Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

[Overcoming boundaries-broadening horizons]. [跨越界限，拓宽视野]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2025-05-26 DOI: 10.1007/s00063-025-01282-9

Georg F Lehner, Michael Joannidis

引用次数: 0

[Overdosing of direct oral anticoagulants]. [直接口服抗凝剂用药过量]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2024-06-25 DOI: 10.1007/s00063-024-01154-8

Marie Anne-Catherine Neumann, Noëlle Sieg, Jorge Garcia Borrega, Christoph Hüser, Michael Caspers, Alexander Shimabukuro-Vornhagen, Boris Böll, Matthias Kochanek, Dennis A Eichenauer, Jan-Hendrik Naendrup

{"title":"[Overdosing of direct oral anticoagulants].","authors":"Marie Anne-Catherine Neumann, Noëlle Sieg, Jorge Garcia Borrega, Christoph Hüser, Michael Caspers, Alexander Shimabukuro-Vornhagen, Boris Böll, Matthias Kochanek, Dennis A Eichenauer, Jan-Hendrik Naendrup","doi":"10.1007/s00063-024-01154-8","DOIUrl":"10.1007/s00063-024-01154-8","url":null,"abstract":"Background: Direct oral anticoagulants (DOAC) are increasingly used for prophylaxis and treatment of thromboembolic events. Incorrectly dosed DOAC treatment is associated with excess mortality.Purpose: This article aims at raising awareness of DOAC overdosing and its causes as well as presenting a diagnostic and therapeutic work-up.Material and methods: Based on a case presentation, a structured review of the current literature on DOAC overdosing was performed and treatment recommendations were extracted.Results: In addition to wittingly or unwittingly increased DOAC intake, common causes of overdose are inadequate dose adjustment for concomitant medication or comorbidities. Global coagulation testing should be supplemented with DOAC-specific testing. Severe bleeding and the need for invasive diagnostics or urgent surgery represent indications for treating DOAC overdoses. Based on the cause of an DOAC overdose, active charcoal, endoscopic pill rescue, antagonization with idarucizumab or andexanet alfa and the targeted substitution of coagulation factors represent treatment options.Conclusion: The sensitization of clinicians is important to ensure a timely diagnosis and adequate treatment of DOAC overdosing. This report provides an overview of current knowledge on diagnostics and treatment; however, further studies are necessary to improve the existing algorithms.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"426-433"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447394","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}

引用次数: 0

[Multimorbidity as a predictor for inpatient admission in clinical emergency and acute medicine : Single-center cluster analysis]. [临床急诊科住院病人的多病症预测因素：单中心聚类分析]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2024-09-11 DOI: 10.1007/s00063-024-01180-6

E Grüneberg, R Fliedner, T Beißbarth, C A F von Arnim, S Blaschke

{"title":"[Multimorbidity as a predictor for inpatient admission in clinical emergency and acute medicine : Single-center cluster analysis].","authors":"E Grüneberg, R Fliedner, T Beißbarth, C A F von Arnim, S Blaschke","doi":"10.1007/s00063-024-01180-6","DOIUrl":"10.1007/s00063-024-01180-6","url":null,"abstract":"Background: Parallel to demographic trends, an increase of multimorbid patients in emergency and acute medicine is prominent. To define easily applicable criteria for the necessity of inpatient admission, a hierarchical cluster analysis was performed.Methods: In a retrospective, single-center study data of n = 35,249 emergency cases (01/2016-05/2018) were statistically analyzed. Multimorbidity (MM) was defined by at least five ICD-10-GM diagnoses resulting from treatment. A hierarchical cluster analysis was performed for those diagnoses initially summarized into 112 diagnosis subclusters to determine specific clusters of in- and outpatient cases.Results: Hospital admission was determined in 81.2% of all ED patients (n = 28,633); 54.7% of inpatients (n = 15,652) and 0.97% of outpatient cases (n = 64) met the criteria for multimorbidity and the age difference between them was highly significant (68.7/60.8 years; p < 0.001). Using a hierarchical cluster analysis, 13 clusters with different diagnoses were identified for inpatient multimorbid patients (MP) and 7 clusters with primarily hematological malignancies for outpatient MP. The length of stay in the ED of inpatient MP was more than twice as long (max. 8.3 h) as for outpatient MP (max. 3.2 h.).Conclusions: The combination of diagnoses typical for MM were characterized as clusters in this study. In contrast to single or combined single diagnoses, the statistically determined characterization of clusters allows for a significantly more accurate prediction of ED patients' disposition as well as for economic process allocation.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"419-425"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299319","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}

引用次数: 0

[Representation of women in senior positions in emergency medicine]. [妇女在急诊医学高级职位中的代表性]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2024-09-24 DOI: 10.1007/s00063-024-01181-5

