Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · May 2019
Review["Terminal" dehydration : Differential diagnosis and body of evidence].
Dehydration in palliative care patients can be associated with increased morbidity and mortality and is nevertheless therapeutically controversial. This article provides an overview of possible causes of dehydration at the end of life and places special emphasis on "terminal" dehydration in the dying. Empirical attitudes of healthcare professionals and persons concerned (patients and relatives) as well as evidence-based findings on "terminal" dehydration are elucidated and the limitations are described. Finally, it is concluded that the appropriate detection of the mode of dehydration (including its underlying pathophysiology) as well as the clinical evaluation of the "reversibility" of the symptoms after fluid therapy, is of central importance in establishing the indications for clinically assisted hydration (CAH).
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Med Klin Intensivmed Notfmed · May 2019
Review[Airway management in intensive care and emergency medicine : What is new?]
In acute respiratory insufficiency, oxygenation and/or ventilation support by mechanical ventilation is an integral part of intensive care and emergency medicine. Effective airway management is essential to prevent hypoxic complications during the securing of the airway. This includes for example the recognition of difficult airways and adequate pre-oxygenation. ⋯ A tracheostomy is often performed for long-term ventilation. It is still unclear which patients benefit from an early tracheostomy. Usually the bed-side percutaneous dilatation tracheostomy technique is used, which is often performed under bronchoscopic guidance.
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Med Klin Intensivmed Notfmed · Apr 2019
Review[Nonbeneficial care-a burden for clinicians and relatives].
Ethically demanding decisions in intensive care as well as the perception of nonbeneficial care can be a burden for clinicians and patients' relatives. ⋯ The perception of nonbeneficial care is a subjective moral judgement. Almost every ICU clinician regularly perceives nonbeneficial care. There is clear evidence that perceived nonbeneficial care is associated with burnout of clinicians and intention to leave the job. For relatives being involved in end-of-life decisions is of particular burden. Clinicians often state that relatives' whishes are the reason for nonbeneficial life-sustaining treatment. A good ethical climate as well as good nurse-physician collaboration are associated with less perception of nonbeneficial care and shorter time to therapy limitations. Structured communication to plan therapy involving relatives might reduce nonbeneficial care and together with supporting interventions reduce staff burnout. Improving communication by consultants in charge has been shown to reduce the burden of relatives. In future, co-treating surgeons must be more strongly involved in interventions.
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Hypercapnic respiratory failure is a frequent problem in critical care and mainly affects patients with acute exacerbation of COPD (AECOPD) and acute respiratory distress syndrome (ARDS). In recent years, the usage of extracorporeal CO2 removal (ECCO2R) has been increasing. ⋯ Optimized use of NIV and lung-protective ventilation remains standard of care in the management of hypercapnic respiratory failure. Currently, ECCO2R has to be considered an experimental approach, which should only be provided by experienced centers or in the context of clinical trials.
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The number of organ donors in Germany has been falling since 2010. In 2017, it reached its lowest level in 20 years with 797 organ donors. With 9.7 organ donors per million inhabitants, Germany lags far behind other European countries. ⋯ This is considered the best way to meet the patient's desire regarding organ donation. With reference to the dramatic development, DSO calls for a broad social debate and a joint initiative involving medical associations, contractors, patient associations and policymakers. Getting organ donation back on track in Germany for the benefit of patients on the waiting lists can only be achieved by a joint effort.