Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Changes in treatment goals and palliative care in the intensive care unit-when and how?]","authors":"Ulrich S Schuler","doi":"10.1007/s00063-025-01324-2","DOIUrl":"10.1007/s00063-025-01324-2","url":null,"abstract":"<p><p>Intensive care for patients with hemato-oncological diseases is a complex interplay between life-prolonging therapy and palliative care. Especially in cases with a limited prognosis, early clarification of treatment goals and transition to palliative-oriented measures become increasingly important. When is a change in treatment goals appropriate in the intensive care unit, and how can patient-centered, suffering-oriented care be implemented in a structured way? The concept of a time-limited trial (TLT) offers a structured framework to allow a limited period of intensive care treatment with clearly defined success criteria in cases of uncertain prognosis. Even more important is to make anticipatory decisions for acute situations through early communication with patients and their families. This is illustrated using the example of discussions around resuscitation attempts. The integration of palliative care, ethics consultation, and interprofessional teams contributes to avoiding overtreatment and to safeguarding patient autonomy.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"561-567"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Patients should not routinely be treated with ECMO in \"peripheral\" hospitals].","authors":"Alexander Supady, Hans-Jörg Busch, Stefan Kluge, Christian Karagiannidis, Dawid L Staudacher, Tobias Wengenmayer","doi":"10.1007/s00063-025-01328-y","DOIUrl":"10.1007/s00063-025-01328-y","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"608-610"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[ST segment elevations and pulmonary edema-\"just\" simple cardiogenic shock caused by ischemia?]","authors":"Maximilian Eichner","doi":"10.1007/s00063-025-01258-9","DOIUrl":"10.1007/s00063-025-01258-9","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"604-607"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional differences, repeated use, and costs of emergency medical services in Germany.","authors":"Martin Roessler, Claudia Schulte, Christoph Bobeth, Isabelle Petrautzki, Laura Korthauer, Janosch Dahmen, Danny Wende, Christian Karagiannidis","doi":"10.1007/s00063-024-01189-x","DOIUrl":"10.1007/s00063-024-01189-x","url":null,"abstract":"<p><strong>Background: </strong>Little is known about regional differences regarding the utilization and costs of emergency medical services (EMS) in Germany. Evidence on characteristics of repeated use of EMS is also scarce.</p><p><strong>Objectives: </strong>To compare German federal states regarding the utilization and costs of EMS and to analyze characteristics of repeated EMS use.</p><p><strong>Materials and methods: </strong>We used BARMER health insurance data on more than 1.4 million German EMS cases in 2022. We estimated EMS use rates (per 1000 inhabitants) and median reimbursements and costs by EMS type (ground transport with/without emergency physician (EP); helicopter emergency medical services), hospitalization status, and federal state. We applied Poisson regression to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CI), capturing relationships between repeated use of EMS and individual characteristics, including care degree and income level.</p><p><strong>Results: </strong>Ground transport EMS use rates varied between federal states by more than 2.6-fold without EP (Bavaria: 84.6; Berlin: 223.2) and 2.1-fold with EP (Bremen: 19.1; Saxony: 41.3). Median reimbursement of ground transport with EP was 132% higher in Schleswig-Holstein (€ 1530) compared with Berlin (€ 660). Approximately one-third of all persons used EMS more than once and accounted for two-thirds of all EMS cases. Repeated EMS use was strongly related to care degree (IRR of care degree 5: 3084; 95% CI 3.012-3.158) and low income (IRR: 1.174; 95% CI 1.161-1.189).</p><p><strong>Conclusions: </strong>The substantial regional heterogeneity in terms of utilization and costs of EMS calls for a nationwide, consistent regulation of EMS in Germany. Additionally, (outpatient) primary nursing care of persons with severe health impairments and health literacy should be strengthened.