Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2019
[Staphylococcus aureus Bacteraemia - an Interdisciplinary Challenge].
Staphylococcus aureus is the second-most-common pathogen among bloodstream infections. Due to a high hospital mortality rate (15 - 40%), frequent complications and recurrences the clinical management of Staphylococcus aureus bacteremia (SAB) is distinct from bacteremia from other pathogens. ⋯ SAB is associated with high morbidity and mortality. Clinical management is complex. By adhering to diagnostic and therapeutic measures, the prognosis can be improved.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2019
[Blood Transfusion: a Guide to Clinical Decision Making].
Nowadays, management of hemotherapy is regulated in Germany by the transfusion act and several guidelines while the transfusing physician is responsible for correct implementation at the bedside. Indications for blood products have to be carefully adapted to the patient's current clinical situation and pre-existing diseases have to be considered as well. Today, for most perioperative elective surgeries, evidence-based transfusion thresholds for packed red blood cell concentrates (RBC) have been defined and should be considered. ⋯ For severe hemolytic transfusion reactions, in almost all cases, wrong blood in tube (WBIT) at the diagnostic bedside blood withdrawal or a mix-up of blood components before transfusion is causative. Massive transfusion situations require a proactive management, which includes RBC, FFP and potentially also PC and coagulation factor concentrates. Prior to elective surgery, anemic patients should be diagnosed and treated for the cause of their anemia, if possible.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2019
[Patient Blood Management: Preoperative Anemia and Case Reports from the Anemia Walk-In Clinic].
Preoperative anemia is independently associated with increased morbidity and mortality and represents the strongest predictor for transfusion of red blood cells. Iron deficiency anemia is the most frequent form of anemia and could easily be treated by supplementation with iron. Patient Blood Management (PBM) focusses on prevention and management of anemia to optimize the patient and reduce unnecessary allogeneic blood products.
-
Re-infusion of washed autologous blood cell salvage from the operative field and wound drainages is used as part of blood conservation strategy within Patient Blood Management (PBM). Cell salvage is an effective method to reduce allogeneic blood transfusion. A main advantage of cell salvage is the prevention of storage-related damage to the erythrocytes. Cell salvage has wide applications in surgeries with expected blood loss higher than 500 ml like cardiac, vascular, orthopedic surgery, and by the use of blood irradiation also in cancer surgery.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2019
[Dysphagia in Tracheostomized Patients after Long-Term Mechanical Ventilation - Become Sensitive to Reduced Pharyngo-Laryngeal Sensitivity].
Independent of the type of critical illness, tracheostomized patients have a high risk of developing a dysphagia. This is potentially life-threatening as it can lead to aspiration and pneumonia. It is therefore essential to perform swallowing diagnostics by means of a bolus dyeing test and/or FEES before oral feeding. Since a physiological airflow through the larynx and adequate subglottic pressure are key components of an effective swallowing act, oralisation should be avoided as far as possible with a blocked tracheal cannula.