Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie最新文献

Patients undergoing challenging medical procedures often suffer from high levels of anxiety and stress. Their most important need is a feeling of control and safety. Hypnotic communication provides a means of addressing these feelings without medication. The core technique is to use the perceived stimuli, like beeping sounds or the pressure of the ventilation mask and re-evaluate them as helpful signs. For example, the beeping sounds can be an indicator of the optimal treatment with the highest level of medical equipment in the intensive care unit and the pressure of the ventilation mask might feel like a tight hug of a friend that wants to help. Positive suggestions work even better when patients are in a trance state. In the intensive care unit, you can use the natural trance state instead of inducing a formal hypnotic trance. Positive suggestions can even help to prevent negative emotions before the challenging medical procedure starts. It greatly improves patients' well-being to replace common phrases in the everyday medical practice. This article gives examples of better phrasings and elaborates the scientific evidence of positive suggestions that can even stop bleeding. The goal is to show simple ways to improve communication with patients and induce feelings of control and safety.

Acute respiratory distress syndrome (ARDS) is a common condition in intensive care medicine. Various intra- and extrapulmonal causes may trigger an epithelial and endothelial permeability increase, which leads to impaired gas exchange due to fluid overload of the alveoli and transmigration of leukocytes. This results in hypoxemia and hypercapnia, as well as deleterious consequences for the macro- and microcirculation with the risk of multi-organ failure and high mortality. This review summarizes ARDS pathophysiology and clinical consequences.

Acute respiratory distress syndrome (ARDS) is still associated with high mortality rates and poses a significant, vital threat to ICU patients because this syndrome is often detected too late (or not at all), and timely therapy and the fastest possible elimination of the underlying causes thus fail to materialize. Artificial Intelligence (AI) solutions can enable clinicians to make every minute in the ICU work for the patient by processing and analyzing all relevant data, thus supporting early diagnosis, adhering to clinical guidelines, and even providing a prognosis for the course of the ICU. This article shows what is already possible and where further challenges lie in this field of digital medicine.

ARDS is a syndrome that can develop as a result of various underlying diseases. For a long time, the prevailing belief was that the course of the disease was comparable regardless of the underlying disease. However, even before the COVID-19 pandemic, it was suspected that there were different manifestations that could be treated more individually and thus reduce the high mortality rate of ARDS, which has remained unchanged for years. The various findings on the heterogeneity of the course of the disease in COVID-related ARDS appear to confirm these assumptions. It is therefore to be expected that the diagnosis and treatment of non-COVID-related ARDS will also have to be individualised according to such phenotypes in the future. However, as long as the effectiveness of such strategies has not been proven in clinical trials, the current recommendations for ARDS therapy will remain valid for the time being. However, the adjustments already formulated in this context to individual pathophysiological conditions with regard to respiratory mechanics, ventilation-perfusion distribution and possible cardiac dysfunction should be made more meticulously than has usually been the case to date.

We report the perioperative course of a 47-year-old patient who underwent a two-stage liver resection for bilobar metastatic colorectal carcinoma. The respiratory asymptomatic patient was tested positive for SARS-CoV-2 by PCR detection one day before the second surgical procedure. Postoperatively, the patient suffered cardiovascular arrest on postoperative day 8 and died despite immediately initiated resuscitative measures. With an initial clinical suspicion of vascular liver failure, postmortem pathologic examination revealed the underlying cause of death to be COVID-19-related myocarditis with acute right heart failure. Individual multidisciplinary risk assessment should be considered very critically when deviating from the "7-week rule" because the benefit is difficult to objectify, even in oncologic patients.

Based on the existing literature, the application of designated, processed EEG-monitors to measure anesthetic depth and the associated clinical implications are explained. EEG-monitors quantify the hypnotic portion of anesthesia, but not the nociceptive properties of anesthetics. Depth of anesthesia monitoring is common practice in many German hospitals and helps to visualize the interindividual variability of anesthetics, especially of propofol. Although deep anesthesia is associated with increased long-term mortality, this relation seems not to be causally related. Nevertheless, depth of anesthesia monitors help to identify patients being especially susceptible to anesthetics. Moreover, they have shown to reduce the incidence of intraoperative awareness and postoperative delirium. The application of processed EEG-monitors to reduce the incidence of postoperative delirium is currently recommended by the European Society of Anaesthesiology and Intensive Care.

Drug-induced methemoglobinemia is a well-known phenomenon as well as induction by poppers (alcylnitrites substance group). Usually, suspicion is thrown in the right direction by a thorough medical history and environmental survey. But if intoxication is unintended and happens within the very private environment diagnosis might be very tricky. We report on an unusual case of accidental intoxication with probably contaminated tablets which were bought in the darknet. Finally, diagnosis was made by blood gas analysis' methemoglobine values.

The improvement of intensive care treatment options leads to an increasing number of patients being treated in this setting. For the majority of those affected and their relatives, this treatment is associated with tremendous stress, but also subsequent physical, psychological and cognitive impairments, the post-intensive care syndrome. The aim of psychosocial support in the intensive care unit is to stabilise and minimise the acute stress. This is done through care services oriented towards trauma therapy interventions and emergency psychology. Equally central are the needs of the patient's relatives and ways to stabilise and relieve them. The third pillar of psychosocial work in the intensive care unit is the support of the treatment team. Finally, an outlook is given for the specialised aftercare of these complex patients in PICS outpatient clinics.