Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2009
Review[Substance-abuse related emergencies--illegal drugs, part II].
For the first time since the year 2000 the number of death due to substance abuse of illegal drugs has increased in Germany in 2007 (+8 % compared to 2006). Emergency situations due to drug abuse are frequent, particular in big cities. ⋯ On the other hand, drug intoxications may mask (other) life-threatening conditions. Emergency situations due to withdrawal offer the possibility to motivate patients to take advantage of specialist-guided abstinence programs.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2008
Review[Techniques of extracorporeal lung support].
For patients with severe acute respiratory distress syndrome techniques of extracorporeal lung support have been established thirty years ago. In the beginning of such a strategy a roller-pump-driven veno-venous extracorporeal membrane oxygenation (ECMO) was used, which was characterized by high complication rate. ⋯ While ECMO enables a complete extrapulmonary gas exchange, iLA provides effective CO(2)-elimination. In this review, technical basements, results from clinical studies, incidence of complications and algorithms for clinical use of extracorporeal lung support systems are discussed.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2008
[Alveolar ventilation and recruitment under lung protective ventilation].
Goal of mechanical ventilation is to improve gas exchange and reduce work of breathing without contributing to further lung injury. Besides providing adequate EELV and thereby arterial oxygenation PEEP in addition to a reduction in tidal volume is required to prevent cyclic alveolar collapse and tidal recruitment and hence protective mechanical ventilation. Currently, there is no consensus if and if yes at which price alveolar recruitment with high airway pressures should be intended ("open up the lung"), or if it is more important to reduce the mechanical stress and strain to the lungs as much as possible ("keep the lung closed"). ⋯ Based on available data neither high PEEP nor other methods used for alveolar recruitment could demonstrate a survival benefit in patients with ARDS. These results may support an individualized titration of PEEP or other manoeuvres used for recruitment taking into consideration the regional effects. Bedside imaging techniques allowing titration of PEEP or other manoeuvres to prevent end-expiratory alveolar collapse (tidal recruitment) and inspiratory overinflation may be a promising development.
-
Anasthesiol Intensivmed Notfallmed Schmerzther · Nov 2008
[Epidemiology and Pathophysiology of the acute respiratory distress syndrome (ARDS)].
Despite the implementation of a multimodal concept of treatment, the acute respiratory distress syndrome (ARDS) is still afflicted with high mortality rates. A reasonable application and combination of possible treatment strategies, such as prone position, positive end-expiratory pressure (PEEP), restrictive volume therapy or nitric oxide (NO), requires pathophysiological and epidemiological knowledge. In the following article we describe basic pathophysiological parameters in development, progression and therapy of ARDS. Furthermore, we try to elucidate possible reasons for considerable limitations of multicentric studies in this field.