intensiv 2010; 18(3): 131-137
DOI: 10.1055/s-0030-1253481
Intensivpflege|Intensivmedizin
© Georg Thieme Verlag KG Stuttgart · New York

Ein Pflege-Beatmungskonzept – Teil 2

Peter Nydahl, Oliver Rothaug
Further Information

Publication History

Publication Date:
29 April 2010 (online)

Zusammenfassung

Der Artikel beschreibt ein pflegerisches Beatmungskonzept, das auf dem Ethikkodex der Deutschen Gesellschaft für Fachkrankenpflege und Funktionsdienste (DGF) basiert und am Patientenerleben sowie verschiedenen Leitlinien orientiert ist. Zu einer „guten” Pflege von beatmeten Patienten fassen wir zehn verschiedene Aspekte in einem teamorientierten Konzept zusammen, nennen Indikationen, Strukturen, Prozesse (Assessments und Algorithmen) und mögliche Ergebnisse. Zur Pflege beatmeter Patienten gehören biografische Anamnese, Angehörigenbetreuung, Anteilnahme (Intensivtagebuch, Information, Nachsorge), Frühmobilisierung unter Beatmung, pulmonale Positionierung in der kritischen Beatmung und umgrenzende Positionierung in der Aufwachphase, leichte pflegegesteuerte Sedierung anhand von Vorgaben und ebensolche Analgesie, Anpassung der Beatmung durch Pflegende wie auch Weaning sowie Vermeidung von Komplikationen (VAP-Bundles, Airway-, BZ-Management, Ernährung, Delirscreening). Wir heben die möglichen Synergieeffekte hervor und möchten damit eine Diskussion anregen und gleichzeitig die Pflege von Beatmeten didaktisch etwas erleichtern.