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"576-584"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[ECMO-care at the crossroads between centralization and regional healthcare realities].","authors":"Dominik J Höchter, Bernhard Oss, Martin Schmölz, Patrick Scheiermann","doi":"10.1007/s00063-025-01329-x","DOIUrl":"10.1007/s00063-025-01329-x","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"611-613"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding cancer disease status and what it means for intensivists.","authors":"Nina Buchtele, Laveena Munshi","doi":"10.1007/s00063-025-01320-6","DOIUrl":"10.1007/s00063-025-01320-6","url":null,"abstract":"<p><p>A thorough understanding of oncological disease status is crucial for managing critically ill patients with cancer. The cancer trajectory predisposes patients to the type of critical illness they could develop and shapes the likelihood of reversibility and the chance for meaningful recovery, including continuation of therapy. This review outlines how disease status-whether new diagnosis, remission, stable disease, or progression-directly impacts differential diagnosis and treatment goals in the intensive care unit (ICU). Prognosis can be subdivided into (1) the comorbid cancer condition and (2) the acute critical care condition. Factors that impact prognosis may be similar including patient frailty, extent of organ failure, and tumor-related factors. While ICU survival remains an important patient-centered outcome, long-term outcomes such as return to treatment and acceptable quality of life have become increasingly important as ICU survival has improved over the past decades. Clear communication about patient values helps align care with realistic goals and avoid disproportionate ICU treatment. However, a critical element of establishing realistic goals includes a thorough understanding of the oncologic disease status. Close collaboration between intensivists and oncologists improves prognostication, treatment planning, and advance care discussions. Early recognition of high-risk patients and clear escalation or limitation pathways help ensure timely ICU transfer when needed. After ICU discharge, coordinated follow-up and rehabilitation support recovery and candidacy for further oncological treatment. An integrated, goal-directed approach enables tailored care for this complex patient group and supports shared decision-making throughout the continuum of cancer care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"568-575"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Modified Delphi study about implementation of early warning scores].","authors":"Peter Nydahl, Florian Grossmann, Vanessa Franke, Marie-Madlen Jeitziner, Susanne Krotsetis, Koroush Kabir, Reto Lingenhag, Tobias Melms, Felix Jakob Neuenfeldt, Dominika Oroszy, Frida Regner, Jan-Peter Braun","doi":"10.1007/s00063-025-01336-y","DOIUrl":"https://doi.org/10.1007/s00063-025-01336-y","url":null,"abstract":"<p><strong>Background: </strong>Early warning scores (EWS) are considered an effective tool for the early detection of clinical deterioration in hospital settings. However, their implementation poses complex demands on institutional structures, processes, and culture.</p><p><strong>Methods: </strong>As part of a modified Delphi study, experts from the Initiative Qualitätsmedizin network with practical experience in EWS implementation were invited to identify necessary structures, processes, and common pitfalls across the project phases of preparation, implementation, evaluation, and anchoring. In three rounds, recommendations were collected, thematically clustered, and rated (0-10, 10 = maximally relevant). Finally, the recommendations were consolidated in a consensus meeting.</p><p><strong>Results: </strong>Eight participants completed all rounds. From 505 responses, 51 consolidated recommendations were identified, all considered as highly relevant (≥ 7 points) in the various rounds. Top priorities were the training of all professional groups (mean 9.3) and transparent communication of results and actions (mean 9.0). Common barriers included lack of information technology (IT) integration, unclear responsibilities, and insufficient feedback. Key success factors were interdisciplinary project teams, early evaluation, and embedding into clinical routines.</p><p><strong>Conclusion: </strong>The consensus-based recommendations can support decision-makers in the systematic implementation of EWS. Structured project planning, interprofessional training, and continuous feedback are key success factors. For sustainable integration, EWS should be embedded into quality systems, continuing education, and clinical routines.