Langenbecks Archiv für Chirurgie. Supplement II, Verhandlungen der Deutschen Gesellschaft für Chirurgie. Deutsche Gesellschaft für Chirurgie. Kongress
-
Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
[Extracorporeal membrane oxygenation and CO2 elimination].
The mortality in patients with ARDS stage IV is 90% according to the classification of Morel (1985) since all experiments as treatment with prostaglandine antagonists and application of antioxidants have to improve the outcome of such patients, we treated 87 patients, aged 5-51 years, between 1985-1990, with a veno-venous extra-corporeal bypass for CO2-elimination and with low frequency positive pressure ventilation according to the method of Kolobow et al. Forty-six of 87 patients survived, i.e. the mortality was reduced to 47%. This is striking evidence that this method is superior to other treatments of patients with ARDS.
-
Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
[Postoperative lung complications--introduction].
Intensive care patients suffer according to literature in 20-60% from pneumonia with a mortality up to 80%. The patient, operation and postoperative therapy influence its pathogenesis. ⋯ Specifity of clinical and plain X-ray diagnosis is only 30-50%. Selective gastrointestinal decontamination, exactly monitored fluid balance, and physio-, and paintherapy seem to be valuable preventive measures.
-
Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
Review[Diagnosis and monitoring of postoperative pulmonary complications].
There is no distinct difference between regular postoperative pulmonary changes and postoperative pulmonary complications (PPC). Beside the "classic" PPC, atelectases and bronchopneumonia, adult respiratory distress syndrome (ARDS) and barotraumas are becoming of increasing importance. ⋯ The varieties of germs found in bronchial secretions and lung parenchyma, however, are not considerably different. CAT scan seems to be the best diagnostic imaging tool for the follow-up of ARDS and barotrauma.
-
Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
[Effects of intuition on determining indications and intraoperative procedure].
Intuition is used in medical decision-making, especially in a decision for surgery and in selection of the surgical procedure. Intuitive decisions are made without reasoning. ⋯ Intuition is related to heuristic techniques and uses them (representativeness, availability, anchoring). Decisions made on the basis of intuition must be controlled by systematic and logical reasoning.
-
Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
[Effect and importance of experience in determining indications and surgical technique].
Medicine is an empirical science in which there are very heterogeneous view about the importance of experience. Numerical data attempt to quantify the required experience for student education and clinical practice. ⋯ Beyond all strategies of decision-making lies the accumulated individual experience of making the right decision at the right time. Experience is also at the bottom of the often cited intuition, clinical judgement and common sense.