Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Apr 2014
Review[Diagnostic markers and assessment of efficacy of antibacterial therapy].
In anti-infective therapy, there is a need for objective diagnostic markers to guide the appropriate selection and duration of antibacterial treatment. In the diagnosis and treatment of bacterial infections, three aspects must be considered: the appropriateness of antibacterial therapy, the initiation and evaluation of an effective initial therapy, and termination of the antimicrobial treatment. Repetitive monitoring of procalcitonin (PCT) has been proposed as such a marker in conjunction with the clinical presentation and microbiological sampling of blood, urine, and/or sputum. ⋯ Examples are calcitonin-producing tumors, medullary C-cell thyroid carcinoma, and acute respiratory distress syndrome (ARDS). PCT can also be elevated in fungal infections. On the other hand, localized and encapsulated infections (e.g., abscess, endocarditis and early stages of infections) can be associated with lowered PCT values.
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Med Klin Intensivmed Notfmed · Apr 2014
Review[Pharmacokinetic and pharmacodynamic aspects in antibiotic treatment].
Severe sepsis and septic shock have a high mortality and, therefore require fast and effective antibiotic treatment with low toxicity. Because of sepsis-induced pathophysiological changes, pharmacokinetics of antimicrobial agents can be altered. Particularly water-soluble drugs display an enhanced volume of distribution during early sepsis. ⋯ They can result in severe complications such as renal failure or ventricular arrhythmias. Conversely, enzyme induction may lead to subtherapeutic drug levels. When continuous renal replacement therapy is required, the dosage of antibiotics has to be adapted according to the results of respective pharmacokinetic studies.
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Med Klin Intensivmed Notfmed · Mar 2014
Review[The golden hour of sepsis: initial therapy should start in the prehospital setting].
Sepsis is a common, time-urgent emergency that is still associated with a high mortality and morbidity rate. A strong correlation between the onset of therapy and survival has been shown. With every hour of delay, survival decreases by 7.6 %. In 2001, four treatment goals that should be performed in the first 6 h of treatment were developed. These form the basis of early goal-directed therapy (EDGT) which is accepted as the standard of treatment for sepsis in the emergency department. ⋯ Body temperature should always be assessed by paramedics. In addition, sepsis must always be considered as part of the differential diagnosis. If the suspicion cannot be ruled out, immediate therapy has to be initiated. Concerning the prehospital use of antibiotics, preliminary results of a study from the center of sepsis control and care in Jena, Germany, showed that this therapy form seems to be safe and effective, but further evaluation is necessary.
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Med Klin Intensivmed Notfmed · Mar 2014
Review[Delirium on the ICU: clinical impact, diagnostic workup, and therapy].
Delirium is an acute, potentially life-threatening organ dysfunction with an incidence reported to range between 10 and 92 %. Delirium is potentially preventable and has a great impact on patients' outcomes, even beyond their stay in the hospital. It was found to be associated with persisting cognitive deficits, increased physical dependence, institutionalization, and increased mortality. ⋯ Prevention and treatment options include behavioral, cognitive training programs and possibly anti-inflammatory and antipsychotic drugs. Delirium requires search for underlying illness, intoxication or drug side effects. This review summarizes recent work from the last two years, giving a brief overview and background information with regard to risk factors, impact on outcome parameters, mechanisms of pathophysiology, non-pharmacological and pharmacological prevention and treatment strategies of delirium in critically ill patients.
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Med Klin Intensivmed Notfmed · Mar 2014
Review[Noninvasive ventilation in out-of-hospital emergency medicine].
Noninvasive ventilation is mechanical respiratory support without the use of an artificial airway. There is no need for a tube or analgosedation. There are some advantages in comparison to invasive forms of ventilation. ⋯ In order to offer noninvasive ventilation to all patients, it also has to be available in the prehospital setting. Modern mechanical ventilators, which are used in emergency medical service, are eligible to provide noninvasive ventilation.