Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 17 de 17
Filter
1.
Atemwegs- und Lungenkrankheiten ; 46(4):245, 2020.
Article in German | ProQuest Central | ID: covidwho-1710725
2.
Deutsche Medizinische Wochenschrift ; 147(1-2):8-9, 2022.
Article in German | Scopus | ID: covidwho-1625371
3.
Deutsche Medizinische Wochenschrift ; 147(01/02):8-9, 2022.
Article in German | Web of Science | ID: covidwho-1610107
4.
Anaesthesist ; 70(Suppl 1): 19-29, 2021 12.
Article in English | MEDLINE | ID: covidwho-1574765

ABSTRACT

Since December 2019 a novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) has rapidly spread around the world resulting in an acute respiratory illness pandemic. The immense challenges for clinicians and hospitals as well as the strain on many healthcare systems has been unprecedented.The majority of patients present with mild symptoms of coronavirus disease 2019 (COVID-19); however, 5-8% become critically ill and require intensive care treatment. Acute hypoxemic respiratory failure with severe dyspnea and an increased respiratory rate (>30/min) usually leads to intensive care unit (ICU) admission. At this point bilateral pulmonary infiltrates are typically seen. Patients often develop a severe acute respiratory distress syndrome (ARDS).So far, remdesivir and dexamethasone have shown clinical effectiveness in severe COVID-19 in hospitalized patients. The main goal of supportive treatment is to ascertain adequate oxygenation. Invasive mechanical ventilation and repeated prone positioning are key elements in treating severely hypoxemic COVID-19 patients.Strict adherence to basic infection control measures (including hand hygiene) and correct use of personal protection equipment (PPE) are essential in the care of patients. Procedures that lead to formation of aerosols should be carried out with utmost precaution and preparation.


Subject(s)
COVID-19 , Critical Illness , Humans , SARS-CoV-2
6.
Deutsche Medizinische Wochenschrift ; 146(12):780-+, 2021.
Article in German | Web of Science | ID: covidwho-1285854
7.
Medizinische Klinik-Intensivmedizin Und Notfallmedizin ; 116(SUPPL 2):68-68, 2021.
Article in German | Web of Science | ID: covidwho-1260335
8.
Medizinische Klinik-Intensivmedizin Und Notfallmedizin ; 116(SUPPL 2):67-68, 2021.
Article in German | Web of Science | ID: covidwho-1260322
9.
Thoracic and Cardiovascular Surgeon ; 69(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1240797

ABSTRACT

Objectives: With the occurrence of the COVID-19 pandemic in the year of 2020 the number of patients in need ofintensive care medicine increased dramatically in many countries. Several of them developed an acute respiratory distresssyndrome (ARDS) linked to the COVID-19 infection and many required the use of extracorporeal membrane oxygenation(ECMO). Methods: We are retrospectively reviewing 141 patients who underwent ECMO for severe COVID-19-related ARDS in amulticenter study at 10 European ECMO centers. Result: A total of 141 patients (67.4% male, median age was 55.4 years (interquartile range [IQR]: 44-67.5) were treatedwith ECMO for confirmed (132) or suspected (9) severe COVID-19-related ARDS. Before ECMO, the median SequentialOrgan Failure Assessment (SOFA) score was 9.0 (IQR: 7.0-11.5), median pH was 7.25 (IQR: 7.20-7.30), and medianPaO /FiO ratio was 70 mm Hg (IQR: 60-77). Venovenous ECMO was provided in 130 patients (92%) and venoarterial ECMO in 11 patients (8%) The median duration ofECMO treatment by now was 11 days, IQR: 7-17). At the time of reporting, 71 confirmed COVID-19 patients (53.8%) arealive, of whom 33 (43.4%) are still in the intensive care unit (9 on ECMO, 24 weaned from ECMO and extubated). Overallmortality so far occurred in 62 patients (46.2%). By now advanced age, low arterial pH, and low platelet count before ECMO were independent risk factors for increasedmortality during the intensive care treatment. Conclusion: Despite a substantial overall mortality of over 40%, approximately half of the patients with severe COVID-19-related ARDS, refractory to conventional treatment, may be successfully managed with ECMO therapy.