Nadja Spitznagel, Christine Hidas, Sylvia Schacher

{"title":"[Representation of women in senior positions in emergency medicine].","authors":"Nadja Spitznagel, Christine Hidas, Sylvia Schacher","doi":"10.1007/s00063-024-01181-5","DOIUrl":"10.1007/s00063-024-01181-5","url":null,"abstract":"Background: Gender equality and the empowerment of women is one of the 17 Sustainable Development Goals formulated by the United Nations. Gender-specific inequalities still exist, especially in medicine. Women are particularly lacking in leadership positions and in visible roles outside of patient care, such as at conferences and in scientific journals.Aim: The aim of the study was to analyse the proportion of women in leadership positions in emergency medicine and the visible roles at emergency medicine conferences and scientific journals.Materials and methods: A selective literature search in PubMed and an evaluation of the conference programmes from 2020-2021 as well as the editorial boards of journals were conducted with regard to the proportion of women.Results: Women continue to be significantly underrepresented on the editorial boards of emergency medicine journals and on the boards of leading emergency medicine organisations. Internationally, there are already programmes to increase the proportion of women in field of publications and scientific conferences; to date, there are only a few such programmes for women in emergency medicine in Germany.Conclusion: Women in healthcare in general and in emergency medicine in particular are not equally represented outside of patient care. To date, there are hardly any programmes to promote women in emergency medicine in Germany. Mentoring, collegial support and organisational change are key to increasing the proportion of women in nonpatient care roles in emergency medicine.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"411-418"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308877","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}

引用次数: 0

[Challenges and physiotherapeutic solutions for obese patients in the acute and postacute intensive care setting]. [急诊和急诊后重症监护环境中肥胖患者面临的挑战和物理治疗解决方案]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2025-03-14 DOI: 10.1007/s00063-025-01263-y

S Nessizius, L Oelinger, N Schmidinger

{"title":"[Challenges and physiotherapeutic solutions for obese patients in the acute and postacute intensive care setting].","authors":"S Nessizius, L Oelinger, N Schmidinger","doi":"10.1007/s00063-025-01263-y","DOIUrl":"10.1007/s00063-025-01263-y","url":null,"abstract":"Physical therapy for obese patients in intensive care units (ICUs) presents a significant challenge. Particularly, class III obesity (body mass index [BMI] ≥ 40, previously called morbid obesity) is associated with specific pathophysiological aspects such as reduced lung compliance, increased intra-abdominal pressure, and impaired respiratory mechanics. These factors complicate both ventilation and early rehabilitation, particularly in the areas of respiratory physiotherapy, exercise therapy, and early mobilization. This article outlines the physiotherapeutic challenges and strategies for dealing with obese patients in ICUs and respiratory intermediate care units (respiratory care units [RCUs]). Special emphasis is placed on the individual positioning of patients, an optimal positive end-expiratory pressure (PEEP) adjustment, and early mobilization. Additionally, the concept of ICU-acquired weakness (ICUAW) is discussed, which is exacerbated in obese patients due to simultaneous inflammation activation and reinforcing immobilization. An exemplary case study illustrates the importance of interdisciplinary collaboration and the use of a structured mobilization concept tailored to the specific needs of obese patients. Particularly, the early initiation of assisted mobilization, the continuous adjustment of ventilation, and the use of innovative techniques to support respiratory physiotherapy contribute to a significant improvement in patient's functionality and quality of life.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"389-396"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634225","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}

引用次数: 0

[Treatment with blood products in the intensive care unit]. [在重症监护室用血液制品治疗]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2025-05-07 DOI: 10.1007/s00063-025-01278-5

Sirak Petros

引用次数: 0

[Acute respiratory distress syndrome-quo vadis : Innovative and individualized treatment approaches]. 急性呼吸窘迫综合征：创新和个性化的治疗方法。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2025-04-22 DOI: 10.1007/s00063-025-01273-w

Nina Buchtele, Thomas Staudinger

{"title":"[Acute respiratory distress syndrome-quo vadis : Innovative and individualized treatment approaches].","authors":"Nina Buchtele, Thomas Staudinger","doi":"10.1007/s00063-025-01273-w","DOIUrl":"10.1007/s00063-025-01273-w","url":null,"abstract":"Acute respiratory distress syndrome (ARDS) is a heterogeneous clinical syndrome characterized by variable pathophysiology and different therapeutic approaches. Recent guidelines emphasize the importance of prone positioning and venovenous extracorporeal membrane oxygenation (VV-ECMO) for the most severe cases, while routine recruitment maneuvers and extracorporeal CO2-removal techniques are no longer recommended. To further advance the personalization of ARDS therapy, the identification of ARDS phenotypes using latent class analysis offers promising approaches for individualized treatment. Additionally, adaptive platform trials and artificial intelligence (AI)-driven decision-support systems may optimize future ARDS management. The future of ARDS treatment is becoming increasingly individualized, based on improved patient stratification, innovative study designs, and the targeted use of modern technologies. This article summarizes recent developments in ARDS therapy, particularly regarding personalized treatment strategies, new study designs, and the application of artificial intelligence.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"379-388"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036081","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}

