Der Anaesthesist
-
The available data on the effectiveness of therapeutic hypothermia in different patient groups are heterogeneous. Although the benefits have been proven for some collectives, recommendations for the use of hypothermia treatment in other groups are based on less robust data and conclusions by analogy. This article gives a review of the current evidence of temperature management in all age groups and based on this state of knowledge, recommends active temperature management with the primary aim of strict normothermia (36-36.5 °C) for 72 hours after cardiopulmonary arrest or severe traumatic brain injury for children beyond the neonatal period.
-
Review Meta Analysis
[Ventilator-associated pneumonia (VAP) : A risk already at the time of anesthetic induction].
Ventilator-associated pneumonia (VAP) is one of the most common and preventable infections in mechanically ventilated patients. It is associated with a high mortality rate. To prevent VAP, various strategies address this issue using "VAP-bundles", which are implemented in many intensive care units. The risk of acquiring VAP starts with the induction of anesthesia, strictly speaking at the time of intubation. This article considers measures to prevent VAP during general anesthesia in adult patients (>18 years). Procedures beyond standard hygienic precautions for VAP prevention are reviewed. ⋯ Beyond standard hygienic precautions, microaspiration should be avoided to prevent VAP. During mechanical ventilation at least 5 cm H2O PEEP is advised. Continuous monitoring and adjustment of cuff pressure is necessary. All patients mechanically ventilated after general anesthesia for more than 24 h should be intubated with an ETT with a port for subglottic suctioning.
-
Acute kidney injury (AKI) is a common and severe complication in patients on the intensive care unit with a significant impact on patient mortality, morbidity and costs of care; therefore, renal protective therapy is most important in these severely ill patients. ⋯ Most important for renal protection is the early identification of patients at risk for AKI or with acute kidney damage before renal function deteriorates further. A stage-based management of AKI comprises more general measures, such as discontinuation of nephrotoxic agents and adjustment of diuretic doses but most importantly early hemodynamic stabilization with crystalloid volume replacement solutions and vasopressors, such as noradrenaline. The aim is to ensure optimal renal perfusion and perfusion pressure. Patients with known arterial hypertension potentially need higher perfusion pressures. Large amounts of hyperchloremic solutions should be avoided. Volume overload and renal vasodilatory substances can also lead to further deterioration of kidney function. There is still no specific pharmacological therapy for renal protection.
-
The world of medicine is becoming from year to year more complex. This necessitates efficient learning processes, which incorporate the principles of adult education but with unchanged periods of further education. The subject matter must be processed, organized, visualized, networked and comprehended. ⋯ An important factor is a healthy mixture of blended learning methods, which also use new technical possibilities. These include a multitude of e‑learning options and simulations, which partly enable situative learning in a "shielded" environment. An exemplary role model of the teacher and feedback for the person in training also remain core and sustainable aspects in medical further education.
-
Meta-analyses have a great impact on medical decision-making. Random errors are, however, often the reason for misinterpretation of interventional effects in meta-analyses. ⋯ The TSA is a suitable tool to minimize the risk of random errors and for a more reliable assessment of the evidence for the results of a meta-analysis.