[Post Resuscitation Care]. / Post Resuscitation Care ­ Postreanimationsbehandlung.

After successful resuscitation, further treatment has a decisive influence regarding patient outcome. Not only overall survival, but also the neurological outcome that is crucial for patients' quality of life can be positively influenced by optimized post-cardiac arrest treatment. The management of various consequences of post-cardiac arrest syndrome is discussed in the current version of the ERC-guidelines in the chapter "post resuscitation care". A step-by-step approach based on an algorithm provides the necessary structure. The immediate treatment and stabilization of patients after ROSC is followed by the diagnosis of the triggering pathology in order to initiate adequate therapy. During the subsequent intensive care treatment, the focus is on optimizing neurological recovery.

[Hemodynamic Monitoring 2.0 - What is Possible on Normal Wards?] / Hämodynamisches Monitoring 2.0 ­ was ist auf Normalstation möglich?

Life threatening events after surgery often occur on the ward. These events could be prevented by early detection of clinical deterioration of patients' health status during ward care. Therefore, an adequate monitoring could help to identify patients at risk, since there is an imbalance of monitoring intensity and the occurrence of life-threatening events during hospital stay.Additional monitoring on the general ward could lead to more patient safety. The practicability of additional monitoring needs to be considered, and therefore the use of available monitoring systems on the ward is limited. Capillary refill time (CRT) and the passive leg raise test (PLR) seem to be usable intermittent monitoring techniques.Continuous monitoring systems ensure a better detection of unwanted events and hemodynamic trends. However, the increased workload for the nursing staff and tethered monitors are unfavorable. Future trends of developing wireless monitoring systems are of paramount importance in this respect. Controlling artefacts is crucial for the successful balance between false alarms and "missed events". An adequate reaction is needed when detecting adverse events to avoid a "failure to rescue".

[Monitoring of Fluid Therapy]. / Monitoring und Steuerung der Flüssigkeitstherapie ­ wozu und womit?

Fluid and volume therapy is of paramount importance in anaesthesia and intensive care medicine. Fluid replacement as well as volume therapy can cause hypervolemia with deleterious consequences. Therefore, a prerequisite for an adequate volume therapy is the assessment of fluid responsiveness. Several monitoring techniques for evaluation of volume status and of volume responsiveness are currently used. However, there are several limitations of the different monitoring techniques that the user should be aware of. An algorithm can be helpful for a structured approach in monitoring volume therapy.

Spectroscopic and Electronic Properties of Molybdacarborane Complexes with Non-innocently Acting Ligands.

The molybdacarboranes [3-{L-κ2 N,N}-3-(CO)2 -closo-3,1,2-MoC2 B9 H11 ] (L=2,2'-bipyridine (2,2'-bpy, 1 a) or 1,10-phenanthroline (1,10-phen, 1 b)) incorporating well-known potentially non-innocent ligands (CO, 2,2'-bpy, 1,10-phen) and the "non-spectator" nido-carborane ([η5 -C2 B9 H11 ]2- ) ligand were prepared and fully characterised. High-resolution mass spectrometry, single-crystal X-ray diffraction methods, spectroscopy (IR, (resonance) Raman, NMR), cyclic voltammetry and spectroelectrochemistry (electrochemical properties) were supported by theoretical investigations of the electronic structure (DFT, CAS-SCF, TD-DFT).

[Coagulation Monitoring and Bleeding Management in Cardiac Surgery]. / Kardioanästhesie: Monitoring der Gerinnung und Gerinnungstherapie.

The transfusion of allogeneic blood products is associated with increased morbidity and mortality. An impaired hemostasis is frequently found in patients undergoing cardiac surgery and may in turn cause bleeding and transfusions. A goal directed coagulation management addressing the often complex coagulation disorders needs sophisticated diagnostics. This may improve both patients' outcome and costs. Recent data suggest that coagulation management based on a rational algorithm is more effective than traditional therapy based on conventional laboratory variables such as PT and INR. Platelet inhibitors, cumarins, direct oral anticoagulants and heparin need different diagnostic and therapeutic approaches. An algorithm specifically developed for use during cardiac surgery is presented.

