Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Acute heart failure-management during the first 120 min : Approach for early stabilization and decongestion].","authors":"M Buerke, H Lemm, A Amerini, P Boettger","doi":"10.1007/s00063-026-01502-w","DOIUrl":"https://doi.org/10.1007/s00063-026-01502-w","url":null,"abstract":"<p><p>Acute heart failure (AHF) is among the most common causes of emergency department, intermediate care, and intensive care unit admission and remains associated with substantial early mortality despite advances in contemporary therapy. The first 120 min of management are particularly critical, as this period determines not only respiratory and hemodynamic stabilization, but also trigger identification, decongestion strategy, and the foundation for subsequent prognostic improvement. This CME article provides a practical, phenotype-based approach to the early management of AHF. The proposed strategy is centered on the rapid classification of patients according to congestion (\"wet\" vs. \"dry\") and perfusion (\"warm\" vs. \"cold\") status. Stabilization and diagnostic work-up must occur simultaneously. Early assessment should focus on identifying acute coronary syndrome, clinically relevant arrhythmias, hypertensive crisis, pulmonary embolism, structural heart disease, and infectious triggers. In addition to clinical examination, electrocardiography, blood gas analysis, and biomarkers, point-of-care ultrasound with lung ultrasound and focused echocardiography play a pivotal role in the first-line evaluation. From a therapeutic perspective, early noninvasive ventilation in cardiogenic pulmonary edema, prompt vasodilation in hypertensive presentations, and effective decongestion with intravenous loop diuretics constitute the core interventions. In cases of insufficient response, escalation strategies such as sequential nephron blockade or selective use of vasoactive agents should be considered. Structured reassessment at short intervals is essential to detect persistent congestion, evolving hypoperfusion, inadequate therapeutic response, or overlooked differential diagnoses. The article emphasizes that successful acute management must already establish the transition toward guideline-directed long-term therapy during the first hours of hospitalization, including early initiation of evidence-based heart failure medication once hemodynamic stabilization has been achieved.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185288","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":"Impella in infarction-related cardiogenic shock: evidence, complications, and implementation of microaxial LV unloading.","authors":"P Boettger, H Lemm, A Geppert, M Russ, K Werdan, M Buerke","doi":"10.1007/s00063-026-01500-y","DOIUrl":"https://doi.org/10.1007/s00063-026-01500-y","url":null,"abstract":"<p><p>Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) remains highly lethal despite early revascularization. Although left ventricular (LV) failure predominates, AMI-CS may also be triggered or dominated by right ventricular (RV) failure, which carries distinct implications for the choice of mechanical support. Escalating catecholamines may increase afterload, provoke arrhythmias, and raise myocardial oxygen demand. Microaxial left ventricular (LV) support (Impella) provides forward flow while unloading the LV, potentially improving the subendocardial perfusion gradient, reducing pulmonary congestion, and limiting catecholamine exposure. Net clinical benefit is conditional and must be balanced against a substantial and predictable complication burden (major bleeding, vascular/limb complications, hemolysis with acute kidney injury, and infection). In the DanGer Shock trial, a protocolized Impella CP strategy in selected patients with ST-elevation myocardial infarction (STEMI)-CS lowered 180-day mortality (45.8% vs. 58.5%; hazard ratio [HR]: 0.74) but increased major complications and renal replacement therapy. Conversely, early venoarterial extracorporeal membrane oxygenation (VA-ECMO [extracorporal membrane oxygenation]) in the ECLS (extra corporal life support)-SHOCK trial did not improve 30-day survival and increased bleeding and vascular complications. Clinically, Impella should be used as part of phenotype-driven shock pathways-early for LV-dominant, congested low-output shock with a reversible trajectory-combined with standardized access/anticoagulation bundles, close complication surveillance, and early reassessment with deliberate escalation or de-escalation.