Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Personalized sepsis therapy and modern trial designs].","authors":"Sascha David, Rolf Erlebach, Alix Buhlmann, Mattia Müller","doi":"10.1007/s00063-026-01495-6","DOIUrl":"10.1007/s00063-026-01495-6","url":null,"abstract":"<p><p>Sepsis is a life-threatening organ dysfunction due to a pathological host response to infection. Despite decades of research, there is still very limited evidence for causal therapeutic approaches targeting this injurious host response. The discrepancy between steadily increasing biological understanding and limited clinical progress is often referred to as the \"translational gap.\" On the one hand, randomized trial designs have focused on heterogeneous patient populations, and on the other, they have mostly used mortality as the primary endpoint. As a result, there is a risk that potentially effective interventions are diluted across biologically diverse patient groups, making relevant effects statistically undetectable. The large number of negative sepsis trials has not only led to fatigue among researchers, but also to concerns about financial risks within the research-driven pharmaceutical industry. More recent studies, however, suggest that precision medicine approaches could offer a way out of this situation. Recent investigations such as ANDROMEDA SHOCK 2, ImmunoSep, and Tigris use physiological or immunological phenotypes for patient selection and combine these with innovative endpoints and modern statistical methods. Together, they demonstrate that a stronger focus on the underlying pathophysiology can reveal clinically relevant benefits that remain hidden in conventional trial designs. These developments mark a fundamental shift in sepsis research: away from universal treatment concepts for everybody and toward individualized, biologically grounded, and adaptive therapeutic strategies.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"550-556"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978478","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":"[Extracorporeal immunomodulation in sepsis : Role, limits, and perspectives of adjuvant blood purification therapies].","authors":"Thorben Pape, Roman Förster, Timm Daron, Benjamin Seeliger, Sascha David, Klaus Stahl","doi":"10.1007/s00063-026-01472-z","DOIUrl":"10.1007/s00063-026-01472-z","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is characterized by a dysregulated host response to infection and remains associated with substantial mortality. Extracorporeal blood purification strategies are explored as adjunctive approaches to modulate host-response dysregulation.</p><p><strong>Objectives: </strong>Practice-oriented overview of current extracorporeal immunomodulatory strategies in sepsis and septic shock and a summary of available evidence and guideline position.</p><p><strong>Materials and methods: </strong>Narrative review focusing on randomized trials, meta-analyses, guidelines, and ongoing study programs addressing nonselective hemoadsorption, selective endotoxin removal, and therapeutic plasma exchange.</p><p><strong>Results: </strong>Evidence for nonselective hemoadsorption remains conflicting; recent higher-quality studies and guidelines do not show a proven clinical benefit and raise potential safety concerns. Selective endotoxin adsorption is biologically plausible and may be relevant in endotoxin-positive subgroups. Therapeutic plasma exchange is supported by mechanistic rationale, small randomized studies, and meta-analyses; confirmation in adequately powered multicenter trials is pending.</p><p><strong>Conclusion: </strong>Extracorporeal immunomodulation should not be regarded as a uniform intervention. Progress will depend on precise patient selection, biomarker-guided allocation, appropriate dosing, and structured implementation. Until robust outcome data are available, these therapies should be used cautiously and preferably in experienced centers or study frameworks.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"544-549"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354257","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":"[Out-of-hospital cardiac arrest : Current recommendations along the chain of survival and patient management].","authors":"Markus Bork, J-S Pooth, G Michels, H-J Busch","doi":"10.1007/s00063-026-01462-1","DOIUrl":"10.1007/s00063-026-01462-1","url":null,"abstract":"<p><p>Out-of-hospital cardiac arrest (OHCA) continues to pose a significant clinical challenge with low survival rates. The updated 2025 guidelines emphasize the critical role of the chain of survival, optimized basic life support (BLS) and the strategic use of extracorporeal cardiopulmonary resuscitation (ECPR). Following the return of spontaneous circulation (ROSC) the clinical course is predominantly shaped by the post-cardiac arrest syndrome (PCAS). Structured care within specialized centers and a multimodal timely neuroprognostication are essential to improve neurological outcomes and facilitate evidence-based decision-making regarding further treatment.