Diversity of Cl− Channels

Cl− channels are widely found anion pores that are regulated by a variety of signals and that play various roles. On the basis of molecular biologic findings, ligand-gated Cl− channels in synapses, cystic fibrosis transmembrane conductors (CFTRs) and ClC channel types have been established, followed by bestrophin and possibly by tweety, which encode Ca2+-activated Cl− channels. The ClC family has been shown to possess a variety of functions, including stabilization of membrane potential, excitation, cellvolume regulation, fluid transport, protein degradation in endosomal vesicles and possibly cell growth. The molecular structure of Cl− channel types varies from 1 to 12 transmembrane segments. By means of computer-based prediction, functional Cl− channels have been synthesized artificially, revealing that many possible ion pores are hidden in channel, transporter or unidentified hydrophobic membrane proteins. Thus, novel Cl−-conducting pores may be occasionally discovered, and evidence from molecular biologic studies will clarify their physiologic and pathophysiologic roles

Einsatz der Lagerungstherapie auf deutschen Intensivstationen

Background.The effects of a systematic change in a patient's position [prone position, continuous lateral rotational therapy (CLRT)] have been investigated in recent years in acute lung injury and have shown an improvement in oxygenation, but controversial results regarding duration of mechanical ventilation, intensive care treatment and mortality compared to conventionally treated patients. We were interested in the practice and acceptance of positioning therapy in German intensive care units (ICU) and performed a national postal survey with respect to evaluation of indications, preference of particular positions, observed complications and additional aspects (costs, influence on other intensive care measures etc.). Methods. A questionnaire (12 multiple choice items) was sent to 1,763 ICUs, which were identified from the "Deutsches Krankenhausadressbuch" (German hospital address book 2005). The analysis was performed anonymously. Results. A total of 702 questionnaires (40.4%) were returned and analysed. The 135 degrees position (incomplete prone position) was most frequently used (50%), while the prone position (25%) and CLRT (18%) were less frequent. The improvement in oxygenation (95%) and the prevention of ventilator-associated complications (75.7%) were important indications for positioning therapy. Results of a blood gas analysis provided the necessary criteria for determining positional therapy. Supporters of the prone position advocated lower cost and better efficacy in comparison to CLRT. The frequency of complications during positioning therapy was reported to be high: hemodynamic instability (73.6%), accidental loss of tube/catheters (50.4%) and patient intolerance (40.7%) were often observed, and complication-free positioning therapy was reported in only 8.6%. Conclusions. The 135 degrees position (incomplete prone position) is the most frequently used positioning therapy in Germany for improvement of oxygenation in patients with acute lung injury. Prone position and CLRT are less frequently used, probably due to an increased frequency of (expected) complications. The authors assume that clear guidelines and algorithms are needed to establish a more routine, safe practical application and a reduction in the complication rate

Arztbegleiteter Patiententransport

Introduction. To relieve existing interhospital transfer systems, a novel transfer vehicle was introduced in Bavaria in 2009. Its aim was to transfer patients who need care by an emergency physician but are not considered intensive care patients. Method. Logistic data (time, duration, location, distance, hospital units) and relevant medical data (urgency, medication, ventilation, special monitoring) were documented. Simultaneously the transport volume of the existing systems were evaluated after the introduction of the novel vehicle. Results. A total of 1762 transfers were documented (on average 1.6/day): 84% took place weekdays and 85% during daytime. Intensive care procedures like invasive hemodynamic monitoring, ventilation, and continuous medication were performed in 51% of patients. In 20 %, discontinuous medication was needed. In 16%, an indication for monitoring by a physician existed. Due to an overall increasing transfer volume no relevant relief was seen for the existing systems. Discussion. There seems to be a need for physician-staffed interhospital transfers especially weekdays during the daytime. In half of the transfers, intensive care-related procedures were performed. Only one third of the patients fulfilled the criteria defined at introduction of the novel vehicle. Therefore a revision of the system seems necessary

Extrakorporale CO2-Elimination als Alternative zur Tracheotomie bei Weaningversagen

We report a patient with chest trauma who was admitted to the ICU after surgery. As he fulfilled protocol-based criteria, he was extubated 7 days after admission. However, despite intermittent non-invasive ventilation, the patient had to be re-intubated on day 10 owing to progressive hypercapnia. We decided to support the patient with a mid-flow veno-venous extracorporeal carbon dioxide removal (ECCO(2)aEuroR) system instead of a tracheotomy. Sufficient CO2 removal was established with a blood flow of 1.5 l/min and the patient was successfully extubated within a few hours. After 5 days of ECCO(2)aEuroR the patient could be weaned and transferred to a general ward in a stable condition