Der Anaesthesist
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There is a worldwide consensus among experts that guidelines and algorithms on airway management contribute to improved patient safety in anesthesia. The present study aimed to determine the current practice of airway management of German anesthesiologists and assess the safety gap, defined as the difference between observed and recommended practice, amongst these practitioners. ⋯ Current practice of airway management showed overall adherence to the current German guidelines on airway management, yet certain areas need to be improved.
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Case Reports
[SARS-CoV-2 positive child-What to do if inhalation induction of anesthesia is unavoidable?]
Induction of anesthesia by inhalation is very common in children due to difficult venous conditions and especially in uncooperative children. During the study on complications in the pediatric anesthesia in Europe (APRICOT study) including almost 30,000 patients, 48% of the children were induced by inhalation. ⋯ Rapid sequence induction is recommended for anesthesia induction and definitive airway management for adults and children in the current pandemic situation. The present case demonstrates that there can be situations in children in which induction of anesthesia by inhalation is unavoidable and shows a potential procedure for reducing the risk of infection for the anesthesia personnel.
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Meta Analysis
[Mortality in sepsis and septic shock in Germany. Results of a systematic review and meta-analysis].
The reported mortality for sepsis and septic shock varies between 15% and 59% in international comparison. For Germany, the number of studies is limited. Previous estimations of mortality in Germany are outdated or based on claims data analyses. Various authors discuss whether lacking quality initiatives and treatment standards in Germany could cause higher mortality for sepsis. This contrasts with the internationally well-recognized performance of the German intensive care infrastructure during the COVID-19 pandemic. ⋯ Our analysis does not support the notion that mortality related to sepsis and septic shock in Germany is higher in international comparison. A higher mortality would not be obvious either, since intensive care, for example also during the COVID-19 pandemic, is regarded as exemplary in Germany and the structural quality, such as the number of intensive care beds per 100,000 inhabitants, is high in international comparison. Nevertheless, deficits could also exist outside intensive care medicine. A comparison of international individual studies should take greater account of the structure of healthcare systems, the severity of disease and the limitations resulting from the data sources used.
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Review Case Reports
[Noninvasive ventilation and positional therapy in COVID-19 : Case report and literature review].
If noninvasive ventilation (NIV or high-flow CPAP) fails in severe cases of COVID-19, escalation of treatment with orotracheal intubation and intermitted prone positioning is provided as standard care. The present case reports show two COVID-19 patients with severe refractory hypoxemia despite NIV treatment during the first wave (first half year 2020) and the resulting influence on the treatment regimen during the second wave (since October 2020) of the pandemic. Both patients (aged 63 years and 77 years) voluntarily positioned themselves on the side or in a prone position without prior sedation and oral intubation. ⋯ The oxygenation index improved in the following days with continued NIV and intermittent prone and side position. The recovered patients were transferred from the intensive care unit at days 5 and 14, respectively after admission. The case reports, along with other reports, show that prone or lateral positioning may be important in the treatment of SARS-CoV‑2 pneumonia in awake and not yet intubated patients.