Literatur

  • 01 http://www.dgf-online.de 3.7.2009
  • 02 Rotondi A J, Chelluri L , Sirio  C  et al.. Patients’ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit.  Crit Care Med. 2002;  30 (4) 746-752
  • 03 Johnson P , St John W , Moyle  W . Long-term mechanical ventilation in a critical care unit: existing in an uneveryday world.  J Adv Nurs. 2006;  53 (5) 551-558
  • 04 Arslanian-Engoren  C , Scott L D. The lived experience of survivors of prolonged mechanical ventilation: a phenomenological study.  Heart Lung. 2003;  32 (5) 328-334
  • 05 Wang K , Zhang B , Li C  et al.. Qualitative analysis of patients’ intensive care experience during mechanical ventilation.  J Clin Nurs. 2009;  18 (2) 183-190
  • 06 Cook D J, Meade M O, Perry A G. Experience of Weaning From Mechanical Qualitative Studies on the Patient’s Ventilation.  Chest. 2001;  120 469-473
  • 07 Stein-Parbury  J , McKinley  S . Patients’ experiences of being in an intensive care unit: a select literature review.  American Journal of Critical Care. 2000;  9 (1) 20-27
  • 08 Sheen L , Oates J . A phenomenological study of medically induced unconsciousness in intensive care.  Aust Crit Care. 2005;  18 (1) 25-29 31-32
  • 09 Besendorf A . Das Erleben von Patienten auf Intensivstationen.  Pflege. 2002;  15 301-308
  • 10 Schelling  G . Post-traumatic stress disorder in somatic disease: lessons from critically ill patients.  Prog Brain Res. 2008;  167 229-237
  • 11 Johannson L , Fjellman-Wiklund  . Ventilated patients’ experiences of body awareness at an intensive care unit.  Advances in Physiotherapy. 2005;  7 154-161
  • 12 Valencia  M , Torres  A . Ventilator-associated pneumonia.  Current Opinion in Critical Care. 2009;  15 30-35
  • 13 Linton D M, van Heerden P V. Guidelines, protocols, regimens, procedures and processes: a recommendation for standardised terminology in ICU patient care activities, while we “bundle along”!.  Critical Care and Resuscitation. 2009;  10 (2) 149-151
  • 14 Nydahl P . Biographische Anamnese – Werkzeug für eine individuelle Pflege.  Pflegen intensiv. 2008;  1 (4) 6-10
  • 15 Ullrich L , Stolecki D . Grünewald M , (Hrsg.) Thiemes Intensivpflege und Anästhesie. Thieme; Stuttgart; 2005: 73-ff
  • 16 Perrin F , Schnakers C , Schabus M  et al.. Brain response to one’s own name in vegetative state, minimally conscious state, and locked-in syndrome.  Arch Neurol. 2006;  63 (4) 562-569
  • 17 Boly  M , Faymonville M E, Peigneux  P  et al.. Auditory processing in severely brain injured patients: differences between the minimally conscious state and the persistent vegetative state.  Arch Neurol. 2004;  61 (2) 233-238
  • 18 Saur P , Gatzert S , Kettler D . Untersuchung zur Befindlichkeit von beatmeten Patienten.  Anästhesiol Intensivmed Notfallmed Schmerztherapie. 2004;  39 542-550
  • 19 Metzing S , Osarek J . Besuchsregelungen auf Intensivstationen. Eine Literaturstudie englischsprachiger Veröffentlichungen von 1984 – 1985.  Pflege. 2000;  13 (4) 242-252
  • 20 Kuhlmann  B . Die Beziehung zwischen Angehörigen und Pflegenden auf der Intensivstation.  Pflege. 2004;  17 145-154
  • 21 Metzing S . Bedeutung von Besuch für Patientinnen und Patienten während ihres Aufenthaltes auf einer Intensivstation. In: Abt-Zegelin A , (Hrsg.) Fokus: Intensivpflege. Schlütersche Verlagsgesellschaft; Hannover; 2004: 159-214
  • 22 British Geriatrics Society .Guidelines for the prevention, diagnosis and management of delirium in older people in hospital. http://www.bgs.org.uk/Publications/Clinical%20Guidelines/clinical_1-2_fulldelirium.htm 18.5.2009
  • 23 Happ  M B, Swigart V A, Tate J A et al.. Family presence and surveillance during weaning from prolonged mechanical ventilation.  Heart Lung. 2007;  36 (1) 47-57
