Der Anaesthesist
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Transport of critically ill patients from the ICU for diagnostic and therapeutic purposes (e.g. CT, endoscopy, radiological catheter-assisted interventions) is a challenge and has steadily increased over the years. ⋯ Proper education and experience in critical care medicine are additional characteristics of the transport team. When these prerequisites are fulfilled a "non-transportable" patient is just as unlikely as a "non-anesthetizable" patient.
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The safe use of cuffed tracheal tubes for children necessitates a cuff pressure limitation at 20-25 cmH2O. The aim of the study was to evaluate the reliability and benefit of a new cuff pressure release valve (opening pressure 20 cmH2O) for children intubated with a cuffed tracheal tube. ⋯ Our data demonstrate that the tested cuff pressure release valve was useful and reliable to limit cuff pressure in tracheal intubated children and adolescents within an acceptable pressure range.
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Several in vitro and animal studies have demonstrated the immunosuppressive effects of opioids and an increased risk of infection. The clinical relevance of these findings is unclear. In this review the relevant animal and human studies on the relationship of opioid use and risk of infection are summarized. ⋯ In the majority of animal studies an increased risk of infection was demonstrated but in human studies these findings were contradictory. However, these studies were frequently underpowered because they involved small patient collectives and do not reflect the standards of evidence-based medicine. In summary, a causal relationship between opioid therapy and an increased risk of infection could neither be conclusively demonstrated nor fully excluded.
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Case Reports
[Ethylene glycol intoxication. Important differential diagnosis in comatose patients with metabolic acidosis].
Ethylene glycol is an alcohol, which is mainly used as antifreeze. Intoxication with ethylene glycol can cause neurological and cardiopulmonary symptoms, metabolic acidosis and acute renal failure. ⋯ In survivors of the acute phase, lasting damage is rare. The case of a 49-year-old patient with ethylene glycol intoxication is reported which was characterized by progressive impairment of consciousness, tetraparesis, hyperventilation and metabolic acidosis.
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With the assistance of digital pen and paper technology in the field of prehospital data reporting, it seems to be possible to fulfill the requirements of "documentation" as well as the requirements of "quality management". The aim of this study was to determine the "primary documentation quality" (PDQ) of a data reporting system based on digital pen and paper technology (so-called DINO) within a helicopter emergency medical service (HEMS) over a 6-month period. ⋯ The "primary documentation quality" of prehospital mission data reporting with the assistance of a digital pen and paper based documentation system (DINO) has been shown to completely fulfill the requirements of rapid and safe data documentation in actual missions, even at this early stage of development.