55 results on '"Elke, Muhl"'
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2. Belastungen für Patienten auf der Intensivstation
- Author
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M. Hüppe, M. Reinberger, R. Bouchard, C. Nau, and Elke Muhl
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Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,Anesthesiology and Pain Medicine ,0302 clinical medicine ,030228 respiratory system ,business.industry ,Medicine public health ,medicine ,030208 emergency & critical care medicine ,General Medicine ,business - Abstract
Es existieren bislang keine Untersuchungen zu Belastungen fur Patienten der Intensivstation, die sowohl das Belastungsempfinden als auch die erlebte Kontrollierbarkeit erfassen. Mit dieser Untersuchung sollten die Fragen beantwortet werden, welche Situationen von Patienten der Intensivstation als belastend erlebt werden, ob diese aus Patientensicht kontrollierbar sind, und ob das Belastungserleben von der Kontrollierbarkeit abhangig ist. Es wurde ein Fragebogen zu 18 potenziell belastenden Situationen fur Patienten der Intensivstation konzipiert. Diese sollten hinsichtlich ihres Vorkommens, der Wiederholungshaufigkeit, der Belastung und des Kontrollempfindens beurteilt werden. 198 Patienten der chirurgischen Intensivstation und 100 Patienten der allgemeinchirurgischen Normalstation wurden wahrend ihres stationaren Aufenthalts befragt. Patienten der Intensivstation erinnerten signifikant mehr Belastungssituationen als die der Normalstation (M ± SD = 10,2 ± 2,7 vs. 6,6 ± 2,0; d = 1,48; p
- Published
- 2020
3. Clinical Nutrition in Critical Care Medicine – Guideline of the German Society for Nutritional Medicine (DGEM)
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Konstantin Mayer, Wolfgang H. Hartl, Gunnar Elke, Stephan C. Bischoff, Geraldine de Heer, Tobias Graf, Axel R. Heller, K. Georg Kreymann, Andreas Rümelin, Elke Muhl, Ulrich Kampa, Thomas W. Felbinger, Christian Stoppe, Michael Adolph, Arved Weimann, Stephan Steiner, and Bernd Niemann
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Societies, Scientific ,0301 basic medicine ,Parenteral Nutrition ,medicine.medical_specialty ,Critical Care ,Critical Illness ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Clinical nutrition ,Enteral administration ,Nutrition Policy ,03 medical and health sciences ,0302 clinical medicine ,Meta-Analysis as Topic ,Germany ,Humans ,Medicine ,Medical nutrition therapy ,Intensive care medicine ,Aged ,Randomized Controlled Trials as Topic ,Aged, 80 and over ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Nutritional Support ,business.industry ,Organ dysfunction ,Guideline ,Respiration, Artificial ,Clinical trial ,Observational Studies as Topic ,Parenteral nutrition ,Observational study ,Nutrition Therapy ,medicine.symptom ,business - Abstract
Summary Purpose Enteral and parenteral nutrition of adult critically ill patients varies in terms of the route of nutrient delivery, the amount and composition of macro- and micronutrients, and the choice of specific, immune-modulating substrates. Variations of clinical nutrition may affect clinical outcomes. The present guideline provides clinicians with updated consensus-based recommendations for clinical nutrition in adult critically ill patients who suffer from at least one acute organ dysfunction requiring specific drug therapy and/or a mechanical support device (e.g., mechanical ventilation) to maintain organ function. Methods The former guidelines of the German Society for Nutritional Medicine (DGEM) were updated according to the current instructions of the Association of the Scientific Medical Societies in Germany (AWMF) valid for a S2k-guideline. According to the S2k-guideline classification, no systematic review of the available evidence was required to make recommendations, which, therefore, do not state evidence- or recommendation grades. Nevertheless, we considered and commented the evidence from randomized-controlled trials, meta-analyses and observational studies with adequate sample size and high methodological quality (until May 2018) as well as from currently valid guidelines of other societies. The liability of each recommendation was described linguistically. Each recommendation was finally validated and consented through a Delphi process. Results In the introduction the guideline describes a) the pathophysiological consequences of critical illness possibly affecting metabolism and nutrition of critically ill patients, b) potential definitions for different disease phases during the course of illness, and c) methodological shortcomings of clinical trials on nutrition. Then, we make 69 consented recommendations for essential, practice-relevant elements of clinical nutrition in critically ill patients. Among others, recommendations include the assessment of nutrition status, the indication for clinical nutrition, the timing and route of nutrient delivery, and the amount and composition of substrates (macro- and micronutrients); furthermore, we discuss distinctive aspects of nutrition therapy in obese critically ill patients and those treated with extracorporeal support devices. Conclusion The current guideline provides clinicians with up-to-date recommendations for enteral and parenteral nutrition of adult critically ill patients who suffer from at least one acute organ dysfunction requiring specific drug therapy and/or a mechanical support device (e.g., mechanical ventilation) to maintain organ function. The period of validity of the guideline is approximately fixed at five years (2018–2023).
- Published
- 2019
4. DGEM-Leitlinie: Klinische Ernährung in der Intensivmedizin – Kurzversion
- Author
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K. Georg Kreymann, Christian Stoppe, Andreas Rümelin, Tobias Graf, Arved Weimann, Axel R. Heller, Wolfgang H. Hartl, Stephan C. Bischoff, Thomas W. Felbinger, Ulrich Kampa, Geraldine de Heer, Gunnar Elke, Bernd Niemann, Konstantin Mayer, Stephan Steiner, Michael Adolph, and Elke Muhl
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Critical illness ,Emergency Medicine ,medicine ,030212 general & internal medicine ,business - Abstract
Zusammenfassung Fragestellung Variationen in der klinischen Ernährungstherapie können die Prognose kritisch kranker Patienten beeinflussen. Hier präsentieren wir die Kurzversion der aktualisierten, konsensbasierten S2k-Leitlinie „Klinische Ernährung in der Intensivmedizin“ der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Kooperation mit 7 anderen nationalen Fachgesellschaften. Als Zielpopulation der Leitlinie wurden kritisch kranke, erwachsene Patienten, die an mindestens einer akuten, medikamentös und/oder mechanisch unterstützungspflichtigen Organdysfunktion leiden, definiert. Methodik Die früheren Leitlinien der DGEM wurden in Einklang mit den aktuellen Richtlinien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) als S2k-Leitlinie aktualisiert. Als Grundlage für die Empfehlungen wurde die Evidenz von randomisiert-kontrollierten Studien, Metaanalysen und Beobachtungsstudien mit angemessener Fallzahl und hoher methodologischer Qualität (bis Mai 2018) sowie aktuell gültige Leitlinien internationaler Fachgesellschaften herangezogen und kommentiert. Die Empfehlungsstärke ist rein sprachlich beschrieben. Jede Empfehlung wurde mittels Delphi-Verfahren abschließend bewertet und konsentiert. Ergebnisse In der vorliegenden Kurzversion werden alle 69 Empfehlungen für essenzielle, praxisrelevante Bestandteile der klinischen Ernährung der Zielpopulation zusammenfassend dargestellt. Ein spezifischer Fokus ist die Adjustierung der Ernährung gemäß den Phasen der kritischen Erkrankung sowie gemäß der individuellen Toleranz gegenüber exogener Substratzufuhr. Unter anderem werden Empfehlungen zur Beurteilung des Ernährungszustandes, zur Indikation für eine klinische Ernährungstherapie, zum Zeitpunkt des Beginns, zum Applikationsweg, zur Menge und Zusammensetzung der Ernährungssubstrate (Makro- und Mikronährstoffe) sowie zu speziellen Aspekten der Ernährung bei adipösen kritisch kranken Patienten und Patienten mit extrakorporalen Unterstützungsverfahren gegeben. Schlussfolgerung Die Kurzversion der Leitlinie gibt eine prägnante Übersicht über alle 69 aktualisierten Handlungsempfehlungen zur enteralen und parenteralen Ernährung erwachsener kritisch kranker Patienten, die an mind. einer akuten, medikamentös und/oder mechanisch unterstützungspflichtigen Organdysfunktion leiden. Die Gültigkeit der Leitlinie beträgt voraussichtlich 5 Jahre (2018 – 2023).