11.
Pneumologie ; 75(2): 88-112, 2021 Feb.
Article in German | MEDLINE | ID: covidwho-1033360

ABSTRACT

Since December 2019, the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus-2) has been spreading rapidly in the sense of a global pandemic. This poses significant challenges for clinicians and hospitals and is placing unprecedented strain on the healthcare systems of many countries. The majority of patients with Coronavirus Disease 2019 (COVID-19) present with only mild symptoms such as cough and fever. However, about 6 % require hospitalization. Early clarification of whether inpatient and, if necessary, intensive care treatment is medically appropriate and desired by the patient is of particular importance in the pandemic. Acute hypoxemic respiratory insufficiency with dyspnea and high respiratory rate (> 30/min) usually leads to admission to the intensive care unit. Often, bilateral pulmonary infiltrates/consolidations or even pulmonary emboli are already found on imaging. As the disease progresses, some of these patients develop acute respiratory distress syndrome (ARDS). Mortality reduction of available drug therapy in severe COVID-19 disease has only been demonstrated for dexamethasone in randomized controlled trials. The main goal of supportive therapy is to ensure adequate oxygenation. In this regard, invasive ventilation and repeated prone positioning are important elements in the treatment of severely hypoxemic COVID-19 patients. Strict adherence to basic hygiene, including hand hygiene, and the correct wearing of adequate personal protective equipment are essential when handling patients. Medically necessary actions on patients that could result in aerosol formation should be performed with extreme care and preparation.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Humans , Inpatients , Pandemics , Practice Guidelines as Topic , SARS-CoV-2
12.
Klinikarzt ; 49(10):409-413, 2020.
Article in German | EMBASE | ID: covidwho-963567
13.
Klinikarzt ; 49(10):409-413, 2020.
Article in German | Scopus | ID: covidwho-900045
15.
Deutsches Arzteblatt International ; 117(31-32):A1498-A1502+A4, 2020.
Article in German | EMBASE | ID: covidwho-847508
16.
Med Klin Intensivmed Notfmed ; 115(8): 641-648, 2020 Nov.
Article in German | MEDLINE | ID: covidwho-840889

ABSTRACT

BACKGROUND: Outbreaks of infectious diseases pose particular challenges for hospitals and intensive care units. OBJECTIVES: Typical infectiological scenarios and their significance for modern intensive care medicine are presented. MATERIALS AND METHODS: Selected pathogens/infectious diseases that have significantly strained the resources of intensive care units are described. RESULTS: Intensive medical care is necessary in severe cases of many infectious diseases. In the context of epidemics/pandemics, many critically ill patients have to be admitted within a short time. Examples are the 2009 H1N1 influenza pandemic, the 2011 enterohemorrhagic Escherichia coli (EHEC) outbreak in northern Germany, the 2014/2015 Ebola fever outbreak and the 2020 coronavirus disease 19 (COVID-19) pandemic. Multidisciplinary teams, protocol development, adequate staffing, and training are required to achieve optimal treatment outcomes, including prevention of healthcare worker infections. CONCLUSIONS: Pandemics and epidemics are unique challenges for intensive care unit preparedness planning.


