Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[TeleCOVID Hessen: implications for the development of new indication areas].","authors":"Anne Grahlmann, Jenny Brandt, Daniela Salzmann, Felix Hoffmann","doi":"10.1007/s00063-024-01107-1","DOIUrl":"10.1007/s00063-024-01107-1","url":null,"abstract":"<p><strong>Background: </strong>During the SARS-CoV‑2 pandemic, the TeleCOVID application was developed in Hessen to connect the intensive care units via telemedicine. After successful implementation, the application should be extended to other indication areas in intensive care medicine.</p><p><strong>Objectives: </strong>The purpose of this study was to evaluate other indications for which the application can be used and which technical requirements are associated with this.</p><p><strong>Materials and methods: </strong>To answer these questions, guideline-based expert interviews were conducted, which were evaluated using a qualitative content analysis.</p><p><strong>Results: </strong>The survey showed that TeleCOVID can be extended to other indication areas in intensive care. Numerous technical requirements were formulated that should be specifically considered when the application is further developed.</p><p><strong>Conclusions: </strong>The telemedical networking of intensive care units generates added value for the actors involved. However, it is important that the data is collected in the best possible standardized and structured way. The communication process should be automated wherever possible to minimise the workload for the participating persons.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543453","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":"[Volume therapy: which preparation for which situation?]","authors":"Timo Mayerhöfer, Georg F Lehner, Michael Joannidis","doi":"10.1007/s00063-024-01194-0","DOIUrl":"10.1007/s00063-024-01194-0","url":null,"abstract":"<p><p>The most commonly used fluids for volume therapy are crystalloids and colloids. Crystalloids comprise 0.9% sodium chloride and balanced crystalloids (BC). Colloids can be divided into artificial colloids and human albumin (a natural colloid). Large studies show advantages for BC over 0.9% NaCl with respect to renal endpoints, probably due to the unphysiologically high chloride content of 0.9% NaCl. However, other studies, such as the BaSICS and PLUS trials, showed no significant differences in mortality in a heterogeneous population. Despite this, meta-analyses suggest advantages for BC. Therefore, BC should be preferred, especially in patients at increased risk of acute kidney injury, with acidemia and/or hyperchloremia. Except for specific indications (e.g., in patients with cirrhosis, sepsis resuscitation after initial volume therapy with BC), albumin should not be used. There is clear evidence of harm from hydroxyethyl starch in intensive care patients.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394582","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":"[Effects of classical or heavy metal music in humans and animals: implications for intensive care medicine].","authors":"Hans-Joachim Trappe, Eva-Maria Völkel, Gerald Reiner","doi":"10.1007/s00063-024-01110-6","DOIUrl":"10.1007/s00063-024-01110-6","url":null,"abstract":"<p><strong>Background: </strong>The importance of music in intensive care medicine is still controversial and the mechanisms of music are unclear. It is important whether different music styles (classical music [CM], Heavy Metal [HM] show measurable effects on blood pressure (BP) or heart rate (HR) in humans or not. It is also unclear whether behavioral patterns are influenced by music (CM, HM) in animals.</p><p><strong>Methods: </strong>We studied the influence of CM (Bach, Orchestral Suite No. 3, BWV 1068) and HM (Band Disturbed: Indestructible) compared to a control group (CO) without music exposure in 120 healthy subjects (60 study subjects, 60 control subjects) and 36 young pigs (18 Pietrains, 18 Wiesenauer Minipigs) according to an identical study protocol (21 minutes of music exposure (CM, HM) or 21 minutes of no music (C0).</p><p><strong>Results: </strong>We were able to clearly demonstrate in 36 pigs that CM led to significantly more activity behavior than HM or CO (p<0,01). HM caused significantly more stress behavior than CM or CO (p<0,01). In humans, there was a decrease in BP_syst, BP_diast or HR (beats per minute [bpm]) among CM: decrease BP_syst -7,5±9,1 mm Hg, BP_diast -4,9±7,5 mm Hg, HR -7,2±10,2 bpm. This was observed less frequently in HM: BP_syst -3,6±7,1 mm Hg, BP_diast -2,7±6,9 mm Hg, HR -5,9±9,0 bpm. The influence of BP and HR was significantly lower in CO compared to music: BP_syst -2,3±7,2 mm Hg, BP_diast -2,0±7,3 mm Hg, HR -5,8±12,3 bpm.</p><p><strong>Conclusions: </strong>BP and HR in humans and behavioral patterns in animals are clearly influenced by music. CM leads more frequently to activity behavior in animals and to lower BP and HR in humans compared to HM or CO. In both animal breeds, stress behavior was observed more frequently in HM compared to CM or CO. Therefore, music may play a role in intensive care medicine.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933690","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":"[Hemodynamic monitoring- (NOT) a nursing task?!]","authors":"Carsten Hermes","doi":"10.1007/s00063-024-01192-2","DOIUrl":"10.1007/s00063-024-01192-2","url":null,"abstract":"<p><p>Ensuring adequate and stable hemodynamic conditions is an essential component of patient care in emergency and intensive care units. The assessment of circulatory status is complex and influenced by patient-specific characteristics, medical staff experience, and available equipment. Hemodynamic monitoring encompasses both invasive and noninvasive methods to monitor circulatory parameters. It supports patient management and ensures therapeutic success by alerting healthcare providers to deviations, including critical values. In practice, numerical data often receive more emphasis than comprehensive patient observation, potentially leading to misinterpretation. Advanced practice nurses (APNs) are highly qualified nursing professionals who work largely autonomously due to their advanced training. However, there is currently no uniform legal regulation for these professions in Germany. Clear definitions and nationwide regulations for related academic programs are necessary. Interprofessional collaboration, as well as the qualifications and numbers of nursing staff, significantly impact therapeutic outcomes. Hemodynamics involves the physical principles of blood flow and the assessment of vital parameters to ensure organ perfusion and oxygenation. The competence and knowledge of nursing staff are crucial for safe patient care. Local standard operating procedures (SOPs) should consider interprofessional collaboration and the qualifications of team members.