Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Sustainability-national and international initiatives in intensive care and emergency medicine].","authors":"Thomas Bein","doi":"10.1007/s00063-024-01199-9","DOIUrl":"10.1007/s00063-024-01199-9","url":null,"abstract":"<p><strong>Background: </strong>Climate change with global warming, natural disasters, species extinction and soil erosion is doubly relevant for medicine: On the one hand, heat waves, floods and other natural disasters lead to new disease patterns to which healthcare systems must adapt. On the other hand, the global healthcare system itself contributes to these effects, as it is estimated that the CO₂ footprint of all healthcare facilities accounts for around 5% of global greenhouse gas emissions.</p><p><strong>Objectives: </strong>National and international initiatives to promote sustainability concepts in intensive care and emergency medicine.</p><p><strong>Materials and methods: </strong>Research on homepages of national and international (specialist) societies dealing with intensive and emergency care medicine and corresponding PubMed search (sustainability and climate change and emergency or intensive care medicine).</p><p><strong>Results: </strong>Six of the 12 national specialist societies surveyed have taken initiatives on sustainability, notable among them the initiative of Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) for a new registration of the S1 guideline \"Sustainability in intensive care and emergency medicine\". On the international scene, the activities of the Australian and New Zealand Intensive Care Society (ANZICS) with numerous publications on the topic of sustainability in intensive care medicine and the practical guide \"A beginners guide to sustainability in intensive care medicine\" as well as the European Society of Anaesthesiology and Intensive Care (ESAIC) with a consensus paper on sustainability should be highlighted.</p><p><strong>Conclusions: </strong>At the national level, initiatives on sustainability (guidelines, working groups, forums) are emerging and are attracting increasing attention and activity. The umbrella organization of German Intensive Care Medicine, the Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), has so far shown no (discernible) activity; there is an urgent need for action here, and health policy and the German Medical Association should also become (even) more involved in reducing the CO₂ footprint in the healthcare sector. Internationally, there are a number of societies and institutions that are promoting the topic of \"sustainability\", although a stronger focus on the area of intensive care and emergency medicine would also be desirable here.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"15-21"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478629","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":"[Climate change and vector-borne disease-significance for intensive care and emergency medicine].","authors":"A J Domdey, S M Thomas","doi":"10.1007/s00063-024-01206-z","DOIUrl":"10.1007/s00063-024-01206-z","url":null,"abstract":"<p><p>Tropical diseases are becoming increasingly important in medical care in Germany due to climate change and the spread of vectors and viruses. The widely distributed Culex mosquitoes in Germany can transmit the West Nile virus, which causes West Nile fever. Severe neuroinvasive disease courses with acute flaccid paralysis, meningitis, and encephalitis are possible. The invasive tiger mosquito (Aedes albopictus) is increasingly establishing itself in Germany and is a potent vector of viruses that have so far occurred mainly in tropical-subtropical areas, including dengue and chikungunya virus. Severe dengue cases can manifest with hemorrhagic dengue fever, shock, or organ involvement. Dengue fever is currently still a travel-related disease in Germany. However, this may change in the context of climate change and increasing vector populations. Enhanced training and continuing education programs, as well as an expansion of diagnostic infrastructure and networking of health authorities and mosquito control, are crucial for optimal patient care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"6-14"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649292","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":"[Sustainability in intensive care and emergency medicine].","authors":"Carsten Hermes, Matthias Kochanek","doi":"10.1007/s00063-024-01225-w","DOIUrl":"https://doi.org/10.1007/s00063-024-01225-w","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"120 1","pages":"3-5"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034558","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":"[EVALI: Severe ARDS requiring ECMO due to e-cigarette use in a 16-year-old male patient].","authors":"H Engelke, R Hillebrand, M Brandes, C Specht, P Lebiedz","doi":"10.1007/s00063-024-01177-1","DOIUrl":"10.1007/s00063-024-01177-1","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"74-76"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511181","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":"[Acute respiratory distress syndrome : Pathophysiology, definition and treatment strategies].","authors":"Thomas Staudinger","doi":"10.1007/s00063-024-01218-9","DOIUrl":"10.1007/s00063-024-01218-9","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is defined as an acute inflammatory syndrome leading to increased pulmonary capillary leakage and subsequent interstitial and alveolar pulmonary edema. Hypoxia is the predominant symptom. The definition of ARDS comprises acute onset, bilateral patchy infiltration on chest X‑ray and a reduction of the ratio of arterial partial pressure of oxygen (PaO₂) to the fraction of inspired oxygen (FiO₂), which also determines the classification into mild (≤ 300), moderate (≤ 200) and severe (≤ 100) ARDS. Treating the underlying cause is the only causal treatment measure. The aim of adjunctive therapy is the maintenance of life or organ functions by ensuring an adequate gas exchange without further damaging the lungs. Adjunctive therapy consists mainly of individually adapted \"protective\" ventilation treatment and the prone position. In severest ARDS, the use of venovenous extracorporeal membrane oxygenation (VV-ECMO) can improve survival if strict criteria for indications and contraindications are followed.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"81-93"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957404","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":"Microbiological findings in a cohort of patients with coronavirus disease 2019 and venovenous extracorporeal membrane oxygenation.","authors":"Christian Glück, Eugen Widmeier, Sven Maier, Dawid L Staudacher, Tobias Wengenmayer, Alexander Supady","doi":"10.1007/s00063-024-01245-6","DOIUrl":"https://doi.org/10.1007/s00063-024-01245-6","url":null,"abstract":"<p><strong>Background: </strong>Venovenous extracorporeal membrane oxygenation (VV ECMO) is an established support option for patients with very severe respiratory failure and played an important role during the coronavirus disease 2019 (COVID-19) pandemic. Bacteria and fungi can lead to severe infectious complications in critically ill patients. The aim of this study was to describe the microbiological spectrum of bacteria and fungi detected in patients with COVID-19-associated respiratory failure supported with VV ECMO in our center.</p><p><strong>Methods: </strong>This retrospective single-center analysis included all patients with COVID-19-associated respiratory failure supported with VV ECMO in our center between March 2020 and May 2022. All findings from microbiological samples, taken as part of clinical routine assessment from initiation of VV ECMO until day 30 were included. Samples were described by site and time of detection and microbiological characteristics.</p><p><strong>Results: </strong>From March 2020 through May 2022, 88 patients with COVID-19-associated respiratory failure received VV ECMO support at our center. In 83/88 patients (94.3%), one or more pathogens were found in microbiological samples. Most pathogens were isolated from samples from the respiratory tract (88.6%). Earliest detection occurred in samples from the respiratory tract with a median time of 5 days to first detection. The most frequently detected pathogens were Staphylococcus spp., Candida spp., Klebsiella spp., Escherichia coli and Enterococcus spp.</p><p><strong>Conclusion: </strong>In this cohort of severely ill COVID-19 patients receiving VV ECMO support, pathogens were frequently detected.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068976","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":"[HEW score-a tool for the homogenisation of donor registrations to the DSO : Multicentre retrospective analysis of three university hospitals].","authors":"Felix Lehmann, Stefan F Ehrentraut, Jan Görtzen-Patin, Martin Söhle, Juliane Langer, Mohammed Banat, Daniel Schrader, Holger Kraus, Johannes Weller","doi":"10.1007/s00063-024-01237-6","DOIUrl":"https://doi.org/10.1007/s00063-024-01237-6","url":null,"abstract":"<p><strong>Background: </strong>The persistently low number of postmortem organ donations in Germany has repeatedly led to political discussions and most recently to the amendment of the Transplantation Act with the strengthening of the role of the transplantation officer and the introduction of a register to document the will to donate. The background to these decisions was the assumption that a relevant proportion of potential organ donors in hospitals were being overlooked and not reported. However, due to the lack of guidelines as to when a potential organ donor must be reported to the DSO (\"Deutsche Stiftung Organspende\"), the existing data is only of limited validity.</p><p><strong>Objectives: </strong>The transplantation officers of the university hospitals in North Rhine-Westphalia (NRW) therefore agreed on the HEW score (brain function loss-suitability-will) presented here as a shared standard for reporting potential organ donors.</p><p><strong>Materials and methods: </strong>Assigning the scores from 1 to 3 to each of the three included attributes results in a score of 111 to 333, and reporting to the DSO is recommended if the threshold value of 213 is exceeded. For implementation, the HEW scores of the cases determined by TransplantCheck from the university hospitals in Bonn, Essen and Düsseldorf from 2022 were collected retrospectively and presented in this paper.