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  • 1
    Publication Date: 2016-06-02
    Description: Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG) and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI) made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF).
    Description: Das hämodynamische Monitoring und die Differentialtherapie mittels adäquater Volumensubstitution sowie positiv inotroper und vasoaktiver Substanzen sind die Grundpfeiler der postoperativen intensivmedizinischen Behandlung von kardiochirurgischen Patienten. Ziel der S3-Leitlinie war es, die Empfehlungen zum Monitoring und zur Therapie Evidenz-basiert zu prüfen sowie Zielkriterien für das Monitoring und die Therapie festzulegen. Die Bewertung erhobener Messparameter im Zusammenhang mit der klinischen Gesamtsituation des Patienten erlaubt die Entwicklung eines weiterführenden Therapiekonzeptes und die Festlegung von Zielkriterien zur Kontrolle des Behandlungserfolges. Bislang existieren Leitlinien und Empfehlungen lediglich für Teilbereiche der kardiochirurgischen Intensivmedizin. So bestehen Leitlinien für den Einsatz des Pulmonalarterienkatheters und der transösophagealen Echokardiographie (TEE) für diesen speziellen Bereich der postoperativen Patientenversorgung.Die Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG) und die Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) haben sich daher zum Ziel gesetzt einen nationalen Ansatz zur Sicherung und Verbesserung der Qualität der postoperativen kardiochirurgischen Intensivmedizin mit der vorliegenden Evidenz-basierten S3-Konsensusleitlinie zu schaffen.Ziel dieser Leitlinie ist eine Bewertung der verfügbaren Monitoring-Verfahren im Hinblick auf Indikationen, Vorgehen, Aussagen, Limitationen, Kontraindikationen und Risiken. Weiterhin die Differentialtherapie mit Volumenersatzlösungen versus positiv inotropen und vasoaktiven Substanzen, die differenzierte Katecholamintherapie einschließlich der Inodilatoren und Kalzium-Sensitizer sowie die Einsatzkriterien der intra-aortalen Ballonpumpe.Die Leitlinie ist in einem standardisierten Prozess nach Vorgaben der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) erstellt worden. Die Verabschiedung der Kernaussagen der Leitlinie erfolgte in zwei Konsensusverfahren unter Moderation der AWMF.
    Keywords: intensive care medicine ; cardiothoracic surgery ; monitoring ; volume therapy ; positive inotropic and vasoactive drugs ; Intensivmedizin ; Kardiochirurgie ; Monitoring ; Volumentherapie ; positiv inotrope und vasoaktive Substanzen ; ddc: 610
    Language: English
    Type: article
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  • 2
    ISSN: 0273-1177
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Mechanical Engineering, Materials Science, Production Engineering, Mining and Metallurgy, Traffic Engineering, Precision Mechanics , Physics
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 0019-1035
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Physics
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    [S.l.] : American Institute of Physics (AIP)
    Review of Scientific Instruments 70 (1999), S. 3435-3438 
    ISSN: 1089-7623
    Source: AIP Digital Archive
    Topics: Physics , Electrical Engineering, Measurement and Control Technology
    Notes: A new type of carbon source using the electron evaporator principle to generate a molecular beam is presented. The electrons are extracted from a hot tungsten filament which is biased negatively up to 1500 V versus the carbon target (ground potential), made from ultrapure pyrolytic graphite. The emission current at a fixed high voltage is controlled via a feedback loop and used to tune the carbon flux. In this way, a flux reproducibility of ±5% is achieved over a working period of 5 months. Flux rates up to 6.1×1011 cm−2 s−1 at a source–sample distance of 250 mm have been achieved. The source design is very compact so it was possible to build it onto a flange with a inner diameter of 40 mm (CF40 flange) which saves mounting space. Using this source it was possible to prepare two dimensional hole gases with hole mobilities up to 160 000 cm2 V−1 s−1 at 1 K. No memory effect was observed. © 1999 American Institute of Physics.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1077-3118
    Source: AIP Digital Archive
    Topics: Physics
    Notes: The degradation of selectivity doped Al0.35Ga0.65As/GaAs heterostructures caused by rapid thermal annealing (RTA) was studied. The samples were annealed for 30 s at temperatures between 600 °C and 850 °C. Thereafter, the samples were characterized by Hall measurements at room temperature. Conventional heterostructures with a random alloy Al0.35Ga0.65As spacer and donor layer show a strong degradation for annealing temperatures of 650 °C or higher. For heterostructures employing a stoichiometric equivalent short period superlattice (SPS) in spacer and donor region only a slight degradation was found for annealing temperatures up to 850 °C. As reason for the increased thermal stability, the suppression of As loss during the annealing by the SPS was identified. © 2001 American Institute of Physics.
    Type of Medium: Electronic Resource
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  • 6
    Source: ACS Legacy Archives
    Topics: Chemistry and Pharmacology , Physics
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0922-3371
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    [S.l.] : American Institute of Physics (AIP)
    Journal of Applied Physics 88 (2000), S. 321-325 
    ISSN: 1089-7550
    Source: AIP Digital Archive
    Topics: Physics
    Notes: We have investigated the electron transport properties of a two-dimensional electron gas in a selectively doped AlxGa1−xAs/GaAs heterostructure with reduced Al content in the doped layer by recording the longitudinal resistance as a function of magnetic field and performing Hall measurements at low magnetic fields on the same sample. The electron density was varied by stepwise illumination and we observe a dip in the mobility versus density dependence around a density of 5.0×1011 cm−2. As a reason for this mobility decrease we identify by magnetotransport measurements the onset of parallel conductance in the Si-doped AlxGa1−xAl layer. With the onset of parallel conductance, the anisotropy in the electron mobility increases significantly. We attribute this to an increase of interface roughness scattering induced by the parallel conducting channel. © 2000 American Institute of Physics.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    College Park, Md. : American Institute of Physics (AIP)
    The Journal of Chemical Physics 91 (1989), S. 646-654 
    ISSN: 1089-7690
    Source: AIP Digital Archive
    Topics: Physics , Chemistry and Pharmacology
    Notes: The infrared spectra of the ν3, ν4, and ν6 bands of formaldehyde in the region from 890 cm−1 to 1580 cm−1 have been obtained at high resolution using tunable diode laser (TDL) and Fourier transform-infrared (FT-IR) spectroscopy. The transition frequencies have been analyzed using a Hamiltonian including terms through sextic in centrifugal distortion and including five interstate vibration–rotation coupling terms. Excited state pure rotational transitions are also included in the data, and their frequencies are reproduced well. Individual measured line intensities are used to determine dipole derivatives and band strengths using the fully coupled, asymmetric top eigenvectors.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Journal of Molecular Spectroscopy 115 (1986), S. 294-304 
    ISSN: 0022-2852
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Chemistry and Pharmacology , Physics
    Type of Medium: Electronic Resource
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