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548483","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":"[Visual diagnosis for experts].","authors":"Laura Arheilger, Nicolas Müller, Mattia M Müller, Christoph Camille Ganter, Rene Hage, Mace Schuurmans, Sascha David","doi":"10.1007/s00063-024-01166-4","DOIUrl":"10.1007/s00063-024-01166-4","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019220","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":"[Bedside imaging].","authors":"Robert Zilberszac","doi":"10.1007/s00063-024-01191-3","DOIUrl":"10.1007/s00063-024-01191-3","url":null,"abstract":"<p><p>Sonography, in particular echocardiography, is essential in the assessment of volume status and hemodynamics in critically ill patients. Examination of the left ventricle, in addition to assessing ventricular function, provides valuable information, including the \"kissing papillary muscle sign,\" which may indicate fluid responsiveness. Examination of the right ventricle is also important because it is sensitive to both volume and pressure overload. Assessment of diastolic function and measurement of inferior vena cava width and variability provide clues to left and right ventricular preload, respectively. Measurement of stroke volume and cardiac output allows further assessment of hemodynamics and also permits determination of stroke volume variability.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394580","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":"[Spiritual care competences of healthcare workers in emergency and intensive care-a prospective questionnaire study].","authors":"J Schwartz, T Tenge, K Lanhenke, S Meier, M Schallenburger, Y-N Batzler, T Roser, D Wetzchewald, M Neukirchen","doi":"10.1007/s00063-024-01185-1","DOIUrl":"https://doi.org/10.1007/s00063-024-01185-1","url":null,"abstract":"<p><strong>Background: </strong>In intensive and emergency care, patients and their relatives are confronted with potentially existential crises. Spiritual care can be an additional resource to address related psychosocial and physical symptoms and to support patients and their relatives. Accordingly, healthcare workers need spiritual skills to recognize and respond to these needs.</p><p><strong>Objectives: </strong>What spiritual competencies do healthcare workers in intensive and emergency care have? Are there differences between professions and genders? What factors influence spiritual competencies?</p><p><strong>Materials and methods: </strong>The prospective questionnaire study included physicians participating in intensive care and emergency medicine courses and nurses who were training or working in intensive and emergency care. Self-reported spiritual competencies were assessed using the Spiritual Care Competence Questionnaire (SCCQ), which captures the following areas: perceptual competence, team-spirit, documentation competence, self-awareness and proactive opening, knowledge about other religions, competence in conversation techniques and proactive empowerment-competence.</p><p><strong>Results: </strong>We included 465 physicians (50% female, years in profession: mean = 4.0, standard deviation [SD] = 3.5) and 86 nurses (80% female, years in profession: mean = 12.7, SD = 10.7). The average SCC was 2.3 (SD 0.4) out of a maximum of 4 points, with higher spiritual competences among spiritual and religious respondents. There were differences in specific competencies between the professions and genders. Women indicated a higher level of competence in the area of perception and conversation skills, physicians in documentation skills.</p><p><strong>Conclusions: </strong>Overall, there is a clear need to train healthcare staff in the field of intensive care and emergency medicine.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511182","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":"https://doi.org/10.1007/s00063-024-01177-1","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-23","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":"[Severe intoxication after yew (Taxus) ingestion-case report and literature review].","authors":"J L Lohmeyer, C Enneking, P Mammen, T Horlacher, M Roiss, G N Schmidt, M W Bergmann, T Spangenberg","doi":"10.1007/s00063-024-01187-z","DOIUrl":"https://doi.org/10.1007/s00063-024-01187-z","url":null,"abstract":"<p><strong>Background: </strong>Severe yew (Taxus) intoxication is a rare condition that can lead to life-threatening cardiac arrhythmia. The survival of patients requires highly specialized emergency and intensive care treatment.</p><p><strong>Objectives: </strong>Systematic overview of the clinical picture and important treatment options.</p><p><strong>Methods: </strong>Case report of severe yew intoxication with subsequent literature review of comparable case reports. Analysis of 33 case reports with a total of 37 critically intoxicated patients from the years 2000-2024 from Europe and North America.</p><p><strong>Results: </strong>Severe yew intoxications were almost exclusively the result of suicidal intent. Patients average age was 33 (± 14.5) years. The use of antiarrhythmic drugs and electrical stimulation of the heart often proved to be ineffective or deteriorating in its effect over time. The use of lipid emulsion and/or digoxin-specific Fab fragments has little evidence. The average duration of a clinically relevant arrhythmogenic effect was 22±11.7 h.</p><p><strong>Conclusions: </strong>The management of yew intoxication is primarily limited to symptomatic treatment. The availability of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in a \"bridge-to-recovery\" concept appears to be of utmost importance.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478628","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-national and international initiatives in intensive care and emergency medicine].","authors":"Thomas Bein","doi":"10.1007/s00063-024-01199-9","DOIUrl":"https://doi.org/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":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-16","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}