[Impairment of oxygenation of patients in surgical intensive care : Early symptom of severe sepsis].

Background: Sepsis and septic shock are major contributors to morbidity and mortality in intensive care patients. Early identification and adequate therapy are of utmost importance to reduce the still high mortality in patients with severe sepsis. Many of the pathophysiologic changes are nonspecific.

[Perspectives on advance directives among German intensive care physicians in leading positions].

Introduction: Six years after introduction of a law for advance directives (AD) in 2009, AD are still discussed controversially. For the first time in Germany, this study investigates intensive care physicians' perspectives on implementation of AD, and corresponding experience of ethical issues.

Methods: A standardized questionnaire was sent to German hospitals with > 300 beds and anesthesiologist-led intensive care units.

Clinical presentation and blood gas analysis of multiple trauma patients for prediction of standard coagulation parameters at emergency department arrival.

Objectives: Trauma-induced coagulopathy (TIC) in multiple trauma patients is a potentially lethal complication. Whether quickly available laboratory parameters using point-of-care (POC) blood gas analysis (BGA) may serve as surrogate parameters for standard coagulation parameters is unknown. The present study evaluated TraumaRegister DGU® of the German Trauma Society for correlations between POC BGA parameters and standard coagulation parameters.

[Hemoglobin-oriented and coagulation factor-based algorithm : Effect on transfusion needs and standardized mortality rate in massively transfused trauma patients].

Background: Bleeding and trauma-induced coagulopathy (TIC) are major contributors to death related to trauma in the first 24 h and the major preventable contributors. Early surgical therapy and aggressive correction of TIC are key steps to prevent death in patients suffering from hemorrhage. Therefore, a standard operating procedure (SOP) using a hemoglobin (Hb)-oriented and coagulation factor-based algorithm for early correction of TIC was introduced in this level 1 trauma center.

Predictors for postoperative nausea and vomiting after xenon-based anaesthesia.

Background: In contrast to volatile anaesthetics, xenon acts by antagonism at N-methyl-d-aspartate receptors and antagonizes 5-hydroxytryptamine type 3 receptors that mediate nausea and vomiting. Therefore, it is unknown whether the same risk factors for postoperative nausea and vomiting (PONV) after volatile anaesthetics apply to xenon-based anaesthesia.

Methods: With ethics committee approval and written informed consent, 502 consecutive patients undergoing xenon-based anaesthesia were included in a multicentre prospective observational study.

[Whole-body-CT in Severely Injured Children. Results of Retrospective, Multicenter Study with Patients from the TraumaRegsiter DGU®].

Background: A fast and comprehensive diagnostic by means of whole-body CT has been shown to reduce mortality in the adult trauma population. Therefore whole-body CT seems to be the standard in adult trauma-patients. Due to the higher radiation exposure of whole-body CT the use of this diagnostic toll in pediatric trauma patients is still under debate.

[Management of a 4MRGN Acinetobacter baumanii outbreak in a burn unit].

Patients with 4MRGN Acinetobacter baumanii infections in a burn unit represent great challenge. The structured management with 7 involved patients in such a situation is presented. After discovering the infectious trigger a management team is established.

The "coagulation box" and a new hemoglobin-driven algorithm for bleeding control in patients with severe multiple traumas.

Background: Extensive hemorrhage is the leading cause of death in the first few hours following multiple traumas. Therefore, early and aggressive treatment of clotting disorders could reduce mortality. Unfortunately, the availability of results from commonly performed blood coagulation studies are often delayed whereas hemoglobin (Hb) levels are quickly available.

[Coagulation management of trauma patients with unstabile circulation : establishment of a hemoglobin-oriented standard operating procedure].

Introduction: Massive hemorrhage is the leading cause of death in the first few hours following multiple trauma, therefore, early and aggressive treatment of clotting disorders and surgical intervention to stop the bleeding are of utmost importance. However, commonly performed clotting tests have a considerable latency of at least 30-45 min, whereas hemoglobin (Hb) levels can be tested very quickly. If a multiple trauma patient has already received fluid resuscitation, a certain relationship may be observed between the hemoglobin value and the development of clotting disturbances.

[Methohexital for treatment of intracranial hypertension].

Background: Barbiturate coma therapy is a useful method to control increased intracranial pressure (ICP) in patients with severe brain damage if standard measures have failed to lower ICP. Pentobarbital (not available in Germany) and thiopental (in Germany only approved for induction of anesthesia) have frequently been used in patients with intracranial hypertension and the effects and side-effects are well-described. However, little is known about the effect of methohexital (the only barbiturate in Germany approved for maintaining anesthesia) in lowering increased ICP.

Trauma care in Germany: major differences in case fatality rates between centers.

Background: Recent years have seen a further decline in the nationwide case fatality rate after major trauma in Germany, but it has not been clear until now whether all centers providing trauma care achieve comparable results. We have attempted to answer this question using data from the trauma registry of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU).

Methods: The standardized mortality rate of each participating center was calculated on the basis of the RISC prognostic score (Revised Injury Severity Classification) and the observed case fatality rate of the center.

[Different case fatality rates at German trauma centres : Critical analysis].

Objective: The level of trauma care in Germany belongs to one of the best worldwide. Nevertheless, previous studies have shown significant differences in the case fatality rates of multiple trauma patients in German trauma centres. The objective of this study was to indentify the reasons for the different outcomes based on data of the trauma registry of the German Society of Orthopaedic Surgery and Traumatology.

Recovery index, attentiveness and state of memory after xenon or isoflurane anaesthesia: a randomized controlled trial.

