{"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":"<p><p>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 CO<sub>2</sub>-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.</p>","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}
{"title":"[Major limb amputation in a geriatric patient following minor laceration].","authors":"Lukas Klein, Saskia Maletzke, Lampros Kousoulas, Hagen Schmal","doi":"10.1007/s00063-024-01228-7","DOIUrl":"10.1007/s00063-024-01228-7","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"434-437"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873163","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}
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":"<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":"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}
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":"<p><p>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.</p>","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}
{"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":"<p><p>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.</p>","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}
Katja Schneider, Stefan Hagel, Jessica Rademacher, Irit Nachtigall, Mathias W Pletz
{"title":"[Antibiotic stewardship-an update : Ongoing development of an initiative].","authors":"Katja Schneider, Stefan Hagel, Jessica Rademacher, Irit Nachtigall, Mathias W Pletz","doi":"10.1007/s00063-025-01290-9","DOIUrl":"https://doi.org/10.1007/s00063-025-01290-9","url":null,"abstract":"<p><p>The burden of disease caused by infections with antibiotic-resistant bacteria is increasing worldwide. The reason for this is the inappropriate use of antibiotics. In addition to the development of new antibiotics, their rational use is crucial to slowing down the development of resistance. Antibiotic stewardship makes an important contribution to reducing the use of antibiotics by implementing programs, particularly in hospitals. In addition, \"diagnostic stewardship\" supports the targeted use of infectiological diagnostics to avoid mis- and overdiagnosis, thereby optimizing anti-infective therapy. The critical review of suspected penicillin allergies (\"delabeling\") also promotes the sensible use of antibiotics. Findings from healthcare research on antibiotics and diagnostic stewardship are increasingly being incorporated into infectiology and sector-specific guidelines.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163135","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}
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":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%).</p><p><strong>Conclusion: </strong>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.</p>","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}
Franziska Wefer, Lars Krüger, Carsten Hermes, Peter Nydahl, Thomas Mannebach, Amrei Mehler-Klamt, Anemone Neumann-Wagner, Franziska Thüne, Susanne Krotsetis, Anett Henck, Marina Ufelmann, Jutta Tewesmeier, Jan Gummert, Sascha Köpke
{"title":"[Treatment algorithm: thirst management for critically ill people with an endotracheal tube or tracheal cannula].","authors":"Franziska Wefer, Lars Krüger, Carsten Hermes, Peter Nydahl, Thomas Mannebach, Amrei Mehler-Klamt, Anemone Neumann-Wagner, Franziska Thüne, Susanne Krotsetis, Anett Henck, Marina Ufelmann, Jutta Tewesmeier, Jan Gummert, Sascha Köpke","doi":"10.1007/s00063-025-01291-8","DOIUrl":"https://doi.org/10.1007/s00063-025-01291-8","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129173","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":"[Recommendation for medical onboarding and training on internal medicine intensive care units].","authors":"Janika Briegel, Anna Carola Hertrich, Julian Hoffmann, Friederike Bennett, Jan-Hendrik Naendrup, Matthias Kochanek, Reimer Riessen","doi":"10.1007/s00063-025-01276-7","DOIUrl":"https://doi.org/10.1007/s00063-025-01276-7","url":null,"abstract":"<p><p>The medical onboarding process for physicians in internal medicine intensive care units in Germany reveals significant deficiencies, as highlighted by a 2023 survey from YDGIIN. Many physicians report feeling insecure and inadequately prepared after their onboarding phase. The study identifies core issues such as heterogeneous levels of training, unstructured onboarding processes, and a lack of support and competency checks in daily clinical practice. To address these challenges, the study proposes solutions including individualized onboarding, mentoring and feedback systems, and a structured onboarding and training plan. The goal is to make the onboarding process more effective, thereby improving the quality of patient care and increasing physician satisfaction.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112422","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":"[Targeted volume therapy in acute pancreatitis: (not) a special case?]","authors":"Matthias Lange, Christian Ertmer","doi":"10.1007/s00063-025-01286-5","DOIUrl":"https://doi.org/10.1007/s00063-025-01286-5","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112426","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}