  • 24 http://www.stiftung-pflege.info/page1/page102/page102.html 18.5.2009
  • 25 http://wwww.guidance.nice.org.uk/CG83 3.6.2009
  • 26 Schelling  G . Post-traumatic stress disorder in somatic disease: lessons from critically ill patients.  Prog Brain Res. 2008;  167 229-237
  • 27 Jones  C , Skirrow  P , Griffiths  R D. Post traumatic stress disorder-related symptoms in relatives of patients following intensive care.  Intensive Care Med. 2004;  30 456-460
  • 28 Knück  D , Nydahl P . Das Intensivtagebuch in Deutschland.  Intensiv. 2008;  16 (5) 249-255
  • 29 Bergbom  I , Svensson C , Berggren E  et al.. Patients’ and relatives’ opinions and feelings about diaries kept by nurses in an intensive care unit: pilot study.  Intensive Crit Care Nurs. 1999;  15 (4) 185-191
  • 30 Combe D . The use of patient diaries in an intensive care unit.  Nurs Crit Care. 2005;  10 (1) 31-34
  • 31 Robson W . An evaluation of patient diaries in intensive care.  World of critical care nursing. 2008;  6 (2) 34-37
  • 32 Storli S , Lind R . The meaning of patients’ lived experience of being followed-up in living with experiences and memories from intensive care. In: Storli S  Living with experiences and memories from being in intensive care – a lifeworld perspective. Dissertation for the degree of philosophiae doctor in health care. University of Tromsø; Tromsø; 2007
  • 33 Bäckman C G, Walther S M. Use of a personal diary written on the ICU during critical illness.  Intensive Care Med. 2001;  27 (2) 426-429
  • 34 Åkerman E . Patient diary and follow up after intensivecare. http://www.nofi.info/forskning/Patient/patdagbok/akermaneva_eng.htm entnommen am 2.5.2008
  • 35 Roulin  m j, Hurst s , Spirig r . Diaries written for ICU patients.  Qual Health Res. 2007;  17 (7) 893-901
  • 36 Hupcey J E,   . Feeling safe: the psychosocial needs of ICU patients.  Nurs Scholarsh. 2000;  32 (4) 361-367
  • 37 Jones C , Skirrow P , Griffiths R D et al.. Rehabilitation after critical illness: a randomized, controlled trial.  Critical Care Medicine. 2003;  31 2456-2461
  • 38 Bailey  P , Thomsen  G E, Spuhler  V J et al.. Early activity is feasible and safe in respiratory failure patients.  Crit Care Med. 2007;  35 (1) 139-145
  • 39 Nydahl P , Flohr H J, Rothaug O . Frühmobilisation und Gehen mit beatmeten Patienten.  Intensiv. im Druck
  • 40 Angus  , Carlet  . Surviving Intensive Care: a report from the 2002 Brussel round table.  Intensive Care Medicin. 2003;  29 368-377
  • 41 Davidson J E, Callery C . Care of the obesity surgery patient requiring immediate-level care or intensive care.  Obes Surg. 2001;  11 (1) 93-97
  • 42 Needham  D M. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function.  JAMA. 2008;  8 (14) 1685-1690
  • 43 Martin  U J, Hincapie  L , Nimchulk  M  et al.. Impact of wholebody rehabilitation in patients receiving chronic mechanical ventilation.  Crit Care Med. 2005;  33 2259-2265
  • 44 Gosselink R , Connor M  et al.. Physiotherapie for adult patients with critical care.  Intensive Care Med. 2006; 
  • 45 Platzer H . Body image/A problem for intensive care patients.  Part 1. Intensive Care Nurse. 1987;  3 61-66
  • 46 Smith S A. Extended body image in the ventilated patient.  Intensive Care Nurse. 1987;  5 31-38
  • 47 Knobel S . Wie man sich bettet, so bewegt man.  Pflege. 1996;  9 134-139
  • 48 Bienstein C , Fröhlich A . Basale Stimulation in der Pflege – die Grundlagen. Kallmeyer; Hannover; 2003
  • 49 Jess O , Nydahl P . Die umgrenzende Positionierung für den Intensivpatienten. (in Vorbereitung)
  • 50 Leitlinienempfehlung der DGAI . Lagerungstherapie zur Prophylaxe oder Therapie von pulmonalen Funktionsstörungen.  Anästh Intensivmed. 2008;  49 S1-S24
  • 51 Drakulovic M B, Torres A , Bauer T T et al.. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial.  Lancet. 1999;  354 1851-1858
