196,388 research outputs found
Centro Servizi Quintel a Ferentino
No full textPresentazione del Centro ervizi Quintel e dell'Incubatore d'imprese del BIC lazio a Ferentin
Centro Servizi QUINTEL a Ferentino
No full textPresentazione del Centro Servizi QUINTEL (Qualità Informatica Telematica) a Ferentin
Percutaneous dilational tracheostomy. Indications-techniques-complications
No full textTracheostomy is a generally accepted procedure that assures free access to the airways in long-term lung ventilation. Apart from surgical tracheostomy, percutaneous dilational tracheostomy (PDT) has been increasingly employed in intensive care units. Presently, five dilatation methods are available, all equally allowing the performance of a secure and low-risk, bedside tracheostomy in the intensive care unit. Exact knowledge of the anatomy of the neck region and of the entire procedure are preconditions for a safe intervention. Percutaneous procedures offer advantages over surgical tracheostomy in terms of complications. To minimize the risks, expertise in airway management during PDT and knowledge of the particularities of cannula replacement in dilational tracheostoma, are compulsory. Encloscopic control assures that the tracheostoma can be placed correctly and that possible complications can be recognised early. The incidence of a serious tracheal stenosis after PDT is low
Organisationsformen der Notfallmedizin aus Sicht der DIVI
No full textModern processes in the organization in German hospitals are decisive to the development of emergency departments and as these represent the interface between outpatient and inpatient care, they have been identified as a strategic success factor. In larger hospitals emergency departments are generally run as independent units with their own management. The growing number of patients in emergency rooms each year demonstrates the future importance of these structures and successful hospital management has to face and handle this challenge. Clear job profiles for the leadership, staff members and structures of these units are needed. This article highlights the requirements for these structures from the perspective of the German Interdisciplinary Association of Critical Care Medicine (DIVI)
Protective and ultra-protective ventilation: using pumpless interventional lung assist (iLA)
No full textAcute lung failure is associated with high mortality and usually requires mechanical ventilation to ensure adequate gas exchange. However, mechanical ventilation itself can be associated with major complications and can aggravate pre-existing lung disease, thus contributing to morbidity and mortality. Extracorporeal gas exchange is increasingly used when conventional mechanical ventilation has failed. In contrast to veno-venous extracorporeal membrane oxygenation (ECMO), pumpless extracorporeal interventional lung assist (iLA) is applied via an arterio-venous bypass into which a gas exchange membrane is integrated. iLA allows for efficient carbon dioxide removal, which allows for a significant reduction in ventilator settings. iLA may be a useful tool in protective or even 'ultraprotective' ventilation, enabling the application of very low tidal volumes in patients with acute respiratory failure of different etiologies. This article reviews the current status and the potential role of interventional (pumpless) lung-assist iLA within the context of lung-protective ventilation strategies. (Minerva Anestesiol 2011;77:537-44
Timing of tracheostomy
No full textCurrently, tracheostomy represents an established procedure for airway management in critically ill patients who require long-term respiratory support, and it is one of the most frequently performed surgical procedures in critically ill patients. It offers a number of practical and theoretical advantages when compared to conventional translaryngeal oro- or nasotracheal intubation, but is also associated with a number of serious complications. In the last 20 years, several retrospective studies, randomized prospective trials, and meta-analyses have been published to determine the best timing for tracheostomy. However, these studies presented conflicting results. All studies performed so far in a prospective randomized fashion were relatively small and underpowered. Currently, several large controlled randomized studies are underway that will hopefully help physicians make better evidence-based decisions on the timing of tracheostomy. Based on our current knowledge, the following recommendations might be made on a low level of evidence: on day 2 or 3 after onset of mechanical ventilation (>48 h of mechanical ventilation or need for an artificial airway) tracheostomy should be seriously considered. Before decisions are made, several questions should be answered: Is the situation suitable for tracheostomy? Are there relevant contraindications for the performance of a tracheostomy? What is the most likely course of the underlying respiratory insufficiency? What is the likelihood the patient will stay in need of invasive mechanical ventilation for more than a week, either because of an ongoing impairment of oxygenation, weaning failure, upper airway obstruction, coma or a swallowing disorder? If no relevant contraindication is present and if the need for invasive mechanical ventilation can be expected to last for more than one week, tracheostomy should be planned and performed within the next 2 days
Protective and ultra-protective ventilation: using pumpless interventional lung assist (iLA)
No full textAcute lung failure is associated with high mortality and usually requires mechanical ventilation to ensure adequate gas exchange. However, mechanical ventilation itself can be associated with major complications and can aggravate pre-existing lung disease, thus contributing to morbidity and mortality. Extracorporeal gas exchange is increasingly used when conventional mechanical ventilation has failed. In contrast to veno-venous extracorporeal membrane oxygenation (ECMO), pumpless extracorporeal interventional lung assist (iLA) is applied via an arterio-venous bypass into which a gas exchange membrane is integrated. iLA allows for efficient carbon dioxide removal, which allows for a significant reduction in ventilator settings. iLA may be a useful tool in protective or even 'ultraprotective' ventilation, enabling the application of very low tidal volumes in patients with acute respiratory failure of different etiologies. This article reviews the current status and the potential role of interventional (pumpless) lung-assist iLA within the context of lung-protective ventilation strategies. (Minerva Anestesiol 2011;77:537-44
Sepsis in adult patients - definitions, epidemiology and economic aspects
No full textWorldwide, sepsis is one of the leading causes of morbidity and mortality. In Germany about 79,000 (116/100,000) suffer from sepsis, and the incidence of severe sepsis and septic shock is about 75,000 cases per year. Patients are at high risk for irreversible organ failure and a lethal course. About 60,000 die from sepsis annually, and survivors have a reduced quality of life. It is presumed that demographic changes will lead to an increased incidence and overall mortality in the future. Additionally sepsis imposes a considerable economic burden to the society. Early and comprehensive treatment significantly improves outcome. An increased knowledge and awareness about the epidemiology, definitions and therapy of sepsis might contribute to the improved outcome. This review aims to present information on current definitions, epidemiology and the economic burden of sepsis
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