Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Apr 2013
Randomized Controlled Trial Multicenter Study Comparative StudyEnteral nutrition is associated with improved outcome in patients with severe sepsis. A secondary analysis of the VISEP trial.
The optimal nutritional strategy remains controversial, particularly in severely septic patients. Our aim was to analyze the effect of three nutritional strategies--enteral (EN), parenteral (PN), and combined nutrition (EN+PN)--on the outcome of patients with severe sepsis or septic shock. ⋯ In patients with severe sepsis or septic shock and prolonged ICU stay, EN alone was associated with improved clinical outcome compared to EN+PN. This hypothesis-generating result has to be confirmed by a randomized-controlled trial in this specific patient population.
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Med Klin Intensivmed Notfmed · Apr 2013
Review[Anaphylaxis. Diagnostic and therapeutic management].
Anaphylaxis is a severe, potentially life-threatening, systemic allergic reaction, which generally happens unexpectedly in healthy individuals. Among children, the most common elicitors are food, insect stings, and drugs. Currently, the incidence of anaphylaxis is increasing. ⋯ If cutaneous, respiratory, gastrointestinal, cardiovascular and neurologic symptoms involving ≥2 organ systems occur, adrenaline/epinephrine, preferably intramuscularly, should be administered. Although allergen skin testing and serological estimation of specific IgE antibodies do not predict who will develop anaphylaxis, they help to identify sensitized individuals at risk. Patients with a history of anaphylaxis need training on how to use the emergency medication and how to recognize and prevent the anaphylactic symptoms.
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Med Klin Intensivmed Notfmed · Apr 2013
Review[Infections in hemato-oncology patients in intensive care. An interdisciplinary challenge].
Infections are among the most common complications in patients with hematologic neoplasms. Due to changes in demographics, the number of hematologic patients with severe infections who require intensive care is expected to increase. Treatment of these patients requires knowledge of multiple specialties. This review summarizes key aspects for the optimal management of infections in critical care patients with hematologic malignancies.
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Med Klin Intensivmed Notfmed · Apr 2013
Review[Cancer patients in the intensive care unit. Goals of therapy, ethics, and palliation].
Providing critical care to cancer patients requires a high degree of practical multidisciplinary teamwork between intensivists and cancer specialists. Intensivists should have a solid basic knowledge of malignant diseases as well as of the typical complications of the underlying illness and its therapies. ⋯ Both parties should have a realistic impression of the short-term intensive care and long-term oncologic options and perspectives of the respective patient. Good cooperation between intensivists and cancer specialists is the basis for meaningful decisions on admission, planning of individual therapeutic aims, successful patient management, and tailored therapy, with a smooth transition into a palliative care setting whenever appropriate.
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Med Klin Intensivmed Notfmed · Apr 2013
Review[Appropriate diagnostics in emergency admission. Echocardiography].
Echocardiography is the central imaging modality for the diagnosis of myocardial, valvular and structural heart disease. Coronary artery disease can be detected by impaired left ventricular function. The rapid bedside application in unstable patients requiring immediate diagnostics and treatment is a decisive advantage of echocardiography. ⋯ Echocardiography also has an important impact in the differential diagnosis of chest pain symptoms. The application of echocardiography in the emergency department may set the course for understanding of the underlying disease processes as well as the required treatment strategy. Due to the operator dependency of the technique, a meaningful application of echocardiography requires an experienced investigator even in the emergency department.