Medizinische Klinik, Intensivmedizin und Notfallmedizin
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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.
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Med Klin Intensivmed Notfmed · Feb 2019
Meta Analysis[Diaries for intensive care unit patients reduce the risk for psychological sequelae : Systematic literature review and meta-analysis].
Diaries are written for patients on intensive care units (ICU) by clinicians and relatives to reduce the risk of psychological complications such as posttraumatic stress disorder (PTSD), anxiety, and depression. The authors of a Cochrane Review on this topic published in 2015, included studies with PTSD diagnoses based on interviews carried out by qualified personnel, and concluded that there is inadequate evidence to support the thesis that ICU diaries reduce the risk of psychological complications. ⋯ ICU diaries may reduce the risk of psychological complications in patients and relatives after ICU stays.
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Med Klin Intensivmed Notfmed · Feb 2019
Review[Apnea test for assessment of brain death under extracorporeal life support].
The fourth edition of the German guideline for the assessment of brain death, published in 2015 by the German Medical Council (Bundesärztekammer), emphasizes the importance of an apnea test. It is also now required under all circumstances of extracorporeal life support. ⋯ The apnea test is an essential part of the bedside examination for the clinical diagnosis of brain death. It is required for all kinds of extracorporeal life support and can be easily performed without endangering the patient. More accurate recommendations for its performance should be considered for the next version of the German guideline for brain death assessment.
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Acute and emergency physicians need to make rapid and far-reaching decisions on the basis of little diagnostic information. In patients with symptoms suggestive of a cardiopulmonary diagnosis, point-of-care lung ultrasound (LUS) is becoming increasingly used. In patients with acute dyspnea, chest pain and shock, LUS increases the diagnostic reliability. ⋯ LUS is also used for treatment follow-up. It is clearly superior to other diagnostic measures (auscultation, chest X‑ray). With ever smaller "handheld" ultrasound devices, the use of ultrasound is also being increasingly used in preclinical situations.
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Diaphragm function is crucial for patient outcome in the ICU setting and during the treatment period. The occurrence of an insufficiency of the respiratory pump, which is predominantly formed by the diaphragm, may result in intubation after failure of noninvasive ventilation. Especially patients suffering from chronic obstructive pulmonary disease are in danger of hypercapnic respiratory failure. ⋯ After intubation and the following inactivity the diaphragm is subject to profound pathophysiologic changes resulting in atrophy and dysfunction. Besides this inactivity-triggered mechanism (termed as ventilator-induced diaphragmatic dysfunction) multiple factors, comorbidities, pharmaceutical agents and additional hits during the ICU treatment, especially the occurrence of sepsis, influence diaphragm homeostasis and can lead to weaning failure. During the weaning process monitoring of diaphragm function can be done with invasive methods - ultrasound is increasingly established to monitor diaphragm contraction, but further and better powered studies are in need to prove its value as a diagnostic tool.