- Published
- 2019
5. DGEM-Leitlinie: 'Klinische Ernährung in der Intensivmedizin'
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Stephan Steiner, Michael Adolph, Geraldine de Heer, Ulrich Kampa, K. Georg Kreymann, Elke Muhl, Arved Weimann, Andreas Rümelin, Axel R. Heller, Wolfgang H. Hartl, Gunnar Elke, Christian Stoppe, Thomas W. Felbinger, Konstantin Mayer, Bernd Niemann, Tobias Graf, and Stephan C. Bischoff
- Subjects
Nutrition and Dietetics ,Medicine (miscellaneous) - Abstract
Zusammenfassung Fragestellung Die enterale und parenterale Ernährungstherapie kritisch kranker Patienten kann u. a. durch den Zeitpunkt des Beginns, die Wahl des Applikationswegs, die Menge und Zusammensetzung der Makro- und Mikronährstoffzufuhr sowie der Wahl spezieller, immunmodulierender Nährsubstrate variieren. Die Durchführung der Ernährungstherapie nimmt Einfluss auf den klinischen Ausgang dieser Patienten. Ziel der vorliegenden Leitlinie ist es, aktualisierte konsensbasierte Empfehlungen zur klinischen Ernährung kritisch kranker, erwachsener Patienten, die an mindestens einer akuten, medikamentös und/oder mechanisch unterstützungspflichtigen Organdysfunktion leiden, zu geben. Methodik Die früheren Leitlinien der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) wurden in Einklang mit den aktuellen Richtlinien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) als S2k-Leitlinie aktualisiert. Entsprechend der S2k-Klassifikation dieser Leitlinie enthalten die dargestellten Empfehlungen keine Angabe von Evidenz- und Empfehlungsgraden, da keine systematische Aufbereitung der Evidenz zugrunde gelegt wurde. Als Grundlage für die Empfehlungen wurden insbesondere die seit Erscheinen der letzten DGEM-Leitlinien Intensivmedizin publizierten randomisiert-kontrollierten Studien und Metaanalysen, Beobachtungsstudien mit angemessener Fallzahl und hoher methodologischer Qualität (bis Mai 2018) sowie aktuell gültige Leitlinien anderer Fachgesellschaften herangezogen und kommentiert. Die Empfehlungsstärke ist rein sprachlich beschrieben. Jede Empfehlung wurde mittels Delphi-Verfahren abschließend bewertet und konsentiert. Ergebnisse Die Leitlinie beschreibt einführend die pathophysiologischen Konsequenzen einer kritischen Erkrankung, welche den Metabolismus und die Ernährbarkeit der Patienten beeinflussen können, ferner die Definitionen unterschiedlicher Erkrankungsphasen im Krankheitsverlauf und sie diskutiert methodologische Aspekte zu ernährungsmedizinischen Studien. In der Folge werden 69 konsentierte Empfehlungen zu wesentlichen, praxisrelevanten Elementen der klinischen Ernährung kritisch kranker Patienten gegeben, darunter die Beurteilung des Ernährungszustands, die Indikation für die klinische Ernährungstherapie, der Beginn und Applikationsweg der Nahrungszufuhr, die Menge und Art der zugeführten Substrate (Makro- und Mikronährstoffe) sowie ernährungstherapeutische Besonderheiten bei adipösen kritisch kranken Patienten und Patienten mit mechanischen Unterstützungssystemen. Schlussfolgerung Mit der Leitlinie werden aktuelle Handlungsempfehlungen zur enteralen und parenteralen Ernährung erwachsener Patienten geben, die an mindestens einer akuten, medikamentös und/oder mechanisch unterstützungspflichtigen Organdysfunktion leiden. Die Gültigkeit der Leitlinie beträgt voraussichtlich 5 Jahre (2018 – 2023).
- Published
- 2018
6. Qualitätsmanagement: Kollegiales Peer-Review-Verfahren in der Intensivmedizin
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Elke Muhl
- Subjects
German ,Quality management ,Nursing ,media_common.quotation_subject ,Intensive care ,language ,Quality (business) ,General Medicine ,Review procedure ,Business ,language.human_language ,media_common - Abstract
We report on the German Peer Review procedure for the quality management of Intensive Care Wards. The third up-date of the quality-indicators was published in 2017. The Peer Review Procedure, its organization, the development of quality indicators in Germany and their benefit for the patients is introduced.
- Published
- 2018
7. Webinar zur S3-Leitlinie Screening, Diagnostik, Therapie und Nachsorge des Bauchaortenaneurysmas
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Franziska Heidemann, Adrian Mahlmann, Mathias Wilhelmi, Eike Sebastian Debus, Walter Gross-Fengels, Christian Stroszczynski, Andreas Walther, Elke Muhl, Sebastian Roth, Norbert Weiss, Reinhart T. Grundmann, and Karin Pfister
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medicine.medical_specialty ,Transplant surgery ,Cardiothoracic surgery ,business.industry ,General surgery ,medicine ,MEDLINE ,Surgery ,Vascular surgery ,business ,Abdominal surgery - Published
- 2020
8. Erratum: DGEM-Leitlinie: 'Klinische Ernährung in der Intensivmedizin'
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Axel R. Heller, Elke Muhl, Michael Adolph, Geraldine de Heer, Gunnar Elke, Andreas Rümelin, Stephan Steiner, Thomas W. Felbinger, Bernd Niemann, Tobias Graf, Wolfgang H. Hartl, Ulrich Kampa, Stephan C. Bischoff, Konstantin Mayer, Arved Weimann, K. Georg Kreymann, and Christian Stoppe
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Nutrition and Dietetics ,business.industry ,Medicine ,Medicine (miscellaneous) ,business - Published
- 2019
9. [DGEM Guideline 'Clinical Nutrition in Critical Care Medicine' - short version]
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Gunnar, Elke, Wolfgang H, Hartl, K Georg, Kreymann, Michael, Adolph, Thomas W, Felbinger, Tobias, Graf, Geraldine, de Heer, Axel R, Heller, Ulrich, Kampa, Konstantin, Mayer, Elke, Muhl, Bernd, Niemann, Andreas, Rümelin, Stephan, Steiner, Christian, Stoppe, Arved, Weimann, and Stephan C, Bischoff
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Parenteral Nutrition ,Enteral Nutrition ,Evidence-Based Medicine ,Critical Care ,Nutritional Support ,Germany ,Humans ,Guidelines as Topic ,Nutrition Therapy - Abstract
Variations of clinical nutrition may affect outcome of critically ill patients. Here we present the short version of the updated consenus-based guideline (S2k classification) "Clinical nutrition in critical care medicine" of the German Society for Nutritional Medicine (DGEM) in cooperation with 7 other national societies. The target population of the guideline was defined as critically ill adult patients who suffer from at least one acute organ dysfunction requiring specific drug therapy and/or a mechanical support device (e.g. mechanical ventilation) to maintain organ function.The former guidelines of the German Society for Nutritional Medicine (DGEM) were updated according to the current instructions of the Association of the Scientific Medical Societies in Germany (AWMF) valid for a S2k-guideline. We considered and commented the evidence from randomized-controlled trials, meta-analyses and observational studies with adequate sample size and high methodological quality (until May 2018) as well as from currently valid guidelines of international societies. The liability of each recommendation was indicated using linguistic terms. Each recommendation was finally validated and consented by a Delphi process.The short version presents a summary of all 69 consented recommendations for essential, practice-relevant elements of clinical nutrition in the target population. A specific focus is the adjustment of nutrition according to the phases of critical illness, and to the individual tolerance to exogenous substrates. Among others, recommendations include the assessment of nutritional status, the indication for clinical nutrition, the timing, route, magnitude and composition of nutrition (macro- and micronutrients) as well as distinctive aspects of nutrition therapy in obese critically ill patients and those with extracorporeal support devices.The current short version of the guideline provides a concise summary of the updated recommendations for enteral and parenteral nutrition of adult critically ill patients who suffer from at least one acute organ dysfunction requiring pharmacological and/or mechanical support. The validity of the guideline is approximately fixed at five years (2018 - 2023).Variationen in der klinischen Ernährungstherapie können die Prognose kritisch kranker Patienten beeinflussen. Hier präsentieren wir die Kurzversion der aktualisierten, konsensbasierten S2k-Leitlinie „Klinische Ernährung in der Intensivmedizin“ der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Kooperation mit 7 anderen nationalen Fachgesellschaften. Als Zielpopulation der Leitlinie wurden kritisch kranke, erwachsene Patienten, die an mindestens einer akuten, medikamentös und/oder mechanisch unterstützungspflichtigen Organdysfunktion leiden, definiert.Die früheren Leitlinien der DGEM wurden in Einklang mit den aktuellen Richtlinien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) als S2k-Leitlinie aktualisiert. Als Grundlage für die Empfehlungen wurde die Evidenz von randomisiert-kontrollierten Studien, Metaanalysen und Beobachtungsstudien mit angemessener Fallzahl und hoher methodologischer Qualität (bis Mai 2018) sowie aktuell gültige Leitlinien internationaler Fachgesellschaften herangezogen und kommentiert. Die Empfehlungsstärke ist rein sprachlich beschrieben. Jede Empfehlung wurde mittels Delphi-Verfahren abschließend bewertet und konsentiert.In der vorliegenden Kurzversion werden alle 69 Empfehlungen für essenzielle, praxisrelevante Bestandteile der klinischen Ernährung der Zielpopulation zusammenfassend dargestellt. Ein spezifischer Fokus ist die Adjustierung der Ernährung gemäß den Phasen der kritischen Erkrankung sowie gemäß der individuellen Toleranz gegenüber exogener Substratzufuhr. Unter anderem werden Empfehlungen zur Beurteilung des Ernährungszustandes, zur Indikation für eine klinische Ernährungstherapie, zum Zeitpunkt des Beginns, zum Applikationsweg, zur Menge und Zusammensetzung der Ernährungssubstrate (Makro- und Mikronährstoffe) sowie zu speziellen Aspekten der Ernährung bei adipösen kritisch kranken Patienten und Patienten mit extrakorporalen Unterstützungsverfahren gegeben.Die Kurzversion der Leitlinie gibt eine prägnante Übersicht über alle 69 aktualisierten Handlungsempfehlungen zur enteralen und parenteralen Ernährung erwachsener kritisch kranker Patienten, die an mind. einer akuten, medikamentös und/oder mechanisch unterstützungspflichtigen Organdysfunktion leiden. Die Gültigkeit der Leitlinie beträgt voraussichtlich 5 Jahre (2018 – 2023).
