Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2011
Review[Patient blood management (part 1) - patient-specific concept to reduce and avoid anemia, blood loss and transfusion].
Patient blood management (PBM) is a patient-specific multidisciplinary, multimodal, evidence-based concept to appropriately conserve and manage a patient's own blood as a vital resource. PBM is based on 3 pillars: the first is the optimization of the patient's endogenous red cell mass, the second is the minimization of bleeding and blood loss and the third involves harnessing and optimizing the patient-specific physiological tolerance of anemia, including adopting more restrictive transfusion thresholds. ⋯ PBM is applicable to surgical and medical patients. The application of PBM systematically reduces the impact of 3 major contributors to negative outcome: anemia, blood loss and transfusion.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2011
Review[Current success and risks of mechanichal circulatory support].
The growing number of patients suffering from severe congestive heart failure (HF) worldwide still means a challenge for the therapeutic options, mainly in the older population. According to the rapid development in the possibilities for mechanical circulatory support (MCS), the increasing use of left ventricular assist devices (LVADs) as bridge to transplantation (BTT) or destination therapy (DT) reflects a change in the up-to-date therapy of HF. This article gives a broad overview concerning indications, patient selection, choice of the device and mainly a study update. It is clearly shown, that VAD therapy has become an effective tool in the treatment of HF, and that the modern continuous flow pumps have replaced the older, bulky, pulsatile devices, especially in the LVAD sector.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2011
Review[Postoperative management of patients undergoing left ventricular assist device implantation].
Left ventricular assist devices (LVAD) have become an important option for the treatment of patients with advanced heart failure. Unfortunately, patients undergoing LVAD-implantation still experience considerable perioperative morbidity and mortality. Right ventricular failure, bleeding, infections and device-associated problems represent the major postoperative complications. The present overview summarizes current strategies for preoperative risk estimation and for the prevention and treatment of frequently occurring perioperative complications.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 2011
Review[Technical possibilities and limitations of mechanical circulatory support].
Ventricular assist devices (VAD) to support the left (LVAD), the right (RVAD) or both ventricles (BVAD) have emerged as one standard of care for advanced heart failure patients. Initially used to bridge patients to transplantation (BTT) they are now more frequently implanted as permanent support (destination therapy, DT). Bridge to recovery (BTR) is a valid option for only a small number of patients. Although there are different devices available, patient selection, preoperative and intraoperative management, and the timing of VAD implantation are the elements critical to successful circulatory support.