Pneumologie
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In many ICU's in these days non-invasive mask ventilation is a technique in addition to the traditional invasive ventilation via endotracheal tube if the patient is able to cooperate. If contraindication (mucus retention, swallowing disorders, acute neurologic disorders, circulatory instability) and definition of interruption criteria are regarded, the method is safe. ⋯ According to pathophysiologic pathways the use of non-invasive techniques seems limited to not-so-advanced stages of the disease in these cases. Considering the growing importance of this technique for the weaning procedure after long-term mechanical ventilation should be established at every ICU.
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Intrapleural administration of fibrinolytic agents has been in use for fifty years; it has, however, been of clinical importance only for the last twenty years. Parallel to clinical reports procoagulant and fibrinolytic activities in pleural effusions are studied. Most types of pleural injury are characterised by fibrin deposition in the pleural space promoted by concurrent local abnormalities of pathways of fibrin formation and its clearance. ⋯ On the basis of the data of literature we recommend to use a single daily dose of 250,000 U streptokinase or 100,000 U urokinase in 50-100 ml normal saline instilled into a chest tube and to maintain dwell times of 2 to 4 hours. Therapy can be continued up to 2 weeks. The pleural space can be drained by large bore chest tubes or small drainage catheters, both radiologically guided, without preference for one method.