</p><p><strong>Results: </strong>Overall, the number of cases to be reported according to the HEW score was 13.5% below the number of cases actually reported at all three sites (126 vs. 109). In all three centres, the refusal rate was high at 54.5-64.9%.</p><p><strong>Conclusion: </strong>The HEW score represents a tool for the detailed recording and standardised reporting of potential organ donors and can enable homogenised reporting behaviour as a data basis for future improvement approaches.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054001","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":"Erratum zu: Handlungsalgorithmus: Hautpflege bei kritisch kranken Patient:innen.","authors":"Armin Hauss, Lars Krüger, Mandy Fröhlich, Franziska Dierkes, Vanessa Stork, Lara Konstanty, Tina Ellerhausen, Sebastian Rieks, Julia Ruhland, Marisa Wittor, Franziska Wefer","doi":"10.1007/s00063-025-01250-3","DOIUrl":"10.1007/s00063-025-01250-3","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034555","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":"[Extracorporeal organ support as a bridging strategy to enable organ donation-a case report with literature review].","authors":"Esther Tautz, Tobias Wengenmayer, Dawid L Staudacher, Wolf Niesen, Jürgen Bardutzky, Laura Heine, Michael Lücking, Johann Lambeck","doi":"10.1007/s00063-024-01240-x","DOIUrl":"https://doi.org/10.1007/s00063-024-01240-x","url":null,"abstract":"<p><p>We report the case of a young patient with severe hypoxic brain injury after cardiopulmonary resuscitation, resulting in brain death/death by neurologic criteria (BD/DNC). Consistent with the patient's expressed wishes, treatment was sustained to facilitate organ donation. However, in the context of a severe post-resuscitation syndrome and physiological disturbances resulting from BD/DNC, refractory circulatory shock ensued. Stabilization was only possible by mechanical circulatory support (MCS). By implementation of MCS for extracorporeal organ support (ECOS), successful organ donation was rendered possible. Further debate is required concerning ethical issues, particularly concerning resource distribution, the timing of ECOS in relation to the diagnosis of BD/DNC and concerning specific consent for the invasive procedure. Until guidelines are presented, we believe that ECOS should be considered in the management of select potential donors in severe shock even before, and certainly after the diagnosis of BD/DNC.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025304","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":"Evaluation of the predictive value of the glucose-to-potassium ratio in predicting in-hospital mortality of patients with sepsis and septic shock.","authors":"Sertaç Güler, Erdal Demirtaş, Dilber Üçöz Kocaşaban, Muhammed Beheşti Sarıhan, Ezgi Esen, Mehmet Ali Ata, Yahya Kemal Günaydın","doi":"10.1007/s00063-024-01244-7","DOIUrl":"https://doi.org/10.1007/s00063-024-01244-7","url":null,"abstract":"<p><strong>Background: </strong>In this study, we aimed to evaluate the role of the glucose-to-potassium ratio in predicting in-hospital mortality and prognosis of patients diagnosed with sepsis and septic shock in an emergency department and admitted to an emergency critical intensive care unit (ICU).</p><p><strong>Methods: </strong>This study was a retrospective and observational evaluation of nontraumatic sepsis and septic shock patients > 18 years of age who were admitted to the emergency department of a tertiary training and research hospital and had available glucose and potassium values at the time of admission. The patients were evaluated over a 24-month period. The primary goal of this study was to examine the relationship between the glucose-to-potassium ratio and in-hospital mortality in sepsis patients.</p><p><strong>Results: </strong>Data derived from 175 patients were included in the statistical analysis. Blood urea nitrogen, creatinine, lactate dehydrogenase, direct bilirubin, C‑reactive protein, and lactate levels were found to be significantly higher in the nonsurvivor group than in the survivor group (p < 0.05). On the other hand, hemoglobin, hematocrit, albumin, pH, HCO₃ and base excess levels were found to be statistically significantly higher in the survivor group than in the nonsurvivor group (p < 0.05). The glucose-to-potassium ratio was not significant in terms of predicting mortality in sepsis patients (p = 0.324). In the receiver-operating characteristic (ROC) analysis of various parameters' significance in terms of predicting mortality, APACHE 2 scores had the highest area under the curve (AUC) value (0.729).</p><p><strong>Conclusion: </strong>According to the results of this study, the glucose-to-potassium ratio did not have a significant value in predicting mortality risk in sepsis and septic shock patients admitted from the emergency department to the emergency critical ICU.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014769","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}