Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[OPTINOFA-Intelligent assistance service for structured assessment in the emergency department].","authors":"Elisabeth Nyoungui, Marina V Karg, Marc Wieckenberg, Katrin Esslinger, Michael Schmucker, Andreas Reiswich, Kai L Antweiler, Tim Friede, Martin Haag, Harald Dormann, Sabine Blaschke","doi":"10.1007/s00063-024-01126-y","DOIUrl":"10.1007/s00063-024-01126-y","url":null,"abstract":"<p><strong>Background: </strong>Case numbers in central emergency departments (EDs) have risen during the past decade in Germany, leading to recurrent overcrowding, increased risks in emergency care, and elevated costs. Particularly the fraction of outpatient emergency treatments has increased disproportionately. Within the framework of the Optimization of emergency care by structured triage with intelligent assistant service (OPTINOFA, Förderkennzeichen [FKZ] 01NVF17035) project, an intelligent assistance service was developed.</p><p><strong>Patients and methods: </strong>New triage algorithms were developed for the 20 most frequent leading symptoms on the basis of established triage systems (emergency severity index, ESI; Manchester triage system, MTS) and provided as web-based intelligent assistance services on mobile devices. To evaluate the validity, reliability, and safety of the new OPTINOFA triage instrument, a pilot study was conducted in three EDs after ethics committee approval.</p><p><strong>Results: </strong>In the pilot study, n = 718 ED patients were included (age 59.1 ± 22 years; 349 male, 369 female). With respect to disposition (out-/inpatient), a sensitivity of 91.1% and a specificity of 40.7%, and a good correlation with the OPTINOFA triage levels were detected (Spearman's rank correlation ρ = 0.41). Furthermore, the area under the curve (AUC) for prediction of disposition according to the OPTINOFA triage level was 0.73. The in-hospital mortality rate of OPTINOFA triage levels 4 and 5 was 0%. The association between the length of ED stay and the OPTINOFA triage level was shown to be significant (p < 0.001).</p><p><strong>Conclusion: </strong>The results of the pilot study demonstrate the safety and validity of the new triage system OPTINOFA. By definition of both urgency and emergency care level, new customized perspectives for load reduction in German EDs via a closer cooperation between out- and inpatient sectors of emergency care could be established.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"208-221"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307541","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":"[Extubation failure in a 70-year-old man after implantation of an event recorder].","authors":"Elvin Bairamov, Paul Zimmermann, Martin Braun, Michael Schlicht","doi":"10.1007/s00063-024-01219-8","DOIUrl":"10.1007/s00063-024-01219-8","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"253-255"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802944","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":"[Septic cardiomyopathy-diagnosis and estimation of disease severity].","authors":"Ursula Müller-Werdan, Alexander Vogt, Karl Werdan","doi":"10.1007/s00063-024-01109-z","DOIUrl":"10.1007/s00063-024-01109-z","url":null,"abstract":"<p><strong>Background: </strong>The relevance of septic cardiomyopathy is frequently underestimated due to the complexity of the pattern of cardiac injury and the corresponding difficulties in quantifying the degree of functional impairment.</p><p><strong>Aim: </strong>Account of the methods for diagnosis and severity classification of septic cardiomyopathy.</p><p><strong>Methods: </strong>Literature review and analysis of the main findings.</p><p><strong>Results: </strong>Septic cardiomyopathy is characterized by both systolic and diastolic impairment of not only the left, but also the right ventricle, as well as by sinus-tachycardiomyopathy (≥ 90-95 beats/min) of variable degree. Sepsis-related organ failure assessment (SOFA) score, left ventricular ejection fraction (LVEF), ECG and cardiac biomarkers do not help in grading severity of septic cardiomyopathy. For that purpose either a sophisticated echocardiography diagnosis is mandatory, or the measurement of those global heart function parameters which take into account the dependency of cardiac output on afterload, in view of the pronounced vasodilatation in sepsis and septic shock, is needed. A suitable parameter on the basis of cardiac output measurement is afterload-related cardiac performance (ACP), which gives the percentage of cardiac output in a septic patient related to the cardiac output a healthy heart pumps when challenged by a fall in systemic vascular resistance to the same extent. The calculation of ACP shows that at least one in two septic patients suffers from impaired heart function and that mortality increases as severity increases.</p><p><strong>Conclusion: </strong>Simple parameters like LVEF are not apt for diagnosis nor for disease severity classification of septic cardiomyopathy. For that purpose either sophisticated echocardiography techniques or load-independent parameters-best validated-ACP measurements are appropriate.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"185-191"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724667","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":"[ST segment elevations and pulmonary edema-\"just\" simple cardiogenic shock caused by ischemia?]","authors":"Maximilian Eichner","doi":"10.1007/s00063-025-01258-9","DOIUrl":"https://doi.org/10.1007/s00063-025-01258-9","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721948","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":"The role of shock indexes and RDW/albumin ratio in upper gastrointestinal bleeding : Predicting adverse outcomes.","authors":"Secdegül Coşkun Yaş, Dilber Üçöz Kocaşaban, Sertaç Güler","doi":"10.1007/s00063-025-01267-8","DOIUrl":"https://doi.org/10.1007/s00063-025-01267-8","url":null,"abstract":"<p><strong>Objective: </strong>Upper gastrointestinal bleeding (UGIB) is a common condition in emergency departments (ED). The aim of this study is to evaluate the effectiveness of the red blood cell distribution width (RDW) to albumin ratio and three types of shock index (SI) as predictors of adverse outcomes in patients with UGIB in the ED.