Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Animal-assisted interventions (AAI) in intensive care : Position of the German Society for Internal Intensive Care and Emergency Medicine].","authors":"Nadine Weeverink, Carsten Hermes, Sebastian Schulz-Stübner, Tobias Ochmann, Matthias Kochanek, Uwe Janssens","doi":"10.1007/s00063-025-01381-7","DOIUrl":"10.1007/s00063-025-01381-7","url":null,"abstract":"<p><p>Animal-assisted interventions (AAI) are increasingly recognized as nonpharmacological adjuncts to intensive care medicine. The aim of this paper by the German Society of Internal Intensive Care and Emergency Medicine (DGIIN) is to summarize the scientific rationale, safety considerations, and implementation recommendations for the use of AAI in intensive care units. Therapeutic effects are attributed to neuroendocrine mechanisms, particularly activation of the oxytocin system and reduction of cortisol levels, which can alleviate anxiety, pain perception, and psychological stress in critically ill patients. Early studies have reported significant reductions in anxiety without an associated increase in nosocomial infections. However, clinical implementation requires well-defined structural, hygienic, and ethical frameworks, including standardized risk analyses, binding hygiene and animal welfare standards, and multiprofessional collaboration integrating intensive care, nursing, infection control, and animal therapy. This paper presents the first systematic recommendations in Germany for the safe and quality-assured integration of animal-assisted interventions into intensive care practice and calls for scientifically accompanied implementation focusing on patient safety, animal welfare, and team well-being.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"187-192"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935386","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":"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":"225-229"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","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":"[Treatment algorithm: tracheostoma and cannula care for critically ill patients].","authors":"Lars Krüger, Franziska Wefer, Peter Nydahl, Daniel Plaß, Richard Schalk, Thomas Mannebach, Tobias Alzen, Pia Kirchhoff, Sarah Köster, Sarah Lohmeier, Anne Oldag, Oliver Rothaug","doi":"10.1007/s00063-025-01374-6","DOIUrl":"10.1007/s00063-025-01374-6","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"230-232"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764438","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":"[ECMO therapies in a low-volume, peripheral hospital].","authors":"Dominik J Hoechter, Bernhard Oss, Martin Schmölz, Patrick Scheiermann","doi":"10.1007/s00063-025-01288-3","DOIUrl":"10.1007/s00063-025-01288-3","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal membrane oxygenation (ECMO) is a therapeutic option for otherwise refractory pulmonary or cardiac failure. While ECMO therapy, as a highly invasive and high-risk procedure, is primarily offered at specialized centers, the time between the indication for and the implementation of ECMO therapy is outcome-relevant. This raises the question of whether ECMO therapy can be safely and successfully implemented in peripheral hospitals.</p><p><strong>Methods: </strong>This retrospective analysis comprised all ECMO patients of a regional hospital for the period 2013-2023. Demographic data as well as therapy and survival data were recorded.</p><p><strong>Results: </strong>During the 10-year observation period, 54 ECMO treatments were performed at the center (53 venovenous ECMO, 1 venoarterial ECMO), of which four were transferred to a specialized center after the therapy was initiated. Of the remaining 50 patients, 24 survived the intensive care therapy (48%).</p><p><strong>Conclusion: </strong>The present study demonstrates that ECMO therapies can be performed safely and with similar outcomes at peripheral hospitals, particularly if supported by a collaborating specialized center. Thus, transfers to specialized centers can be limited to patients with complicated courses.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"219-224"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132024","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":"[Endocrine emergencies].","authors":"Dirk Weismann","doi":"10.1007/s00063-026-01422-9","DOIUrl":"10.1007/s00063-026-01422-9","url":null,"abstract":"<p><p>An endocrine crisis is a hormonal disorder that leads to death if left untreated. The fundamental importance of endocrine regulatory circuits for homeostasis is also evident in critical illnesses-as a consequence of another disease or as a cause. In fact, the clinical presentation of a crisis is often nonspecific and therefore differs from the classical presentation of endocrine disorders. This review summarizes intensive care aspects of crises due to glucocorticoid deficiency (adrenal crisis) or excess (Cushing's crisis), excess thyroid hormone (thyroid storm), and hypercalcemic crisis (parathyroid crisis). The focus is on differential diagnostic classification, stabilization as a primary intensive care task, and differentiation from detailed endocrinological differential diagnostics.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"237-245"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437123","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":"[Recommendations of the DGIIN and DGINA on the structure and staffing of integrated emergency centres].","authors":"Hans-Jörg Busch, Felix P Hans, Martin Pin, Patrick Dormann, Christian Wrede, Domagoj Schunk, Torben Brod, Martin Möckel, Guido Michels, Carsten Hermes, Jonas Augustinski, Dominik Gottlieb, Sebastian Wolfrum","doi":"10.1007/s00063-025-01398-y","DOIUrl":"10.1007/s00063-025-01398-y","url":null,"abstract":"<p><p>The planned introduction of integrated emergency centres (INZ) represents a pivotal decision for the future of emergency care in Germany. The aim is cross-sectoral management of patients, integrating the hospital emergency department as the inpatient sector and the ambulatory on-call medical service. Previous recommendations by DIVI (German Interdisciplinary Association for Intensive and Emergency Medicine) and DGINA (German Society for Emergency Medicine) primarily addressed emergency departments without an integrated on-call practice. With these recommendations, DGIIN (German Society for Internal Medicine Intensive and Emergency Medicine) and DGINA present a concept for the structure, staffing, and quality assurance of INZ. The central element is the central point of assessment as the common point of entry. Using validated instruments, a standardized assessment of urgency is performed there, followed by allocation to the appropriate sector. This requires digital, interoperable documentation and