  • 52 van Nieuwenhoven C A, Vandenbroucke-Grauls C , van Thiel F H et al.. Feasibility of the semirecumbent position to prevent ventilator-associated pneumonie: A randomized study.  Crit Care Med. 2006;  34 (2) 396-402
  • 53 Willams Z , Chan R , Kelly E . A simple device to increase rates of compliance in maintaining 30-degree head-of-bed elevation in ventilated patients.  Crit Care Med. 2008;  36 (4) 1155-1157
  • 54 Rothaug O , Sabel K , Kalterwasser A . Drehen und Wenden – was ist eigentlich möglich?.  Intensiv. 2008;  16 74-83
  • 55 Dellweg D , Haidl P , Barchfeld T  et al.. Einfluss des Atemmusters und der Körperposition auf die resistive inspiratorische Atemarbeit und den Sauerstoffverbrauch.  Pneumologie. 2006;  60 S1-V223 DOI: 10.1055/s-2006-934039
  • 56 Richard J-C M, Maggiore S M, Mancebo J M et al.. Effects of vertical positioning on gas exchange and lung volumes in acute respiratory distress syndrome.  Intensive Care Medicine. 2006;  32 1623-1626
  • 57 Kress J P, Pohlmann A S, Alverdy J  et al.. The impact of morbit obesity on oxygen cost of breathing VO(2RESP)) at rest.  Am J respire Crit Care Med. 1999;  160 883-886
  • 58 Barchfeld T , Schönhofer B , Wenzel M  et al.. Work of breathing in differentiation of various forms of sleep-related breathing disorders.  Pneumonologie. 1997;  51 931-935
  • 59 Dubb R , Hekler M , Kaltwasser A . Bauchlagerung von Intensivpatienten – Gibt es neue Trends?.  Intensiv. 2004;  12 4-8
  • 60 Messerole E , Peine P , Wittkopp S  et al.. The pragmatics of prone positioning.  Am J Respir Crit Care Med. 2002;  165 1359-1363
  • 61 Brook A D, Ahrens T S, Schaiff R  et al.. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation.  Crit Care Med. 1999;  27 (12) 2609-2615
  • 62 Jackson J C, Hart R P, Gordon S M et al.. Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem.  Critical Care . 2007;  11 R27 http://ccforum.com/content/11/1/R27 Zugriff 03.06.2009
  • 63 Nelson B J, Weinert C R, Bury C R et al.. Intensive care unit drug use and subsequent quality of life in acute lung injury patients.  Crit Care Med. 2000;  28 3626-3630
  • 64 Ely E W, Truman B , Shintani A  et al.. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS).  JAMA. 2003;  289 2983-2991
  • 65 Kress J P, Pohlman A S, O’Connor M F et al.. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation.  N Engl J Med. 2000;  342 1471-1477
  • 66 Leitlinie der DGAI .Sedierende und analgetische Therapie im Rahmen der Intensivmedizin. http://www.awmf-online.de Zugriff 03.06.2009
  • 67 Tonnelier J M, Prat G , Le Gal G  et al.. Impact of a nurses protocol-directed weaning procedure on outcomes in patients undergoing mechanical ventilation for longer than 48 hours: a prospective cohort study with a matched historical control group.  Crit Care. 2005;  9 R83-89
  • 68 Bion J F. Sedation and analgesia in the intensive care unit.  Hospital update. 1988;  2 1272-1286
  • 69 Novaes M A, Knobel E , Bork A M et al.. Stressors in ICU: perception of the patient, relatives and health care team et al.  Int Care Med. 1999;  25 1421-1426
  • 70 Whipple J K et al.. Analysis of pain management in critically ill patients.  Pharmacotherapy. 1995;  15 592-599
  • 71 Strohbücker B , Osterbrink J . Algorithmus pflegerisches Schmerzmanagement. Anlage A zum Expertenstandard „Schmerzmanagement in der Pflege” 2004. Deutsches Netzwerk für Qualitätsentwicklung in der Pflege. http://www.dnqp.de Zugriff 03.06.2009
  • 72 Dreyer A , Nortvedt P . Sedation of ventilated patients in intensive care units: relatives‘ experiences.  J Adv Nurs. 2008;  61 549-556
  • 73 Patak L , Gawlinski A , Fung N I et al.. Communication boards in critical care: patients‘ views.  Appl Nurs Res. 2006;  19 182-190