- Published
- 2019
10. Adäquate Volumensubstitution bei septischem Schock unter hohen Katecholamindosen
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Elke Muhl, C. Zimmermann, J.C. Lewejohann, Tobias Keck, M. Hansen, and H Braasch
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Gynecology ,medicine.medical_specialty ,Resuscitation ,Septic shock ,business.industry ,030208 emergency & critical care medicine ,Emergency Nursing ,Critical Care and Intensive Care Medicine ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Fluid therapy ,Emergency Medicine ,Internal Medicine ,medicine ,business - Abstract
Beim septischen Schock sollten vasokonstriktorische und positiv inotrope Substanzen moglichst erst dann eingesetzt werden, wenn sich Blutdruck und Organperfusion trotz Vorlastoptimierung nicht adaquat verbessern lassen. Der zunehmende Einsatz des hamodynamischen Monitorings hat gezeigt, dass in einigen Fallen bei initial unzureichender Volumensubstitution hoch dosierte Katecholamine Verwendung finden. Ziel der Studie ist zu zeigen, dass es in einigen Fallen moglich ist, durch eine dem Bedarf entsprechende Volumensubstitution verbunden mit einer gezielten Reduktion der Katecholamindosis deren Bedarf zu reduzieren. In einer retrospektiven Beobachtungsstudie wurden 29 Patienten einer chirurgischen Intensivstation (17 mannlich, 12 weiblich; mittleres Alter ± Standardfehler: 71 ± 10 Jahre) mit septischem Schock analysiert, die hoch dosiert Katecholamine erhielten (Noradrenalin 0,204; Dobutamin 3,876; Adrenalin 0,025 µg/kgKG/min im Median; bis zu 0,810/22,222/0,407 µg/kgKG/min; 28/20/17 Patienten). Die Extremitaten waren initial bei allen Patienten kuhl und marmoriert, wahrend der mittlere arterielle Druck ≥ 65 mmHg war. Der mediane zentrale Venendruck betrug 17 mmHg (5–34 mmHg), der Laktatspiegel 2,78 mmol/l (0,93–10,67 mmol/l). Das Standardtherapiekonzept umfasste eine forcierte, dem Bedarf entsprechende Volumensubstitution, kombiniert mit einer aktiven Reduktion vasokonstriktorischer und positiv inotroper Substanzen, deren Ausmas mithilfe eines Autotransfusionsmanovers, klinischer Zeichen und in 19 Fallen mithilfe eines hamodynamischen Monitorings gesteuert wurde (Pulmonaliskatheter, Vigilance II™: n = 10; FloTrac, Vigileo™: n = 9, davon PreSpep™: n = 5, Edwards Lifesciences). Der Volumenbelastungstest wurde bei Wiedererwarmung der Extremitaten, ansteigenden Diuresemengen und fehlender Reaktion auf das Autotransfusionsmanover beendet. Die mittlere Katecholamindosis lies sich bei allen Patienten signifikant reduzieren: Noradrenalin 0, Dobutamin 1,852, Adrenalin 0 µg/kgKG/min (bis zu 0,133/6,289/0,091 µg/kgKG/min; p
- Published
- 2015
11. [Peer Review for Quality Management in Intensive Care Medicine]
- Author
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Elke, Muhl
- Subjects
Intensive Care Units ,Critical Care ,Germany ,Humans ,Quality Indicators, Health Care - Abstract
We report on the German Peer Review procedure for the quality management of Intensive Care Wards. The third up-date of the quality-indicators was published in 2017. The Peer Review Procedure, its organization, the development of quality indicators in Germany and their benefit for the patients is introduced.
- Published
- 2018
12. Risiken und Komplikationen in der Allgemein- und Viszeralchirurgie
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Wenzel Schöning, Norbert Pallua, Henner Schmidt, Kerstin Kols Ass. Jur., Christoph-Thomas Germer, Fritz Klein, Stefanie Wolff, Arnulf H. Hölscher, Kerstin Lorenz, Pawel Mroczkowski, Dieter Berger, Thomas Joh. Musholt, René Mantke, Werner Hohenberger, Georg Lurje, Atanas Ignatov, Tim O. Vilz, Andreas Becker, Jan G. D’Haese, Hans Lippert, Hardy Krause, Christian A. Gutschow, Ulf Neumann, Frank Meyer, Stefan Bohr, Christian Herrmann, J. Werner, Walter Asperger, Nicolas Schlegel, Klaus Weber, Johann Pratschke, Jürgen Weitz, Andreas Volk, Christiane J. Bruns, Mia Kim, Thomas Manger, Maik Sahm, Felix Watzka, Stefan P. Mönig, Elke Muhl, Nguyen Thanh, Christine Stroh, Henning Dralle Frcs, Facs, Febs, Joachim Reibetanz, Rick Schneider, A. Janitzky, and Jörg C. Kalff
- Published
- 2018
13. Intermediate care units : Recommendations on facilities and structure
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V. Parvu, G W Sybrecht, K. R. Steinmeyer-Bauer, T. Nicolai, K. Notz, E. Herting, D. Schneider, Elke Muhl, E. Rickels, Michael Quintel, Stefan Kluge, Gernot Marx, A. Markewitz, Christian Waydhas, and Tobias Welte
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Gerontology ,Critical Care ,Medizin ,030204 cardiovascular system & hematology ,Emergency Nursing ,Critical Care and Intensive Care Medicine ,law.invention ,Unit (housing) ,Scientific evidence ,Indirect evidence ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,law ,Intensive care ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Structure (mathematical logic) ,business.industry ,medicine.disease ,Intensive care unit ,Intensive Care Units ,Emergency Medicine ,Medical emergency ,business ,Intermediate Care Facilities ,Intermediate care - Abstract
A growing number of patients with increasingly complex or specialized diseases are being treated in hospitals worldwide. The treatment requirements of some of these patients are exceeding the capacity of standard nursing units. However, the severity of these diseases or the treatment requirements for these specific clinical pictures do not always justify admission to an intensive care unit. For this reason, an increasing number of special units (intermediate care units) are being set up to offer highly specialized treatment and close monitoring, in order to fulfil an intermediate role between the standard care unit and the intensive care unit. The recommendations of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) on the personnel, capacity, equipment and structure of these units are intended to provide the framework for the setting up and operation of intermediate care units in collaboration with experts on both an evidence-based and an expert-based basis (where scientific evidence is not available). Where only minimal or indirect evidence is available, patient safety is paramount in the formulation of the recommendation.
- Published
- 2017
14. Management of Complications after Major Gastrointestinal Surgery
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Elke Muhl, Klaus Fellermann, Martin K. Angele, Wolfgang H. Hartl, Richard Hummel, Peter Hunold, Georg Kähler, and Ulrich F. Wellner
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03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Text mining ,business.industry ,030220 oncology & carcinogenesis ,Gastroenterology ,Medicine ,030211 gastroenterology & hepatology ,Surgery ,business ,Interdisciplinary Discussion - Published
- 2017
15. Management of Complications after Major Gastrointestinal Surgery
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Elke Muhl
- Subjects
Editorial ,Gastroenterology ,Surgery - Published
- 2017
16. Volumentherapie in der Sepsis: Wann ist das Limit erreicht?
- Author
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Elke Muhl
- Subjects
Gynecology ,Sepsis ,medicine.medical_specialty ,business.industry ,Gastroenterology ,medicine ,Surgery ,medicine.disease ,business - Abstract
Hintergrund: Die Endpunkte der Volumentherapie bei schwerer Sepsis und septischem Schock sind nicht selten Gegenstand kontroverser Diskussionen am Krankenbett. Methode: Anhand der Leitlinien und der aktuellen Literatur werden die Zielparameter sowie die durch Volumentherapie erreichbaren Wirkungen und Nebenwirkungen vorgestellt. Ergebnisse: Werden die Zielparameter der Volumentherapie in der Sepsis nicht in den ersten 6 h erreicht, ist ein erweitertes hämodynamisches Monitoring zur Überwachung der Vorlast und der Volumenreagibilität sowie der Gewebsoxygenierung indiziert. Eine Überinfusion führt nicht selten zu grotesken Anasarka und Nebenwirkungen am Herz, an der Lunge und im Abdomen, die lebensbedrohliche Ausmaße annehmen können. Schlussfolgerung: Die Grenzen der Volumentherapie sind nicht nur in hämodynamischen Zielparametern zu sehen, sondern auch in den Nebenwirkungen der Volumentherapie, die im Rahmen der Sepsisbehandlung nicht sämtlich vermieden, aber in ihren Auswirkungen begrenzt werden können.
- Published
- 2013
17. Sepsisquelle Abdomen - zwischen interventioneller, chirurgischer und intensivmedizinischer Therapie
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Tobias Keck, Peter Hunold, Wolfgang H. Hartl, Elke Muhl, Evelyn Kramme, and Klaus Fellermann
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medicine.medical_specialty ,Abdominal sepsis ,business.industry ,Gastroenterology ,Medicine ,Surgery ,business ,Intensive care medicine ,Intensive care treatment - Published
- 2013
18. Thromboseprophylaxe und perioperative Therapie mit Antikoagulantien
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Martin Hoffmann, Elke Muhl, Stefan Limmer, Erik Schlöricke, Peter Kujath, and Hans-Peter Bruch
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Gynecology ,medicine.medical_specialty ,business.industry ,Gastroenterology ,medicine ,Surgery ,business ,Niedermolekulares heparin - Abstract
Die perioperative Thromboseprophylaxe wird in Deutschland zumeist mit niedermolekularem Heparin (NMH) durchgefuhrt. Bei der Anwendung von NMH muss auf die Nierenfunktion geachtet werden und gegebenenfalls die Dosis bei eingeschrankter Nierenfunktion angepasst werden. Auch beim sog. Bridging, dem Unterbrechen einer Therapie mit Vitamin-K-Antagonisten, sollte bevorzugt NMH verwendet werden. Hierbei zeigen neueste Daten, dass bis dato wahrscheinlich viel zu hoch wahrend der Uberbruckungsphase antikoaguliert wurde. Bei niedrigem und mittlerem Risiko scheint eine Gabe der Thromboseprophylaxedosierung des NMH ausreichend zu sein, wenn die orale Antikoagulation zugig wieder aufgenommen wird. Bei der Pausierung einer dualen oder singularen antithrombozytaren Therapie muss ein besonderes Augenmerk auf stattgefundene Stentimplantationen oder ein akutes Koronarereignis gelegt werden. Das unkritische Pausieren der Thrombozytenaggregationshemmer kann deletare Folgen haben.
