Articles: adult.
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Review
Veno-venous ECMO: a synopsis of nine key potential challenges, considerations, and controversies.
Following the 2009 H1N1 Influenza pandemic, extracorporeal membrane oxygenation (ECMO) emerged as a viable alternative in selected, severe cases of ARDS. Acute Respiratory Distress Syndrome (ARDS) is a major public health problem. Average medical costs for ARDS survivors on an annual basis are multiple times those dedicated to a healthy individual. Advances in medical and ventilatory management of severe lung injury and ARDS have improved outcomes in some patients, but these advances fail to consistently "rescue" a significant proportion of those affected. ⋯ Since the 2009 H1N1 pandemic ECMO has gained a wider acceptance. There are challenges that still must be overcome. Further investigations of the benefits and effects of ECMO need to be undertaken in order to facilitate the implementation of this technology on a larger scale.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2014
Review[Indications, risk factors, specialities and after-care of surgical treatment for cardiac and thoracic vascular diseases].
Despite a known high risk and complexity in the operative therapy of cardio-thoracic patients, cardiac surgery is medical routine activity today. The German Society of Cardiothoracic Surgery regularly analyses the more than 100.000 cases a year in Germany. Fixing procedural statics, it gives us the knowledge of individual risk factors and success rates for surgical therapy of our patients. Following we want to shortly summarize indications, risk factors, specialities and after-care of surgical treatment for cardiac and thoracic vascular diseases in adults.
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Int J Chron Obstruct Pulmon Dis · Jan 2014
ReviewDistinguishing adult-onset asthma from COPD: a review and a new approach.
Adult-onset asthma and chronic obstructive pulmonary disease (COPD) are major public health burdens. This review presents a comprehensive synopsis of their epidemiology, pathophysiology, and clinical presentations; describes how they can be distinguished; and considers both established and proposed new approaches to their management. Both adult-onset asthma and COPD are complex diseases arising from gene-environment interactions. ⋯ The current management of chronic asthma in adults is based on achieving and maintaining control through step-up and step-down approaches, but further trials of back-titration in COPD are required before a similar approach can be endorsed. Long-acting inhaled anticholinergic medications are particularly useful in COPD. Other distinctive features of management include pulmonary rehabilitation, home oxygen, and end of life care.
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Ont Health Technol Assess Ser · Jan 2014
ReviewTeam-Based Models for End-of-Life Care: An Evidence-Based Analysis.
End of life refers to the period when people are living with advanced illness that will not stabilize and from which they will not recover and will eventually die. It is not limited to the period immediately before death. Multiple services are required to support people and their families during this time period. The model of care used to deliver these services can affect the quality of the care they receive. ⋯ Moderate-quality evidence shows that a comprehensive, direct-contact, team-based model of care provides the following benefits for end-of-life patients with an estimated survival of up to 9 months: it improves caregiver satisfaction and increases the odds of dying at home while decreasing the odds of dying in a nursing home. Moderate-quality evidence also shows that improvement in patient quality of life, symptom management, and patient satisfaction occur when end-of-life care via this model is provided early (up to 24 months before death). However, using this model to deliver end-of-life care does not impact hospital admissions or hospital length of stay. Team membership includes at minimum a physician and nurse, with at least one having specialist training and/or experience in end-of-life care. Team services include symptom management, psychosocial care, development of patient care plans, end-of-life care planning, and coordination of care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2014
Review[Vascular cannulation and hemodynamic monitoring for cardiac and thoracic vascular surgery - a review].
Cardiac surgery requires cardiopulmonary bypass (CPB) with extracorporeal circulation (ECC) for intracardiac procedures. The surgical strategy determines access for monitoring and insertion sites with high-flow cannulas. ⋯ Therefore, the knowledge of the vascular anatomy is essential to provide professional care to patients undergoing ECC during thoracic vascular and cardiac surgery. This article is a review of hemodynamic monitoring and access for ECC in patients for adult cardiac surgery for anaesthesiologists and intensivists.