Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2012
[Which kind of therapy for which patient? Choosing the ventilator strategy in ARDS].
Ventilator-induced lung injury (VILI) contributes to the high mortality of ALI/ARDS. Lung protective ventilation with a tidal volume of 6 ml / kgIBW (Ideal Body Weight) and a plateau pressure <30 cm H2O has shown to reduce mortality and was thus selected as one of ten quality indicators for critical care in Germany. ⋯ Measurements of transpulmonary pressure by an oesophageal probe or electrical impedance tomography (EIT) are promising approaches, but still need to proof their superiority. Until then, every clinician must aim to translate the recommendations of lung protective ventilation into daily practice.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2012
[If mechanical ventilation comes to its limits: extracorporeal lung assist].
Extracorporeal lung assist can be performed pumpless by using the arterio-venous driving pressure or pumpdriven in a veno-venous mode. Oxygenation is maintained via the native lungs and depends mainly on mean airway pressure during mechanical ventilation. ⋯ It aims at a further reduction of the applied tidal volume and peak pressures in order to reduce the intensity of the pulmonary and systemic inflammatory response which is the main factor for the development of multi-organ failure in this group of patients. Eventually patients with acute exacerbation of a chronic pulmonary disease might also benefit from extracorporeal ventilation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2012
[Patient's participation during the pre-anesthesia visit --"if you have no more questions ..."].
Preanesthesia visits are highly complex communicative events with legally demanded participation of the patients. The contribution describes the logical communicative course of this communication type as well as the communicative tasks of the participants. It is shown that physicians in fact offer opportunities for patients' questions but combine them with initiatives for the completion of the interaction; formulations of such offerings are also discouraging patients' questions. Initiative questions of patients during the conversation otherwise indicate where patients are in need for questions.
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Among clinical benefits like reduction in blood loss, faster postoperative recovery of gastrointestinal and lung function, lower rate of perioperative complications and less postoperative pain level, cost reduction by shortening of hospital stay plays a pivotal role for high incidence of laparoscopic surgery. Elevated intraabdominal pressure due to creation of pneumoperitoneum induces various pathophysiologic changes. Most of these changes are clinical inapparent in case of appropriate anesthesiologic management. This paper aims to sensibilize the anaesthesiologist for pathophysiologic changes, particularly with regard to hemodynamic and pulmonary complications, differential diagnosis and therapies.