- Published
- 2011
19. Stoffwechselveränderungen und Ernährungstherapie von Patienten nach großen viszeralchirurgischen Eingriffen und bei chirurgischen Intensivpatienten
- Author
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Elke Muhl and Wolfgang H. Hartl
- Subjects
Gastroenterology ,Surgery - Abstract
Nach chirurgischer Homoostasestorung kommt es durch hormonelle sowie immunologische Veranderungen regelhaft zu charakteristischen passageren Stoffwechselveranderungen (Hyperglykamie, Eiweiskatabolie)
- Published
- 2011
20. Patientenvorbereitung sowie intra- und postoperatives Managementkonzept für die Ösophagusresektion
- Author
-
Stefan Limmer, Tilman Laubert, Franz G. Bader, Philipp Hildebrand, Hermann Heinzeb, Armin Frank, Markus Kleemann, Uwe J. Roblick, Elke Muhl, Hans-Peter Bruch, Hamed Esnaashari, Thomas Jungbluth, and Frank Hackmann
- Subjects
Gastroenterology ,Surgery - Abstract
Trotz der Reduzierung der Mortalitat nach Osophagusresektion an Zentren auf unter 5% ist die Chirurgie des Osophagus nach wie vor durch hohe perioperative Morbiditat gekennzeichnet. Die chirurgischen
- Published
- 2011
21. Appropriate fluid resuscitation of septic shock patients pretreated with high doses of catecholamines
- Author
-
C Zimmermann, Tobias Keck, H Braasch, J.C. Lewejohann, M. Hansen, and Elke Muhl
- Subjects
medicine.medical_specialty ,Resuscitation ,business.industry ,Septic shock ,Emergency medicine ,Poster Presentation ,High doses ,Medicine ,Critical Care and Intensive Care Medicine ,business ,medicine.disease ,Intensive care medicine - Published
- 2015
22. Prophylaxen in der Intensivmedizin
- Author
-
Elke Muhl, Martin Hoffmann, Susanne Krotsetis, and Tobias M. Bingold
- Abstract
Die Pneumonieprophylaxe in der Intensivmedizin ist fur Patienten aufgrund einer deutlich erhohten Morbiditat, Letalitat sowie fur das Krankenhaus infolge deutlich erhohter Therapiekosten von elementarer Bedeutung (Muscedere et al. 2008a). Ziel dieses Beitrags ist es, einen Uberblick uber die empfohlenen Masnahmen zur Pneumonieprophylaxe auf der Intensivstation zu geben. In ▸ Kap. 60 ist die Pneumonie in allen weiteren Aspekten beschrieben.
- Published
- 2015
23. Release of Vancomycin and Teicoplanin from a Plasticized and Resorbable Gelatin Sponge: in Vitro Investigation of a New Antibiotic Delivery System with Glycopeptides
- Author
-
T. Krüger, Elke Muhl, Sören Gatermann, H.-P. Bruch, D. Thorn, Heiko Iven, and O. Drognitz
- Subjects
Microbiology (medical) ,food.ingredient ,medicine.drug_class ,Antibiotics ,Gelatin ,Microbiology ,chemistry.chemical_compound ,Drug Delivery Systems ,food ,Vancomycin ,medicine ,Glycerol ,Incubation ,Chromatography ,biology ,Chemistry ,Teicoplanin ,Glycopeptides ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,Glycopeptide ,Anti-Bacterial Agents ,Sponge ,Infectious Diseases ,Delayed-Action Preparations ,Plastics ,Half-Life ,medicine.drug - Abstract
The aim of this study was to evaluate the efficacy of sustained release of vancomycin and teicoplanin from a resorbable gelatin glycerol sponge, in order to establish a new delivery system for local anti-infective therapy.60 plasticized glycerol gelatin sponges containing either 10 or 20% gelatin (w/v) were incubated in vancomycin or teicoplanin solution at 20 degrees C for either 1 or 24 h. In vitro release properties of the sponges were investigated over a period of 1 week by determining the levels of vancomycin and teicoplanin eluted in plasma using fluorescent polarization immunoassay. The rate constant and the half-life for the antibiotic release of each group were calculated by linear regression assuming first order kinetics.Presoaking for 24 h was associated with a significant increase in the total antibiotic release in all groups opposed to 1 h of incubation, except for the 10% sponges presoaked in teicoplanin. Doubling the gelatin content of the sponges from 10 to 20% significantly increased the total release of antibiotic load only in teicoplanin-containing sponges after 24 h incubation. In all corresponding groups investigated, release of vancomycin was more prolonged compared to teicoplanin, which allowed a gradual release beyond 5 days. The half-life (h +/- SEM) of both types of vancomycin-containing sponges was significantly prolonged by 24 h incubation in comparison to 1 h incubation (29.1 +/- 5.9 vs 5.9 +/- 1.0; p0.001, 30.0 +/- 2.1 vs 11.1 +/- 1.9; p0.001). However, neither doubling the gelatin content of the sponges nor a prolonged incubation was associated with a significantly prolonged delivery of teicoplanin.This study demonstrated a better diffusion-controlled release of vancomycin-impregnated glycerol gelatin sponges compared to those pretreated with teicoplanin. The plasticized glycerol gelatin sponge may be a promising carrier for the application of vancomycin to infected wounds for local anti-infective therapy.
- Published
- 2006
24. Haut- und Weichgewebsinfektionen
- Author
-
Peter Kujath and Elke Muhl
- Subjects
business.industry ,Medicine ,business - Published
- 2014
25. Rezidivierende Candida-Sepsis mit protrahiertem Lungenversagen und schwerer Leberdysfunktion. Recurrent Candida sepsis with prolonged respiratory failure and severe liver dysfunction
- Author
-
Elke Muhl, J Lewejohann, C Zimmermann, H-P Bruch, and M Hansen
- Subjects
medicine.medical_specialty ,biology ,business.industry ,Septic shock ,medicine.medical_treatment ,Dermatology ,General Medicine ,biology.organism_classification ,medicine.disease ,Gastroenterology ,Sepsis ,Infectious Diseases ,Respiratory failure ,Internal medicine ,Intensive care ,Immunology ,medicine ,Renal replacement therapy ,business ,Candida albicans ,Fungemia ,Immunodeficiency - Abstract
Systemic mycoses, especially pulmonary diseases and septicemia are observed increasingly at intensive care units. Essential risk factors for development of candidosis are the expanded use of antibiotics and immunocompromised patients, caused either as a result of a severe underlying disease or iatrogenically induced after organ transplantation. Candida albicans is the most frequent pathogen in microbiological findings. Blood cultures are only positive in massive fungemia. We report a 50-year-old patient with recurrent Candida-septicemia: rupture of the distal esophagus after dilatation because of cardiac achalasia with mediastinal emphysema and mediastinitis. Severe acute respiratory distress syndrome after aspiration with septic shock and acute renal failure at the beginning. Long-term mechanical ventilation, continuous renal replacement therapy and multifarious antibiotic therapy. Early microbiological samples of several positive blood cultures and bronchoalveolar lavages revealed the presence of Candida albicans. In the further clinical course, detection of Pseudomonas species in bronchoalveolar lavages and Staphylococci as well as Enterococci in a number of positive blood cultures. Later on development of a severe liver dysfunction with test results that showed an intrahepatic cholestasis. Because of coagulation failure commencement of artificial liver support with the MARS-system (molecule adsorbent recirculating system). Decrease of high bilirubin levels was accompanied by improvement of clinical condition of the patient. In the following course, repeated severe systemic infections with phases of septicemia or rather septic shock and detection of Candida in several positive blood cultures and bronchoalveolar lavages. In each case increasing bilirubin levels with signs of intrahepatic cholestasis and each time improvement with antimycotic therapy (voriconazol, caspofungin and fluconazol). The patient showed more and more signs of immunodeficiency in the sequel. The clinical appearance of candidosis is manifold. Systemic Candida infections are frequent in patients with immunodeficiency. A recurrent Candida septicemia with prolonged respiratory failure and severe liver dysfunction in form of cholestatic hepatosis, that improved several times with antimycotic therapy in combination with evidence based intensive care measures and artificial organ support is a comparatively rare event.
- Published
- 2005
26. Antimykotika unter kontinuierlicher Nierenersatztherapie. Antimycotic drugs under continuous renal replacement therapy
- Author
-
Elke Muhl
- Subjects
Voriconazole ,medicine.medical_specialty ,business.industry ,Itraconazole ,medicine.medical_treatment ,Urology ,Dermatology ,General Medicine ,urologic and male genital diseases ,Surgery ,chemistry.chemical_compound ,Infectious Diseases ,Renal Elimination ,Pharmacokinetics ,chemistry ,Hemofiltration ,medicine ,Renal replacement therapy ,Caspofungin ,business ,Fluconazole ,medicine.drug - Abstract
In critically ill patients with acute renal failure and continuous renal replacement therapy (CRRT), the elimination of antimycotic agents is influenced by many factors; these include not only the nature and dose of the renal replacement therapy but also the properties of the medicine. High protein binding, a high molecular weight and little or no renal elimination even in subjects with normal renal function suggest that a substance is not eliminated by CRRT. This is the case with amphotericin B, caspofungin, itraconazole and voriconazole, but not with fluconazole. In the case of fluconazole, an increase in dose than that used in patients with normal renal function may be required according to the nature and dose of CRRT, because the clearance of fluconazole can be substantially higher under CRRT than in subjects with normal renal function. Daily doses of 800 mg or more may be necessary. As a result of the diverse influences on elimination in patients receiving CRRT, the determination of fluconazole through concentrations cannot be dispensed with, in order to avoid underdosing and a failure of the antimycotic therapy.
