Anaesthesist最新文献

{"title":"[Targeted temperature management after cardiac arrest : What is new?]","authors":"Elena Kainz,&nbsp;Marlene Fischer","doi":"10.1007/s00101-022-01091-1","DOIUrl":"https://doi.org/10.1007/s00101-022-01091-1","url":null,"abstract":"<p><p>The current guidelines of the European Resuscitation Council recommend targeted temperature management to improve functional neurological outcome in comatose survivors after cardiac arrest. With the pathophysiological background of hypothermia-induced neuroprotection for prevention of hypoxic-ischemic encephalopathy, targeted temperature management is a key measure and represents a central aspect in postresuscitation care.In the 2021 guidelines the application of targeted temperature management in postresuscitation care has been recommended for all rhythms and irrespective of the location of cardiac arrest. Targeted temperature management is advocated for adult patients who remain unresponsive following return of spontaneous circulation (ROSC) after either out-of-hospital cardiac arrest or in-hospital cardiac arrest. The body temperature should be maintained at a constant value between 32 °C and 36 °C for at least 24 h. To avoid rebound hyperthermia, fever following targeted temperature management, defined as a temperature above 37.7 °C, should be prevented and treated for at least 72 h after ROSC in persistently comatose patients. The routine use of prehospital cooling by rapid infusion of large volumes of cold i.v. fluid immediately after ROSC is not recommended.Based on a systematic review of the current literature, this article summarizes the results of randomized trials and new findings on targeted temperature management in comatose adult patients after cardiac arrest. The review has a particular focus on the most recent evidence regarding the optimum range of target temperatures. Furthermore, recent data on preclinical management, different patient populations, the duration of targeted temperature management, cooling methods and rebound hyperthermia are discussed.The impact of targeted temperature management on neurological outcome after cardiac arrest has been a matter of controversy. Despite contradictory results and heterogeneity of study designs, the current evidence supports the relevance and the necessity of strict temperature control in postresuscitation care for neuroprotection and improvement in functional neurological outcomes.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"85-93"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39837750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Contra: liberalization of fluid fasting before elective surgery? : If nothing goes wrong is everything all right?]","authors":"Peter Kienbaum,&nbsp;Benedikt Pannen","doi":"10.1007/s00101-021-01059-7","DOIUrl":"https://doi.org/10.1007/s00101-021-01059-7","url":null,"abstract":"","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"54-55"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39558914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Biomarkers for diagnosis and treatment guidance of sepsis-Nothing more than a piece of a puzzle].","authors":"Thorsten Brenner,&nbsp;Thomas Schmoch","doi":"10.1007/s00101-021-01063-x","DOIUrl":"https://doi.org/10.1007/s00101-021-01063-x","url":null,"abstract":"","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39689089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Pro: liberalisation of fluid fasting before elective surgery? : Old habits die hard].","authors":"Sabine Friedrich,&nbsp;Patrick Meybohm,&nbsp;Peter Kranke","doi":"10.1007/s00101-021-01060-0","DOIUrl":"https://doi.org/10.1007/s00101-021-01060-0","url":null,"abstract":"","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"52-53"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39566834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Primum nihil nocere-all just a question of feeling?]","authors":"Peter Kienbaum,&nbsp;Benedikt Pannen","doi":"10.1007/s00101-021-01079-3","DOIUrl":"https://doi.org/10.1007/s00101-021-01079-3","url":null,"abstract":"","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"58"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39832847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Rare superinfection in a COVID-19 patient-A chronology].","authors":"E Gamon,&nbsp;D Tammena,&nbsp;M Wattenberg,&nbsp;T Augenstein","doi":"10.1007/s00101-021-01018-2","DOIUrl":"https://doi.org/10.1007/s00101-021-01018-2","url":null,"abstract":"<p><p>After a resuscitation situation a SARS-CoV‑2 sample from a 55-year-old man who had been in the hospital for elective ablation for atrial fibrillation was tested positive. The patient history revealed that there had been a previous confirmed contact with a COVID-19 positive patient. The patient developed the complete set of symptoms of COVID-19 pneumonia with extensive intensive care treatment. After about 2 weeks of treatment, weaning had to be stopped due to the deterioration of the severe septic condition of the patient and he showed microbiological evidence of a superinfection with Cryptococcus neoformans and later Leclercia adecarboxylata. The patient was treated successfully and survived the disease.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"38-49"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-021-01018-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39339106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Emergency service care of mountain bike elite races : Rescue concept and analysis of 5 years of world cup elite cross-country/downhill and marathon stage races].","authors":"S Cajani,&nbsp;H Fischer,&nbsp;U Pietsch","doi":"10.1007/s00101-021-00999-4","DOIUrl":"https://doi.org/10.1007/s00101-021-00999-4","url":null,"abstract":"<p><strong>Background: </strong>Despite the ever-gaining popularity of mountain bike sports, the number of studies in regards to injury patterns and organizational aspects of rescue services is rather sparse. To efficiently support mass events such as the Union Cycliste Internationale (UCI) World Cup and UCI Championship, the World Championships and Swiss Epic Marathon, efficient rescue concepts are crucial. Challenges include high risk of injury in disciplines such as Downhill as well as the need to cover events in remote and often rough terrain in the Swiss Alps during the Swiss Epic Marathon, providing medical services not only for participants but also for spectators. We analysed the number of injuries sustained by participants as well as the different challenges for rescue services at these events.</p><p><strong>Methods: </strong>Retrospective analysis of emergencies at the Swiss Epic from 2016-2020, the UCI World Cup Races from 2015-2017 and 2019, as well as the UCI Championship 2018. Summary of the organizational aspects of the attending rescue services and special requirements and track concepts used at the events analysed.