Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Oct 1989
Review[Personal experiences with extracorporeal CO2 elimination in patients with severe ARDS--a current review].
The method of extracorporeal CO2 elimination (ECCO2-R) as described by Luiciano Gattinoni and Theodor Kolobow is compared with earlier extra corporeal methods such as extracorporeal membrane oxygenation. The physiological fundamentals of the method, as well as indications and contraindications are explained. - The results of more than 100 patients treated worldwide are discussed together with the present problems of the method. In cases of severe ARDS stage IV, ECCO2-R definitely reduces mortality.
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Anasth Intensivther Notfallmed · Oct 1989
[Acute respiratory distress syndrome of the adult (ARDS) and artificial respiration--results in surgical intensive care patients].
A prospective clinical trial was performed in an operative intensive care unit to examine the incidence and outcome of patients with adult respiratory distress syndrome (ARDS) and the outcome of intensive care patients on mechanical ventilation and the incidence of barotrauma and pulmonary infection. 161 mechanically ventilated patients showed an overall mortality of 19.9%. The mortality rate in the ARDS patients was 11 of 26. Most of these patients with ARDS died from multiorgan failure. ⋯ We conclude from these data that --according to the literature the outcome of surgical ICU patients on mechanical ventilation with and without ARDS is more favourable than that of medical ICU patients; --the interpretation of therapeutic results and of epidemiological data in ARDS patients is possible only by providing exact and detailed criteria; these should include compliance data; --evaluation of present ARDS therapy by comparison to previous data, even when the same criteria are applied, e.g. ECMO-criteria, may fail as the outcome of conventional therapeutic measurements - mechanical ventilation - may have improved. A controlled randomised trial might be more suitable for evaluation of alternative therapy in ARDS.
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In recent years progress in anaesthesia and surgery has led to improvements in care for traumatized patients. This progress not only affects emergency treatment, but also critical care. Although today a failure of one organ system can be successfully treated in most cases, the problem of multiple organ failure is still unsolved. ⋯ Among the special problems are disturbances of the patients immune system, nosocomial infections with the development of sepsis and its impact on organ functions, hypermetabolism and metabolic failure. The improved insight into the cellular and humoral pathophysiology has led to changes in diagnostic and therapeutic procedures in these patients. Only an aggressive, combined effort of many medical specialties from the beginning and an early recognition and treatment of complications and organ dysfunctions can lead to optimal results.
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Anasth Intensivther Notfallmed · Jun 1989
Case Reports[Adult respiratory distress syndrome in legionella pneumonia--successful treatment with extracorporeal CO2 elimination procedures].
We report on successful treatment of an 46-year-old patient with ARDS (Adult Respiratory Distress Syndrome), caused by legionella-pneumophilia-pneumonia. The treatment with conventional artifical mechanical ventilation had failed. ⋯ Supported by antimicrobial therapy with Erythromycin and Rifampicin the lung function could be improved to "restitutio ad integrum". Changes in chest radiographs, clinical parameters of ventilation, gas exchange and haemodynamics as well as the results of sequential pulmonary studies are demonstrated and discussed.