Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Intensive care nursing for oncological patients].","authors":"Andreas Jurkscheit, Carsten Hermes, Daniel Marqueses, David Wittkamp","doi":"10.1007/s00063-025-01312-6","DOIUrl":"10.1007/s00063-025-01312-6","url":null,"abstract":"<p><strong>Background: </strong>With the rising incidence of cancer, the number of oncological patients in intensive care units (ICUs) is steadily increasing. Treatment-related complications, multiorgan failure, and age-related comorbidities contribute to this trend, requiring highly specialized intensive nursing care.</p><p><strong>Objectives: </strong>How can intensive care nursing for oncological patients be optimized while considering clinical, ethical, and psychosocial aspects?</p><p><strong>Methods: </strong>This work is based on a structured literature review of current studies, guidelines, and nursing science publications related to the care of cancer patients in critical care settings.</p><p><strong>Results: </strong>Common reasons for ICU admission include respiratory insufficiency, infections, gastrointestinal complications, and treatment-induced side effects. Intensive care nurses play a central role in infection prevention, respiratory support, nutritional management, and skin integrity care. In addition to clinical expertise, they are key in communication, psychosocial support, and ethical decision-making processes.</p><p><strong>Conclusion: </strong>The intensive care of oncological patients is complex and requires interdisciplinary collaboration. Not only technical competence but also ethical awareness, structured communication, and emotional support are essential for delivering high-quality, patient-centered care in the ICU.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"546-551"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790441","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":"[Hemato-oncology in intensive care medicine].","authors":"Matthias Kochanek, Thomas Staudinger","doi":"10.1007/s00063-025-01325-1","DOIUrl":"https://doi.org/10.1007/s00063-025-01325-1","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"120 7","pages":"539-540"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240147","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":"[Modern immunotherapy and emergency situations : Toxicities of CAR T-cell therapies and BiTEs, their management, and their relevance in intensive care medicine].","authors":"Judit Grans-Siebel, Jorge Garcia Borrega, Boris Böll, Franziska Bach","doi":"10.1007/s00063-025-01316-2","DOIUrl":"10.1007/s00063-025-01316-2","url":null,"abstract":"<p><p>Novel immunotherapies such as chimeric antigen receptor T‑cell therapy (CAR T‑cell therapy) and bispecific T‑cell engagers (BiTEs) have transformed the treatment of hematologic malignancies in recent years. Despite their high efficacy, they pose considerable risks, particularly for cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Both typically occur within the first 2 weeks after therapy and may require admission to an intensive care unit (ICU). Other relevant side effects include persistent cytopenias, hypogammaglobulinemia, and increased susceptibility to infections. These long-term complications are gaining importance and require structured follow-up strategies. Up to 35% of patients undergoing CAR T‑cell therapy require intensive care, mostly due to CRS or ICANS. Nevertheless, the rates of organ support and ICU mortality remain comparatively low, indicating that these toxicities are, in principle, manageable. The severe toxicities of these novel therapies increasingly pose ethical challenges in intensive care. Decision-making frameworks such as the \"ICU trial\" model can provide valuable guidance. This article offers a comprehensive overview of acute and delayed side effects of immune-based therapies, their intensive care management, and current strategies for optimizing patient care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"552-560"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975702","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":"[Structured triage in the emergency department via intelligent assistant service OPTINOFA : Results of a multicenter, cluster-randomized and controlled interventional study in Germany].","authors":"Sabine Blaschke, Harald Dormann, Rajan Somasundaram, Christoph Dodt, Ingo Graeff, Hans-Jörg Busch, Bernadett Erdmann, Marc Wieckenberg, Christoph Haedicke, Katrin Esslinger, Elisabeth Nyoungui, Tim Friede, Felix Walcher, Julia Talamo, Julia K Wolff","doi":"10.1007/s00063-024-01229-6","DOIUrl":"10.1007/s00063-024-01229-6","url":null,"abstract":"<p><p>In Germany, a substantial reform of emergency care is strictly recommended. Regulation of patient flows into the ambulatory and stationary sectors remains a major issue.In the OPTINOFA project funded by Innovationsfunds, a new triage system was developed for a