188 research outputs found
Inflammatory mediators, infection, sepsis, and multiorgan failure after severe trauma
No full textThe relation of (multiple) organ failure (OF) to the release of inflammatory mediators and the incidence of infection and sepsis was studied prospectively in 100 patients with multiple trauma (injury severity score=37). Sixteen patients died of OF, 47 patients survived OF, and 37 patients had no OF. Fifteen (24%) of the patients with OF showed no signs of infection. In patients with early onset of OF (n=45), infection followed with a lag of 2 or more days. In 16 (44%) of these patients, infection led to a deterioration in organ function. With late onset of OF (n=18), infection preceded OF in nine patients. Polymorphonuclear leukocyte—elastase, neopterin, C-reactive protein, lactate, antithrombin III, and phospholipase A discriminated significantly among the three outcome groups. Of all factors, only polymorphonuclear leukocyte—elastase showed a difference between patients with and without infection or sepsis, respectively. These data indicate that infection might not play a crucial role in the pathogenesis of posttraumatic OF in a substantial portion of patients with trauma. Early OF, especially, seems to be mainly influenced by the direct sequelae of tissue damage and shock (eg, the release of inflammatory mediators). Since infection and sepsis did not lead to an augmented release of mediators in patients with trauma, the role of both entities remains unclear
Bedarf an psychologischer Versorgung auf deutschen Intensivstationen - Ergebnisse einer Befragung von Mitgliedern der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin
No full textPeer reviews in intensive care medicine: pragmatic approach to quality management
No full textCritical care medicine usually involves the implementation of measures resulting in significant consequences for the patient - including possible mistakes arising directly or indirectly from daily routine processes. In addition, an ever-widening range of pharmaceutical and technological options may also often have an impact. The increasing complexity of pharmaceuticals and technical aids must be monitored and taken into account. The need for 24-hour care requires the daily presence of a variety of IC specialists and the interchange of data. Immediate coordinated expert action is equally as important as professional competence in dealing with current limitations of medical science. Intensivists are increasingly being confronted with the demands of professional quality management requirements within the ICU. This aspect is highlighted by the Vienna declaration on ICU patient safety drawn up at the 2009 European Congress of the ESICM [1]. This includes a commitment to actively pursue quality management within the setting of intensive care medicine. The present article describes a practical and effective approach to this complex subject matter and the external evaluation of critical care by peer review, which has already been successfully implemented in Germany and is set to gain in significance
Peer reviews in intensive care medicine: pragmatic approach to quality management
No full textCritical care medicine usually involves the implementation of measures resulting in significant consequences for the patient - including possible mistakes arising directly or indirectly from daily routine processes. In addition, an ever-widening range of pharmaceutical and technological options may also often have an impact. The increasing complexity of pharmaceuticals and technical aids must be monitored and taken into account. The need for 24-hour care requires the daily presence of a variety of IC specialists and the interchange of data. Immediate coordinated expert action is equally as important as professional competence in dealing with current limitations of medical science. Intensivists are increasingly being confronted with the demands of professional quality management requirements within the ICU. This aspect is highlighted by the Vienna declaration on ICU patient safety drawn up at the 2009 European Congress of the ESICM [1]. This includes a commitment to actively pursue quality management within the setting of intensive care medicine. The present article describes a practical and effective approach to this complex subject matter and the external evaluation of critical care by peer review, which has already been successfully implemented in Germany and is set to gain in significance
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