Was gibt es Neues in der Intensivmedizin - eine Übersicht

Zusammenfassung

Die vorliegende Arbeit gibt eine Zusammenfassung wichtiger Untersuchungen zu Fragen der Intensivmedizin, die in intensivmedizinischen oder chirurgischen Fachzeitschriften im Jahr 2004 publiziert worden sind. Hierbei wurden ausschließlich klinische Studien berücksichtigt, überwiegend Metaanalysen und randomisierte Studien, sowie einzelne besonders wichtige oder interessante Beobachtungsstudien. Neben der Darstellung der wichtigsten Ergebnisse wurde auch eine Bewertung versucht, die jedoch nicht umfassend und vollständig sein kann, sondern als Denkanstoß für die kritische Würdigung durch den Leser gedacht ist. Bei der großen Zahl hochwertiger und relevanter Studien fällt auf, dass hierin auch eine signifikante Anzahl von Untersuchungen mit negativem Ergebnis enthalten ist und auf diese Weise ganz erheblich zur Festlegung des aktuellen Erkenntnisstandes beigetragen wird. Einige dargestellte Fragestellungen seien hier angesprochen: Vasopressin als Alternative zu Adrenalin bei der kardiopulmonalen Reanimation, Spezifizierung der Indikationen für den Einsatz von aktiviertem Protein C in der Sepsis, Bedeutung der Steroidtherapie bei Sepsis und Schädel-Hirn-Trauma, Epidemiologie des ARDS, Rolle von Sedierungsprotokollen, Weaningprotokollen und dem Zeitpunkt einer Tracheotomie für die Beatmungsdauer, Nutzen antibakteriell beschichteter Katheter zur Vermeidung der Katheter-assoziierten Sepsis und der Nutzen einer enteralen Ernährung im Vergleich zur parenteralen Applikation.

Abstract

This manuscript gives a review about important studies addressing problems in intensive care medicine that have been published in journals focussing on critical care medicine and surgery in 2004. Only clinical studies are included in this review, mostly metaanalyses, randomized controlled trials and a few important or interessting observational studies. In addition to describing major results a critical appraisal of each study is undertaken, which, however, is neither comprehensive nor complete. It is merely intentioned to address some important aspects for the reader that should be accounted for while interpreting the results. It is important to note that among the large number of excellent studies there is a substantial proportion of trials with negative results that significantly add to our knowledge. Some of the topics addressed in this manuscript include vasopressin as an alternative to epinephrine during cardipulmonary resuscitation, a specification concerning the use of activated protein C in patients with sepsis, the role of steroids in the treatment of sepsis and traumatic brain injury, the epidemiolody of ALI and ARDS, the role of sedation protocols, weaning protocols and the timing of tracheostomy for the duration of mechanical ventilation, the potential benefit of catheters with antimicrobial coating to reduce catheter-related sepsis, and the benefit of enteral nutrition as compared to the parenteral application.

Intensivmedizin - klinische Studien - randomisierte Studien - Metaanalysen

intensive care medicine - critical care - clinical trials - randomized trials - metaanalysis - outcome

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