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"594-605"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148303674","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":"[Palliative extubation after ROSC in the emergency setting-a guideline for emergency physicians].","authors":"Christian Volberg, Katharina Politt, Sebastian Passon, Nils Heuser, Elena Hofacker, Hinnerk Wulf","doi":"10.1007/s00063-025-01271-y","DOIUrl":"10.1007/s00063-025-01271-y","url":null,"abstract":"<p><p>In the prehospital emergency setting, resuscitation following cardiac arrest is initiated as soon as possible after arrival of the emergency services in order to minimize the no-flow time, i.e., the period during which there is no blood circulation and therefore no oxygen supply to the organs. There is frequently no opportunity to ask relatives about the prespecified or presumed wishes of the patient, e.g., in the form of a living will, until after initiation of emergency medical interventions. If an advance directive stipulates \"do not resuscitate\" (DNR), then this wish is legally binding for treatment. However, if return of spontaneous circulation (ROSC) has been achieved in the meantime, the treating emergency team faces an ethical dilemma, and patients are often taken to hospital against their prespecified will. This leads to unwanted overtreatment. Based on three case reports, the following article discusses the ethical and legal aspects of palliative extubation after ROSC in patients with a predefined DNR status.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"557-566"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036008","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":"[Vasopressors in septic shock: the old and the new].","authors":"Reimer Riessen, David J Heister, Janika Briegel","doi":"10.1007/s00063-026-01480-z","DOIUrl":"10.1007/s00063-026-01480-z","url":null,"abstract":"<p><p>Septic shock is characterized by a collapse of physiological circulatory regulation with profound vasoplegia, relative vasopressor insufficiency, and frequently concomitant myocardial dysfunction. In this review, we first outline the physiological roles and interactions of the three key endogenous vasopressor systems-the sympathetic nervous system/noradrenaline, arginine vasopressin, and the renin-angiotensin-aldosterone system-in maintaining blood pressure, organ perfusion, and intravascular volume. We then summarize the main mechanisms of septic vasoplegia. On this basis, we present current recommendations from the 2026 Surviving Sepsis Campaign and the 2025 update of the German S3 guideline on sepsis regarding the use of noradrenaline as a first-line vasopressor and vasopressin as add-on therapy, adrenaline/dobutamine in the setting of cardiac dysfunction, and corticosteroids in refractory shock. Finally, we emphasize the close interdependence of vasopressor therapy and fluid management.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"530-537"},"PeriodicalIF":1.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609255","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 one-minute wonders in professional practice, research, and teaching].","authors":"Lars Krüger, Thomas Mannebach, Peter Nydahl, Elke Hotze, Benjamin Kühme, Gero Langer, Carsten Hermes, Valery Maurice Kitz, Matthias Kochanek, Sascha David, Marianne Rahner, Birgit Schmidt","doi":"10.1007/s00063-026-01501-x","DOIUrl":"https://doi.org/10.1007/s00063-026-01501-x","url":null,"abstract":"<p><p>One-minute wonders (OMWs) are used internationally and nationally in various settings as a part of educational initiatives. To date, there are no standardized criteria for evaluating OMWs within the framework of quality assurance and performance assessment. The aim of the current study was to develop a checklist and a criteria-based scoring system for testing and evaluating OMWs. The theory-based development of these instruments was carried out in a consensus process, drawing on cognitive load theory and the concept of microlearning. The result was a practical checklist consisting of 11 items. The criteria-based scoring system contains 9 main categories with 25 items, for which a total of 100 points can be reached in the quality assessment. The developed checklist and the derived assessment and evaluation criteria can serve as a resource for authors and instructors. In the long term, these recommendations should be evaluated and incorporated into a manual or reporting statement, for example through a Delphi study.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076290","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":"Care gaps in an uninsured population in Germany: insights from open.med Munich.","authors":"Nadja Spitznagel, Gianni Varnaccia, Doreen Reinbacher, Annemarie Weber, Dominik Hinzmann","doi":"10.1007/s00063-026-01499-2","DOIUrl":"https://doi.org/10.1007/s00063-026-01499-2","url":null,"abstract":"<p><strong>Background: </strong>In Germany, people without health insurance face barriers to routine care. open.med Munich provides humanitarian care through Doctors of the World.</p><p><strong>Methods: </strong>We retrospectively analyzed pseudonymized 2024 routine data on demographics, insurance/residency, housing, access barriers, diagnoses, and emergency referrals. Emergency referral meant an open.med-initiated referral for emergency-level assessment/intervention.</p><p><strong>Results: </strong>In 2024, 984 patients consented to data use, generating 3738 contacts. Of these, 865 (88%) had no health insurance, 890 (91%) were homeless/in precarious housing, and 407 (42%) were legally excluded from German social/health benefits. Emergency referral was required for 54 (5.5%). Among 949 patients with ≥1 diagnosis, the most frequent ICD-10-GM chapters were symptoms/abnormal findings (R00-R99, 215, 23%), respiratory (J00-J99, 183, 19%), circulatory (I00-I99, 178, 19%), health-status/contact factors (Z00-Z99, 166, 18%), digestive (K00-K93, 158, 17%), musculoskeletal/connective tissue (M00-M99, 158, 17%), infectious/parasitic (A00-B99, 149, 16%), injuries/poisoning (S00-T98, 119, 13%), and mental/behavioral disorders (F00-F99, 126, 13%). Among emergency referrals, injuries/poisoning were most frequent (18, 33%), followed by cardiovascular (7, 13%), respiratory (6, 11%), gastrointestinal (6, 11%), and pregnancy-related complications (5, 9%).