Klinische Wochenschrift
-
Klinische Wochenschrift · Jan 1991
Review[Use of hypertonic saline solutions in intensive care and emergency medicine--developments and perspectives].
The primary factor rendering patients at risk of developing multiple system organ failure after shock and trauma is the persistence of impaired microcirculation along with its sequelae for cellular and organ function. Bolus infusion (2-5 min) of 4 ml/kg hypertonic/hyperoncotic saline solution through a peripheral vein is a new concept for primary resuscitation from severe hypovolemia associated with trauma and hemorrhage and is termed "small-volume resuscitation". The experimental data obtained by various research groups have demonstrated the efficacy of 7.2%-7.5% saline solution in restoring central hemodynamics and organ blood flow. ⋯ Of particular importance are the data obtained in experiments on traumatic-hemorrhagic hypovolemia in beagles, which proved that the infusion of 10% dextran 60 in 7.2% saline (hypertonic-hyperoncotic solution) restores nutritional blood flow within less than 5 min, thereby enhancing the circulatory effect of hypertonic saline alone. In the pre-clinical setting, small-volume resuscitation by means of hypertonic saline/dextran solution is aimed at the rapid normalization of the compromised microcirculation and, thus, at the prevention of late complications such as sepsis and multiple system organ failure. The novelty of hypertonic saline/dextran resuscitation lies in its operational mechanism at the microcirculatory level, which also renders this concept attractive for volume support in endotoxemia and septic shock.(ABSTRACT TRUNCATED AT 250 WORDS)
-
The surgeon uses the scalpel rather than the prescription pad, but this fact is deceptive. Analysis of the development of surgical history yields an impressive insight into the interaction between medication and operative treatment. ⋯ With regard to drugs, intensive care medicine confronts the surgeon with an inconceivable complex of interactions, side effects and dose adaptations. In addition, human suggestibility influences the outcome of operative interventions no less than medical drugs.
-
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.
-
The type of fluid that should be infused in the critically ill patient remains controversial. In the presence of normal lungs, maintenance of the colloid osmotic pressure (COP) can limit the development of pulmonary edema when the hydrostatic pressure is raised. ⋯ The larger increase obtained in extravascular fluids by the use of crystalloids could limit the availability of cellular oxygen. Nevertheless, differences in morbidity and mortality have not been related to the type of fluid infused, suggesting that the amount of fluid is a more important factor.
-
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.