Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献_第2页

[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

[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

[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

[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

[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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106132/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Delirium: long-term sequelae and aftercare with special consideration to posttraumatic stress disorder]. [谵妄：长期后遗症和后遗症，特别考虑创伤后应激障碍]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2025-05-05 DOI: 10.1007/s00063-025-01279-4

Anna Carola Hertrich, Sophia Grundei

{"title":"[Delirium: long-term sequelae and aftercare with special consideration to posttraumatic stress disorder].","authors":"Anna Carola Hertrich, Sophia Grundei","doi":"10.1007/s00063-025-01279-4","DOIUrl":"10.1007/s00063-025-01279-4","url":null,"abstract":"Delirium is a frequent syndrome among hospitalized patients, with a prevalence of 10-30% on general wards, up to 50% on palliative care units and 30-80% on intensive care units (ICU). Defined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) as an acute, reversible disturbance of attention, cognition and consciousness, delirium is associated with infections, surgery, trauma and other disease conditions. Risk factors include advanced age, pre-existing neurocognitive disorders and substance abuse. Delirium is associated with increased mortality, longer hospitalization and the occurrence of post-hospital discharge complications, including post-intensive care syndrome (PICS) and posttraumatic stress disorder (PTSD). A structured post-inpatient management is limited, highlighting the need for specialized aftercare clinics. On the ICU early detection through tools, such as confusion assessment method for the ICU (CAM-ICU) and preventive measures, including the ABCDEF bundle, are essential. Family involvement and patient education can mitigate long-term effects. A greater awareness of the impact of delirium and the long-term sequelae is crucial to improve patient recovery and to address both physical and psychological needs.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"397-402"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042990","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

[Antibiotic stewardship-an update : Ongoing development of an initiative]. [抗生素管理——最新进展：一项倡议的持续发展]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-05-28 DOI: 10.1007/s00063-025-01290-9

Katja Schneider, Stefan Hagel, Jessica Rademacher, Irit Nachtigall, Mathias W Pletz

引用次数: 0

[ECMO therapies in a low-volume, peripheral hospital]. [小容量外围医院的ECMO治疗]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-05-23 DOI: 10.1007/s00063-025-01288-3

Dominik J Hoechter, Bernhard Oss, Martin Schmölz, Patrick Scheiermann

{"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":"https://doi.org/10.1007/s00063-025-01288-3","url":null,"abstract":"Introduction: 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.Methods: 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.Results: 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%).Conclusion: 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.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0