</p><p><strong>Conclusion: </strong>Spectrum comprised common conditions. Structurally obstructed routine care may contribute to delayed presentation and emergency referrals. Reform should include coverage clearing, non-punitive referrals, interpreters, and coordination among emergency, social, insurance, and humanitarian services.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983964","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":"[Controlled Donation after Circulatory determination of Death (cDCD) : A position paper by the DCD working group of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI)].","authors":"Klaus Michael Lücking, Gerold Söffker, Frank Erbguth, Stefan Meier, Gerald Neitzke, Stefanie Westermann, Klaus Hahnenkamp, Anke Hierundar, Josephin Jahnke, Uwe Janssens, Susanne Jöbges, Arnold Kaltwasser, Stefan Kleinschmidt, Kathrin Knochel, Urs Münch, Wolf-Dirk Niesen, Anna-Henrikje Seidlein, Martin Söhle, Alexander Supady, Esther Tautz, Steffen Augsberg, Paul Bidmon, Gertrud Greif-Higer, Stefan Huster, Renato Lenherr, Bettina Schöne-Seifert","doi":"10.1007/s00063-026-01476-9","DOIUrl":"https://doi.org/10.1007/s00063-026-01476-9","url":null,"abstract":"<p><p>In Germany at present, patients with a deleterious brain damage must be denied their wish for organ donation if the full clinical picture of \"brain death\" (DNC) does not occur. This significantly limits the individual patient's autonomy at the end of life. Intensive care may and must be withdrawn if the patient refuses its continuation. Following withdrawal of life-sustaining measures (WLST), the patient then dies - whilst receiving palliative care - as a result of cardiocirculatory arrest. In many countries, a patient's death following cardiocirculatory arrest may - under strictly regulated conditions - be followed by organ donation (controlled Donation after Circulatory determination of Death, cDCD): Cardiocirculatory arrest occurs after WLST under intensive care monitoring. After a \"no-touch\"- period of five minutes, spontaneous resumption of cardiac activity is no longer to be expected. The collapse of the entire circulatory system results in a complete cessation of cerebral blood flow and, consequently, the rapid onset of the global loss of brain function. In accordance with the patient's wishes, cardiopulmonary resuscitation is not performed, thus leading to a permanent loss of brain function. Clinical examination of brainstem reflexes once the no-touch period has elapsed confirms this permanent loss of cerebral function and the patient is declared dead. Organ donation may follow if desired by the patient. The transplant outcomes for organs donated following cDCD are on a par with those from DBD donation. cDCD respects and fulfils the wish to donate organs expressed by many intensive care patients. A foreseeable increase in organ donations will have a significant impact on the lives of patients on the transplant waiting lists.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971943","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":"[Left ventricular assist devices in emergency medicine : Case-based analysis for emergency medical services and emergency departments].","authors":"Mark-Alexander Solf, R Tomasi, C-E Kamla, J Kreuzer, M Feuerecker, P Scheiermann, D-J Höchter, T Schumann, C Müller","doi":"10.1007/s00063-026-01490-x","DOIUrl":"https://doi.org/10.1007/s00063-026-01490-x","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular assist devices (LVAD) are an established treatment for advanced heart failure. Due to the continuous flow, pulse palpation, noninvasive blood pressure measurement and pulse oximetry are often unreliable in acute care.</p><p><strong>Objective: </strong>Case-based analysis of the acute care of patients with left ventricular assist devices in emergency medical services and emergency departments, exemplified by a patient supported with HeartMate 3® and derivation of practical recommendations for action.</p><p><strong>Material and methods: </strong>Anonymized prehospital and clinical documentation of a 67-year-old female patient was evaluated. Monitoring, clinical assessment, device and power supply checks, pump parameters, diagnostics and triage were analyzed using consensus documents, reviews, registry data and manufacturer's data.</p><p><strong>Results: </strong>In this study three key problem areas emerged: unreliable standard monitoring, initial misclassification as technical device failure and necessary contextual interpretation of pump parameters. Prehospital findings included dyspnea, cyanosis, impaired consciousness and inability to obtain blood pressure or oxygen saturation values. The later device readout showed stable parameters without acute pump malfunction. The underlying cause was severe Staphylococcus aureus bacteremia with renal replacement therapy-dependent renal failure.</p><p><strong>Conclusion: </strong>Severe clinical deterioration in LVAD patients is not necessarily pump-related. Key elements are perfusion assessment, device and power supply checks, interpretation of pump parameters, extended diagnostics and early consultation with an LVAD center.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971998","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":"[Action algorithm: eye wash in cases of acute chemical burn].","authors":"Guido Michels, Peter Nydahl, Thomas A Fuchsluger","doi":"10.1007/s00063-026-01498-3","DOIUrl":"https://doi.org/10.1007/s00063-026-01498-3","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957202","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}