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[Tracheotomy : Indication and implementation]. [气管切开术：适应症和实施]。
IF 1.3 4区 医学
Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-11-01 Epub Date: 2024-10-11 DOI: 10.1007/s00063-024-01184-2
Michael Oppert, Markus Jungehülsing, Lutz Nibbe
{"title":"[Tracheotomy : Indication and implementation].","authors":"Michael Oppert, Markus Jungehülsing, Lutz Nibbe","doi":"10.1007/s00063-024-01184-2","DOIUrl":"10.1007/s00063-024-01184-2","url":null,"abstract":"<p><p>Tracheotomy has long been performed outside of intensive care medicine. In modern medicine, it has a firm place in the management of critically ill and emergency care patients as well as in cancer surgery of the head and neck, the care of long-term ventilated patients, patients with swallowing disorders, and neurological diseases. The indication, technique, and timing of tracheotomy are very different for the various diseases. This article provides an overview of the different indications, surgical techniques, and timing of tracheotomy in modern intensive care medicine.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"694-702"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401709","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}
引用次数: 0
[Hemodynamic monitoring and volume management]. [血液动力学监测和容量管理]。
IF 1.3 4区 医学
Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-11-01 Epub Date: 2024-11-05 DOI: 10.1007/s00063-024-01200-5
Thomas Staudinger, Uwe Janssens
{"title":"[Hemodynamic monitoring and volume management].","authors":"Thomas Staudinger, Uwe Janssens","doi":"10.1007/s00063-024-01200-5","DOIUrl":"https://doi.org/10.1007/s00063-024-01200-5","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"119 8","pages":"611-613"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584715","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}
引用次数: 0
[Functional hemodynamic monitoring]. [功能性血液动力学监测]。
IF 1.3 4区 医学
Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-11-01 Epub Date: 2024-09-30 DOI: 10.1007/s00063-024-01190-4
Uwe Janssens
{"title":"[Functional hemodynamic monitoring].","authors":"Uwe Janssens","doi":"10.1007/s00063-024-01190-4","DOIUrl":"10.1007/s00063-024-01190-4","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients in the intensive care unit require intensified monitoring to control the treatment with volume and/or vasoactive substances.</p><p><strong>Research question: </strong>What role does functional hemodynamic monitoring play in controlling treatment and what techniques are used to manage this?</p><p><strong>Material and methods: </strong>Review of the current literature.</p><p><strong>Results and discussion: </strong>Precise knowledge of the physiology of the cardiovascular system as well as the pathophysiology of individual clinical pictures and the possibilities of invasive and noninvasive monitoring are the prerequisites for the indications, implementation and interpretation of functional hemodynamic monitoring. An understanding of the heart-lung interaction and the influence of invasive ventilation on the volumetric target parameters, such as stroke volume variation, systolic pressure variation and pulse pressure variation as well as sonography of the inferior vena cava are indispensable prerequisites for the question of volume responsiveness. Other maneuvers, such as the passive leg raising test, can be very helpful when deciding on volume administration in everyday clinical practice. Static parameters such as central venous pressure generally play no role and if any only a subordinate one.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"614-623"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330669","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}
引用次数: 0
[The ROSE concept: modern fluid management in intensive care medicine]. [ROSE 概念：重症监护医学中的现代液体管理]。
IF 1.3 4区 医学
Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-11-01 Epub Date: 2024-10-09 DOI: 10.1007/s00063-024-01193-1
Carsten Willam, Larissa Herbst
{"title":"[The ROSE concept: modern fluid management in intensive care medicine].","authors":"Carsten Willam, Larissa Herbst","doi":"10.1007/s00063-024-01193-1","DOIUrl":"10.1007/s00063-024-01193-1","url":null,"abstract":"<p><p>The ROSE concept, which is the acronym of resuscitation, optimization, stabilization and evacuation, describes the phases of fluid therapy, based on the pathophysiology of septic shock. During the first two phases, aggressive fluid therapy that is guided by clinical and hemodynamic parameters is mandatory. During the stabilization phase, recovery from shock and microcirculatory injury occurs, which enables the depletion of fluid overload in the fourth and final phase. Ultimately, euvolemia needs to be regained, which reverts interstitial edema and organ dysfunction.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"634-639"},"PeriodicalIF":1.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394581","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}
引用次数: 0
[Volume therapy: which preparation for which situation?] [容量疗法：哪种制剂适用于哪种情况？］
IF 16.4 4区 医学
Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-11-01 Epub Date: 2024-10-09 DOI: 10.1007/s00063-024-01194-0
Timo Mayerhöfer, Georg F Lehner, Michael Joannidis
{"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":" ","pages":"640-649"},"PeriodicalIF":16.4,"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}
引用次数: 0
[TeleCOVID Hessen: implications for the development of new indication areas]. [黑森州 TeleCOVID：对开发新适应症领域的影响]。
IF 1.3 4区 医学
Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-11-01 Epub Date: 2024-01-24 DOI: 10.1007/s00063-024-01107-1
Anne Grahlmann, Jenny Brandt, Daniela Salzmann, Felix Hoffmann
{"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":" ","pages":"672-677"},"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}
引用次数: 0
[Effects of classical or heavy metal music in humans and animals: implications for intensive care medicine]. [古典或重金属音乐对人类和动物的影响：对重症监护医学的影响]。
IF 1.3 4区 医学
Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-11-01 Epub Date: 2024-02-22 DOI: 10.1007/s00063-024-01110-6
Hans-Joachim Trappe, Eva-Maria Völkel, Gerald Reiner
{"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<sub>syst</sub>, BP<sub>diast</sub> or HR (beats per minute [bpm]) among CM: decrease BP<sub>syst</sub> -7,5±9,1 mm Hg, BP<sub>diast</sub> -4,9±7,5 mm Hg, HR -7,2±10,2 bpm. This was observed less frequently in HM: BP<sub>syst</sub> -3,6±7,1 mm Hg, BP<sub>diast</sub> -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<sub>syst</sub> -2,3±7,2 mm Hg, BP<sub>diast</sub> -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":" ","pages":"678-689"},"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}
引用次数: 0
[Hemodynamic monitoring- (NOT) a nursing task?!] [血液动力学监测--（不是）护理工作？］
IF 16.4 4区 医学
Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-11-01 Epub Date: 2024-10-29 DOI: 10.1007/s00063-024-01192-2
Carsten Hermes
{"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":" ","pages":"629-633"},"PeriodicalIF":16.4,"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}
引用次数: 0
[Bedside imaging]. [床旁成像］
IF 1.3 4区 医学
Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-11-01 Epub Date: 2024-10-09 DOI: 10.1007/s00063-024-01191-3
Robert Zilberszac
{"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":" ","pages":"624-628"},"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}
引用次数: 0
[Visual diagnosis for experts]. [专家视觉诊断]。
IF 1.3 4区 医学
Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-11-01 Epub Date: 2024-08-22 DOI: 10.1007/s00063-024-01166-4
Laura Arheilger, Nicolas Müller, Mattia M Müller, Christoph Camille Ganter, Rene Hage, Mace Schuurmans, Sascha David
{"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":" ","pages":"690-693"},"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}
引用次数: 0
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