Minerva anestesiologica
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Minerva anestesiologica · Feb 2011
Multicenter StudyPrehospital emergency physicians' experiences with advance directives in Germany: a questionnaire-based multicenter study.
Palliative medical emergencies and end-of-life decisions resulting from the exacerbation of cancer account for approximately 3% of all out-of-hospital emergency applications in Germany. Therefore, prehospital emergency physicians (EP) may be confronted with advance directives and ethical and end-of-life decisions. The purpose of the study was to identify EPs' knowledge about ethical and end-of-life decisions and their legal education and experiences concerning advance directives. ⋯ The prehospital emergency treatment of palliative care patients can be particularly challenging for any EP. A high percentage of the EPs in our study felt insecure in dealing with advance directives and ethical and end-of-life decisions in palliative care patients. Our results suggest that EPs may need more information and education about palliative medical care, legal issues and ethical and end-of-life decisions to provide adequate patient-oriented palliative care in prehospital emergency situations.
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Minerva anestesiologica · Feb 2011
ReviewSelective decontamination of the digestive tract as infection prevention in the critically ill. A level 1 evidence-based strategy.
Selective decontamination of the digestive tract (SDD) evolved into evidence-based medicine as a tool to prevent infections in critically ill patients. It significantly reduces mortality, pneumonia, bloodstream infections and the onset of resistance if the full four-component regimen is used. The use of only oral decontamination may reduce the incidence of pneumonia, but it has no significant impact on mortality. Moreover, the full SDD protocol significantly reduces the fecal carriage of multiresistant aerobic Gram-negative bacteria, whereas oral decontamination only is associated with increased carriage of multiresistant aerobic Gram-negative bacilli.
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Minerva anestesiologica · Feb 2011
Case ReportsChest pain caused by tracheostomy tube malposition: the importance of choosing the right tube.
We describe a case of chest pain caused by tracheostomy tube malposition in a 65-year old woman with chronic respiratory failure due to chronic obstructive pulmonary disease. This report highlights the importance of the correct choice of tracheostomy tube devices for mechanically ventilated and/or spontaneously breathing patients.
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Minerva anestesiologica · Feb 2011
Fast-track surgery: it is time for the anesthesiologist to get involved!
Fast-track methodology has been developed with the aim of improving postoperative recovery and reducing perioperative morbidity and mortality. A multidisciplinary approach involving surgeons, anesthesiologists, nurses and physiotherapists is necessary. While the surgical community has revised many of the standard principles used in clinical practice, anesthesiologists still need to contribute more to further optimize and facilitate recovery after surgery.