Der Anaesthesist
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Microcirculatory dysfunctions play a central role in the pathophysiology of sepsis and shock. Modern methods enable microvascular monitoring in man and offer the possibility to test the effect of novel therapeutical strategies for sepsis. Furthermore, these techniques may be future tools for the monitoring of critically ill patients. ⋯ Alterations in sublingual microvascular blood flow are detected by intravital microscopy in septic patients and were identified as an outcome predictor. Furthermore, the role of gastrointestinal pCO2-tonometry for microcirculatory monitoring of the perfusion of splanchnic organs during sepsis is discussed. The true clinical value of these techniques has yet to be established and will depend on larger clinical trials showing an impact on diagnostics and patient management.
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Case Reports
[Accidental hypothermia in the household environment. Importance of preclinical temperature measurement].
In emergency medicine accidental hypothermia in non-traumatized patients is a rare situation. To emphasize the need for a precise preclinical temperature measurement, two cases of accidental hypothermia (28.2 degrees C and 29.3 degrees C core temperature) are presented which occurred under conditions that did not give a direct suspicion of hypothermia. In one case the immediate diagnosis lead to complete convalescence, the other patient died of multiple organ failure. The primary diagnosis, diagnostic methods and therapy as well as the primary treatment are discussed.
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Recruitment maneuvers have been proposed as an adjunct to mechanical ventilation to re-expand collapsed lung regions. Although, in most patients recruitment maneuvers improve gas exchange a controversial discussion on recruitment maneuvers remains. ⋯ The different recruitment maneuvers and possible monitoring are discussed as well as the influence of recruitment on other organs. Furthermore, we discuss whether recruitment maneuvers are useful if patients with acute lung injury or acute respiratory distress syndrome are ventilated with a lung-protective strategy.
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Diagnosis and therapy of hemodynamic instability are of the utmost importance in the treatment of critically ill patients during surgery and in intensive care. For both diagnosis and therapy, adequate and preferably continuous hemodynamic monitoring is essential. ⋯ The ongoing discussion on the risk-benefit ratio of such a pulmonary artery catheter has led to the introduction of several less invasive methods for determining cardiac output. The aim of this review is to provide background information on these alternative methods and to discuss the individual advantages and disadvantages of each method in the context of their clinical applicability.
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Clinical Trial
[Analgesia with remifentanil in spontaneously breathing patients undergoing brief but painful radiological procedures].
Percutaneous transhepatic biliary drainage (PTBD) and stenting are very painful procedures in interventional radiology and require potent analgesia; employing remifentanil in spontaneously breathing patients may be one possible strategy. ⋯ Employing a remifentanil infusion for brief interventional radiology procedures in palliative treatment of patients resulted in high patient and radiologist comfort.