structured primary evaluation of both urgency and care level of emergency cases. OPTINOFA was evaluated in a cluster-randomized, controlled multicenter trial using a stepped-wedge design in eight emergency departments (ED) from 1 July 2019 to 31 May 2021. Additionally, data from one ED were used for comparison of temporal changes without intervention. The primary study endpoint represented the increase of patient transfers to the ambulatory sector; secondary endpoints included the outcome, process and quality indicators as well as mean emergency care costs.In the study, 46,558 emergency cases were included in the control period and 37,485 emergency cases in the intervention period. Concerning the primary endpoint, a significant increase of transfers to the ambulatory sector were detected in the per-protocol EDs (p < 0.001, odds ratio = 10.59). Waiting times were significantly reduced by an average 20 min in the intervention phase. Furthermore, a stable admission rate was found within 3 days after initial ED presentation. Cost analysis revealed no increase of treatment expenses within 28 days after ED admission.In this project a valid assistant service for structured primary evaluation of urgency and care level was successfully developed for emergency cases and served as a digital triage instrument with interoperable format. Clinical trial results revealed great potential for the OPTINOFA triage system to control patient flows in emergency and acute medicine.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"585-595"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830623","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":"[Video laryngoscopy in the intensive care unit-A current assessment].","authors":"Claudia Römer, Dominik Jarczak, Stefan Kluge, Jörn Grensemann","doi":"10.1007/s00063-025-01332-2","DOIUrl":"https://doi.org/10.1007/s00063-025-01332-2","url":null,"abstract":"<p><p>Video laryngoscopy (VL) and direct laryngoscopy (DL) are both intubation methods used on the intensive care unit although it is unclear if the routine use of VL is meaningful in this setting. A systematic literature search was carried out up to April 2024 in the data banks MEDLINE, CENTRAL and LIVIVO. Included were studies in which a comparison between VL and DL in adult patients on the intensive care unit was carried out. The primary endpoint was determined as the rate of the first attempt success (FAS). The secondary endpoints were visualization of the glottis according to Cormack-Lehane, the time to intubation and complications. A total of 13 studies with 4232 intubations were included. The FAS was significantly higher for VL compared to DL (odds ratio, OR = 1.97, 95% confidence interval, CI 1.47-2.64, p < 0.001). The use of VL led to an improved visualization of the glottis according to Cormack-Lehane and was associated with a lower rate of esophageal intubation failure and hypoxemia. This resulted in tendencies for action for the future utilization of VL on the intensive care unit. Further studies should evaluate the experience of the user with intubation, various VL designs and the use of bougies and stylets to be able to make a better assessment of the routine use of VL on the intensive care unit.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193498","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":"[Ten key messages of the German S3 guideline on invasive ventilation and use of extracorporeal techniques in patients with acute respiratory failure].","authors":"Falk Fichtner, Stefan Kluge, Sven Laudi, Onnen Moerer, Steffen Weber-Carstens, Michael Sander","doi":"10.1007/s00063-025-01333-1","DOIUrl":"https://doi.org/10.1007/s00063-025-01333-1","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132179","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":"[Current health economic and policy issues in intensive care and emergency medicine].","authors":"Michael Buerke, Engin Tükenmez","doi":"10.1007/s00063-025-01334-0","DOIUrl":"https://doi.org/10.1007/s00063-025-01334-0","url":null,"abstract":"<p><p>In 2025, intensive care and emergency medicine in Germany face profound structural and political transformation. The new Hospital Care Improvement Act (KHVVG) introduces a three-pillar financing model consisting of standby budgets, nursing reimbursement, and residual DRGs, aiming to reduce economic incentives and strengthen quality, safety, and specialization. At the same time, workforce shortages in medicine and nursing, as well as the integration of new roles such as Advanced Practice Nurses and Physician Assistants, pose major challenges. Structural reforms, regionalization, and the establishment of specialized centers are designed to ensure efficient resource allocation. Digitalization, telemedicine, and artificial intelligence offer opportunities for process optimization, cost management, and improved care quality, but require standardized frameworks and effective change management. In addition, sustainability initiatives, outpatient shifts, and quality-oriented payment models are gaining relevance. Overall, these developments mark a paradigm shift intended to secure high-quality, safe, and sustainable care for critically ill and emergency patients.