Der Anaesthesist
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Case Reports
[Pyoderma gangrenosum following AICD implantation: differential diagnosis to necrotizing fasciitis].
Pyoderma gangrenosum is rarely seen in the surgical disciplines. In the described case the patient was initially diagnosed with necrotizing fasciitis and admitted to the intensive care unit suffering from septic shock. ⋯ Following weeks of broad spectrum antibiotics and wound debridement without clinical improvement the alternative diagnosis of pyoderma gangrenosum was reached. Consequently the patient was treated with immunosuppressive therapy and his condition improved rapidly such that he was ultimately discharged to rehabilitation.
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An increase in ethical conflicts is being observed in the modern intensive care setting, as more complex therapeutic strategies are available and the treatment of old and very old patients is integrated into the clinical routine due to changes in medical options and social epidemiology. Physicians, nurses and families need ethical support to come to a decision about medical treatment when value conflicts are involved. ⋯ The increase of the incidence of ethical conflicts in the intensive care setting may impact ethics consultations which help the integration of ethical principles into the clinical practice.
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A total of three intensive care units (ICU) at a German university hospital were involved in an outbreak of Burkholderia cepacia complex (Bcc). ⋯ The source of the outbreak was an intrinsically contaminated alcohol-free mouthwash. Detection of Bcc in specimens from ICU patients should lead to further investigations. Antiseptic oral care products are recommended for reducing the risk of VAP but they may be microbiologically contaminated and, in consequence, increase the risk. The safety of patient care products should be increased by stricter regulations.
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Review Guideline
[Nutrition and fluid management in palliative medicine: do food and drink keep body and soul together?].
Induction, implementation and continuation of an invasive nutrition or fluid administration in patients with advanced, life-limiting illnesses is an often controversial but also very emotionally discussed topic. This article summarizes the current state of knowledge based mainly on the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines and is intended as a simple guide for clinical practice. ⋯ Patients in the final stage of a disease rarely suffer from hunger or thirst. In this phase of the disease other things, such as monitoring of patients and relatives play a much more important role.
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Obstructive sleep apnea (OSA) can affect all ages from infants to adults. The clinical pathology is initially age-dependent and symptoms first become comparable to those in adults during adolescence. ⋯ Crucial for anesthesia is a presumptive diagnosis in order to consider OSA for the forthcoming strategy. Safety aspects in the treatment of OSA children are especially related to the perioperative securing of the airway and a sufficiently long monitoring of respiratory functions.