Pneumologie最新文献

{"title":"Grünes Krankenhaus: innovatives Konzept für eine klimaneutrale Zukunft des Gesundheitssystems.","authors":"","doi":"10.1055/a-2319-4418","DOIUrl":"https://doi.org/10.1055/a-2319-4418","url":null,"abstract":"","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Non-invasive Mechanical Ventilation in Acute Respiratory Failure. Clinical Practice Guidelines - on behalf of the German Society of Pneumology and Ventilatory Medicine].","authors":"Michael Westhoff, Peter Neumann, Jens Geiseler, Johannes Bickenbach, Michael Arzt, Martin Bachmann, Stephan Braune, Sandra Delis, Dominic Dellweg, Michael Dreher, Rolf Dubb, Hans Fuchs, Nina Hämäläinen, Hans Heppner, Stefan Kluge, Matthias Kochanek, Philipp M Lepper, F Joachim Meyer, Bernhard Neumann, Christian Putensen, Dorit Schimandl, Bernd Schönhofer, Dierk Schreiter, Stephan Walterspacher, Wolfram Windisch","doi":"10.1055/a-2148-3323","DOIUrl":"10.1055/a-2148-3323","url":null,"abstract":"<p><p>The guideline update outlines the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.Non-invasive ventilation (NIV) has a high value in therapy of hypercapnic acute respiratory failure, as it significantly reduces the length of ICU stay and hospitalization as well as mortality.Patients with cardiopulmonary edema and acute respiratory failure should be treated with continuous positive airway pressure (CPAP) and oxygen in addition to necessary cardiological interventions. This should be done already prehospital and in the emergency department.In case of other forms of acute hypoxaemic respiratory failure with only mild or moderately disturbed gas exchange (PaO₂/FiO₂ > 150 mmHg) there is no significant advantage or disadvantage compared to high flow nasal oxygen (HFNO). In severe forms of ARDS NIV is associated with high rates of treatment failure and mortality, especially in cases with NIV-failure and delayed intubation.NIV should be used for preoxygenation before intubation. In patients at risk, NIV is recommended to reduce extubation failure. In the weaning process from invasive ventilation NIV essentially reduces the risk of reintubation in hypercapnic patients. NIV is regarded useful within palliative care for reduction of dyspnea and improving quality of life, but here in concurrence to HFNO, which is regarded as more comfortable. Meanwhile NIV is also recommended in prehospital setting, especially in hypercapnic respiratory failure and pulmonary edema.With appropriate monitoring in an intensive care unit NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41209956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Prognostic factors in an individualised approach to non-pharmacological therapy of COVID-19: from oxygen and mechanical ventilation to extracorporeal membrane oxygenation].","authors":"Sandhya Matthes, Johannes Holl, Johannes Randerath, Marcel Treml, Georgios Sofianos, Michael Bockover, Ulrike Oesterlee, Simon Herkenrath, Johannes Knoch, Lars Hagmeyer, Winfried Randerath","doi":"10.1055/a-2235-6357","DOIUrl":"10.1055/a-2235-6357","url":null,"abstract":"<p><strong>Background: </strong>Our centre followed a stepwise approach in the nonpharmacological treatment of respiratory failure in COVID-19 in accordance with German national guidelines, escalating non-invasive measures before invasive mechanical ventilation (IMV) or extracorporeal membrane oxygenation (ECMO). The aim of this study was to analyse this individualized approach to non-pharmacologic therapy in terms of patient characteristics and clinical features that may help predict more severe disease, particularly the need for intensive care.</p><p><strong>Method: </strong>This retrospective single-centre study of COVID-19 inpatients between March 2020 and December 2021 analysed anthropometric data, non-pharmacological maximum therapy and survival status via a manual medical file review.</p><p><strong>Results: </strong>Of 1052 COVID-19-related admissions, 835 patients were included in the analysis cohort (54% male, median 58 years); 34% (n=284) received no therapy, 40% (n=337) conventional oxygen therapy (COT), 3% (n=22) high flow nasal cannula (NHFC), 9% (n=73) continuous positive airway pressure (CPAP), 7% (n=56) non-invasive ventilation (NIV), 4% (n=34) intermittent mandatory ventilation (IMV), and 3% (n=29) extracorporeal membrane oxygenation (ECMO). Of 551 patients treated with at least COT, 12.3% required intubation. A total of 183 patients required ICU treatment, and 106 (13%) died. 25 (74%) IMV patients and 23 (79%) ECMO patients died. Arterial hypertension, diabetes and dyslipidemia was more prevalent in non-survivors. Binary logistic analysis revealed the following risk factors for increased mortality: an oxygen supplementation of ≥2 L/min at baseline (OR 6.96 [4.01-12.08]), age (OR 1.09 [1.05-1.14]), and male sex (OR 2.23 [0.79-6.31]).</p><p><strong>Conclusion: </strong>The physician's immediate clinical decision to provide oxygen therapy, along with other recognized risk factors, plays an important role in predicting the severity of the disease course and thus aiding in the management of COVID-19.