  • 74 L’Her E , Lellouche F , Ferrand E  et al.. Is tracheostomy less comfortable than translaryngeal intubation?.  Am J Respir Crit Care Med. 2003;  167 A302 In: Boles J M. et al. Weaning from mechanical ventilation.  Eur Respir J. 2007;  29 1033-1056
  • 75 Büssing   et al.. Pflege. 2000;  13 291-296 Meissner E  et al.. Intensivmedizin und Notfallmedizin. 1992;  29 114-122
  • 76 Yang K L, Tobin M J. A prospective study of Indexes predicting the outcome of trials of weaning from mechanical ventilation.  N Engl J Med. 1991;  324 1445-1450
  • 77 Nilius G , Franke K , Domanski U . Kontinuierliche Messung des Repid shallow breathing Index bei Spontnatmungsversuchen im Weaning-Prozess.  Pneumologie. 2006;  60 S1-V180 DOI: 10.1055/s-2006-934038
  • 78 Frutos-Vivar F , Ferguson N D, Esteban A  et al.. Risc factors for extubation failure in patients Following a successful spontaneous Breathing trial.  Chest. 2006;  130 1664-1671
  • 79 S3-Leitlinie .Nicht-invasive Beatmung als Therapie der akuten respiratorischen Insufizienz. http://www.awmf-online.de Zugriff 03.06.2009
  • 80 Nava S , Gregoretti C , Fanfulla F  et al.. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients.  Crit Care Med . 2005;  33 2465-2470
  • 81 Ely E W, Baker A M, Dunagan D P et al.. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously.  N Engl J Med. 1996;  19/335 1864-1869
  • 82 Kollef M H, Shapiro S D, Silver P  et al.. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation.  Crit Care Med. 1997;  25 567-574
  • 83 Marelich G P, Murin S , Battistella F . Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia.  Chest. 2000;  118 459-467
  • 84 Krishnan J A, Moore D , Robeson  C  et al.. A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation.  Am J Respir Crit Care Med. 2000;  169 673-678
  • 85 Epstein S K. Weaning from ventilatory support.  Current opinion in Critical Care . 2009;  15 36-43
  • 86 Rothaug O , Kaltwasser A . Hilfen im Weaningprozess.  PflegenIntensiv. 2009;  3 6-11
  • 87 Schou L , Egerod I . A qualitative study into the lived experience of post-CABG patients during mechanical ventilator weaning.  Intensive and Critical Care Nursing. 2008;  24 171-179
  • 88 Nydahl P . Schön tief Luft holen? Basale Stimulation im Weaning.  Intensiv. 2002;  5 202-211
  • 89 Prosiegel M  (federführend). Qualitätskriterien und Standards für die Diagnostik und Therapie von Patienten mit neurologischen Schluckstörungen. Neurogene Dysphagien – Leitlinien 2003 der DGNKN.  Neurol & Rehabil. 2003;  9 157-181
  • 90 OʼKeefe-McCarthy S , Santiago C , Lau G . Ventilator-associated pneumonia bundled strategies: an evidence-based practice.  Worldviews Evid Based Nurs. 2008;  5 193-204
  • 91 Jain M , Miller L , Belt D  et al.. Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change.  Qual. Saf. Health Care. 2006;  15 235-239
  • 92 Fox M Y. Toward a zero VAP rate: personal and team approaches in the ICU.  Critical care nursing quarterly . 2006;  29 108-114
  • 93 Girard T D, Kress J P, Fuchs B D et al.. Sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial.  http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22GirardTD%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus Lancet. 2008;  12 126-134
  • 94 Gastmeier P  et al.. Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Gastmeier+P%22%5BAuthor%5D J Hosp Infect. 2006;  64 16-22
  • 95 Bloos F , Müller S , Harz A  et al.. Effects of staff training on the care of mechanically ventilated patients: a prospective cohort study.  Br J Anaesth. 2009;  20
  • 96 Institut for healthcare improvement .http://www.ihi.org
  • 97 Zilberberg M D, Shorr A F, Kollef M H. Implementing quality improvements in the intensive care unit: ventilator bundle as an example.  Crit Care Med. 2009;  37 305-309