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114972","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 disorders of potassium homeostasis : Diagnosis and emergency treatment].","authors":"Armin Finkenstedt, Michael Joannidis","doi":"10.1007/s00063-025-01331-3","DOIUrl":"https://doi.org/10.1007/s00063-025-01331-3","url":null,"abstract":"<p><p>Potassium disorders are common in patients treated in emergency departments or intensive care units and are associated with increased mortality. Severe hyperkalemia but also severe hypokalemia can lead to fatal arrhythmias and therefore necessitate emergency treatment. This article gives guidance on the diagnostic and therapeutic approach in patients with acute dyskalemia. Correct diagnosis requires not only a reliable measurement of serum potassium concentration but also knowledge of changes to the electrocardiogram caused by dyskalemia. This article outlines key steps in the treatment of hyperkalemia, including cardioprotection, shifting potassium into cells, and removing potassium from the body. Important pitfalls of potassium replacement in hypokalemia and the further approach after completion of initial emergency treatment are also reviewed.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115006","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":"[Management of acute abdomen in clinical acute and emergency medicine : Focus on gastrointestinal diseases].","authors":"Philipp Kasper, Seung-Hun Chon, Hans-Michael Steffen, Münevver Demir, Bianca Holzapfel, Natalie Jaspers, Christoph Neumann-Haefelin","doi":"10.1007/s00063-025-01321-5","DOIUrl":"https://doi.org/10.1007/s00063-025-01321-5","url":null,"abstract":"<p><p>Acute abdomen can represent a serious clinical condition with a variety of different and potentially life-threatening underlying causes. Rapid identification of the underlying etiology through a structured approach and the prompt initiation of adequate diagnostic and treatment measures is highly relevant in order to reduce the patient's mortality risk. This article provides an overview of important differential diagnoses of an acute abdomen and describes recommended diagnostic and therapeutic measures that are relevant in acute and emergency clinical care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031099","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 preclinical emergency medicine : What is the influence of ethical considerations on sustainable and resource-saving practices in prehospital emergency medicine?]","authors":"Julia Johanna Grannemann, Martin Deicke, Eugen Latka, Bernd Strickmann, Gerrit Jansen","doi":"10.1007/s00063-025-01322-4","DOIUrl":"10.1007/s00063-025-01322-4","url":null,"abstract":"<p><strong>Background and objectives: </strong>Sustainability in prehospital emergency medicine has received little attention, unlike in the hospital sector, where climate change and resource conservation are increasingly addressed. Ecological sustainability holds ethical significance within the Georgetown Mantra, as individual health must be viewed within the broader context of public health. The World Health Organization considers climate change the greatest threat to human health in the 21st century.</p><p><strong>Methods: </strong>An online survey of 23 questions was conducted among emergency medical personnel. This study focuses on three specific questions related to ethical considerations of sustainable practices in emergency medicine. Subgroup analyses were performed.</p><p><strong>Results: </strong>A total of 387 respondents (73% men, 27% women, aged 18-65 years, 17% physicians) participated. Most acknowledged climate change as a major health threat, but the 18-24 age group considered waste management less important in emergencies and prioritized individual health over public health. This age group also showed the lowest concern for climate change.</p><p><strong>Conclusion: </strong>The low concern about climate change among 18- to 24-year-old emergency medical staff, along with their lower prioritization of waste separation, highlights the need for targeted education. This study is the first to show age- and profession-specific differences in the prioritization of individual versus public health, sustainable behavior, and the perceived relevance of climate change. Sustainable practices in emergency medicine could contribute to global public health and promote intergenerational justice. Ethical considerations play a critical role in balancing acute care with long-term sustainability.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975725","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}