Med Klin
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To determine the short-term hemodynamic and clinical effects of levosimendan, a calcium-sensitizing agent, in patients with decompensated heart failure. ⋯ Levosimendan causes rapid improvement in hemodynamic function in patients with cardiogenic shock. These hemodynamic effects are not associated with relevant adverse events. Levosimendan may be of value in the short-term management of patients with cardiogenic shock.
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Although validated instruments are readily available for structured outcome assessment, this has been rarely employed in German intensive care units yet. Analysis of the effectiveness or efficiency of intensive care medicine without systematic assessment of outcomes and underlying structures and processes is impossible. Detailed knowledge of outcomes is mandatory, when continuous quality improvement is warranted. ⋯ Owing to the advancement of medicine regular updates of guidelines are mandatory. Moreover, targets for the quality assessment need to be adjusted accordingly. This finally leads toward a continuous quality improvement process.
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Crucial for the management of acute renal failure is the differentiation in a prerenal, renal and postrenal form. Prerenal acute renal failure, i.e., hypovolemia, and postrenal acute renal failure, i.e., urinary obstruction, can be treated specifically, and generally, these forms of acute renal failure resolve quickly. By contrast, for intrinsic acute renal failure with acute tubular necrosis, there is no specific therapy and supportive care is necessary until renal function resumes. ⋯ With the incidence of acute renal failure, the prognosis of intensive care patients deteriorates significantly. Temporary extracorporeal detoxification is often necessary, until eventually, there is a restitution of renal function. The prognosis of acute renal failure in intensive care patients is poor, if there is preexisting renal disease or the cause of the acute renal failure cannot be eliminated.
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Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the two most serious metabolic complications of diabetes mellitus (DM). These disorders can occur in both type 1 and type 2 DM. DKA is characterized by hyperglycemia, ketone body formation and metabolic acidosis. ⋯ The prognosis of both conditions is substantially worsened in patients > 65 years of age and in the presence of coma and hypotension. Mainstays of therapy are intravenous insulin and fluid replacement as well as the concomitant treatment of the precipitating factors. Improved patient education and implementation of measures such as home glucose and ketone monitoring might decrease the number of hospital admissions due to DKA and HHS, which are, in their majority, preventable).
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The progression of chronic kidney disease (CKD) is more than just a simple, creeping loss of kidney function finally resulting in end-stage renal disease (ESRD). First, the growing incidence of CKD implies an exploding socioeconomic burden. Second, clear evidence indicates that CKD is associated with an independent massive increase in the patient's cardiovascular risk. ⋯ Our current understanding of optimized antihypertensive and antiproteinuric therapy favors a multimodal treatment regimen. Reduction of proteinuria toward levels < 0.5 g per day would be ideal. By this intervention the risk for both ongoing renal function loss as well as the risk of cardiovascular disease can be markedly reduced.