Background: Performance of patients immediately after anaesthesia is an area of special interest and so a clinical trial was conducted to compare Xenon with Isoflurane anaesthesia. In order to assess the early cognitive recovery the syndrome short test (SST) according to Erzigkeit (Geromed GmbH) was applied.

Methods: ASA I and II patients undergoing long and short surgical interventions were randomised to receive either general anaesthesia with Xenon or Isoflurane.

Assessing the depth of hypnosis of xenon anaesthesia with the EEG.

Xenon was approved as an inhaled anaesthetic in Germany in 2005 and in other countries of the European Union in 2007. Owing to its low blood/gas partition coefficient, xenons effects on the central nervous system show a fast onset and offset and, even after long xenon anaesthetics, the wake-up times are very short. The aim of this study was to examine which electroencephalogram (EEG) stages are reached during xenon application and whether these stages can be identified by an automatic EEG classification.

The breast feeding mother and xenon anaesthesia: four case reports. Breast feeding and xenon anaesthesia.

Background: Four nursing mothers consented to anaesthesia for urgent surgery only on condition that their ability to breast feed would not be impaired.

Methods: Following induction of general anaesthesia with propofol and remifentanil, 65-69% xenon supplemented with remifentanil was used as an inhalational anaesthetic for maintenance.

Results: After finishing surgery the women could be extubated between 2:52 and 7:22 minutes.

[Desmopressin (Minirin) in multiple trauma--a case report].

Bleeding and clotting disturbances are not uncommon in trauma patients and require an early and consequent therapy. Under the prevalent pathophysiological circumstances of hypothermia, acidosis and clotting disturbances, desmopressin seems to be a possible option to control diffuse bleeding. We report about 2 trauma patients with diffuse bleeding and in whom desmopressin was used successfully to control bleeding from the point of view of the authors.

Long-distance repatriation by an EMS helicopter.

In Europe, long-distance repatriation flights are usually executed by fixed-wing aircraft. We report an international long-distance repatriation flight by the helicopter emergency medical service (HEMS), with a total flight time of almost 7 hours. The flight itself, the medical requirements, and aviation problems are discussed.

Alcohol-positive multiple trauma patients with and without blood transfusion: an outcome analysis.

Background: Blood transfusion is a common therapy for multiple trauma patients, and is often performed soon after hospital admission. It is unclear whether the need for a blood transfusion in multiply injured patients presenting with a positive blood alcohol concentration (BAC) is associated with increased morbidity/mortality, since their risk behavior differs significantly from patients with a negative BAC. In this study, we evaluated the role of blood transfusion in the treatment of BAC-positive multiple trauma patients.

[Misleading anisocoria in a comatose 15-year-old with head injury].

Anisocoria after blunt head trauma, associated with altered vigilance, is not unusually assumed to expanding intracranial mass lesion. Obvious signs of head-trauma and vomiting might strengthen this diagnosis. We report from an unconscious 15-year-old girl (Glasgow-Coma-Scale score 3) that showed these symptoms secondary after head-trauma due to alcohol intoxication but turned out to be misleading after cranial computed tomography (CT).

Does brain temperature correlate with intracranial pressure?

Objective: A positive correlation between brain temperature and intracranial pressure (ICP) has been proposed for patients under intensive care conditions.

Design And Methods: Data were recorded at 5-minute intervals in patients under ICP monitoring conditions. Brain temperature: combined ICP/temperature probe (Raumedic), core temperature: indwelling urinary catheter with temperature probe (Rüsch).

[Prevention of thromboembolism in German intensive care units : Results of a nationwide survey].

Background: Intensive care unit (ICU) patients have a high risk of developing venous thromboembolism (VTE) and prophylaxis is recommended. Venous thromboembolism confers considerable morbidity and mortality in hospitalized patients, although few studies have focused on critically ill patients.

Method And Objective: A systematic prospective mailed self-administered survey of 645 German ICU directors was performed, representing 652 ICUs throughout the country.

Score-based immunoglobulin G therapy of patients with sepsis: the SBITS study.

Objective: Intravenous immunoglobulin as an adjunctive treatment in sepsis was regarded as promising by a Cochrane meta-analysis of smaller trials. In this phase III multicenter trial, we assessed whether intravenous immunoglobulin G (ivIgG) reduced 28-day mortality and improved morbidity in patients with score-defined severe sepsis.

Design: Randomized, double-blind, placebo-controlled, multicenter trial.

New aspects in the emergency room management of critically injured patients: a multi-slice CT-oriented care algorithm.

Background: Time-critical care of seriously injured patients is gaining more and more significance. The availability of the multi-slice CT allows a complete diagnostic assessment of injured patients in 90-240 s, but is presently carried out only at the conclusion of basic diagnostics. We investigated the effects of a clinical algorithm using multi-slice CT scanning ahead of other measures in the clinical care of seriously injured patients.

[Arterial air embolism following multiple injuries after a fall from the tenth floor].

We report about the case of a 20-year-old patient who fell from the tenth floor. The patient suffered multiple injuries and systemic gas embolism. He survived his injuries despite CPR, massive transfusion, development of ARDS and SIRS with minimal neurological deficit.

[The design of the VISEP trial. Critical appraisal].

The survey transcript of the VISEP interventional trial "Prospective randomized multicenter study on the influence of colloid vs crystalloid volume resuscitation and of intensive vs conventional insulin therapy on outcome in patients with severe sepsis and septic shock" [Clinical trials.gov. identifier: NCT00135473; study start April 2003] comprises, according to the data of the year 2003, methodological shortcomings which challenge a priori the study design and thus the resolution of the purpose of the study, i.