Medizinische Klinik, Intensivmedizin und Notfallmedizin
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The primary aim of cardiopulmonary resuscitation after cardiac arrest is to achieve the return of spontaneous circulation (ROSC). However, following ROSC the clinical and neurologic outcome is mainly influenced by adequate treatment in the postresuscitation period. There are several novel recommendations in the current 2010 guidelines of the European Resuscitation Council (ERC) concerning advanced life support (ALS). ⋯ Major aspects concerning the therapy of the postcardiac arrest syndrome include temperature management with therapeutic hypothermia, mechanical ventilation and the extent of oxygenation and blood glucose control. Thus, the initial cardiopulmonary resuscitation and the following postresuscitation treatment have to be considered as merging therapy concepts. Only a standardized therapeutic approach in these different phases of treatment will result in successful resuscitation with high rates of survival and good neurologic outcome.
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Med Klin Intensivmed Notfmed · Feb 2015
Review[Sepsis - Knowledge of non-physician personnel in Africa. A cross-sectional study in Malawian district hospitals].
Malawi has one of the worst human resource situations in the world and each clinically working doctor has to serve around 50,000 patients. There are almost no Malawian specialists physicians so that in the district hospitals it is usually non-medical staff (e.g. anesthesia clinical officer) who have the responsibility for severely sick patients with sepsis. At the Queen Elizabeth Central Hospital we have organized different courses over the years to support these colleagues. ⋯ Healthcare workers in Malawi are not aware of key recommendations of the Surviving Sepsis Campaign. Guidelines have to be adapted to the specific healthcare structures in underdeveloped countries. We realized the wish and the desire of the participants for more training and more courses in Malawi. In order to be able to support these needs we would like to invite cooperation from interested institutions and colleagues for a special sepsis course on the occasion of the annual World Sepsis Days.
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Med Klin Intensivmed Notfmed · Nov 2014
Review[Neurological and psychological long-term effects of sepsis].
In addition to the limitations to the health-related quality of life that have been compiled with validated test instruments, a number of former sepsis patients suffer from functional impairments, which are categorized under the terms critical illness polyneuropathy (CIP) or critical illness myopathy (CIM), which have been in existence for over 20 years now. ⋯ The degree of functional deficits resulting from sepsis and the actual quality of life of those affected may, however, be influenced by taking appropriate rehabilitation measures. However, neither therapeutic rehabilitation standards nor any rehabilitation facilities tailored to the needs of these patients currently exist.
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The Surviving Sepsis Campaign strongly recommends that intravenous antibiotic therapy should be started as early as possible, ideally within the first hour of recognition of severe sepsis or septic shock. There is ample evidence that failure to initiate early antimicrobial treatment correlates with increased morbidity and mortality. ⋯ The administration of antibiotics based on the local epidemiology should be initiated quickly in critically ill patients with severe sepsis and septic shock. In patients who are not in septic shock, treatment can be withheld, while awaiting further studies or clinical assessment to confirm the suspicion of infection.
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The treatment of patients with severe sepsis and septic shock continues to evolve. Recent studies have enunciated the benefit of early goal-directed therapy (EGDT) during the first 6 h after recognition of the condition. With EGDT a reduction in mortality of over 16% was shown over standard care. Thereafter the components of the EGDT were consequently implemented in the international Surviving Sepsis Campaign as well as the German sepsis guidelines. Nevertheless the medical community's enthusiasm for EGDT has remained indecisive. There remains a profound skepticism about treatment targets such as central venous pressure or mean arterial pressure as well as central venous oxygen saturation. Moreover multiple barriers such as critical shortage of nursing staff, problems in obtaining central venous pressure monitoring or lack of agreement with the EGDT resuscitation protocol may lead to non-adherence to EGDT early in the course of sepsis. ⋯ The Severe Sepsis 3-Hour Resuscitation Bundle and the 6-Hour Septic Shock Bundle represent a distillation of the concepts and recommendations found in the practice guidelines published by the Surviving Sepsis Campaign. The bundles are designed to allow teams to follow the timing, sequence, and goals of the individual elements of care. Early recognition, early mobilization of resources, and multidisciplinary collaboration are imperative to enhance the prognosis of patients with sepsis.