A systematic diagnostic and therapeutic approach for the treatment of patients after cardio-pulmonary resuscitation: a prospective evaluation of 212 patients over 5 years.

A literature on systematic treatment protocols for patients after resuscitation for cardiac arrest is lacking. We evaluated a systematic protocol, including ECG, echocardiogram, urgent cardiac catheterisation ("STEMI-like" workflow), CT scans, laboratory findings, IABP, hypothermia, and cMRI, prospectively over 5 years. The primary endpoint was the Cerebral Performance Category Scale (CPCS).

Rosiglitazone dampens pulmonary inflammation in a porcine model of acute lung injury.

The hallmarks of acute lung injury (ALI) are the compromised alveolar-capillary barrier and the extravasation of leukocytes into the alveolar space. Given the fact that the peroxisome proliferator-activated receptor-γ agonist rosiglitazone holds significant anti-inflammatory properties, we aimed to evaluate whether rosiglitazone could dampen these hallmarks of local pulmonary inflammation in a porcine model of lung injury. For this purpose, we used a model of lipopolysaccharide (LPS, 50 μg/kg)-induced ALI.

ICU personnel have inaccurate perceptions of their patients' experiences.

Background: Intensive care unit (ICU) patient care bases - among others - upon the staff's assumptions about each patient's subjective preferences and experiences. However, these assumptions may be skewed and thus result in client-professional gaps (cp-gaps), which occur in two subtypes, hyperattention and blind spots to certain burdens. cp-gaps typically reduce quality of care.

[Patients at the end of life in the intensive care unit: cultural aspects of accompaniment].

The accompaniment of people in the face of death offers insights into dimensions which are mostly not seen in ordinary life. These insights also exist in intensive care in German hospitals and are highly relevant in medical decision making. End-of-life decisions in particular often determine medical, cultural and spiritual aspects concerning medical treatment and therapeutic targets and if necessary new therapy targets.

[Use of 2 % hyperbaric prilocaine for spinal anesthesia : sensitivity analysis in outpatient surgery].

Background: Hyperbaric prilocaine 2 % has been available for spinal anesthesia in Germany for 2 years and is characterized by a short duration of action, a lack of postspinal urine retention and a reduction of transient neurological syndromes. However, desirable pharmacological properties are contrasted by higher pharmacological costs compared to hyperbaric bupivacaine 0.5 %.

[Palliative care oriented therapy for all patients : recommendations of an expert circle].

Background: Since 2011 palliative care has been a compulsory part of the German medical study course (so-called Q13 palliative and pain medicine). Palliative care content does not, however, as often taught, have to focus only on patients in the so-called palliative stages of disease. The aim of this investigation was to encourage a discussion concerning the integration of palliative care aspects into general medical treatment.

Extracorporeal cell therapy of septic shock patients with donor granulocytes: a pilot study.

Introduction: Neutrophil granulocytes are the first defense line in bacterial infections. However, granulocytes are also responsible for severe local tissue impairment. In order to use donor granulocytes, but at the same time to avoid local side effects, we developed an extracorporeal immune support system.

[Palliative care and end-of-life patients in emergency situations. Recommendations on optimization of out-patient care].

Background: At the end of life acute exacerbations of medical symptoms (e.g. dyspnea) in palliative care patients often result in emergency medical services being alerted.

The neuronal guidance protein netrin-1 reduces alveolar inflammation in a porcine model of acute lung injury.

Introduction: Acute lung injury (ALI) is an inflammatory disorder of pulmonary or extrapulmonary origin. We have previously demonstrated that netrin-1 dampens murine ALI, and in an attempt to advance this finding into future clinical practice we evaluated whether netrin-1 would reduce alveolar inflammation during porcine ALI.

Methods: This was a controlled in vivo experimental study in pigs.

[Controlling and operation management in hospitals].

The economical pressure on the health system and especially on hospitals is growing rapidly. Hence, economical knowledge for people in medical executive positions becomes imperative. In advanced and forward-looking hospitals controlling is gaining more and more weight, because it takes over a coordinative responsibility.

[Delivering bad news: How to improve communication with relatives].

Communicating bad news, e.g. the message of the death of a close relative, is not a straight forward task for physicians.

Thoracic epidural anesthesia in sepsis--is it harmful or protective?

Research interest in epidural anesthesia during sepsis has grown over the past years and studies have tried to determine its mechanisms, which should, theoretically, protect organs and reduce morbidity and mortality. However, different experimental approaches in different animal models have provided conflicting results over whether epidural anesthesia has protective or harmful effects and whether these alter depending on the phase of sepsis, the spread of epidural anesthesia or additional supportive therapies. In the future, more standardized research is necessary to integrate the results of all studies, which have been published.

