Der Anaesthesist
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Review
[Surviving Sepsis Campaign update 2018: the 1 h bundle : Background to the new recommendations].
A new update of the sepsis bundle was published by the Surviving Sepsis Campaign (SSC) in April 2018. The original 3 h and 6 h bundles have been restructured and combined into a 1‑h bundle. The recommendations comprehensively focus on diagnostic and therapeutic measures which should be carried out within 1 h after recognition of sepsis. This article presents the background and discusses criticisms of the new recommendations.
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Acute kidney injury (AKI) is a frequent complication in the perioperative period and is associated with a high morbidity and mortality. AKI is an independent risk factor for adverse outcome. The Kidney Disease: Improving Global Outcome (KDIGO) guidelines define AKI based on increases in serum creatinine and/or urinary output. Since there is no causal therapy available, early detection and timely implementation of preventive measures are of particular importance. ⋯ For timely diagnosis and prevention of AKI the recommendations for action of the KDIGO guidelines should be implemented. High-risk patients should be detected early in the perioperative period in order to be able to initiate preemptive strategies in a timely manner.
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Out of hospital cardiac arrest (OHCA) is encountered on a regular basis in prehospital care. Specific guidelines exist for cardiopulmonary resuscitation. Guidelines cover most related situations but cannot cover all of them. ⋯ The guidelines provided no answers to this specific situation. Wittingly, the emergency physician decided to abandon the standard approach. Based on this case, this article discusses the pathophysiological considerations and an approach deviating from the standard approach, which could have led to a positive patient outcome without casting doubt on the current resuscitation guidelines.
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Minimum volume thresholds for specific surgical procedures in German hospitals were established in 2004 but remain controversial. For the first time, this study investigated the relationship between hospital performance volume and surgical procedure duration in a multicenter approach. The question here was whether a concentration on frequently performed procedures leads to a reduction in surgical process times. ⋯ The case volume only appeared to have a direct but limited influence on incision to suture times in laparoscopic and arthroscopic procedures. Overall, the hospital performance volume appeared to be of subordinate importance in terms of OR-economics.
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Adults with congenital heart disease (CHD) represent an increasing proportion of patients undergoing non-cardiac surgery. ⋯ Decisive for the perioperative outcome of patients with CHD are the identification of high-risk patients, understanding of the individual situation with respect to the underlying pathophysiology and the intraoperative maintenance of cardiac output.