[Brain death diagnosis after sedation with propofol or sufentanil. Recommendations for the usage of toxicological analytics]. / Hirntoddiagnostik nach Gabe von Propofol oder Sufentanil. Empfehlungen zum Umgang mit toxikologischer Analytik.

BACKGROUND: Before the clinical diagnosis of brain death is made, toxicological analyses are often performed for the exclusion of effective serum levels of previously applied sedating drugs. For propofol and sufentanil there are no uniform recommendations for the usage of toxicology test results. OBJECTIVES: To develop a standard practice in the diagnosis of brain death after therapeutic application of one of these drugs. MATERIAL AND METHODS: Based on the current literature and the available analytical assays, an ad hoc working group consisting of specialists in toxicology and intensive care medicine compiled recommendations for the usage of toxicological analytics in the diagnosis of brain death at the Rostock University Hospital. RESULTS: For propofol, current analytical assays allow the quantification of serum concentrations of 0.2 µg/ml and lower; the execution of clinical brain death diagnostics is recommended by the ad hoc group only at propofol serum levels lower than 0.4 µg/ml. For sufentanil, the currently prevalent assays set lower determination limits of about 0.2 ng/ml in serum and 0.1 ng/ml in urine, which is above the cautiously adopted lower therapeutic serum concentration of 0.02 ng/ml. Therefore after negative determination of sufentanil (< 0.2 ng/ml) in blood serum, the following alternative procedures are recommended: (1) the execution of clinical brain death diagnostics under administration of naloxone; or (2) at intact renal function the additional negative determination of sufentanil in urine (< 0.1 ng/ml). If an assay allowing the detection of sufentanil at ≤ 0.01 ng/ml is available, brain death diagnostics should be carried out only at a serum level lower than 0.02 ng/ml. CONCLUSION: These recommendations may serve as a proposal for similar standards in other hospitals.

[Fever in intensive care patients]. / Fieber in der Intensivmedizin.

Fever is an unspecific symptom of most intensive care patients during their stay on an intensive care unit. The reasons for the increase of body temperature often remain unclear, even extended diagnostic measures are performed. The pathogenetic relevance of fever is commonly underestimated and leads to unreflected treatment of every increase of body temperature above 38 C. But the development of fever in patients is quite often useful and should not be treated with antipyretics. Physical measures like ice packs and surface cooling are only allowed to be used, if the central set point is lower than the actual core body temperature. This gradient can be recognized, when the patient starts to sweat. Principally, the treatment of fever in cardiovascular risk patients, patients with high risk for adverse neurological outcome, pregnant women during the first trimenon and in children with seizures must start with pharmacological interventions,which can be followed by physical measures.