management systems ensuring information flow to the emergency department, the on-call practice, and the 116117 and 112 dispatch centres. The on-call practice within the INZ must cover a broad general medical spectrum, including basic diagnostic equipment (echocardiography [ECG], ultrasound, point-of-care testing [POCT] laboratory), and must be staffed with physicians with clinical experience as well as clearly defined qualification profiles for nursing and administrative staff. For the emergency department within the INZ, the structural requirements of the German Federal Joint Committee (G-BA) apply. In addition, specific nursing qualifications (e.g. emergency nursing, triage) and INZ-adapted staff-to-patient ratios are required. Digital management tools, waiting time management, and central bed management are mandatory in INZ. In these recommendations, DGIIN and DGINA emphasize that INZ must be established as an independent model of care with binding structural and staffing standards in order to ensure safe and efficient emergency care also for resource-intensive \"hybrid\" cases at the interface between in- and outpatient care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"169-183"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935431","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":"[Cardiac resuscitation-associated lung edema (CRALE): evaluation of diagnostic and therapeutic approaches by an expert group of the German Cardiac Society].","authors":"Ingo Voigt, Tobias Graf, Tobias Wengenmayer, Dawid L Staudacher, Michael Preusch, Christan Jung, Guido Michels","doi":"10.1007/s00063-025-01268-7","DOIUrl":"10.1007/s00063-025-01268-7","url":null,"abstract":"<p><p>Sudden cardiac arrest (CA) is one of the leading causes of death in Europe, with over 70,000 cases annually in Germany. This study aims to evaluate diagnostic and therapeutic approaches for pulmonary edema in the post-resuscitation phase among intensive care physicians in Germany. Methods: The Working Group on Cardiopulmonary Resuscitation (AG42) of the German Cardiac Society conducted a web-based survey among its members. The survey assessed diagnostic methods, therapeutic strategies, and risk factors related to pulmonary edema after resuscitation. Results: A total of 77 participants, with a mean age of 43.9 years (±9.6), took part in the survey. Among them, 54.5% had more than 10 years of clinical experience in acute and intensive care medicine. Most clinics have access to radiological and sonographic procedures as well as advanced hemodynamic monitoring. Diagnostic measures are predominantly performed immediately upon admission (49.4%) or within one hour (36.4%) and are typically monitored every eight hours (77.9%). The oxygenation index (paO₂/F_iO₂) is used by 64.9% to assess the severity of pulmonary edema, followed by qualitative evaluation of chest X-rays (46.8%) and B-line scoring via lung ultrasound (33.8%). Therapeutic approaches focus on optimizing ventilation parameters, hemodynamic management, and the use of loop diuretics. To prevent pulmonary edema, participants favor a differentiated therapy involving volume and vasoactive agents, guided by invasive hemodynamic measurements. Conclusion: Pulmonary edema, alongside cardiac and cerebral dysfunctions, represents a significant challenge in managing post-resuscitation syndromes. The survey results reveal substantial variability in diagnostic and therapeutic approaches. Prospective studies are needed to better understand the complex pathological mechanisms and develop standardized protocols.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"208-218"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701964","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":"[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":"233-236"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","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}

{"title":"[Registration procedures in smartphone-based first responder alerting systems in Germany : A nationwide secondary data analysis with a local implementation example].","authors":"Kristin Schuhmann, Stefan Beckers, Dominik Blunck, Andre Nohl, Hanna Schröder, Florian Breuer","doi":"10.1007/s00063-026-01430-9","DOIUrl":"https://doi.org/10.1007/s00063-026-01430-9","url":null,"abstract":"<p><strong>Background: </strong>Smartphone-based first responder alert systems are a key component of the chain of survival in out-of-hospital cardiac arrest. In Germany, there are considerable regional differences in terms of qualification requirements and registration and approval processes. The impact of these barriers to access on the number of registered first responders has not yet been systematically investigated.</p><p><strong>Methods: </strong>A retrospective secondary data analysis was performed based on freely available data. Ninety-nine regions with complete information on registration procedures, qualification requirements, and the number of registered first responders were included. In addition, the effect of voluntary 2 h short training courses on chest compressions on the subjective confidence of participants was examined in the Rheinisch-Bergisch district using a survey.</p><p><strong>Results: </strong>At the time of data collection, a smartphone-based first responder alert system had been implemented in 45% of emergency medical service areas. The average registration rate was 0.246% of the population. Regions with self-registration procedures had significantly higher registration rates than regions with formal registration (0.267% vs. 0.152%; p < 0.001). In two regions with self-declaration only and no verification of proof, rates of up to 0.489% were achieved. In the local case study, 2217 first responders were registered, 40% of whom had first aid qualifications only. The short training course was associated with a significant increase in subjective safety.</p><p><strong>Conclusion: </strong>Low-threshold registration procedures are associated with higher registration rates in smartphone-based first responder alert systems. Accompanying short training courses can apparently increase the subjective confidence of first responders. Reducing formal barriers to access could help improve the availability of volunteer first responders. However, the effects of lower barriers to access on the psychological stress of first responders and on patient outcomes are unclear.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516158","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: Anlagekontrolle nasogastraler Ernährungssonden bei Erwachsenen.","authors":"Peter Nydahl, Olaf Boenisch, Susanne Krotsetis, Lars Krüger, Fridolin Streibert","doi":"10.1007/s00063-026-01426-5","DOIUrl":"10.1007/s00063-026-01426-5","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437110","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}