Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Guidelines for the treatment of fractures in children include social and therapeutic parameters, such as adequate hospitalization for children, a definitive therapy with a low degree of invasiveness, and a high degree of freedom of mobility. The selection of a method is linked to the patient's requests. ⋯ Therapeutic strategies should be compared not only with regard to results, but also with regard to effectivity and efficiency. There are no strict guidelines in therapeutic procedures whatsoever.
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In a cooperative effort involving each medical society the joint study group of the medical research societies in Germany (AWMF) has established guidelines for the diagnosis and treatment of various diseases. Special guidelines which pertain specifically to operative intensive care medicine do not exist. However, official recommendations have been made for intensive care management in general. ⋯ Also yet the value of those guidelines cannot be assessed. It is beyond doubt that besides being of benefit, they do present some dangers. One must point out that these guide lines are recommendations and not rules upon which medical liability may be based.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
Comparative Study[Effective costs of intensive care: TISS and TISS-28 for the evaluation of an intensive care unit].
In 1996, Miranda published the TISS-28, a simplified version of the well-known Therapeutic Intervention Scoring System (TISS) for the evaluation of intensive care. A prospective observational study in 939 patients compared both scores, and the TISS-28 was found to show less interobserver variation. A cost analysis based on 1995 data revealed a value of 68.70 DM per TISS-28 point, which can be used to calculate the average costs for groups of patients, e.g., 1410 DM for 1 day postoperative surveillance in the ICU.
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Ever-increasing knowledge of the pathomechanisms and the phasic pathogenesis of ARDS has increased the demand for adequate monitoring and has modified therapeutic strategies. The influence of monitoring by double indicator dilution technique (COLD system) with the close measurement of extravascular lung water on the diagnosis and therapy of ARDS is presented. Pressure-controlled ventilation (< 35 cm H2O) in combination with moderate PEEP, kinetic therapy (prone position) and elective CVVH already in the early stages of ARDS can be regarded as the standard therapy. The effectiveness of NO inhalation, prostaglandins and radical scavengers still has to be improved in controlled clinical trials.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Shock room management in severe craniocerebral trauma].
Early clinical management of severe head injury should take place in an emergency resuscitation room and be conducted according to the guidelines of the treatment of severely injured patients with attention given to time. The first phase (with a maximum duration of 30 min) comprises physical examination, stabilisation of vital functions and basic technical diagnostics. With pulmonary and circulatory functions stabilized, the second phase begins with a craniol computed tomography examination followed by adequate therapeutic measures, including, if necessary, the CT-controlled implantation of an intracranial pressure catheter.