Med Klin
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Noninvasive respiration modes have recently gained growing importance. Just with patients which are respiratory insufficient due to neuromuscular diseases or severe kyphoscoliosis, encouraging experiences have been made. ⋯ In a majority of cases postoperative nasal ventilation allows early extubation within 24 hours postoperatively. From 27 patients 23 could be extubated at the first day postoperatively, 3 more were extubated definitively until day 3.
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Mechanical ventilation via a tracheal tube is an invasive measure whose complications may prevent recovery from respiratory failure. Today, noninvasive positive pressure ventilation via mouthpiece or mask is an economically and medically successful alternative for the treatment of chronic respiratory failure and acute exacerbation of COPD, respectively. Within certain limits, noninvasive ventilation may take over inspiratory work of breathing as well as elevate mean airway pressure and inspiratory oxygen concentration. ⋯ Clinical applications of noninvasive ventilation within these limits are acute exacerbation of COPD, congestive heart failure with pulmonary edema or atelectasis. Respiratory muscle fatigue, cardiogenic and septic shock, severe pneumonia and ARDS are still absolute indications for invasive ventilation. Table 1 specifies 12 disadvantages and endpoints of noninvasive mechanical ventilation.
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Noninvasive positive pressure ventilation (NPPV) via face mask offers in comparison to endotracheal intubation in treating patients with acute respiratory failure (ARF) advantages like allowing swallowing and coughing. We report our experiences and try to verify the indications and the efficacy of NPPV. ⋯ Our data indicate that application of NPPV is an effective and safe alternative to endotracheal intubation in many patients with hypercapnic ventilatory failure. NPPV is also successful in patients with hypoxemic RF with a milder course.
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Inhibitors of factor VIII are a rare condition in non-hemophiliacs, but they are frequently responsible for life threatening hemorrhage. Acquired factor VIII:C inhibitors represent the spontaneous development of autoantibodies that partially or completely neutralize the plasma coagulant activity of the clotting factor. The autoantibodies can arise in diverse clinical settings, in older adults they are frequently associated with immunologic disorders or malignancies. ⋯ Six months after severe hemorrhaging the patient was clinically stable and PSA levels were normal. This case demonstrates the necessity of a precise diagnosis and therapy regimen of this coagulopathy based on clinical and laboratory data. In the absence of hemorrhage immuno-suppressive therapy with corticosteroids is indicated, in a patient with severe bleeding and high inhibitor titer (> or = 5 BU) porcine factor VIII should be administered.