Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2021
Review[Extracorporeal Strategies in Sepsis Treatment: Role of Therapeutic Plasma Exchange].
Mortality in sepsis remains high. Various techniques for extracorporeal cytokine removal have been investigated as additional therapeutic measures in sepsis and septic shock. ⋯ The use of extracorporeal blood purification methods cannot be recommended for sepsis patients outside of clinical trials given the current lack of evidence of their efficacy. Future investigations should aim to homogenize the studied patient collective in respect to clinical sepsis severity, time point of intervention and different inflammatory (sub-)phenotypes.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2021
Review[Diabetes mellitus in Anaesthesia - Optimal Blood Sugar Control in the Perioperative Phase].
Uncontrolled high blood sugar can be dangerous for diabetics throughout the perioperative period - in particular, when blood glucose levels exceed a threshold of 250 mg/dl or HbA1c levels are higher than 8.5 - 9%. In such cases, all elective surgery should be withheld to minimize the risk of severe complications. ⋯ Current literature suggests that non-critically ill diabetics should be treated with rapid-acting insulin analogues subcutaneously in operating theatres, whereas critically ill patients should receive continuous intravenous insulin infusions using a standardized protocol. In summary, this review can give a hand in dealing with diabetics during the perioperative period and offers guidance in controlling blood sugar levels with the help of oral antidiabetic drugs and insulin.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2021
[Acute Kidney Injury: Epidemiology, Pathophysiology, Repair Mechanisms].
Acute kidney injury (AKI) is a major complication in critically ill patients and affects up to 50% of those admitted to intensive care units. Causes of AKI include patient specific factors (susceptibility: e.g. age, pre-existing chronic kidney disease, chronic heart failure, diabetes) and patient unspecific factors (exposure: e.g. sepsis, hypovolemia, cardiac surgery, nephrotoxin application). Mortality of severe AKI is in the range of 40 - 50%. ⋯ Therefore, the prevention of AKI is of an utmost importance. The recommended preventive measures include optimization of hemodynamics and volume status, close monitoring of creatinine levels and urine output, avoidance or discontinuation of nephrotoxic drugs, normoglycemia and the application of alternatives to radiocontrast agents if possible. As the long term prognosis of AKI highly depends on renal recovery, the 2 major goals for the future will be 1) the early identification of patients at AKI risk and 2) the support of renal recovery of AKI patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2021
[Prehospital and In-hospital Concepts for Disaster Response and Preparedness].
Disaster medicine faces complex challenges and will play an increasing role in the future. Disaster medicine is dominated by a phased imbalance of available and required resources. Various factors, such as a possible hazard for the rescue forces, inaccessible terrain or even destroyed infrastructure increase the complexity enormously. ⋯ These plans can only be guiding structures; the adaptation to the actual circumstances of the incident and the situation-adapted interpretation of the plans is the responsibility of the operational commanders. A clear leadership structure is essential for both preclinical and clinical operations. In this article, we describe important basic principles of disaster medicine mission planning and management.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 2021
[Perthes Syndrome after Roll-Over Trauma].
Roll-over trauma and associated traumatic entrapments frequently result in serious polytraumatisation. In rare cases, severe extrathoracic compressions and a protracted entrapment period can lead to Perthes syndrome, also known as traumatic asphyxia. The Perthes syndrome manifests itself by a triad of craniocervical cyanosis, facial petechiae and subconjunctival haemorrhages, enabling a rapid diagnosis based on these typical clinical features. ⋯ An early identification of this condition, the elevation of the upper body to allow adequate venous drainage in addition to ensuring sufficient oxygenation are essential for optimal therapy. In general, no long-term complications are to be expected for Perthes syndrome. The stasis usually disappears completely within a few months.