Carsten Willam, Michael Joannidis, Achim Jörres, Michael Oppert, Michael Schmitz, Stefan John
{"title":"[Ten key messages from the S3 guideline for evidence-based renal replacement therapy in intensive care medicine].","authors":"Carsten Willam, Michael Joannidis, Achim Jörres, Michael Oppert, Michael Schmitz, Stefan John","doi":"10.1007/s00063-025-01297-2","DOIUrl":"https://doi.org/10.1007/s00063-025-01297-2","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498821","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}
Torben Brod, Uta Hillebrand, Christoph Schröder, Andreas Flemming, Nils Schneider, Tanja Schleef
{"title":"[Predictability of patient disposition from emergency medical services triage categories: exploratory analysis of routine data].","authors":"Torben Brod, Uta Hillebrand, Christoph Schröder, Andreas Flemming, Nils Schneider, Tanja Schleef","doi":"10.1007/s00063-025-01300-w","DOIUrl":"https://doi.org/10.1007/s00063-025-01300-w","url":null,"abstract":"<p><strong>Background: </strong>Efficient and patient-centered emergency care requires early control of patient flow. It is unclear whether this is already possible in the prehospital phase by emergency medical services (EMS) and whether this can contribute to relieving pressure on emergency departments (EDs).</p><p><strong>Objectives: </strong>To examine the correlation between prehospital triage categories by EMS personnel and patient admission/discharge after treatment in the ED, and to assess the use of hospital resources for patients who remained outpatients.</p><p><strong>Methods: </strong>Retrospective analysis of routine preclinical and clinical data from all patients presenting to the ED of a university hospital by EMS over a 2-week period. Analyses were performed descriptively and using the Mann-Whitney U test and the χ<sup>2</sup> test. Positive and negative predictive values were also calculated.</p><p><strong>Results: </strong>During the observation period, 570 EMS patients were seen in the ED, of whom 307 (53.9%) remained as outpatients. For 309 (54.2%) of the patients, the triage category assigned by the EMS corresponded to the type of subsequent care (outpatient/inpatient); in 249 cases (43.7%) the need for inpatient care was overestimated. In addition, 262 patients (85.3%) received at least one diagnostic or therapeutic resource prior to discharge, the most common being X‑rays (118/38.4%).</p><p><strong>Conclusion: </strong>In only about half of the cases was the EMS personnel's prognosis consistent with the subsequent decision to admit or discharge the patient from the ED. Patients who remained as outpatients tended to require further diagnostic and therapeutic resources. Therefore, direct transfer of EMS patients to alternative care structures seems risky in the current environment.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498820","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}
Carsten Willam, Mariam Abu-Tair, Matthias Bayer, Romuald Bellmann, Frank Brunkhorst, Florian Custodis, Jan Galle, Carsten Hermes, Michael Joannidis, Stefan John, Achim Jörres, Thomas Kerz, Detlef Kindgen-Milles, Martin Koczor, Rainer Kram, Martin K Kuhlmann, Michael Oppert, Georg Schlieper, Michael Schmitz, Alexander Zarbock, Melanie Meersch
{"title":"[S3 guideline on renal replacement therapy in intensive care medicine : Evidence-based implementation of renal replacement therapy in critically ill patients].","authors":"Carsten Willam, Mariam Abu-Tair, Matthias Bayer, Romuald Bellmann, Frank Brunkhorst, Florian Custodis, Jan Galle, Carsten Hermes, Michael Joannidis, Stefan John, Achim Jörres, Thomas Kerz, Detlef Kindgen-Milles, Martin Koczor, Rainer Kram, Martin K Kuhlmann, Michael Oppert, Georg Schlieper, Michael Schmitz, Alexander Zarbock, Melanie Meersch","doi":"10.1007/s00063-025-01293-6","DOIUrl":"https://doi.org/10.1007/s00063-025-01293-6","url":null,"abstract":"<p><p>Besides mechanical ventilation, renal replacement therapy is the most frequently performed organ replacement therapy in intensive care medicine. However, there is a lack of consensus- and evidence-based recommendations for the implementation of renal replacement therapy according to the best current knowledge and evidence. This guideline describes the topics of starting a renal replacement therapy, modality (diffusion or convection, continuous or intermittent procedures), anticoagulation, adequate dose, and criteria for stopping renal replacement therapy. In addition, the current evidence on adequate anti-infective therapy is presented under the special features of acute kidney injury and renal replacement therapy.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477550","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}
Christian Hohmann, Ludwig Abel-Andrée, Dariusz Peszko, Tanja Knoll, Rolf Dembinski
{"title":"[Yeasts in the lung-colonization or catastrophe? : An infectious disease complication in a patient with acute myeloid leukemia].","authors":"Christian Hohmann, Ludwig Abel-Andrée, Dariusz Peszko, Tanja Knoll, Rolf Dembinski","doi":"10.1007/s00063-025-01301-9","DOIUrl":"10.1007/s00063-025-01301-9","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334237","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}