</p><p><strong>Methods: </strong>The study was designed as a retrospective, single-center study, and patients were screened using electronic medical records. Glasgow Blatchford, RDW/albumin ratio, SI, modified SI (MSI), and age SI were calculated, and adverse outcomes were defined as ICU admission, red blood cell transfusion, in-hospital mortality, and 30-day mortality. The effectiveness of these parameters in predicting adverse outcomes in UGIB patients admitted to the ED was evaluated.</p><p><strong>Results: </strong>The study enrolled 174 patients, of whom 17.2% required admission to the ICU, 33.9% received red blood cell transfusions, and 10.3% died within 30 days. Patients with adverse outcomes had significantly higher SI, MSI, age SI, and RDW/albumin ratio values. All four indices were statistically significant predictors of adverse outcomes (area under the curve [AUC] SI: 0.676; AUC MSI: 0.706; AUC age SI: 0.778; AUC RDW/albumin: 0.787). Age SI showed significantly higher prognostic performance in predicting adverse outcomes than SI and MSI.</p><p><strong>Conclusion: </strong>The present study suggests that SI, MSI, age SI, and RDW/albumin ratio may be useful in predicting adverse outcomes in patients with UGIB. The RDW/albumin ratio was effective in predicting mortality, while age SI showed a higher predictive ability for adverse outcomes compared to SI and MSI.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701972","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":"https://doi.org/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":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-24","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":"[S1 guideline on sustainability in intensive care and emergency medicine].","authors":"M Kochanek, M Berek, S Gibb, C Hermes, H Hilgarth, U Janssens, J Kessel, V Kitz, J Kreutziger, M Krone, D Mager, G Michels, S Möller, T Ochmann, S Scheithauer, I Wagenhäuser, N Weeverink, D Weismann, T Wengenmayer, F M Wilkens, V König","doi":"10.1007/s00063-025-01261-0","DOIUrl":"https://doi.org/10.1007/s00063-025-01261-0","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701968","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":"[S1 guideline: diagnosis and treatment of invasive pulmonary aspergillosis in critically ill/intensive care patients].","authors":"Dominic Wichmann, Martin Hoenigl, Philipp Koehler, Christina Koenig, Frederike Lund, Sebastian Mang, Richard Strauß, Markus Weigand, Christian Hohmann, Oliver Kurzai, Claus Heußel, Matthias Kochanek","doi":"10.1007/s00063-025-01265-w","DOIUrl":"https://doi.org/10.1007/s00063-025-01265-w","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674678","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 hypercalcemia in intensive care medicine].","authors":"Katharina Politt, Christine Gaik, Thomas Wiesmann","doi":"10.1007/s00063-025-01259-8","DOIUrl":"https://doi.org/10.1007/s00063-025-01259-8","url":null,"abstract":"<p><p>Hypercalcemic crisis is a rare but life-threatening complication of severe hypercalcemia. In most cases (> 90%), primary hyperparathyroidism or malignancy are the causes of a hypercalcemic crisis. Prodromes are often nonspecific and can present as nausea, vomiting, or a lack of concentration. The transition from hypercalcemia to a hypercalcemic crisis is often caused by a dysregulated volume status. As rapid treatment is essential, differential diagnostics should not delay treatment. In the human body, there is a complex system that keeps the extracellular calcium concentration within a narrow range (total calcium level: 2.1-2.5 mmol/L), whereby only about 50% of the total extracellular calcium is ionized and, therefore, biologically active. The remaining 50% is mostly bound to albumin and globulins. A hypercalcemic crisis is defined as a (albumin-corrected) total calcium over 3.5 mmol/L with accompanying severe symptoms. In addition to the measurement of the albumin-corrected total calcium concentration and ionized calcium, measuring the (intact) parathyroid hormone level is also crucial, as the causes of the hypercalcemic crisis can be roughly divided into parathyroid hormone (PTH)-dependent and PTH-independent causes. Initially, treatment is primarily symptomatic; in patients with a hypercalcemic crisis, the focus is on evaluation and appropriate emergency treatment according to the ABCDE scheme (e.g., securing the airway). At the same time, the calcium level should be lowered as quickly as possible in a controlled manner. Therefore, differentiated volume therapy is recommended. In addition, treatment with loop diuretics such as furosemide can be considered (after correcting hypovolemia). If therapy is not successful quickly or if there are contraindications to increased fluid administration (e.g., cardiac or renal insufficiency), the start of (calcium-free) dialysis is usually unavoidable. Calcitonin can be used to rapidly reduce calcium levels. Depending on the clinical cause of the severe hypercalcemia, cinacalcet, bisphosphonates, and denosumab are also drugs that can effectively reduce calcium levels within 2-3 days. The long-term prognosis depends on the underlying disease. A cohort of patients with primary hyperparathyroidism showed a 3-year survival rate of 80%.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674682","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":"[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":"https://doi.org/10.1007/s00063-025-01262-z","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>What person-centered challenges and support services are available for vulnerable relatives in the ICU?</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}