Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2022
[Mobilization of Intensive Care Unit Patients: How Can the ICU Rooms and Modern Medical Equipment Help?]
Intensive Care Unit patients frequently develop physical impairments, mainly weakness, during their ICU stay. Early mobilization is a central therapeutic element in patients on an intensive care unit to prevent and treat these physical sequelae to conserve independence. Different barriers such as lacking patient motivation, insufficient staffing and fear of dislocating vascular access or the airway led to insufficient implementation of current guideline recommendation. ⋯ Trials are still outstanding. Robotics integrated in the ICU bed or in form of exoskeletons are currently being piloted in critically ill patients with many expected benefits due to the ability to support patients tailored to their individual needs, reduce staff requirements as the robotics will cover support function and improved duration and intensity of mobilization as for example the patient can be ambulated without ever leaving the bed, which also translates into potentially reduced fear regarding dislocation of the airway or vascular access. Currently, evidence on the benefits regarding the integration of ICU rooms as well as modern medical technology into the process of (early) mobilization is lacking but especially in the sector of robotics a huge potential is to be suspected.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2022
Review[Anesthetic and Perioperative Management in Carotid Endarterectomy (CEA), Part 1: Anesthetic Procedures].
Carotid endarterectomy is a standard procedure in therapy and prevention of ischemic stroke in particular patients. To ensure an optimal anesthetic management, fundamental knowledge of anatomy, pathophysiology and surgical technique is essential. General anesthesia may be considered as well as regional anesthesia in affected patients. This article reviews the cause of extracranial carotid artery stenosis, its surgical and anesthetic treatment as well as perioperative characteristics.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2022
Case Reports[Lethal Heatstroke with Disseminated Intravascular Coagulopathy].
We report on a case of severe heat stroke due to extended exposure to the sun in an enclosed glass cabin of an agricultural vehicle. Patient treatment, lab results and complications are reported and we examine the current literature on heat stroke. Heat stroke is a very rare and highly severe condition mostly suffered by vulnerable individuals or individuals exposed to extreme physical strain. ⋯ Haemostasis is also directly affected by the elevated temperature. Besides physical cooling, there is no known specific treatment to prevent secondary damage from heat stroke. Additionally, supportive care and ICU monitoring should be applied.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2022
[Light Therapy for Prevention of Delirium in Critically Ill Patients: What's the Evidence?]
Circadian dysrhythmia affects the majority of ICU patients and has far-reaching effects on organ functioning. At the level of the central nervous system, circadian misalignment facilitates executive cognitive dysfunction and the development of ICU delirium. ⋯ Results from preliminary research indicate that multidimensional, patient-specific chronotherapeutic concepts developed specifically for the ICU setting may help improve the healing process of patients. Circadian lighting therapy might be a promising intervention in this context.
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Noise pollution in the intensive care unit is not only an omnipresent but also a considerable problem, both for patients and healthcare staff. There are a number of significant sources of noise that are at least partially responsible for the frequent and serious sleep disorders of intensive care unit patients. This has a negative impact on the recovery of intensive care patients and favours the occurrence of delirium, which can be associated with increased overall mortality. This article provides a summary of the current evidence on the occurrence of noise-associated consequences and possible options for reducing noise exposure in the intensive care unit and offers perspectives for improving treatment of intensive care patients.