Klinische Wochenschrift
-
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.
-
Klinische Wochenschrift · Jan 1991
Review[How painful is long-term ventilation? Considerations on the importance of analgesia within the scope of analgosedation].
The goal of analgesia and sedation in intensive care units is most often achieved using numerous drug combinations, mostly justified by physicians' and nurses' habits instead of rational pharmacological criteria for the choice of drugs and dosages. The present paper aims at defining the analgesic situation of ventilated intensive care patients and concludes from analogy with other, better understood states of pain that the importance of analgesic drugs is frequently overrated. To achieve effective analgesia and sedation in individual patients, the dosage must be titrated to individual needs. The author suggests that standardized baseline analgesia should be used, which enables sedation to be titrated, whereas the opposite is not practicable in clinical routine.
-
The patterns of recovery of patients who received seven different analgesic and sedative treatments were investigated with regard to the time at which the subjects awoke. For observations of the neurologic status, we developed a special score. ⋯ Piritramid/promethazine, pethidine/flunitrazepam, pethidine/promethazine and tramadol/methohexital required more time for awakening. On the basis of these results, we prefer to use the combination of fentanyl/midazolam, alfentanil/midazolam and ketamine/flunitrazepam to judge all patients' neurologic scores.
-
Klinische Wochenschrift · Jan 1991
Case Reports[Thiamine deficiency as a cause of life threatening lactic acidosis in total parenteral nutrition].
Two patients aged 37 and 44 years developed life-threatening lactic acidosis following abdominal surgery and a period of about 3 weeks of total parenteral nutrition. Septicaemia and hypoxia were excluded as possible causes. Conventional treatment including high doses of buffer agents was unsuccessful. ⋯ In both patients, the lactic acidosis improved immediately, and it disappeared following the second dose of thiamine. Both patients were subsequently discharged as symptom-free. As part of the pyruvate-dehydrogenase (PDH) complex, thiamine was capable of improving the life-threatening situation.
-
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.