Dietrich Stoevesandt, Lina Woydt, Joachim Koppenberg, Michael Wolf, Dmitrij Pinekenstein, Stefan Watzke, Thomas Lange, Sascha Kolokowsky, Simone Hettmer, Hartmut Stefani, Franz Stangl, Martin R Fischer
{"title":"[Intraosseous access in infants-development of an anatomical training model].","authors":"Dietrich Stoevesandt, Lina Woydt, Joachim Koppenberg, Michael Wolf, Dmitrij Pinekenstein, Stefan Watzke, Thomas Lange, Sascha Kolokowsky, Simone Hettmer, Hartmut Stefani, Franz Stangl, Martin R Fischer","doi":"10.1007/s00063-025-01295-4","DOIUrl":"https://doi.org/10.1007/s00063-025-01295-4","url":null,"abstract":"<p><strong>Background: </strong>Safe intraosseous (i.o) access as an alternative to intravenous (i.v.) access is essential in the treatment of infants and young children in emergency medicine. However, the literature shows high misplacement rates and insufficient training opportunities for potential users. The aim of this study was to analyze malpunctures in postmortem computed tomography (CT) imaging and to develop and evaluate a realistic, cost-effective three-dimensionally (3D) printed training model for i.o. punctures in children under 2 years of age.</p><p><strong>Materials and methods: </strong>The CT data from 25 deceased children under 2 years of age were retrospectively analyzed to document the frequency and type of malpunctures. Based on the findings, a three-part model was produced using filament 3D printing and silicone moulding. The realistic representation of skin, connective tissue, and bone was evaluated by 55 experienced users on a Likert scale.</p><p><strong>Results: </strong>In 40% of the punctures analyzed, there was incorrect placement, often due to inadequate anatomical assessment. The model developed was rated by the interviewees as suitable for beginner training. Suggestions for improvement mainly concerned haptic skin characteristics and the simulation of the loss of resistance after cortical penetration. Material costs for the training model were around 50 cents per puncture.</p><p><strong>Conclusion: </strong>The 3D printed model offers a cost-effective, anatomically precise training option for intraosseous punctures in infants. It can contribute to the improvement of competence and safety during i.o. access, provided it is supplemented by regular training. Future enhancements should further optimize haptic skin characteristics and should provide better feedback on puncture success.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327489","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}
Jana Ackmann, Judit Grans-Siebel, Christoph Hüser, Volker Burst, Christoph Adler
{"title":"[Lipid rescue as a bail-out strategy in a repeatedly resuscitated patient].","authors":"Jana Ackmann, Judit Grans-Siebel, Christoph Hüser, Volker Burst, Christoph Adler","doi":"10.1007/s00063-025-01292-7","DOIUrl":"https://doi.org/10.1007/s00063-025-01292-7","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327490","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":"[Anisocoria in the intensive care unit].","authors":"Sebastian Herren, Jowita Bruno, Victor Speidel","doi":"10.1007/s00063-025-01283-8","DOIUrl":"https://doi.org/10.1007/s00063-025-01283-8","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267737","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":"[Overcoming boundaries-broadening horizons].","authors":"Georg F Lehner, Michael Joannidis","doi":"10.1007/s00063-025-01282-9","DOIUrl":"https://doi.org/10.1007/s00063-025-01282-9","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"120 5","pages":"367-368"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144195","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}
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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.).</p><p><strong>Conclusions: </strong>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.</p>","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106161/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Treatment with blood products in the intensive care unit].","authors":"Sirak Petros","doi":"10.1007/s00063-025-01278-5","DOIUrl":"10.1007/s00063-025-01278-5","url":null,"abstract":"<p><p>The evidence for the administration of blood products in the critically ill is frequently meagre. It is often difficult to differentiate between adaptive changes and pathological alterations of blood components requiring treatment. Anemia is frequently observed in critically ill patients; however, there is no evidence for a benefit of a liberal transfusion strategy. Thrombocytopenia and alterations in plasmatic coagulation could correlate with an unfavorable outcome but they are not predictive regarding a substitution. Therefore, the indications for platelet transfusion and the administration of plasma or coagulation factor concentrates should always be clinically and critically evaluated. There is also no evidence for the generous use of albumin in intensive care medicine. In conclusion, a restrictive strategy is recommended for all blood products. The available evidence and a critical clinical assessment should be the mainstays of the decision for treatment with blood products.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"438-446"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027316","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}