Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Aug 2020
[Current ethical challenges in intensive care in the face of the corona pandemic].
In view of dramatically increasing patient numbers worldwide in the face of the corona pandemic and scarce resources in intensive care medicine in many countries, some of which are dramatically undersupplied, concerns and fears have spread among the population in Germany. Healthcare workers didn't know how to deal with an overload of the healthcare system. Numerous inquiries from concerned physicians as well as ethics committees prompted the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) together with seven other medical associations to work out a clinical-ethical recommendation on "Decisions on resource allocation in emergency and intensive care in the context of the COVID-19 pandemic".
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Dtsch. Med. Wochenschr. · Aug 2020
Guideline[Nontuberculous mycobacterial pulmonary disease - The new ATS/ERS/ESCMID/IDSA Guideline].
The new ATS/ERS/ESCMID/IDSA guideline answers 22 PICO questions on the treatment of lung diseases caused by Mycobacterium avium complex (MAC), M. kansasii, M. xenopi and M. abscessus.
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Since its outbreak, coronavirus disease 2019 (COVID-19) has rapidly resulted in a global pandemic. Underlying cardiovascular disease (CVD) is associated with severe COVID-19 infection and adverse clinical outcomes. While COVID-19 predominantly causes respiratory symptoms, a substantial number of patients eventually develop an acute cardiovascular syndrome associated with an excessive risk of mortality. ⋯ In times of rigorous public health measures such as social distancing, efforts should be undertaken to ensure timely treatment of acute CVD and continuation of guideline-directed treatment in order to avoid an increase in morbidity and mortality. In addition to its acute complications, COVID-19 is likely to be associated with long-term cardiovascular damage. Consequently, for a subgroup of patients a long-term management strategy is needed.
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Dtsch. Med. Wochenschr. · Aug 2020
[Dilemma situation: Oral anticoagulation in dialysis patients with non-valvular atrial fibrillation].
In patients with intact kidney function and in patients with mild to moderate chronic kidney disease (CKD), strong evidence suggests the use of non-vitamin K dependent oral anticoagulants (NOAC) for preventing ischemic strokes and systemic thromboembolic events in patients with non-valvular atrial fibrillation (nvAF) and elevated thromboembolic risk. In contrast, less evidence is available on the risk-benefit ratio of oral anticoagulation (OAC) in patients with nvAF and severe CKD, particularly in dialysis patients. ⋯ Considering absence of strong evidence, the authors suggest that in dialysis patients with nvAF, in whom the treatment team sees the clear need to prevent thromboembolic events, the use of NOACs or left atrial appendage occlusion should be preferred over treatment with vitamin K antagonists. Any OAC treatment for dialysis patients with nvAF is not in-label in most European countries.
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Dtsch. Med. Wochenschr. · Aug 2020
[Unexpected increase in extravascular lung water after acute lung injury].
We report on a 27-year-old female patient presenting with pneumonia and developing acute respiratory distress syndrome. Using transpulmonary thermodilution, an elevated extravascular lung water was detected (17 ml/kg). Patient required lung-protective mechanical ventilation and received antibiotic therapy. Negative fluid balance was targeted. Under this treatment, respiratory function improved, inflammation parameters declined, and extravascular lung water was recurrent (10 ml/kg). Subsequently, extravascular lung water increased to 29 ml/kg. ⋯ As mechanism for this catheter dislocation, we propose a Valsalva maneuver or spontaneous movements of the upper body of the patient. Sudden increase in extravascular lung water may reflect central venous catheter tip dislocation and chest x-ray should be considered to verify catheter tip position.