Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2010
[Management of sleep-related abnormal breathing by cardiologists and hospital departments of cardiology].
In the general population there is a high prevalence of sleep-related disorders of breathing (sleep apnea). In addition to being leading symptom of excessive day-time sleepiness they are also important predictors are cardiovascular disease such as arterial hypertension, heart failure, cardiac arrhythmias and stroke. Are the cardiologists the specialists who recognize such patients and refer them to diagnostic procedures and treatment? ⋯ Cardiologists in private practice and cardiologists in hospital departments know about sleep-related abnormal breathing. The use of portable sleep apnea monitors and of polysomnography in special as parts of sleep centers within cardiology departments should be improved.
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Dtsch. Med. Wochenschr. · Feb 2010
Review[Microbiological monitoring of ventilator-associated pneumonia in an intensive care unit].
Ventilator-associated pneumonia is the most frequent nosocomial infection in intensive care units (ICU) and causes high mortality. Approximately 50% of all antibiotics in ICUs are administered for the treatment of respiratory tract infections. Prompt and appropriate antibiotic treatment is paramount for a favourable clinical outcome as any delay in diagnosis and treatment will result in increased mortality. ⋯ The majority of published studies favour surveillance cultures, because these can often predict the pathogens responsible for pneumonia and lead to timely administration of adequate antimicrobial therapy. Although the rationale behind this approach appears evident, the impact of surveillance cultures on clinical outcome as well as their cost effectiveness remains to be determined. Therefore, at this point, national and international guidelines do not recommend the routine use of surveillance cultures in mechanically ventilated patients but stress the need for larger, well designed clinical studies.