Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2020
Case Reports[Uncertain Acute Hemodynamic Instability after Severe Burn Injury: an (Un-)Usual Complication].
First aid and treatment of burn patients pose a challenge to responsible physicians. Primary assessment should include an evaluation of the degree and extent of the burn injuries as well as a physical examination for other trauma injuries and trauma caused by the inhalation of toxic agents. One should focus on removal of the burning source, preservation of body temperature, sterile coverage of the burnt areas, pain management and sufficient hemodynamic stabilization. ⋯ A high or increasing gap between expiratory and arterial CO2 tension accompanied by typical symptoms like tachycardia and hypotension or respiratory distress may be caused by PAE. An echocardiogram can provide information about possible pathophysiological changes typical for PAE, nevertheless, CT-angiography is today's clinical gold standard for the diagnosis of PAE. As therapeutic measures, heparin should be administered, and thrombolysis should be considered in case of persisting hemodynamic instability, attentively taking possible contraindications into account.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2020
Review[Update Extracorporeal Lung Support].
Extracorporeal lung support is increasingly implemented worldwide in clinical practice in patients with severe acute respiratory distress syndrome (ARDS) and is required when mechanical ventilation is unable to establish sufficient pulmonary gas exchange or if the respirator settings are persistent elevated with an increased risk for ventilator induced lung injury (VILI). Besides that, hypercapnic respiratory failure in patients with acute exacerbation of COPD (AECOPD) or acute respiratory syndrome (ARDS) is common and may require extracorporeal elimination of carbon dioxide by ECCO2R, which also has been increasingly used in the clinical setting. ⋯ Therefore extracorporeal lung support should be still considered as a rescue therapy. In this review, based on a selective literature research and clinical experience of the authors, management of patients with extracorporeal lung assist, focusing on ECMO and ECCO2R is summarized.
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Renal replacement therapy (RRT) remains the cornerstone of treatment for severe acute kidney injury. However, despite its spreading use along with rising incidences of acute kidney injury, evidence of most recommendations is limited so far. Early initiation of RRT seems to reduce mortality but is associated with higher incidence of adverse events. ⋯ Intensified RRT with a prescribed dose ≥ 35 mL/kg/h has no benefit with regard to mortality but is associated with higher occurrence of complications. Urine output has the best prognostic value for cessation of RRT. Biomarkers of renal impairment and recovery are needed for better guidance of therapy.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Mar 2020
[Update Cardiac Support and Assist Therapies].
The management of acute and chronic heart failure utilizes various different techniques and medical devices. Different mechanical chest compression devices (mCPR), intraaortic balloon pump, catheter-based heart pumps like Impella®, and different kinds of ECLS/ECMO are mainly used as bridge to recovery. Venovenous ECMO gained wide acceptance after the CESAR trial. ⋯ Principles and limitations of these concepts are discussed. Surgically implanted devices that include left and right ventricular assist devices (LVAD, RVAD), biventricular VADs and the total artificial heart (TAH) are commonly used as bridge to transplant or destination therapies. Quality of life must be considered in the use of the devices, as the life-saving devices come with restrictions in the patients' lives.