- Published
- 2005
27. Measurement and Calculation of the Extracorporeal Elimination of Vancomycin During Continuous Venovenous Hemodiafiltration and Continuous Venovenous Hemofiltration in Critically Ill Patients
- Author
-
Hans-Peter Bruch, Heiko Iven, Jens Bundesen, and Elke Muhl
- Subjects
Volume of distribution ,business.industry ,Critically ill ,medicine.medical_treatment ,Continuous venovenous hemodiafiltration ,Critical Care and Intensive Care Medicine ,Extracorporeal ,Continuous venovenous hemofiltration ,Anesthesia ,Medicine ,Vancomycin ,Dosing ,Renal replacement therapy ,business ,medicine.drug - Abstract
Six surgical intensive care patients with continuous renal replacement therapy and therapy with vancomycin entered the prospective clinical study. The first day the patients were treated with continuous venovenous hemodiafiltration (CVVHDF) and the second day with continuous venovenous hemofiltration (CVVH). Three patients received 500 mg and three patients received 1000 mg of vancomycin every 12 hours. Monoclonal fluorescence polarization immunoassay (AxSYM) of vancomycin levels was performed from serum and dialysate/ultrafiltrate (during CVVHDF) or ultrafiltrate (during CVVH). Blood flow was 90 ml/hr, substitution 1 L/hr predilution, dialysate flow 1 L/hr (CVVHDF). The extracorporeal elimination of vancomycin during CVVHDF and CVVH is nearly linear but shows wide interindividual variation. The extracorporeal clearance of vancomycin was 24.2 ± 3.1 ml/min during CVVHDF (total clearance 60.4 ±18.1 ml/min) and 14.5 ± 2.4 ml/min during CVVH (total clearance 50.2 ± 14.9 ml/min). Intraindividual comparison revealed a significantly higher elimination of vancomycin by CVVHDF (p < 0.028). Peak serum vancomycin levels in patients receiving vancomycin 1g/day were 24.7 ± 5.3 μg/ml (CVVH) and 23.1 ± 5.2 μg/ml (CVVHDF), and with 2 g/day were 33.5 ± 2.7 μg/ml (CVVH) and 27.3 ±4.1 μg/ml (CVVHDF). The daily excreted amount of vancomycin during CVVHDF (r2 = 0.950, p = 0.01) and CVVH (r2 = 0.947, p = 0.01) can be calculated from a vancomycin level in the ultrafiltrate/dialysate outlet (CVVHDF) or the ultrafiltrate (CVVH) 8 hours after dosing. The 8-hour concentration of vancomycin in the ultrafiltrate from CVVH (or ultrafiltrate/dialysate from CVVHDF) during continuous renal replacement therapy serves as a basis for predicting extracorporeal elimination within 24 hours for the individual patient. Since critically ill patients show wide interindividual and intraindividual differences in the volume of distribution, clearance, and elimination half-life of vancomycin during therapy, the estimation of serum levels remains a necessity.
- Published
- 2001
28. Fiberoptic Bronchoscopy of Intubated Patients with Life-threatening Hemoptysis
- Author
-
Elke Muhl, Jan-C. Lewejohann, Hans-P. Bruch, Joachim Gleiss, and Hans-J. Düpree
- Subjects
Male ,Hemoptysis ,medicine.medical_specialty ,Epinephrine ,medicine.medical_treatment ,Sodium Chloride ,law.invention ,Esophagus ,Bronchoscopy ,law ,medicine ,Fiber Optic Technology ,Humans ,Intubation ,Aged ,Retrospective Studies ,Mechanical ventilation ,medicine.diagnostic_test ,business.industry ,Respiratory disease ,Middle Aged ,medicine.disease ,Respiration, Artificial ,Intensive care unit ,Cardiac surgery ,Surgery ,Respiratory failure ,Anesthesia ,Female ,business ,Abdominal surgery - Abstract
Bleeding in the tracheobronchial tree in intubated patients on an intensive care unit is a potentially life-threatening incident. The antecedent state of disease and frequent respiratory failure require immediate and effective therapeutic measures to avoid further respiratory and cardiocirculatory depression. We present our bronchoscopic management of endobronchial bleeding. Cardiorespiratory function must be maintained by modification of the mechanical ventilation and drug therapy owing to the patient's condition. Seven consecutive patients with acute endobronchial bleeding were treated with fiberoptic bronchoscopy and instillation of cold epinephrine-saline solution (1:10,000-100,000) during the period of July 1997 to December 1997. Control of bleeding was achieved after 1 to 20 (mean +/- SEM: 5.86 +/- 0.93) bronchoscopic interventions during a period of 0.5 hours to 10 days. One control bronchoscopy was performed additionally in every patient. Cardiocirculatory instability was observed in five patients. Six patients survived; one patient died of uncontrolled bleeding caused by severe pulmonary aspergillosis. Fiberoptic endobronchial epinephrine instillation is an effective therapy for life-threatening hemoptysis in critically ill patients. Widespread use of flexible bronchoscopy makes this procedure immediately applicable in critical situations. Intubated and mechanically ventilated patients with life-threatening hemoptysis especially benefit from this rapidly feasible procedure.
- Published
- 2001
29. High Incidence of Active Cytomegalovirus Infection Among Septic Patients
- Author
-
Gregor Bein, Holger Hackstein, Elke Muhl, Holger Kirchner, and Astrid S. T. Kutza
- Subjects
Male ,Microbiology (medical) ,Human cytomegalovirus ,Congenital cytomegalovirus infection ,Cytomegalovirus ,Enzyme-Linked Immunosorbent Assay ,Antibodies, Viral ,medicine.disease_cause ,Polymerase Chain Reaction ,Herpesviridae ,Viral Matrix Proteins ,Sepsis ,Betaherpesvirinae ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Antigens, Viral ,biology ,business.industry ,Incidence ,virus diseases ,Middle Aged ,Phosphoproteins ,medicine.disease ,biology.organism_classification ,Immunohistochemistry ,Blotting, Southern ,Infectious Diseases ,Alanine transaminase ,Immunoglobulin G ,Cytomegalovirus Infections ,DNA, Viral ,Immunology ,biology.protein ,Cytokines ,Female ,Viral disease ,business - Abstract
Cytomegalovirus (CMV) infection is an important cause of disease in immunocompromised patients. In a prospective longitudinal study of 34 septic patients, the incidence of active CMV infection was examined. Eleven of 34 patients (32.4%) had active CMV infection, diagnosed by immunocytochemical staining of CMV pp65 antigen in blood leukocytes and/or detection of CMV DNA by PCR. Positive results for CMV infection were obtained in a median of 4 days (by PCR) or 11 days (by staining of pp65 antigen) after onset of sepsis. Twenty patients for whom more than one sample was examined were selected for further analysis. Among the patients with active CMV infection (nine of 20) there was a trend toward higher median values of tumor necrosis factor alpha, interleukin-1 beta, alanine aminotransferase, and aspartate aminotransferase in plasma, in comparison with the values for patients without CMV infection. Sepsis in patients with CMV infection may affect outcome of the disease.
- Published
- 1998
30. Kinetische Therapie im Rahmen der Behandlung septischchirurgischer Patienten
- Author
-
H-P Bruch, M Hansen, and Elke Muhl
- Subjects
medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Scope (project management) ,business.industry ,General surgery ,Emergency Medicine ,Medicine ,General Medicine ,Critical Care and Intensive Care Medicine ,business ,Surgery ,Surgical patients - Published
- 1997
31. Verbesserte Technik der Dilatationstracheostomie und erste Ergebnisse
- Author
-
C. Franke, H-P Bruch, and Elke Muhl
- Subjects
medicine.medical_specialty ,Percutaneous ,business.industry ,Anterior wall ,General Medicine ,Dissection (medical) ,Critical Care and Intensive Care Medicine ,medicine.disease ,Surgery ,Tracheostomy Procedure ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Emergency Medicine ,medicine ,Paratracheal ,Tears ,Vein ,business ,Severe complication - Abstract
Percutaneous dilatational tracheostomy is a simple bedside procedure and can be performed with a minimum of time and staff. Tears in the posterior wall of the trachea and paratracheal displacement of the tube are possible complications. These complications can be avoided by performing the procedure under bronchoscopic control. We report on 14 dilatational tracheostomies using this new technique. As a severe complication we noted bleeding from a vein with lethal blood aspiration in one case. Bleeding during dilatational tracheostomy procedure requires changing of technique and dissection of the anterior wall of the trachea.
- Published
- 1995
32. [Pulmonary zygomycosis--a rare angioinvasive fungal infection]
- Author
-
J, Lewejohann, Elke, Muhl, M, Birth, P, Kujath, and H P, Bruch
- Subjects
Male ,Immunocompromised Host ,Fatal Outcome ,Lung Diseases, Fungal ,Humans ,Mucormycosis ,Female ,Bronchoalveolar Lavage Fluid ,Rhizopus ,Aged - Abstract
Zygomycosis caused by Rhizopus species is an aggressive and rapidly progressive opportunistic fungal infection in immunocompromised patients. It comprises mucocutaneous, rhinocerebral, pulmonary, urological and disseminated infections. Predisposing factors are immunosuppression owing to severe diseases, immunological defects or metabolic disturbances like diabetic ketoacidosis. Rhizopus infections are characterized by angioinvasive growth, necroses of infected tissue and perineural invasion. The histopathologic demonstrable invasion of blood vessels is remarkable for a fungal infection. The mortality of zygomycosis is very high, especially for disseminated disease and when immunosuppression cannot be corrected. We report about two cases of pulmonary zygomycosis, caused by Rhizopus spp.: patient 1, female 73 years old: Delayed clinical course according to hip arthroplasty infection and infection of a femoropopliteal bypass of the right leg, eventually exarticulation of the right hip joint, Pseudomonas pneumonia, severe sepsis caused by staphylococci, acute respiratory distress syndrome (ARDs), acute renal failure and multiple use of antibiotics. Subsequently detection of Rhizopus spp. in the bronchoalveolar lavage and treatment with amphotericin B for this reason. Patient 2, male 68 years old: transplantation of kidney in past medical history, presenting with acute renal failure and with quite a few infections before. In the sequel development of abscessing pneumonia on the right side with a pleural empyema. Rhizopus spp. were detected by microbiological testing in the empyema fluid. These findings required surgical intervention, resection of the lower lobe of the right lung and within the same operation of the renal graft because of rejection. The patient was treated with caspofungin. The further course was delayed by several septic phases. Both patients died later on in spite of all efforts. The very rarely seen pulmonary zygomycosis caused by infection with Rhizopus spp. developed in both patients owing to immunosuppression, in one patient iatrogenically induced by immunosuppressive drugs after organ transplantation, in the other as a result of prolonged severe sepsis. In comparison with other mycoses treatment of Rhizopus infections remains difficult. The affinity to blood vessels, where the fungi multiply, and their feature of vascular invasion with thrombosis and infarction complicate therapeutic efforts.