  • 98 Bonello R S, Fletcher C E, Becker W K et al.. An intensive care unit quality improvement collaborative in nine Department of Veterans Affairs hospitals: reducing ventilator-associated pneumonia and catheter-related bloodstream infection rates.  Jt Comm J Qual Patient Saf. 2008;  34 639-645
  • 99 Blamoun J , Alfakir M , Rella M E et al.. Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit.  Am J Infect Control. 2009;  37 172-175
  • 100 Youngquist P , Carroll M , Farber M  et al.. Implementing a ventilator bundle in a community hospital.  Jt Comm J Qual Patient Saf. 2007;  33 219-225
  • 101 Wip C , Napolitano L . Bundles to prevent ventilator-associated pneumonia: how valuable are they?.  Curr Opin Infect Dis. 2009;  22 159-166
  • 102 Resar R , Pronovost P , Haraden C  et al.. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia.  Jt Comm J Qual Patient Saf. 2005;  31 243-248
  • 103 Hermans G , De Jonghe B , Bruyninckx F  et al.. Interventions for preventing critical illness polyneuropathy and critical illness myopathy. The Cochrane Database of Systematic Reviews 2009 http://www.chochrane.org
  • 104 Alb   et al.. Critical Illness Polyneuropathy & Critical Illness Myopathy.  AINS. 2007;  4 250-258
  • 105 Svenningsen H . Incidence of ICU-delirium. 2008 http://www.efccna.org/downloads/congress/thursday/17-svenningsen.pdf 03.06.2009
  • 106 Klugkist M , Sedemund-Adib B , Schmidtke C  et al.. Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Diagnostik des postoperativen Delirs bei kardiochirurgischen Patienten.  Anaesthesist. 2008;  57 464-474
  • 107 Ely E W, Shintani A , Truman B  et al.. Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit.  JAMA. 2004;  291 1753-1762
  • 108 Ambrosino  , Clini E . Long-term mechanical ventilation and nutrition.  Respir Med . 2004;  98 413-420
  • 109 Bassili H R, Deitel M . Nutritional support in long term intensive care with special reference to ventilator patients: a reviec.  Can Anaesth Soc . 1991;  28 17-21
  • 110 Bolton C F, Breuer A C. Critical illness polyneuropathy.  Muscle Nerve. 1999;  22 419-424
  • 111 Gramlich L , Kichian G , Pinilla J  et al.. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature.  Nutrition. 2004;  20 843-848
  • 112 Artinian V , Krayem H , DiGiovine B . Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients.  Chest. 2006;  129 960-967
  • 113 Kreymann  G , Adolph M , Druml W  et al.. Leitlinie Parenterale Ernährung der DGEM: Intensivmedizin.  Akt Ernähr Med. 2007;  28 589-592
  • 114 Metheny N A, Clouse R E, Chang Y H et al.. Tracheobronchial aspiration of gastric contens in critically ill tube-fed patients: frequency, outcomes, and risk factors.  Crit Care Med. 2006;  34 1007-1015
  • 115 Barr J , Hecht M , Flavin K E et al.. Outcomes in critically ill Patients before and after the Implementation of an evidence-based nutritional management protocol.  Chest. 2004;  125 1446-1457
  • 116 Antonovsky A . Salutogenese: Zur Entmystifizierung der Gesundheit. Dgvt; Tübingen; 1997
  • 117 Engström A , Grip K , Hamrén M . Experiences of intensive care unit diaries: ʼtouching a tender wound‛.  Nurs Crit Care. 2009;  14
  • 118 Olbrich C . Pflegekompetenz. Hans Huber; Bern; 1999
  • 119 http://www.ahrq.gov/downloads/pub/evidence/pdf/nursestaff/nursestaff.pdf Zugriff 03.06.2009

01 Literatur am Ende des dritten Teils.

Peter Nydahl

Universitätsklinikum Schleswig-Holstein, Campus Kiel

Neurozentrum

Neurologische Intensivstation und Stroke Unit N1

Schittenhelmstraße 10

24105 Kiel

URL: http://www.nydahl.de

Email: peter@nydahl.de

Oliver Rothaug

Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin

Anaesthesiologie II – Operative Intensivstation 0118

Universitätsmedizin Göttingen

Robert-Koch-Straße 40

37075 Göttingen

Email: o.rothaug@gmx.de