The presented modification of dilatational tracheotomy is a safe and effective technique which can be performed on the intensive care unit. Compared with conventional tracheotomy the new method is quickly done and will be an integral part of intensive care treatment.

Numerous patient-related clinical parameters and treatment-specific variables have been identified as causing or contributing to the severity of peritonitis. We postulated that a combination of clinical and surgical markers and scoring systems would outperform each of these predictors in isolation. To investigate this hypothesis, we developed a multivariable model to examine whether survival outcome can reliably be predicted in peritonitis patients treated with open abdomen. This single-center retrospective analysis used univariable and multivariable logistic regression modeling in combination with repeated random sub-sampling validation to examine the predictive capabilities of domain-specific predictors (i.e., demography, physiology, surgery). We analyzed data of 1,351 consecutive adult patients (55.7% male) who underwent open abdominal surgery in the study period (January 1998 to December 2018). Core variables included demographics, clinical scores, surgical indices and indicators of organ dysfunction, peritonitis index, incision type, fascia closure, wound healing, and fascial dehiscence. Postoperative complications were also added when available. A multidomain peritonitis prediction model (MPPM) was constructed to bridge the mortality predictions from individual domains (demographic, physiological and surgical). The MPPM is based on data of n = 597 patients, features high predictive capabilities (area under the receiver operating curve: 0.87 (0.85 to 0.90, 95% CI)) and is well calibrated. The surgical predictor “skin closure” was found to be the most important predictor of survival in our cohort, closely followed by the two physiological predictors SAPS-II and MPI. Marginal effects plots highlight the effect of individual outcomes on the prediction of survival outcome in patients undergoing staged laparotomies for treatment of peritonitis. Although most single indices exhibited moderate performance, we observed that the predictive performance was markedly increased when an integrative prediction model was applied. Our proposed MPPM integrative prediction model may outperform the predictive power of current models.

Patients under continuous sedation with sufentanil exhibit a statistically significant rise in arterial PCO2, however this respiratory depression is only slight and has no clinical significance. Mechanically assisted spontaneous ventilation modes can safely be used under continuous sedation with sufentanil, midazolam or clonidine.

There are recent reports on postoperative pulmonary complications in patients with esophageal cancer who were treated preoperatively with chemotherapy and irradiation. The Hamburg Esophageal Study Group is currently undertaking a prospective randomized study to evaluate the efficacy of preoperative treatment. Postoperative pulmonary complications and mortality in these patients with either a combined preoperative treatment (group 1, n = 11) or chemotherapy alone (group 2, n = 9) are evaluated in the present paper. Complete remission of the tumor was found more often in group 1 (54.6%) than in group 2 (22.2%). However, postoperatively the patients of group 1 developed adult respiratory distress syndrome (ARDS; 54.6%) more frequently than in group 2 (11.1%), and all patients with ARDS died. Thus, although the combined preoperative treatment is more effective in tumor remission, it is associated with a higher respiratory failure and postoperative mortality. Therefore, the preoperative regime has now been changed by the study group. Since after the clinical manifestation of ARDS no causative clinical therapy is available up to now, attention must be focused on the prevention of respiratory failure.

Indication, timing and technique of tracheostomy in intensive care medicine have changed significantly during the last decade. Benefits and risks of percutaneous dilatational tracheostomy are reviewed in the current literature. Typical complications are misplacement of the tracheal cannula, injury to the trachea, trachealstenosis, rupture of the cuff-ballon and death. The results of a questionnaire about the use, timing and complications of percutaneous dilatational tracheostomy at 651 German intensive care units are presented. In Germany tracheostomy is performed within 20 days in 75% of patients on mechanical ventilation, following the recommendation of the Consensus Conference on Artificial Airways in Patients Receiving Mechanical Ventilation from 1989. Percutaneous dilatational tracheostomy in Germany is performed following the methods described by Ciaglia in 58% of intensive care units, Griggs in 35% and Fantoni in 7%.