- Published
- 2005
33. [Antimycotic drugs under continuous renal replacement therapy]
- Author
-
Elke, Muhl
- Subjects
Renal Replacement Therapy ,Antifungal Agents ,Metabolic Clearance Rate ,Humans ,Hemofiltration - Abstract
In critically ill patients with acute renal failure and continuous renal replacement therapy (CRRT), the elimination of antimycotic agents is influenced by many factors; these include not only the nature and dose of the renal replacement therapy but also the properties of the medicine. High protein binding, a high molecular weight and little or no renal elimination even in subjects with normal renal function suggest that a substance is not eliminated by CRRT. This is the case with amphotericin B, caspofungin, itraconazole and voriconazole, but not with fluconazole. In the case of fluconazole, an increase in dose than that used in patients with normal renal function may be required according to the nature and dose of CRRT, because the clearance of fluconazole can be substantially higher under CRRT than in subjects with normal renal function. Daily doses of 800 mg or more may be necessary. As a result of the diverse influences on elimination in patients receiving CRRT, the determination of fluconazole through concentrations cannot be dispensed with, in order to avoid underdosing and a failure of the antimycotic therapy.
- Published
- 2005
34. [Recurrent Candida sepsis with prolonged respiratory failure and severe liver dysfunction]
- Author
-
J, Lewejohann, M, Hansen, C, Zimmermann, Elke, Muhl, and H P, Bruch
- Subjects
Recurrence ,Liver Diseases ,Sepsis ,Candidiasis ,Humans ,Middle Aged ,Respiratory Insufficiency ,Candida - Abstract
Systemic mycoses, especially pulmonary diseases and septicemia are observed increasingly at intensive care units. Essential risk factors for development of candidosis are the expanded use of antibiotics and immunocompromised patients, caused either as a result of a severe underlying disease or iatrogenically induced after organ transplantation. Candida albicans is the most frequent pathogen in microbiological findings. Blood cultures are only positive in massive fungemia. We report a 50-year-old patient with recurrent Candida-septicemia: rupture of the distal esophagus after dilatation because of cardiac achalasia with mediastinal emphysema and mediastinitis. Severe acute respiratory distress syndrome after aspiration with septic shock and acute renal failure at the beginning. Long-term mechanical ventilation, continuous renal replacement therapy and multifarious antibiotic therapy. Early microbiological samples of several positive blood cultures and bronchoalveolar lavages revealed the presence of Candida albicans. In the further clinical course, detection of Pseudomonas species in bronchoalveolar lavages and Staphylococci as well as Enterococci in a number of positive blood cultures. Later on development of a severe liver dysfunction with test results that showed an intrahepatic cholestasis. Because of coagulation failure commencement of artificial liver support with the MARS-system (molecule adsorbent recirculating system). Decrease of high bilirubin levels was accompanied by improvement of clinical condition of the patient. In the following course, repeated severe systemic infections with phases of septicemia or rather septic shock and detection of Candida in several positive blood cultures and bronchoalveolar lavages. In each case increasing bilirubin levels with signs of intrahepatic cholestasis and each time improvement with antimycotic therapy (voriconazol, caspofungin and fluconazol). The patient showed more and more signs of immunodeficiency in the sequel. The clinical appearance of candidosis is manifold. Systemic Candida infections are frequent in patients with immunodeficiency. A recurrent Candida septicemia with prolonged respiratory failure and severe liver dysfunction in form of cholestatic hepatosis, that improved several times with antimycotic therapy in combination with evidence based intensive care measures and artificial organ support is a comparatively rare event.
- Published
- 2005
35. Sepsisquelle Abdomen - zwischen interventioneller, chirurgischer und intensivmedizinischer Therapie
- Author
-
Elke Muhl and Klaus Fellermann
- Subjects
Gastroenterology ,Surgery - Abstract
Fellermann: Ein singularer Parameter ist meines Erachtens nicht verfugbar. Fur jedwedes Eingriffsverfahren gilt, dass diverse hamodynamische und laborchemische Kenngrosen auf eine Sanierung hindeuten, so z.B. ein Schwinden der SIRS (systemisches inflammatorisches Response-Syndrom)-Kriterien. Hier ist in erster Linie arztliche Beurteilung und Gewichtung gefragt. Bezuglich endoskopisch durchgefuhrter Drainagen oder Nekrosektomien ist auch der lokale Eindruck nicht zu unterschatzen. Eine Einschatzung gemas irgendwelcher Scoring-Systeme, sei es auch sepsisadaptiert, ist im klinischen Gebrauch viel zu sperrig und wenig hilfreich. Allenfalls lasst sich damit die Mortalitat prognostizieren (APACHE II, MPI).
- Published
- 2013
36. Title Page · Editorial Board
- Author
-
Franz G. Bader, Philipp Hildebrand, Martin Hoffmann, Peter Kujath, Armin Frank, Elke Muhl, Hermann Heinze, Tilman Laubert, Christian Eckmann, Hamed Esnaashari, Hans-Peter Bruch, Hans-Rudolf Raab, Arved Weimann, Magnus Kaffarnik, Markus Kleemann, Richard Viebahn, Axel Richter, Daniel Seehofer, Frank Hackmann, Peter Neuhaus, Erik Schlöricke, Uwe J. Roblick, Johan Friso Lock, Ulrich T. Hopt, Wolfgang Schwenk, Tobias Keck, Wolfgang H. Hartl, Thomas Jungbluth, Karl J. Oldhafer, Justyna Swol, Hermann Heinzeb, Thomas A. Schildhauer, Stefan Utzolino, W. F. A. Hiller, Martin Stockmann, Hauke Lang, Carolin Kayser, and Stefan Limmer
- Subjects
media_common.quotation_subject ,Gastroenterology ,Library science ,Surgery ,Editorial board ,Art ,Title page ,media_common - Published
- 2012
37. Inhalt – Contents, Vol, 10, Supplement 2, 1994
- Author
-
J. Schleef, V. Wilden, K. Nösner, A. Woltmann, Ch.W. Waydhas, W. Gail, H. Dittrich, R. Broil, H. Thomas, M. Barthel, K. Kolp, H. Niemann, K. Koch, R. Reding, J. Petermann, B.M. Harnoß, P. Dollinger, B. Klosterhalfen, Elke Muhl, G.J. Winkeltau, T. Hau, D. Lorenz, A. Schafmayer, W. Sendt, H.B. Reith, Jan-Peter Braun, J. Izibicki, K.-H. Treutner, B. Eibl-Eibesfeldt, H. Schmidt, W. Weissenhofer, J. Focht, H.-W. Waclawiczek, R. Häring, G. Berger, Leonhard Schweiberer, R. Schlemminger, W. Kozuschek, Hans-Peter Bruch, G.U. Winkeltau, G. Müller, H.D. Czarnetzki, H. Waldner, M. Teschner, and B. Helms
- Subjects
Gastroenterology ,Surgery - Published
- 1994
38. Pharmacokinetics of levofloxacin during continuous venovenous hemodiafiltration and continuous venovenous hemofiltration in critically ill patients
- Author
-
Heiko Iven, Hans-Peter Bruch, Carsten Boos, Sven G. Guenter, and Elke Muhl
- Subjects
Male ,Ofloxacin ,Metabolic Clearance Rate ,medicine.medical_treatment ,Critical Illness ,Hemodiafiltration ,Levofloxacin ,Extracorporeal ,Pharmacokinetics ,Anti-Infective Agents ,Intensive care ,Sieving coefficient ,Hemofiltration ,medicine ,Humans ,Pharmacology (medical) ,Renal replacement therapy ,Chromatography, High Pressure Liquid ,Antibacterial agent ,Aged ,business.industry ,Acute Kidney Injury ,Middle Aged ,Anesthesia ,Area Under Curve ,Female ,business ,medicine.drug ,Half-Life - Abstract
Study Objective. To assess the pharmacokinetics of levofloxacin during continuous venovenous hemodiafiltration (CVVHDF) and continuous venovenous hemofiltration (CVVH). Design. Nonrandomized pharmacokinetic evaluation. Setting. University surgical intensive care unit. Patients. Six critically ill patients. Intervention. Five patients received levofloxacin 500 mg/day and one patient received levofloxacin 125 mg/day. All patients received continuous renal replacement therapy: CVVHDF on day 1 and CVVH on day 2, using an acrylonitrile hollow-fiber 0.9-m2 filter, constant blood flow rate of 90 ml/minute, substitution flow rate of 1 L/hour predilution, and dialysate flow rate of 1 L/hour (CVVHDF). Measurements and Main Results. Serum, ultrafiltrate, and dialysate concentrations of levofloxacin were determined by high-performance liquid chromatography. Extracorporeal clearance was 26.05 ± 4.66 ml/hour during CVVHDF and 15.71 ± 2.73 ml/hour during CVVH (p
- Published
- 2002
39. Perioperative Medizin großer viszeralchirurgischer Eingriffe
- Author
-
Elke Muhl and Wolfgang H. Hartl
- Subjects
Gastroenterology ,Surgery - Abstract