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148492","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":"[Documentation of changes in goals of care in intensive care units - retrospective medical record analysis of deceased patients].","authors":"Johanna Stracke, Sukhvir Kaur, Sophie Meesters, Jorge Garcia Borrega, Christoph Adler, Michael Groß, Boris Jeger, Katharina Ludwig-Stollenwerk, Cornelia Zur Nieden, Mattias Vollmer, Raymond Voltz, Aneta Schieferdecker, Steffen T Simon, Kerstin Kremeike","doi":"10.1007/s00063-026-01504-8","DOIUrl":"https://doi.org/10.1007/s00063-026-01504-8","url":null,"abstract":"<p><strong>Background: </strong>End-of-life intensive care interventions correlate with a reduced quality of life of dying patients. Reassessment of clinical indication and patients' preferences, along with potential changes in goals of care, is needed. Changes in goals of care are not sufficiently documented in some instances.</p><p><strong>Objectives: </strong>Analysis of terms used to document changes in goals of care in medical records and documented therapy adjustment.</p><p><strong>Materials and methods: </strong>Retrospective analysis of n = 160 records of deceased patients from four intensive care units (n = 40 per unit) of one university hospital. Descriptive and qualitative content analysis were performed using Excel (Microsoft Corporation, Redmond, Washington, USA) and MAXQDA 24 (VERBI Software GmbH, Berlin, Germany).</p><p><strong>Results: </strong>Documentation of changes in goals of care were found in 78% (125/160) of the records. Terms describing changes could be categorized into eleven groups: 'Palliative' (n = 29), 'Treatment withdrawal' (n = 19), 'Best supportive care/symptom control' (n = 18), 'Do not escalate' (n = 13), 'Limitation of therapy' (n = 11), 'Changes in goals of care' (n = 10), 'Do not resuscitate/do not intubate' (n = 10), 'Freeze' (n = 7), 'Specific interventions' (n = 3), 'Mixed terms of changes in goals of care' (n = 3) and 'Others' (n = 2). In the sample, descriptive differences were observed in the frequency of terms depending on ward and patients' age. Therapy adjustments varied in some cases between the terms. For example, mechanical ventilation was discontinued most frequently in the group 'Palliative', at 71% (17/24).</p><p><strong>Conclusion: </strong>Recommended terms to describe goals of care were used inconsistently. Changes in measures and the terms showed only partially similar patterns. A uniformly defined understanding of the team and a structured application of the terms could support the interdisciplinary implementation of changes in goals of care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117247","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":"Adjuvante Therapien bei Sepsis – zwischen Hoffnung, Evidenz und Präzisionsmedizin.","authors":"Sascha David, Victoria Ochmann König","doi":"10.1007/s00063-026-01496-5","DOIUrl":"https://doi.org/10.1007/s00063-026-01496-5","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"121 7","pages":"527-528"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117253","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":"[Syncope diagnosis in the emergency room-importance of the ESC guidelines].","authors":"H Epping, M Müller-Schilling, G Dirrigl, F Rockmann, T Brünnler","doi":"10.1007/s00063-025-01326-0","DOIUrl":"10.1007/s00063-025-01326-0","url":null,"abstract":"<p><strong>Background: </strong>Syncope is a common and clinically relevant condition in the emergency department. Accurate risk stratification is essential to distinguish between benign and serious causes, guiding appropriate outpatient or inpatient management. This is crucial for preventing complications and ensuring cost-effective care.</p><p><strong>Objective: </strong>This study evaluates the applicability of the 2018 ESC guidelines (European Society of Cardiology) in clinical practice.</p><p><strong>Methods: </strong>A retrospective analysis was conducted at a tertiary care emergency department. Data from all patients who presented with syncope in 2022 were included.</p><p><strong>Results: </strong>A total of 492 patients were analyzed, including 327 (62.8%) inpatients who underwent full evaluation. High-risk criteria were significantly more frequent among inpatients, while low-risk syncope was more common in the outpatient group. The high-risk criteria of the ESC guidelines demonstrated a sensitivity of 90.8% for the detection of dangerous syncope. In addition, recurrent syncope within the last 12 months was associated with an increased risk of dangerous syncope.</p><p><strong>Conclusion: </strong>The ESC guidelines demonstrated a sensitivity of over 90%, establishing them as a reliable tool for risk stratification in patients with syncope. Recurrent syncope may represent an additional high-risk criterion that should be further investigated in future prospective studies.