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Non-invasive Mechanical Ventilation in Acute Respiratory Failure. Clinical Practice Guidelines - on behalf of the German Society of Pneumology and Ventilatory Medicine].","authors":"Michael Westhoff, Peter Neumann, Jens Geiseler, Johannes Bickenbach, Michael Arzt, Martin Bachmann, Stephan Braune, Sandra Delis, Dominic Dellweg, Michael Dreher, Rolf Dubb, Hans Fuchs, Nina Hämäläinen, Hans Heppner, Stefan Kluge, Matthias Kochanek, Philipp M Lepper, F Joachim Meyer, Bernhard Neumann, Christian Putensen, Dorit Schimandl, Bernd Schönhofer, Dierk Schreiter, Stephan Walterspacher, Wolfram Windisch","doi":"10.1055/a-2196-9136","DOIUrl":"10.1055/a-2196-9136","url":null,"abstract":"","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71485103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hurdles on the way to the diagnosis of asthma and successful therapy.","authors":"Thomas Hausen","doi":"10.1055/a-2319-4464","DOIUrl":"https://doi.org/10.1055/a-2319-4464","url":null,"abstract":"<p><p>There are many potential hurdles, obviously at the forefront of patient care which may impede the correct and early diagnosis of asthma, as well as successful, appropriate treatment. Although the illness is often accompanied by many typical signs which may enable a rapid diagnosis, these are often overlooked or misinterpreted. Symptoms may not be recognised or confused with others, such as respiratory infections, and inappropriate diagnostic tests used. Inappropriate therapy (absent or insufficient dosage of a topical anti-inflammatory and/or exclusive usage of a short-acting beta-agonist) and failure to adapt therapy may further impede the patient's chance to live without symptoms.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[EBUS-guided cryobiopsy in the diagnosis of mediastinal lesions - step by step].","authors":"Erik Büscher, Ruediger Karpf-Wissel, Faustina Funke, Kaid Darwiche","doi":"10.1055/a-2295-5921","DOIUrl":"10.1055/a-2295-5921","url":null,"abstract":"<p><p>Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the gold standard in the diagnosis of mediastinal and hilar lesions. For certain purposes, such as the diagnosis and subtyping of lymphoproliferative disorders or molecular pathology, a larger amount of intact sample material is required. EBUS cryobiopsy is a new and efficient tool for this purpose. As it is a new approach, there is still no standardised workflow. In this review, we present the procedure step by step as it is performed at the Ruhrlandklinik in Essen.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sektion 8","authors":"","doi":"10.1055/a-2264-7728","DOIUrl":"https://doi.org/10.1055/a-2264-7728","url":null,"abstract":"","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141395936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sektion 9","authors":"","doi":"10.1055/a-2264-7743","DOIUrl":"https://doi.org/10.1055/a-2264-7743","url":null,"abstract":"","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141392503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Home mechancial ventilation: quality of life and the final stage of life].","authors":"Sarah Bettina Stanzel, Bernd Schönhofer","doi":"10.1055/a-2202-5558","DOIUrl":"10.1055/a-2202-5558","url":null,"abstract":"<p><p>The evaluation of health-related quality of life (HRQL) has gained importance in recent years. Disease-specific questionnaires are available for respiratory insufficiency, which enable the assessment of HRQL. The Severe Respiratory Insufficiency (SRI) questionnaire, which was specially developed for patients with respiratory insufficiency, is ideal for quantifying the quality of life in patients receiving home mechanical ventilation (HMV). Studies using the SRI questionnaire demonstrated that the physical functioning of patients with chronic lung diseases of various etiologies is significantly impaired, but frequently without significant impairment of psychological well-being. Therefore, severity of the disease and HRQL do not necessarily correlate with each other.Both invasive and non-invasive mechanical ventilation can improve quality of life. Co-morbidity, and above all advanced age, have the highest negative predictive value with regard to in-hospital mortality and weaning failure. The number of patients older than 80 years who remain dependent on invasive HMV after prolonged weaning in Germany is increasing significantly. High dependence on invasive HMV is often associated with a loss of quality of life and autonomy. Thus, ethical issues of the continued treatment of ventilated patients at the end of life are discussed increasingly.After weaning failure, the indication for invasive HMV should be critically examined and should focus on potentially severely reduced quality of life and poor prognosis, as well as the patient's wishes. If previously agreed treatment goals can no longer be achieved during the course of invasive HMV, changing the therapy goals should be discussed within the clinical team, with the patient, their relatives and, if necessary, with legal representatives.In order to avoid overtreatment and unnecessary patient suffering during invasive HMV, advanced care planning should be started as early as possible and if necessary accompanied by palliative medical measures.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139417874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[CF Lung Disease - a German S3 Guideline: Pseudomonas aeruginosa].","authors":"Carsten Schwarz, Jutta Bend, Helge Hebestreit, Michael Hogardt, Christian Hügel, Stephan Illing, Jochen G Mainz, Ernst Rietschel, Sebastian Schmidt, Bernhard Schulte-Hubbert, Helmut Sitter, Marc Oliver Wielpütz, Jutta Hammermann, Ingo Baumann, Frank Brunsmann, Doris Dieninghoff, Ernst Eber, Helmut Ellemunter, Patience Eschenhagen, Caroline Evers, Saskia Gruber, Assen Koitschev, Julia Ley-Zaporozhan, Uta Düesberg, Hans-Joachim Mentzel, Thomas Nüßlein, Felix C Ringshausen, Ludwig Sedlacek, Christina Smaczny, Olaf Sommerburg, Sivagurunathan Sutharsan, Ralf-Peter Vonberg, Ann-Katrin Weber, Jovita Zerlik","doi":"10.1055/a-2278-6685","DOIUrl":"10.1055/a-2278-6685","url":null,"abstract":"","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139997229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}