Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Approximately 10% of patients with mechanical ventilation experience prolonged weaning and also have an increased morbidity and mortality. Once spontaneous breathing trials have failed the organ systems responsible should be identified. ⋯ Respiratory and cardiac limitations of weaning can be overcome by reducing the ventilatory load, training of the ventilatory muscles and reducing cardiac workload. A cooperative sedation strategy as well as an early start of weaning and rehabilitation can prevent prolonged weaning in critically ill patients.
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Med Klin Intensivmed Notfmed · Nov 2012
Review[Ventilation strategies for chronic obstructive pulmonary disease].
Chronic obstructive pulmonary disease (COPD) is considered to be one of the most frequent pulmonary diseases in industrialized countries. Non-invasive ventilation (NIV) is the first choice therapy in acute exacerbations of chronic hypercapnic respiratory failure (AE-COPD). Effective delivery of NIV requires a specialized interdisciplinary team with sufficient monitoring. ⋯ Assisted ventilation modes are preferred over controlled ventilation modes in intubated COPD patients. Settings of respirators have to be aimed at a reduction of intrinsic PEEP and dynamic hyperinflation. This includes sufficient external PEEP, long expiration times and low respiratory frequencies even allowing for permissive hypercapnia.
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Med Klin Intensivmed Notfmed · Nov 2012
Review Comparative Study[Positioning of patients with acute respiratory failure].
The collapse of lung tissue, edema and intrapulmonary shunt are the main symptoms in patients with acute respiratory insufficiency. The techniques of ventilation in a prone position and continuous lateral rotational therapy (CLRT) are based on these pathophysiological changes. Ventilation in a prone position was found to improve ventilation and perfusion relationships and reduction in the pleural pressure gradient. ⋯ In contrast CLRT is considered to be an early therapeutic or prophylactic measure aimed at prevention of ventilation-associated complications. In trauma patients these beneficial effects were demonstrated in several studies. Positioning therapy can be accompanied by potentially serious complications (e.g. face and skin ulceration, accidental loss of tubes and catheters and cardiac arrhythmias) and its use requires routine management and exact knowledge of indications and risks.
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Med Klin Intensivmed Notfmed · Nov 2012
Review[Ventilation in acute respiratory distress. Lung-protective strategies].
Ventilation of patients suffering from acute respiratory distress syndrome (ARDS) with protective ventilator settings is the standard in patient care. Besides the reduction of tidal volumes, the adjustment of a case-related positive end-expiratory pressure and preservation of spontaneous breathing activity at least 48 h after onset is part of this strategy. Bedside techniques have been developed to adapt ventilatory settings to the individual patient and the different stages of ARDS. This article reviews the pathophysiology of ARDS and ventilator-induced lung injury and presents current evidence-based strategies for ventilator settings in ARDS.
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Septic encephalopathy describes a diffuse cerebral dysfunction in association with sepsis. It is the most common cause of altered brain function in the intensive care unit setting but other causes have to be excluded. Alterations in the level of consciousness occur early and are common. ⋯ Diagnostic procedures should exclude frequent differential diagnoses, such as stroke, meningitis or encephalitis. Cerebral computed tomography (CT) is usually unremarkable but magnetic resonance imaging (MRI) may reveal vasogenic edema in terms of a posterior reversible encephalopathy syndrome. Septic encephalopathy requires an adequate therapy of the sepsis syndrome but a specific therapy is not yet available.