Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2013
Review Case Reports[In Process Citation].
Patients with univentricular congenital heart disease are treated with Fontan-procedure for more than 40 years resulting in mainly good life-quality for pediatric and now more and more adult patients. Due to prolonged life expectation and adequate physical state, adolescent and adult Fontan-patients participate in normal life activities like the main population. Mass events like open-air concerts and sport events belong to these activities. ⋯ Visitors with minor or major health problems are treated by emergency response services like the German Red Cross, the German St Johns Ambulance and the German Order of Malta. The article refers to the special pathophysiology and management of Fontan-patients in emergency and anaesthesiologic settings based on a case report from the Southside Festival. Due to increasing "fontanpopulation" profound education of attending physicians and paramedics is inevitable to provide good quality in prehospital and innerhospital care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2013
Review[Current concepts of weaning children from invasive ventilation].
Timely weaning from invasive ventilation is of major importance to limit time of invasive ventilation and improve outcomes. However, in pediatrics only limited knowledge on the optimal weaning approach is available. ⋯ Standardized daily evaluation of weaning readiness, daily interruption of sedation, use of pediatric sedation protocols, application of noninvasive ventilation and prophylactic treatment with steroids of patients with high risk for post-extubation upper airway obstruction have been shown to decrease duration of invasive ventilation or to decrease the risk of extubation failure. However, due to the heterogeneous patient population in pediatric intensive care units, an individual approach might be necessary for certain subgroups of pediatric patients.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2013
Review[Monitoring of the respiratory muscle function during weaning from mechanical ventilation].
Early weaning and discontinuation of mechanical ventilation can help prevent respiratory muscle dysfunction in critically ill patients. Prolonged mechanical ventilation and failure to use adequate strategies to discontinue mechanical ventilation can even enhance and perpetuate respiratory muscle dysfunction. ⋯ Therefore, accurate monitoring of the respiratory muscle function is a valuable tool for the clinician at the bedside to assess to optimal weaning strategy and, ideally, would predict either weaning failure or success. In this review, we briefly summarize the available techniques, measurements and equipment required for the monitoring of respiratory muscle function in the intensive care unit.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2013
[Weaning - Defintion and clinical context from the neurologist's view].
Special conditions in neurologic patients arise, first, from abnormal breathing patterns with brain lesions. These however may be managed effectively by adaptive ventilator settings together with special drugs thus not ultimatively precluding weaning. ⋯ In acute neuromuscular diseases during the weaning process special attention should be payed to the parameters of muscle strength, and for disturbances of swallowing at least after extubation. In degenerative terminally decompensated neuromuscular disease, an exact diagnosis and information is essential to help the patient in decision-making towards terminal weaning or long-term home ventilatory support.