引用次数: 0

[Major limb amputation in a geriatric patient following minor laceration]. [老年患者因轻微撕裂伤而截肢]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2024-12-21 DOI: 10.1007/s00063-024-01228-7

Lukas Klein, Saskia Maletzke, Lampros Kousoulas, Hagen Schmal

引用次数: 0

[Vasoactive agents in septic shock-individualized strategies]. 感染性休克中的血管活性药物——个体化策略。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2025-04-24 DOI: 10.1007/s00063-025-01272-x

Georg Franz Lehner, Timo Mayerhöfer, Fabian Perschinka, Bernhard Benda, Michael Joannidis

{"title":"[Vasoactive agents in septic shock-individualized strategies].","authors":"Georg Franz Lehner, Timo Mayerhöfer, Fabian Perschinka, Bernhard Benda, Michael Joannidis","doi":"10.1007/s00063-025-01272-x","DOIUrl":"10.1007/s00063-025-01272-x","url":null,"abstract":"Hemodynamic stabilization and preservation of organ perfusion are central elements in the management of septic shock. This is achieved by fluid resuscitation and by administration of vasoactive agents. Current guidelines recommend norepinephrine as the first-line vasoactive substance. In cases of high norepinephrine requirements the addition of nonadrenergic vasopressors is recommended. Furthermore, evidence suggests that early use of complementary vasoactive substances may provide additional benefits. Such a regimen, in terms of a broad-spectrum vasopressor approach, appears physiologically plausible. Post hoc analyses of studies investigating vasopressin or angiotensin II also suggest that specific subphenotypes may particularly benefit from individual vasoactive agents. Adjunctive therapy with hydrocortisone and fludrocortisone can improve vasopressor responsiveness and reduce mortality. In cases of cardiac dysfunction, a trial with dobutamine or a switch from norepinephrine to epinephrine is recommended. To enhance inodilator effects, milrinone or levosimendan may represent additional therapeutic options for certain patients. Although short-acting beta-blockers are not part of the standard treatment for septic shock, they may, in selected cases, contribute to hemodynamic improvement in patients with inadequately high sinus tachycardia or atrial tachyarrhythmias. Based on pathophysiological considerations and the currently available evidence, targeted use of specific vasoactive substances in defined subphenotypes may be justified. An initial broad-spectrum vasopressor strategy incorporating biomarkers such as renin and patient-specific characteristics followed by a focused de-escalation approach could represent a promising concept. However, the effectiveness of these strategies requires further investigation in randomized controlled trials.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"369-378"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064647","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}

引用次数: 0

[Challenges and perspectives of family support in the intensive care unit: focus on vulnerable relatives]. [重症监护室家庭支持的挑战和观点：关注弱势亲属]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2025-03-18 DOI: 10.1007/s00063-025-01262-z

Magdalena Hoffmann, Matthias Thomas Exl, Maria Brauchle, Karin Amrein, Marie-Madlen Jeitziner

{"title":"[Challenges and perspectives of family support in the intensive care unit: focus on vulnerable relatives].","authors":"Magdalena Hoffmann, Matthias Thomas Exl, Maria Brauchle, Karin Amrein, Marie-Madlen Jeitziner","doi":"10.1007/s00063-025-01262-z","DOIUrl":"10.1007/s00063-025-01262-z","url":null,"abstract":"Background: Supporting relatives in the intensive care unit (ICU) is a complex task, especially when it comes to vulnerable people such as children, very old persons or socioeconomically disadvantaged persons. They are exposed to particular physical and psychological stress and require targeted awareness from healthcare professionals.Objective: What person-centered challenges and support services are available for vulnerable relatives in the ICU?Results: This article highlights the various challenges and support services for vulnerable relatives in ICUs. Depending on the group and individual, there are a variety of challenges such as a lack of helpful coping strategies, difficult access to adequate information, communication problems and a generally increased risk of persistent long-term consequences. Targeted training of specialist staff, specific practical instructions, culturally sensitive communication strategies and the use of supporting resources even digital ones can enable person-centered and vulnerability-reducing support.Conclusion: A high level of interprofessional and intercultural competence and the development of specific support services can relieve the burden on both relatives and specialist staff and contribute to improving the quality of care.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"403-410"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659478","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}

引用次数: 0