Grose viszeralchirurgische Eingriffe sind nicht nur eine Herausforderung fur den Chirurgen als Operateur, sondern auch fur den Chirurgen als perioperativ tatigen Arzt und fur den operativen Intensivmediziner. Die Erweiterung der operationstechnischen Moglichkeiten zur Minimierung des operativen Traumas (minimal invasive Chirurgie) und die Entwicklung in der Intensivmedizin in den letzten Jahren haben Operationen ermoglicht, die vor mehr als zehn Jahren noch undenkbar waren. So kommen immer komplexer vorerkrankte und immer altere Patienten zu immer komplexeren Eingriffen in unsere Kliniken. Zur perioperativen Medizin in der Viszeralchirurgie (und auch in allen anderen chirurgischen Gebieten) gehoren neben der praoperativen Risikoabschatzung, der Patientenkonditionierung und -vorbereitung sowie der differenzierten Indikationsstellung auch die postoperative Uberwachung, Komplikationsvermeidungsstrategien und das Komplikationsmanagement. Sie beinhaltet unter anderem Schmerztherapie, Ernahrungstherapie, Therapie der Sepsis, Volumenmanagement, Antibiotikatherapie, Gerinnungsmanagement und Thromboseprophylaxe, aber auch die Berucksichtigung diverser – meist internistischer – Begleiterkrankungen und zudem eingriffsspezifische Behandlungskonzepte. Einige dieser Themen werden im vorliegenden Heft zur perioperativen Medizin viszeralchirurgischer Eingriffe behandelt. Die perioperative Medizin leistet einen zunehmend wichtigen Beitrag in der Behandlung chirurgischer Patienten – praoperativ auf den normalen Pflegestationen, postoperativ auch auf den Intensivstationen. Der Chirurg muss die Herausforderungen der perioperativen Medizin annehmen. Wenn wir als Chirurgen dieses Arbeitsfeld nicht kompetent besetzen, werden es andere tun (mussen). Die obligatorische sechsmonatige Weiterbildung in der Intensivmedizin im Rahmen der Weiterbildung in einem chirurgischen Fach dient unter anderem auch dazu, Arzte fur dieses Tatigkeitsfeld fit zu machen. Ob diese Weiterbildungszeit dafur ausreicht, erscheint allerdings fraglich angesichts der Komplexitat der perioperativen Probleme unserer Patienten. Eine Veranderung der Weiterbildungsstruktur sollte in den Fachgesellschaften und Berufsverbanden sowie in den Arztekammern diskutiert und angegangen werden: Nur wenige Chirurgen absolvieren die zweijahrige Zusatzweiterbildung «Intensivmedizin», auch weil Karriereperspektiven fehlen und die Arbeitsbedingungen durch Schichtdienst und Personalmangel wenig attraktiv sind. Die Chirurgie hat ein Nachwuchsproblem, die chirurgische Intensivmedizin noch viel mehr – und zum Teil auch die Intensivmedizin in anderen Fachern. Ein Losungsansatz konnte die Umwandlung der Zusatzweiterbildung «Intensivmedizin» in einen Schwerpunkt Intensivmedizin in den Fachern Anasthesiologie, Chirurgie, Innere Medizin, Kinderund Jugendmedizin und Neurologie/Neurochirurgie sein. Als weiterer Baustein innerhalb der Weiterbildungsmoglichkeiten ist eine neue Zusatzweiterbildung «Perioperative Medizin» denkbar fur alle chirurgischen Fachgebiete mit Zugang zur Weiterbildung «Intensivmedizin» (also fur Allgemeinund Viszeralchirurgie, Herzund Gefaschirurgie, Thoraxchirurgie, Unfallchirurgie, Neurochirurgie und Plastische Chirurgie/Verbrennungsmedizin). Fur den Erwerb einer solchen Zusatzweiterbildung sollte eine mindestens einjahrige intensivmedizinische Weiterbildung Voraussetzung sein. Die Weiterbildung sollte fokussiert sein auf die Versorgung von chirurgischen Patienten auf der Normalstation, auf ihre metabolischen, internistischen, kardiologischen, pulmonologischen und neurologischen Begleiterkrankungen, Ernahrung, Schmerztherapie und auf adjuvante medikamentose Therapien im perioperativen Kontext. Die so weitergebilde
- Published
- 2011
40. Wertigkeit des APACHE–II als Verlaufsscore auf einer chirurgischen Intensivstation
- Author
-
Elke Muhl, H-P Bruch, J Lewejohann, and M. Hansen
- Abstract
In einer prospektiven Studie wurde der Zusammenhang zwischen dem Verlauf der APACHE-II-Score und dem Uberleben bzw. der In–Unit–Mortalitat bei 647 konsekutiven Patienten auf einer chirurgischen Intensivstation untersucht. Mit einer linearen Regressionsanalyse wurden die individuellen Score-Verlaufe der n=4 8 verstorbenen und die einer gleich grosen reprasentativen Stichprobe von den uberlebenden Patienten ausgewertet. Die lineare Regressionsanalyse der individuellen Score–Verlaufe der uberlebenden (m ± SEM : – 5,47 ± 0,80) und verstorbenen (m ± SEM:1,52 ±0,61) Patienten zeigt einen signifikanten Unterschied der Steigungen (p=0,05). Ein Anstieg des APACHE-II-Score im Verlauf einer Intensivtherapie kann schon fruhzeitig auf eine ungunstige Prognose hindeuten, wahrend ein deutlicher Abfall der Werte im Verlauf eher auf ein positives Outcome hindeutet.
- Published
- 1997
41. Ärztinnen in einer chirurgischen Universitätsklinik 1980 bis 1996
- Author
-
Elke Muhl, H.-P. Bruch, and S. Seemann
- Subjects
medicine.medical_specialty ,Child care ,business.industry ,Family medicine ,Medicine ,business ,University hospital - Abstract
From 1980 to 1996 214 male and 51 female physicians were employed at the Department of Surgery of the University Hospital of Lubeck (Germany). The percentage of female surgeons increased from 13% in 1980 to 20% in 1996. Nowerdays female surgeons more often succeed in becoming a specialist, a ward physician or senior physician. Female physicians often quit their j ob in surgery because of reasons in their family background (child care, change of place of their husband’s job).
- Published
- 1997
42. Local application of vancomycin for prophylaxis of graft infection: release of vancomycin from antibiotic-bonded Dacron grafts, toxicity in endothelial cell culture, and efficacy against graft infection in an animal model
- Author
-
Elke Muhl, Andreas Dendorfer, Hans-Peter Bruch, Hans Iven, and Sören Gatermann
- Subjects
medicine.medical_specialty ,Prosthesis-Related Infections ,Swine ,medicine.disease_cause ,Staphylococcal infections ,Prosthesis Design ,Blood vessel prosthesis ,Staphylococcus epidermidis ,Vancomycin ,medicine ,Animals ,Antibiotic prophylaxis ,Prosthesis-Related Infection ,Cells, Cultured ,biology ,Teicoplanin ,business.industry ,Polyethylene Terephthalates ,General Medicine ,Antibiotic Prophylaxis ,Staphylococcal Infections ,medicine.disease ,biology.organism_classification ,Surgery ,Anti-Bacterial Agents ,Blood Vessel Prosthesis ,Femoral Artery ,surgical procedures, operative ,Staphylococcus aureus ,Endothelium, Vascular ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Methicillin-resistant strains of Staphylococcus epidermidis cause an increasing number of prosthetic infections. This prompted us to test the uptake of vancomycin in various graft materials in vitro, its influence on graft healing, and its efficacy against graft infection in pigs. Incubation of six different Dacron graft materials in a vancomycin solution (20 gm/L) was performed. Grafts were then placed in plasma, and samples were taken over 72 hours to determine vancomycin levels. Release of vancomycin ranged from 775 micrograms/cm2 to 3691 micrograms/cm2 after 1 hour of incubation. Gelatin-covered grafts increased release of vancomycin fourfold when incubation time was extended to 24 hours: uncovered grafts or the collagen-covered graft did not. Graft healing was not complicated when a vancomycin-bonded, gelatin-impregnated Dacron graft was implanted to replace the common femoral artery in pigs. Four weeks after implantation, histologic examination revealed normal development of neointima and perigraft scar tissue in the vancomycin-treated (n = 4) and untreated (n = 5) grafts. To test the efficacy of local vancomycin against graft infection, grafts were implanted in the groin of pigs and contaminated with 2 x 10(7) colony-forming units of Staphylococcus aureus. Four weeks after implantation, all grafts were infected in the untreated group (n = 6), with abscess, nonincorporated graft, and detection of S. aureus from the graft. In the treatment group (n = 6) vancomycin was added to the contaminated grafts. As a carrier for the vancomycin, we used a resorbable gelatin-glycerol foam. All grafts healed without infection. The difference between the treated and untreated groups is statistically significant (p < 0.05). We conclude that it may be effective to prevent graft infection with local application of vancomycin if an in situ replacement of infected graft (infected by gram-positive bacteria) is necessary or if there is a high risk of infection by methicillin-resistant- staphylococci.
