Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Jun 2015
Review[Respiratory emergencies and airway management in children].
Respiratory emergencies in children are frequent and are caused by the specific airway anatomy and the susceptibility for infections. This article reviews the specific approach to pediatric airway management. According to the ABC guidelines of the European Resuscitation Council, the described algorithm should help to identify, classify, and treat such emergencies, giving those with less pediatric experience a tool for the management of respiratory illness in children. Focus is on the emergency care of the most common diseases in this age group.
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The activation of multiple pro- and anti-inflammatory mediators is a key feature in the pathophysiology of sepsis. Many of these mediators may directly contribute to organ dysfunction and determine disease severity. So far our ability to modulate these upregulated mediator pathways is very limited. Therefore the adsorption of such mediators via an extracorporeal circuit may be a beneficial intervention during sepsis. ⋯ Whilst biochemical efficacy could be demonstrated by some of the systems, controlled and randomized studies demonstrating improved clinical endpoints are still lacking. Therefore the use of such therapies outside clinical studies cannot yet be recommended.
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Med Klin Intensivmed Notfmed · May 2015
Review Comparative Study[Acute kidney injury: choice of the initial modality for renal replacement therapy].
Continuous and intermittent renal replacement therapies are thought to be equally adequate approaches for the treatment of patients with acute kidney injury. Accordingly, current guidelines advocate the use of different modalities in a complementary fashion, i.e., to tailor therapy to the specific clinical situation. ⋯ Intermittent hemodialysis, on the other hand, remains the therapy of choice for the rapid correction of life-threatening electrolyte abnormalities or metabolic acidosis. During the further course of treatment, an individualized approach should be continued which may include a switch between modalities based on current therapeutic goals and potential risks for side effects of renal replacement therapy.
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Med Klin Intensivmed Notfmed · Apr 2015
Review[Noninvasive ventilation in patients with persistent hypercapnia].
Chronic respiratory failure is caused by insufficiency of the inspiratory muscles, i.e. mainly the diaphragm, which represents the so-called "respiratory pump". Insufficiency of the respiratory pump causes hypercapnia. ⋯ Strong evidence supports the use of domiciliary NIV already in mild degrees of chronic respiratory failure caused by neuromuscular diseases, thoracic restrictions and obesity hypoventilation. In these diseases long-term NIV improves both physiological parameters (such as blood gases) and clinical outcome, e.g. exercise capacity, right heart dysfunction, sleep quality, disease-specific aspects of health-related quality of life (HRQL) and survival rate. In contrast, its influence on long-term survival in chronic obstructive pulmonary disease (COPD) patients is not clearly proven. Prescription of home NIV in COPD should therefore be restricted to severe degrees of chronic respiratory failure. Finally, there is an indication for domiciliary NIV in patients after prolonged weaning from mechanical ventilation. This paper elaborates underlying pathophysiology, diseases and how NIV works in chronic hypercapnic respiratory failure.
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Med Klin Intensivmed Notfmed · Apr 2015
Review[Indication and control of volume therapy. First things first].
Fluid therapy is a core concept in the management of perioperative and critically ill patients for maintenance of intravascular volume and organ perfusion. The clinical determination of the intravascular volume can be extremely difficult. Indication and control for intravascular volume therapy are among the most difficult aspects of intensive care. ⋯ Case history, clinical examinations, bedside ultrasonography, and invasive hemodynamic monitoring complete the assessment and allow clinicians to assess volume responsiveness.