immediate diagnosis and preferably individualized ventilation therapy. If possible, non-invasive ventilation should be considered to avoid complications of invasive mechanical ventilation. Especially in patients with ARDS and moderate to severe cases, non-invasive ventilation may not be suitable and should not be used uncritically. ⋯ So for today the best thing is to implement the current evidence consequently. This includes lung-protective ventilation with an adequate PEEP and a tidal volume between 6 and 8 ml/kg IBW and a limitation of peak pressure or driving pressure. According to this early mobilization and positioning including prone-position is important, same as a score-based sedation regime and an individualized volume therapy.