S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders : Revision 2015: S2e guideline of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI).

The German Society of Anesthesiology and Intensive Care Medicine (DGAI) commissioneda revision of the S2 guidelines on "positioning therapy for prophylaxis or therapy of pulmonary function disorders" from 2008. Because of the increasing clinical and scientificrelevance the guidelines were extended to include the issue of "early mobilization"and the following main topics are therefore included: use of positioning therapy and earlymobilization for prophylaxis and therapy of pulmonary function disorders, undesired effects and complications of positioning therapy and early mobilization as well as practical aspects of the use of positioning therapy and early mobilization. These guidelines are the result of a systematic literature search and the subsequent critical evaluation of the evidence with scientific methods. The methodological approach for the process of development of the guidelines followed the requirements of evidence-based medicine, as defined as the standard by the Association of the Scientific Medical Societies in Germany. Recently published articles after 2005 were examined with respect to positioning therapy and the recently accepted aspect of early mobilization incorporates all literature published up to June 2014.

[Prevention of organ failure in an organ donor. Early identification and maximum protective therapy after multiple trauma]. / Verhinderung des Organversagens beim Organspender. Frühzeitige Identifikation und maximale protektive Therapie nach Polytrauma.

ANAMNESIS: A 18-year-old woman suffered from severe multi-trauma in combination with acute brain injury (Glasgow Coma Scale Score = 4) after road accident. After prolonged rescue measures and emergency stabilisation the patient was transferred by helicopter to the emergency department of our clinic. INVESTIGATIONS: Cranial computer tomography showed a severe general cerebral edema and a marked reduction in cerebral perfusion. Additionally, blunt abdominal injury, severe chest injury and multiple fractures were seen. Due to the severe and diffuse brain injury, a neurosurgical intervention was not possible. The patient was transferred to the intensive care unit. THERAPY AND COURSE: Intensive supportive therapy was started (artificial ventilation, massive transfusion, volume replacement, insertion of a chest tube, renal replacement therapy). Control cerebral computer tomography indicated a complete destruction of the cerebral parenchyma and infarction. Sedation was stopped. After 48-hours of intensive care therapy brain death was stated and the approval for organ donation was given by the next of kin. Heart and kidneys were explanted and transplanted successfully. CONCLUSION: Even under conditions of limited organ functions early identification and maximal supportive therapy may help to supply organ donation. Under certain condition, multiorgan failure may be reversible in possible organ donors.