Klinische Wochenschrift
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In pediatric intensive care, analgesia and sedation has become increasingly important for newborns as well as prematures in recent years. However, its importance is frequently not well recognized and sedation is confounded with analgesia. In our intensive-care unit (ICU), fentanyl and midazolam have proved to be useful. ⋯ During the concomitant administration of midazolam and fentanyl, significantly less midazolam was needed to achieve appropriate analog-sedation. Prior to the administration of analgesics and sedatives, care should be taken to ensure that circulatory conditions are stable and that there is no hypovolemia, and the drugs must be given slowly during several minutes. Especially in a pediatric ICU, light and noise should be diminished and contact between the parents and the child should be encouraged, even when the child is undergoing mechanical ventilation.
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Klinische Wochenschrift · Jan 1991
Review[Disorders of blood coagulation in the intensive care unit: what is important for diagnosis and therapy?].
In the haemostatic system there is normally a stable balance between its components (vessel wall, platelets, coagulation, fibrinolysis), which are in continuously close interaction. Disturbances of this balance may lead to bleeding, thrombosis, or thrombohaemorrhagic consumptive disorders. The task of haemostaseologic diagnostics is to discover eventual preexisting but as yet undiagnosed disturbances in any patient entering an intensive care unit and, in cases of acute bleeding, to provide useful information that facilitates therapeutic decisions. ⋯ Promising attempts to overcome DIC via substitution of antithrombin III and fresh frozen plasma are discussed. Optimal management of complications and monitoring of therapy requires the close teamwork of attending surgeons or physicians and haemostaseologists. The purpose of any therapy is to preserve or regain the balance of haemostasis.
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Klinische Wochenschrift · Jan 1991
Comparative Study[Supplemental infection therapy with i.v. immunoglobulins (polyvalent IgG and Pseudomonas IgG)--results of an observational case study with 163 patients].
The impact of i.v. immunoglobulin (IVIG) therapy on the survival of adult septic patients cannot yet be considered either proved or disproved. To define optimal criteria for a large multicenter placebo-controlled trial, a multicenter observational study was carried out in 163 medical and surgical patients exhibiting a total of 173 episodes of sepsis and septic shock [Elebute (El) sepsis score; 19 +/- 0.5). ⋯ This improvement, associated with an improved prognosis (mortality, 24% vs 55%), was found in all subgroups, most importantly, polyvalent IgG vs Pseudomonas IgG treatment; medical vs surgical patients; moderate vs severe MOF; and gram-positive vs gram-negative septicemia. Thus, all of these patients should be included in future placebo-controlled, randomized IVIG trials.(ABSTRACT TRUNCATED AT 250 WORDS)
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Clinical (artificial) nutrition in patients in a surgical intensive care unit (ICU) is a supportive, and not a therapeutic, measure. However, it is as necessary as medical or surgical treatment, because nutrition can prolong life, so that time is bought during which the clinician can start adequate treatment. Studies on the effectiveness of clinical nutrition are rare and difficult, but there is a huge amount of indirect evidence supporting the following basic concept. ⋯ This kind of clinical nutrition obviates the need for concern about the optimal substrate composition. Moreover, enteral nutrition appears to be much simpler and more logical than parenteral nutrition. There is evidence suggesting that there are even clinical advantages of enteral nutrition.
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Klinische Wochenschrift · Jan 1991
[The role of antibiotic therapy for postoperative infectious complications].
Prospective analysis of the postoperative course of 1461 patients following major visceral surgery showed that postoperative complications scurred in 17.3% (253) of cases; 81% of the complications were related to the surgical procedure (surgical complications), whereas in 18.2% (46) of the patients, they complications were not related to surgery (non-surgical complications). Among septic cases, the relationship between surgical vs non-surgical complications was 141 to 29 patients, or 5:1. Early surgical reintervention was performed in all 141 patients exhibiting abdominal sepsis. ⋯ Early surgical reintervention is always the treatment of choice for these complications. Antibiotics are regarded only as an adjuvant measure. For the rather rare septic complications that are not related to surgery, antibiotic therapy is used.