Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Review[Lung protective ventilation - pathophysiology and diagnostics].
Mechanical ventilation may lead to lung injury depending on the ventilatory settings (e.g. pressure amplitudes, endexpiratory pressures, frequency) and the length of mechanical ventilation. Particularly in the inhomogeneously injured lungs of ARDS patients, alveolar overextension results in volutrauma, cyclic opening and closure of alveolar units in atelectrauma. ⋯ These side effects are reduced, but not eliminated with the currently recommended ventilation strategy with a tidal volume of 6 ml/kg idealized body weight. It is our hope that in the future optimization of ventilator settings will be facilated by bedside monitoring of novel indices of respiratory mechanics such as the stress index or the Slice technique, and by innovative real-time imaging technologies such as electrical impedance tomography.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Review[Lung protective ventilation. Ventilatory modes and ventilator parameters].
Mechanical ventilation has a considerable potential for injuring the lung tissue. Therefore, attention has to be paid to the proper choice of ventilatory mode and settings to secure lung-protective ventilation whenever possible. ⋯ The adjustment of inspiration and expiration time should consider the actual breathing mechanics and anticipate the generation of intrinsic PEEP. Ventilatory modes with the possibility of supporting spontaneous breathing should be used as soon as possible.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Review[Lung protective ventilation - supportive and adjunctive therapies in acute lung injury].
Various supportive and adjunctive therapies to conventional mechanical ventilation have been evaluated in patients with acute lung injury and acute respiratory distress syndrome (e.g. nitric oxide, prone position, surfactant, glucocorticoids). Although some investigations have shown promising improvements in oxygenation and physiological variables, large randomized trials of adjunctive and supportive therapies showed no impact on survival.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Review[How to judge a good anaesthesia from a bad one - a critical review of recovery scores and other techniques to assess the result quality of anaesthesia procedures].
Patients, general public and health insurance funds focus more and more on the quality of medical performance. Anaesthesia related severe morbidity and mortality are unsuitable to judge the quality of an anaesthesia procedure. Other aspects like rapid and comfortable postoperative recovery or satisfaction of the patients with the anaesthesia procedure experience therefore rising attention. With this critical review we aim to give support for appraisal of already published studies and for design and realization of future trials.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2008
Case Reports[Amputation of upper extremity: a case report - preclinical care of an 37 year old man].
This case report describes the prehospital care of a person after an occupational accident. The amputation of whole extremities is rare and needs a standardized procedure: at first lifesaving procedures are necessary before saving the limb. The work at a conveyor belt resulted in taking of an arm. On the basis of this case report the prehospital management is discussed focalizing the complete treatment of the patient and his amputated extremity as well as the transport from the scene of accident to a suitable hospital.