Der Anaesthesist
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Severe clinical incidents occur in up to 10% of all non-intensive care unit (ICU) patients, which have an estimated mortality of 5-8%. As in the prehospital setting, early clinical warning signs can be identified in the majority of cases. ⋯ According to this concept, METs would evaluate and treat non-ICU patients at risk at an early stage before a potentially fatal deterioration of cardiorespiratory parameters occurs. This article reviews available data on preventive in-hospital intensive care medicine and reflects on the circumstances for an implementation of METs in Germany, Austria and Switzerland.
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Electrical impedance tomography (EIT) is a non-invasive, radiation-free functional imaging technique, which offers the possibility of continuous bedside measurement of regional lung ventilation. The principle of EIT is based on the input of alternating current and voltage measurement via surface electrodes placed around the thorax, which measure changes of electrical impedance parallel to changes in aeration within the lungs. ⋯ For more than 20 years EIT has been intensively used for research purposes, but has not yet been used for the monitoring of regional lung function in the routine clinical setting. This review describes the status of EIT in the clinical routine, its possibilities and limitations.
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Preeclampsia is a pregnancy-associated illness affecting multiple organ systems. Symptoms typically occur after the 20th week of gestation and consist of hypertension (>140/90 mmHg) and proteinuria (>300 mg/day). It is one of the leading causes of premature birth worldwide and early diagnosis and treatment are essential for both fetal and maternal health. ⋯ Magnesium is the cornerstone for both prevention and control of eclamptic cerebrovascular events. In cases of severe preeclampsia and eclampsia prompt delivery is indicated, often carried out by Cesarean section (>34 weeks of gestation). Compared to general anesthesia, regional anesthesia techniques offer certain advantages to both mother and fetus and in the absence of contraindications are the methods of choice.
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Historically, calculation of staffing requirements for anesthesia has developed from index numbers derived from the workplace method to the service performance method (XX time). The DRG revenues result from an average calculation of costs that results from an assumed calculation of staffing requirements based on the service performance method. ⋯ In a second step the services rendered in a specified organization are then assessed for efficiency and if necessary optimized. Just as it applies to the whole clinical center, in departments of anesthesiology DRG revenues should be brought in line with the actual costs.
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Mechanical ventilation and positive end-expiratory pressure (PEEP) are considered to be the cornerstones of therapy for acute lung failure and acute respiratory distress syndrome (ARDS), when high levels of PEEP are applied in order to maintain or restore oxygenation, despite the fact that aggressive mechanical ventilation can markedly affect cardiac function in a complex and often unpredictable fashion. As heart rate usually does not change with PEEP, the entire fall in cardiac output is a consequence of a reduction in left ventricular stroke volume (LVSV). ⋯ Mechanical ventilation with PEEP, like any other active or passive ventilatory maneuver, primarily affects cardiac function by changing lung volume and intrathoracic pressure (ITP). In order to describe the direct cardiocirculatory consequences of respiratory failure necessitating mechanical ventilation and PEEP, this review will focus on the effects of changes in lung volume, factors controlling venous return, the diastolic interactions between the ventricles and the effects of intrathoracic pressures on right and left ventricular function.