[How to become a Respiratory Therapist in Germany - Status quo and Development Prospects].

The profession respiratory therapist is well established in Germany 10 years after the introduction. 600 participants have successfully graduated from the training facilities.Our goals are high quality interprofessional teamwork and medical assistance inclusive delegation of formerly physician activities.

HERMES European Accreditation of Training Centres in Adult Respiratory Medicine: criteria validation and revision.

Four respiratory medicine disease categories appear in the global top 10 causes of mortality [1], resulting in 600 000 people dying from respiratory disease in Europe each year. The economic burden of respiratory diseases in Europe exceeds 380 billion euros. In a fast-developing environment, new clinical challenges have arisen for pulmonary specialists; techniques and procedures have evolved and become more complex.

[Noninvasive Mechanical Ventilation in Acute Respiratory Failure].

The non-invasive ventilation (NIV) is widespread in the clinical medicine and has attained meanwhile a high value in the clinical daily routine. The application of NIV reduces the length of ICU stay and hospitalization as well as mortality of patients with hypercapnic acute respiratory failure. Patients with acute respiratory failure in context of a cardiopulmonary edema should be treated in addition to necessary cardiological interventions with continuous positive airway pressure (CPAP) or NIV.

S2k-Guideline "Prolonged Weaning".

All mechanically ventilated patients must be weaned from the ventilator at some stage. According to an International Consensus Conference the criteria for "prolonged weaning" are fulfilled if patients fail at least 3 weaning attempts (i. e.

[Further training for medical specialists in respiratory medicine: how can we improve it?].

Young physicians in Germany often criticize the advanced training programme, especially the lack of structure and the insufficient rotations. The Medical Association in each Bundesland/federal state require to include a proposal for advanced training and rotation in a trainer's aplication for an educational license. However, there is no systematic scrutiny of these concepts and therefore the criteria stated outcomes are often only incompletely met.

Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial.

Background: Evidence is weak for the ability of long-term non-invasive positive pressure ventilation (NPPV) to improve survival in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD). Previous prospective studies did not target a reduction in hypercapnia when adjusting ventilator settings. This study investigated the effect of long-term NPPV, targeted to markedly reduce hypercapnia, on survival in patients with advanced, stable hypercapnic COPD.

[Prolonged weaning: S2k-guideline published by the German Respiratory Society].

Mechanical ventilation (MV) is an essential part of modern intensive care medicine. MV is performed in patients with severe respiratory failure caused by insufficiency of the respiratory muscles and/or lung parenchymal disease when/after other treatments, i. e.

[Acceptance of a telemonitoring device in patients with chronic obstructive pulmonary disease].

Objective: The aim of this trial was to assess the acceptance of a telemonitoring device (Health Buddy®) by patients with chronic obstructive pulmonary disease (COPD). The device makes it possible to monitor vital parameters and to ask questions about symptoms, behavior and disease-specific knowledge.

Method: A single-arm non-randomized clinical study was performed for three months in 43 patients with severe/very severe COPD.

Invasive home mechanical ventilation, mainly focused on neuromuscular disorders.

Introduction And Background: Invasive home mechanical ventilation is used for patients with chronic respiratory insufficiency. This elaborate and technology-dependent ventilation is carried out via an artificial airway (tracheal cannula) to the trachea. Exact numbers about the incidence of home mechanical ventilation are not available.

[Palliative care in respiratory medicine].

Palliative care should be part of respiratory medicine for two reasons: first, many respiratory diseases--besides thoracic tumours--need palliative care in the late stages of the disease. Second, dyspnoea is a common symptom in advanced, primary extrapulmonary diseases and the knowledge of respiratory specialists can be beneficial in the treatment of this symptom. In this paper we describe frequent symptoms of advanced pulmonary diseases and their treatment.

[The respiratory therapist].

Because of the expected significant growth in the elderly population and respiratory diseases, the topic of "delegation of physician's duties" is of increasing importance to the German health-care system. In 2004 the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V.

[Care of patients under mechanical ventilation at home and in nursing home conditions. Position paper of the German Medical Associations of Pneumology and Ventilatory Support ("Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V." and "Arbeitsgemeinschaft für Heimbeatmung und Respiratorentwöhnung e. V.")].

The advances in intensive and critical care medicine have not only improved the prognosis of patients with acute respiratory failure but have also increased the number of ventilator-dependent patients. The continuously increasing number of patients, the differentiation of care-giving institutions and the technical progress make it necessary to re-evaluate the quality of health care in weaning centres and outpatient care of patients on long-term ventilation. Therefore, the German medical associations of pneumology and ventilatory support, "Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.

[Management of secretion in patients with neuromuscular diseases].

Background: Many patients with neuromuscular diseases suffer from a weak cough. Due to infection or aspiration a life-threatening situation may occur. There are different options for the therapists to improve secretion clearance from the airways in the patient with a weak cough.

[Mechanical ventilation in acute ventilatory insufficiency].

Acute ventilatory insufficiency is characterized by hypercapnia, respiratory acidosis and secondary hypoxemia. The primary target of mechanical ventilation is improvement of alveolar ventilation, that means compensation of the ventilatory insufficiency. Noninvasive ventilation started as ventilatory support during the big polio epidemic, at that time in form of negative pressure ventilation.

[Recommendations for the treatment of respiratory complications in case of a viruspandemic].

In case of a viral pandemic without availability of effective vaccination, one can expect to be faced with additional 250 to 300 new admissions per hospital per week given the worst case scenario. Major complications are expected to occur in the respiratory system with the focus on viral pneumonia often complicated by bacterial superinfection. Frequently these patients will require artificial ventilation.

[Respiratory therapist: introduction of a new profession].

Respiratory therapists are healthcare professionals taking care of patients with pulmonary disorders. They are an allied health specialty, practicing under medical direction. The professionalism of nurses and therapists must grow up to act successfully in new fields of medicine, where evidence-based independent action is necessary.