Subject(s)
Coronavirus Infections , Disasters , Influenza A Virus, H1N1 Subtype , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Critical Care , Germany , Humans , SARS-CoV-2
17.
Pneumologie ; 74(6): 337-357, 2020 Jun.
Article in German | MEDLINE | ID: covidwho-611131

ABSTRACT

Against the background of the pandemic caused by infection with the SARS-CoV-2, the German Society for Pneumology and Respiratory Medicine (DGP e.V.), in cooperation with other associations, has designated a team of experts in order to answer the currently pressing questions about therapy strategies in dealing with COVID-19 patients suffering from acute respiratory insufficiency (ARI).The position paper is based on the current knowledge that is evolving daily. Many of the published and cited studies require further review, also because many of them did not undergo standard review processes.Therefore, this position paper is also subject to a continuous review process and will be further developed in cooperation with the other professional societies.This position paper is structured into the following five topics:1. Pathophysiology of acute respiratory insufficiency in patients without immunity infected with SARS-CoV-22. Temporal course and prognosis of acute respiratory insufficiency during the course of the disease3. Oxygen insufflation, high-flow oxygen, non-invasive ventilation and invasive ventilation with special consideration of infectious aerosol formation4. Non-invasive ventilation in ARI5. Supply continuum for the treatment of ARIKey points have been highlighted as core statements and significant observations. Regarding the pathophysiological aspects of acute respiratory insufficiency (ARI), the pulmonary infection with SARS-CoV-2 COVID-19 runs through three phases: early infection, pulmonary manifestation and severe hyperinflammatory phase.There are differences between advanced COVID-19-induced lung damage and those changes seen in Acute Respiratory Distress Syndromes (ARDS) as defined by the Berlin criteria. In a pathophysiologically plausible - but currently not yet histopathologically substantiated - model, two types (L-type and H-type) are distinguished, which correspond to an early and late phase. This distinction can be taken into consideration in the differential instrumentation in the therapy of ARI.The assessment of the extent of ARI should be carried out by an arterial or capillary blood gas analysis under room air conditions and must include the calculation of the oxygen supply (measured from the variables of oxygen saturation, the Hb value, the corrected values of the Hüfner number and the cardiac output). In principle, aerosols can cause transmission of infectious viral particles. Open systems or leakage systems (so-called vented masks) can prevent the release of respirable particles. Procedures in which the invasive ventilation system must be opened, and endotracheal intubation must be carried out are associated with an increased risk of infection.The protection of personnel with personal protective equipment should have very high priority because fear of contagion must not be a primary reason for intubation. If the specifications for protective equipment (eye protection, FFP2 or FFP-3 mask, gown) are adhered to, inhalation therapy, nasal high-flow (NHF) therapy, CPAP therapy or NIV can be carried out according to the current state of knowledge without increased risk of infection to the staff. A significant proportion of patients with respiratory failure presents with relevant hypoxemia, often also caused by a high inspiratory oxygen fraction (FiO2) including NHF, and this hypoxemia cannot be not completely corrected. In this situation, CPAP/NIV therapy can be administered under use of a mouth and nose mask or a respiratory helmet as therapy escalation, as long as the criteria for endotracheal intubation are not fulfilled.In acute hypoxemic respiratory insufficiency, NIV should be performed in an intensive care unit or in a comparable unit by personnel with appropriate expertise. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring with readiness to carry out intubation must be ensured at all times. If CPAP/NIV leads to further progression of ARI, intubation and subsequent invasive ventilation should be carried out without delay if no DNI order is in place.In the case of patients in whom invasive ventilation, after exhausting all guideline-based measures, is not sufficient, extracorporeal membrane oxygenation procedure (ECMO) should be considered to ensure sufficient oxygen supply and to remove CO2.


Subject(s)
Continuous Positive Airway Pressure , Noninvasive Ventilation/methods , Positive-Pressure Respiration , Practice Guidelines as Topic , Pulmonary Edema/therapy , Respiratory Distress Syndrome/therapy , Respiratory Insufficiency/therapy , Berlin , Betacoronavirus , COVID-19 , Continuous Positive Airway Pressure/standards , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Humans , Intubation, Intratracheal , Lung/physiopathology , Lung/virology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pulmonary Edema/etiology , Respiratory Distress Syndrome/etiology , Respiratory Insufficiency/prevention & control , SARS-CoV-2 , Societies, Medical
SELECTION OF CITATIONS
SEARCH DETAIL