</p><p><strong>Results: </strong>Significantly higher probability of injury in Downhill disciplines vs. Cross-Country. In particular traumatic brain injury and extremity fractures. More severe injuries (NACA III to IV) were more common in Downhill compared to other disciplines (p < 0,01).</p><p><strong>Conclusion: </strong>Mass events require rescue concepts tailored to the competition's sport as well as it's terrain. The number of injuries was low but their severity necessitates highly qualified personnel and efficient rescue logistics to be planned beforehand. GPS-tracking and central disposition of mobile rescue resources is essential for marathon races while track competitions benefit from a mix of stationary posts and mobile units.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"59-64"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-021-00999-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39098477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcome and characteristics of critical care for nontrauma patients in the emergency department.","authors":"Jessika Stefanie Kreß,&nbsp;Marc Rüppel,&nbsp;Hendrik Haake,&nbsp;Jürgen Vom Dahl,&nbsp;Sebastian Bergrath","doi":"10.1007/s00101-021-00953-4","DOIUrl":"https://doi.org/10.1007/s00101-021-00953-4","url":null,"abstract":"<p><strong>Background: </strong>Emergency medical care for critically ill nontrauma patients (CINT) varies between different emergency departments (ED) and healthcare systems, while resuscitation of trauma patients is always performed within the ED. In many ED CINT are treated and stabilized while in many German smaller hospitals CINT are transferred directly to the intensive care unit (ICU) without performing critical care measures in the ED. Little is known about the resuscitation room management of CINT regarding patient characteristics and outcome although bigger hospitals perform ED resuscitation of CINT in routine care. Against this background we conducted this retrospective analysis of CINT treated by an ED resuscitation room concept in a German 756 bed teaching hospital.</p><p><strong>Methods: </strong>The collective of CINT treated within the ED resuscitation room (1 October 2018 to 31 March 2019) was analyzed after ethical approval. After each resuscitation room operation, the team leader filled out a standardized paper-based questionnaire and qualified the patient as a resuscitation room patient this way. Only patients who underwent invasive procedures and were admitted to ICU or died in the ED were included. Patient characteristics, performed critical care measures, short-term outcomes and the comparison of admission characteristics between survivors and non-survivors were evaluated. Additionally, the accordance of ED admission diagnoses and discharge diagnoses were analyzed.</p><p><strong>Results: </strong>Overall, 243 of 19,854 ED patients (1.22%) were treated in the resuscitation room. After exclusion of trauma patients, 193 (0.97%) CINT were included. Overall mortality was 29% (n = 56), 24‑h mortality was 13% (n = 25). Patient characteristics (vital signs, blood gas analysis) differed significantly between survivors and nonsurvivors except for respiratory rate and pain scale. An excerpt of conducted resuscitation room measures was as follows: arterial line n = 78 (40%); noninvasive ventilation n = 60 (31%); endotracheal intubation n = 56 (29%); cardiopulmonary resuscitation n = 19 (10%), central venous line n = 8 (4%). The number of conducted measures differed between survivors and nonsurvivors (median and interquartile range, IQR): 4 (IQR 2) vs. 4 (IQR 3) p = 0.0453. The length of ED stay was 148.2 ± 202.7 min until the patient was admitted to an ICU or died within the ED. ED admission diagnoses matched with hospital discharge diagnoses in 78%.</p><p><strong>Conclusion: </strong>The observed mortality was high and was comparable to patient collectives with septic shock. Nonsurvivors showed significantly more impaired vital parameters and blood gas analysis parameters. Vital parameters together with blood gas analysis might enable ED risk stratification of CINT. Resuscitation room management enables immediate stabilization and diagnostic work-up of CINT even when no ICU bed is available. Furthermore, optimal allocation to speciali","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"30-37"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-021-00953-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25569913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Prophylactic administration of hypertonic saline in traumatic brain injury does not improve the 6-month outcome : COBI randomized clinical trial].","authors":"Ghaith Mohsen,&nbsp;Lars Eichhorn","doi":"10.1007/s00101-021-01017-3","DOIUrl":"https://doi.org/10.1007/s00101-021-01017-3","url":null,"abstract":"","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"50-51"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00101-021-01017-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39255117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Which biomarkers for diagnosis and guidance of anti-infection treatment in sepsis?]","authors":"Johannes Ehler, Christoph Busjahn, Tobias Schürholz","doi":"10.1007/s00101-021-01067-7","DOIUrl":"10.1007/s00101-021-01067-7","url":null,"abstract":"<p><p>To date no biomarker has been identified bringing together perfect sensitivity and specificity to discriminate between inflammation and infections. Since the 1930s new markers of tissue damage and endothelial damage have been identified but which are incapable of identifying infections in every clinical setting to enable initiation of early antibiotic treatment. In this review the most important classical biomarkers and upcoming new PCR-based approaches are addressed. These markers are highlighted with respect to special clinical settings and to control the success of antibiotic treatment. The issue of discrimination between inflammation and infection is not yet solved. Based on one single biomarker it is impossible to decide whether infection is the reason for the patient's worsening condition but the combination of biomarkers or the integration of new biomarkers may be a meaningful supplement. The measurement of different biomarkers of infection or inflammation is part of the routine in critical care and will be essential in the future.</p>","PeriodicalId":50796,"journal":{"name":"Anaesthesist","volume":" ","pages":"3-11"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8588778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39615245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}