Lack of evidence for pleiotropic effects of clopidogrel on endothelial function and inflammation in patients with stable coronary artery disease: results of the double-blind, randomized CASSANDRA study.

BACKGROUND: Recently we have demonstrated a dose-dependent improvement of endothelial function after administration of a single loading dose of clopidogrel in patients with coronary artery disease (CAD). We therefore hypothesized that chronic therapy with clopidogrel may improve endothelial function in patients with CAD. METHODS: In a double-blind, randomized, monocentric study 120 patients with established CAD were randomized to one of the following treatment arms: clopidogrel 75 mg q.d., acetylsalicylic acid (ASA) 100 mg q.d., or a combination of ASA and clopidogrel. Endothelium-dependent flow-mediated dilation (FMD) and endothelium-independent nitroglycerin-mediated dilation (NMD) of the brachial artery were determined before and after 28 days of treatment. The effect of clopidogrel was monitored in vitro by ADP-induced platelet aggregation in platelet-rich plasma. Effects of treatment on platelet superoxide production were measured by lucigenin-enhanced chemiluminescence in washed platelets. C-reactive protein, RANTES and monocyte chemoattractant protein-1 were determined as inflammatory markers. The study was registered as ISRCTN34097747. RESULTS: Treatment groups were comparable regarding age, gender, cardiovascular risk factor distribution and concomitant medication. FMD [median (IQR) ASA, +0.8 (-2.0; 2.7); ASA + clopidogrel, ±0 (-2.0; 2.9); clopidogrel, +1.0 (-1.1; 2.4); P = n.s.], NMD, platelet superoxide production or inflammatory markers remained unchanged in all treatment groups. CONCLUSION: We conclude that the beneficial effects of short-term effects of clopidogrel on endothelial function of patients with CAD are abolished after long-term clopidogrel treatment.

Effects of pentaerythritol tetranitrate on endothelial function in coronary artery disease: results of the PENTA study.

BACKGROUND: Pentaerythritol tetranitrate (PETN) differs from other organic nitrates by the lack of tolerance induction and by antioxidative properties. The purpose of this study was to determine the effect of PETN on endothelial function in patients with coronary artery disease (CAD). We hypothesized that the treatment with PETN improves endothelial function in patients with CAD. METHODS: In a prospective, double-blind study, we randomly assigned 80 patients to treatment for 8 weeks with oral PETN 80 mg t.i.d. (PETN) or placebo (C). The primary endpoint was the absolute change in brachial artery flow-mediated dilation (FMD) from baseline to follow-up. Furthermore, changes in nitroglycerin-mediated dilation (NMD), digital peripheral arterial tonometry (PAT) index, vascular shear stress, mean flow velocity, plasma bilirubin, C-reactive protein (CRP) and thiobarbituric acid reactive substances (TBARS), serum ferritin, and the activity of the PETN bioactivating enzyme aldehyde dehydrogenase-2 (ALDH-2) in peripheral blood mononuclear cells were analyzed. Raw data entry, data monitoring and statistical analysis were performed independently. RESULTS: The treatment groups were comparable regarding demographics, cardiovascular risk and concomitant medication. There was no difference in the change in FMD between the two treatment groups (mean +/- SD: PETN: +1.6 +/- 3.3% vs. C: +1.4 +/- 4.1%; P = 0.7). NMD increased after treatment with PETN and was higher compared with C (PETN: +3.8 +/- 5.5% vs. C: +0.6 +/- 4.2%; P = 0.004). Mean PAT index and ALDH-2 activity remained unchanged. Relative changes in mean flow volume (P = 0.04) and mean flow velocity (P = 0.01) upon ischemia increased in the PETN group versus C. Changes in bilirubin, ferritin, TBARS and CRP did not differ between the groups. CONCLUSIONS: We conclude that chronic PETN therapy in patients with CAD may be established for symptomatic treatment without adverse effects on endothelial function and with beneficial effects on the microcirculation.