Langenbecks Archiv für Chirurgie. Supplement II, Verhandlungen der Deutschen Gesellschaft für Chirurgie. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
Review[Diagnosis and monitoring of postoperative pulmonary complications].
There is no distinct difference between regular postoperative pulmonary changes and postoperative pulmonary complications (PPC). Beside the "classic" PPC, atelectases and bronchopneumonia, adult respiratory distress syndrome (ARDS) and barotraumas are becoming of increasing importance. ⋯ The varieties of germs found in bronchial secretions and lung parenchyma, however, are not considerably different. CAT scan seems to be the best diagnostic imaging tool for the follow-up of ARDS and barotrauma.
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Organ injuries are a frequent occurrence: The Surgical Department of Wuerzburg University treated 270 patients between 1983 and 1987. More than one-fifth of these patients had undergone primary surgery at other hospitals and came to us for reoperation or intensive care. The successful treatment of such severe and often multiple, simultaneous injuries depends on well-trained surgeons whose undelayed consultation with specialists is not impeded by bureaucratic hospital organization.
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Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
[Extracorporeal membrane oxygenation and CO2 elimination].
The mortality in patients with ARDS stage IV is 90% according to the classification of Morel (1985) since all experiments as treatment with prostaglandine antagonists and application of antioxidants have to improve the outcome of such patients, we treated 87 patients, aged 5-51 years, between 1985-1990, with a veno-venous extra-corporeal bypass for CO2-elimination and with low frequency positive pressure ventilation according to the method of Kolobow et al. Forty-six of 87 patients survived, i.e. the mortality was reduced to 47%. This is striking evidence that this method is superior to other treatments of patients with ARDS.
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Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
[Simplified surgical procedure for closure of the ductus arteriosus in premature infants].
The necessity of closing a hemodynamically significant patent ductus arteriosus (PDA) in a premature neonate is unequivocal. Until 12/86 the PDA was disected and ligated and a chest tube was inserted (127 pts.) Since 1/87 45 pts. (weight less than 1500 g) underwent PDA-closure using a metal-clip and no chest tube. Simplified surgical technique in closure of PDA in the premature neonate has led to a marked reduction of operating time (mean from 36 to 18 min) and has decreased the incidence of perioperative complications.
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Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
Review[Perioperative respiratory therapy and postoperative pain therapy].
Especially patients with preexisting bronchopulmonary diseases or those undergoing operations in the upper abdomen or thoracotomies are susceptible to post-operative pulmonary complications. All patients at risk should learn the prophylactic respiratory maneuvers preoperatively. ⋯ If given in an equipotent dose, nearly every opioid provides sufficient postoperative analgesia. Wide interindividual variation in the needed dose requires that opioids be titrated intravenously.