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Positioning therapy and (early) mobilisation in intensive care units : Insights from the current S3 guideline].","authors":"Linus O Warner, Ligia C Fonseca Höflinger, Stefan J Schaller, Carsten Hermes","doi":"10.1007/s00063-025-01303-7","DOIUrl":"10.1007/s00063-025-01303-7","url":null,"abstract":"<p><p>The S3 guideline \"Positioning therapy and mobilisation in critically ill patients in intensive care units\" replaces the S2e guideline on the prophylaxis and treatment of pulmonary dysfunctions. The 2023 updated version revised the evidence assessment based on the Oxford system and has integrated new scientific findings since 2015, formulated using specific PICO (P: population/patient/problem, I: intervention, C: comparison, O: outcome) questions. An amendment in 2024 corrected minor errors and updated the evidence assessment again. A central aspect is the differentiated approach to early mobilisation, which now explicitly recommends mobilisation within 72 h of ICU admission. Furthermore, new chapters on assistive devices and neuromuscular electrical stimulation have been added to outline additional therapeutic options for positioning therapy and mobilisation in critically ill patients.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"614-623"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Patients with cancer: a challenge for emergency departments].","authors":"Tobias Liebregts, R Lammermann, M Klein-Helmkamp, Christian Reinhardt","doi":"10.1007/s00063-025-01311-7","DOIUrl":"10.1007/s00063-025-01311-7","url":null,"abstract":"<p><p>The number of patients with active cancer continues to rise and leads to increased emergency department visits. The symptoms are frequently associated with the underlying malignancy and include dyspnea, fever, pain, as well as gastrointestinal and neurological complaints. Hospitalization and intensive care unit admission rates are high and impose a significant burden on resource utilization. Identifying factors contributing to potentially preventable emergency department visits is pivotal. Broader access to ambulatory cancer care and improved interdisciplinary collaboration are likely to improve patient allocation. On the one hand, early initiation and expertise of palliative care is warranted to avoid futile interventions near end of life. On the other hand, current triage tools may not be sufficient to identify cancer patients with urgent need for medical interventions. In particular, new adverse events, such as immunotherapy-associated complications need to be recognized. Therefore, continuous medical education in the field of hemato-oncology for emergency department staff plays a key role in securing high quality emergency care for cancer patients.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"541-545"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Spiritual care competences of healthcare workers in emergency and intensive care-a prospective questionnaire study].","authors":"J Schwartz, T Tenge, K Lanhenke, S Meier, M Schallenburger, Y-N Batzler, T Roser, D Wetzchewald, M Neukirchen","doi":"10.1007/s00063-024-01185-1","DOIUrl":"10.1007/s00063-024-01185-1","url":null,"abstract":"<p><strong>Background: </strong>In intensive and emergency care, patients and their relatives are confronted with potentially existential crises. Spiritual care can be an additional resource to address related psychosocial and physical symptoms and to support patients and their relatives. Accordingly, healthcare workers need spiritual skills to recognize and respond to these needs.</p><p><strong>Objectives: </strong>What spiritual competencies do healthcare workers in intensive and emergency care have? Are there differences between professions and genders? What factors influence spiritual competencies?</p><p><strong>Materials and methods: </strong>The prospective questionnaire study included physicians participating in intensive care and emergency medicine courses and nurses who were training or working in intensive and emergency care. Self-reported spiritual competencies were assessed using the Spiritual Care Competence Questionnaire (SCCQ), which captures the following areas: perceptual competence, team-spirit, documentation competence, self-awareness and proactive opening, knowledge about other religions, competence in conversation techniques and proactive empowerment-competence.</p><p><strong>Results: </strong>We included 465 physicians (50% female, years in profession: mean = 4.0, standard deviation [SD] = 3.5) and 86 nurses (80% female, years in profession: mean = 12.7, SD = 10.7). The average SCC was 2.3 (SD 0.4) out of a maximum of 4 points, with higher spiritual competences among spiritual and religious respondents. There were differences in specific competencies between the professions and genders. Women indicated a higher level of competence in the area of perception and conversation skills, physicians in documentation skills.</p><p><strong>Conclusions: </strong>Overall, there is a clear need to train healthcare staff in the field of intensive care and emergency medicine.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"596-603"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}