- Published
- 1996
43. Kosten- und Zeitersparnis durch die Dilatationstracheotomie unter bronchoskopischer Kontrolle
- Author
-
Elke Muhl, Ch. Franke, and M. Hansen
- Subjects
Dorsum ,medicine.medical_specialty ,Bronchoscopy ,medicine.diagnostic_test ,business.industry ,Perforation (oil well) ,Medicine ,respiratory system ,business ,Surgery - Abstract
Forty-seven patients underwent dilatational tracheostomy with bronchoscopic support. Bronchoscopic support during the procedure prevents perforation of the dorsal wall of the trachea and reveals any bleeding into the trachea. Complications intra- and postoperatively have not been seen as yet (follow-up up to 1 year). Duration of the procedure was 8 min versus 30 min for the conventional tracheostomy (mean values).
- Published
- 1996
44. Akutes Nierenversagen beim kritisch-kranken alten Menschen — ein Anlaß zum Therapieverzicht?
- Author
-
Elke Muhl, H.-P. Bruch, and M. Hansen
- Subjects
medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Internal medicine ,Group ii ,medicine ,Surgical intensive care unit ,business ,Prospective cohort study - Abstract
846 patients on a surgical intensive care unit (436 patients over 70 years old = group I, 410 patients up to 70 years old = group II) were included in a prospective study of incidence, mortality and reversibility of acute renal failure (ARV). APACHE II-Score showed no diffences (17.5 in group I and 15 in group II), but a preexisting renal insufficiency was seen in 18.1% in group I and in 7% in group II (p < 0.05). Incidence of acute renal failure (group I 7.3%, group II 8.3%) and mortality of patients with ARV (group I 18.7%, group II 17.6%) was comparable in both groups.
- Published
- 1996
45. Hinweise für Autoren
- Author
-
Richard Viebahn, Magnus Kaffarnik, Stefan Limmer, Uwe J. Roblick, Wolfgang Schwenk, Martin Stockmann, Tilman Laubert, Hauke Lang, Johan Friso Lock, Wolfgang H. Hartl, Thomas Jungbluth, Arved Weimann, Markus Kleemann, Karl J. Oldhafer, Peter Kujath, Axel Richter, Martin Hoffmann, Tobias Keck, Daniel Seehofer, Hans-Rudolf Raab, Erik Schlöricke, Franz G. Bader, Philipp Hildebrand, Hermann Heinze, Elke Muhl, Armin Frank, Christian Eckmann, Ulrich T. Hopt, Peter Neuhaus, Thomas A. Schildhauer, Hans-Peter Bruch, Stefan Utzolino, Carolin Kayser, Hamed Esnaashari, Frank Hackmann, Justyna Swol, W. F. A. Hiller, and Hermann Heinzeb
- Subjects
medicine.medical_specialty ,Complementary and alternative medicine ,business.industry ,Rare case ,Medicine ,business ,medicine.disease ,Dermatology ,Hibernoma - Abstract
A rare case of hibernoma about the nipple in a 9-year-old boy is presented: the tumour was peculiar not only for the age and region, but also for its superficial, subepidermal site.
- Published
- 2012
46. Importance of adequate fluid resuscitation in patients with severe septic shock on high catecholamine doses
- Author
-
J Lewejohann, H Braasch, D Wichmann, M Hansen, Elke Muhl, and H-P Bruch
- Subjects
medicine.medical_specialty ,Resuscitation ,business.industry ,Septic shock ,Fluid loading ,Hemodynamics ,Critical Care and Intensive Care Medicine ,medicine.disease ,Anesthesia ,Poster Presentation ,Catecholamine ,Medicine ,In patient ,business ,Intensive care medicine ,medicine.drug - Abstract
Evolution of hemodynamic monitoring revealed many septic shock patients on high catecholamines without proper fluid loading before. The aim of our study was to show that it is possible in quite a few cases to reduce these agents by a forced volume resuscitation combined with active reduction of catecholamines.
- Published
- 2008
47. Management of an outbreak of multiresistant Acinetobacter baumanii infection in a surgical intensive care unit
- Author
-
C Zimmermann, H-P Bruch, F Seyfried, Elke Muhl, M Prang, A Henning, J Lewejohann, and M Hansen
- Subjects
Mechanical ventilation ,medicine.medical_specialty ,business.industry ,Septic shock ,medicine.medical_treatment ,Convalescence ,media_common.quotation_subject ,Pleural empyema ,Critical Care and Intensive Care Medicine ,medicine.disease ,Surgery ,Pneumonia ,Respiratory failure ,Poster Presentation ,Medicine ,Endoscopic stenting ,business ,Central venous catheter ,media_common - Abstract
The first report of multiresistant Acinetobacter baumanii (MRAB) was published in 1994. We report about an outbreak sensitive to Polimyxin only. In June 2006 a German holidaymaker (male, 70 years old; patient 1) in Greece felt dyspnea, thoracic pain and fever. He went to a hospital in Crete. CT indicated left-sided pleural empyema, mediastinal emphysema, pericardial effusion and pneumonia. Rapid deterioration lead to septic shock with need for mechanical ventilation. He came to our ICU (15 beds and six IMC beds) via air transport. Endoscopy showed esophagus perforation with need for operation and endoscopic stenting. Several BALs and a central venous catheter from the beginning showed MRAB with intermediate susceptibility to meropenem/aminoglycosides only. The patient received meropenem and gentamycin at first. Despite isolation, MRAB spread over and infected eight more patients in separate rooms and different sections of the ICU 32 days later. Further transmission occurred within a few days: three male patients with multiple trauma (42, 20, and 62 years old; patients 2, 3, and 4), cardia carcinoma (female, 66 years old; patient 5), necrotizing pancreatitis (female, 78 years old; patient 6), splenomegaly owing to polycythaemia vera (male, 74 years old; patient 7 – MRAB diagnosis postmortem), rectal carcinoma (female, 76 years old; patient 8 – isolation because of MRSA infection even before) and respiratory failure after gastric banding (female, 41 years; patient 9). All patients suffered from septic shock with high fever, needed high volume replacement and catecholamines several times and prolonged mechanical ventilation. MRAB was isolated in the tracheal secretion or BAL in all patients, in abdominal drainage (patient 6), and in central venous catheter (patient 5). Environmental investigations showed no problematic circumstances. Colistin i.v. is not available in Germany so it had to be procured from the USA, which caused a delay of treatment for a few days. Another delay occurred because of the rapid growing number of patients who needed Colistin. Patients were treated with an adjusted dosage for 16 days. All patients of the ICU were isolated to avoid new infections as a precaution. After convalescence of two patients, all MRAB patients were moved to the IMC, which was converted to an ICU for this period, to isolate infected patients from uninfected. Three out of nine patients died. All these laborious measures with a great expenditure of logistics worked well; no further transmissions were observed.
- Published
- 2007
48. [Untitled]
- Author
-
H-P Bruch, E Rieh, J Lewejohann, B Börner, and Elke Muhl
- Subjects
medicine.medical_specialty ,ARDS ,Respiratory distress ,business.industry ,Oxygenation index ,Oxygenation ,respiratory system ,Lung injury ,Critical Care and Intensive Care Medicine ,medicine.disease ,Prone ventilation ,Prone position ,Internal medicine ,medicine ,Cardiology ,Breathing ,Intensive care medicine ,business - Abstract
In acute respiratory failure (ARF), in particular acute lung injury (ALI) and respiratory distress syndrome (ARDS), an intervention in the form of rotational therapy (RT) or the prone position (PP) may improve oxygenation by recruiting alveoli situated in dorsal-dependent regions and by alteration of the ventilation/perfusion ratio. The efficacy of this interventions can be demonstrated among other parameters by the course of the oxygenation index. The aim of our study is to analyze the prognostic value of the course of the oxygenation index before and after such an intervention.
- Published
- 2006
49. [Untitled]
- Author
-
Elke Muhl, J Lewejohann, B Börner, E Rieh, and H-P Bruch
- Subjects
medicine.medical_specialty ,ARDS ,Supine position ,Lung ,Respiratory distress ,business.industry ,Oxygenation ,respiratory system ,Lung injury ,Critical Care and Intensive Care Medicine ,medicine.disease ,respiratory tract diseases ,Prone position ,medicine.anatomical_structure ,Internal medicine ,medicine ,Breathing ,Cardiology ,Intensive care medicine ,business - Abstract
In acute respiratory failure (ARF), in particular acute lung injury (ALI) and respiratory distress syndrome (ARDS), change from the supine position (SP) to the prone position (PP) or the use of kinetic therapy can improve oxygenation by recruiting alveoli situated in dorsal-dependent regions of the lung and by alteration of the ventilation/perfusion ratio. The efficacy of this intervention can be demonstrated by the course of oxygenation index. The aim of our study is to compare prone position ventilation (PP) and kinetic therapy (KT) in the first 5 days after intervention in patients with acute respiratory failure.
- Published
- 2005
50. [Untitled]
- Author
-
E Rieh, J Lewejohann, H-P Bruch, and Elke Muhl
- Subjects
medicine.medical_specialty ,ARDS ,Lung ,business.industry ,Oxygenation index ,Oxygenation ,respiratory system ,Lung injury ,Critical Care and Intensive Care Medicine ,medicine.disease ,respiratory tract diseases ,Prone position ,medicine.anatomical_structure ,Internal medicine ,Cardiology ,Breathing ,Medicine ,business ,Intensive care medicine ,Perfusion - Abstract
In acute respiratory failure, classified as acute lung injury (ALI) or the more severe acute respiratory distress syndrome (ARDS), prone position ventilation (PPV) can improve oxygenation by recruiting alveoli situated in dorsal-dependent regions of the lung and by alteration of the ventilation/perfusion ratio. The aim of our study is to analyze the prognostic value of the change of oxygenation after starting prone position ventilation in ARF.
- Published
- 2003
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