Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Hyponatremia is the most common electrolyte disorder in the hospital setting and is defined as a serum sodium concentration less than 135 mmol/l. Most patients have mild hyponatremia (plasma sodium concentration 130-134 mmol/l) and few if any symptoms. Serum sodium concentrations between 120 and 129 mmol/l can be associated with lack of concentration, nausea, forgetfulness, apathy and loss of balance. ⋯ Recently a new class of pharmacological agents has become available, the vaptans, orally taken vasopressin antagonists. Clinical trials showed them to provide effective, specific and safe therapy of hyponatremia. In Europe tolvaptan, the only such agent on the market is now approved for the treatment of euvolemic hyponatremia.
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The review presents the concept of immunonutrition in enteral and parenteral nutrition of the critically ill. The present indications for supplementing immune enhancing and anti-inflammatory substances are summarized and discussed in accordance with the recent literature and guidelines.
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Med Klin Intensivmed Notfmed · Feb 2013
Review[Vertigo and dizziness. Diagnostic algorithm from the perspective of emergency medicine].
Vertigo and dizziness are common symptoms in the acute care setting and have a wide diagnostic range. The most deleterious diagnosis is vertebrobasilar disease with brain infarction in the posterior fossa. ⋯ The suspicion of a central cause of vertigo is ideally confirmed by a magnetic resonance imaging (MRI) scan. Most patients with a peripheral cause of vertigo can be discharged under symptomatic therapy with the advice to consult an ear nose and throat physician while patients with a central cause of vertigo are admitted for further neurological treatment.
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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.