Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Apr 2008
Multicenter Study[Weaning from mechanical ventilation. A survey of the situation in pneumologic respiratory facilities in Germany].
The prevalence of difficult or prolonged weaning from mechanical ventilation is increasing because of a growing number of elderly patients with multiple diseases and pulmonary problems requiring mechanical ventilation. Intensive care units (ICU) are inclined to refer to specialized unit those patients who are difficult to wean. A nationwide survey of German facilities was conducted and this article reports the current state of weaning centers staffed by chest physicians. ⋯ Weaning was successful in two thirds of patients who had been on prolonged mechanical ventilation and had then been transferred to weaning facilities staffed by chest physicians. These centres effectively improved the quality of care of patients on prolonged mechanical ventilation by avoiding long-term invasive ventilation and sparing cost-intensive ICU resources. The problems that still exist may be overcome by a network of weaning facilities.
-
Dtsch. Med. Wochenschr. · Apr 2008
Case Reports[Bilateral fractures of the humerus after hypoglycemic seizure].
An 87 year-old woman with insulin dependent diabetes was referred to our hospital because she had sustained a generalized tonic-clonic seizure. Initial blood sugar concentration before hospital admission was 1.1 mmol/l. ⋯ The presentation of simultaneous bilateral fractures of the humerus is a rare but severe and almost pathognomonic complications of generalized tonic-clonic seizures, for example in the context of marked hypoglycemia. Appropriate monitoring and treatment of blood sugar levels in diabetics must be emphasized.
-
Dtsch. Med. Wochenschr. · Apr 2008
Review[Complications after lung transplantation. Part 1: Intensive medical and pneumologic complications].
Primary graft dysfunction and/or phrenic nerve lesion are common complications in the early phase after lung transplantation. Respiratory insufficiency is the most common reason for admission to the intensive care unit for patients after lung transplantation. Pulmonary complications in the post transplant management are acute allograft rejection (50% in the first year), infections, endobronchial bleeding, necrosis and fibrinous bronchitis. Chronic graft dysfunction (bronchiolitis obliterans syndrome) and infections are major obstacles to long-term survival.
-
Central sleep apnea (CSA) is characterized by a lack of drive to inspire for at least 10 sec. In the CSA-syndrome accompanying arousals and desaturations of the arterial blood cause sleep disturbances and sympathetic nerve activations which lead to excessive daytime sleepiness and increase the risk for cardiovascular morbidity. There are six manifestations of CSA: a rare primary or idiopathic form, often in hypocapnic patients with an increased hypercapnic ventilatory drive; Cheyne-Stokes respiration, characterised by periodic CSA and a crescendo/decrescendo breathing pattern, often in patients with severe cardiac or neurological diseases; high altitude-induced periodic breathing (above 4000 m), CSA due to medical or neurological conditions; CSA due to drug or substance use; and primary sleep apnea of infancy. Besides the consequent treatment of the underlying medical conditions therapeutic options include the use of drugs, e. g. acetacolamide or oxygen, as well as non-invasive ventilation, e. g. continuous positive airway pressure (CPAP) or adaptive servo-ventilation.
-
Dtsch. Med. Wochenschr. · Apr 2008
Review[The effects of air pollution and climate change on pulmonary diseases].
From as early as 1930 there has been evidence for effects on health of air pollution. Ozone, particulates and nitrogen dioxide are the most important pollutants today. The acute increase in air pollution leads to a significant raise in morbidity and mortality. ⋯ Chronic exposure to pollution causes bronchitis, accelerated decline of lung function and impaired maturing of the lungs. Ozone and a residence in proximity to major roads seem to play a role in the development of asthma. A further important environmental factor is climate change, which has an impact on air pollution but also on distribution and quality of aero-allergens and the dissemination and transmission of respiratory pathogens.