Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2024
Review[Extracorporeal Support Strategies in Liver Failure - Focus on Albumin Dialysis and Therapeutic Plasma Exchange].
Combining albumin dialysis for the removal of hydrophobic substances with classical haemodialysis in the treatment of acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) has a strong theoretical rational and clinical data showed a positive effect on laboratory and partly clinical characteristics of ALF and ACLF. However, neither the MARS nor the Prometheus System has so far been able to demonstrate a mortality benefit in ALF or ACLF patients. To date, only the use of therapeutic plasma exchange (TPE) has demonstrated significant removal of pathogen-associated (PAMPs), damage-associated molecular patterns (DAMPs) and pro-inflammatory cytokines. ⋯ In ALF, both high-volume and standard-volume TPE showed a significant improvement in survival. The data on the use of TPE in ACLF is still sparse, with only two Chinese monocentric studies in patients with exclusively hepatitis B-associated ACLF suggesting potentially improved survival with TPE. The currently recruiting APACHE study will include patients with the modern EASL-CLIF definition of ACLF.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2024
[IT Failures in Hospitals - Structures and Processes in Hospitals for Coping Cyber Attacks].
Clinics are, by definition, part of a country's critical infrastructure. In recent years, hospitals have increasingly become the target of cyber attacks, resulting in disruptions to their functionality lasting weeks to even months. According to the "National Strategy for the Protection of Critical Infrastructures (CRITIS Strategy)", clinics are legally obligated to take preventive measures against such incidents. ⋯ Additionally, paper-based alternative solutions, such as request forms for diagnostic or consultation services, department-specific emergency documents, and patient documentation charts, should be kept in a readily accessible location known to staff in the respective areas. The complete restoration of a clinic's network after a cyber attack often requires extensive recovery of numerous IT systems, which may take weeks to months in some cases. If the hospital has robust plans for cyber emergency preparedness, including regular scans and real-time backups, stabilization and a quicker resumption of operations may be possible.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2024
[Giraffes and Zebras on the Runway: the AMREF Flying Doctors (AFD) of Africa].
In remote regions of Kenya, access to healthcare remains a persistent challenge, exacerbated by vast distances, rough terrain, and inadequate infrastructure. Amidst these obstacles, the AMREF Flying Doctors (AFD) based in Nairobi at Wilson Airport emerge embodying the spirit of medical outreach and innovation. Founded with the mission to provide timely medical assistance to underserved communities, this esteemed organization utilizes air transport to bridge the geographical barriers that often impede access to essential healthcare services. ⋯ Operating with precision and efficiency, their fleet of aircraft is able to respond to emergencies, delivering medical teams and supplies to remote areas with the necessary celerity and exactness. Providing timely medical assistance, emergency evacuations, and specialized care to areas inaccessible by conventional means the service operates through a network of dedicated medical professionals, aviation experts, and technological infrastructure, ensuring rapid response and efficient delivery of medical services. This article follows a volunteer doctor and the author on the exciting journey to the Flying Doctors of Africa, based at Wilson Airport/Nairobi who reach out to a patient in medical needs from a rural airstrip within the Maasai Mara on which wild animals roam to medical evacuations which can span the entire globe.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2024
Review[Practice Guidelines for Central Venous Access 2020 - Time for German Guidelines].
The American Society of Anesthesiologists released practice guidelines for central venous access in 2020, and the entire world literature was examined for evidence on how to perform the entire process with best practice and minimal risk and harm to the patient. These guidelines may serve as a gold standard for individual procedural steps, allowing practitioners and hospital departments to critically question the own standard and improve upon them. We interpreted the guidelines for individual procedural steps on how to improve success of catheterization, minimize risks or adverse effects, enhance the management of accidental arterial punctures, adhere to evidence-based practices, and generally reduce the trauma of puncturing. ⋯ In our view, it is time to implement a national guideline for central venous access using ultrasound in Germany. Doing so may improve success rates in the first attempt, reduce procedural time, decrease the number of needle insertions per patient, and lower the rate of arterial punctures. This approach represents best practice from ethical, insurance, civil rights, and patient security perspectives, and is supported by relevant societies.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2024
Review[Extracorporeal Cardiopulmonary Resuscitation(ECPR) - the Future?].
In recent years, invasive resuscitation methods utilizing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have gained significant attention. Despite advances in traditional resuscitation measures, out-of-hospital cardiac arrest (OHCA) mortality remains high. In the context of extracorporeal cardiopulmonary resuscitation (ECPR), VA-ECMO therapy offers a promising approach by providing circulatory support during cardiac arrest, allowing time for diagnostic evaluation and targeted therapy. ⋯ Early studies indicate promising outcomes with CARL therapy, emphasizing the importance of a well-coordinated and structured approach to ECPR implementation. In summary, ECPR shows promise in improving survival rates for OHCA patients within a well-organized healthcare system. However, further research is needed to refine patient selection criteria and optimize treatment protocols, ultimately enhancing patient outcomes in cardiac arrest scenarios.