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"567-573"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304113","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":"[Updated management algorithm: non-invasive ventilation (NIV)].","authors":"Guido Michels, Hans-Jörg Busch, Stefan Kluge","doi":"10.1007/s00063-026-01465-y","DOIUrl":"10.1007/s00063-026-01465-y","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"590-593"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254100","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":"[Digitalization and artificial intelligence in intensive care and emergency medicine : German Society for Internal Intensive Care and Emergency Medicine (DGIIN) position paper on targeted introduction].","authors":"Leo Benning, Markus Haar, Anna Haftenberger, Dario Antweiler, Oliver Steidle, Ralf Möller, Robert Simon Schiff, Sebastian Wolfrum, Mattis Hartwig, Marek Seitz, Georg Widhalm, Sabine Wingen, Hans-Jörg Busch, Guido Michels","doi":"10.1007/s00063-026-01494-7","DOIUrl":"10.1007/s00063-026-01494-7","url":null,"abstract":"<p><p>In this position paper, the German Society for Internal Intensive Care and Emergency Medicine e. V. (Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin, DGIIN) sets out its principles for the introduction of digitization and artificial intelligence (AI) into emergency and intensive care medicine. A prerequisite for their introduction is a targeted qualification for physicians and healthcare professions so that they can assess technological fundamentals, uncertainties, and regulatory frameworks, as well as the possibilities and limitations of medical use cases. The central principle for the development and introduction of digitization and AI applications is co-development, in which clinical expertise, science, industry, and regulators jointly develop digitization and AI solutions to ensure that they meet clinical needs, are safe, and are practical to use. Due to different care delivery contexts, context-specific solutions are required. In particular, the requirements of medical device regulations, AI regulations, and data protection must be taken into account. Implementation must enable integration into existing IT systems and interoperable data infrastructures. Ultimately, the applicability of AI depends on organizational implementation strategies, technical interoperability standards, and an actively designed professional context so that digitization and AI applications can be integrated into clinical decision-making in a responsible, transparent, and effective manner-all instrumental features for their use in time-critical medical situations, e.g., in intensive care units and emergency departments.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"574-585"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978480","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":"[Pharmacological immunomodulation in sepsis].","authors":"Christian Bode","doi":"10.1007/s00063-026-01481-y","DOIUrl":"10.1007/s00063-026-01481-y","url":null,"abstract":"<p><p>Sepsis is defined as a dysregulated host response to infection; it is one of the leading causes of death in intensive care units worldwide. Immunological dysregulation plays a central role in the pathophysiology of sepsis and thus represents a promising therapeutic target for its treatment. However, the immune response is complex, and hyperinflammation and immune paralysis can occur simultaneously or sequentially, in different compartments, and with individually variable courses. Although a broad spectrum of immunomodulatory substances is available in principle, clinical trials have long yielded disappointing results. Growing evidence suggests that the cause of this lies less in the failure of individual substances than in the failure to account for the immunological heterogeneity of the clinical picture. This article provides a structured overview of pharmacological approaches to immunomodulation in sepsis, ranging from anti-inflammatory to immunostimulatory therapies. A particular focus is placed on biomarker-guided personalized immunotherapy. A prospective, multicenter, randomized study on this topic was recently published for the first time, which achieved a positive primary endpoint in sepsis patients through a personalized therapeutic approach, thereby paving the way for future sepsis therapy.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"538-543"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473675","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":"[Ebola virus disease-clinical relevance in intensive care and emergency medicine].","authors":"Priyanka Boettger, Henning Lemm, Michael Buerke, Christoph Lübbert","doi":"10.1007/s00063-026-01492-9","DOIUrl":"10.1007/s00063-026-01492-9","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"586-589"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957252","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":"OMW: Adjuvante Sepsistherapie.","authors":"Sascha David, Victoria Ochmann König","doi":"10.1007/s00063-026-01488-5","DOIUrl":"https://doi.org/10.1007/s00063-026-01488-5","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"121 7","pages":"529"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117225","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}