Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2011
Review[Current approaches to the treatment of severe hypoxic respiratory insufficiency (acute lung injury; acute respiratory distress syndrome)].
Lung-protective ventilation with a low tidal volume, plateau pressure < 30 cm H(2)O. oxygen saturation > 90% and permissive hypercapnia results in reduction of the mortality rate in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The level of the positive end-expiratory pressure (PEEP) must be chosen in relation to oxygen requirement. High frequency oscillatory ventilation and neurally adjusted ventilatory assist are promising methods. ⋯ The sedation should be interrupted daily, with phases of awakenings and, if possible, spontaneous breathing. Methods of supportive treatment: Positional treatment (prone position) and inhalation of vasodilators can improve ventilation/perfusion mismatch and thus oxygenation. However, administration of surfactant is currently not advised in adult respiratory failure.
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Sudden loss of consciousness can be caused by syncope or epileptic seizure, which therefore requires a diagnostic work-up including cardiological and neurological examinations. Thus, in clinical practice cooperation of these two medical specialties is common and of high relevance. ⋯ Cardiac channelopathies such as long QT syndrome may be associated with seizures, suggesting a possible link between cardiac and cerebral channelopathy. We here review in detail cardiac effects due to epileptic seizures as well as possible pathogenetic correlations between cardiac and epileptic diseases.
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Dtsch. Med. Wochenschr. · Feb 2011
Review[Hemodynamic monitoring in the intensive care unit: pulmonary artery catheter versus PiCCO].
Hemodynamic monitoring is essential in the diagnosis and management of critically ill patients. Cardiac output represents a major monitoring parameter. ⋯ Thermodilution pulmonary artery catheter and pulse contour analysis by PiCCO are widely used techniques to measure cardiac output in intensive care unit. This review describes the basic principles, limitations and complications of both monitoring tools.
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New guidelines of the "Kidney Disease: Improving Global Outcome" (KDIGO) working group standardize the definition of acute kidney injury (AKI) and acute kidney disease (AKD) allowing the assessment of prognosis and efficacy of prophylactic and therapeutic measures in different patient cohorts. The degree of severity and the duration of acute kidney injury are critical factors for the development of chronic kidney disease and mortality. ⋯ Recently employed biomarkers are promising for the early detection and prognosis of AKI, but cannot yet be used as routine tests. Microscopic urinalysis, a very old and cost-effective diagnostic measure, provides valuable informations about the severity and the course of AKI.
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Dtsch. Med. Wochenschr. · Feb 2011
Case Reports[Dyspnea in a 45-year-old man with liver cirrhosis].
During evaluation for a liver transplantation in a 45-year-old man with alcoholic liver he complained of exertional dyspnea. He had grade 3 chronic obstructive pulmonary disease (COPD) after nicotine abuse of 50 pack-years. One and a half years earlier the patient had been treated for tuberculosis. ⋯ Treating patients with advanced liver cirrhosis and dyspnea a hepatopulmonary syndrome must be taken into consideration. Typically there will be found a right-left-shunt. In addition, coexistent comorbidities as a reason for dyspnea have to be excluded.