Bbeta15-42 (FX06) reduces pulmonary, myocardial, liver, and small intestine damage in a pig model of hemorrhagic shock and reperfusion.

Objective: The fibrin-derived peptide Bbeta15-42 (also called FX06) has been shown to reduce myocardial infarct size following ischemia/reperfusion. Hemorrhagic shock (HS) followed by volume resuscitation represents a similar scenario, whereby a whole organism is vulnerable to reperfusion injury.

Design: We subjected male farm-bred landrace pigs ( approximately 30 kg) to HS by withdrawing blood to a mean arterial pressure of 40 mm Hg for 60 minutes.

[The (non)sense of certification in intensive care medicine. The problem of the detection of suitable indicator systems].

Certification is a compulsory element of today's quality management. However, the instruments used for certification have mostly originally been developed for industrial purposes. Even with tried and tested adaptation to hospital structures, transferring these instruments to the medical environment implies partial negligence of outcome quality.

[Persistent intractable hiccup in the perioperative period].

We describe a case of hiccup in an awakening patient. Since there was no success in stopping the hiccup by deepening anaesthesia with Desflurane, we used Propofol 1.3 mg/kg BW as a short acting i.

[Central venous cannulation--the important things, you should know!].

Central venous cannulation is essential for management of patients who are critically ill or require major surgery. Based on approximately 90 studies, the use and maintainance of catheters, typical complications, most common puncture sites and techniques were sighted to give an overview over the state-of-the-art concerning central venous catheters.

Xenon anesthesia impairs hepatic oxygenation and perfusion in healthy pigs.

Background: Over the last 15 years, there has been growing interest in the noble gas xenon as a new inhalational anesthetic. This is due to its favorable pharmacological properties such as short onset and offset, as well as its hemodynamic stability. However, most volatile anesthetics appear to play an important role in the multi-factorial etiology of perioperative liver injury by decreasing liver blood flow with a subsequent reduction of hepatic oxygen supply.

[Brain death in children--how to deal with the parents?].

For parents the death of children is hard to bear and to accept. In situations where a brain death needs to be diagnosed, the psychological stress for parents who lose their child is aggravated due to a mostly sudden and unprepared confrontation with this situation. The rationality to accept the death of a their child is opposed by the hope for recovery as long as the children are "warm and dead" instead of "cold and dead" due to the maintenance of cardiac circulation.

[Quality management in health care - continuous improvement of processes and outcomes].

What is quality, what is quality management? Who is responsible for quality management in a hospital? Which tools, communication instruments and which instruments for feed back are necessary for institutions to control its tasks in a multi-disciplinary environment? Are there various requirements concerning quality management systems in different hospitals or departments? Which tools of quality management are used in German anaesthesia and intensive care departments? This paper gives an introduction to quality management systems in hospitals and an overview of current models in anaesthesia and intensive care medicine.

[How to calculate the budget of an anaesthetic or intensive care department from revenues of g-DRGs].

In Germany the economical framework of the health system in general and the hospitals in particular has changed dramatically over the last years. The conversion of funding to DRGs has implicated a reduction of budgets. The apportioning of budgets by keys of officially calculating hospitals forces single departments and disciplines to choose financial goals of a hospital as their particular interest and not the financial goals of a department.

[Marketing for hospitals--an issue?].

Since economization of medicine continues, marketing is becoming more and more important. To shape marketing activities in correspondence with their professional ethics, physicians need some basic knowledge about marketing. The process of marketing consists of SWOT-analysis, market segmentation, market differentiation, positioning and the marketing-mix with ist most important component, the marketing communication.

[Influence of clonidine-induced systemic sympathicolysis on oxygenation and perfusion of the liver. Investigations with healthy pigs under general anesthesia].

Background: Increased sympathetic nervous activity which induces vasoconstriction and decreases perfusion may be an underlying mechanism behind the development of perioperative liver damage. This animal study was designed to assess how clonidine-induced systemic sympathicolysis affects liver oxygenation with respect to induced hypotension and vasodilatation under physiological conditions.

Methods: Following ethical approval 17 anesthetized and acutely instrumented pigs were randomly assigned to 2 groups.

Protective effects of PARP inhibition on liver microcirculation and function after haemorrhagic shock and resuscitation in male rats.

Objective: The aim of this study was to investigate the impact of the water-soluble poly-(ADP)-ribose-polymerase (PARP) inhibitor 5-aminoisoquinolinone (5-AIQ) on liver microcirculation and function after haemorrhagic shock and resuscitation.

Design: Controlled, randomized animal study.

Setting: University animal care facility and research laboratory.