Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献_第3页

Is there still a place for ECCO₂R? ECCO2R 还有用武之地吗？

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-10-09 DOI: 10.1007/s00063-024-01197-x

Thomas Staudinger

{"title":"Is there still a place for ECCO2R?","authors":"Thomas Staudinger","doi":"10.1007/s00063-024-01197-x","DOIUrl":"https://doi.org/10.1007/s00063-024-01197-x","url":null,"abstract":"The therapeutic target of extracorporeal carbon dioxide removal (ECCO2R) is the elimination of carbon dioxide (CO2) from the blood across a gas exchange membrane without influencing oxygenation to a clinically relevant extent. In acute respiratory distress syndrome (ARDS), ECCO2R has been used to reduce tidal volume, plateau pressure, and driving pressure (\"ultraprotective ventilation\"). Despite achieving these goals, no benefits in outcome could be shown. Thus, in ARDS, the use of ECCO2R to achieve ultraprotective ventilation can no longer be recommended. Furthermore, ECCO2R has also been used to avoid intubation or facilitate weaning in obstructive lung failure as well as to avoid mechanical ventilation in patients during bridging to lung transplantation. Although these goals can be achieved in many patients, the effects on outcome still remain unclear due to lack of evidence. Despite involving less blood flow, smaller cannulas, and smaller gas exchange membranes compared with extracorporeal membrane oxygenation, ECCO2R bears a comparable risk of complications, especially bleeding. Trials to define indications and analyze the risk-benefit balance are needed prior to implementation of ECCO2R as a standard therapy. Consequently, until then, ECCO2R should be used in clinical studies and experienced centers only. This article is freely available.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394584","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

ECPR-the evolving role in cardiac arrest. ECPR - 在心脏骤停中不断发展的作用。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-10-09 DOI: 10.1007/s00063-024-01196-y

Alexander Supady

{"title":"ECPR-the evolving role in cardiac arrest.","authors":"Alexander Supady","doi":"10.1007/s00063-024-01196-y","DOIUrl":"https://doi.org/10.1007/s00063-024-01196-y","url":null,"abstract":"Extracorporeal cardiopulmonary resuscitation (ECPR) describes the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) to restore blood circulation in patients during refractory cardiac arrest. So far, ECPR is not the standard of care but has become part of clinical routine for select patients in many places. As ECPR is a highly invasive support option associated with considerable risks for fatal complications, premature use in patients who may have return of spontaneous circulation should be avoided. However, the selection criteria for ECPR are still evolving, as the search for evidence is ongoing. Recent randomized controlled trials of different ECPR strategies support its use within integrated systems built around highly specialized ECPR centers. The ECPR caseload is an important predictor of patient survival, and continuous training is key for evidence-based quality of care. Typical complications after ECPR include vascular injury or malposition of cannulas, thrombotic complications, hemolysis, and bleeding events that require early detection and interdisciplinary management. When provided by highly specialized and well-trained expert teams in dedicated ECPR centers within integrated pre-hospital and intra-hospital emergency care systems, ECPR may improve survival in select patients with refractory cardiac arrest. This article is freely available.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394583","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

Erratum zu: Stellenschlüssel für therapeutische Gesundheitsfachberufe auf Intensivstationen. 勘误：重症监护室治疗医护人员的人员配备比例。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-10-01 DOI: 10.1007/s00063-024-01145-9

Silke Klarmann, Anke Hierundar, Teresa Deffner, Andreas Markewitz, Christian Waydhas

引用次数: 0

[Effects of nursing visits on primary nursing : An evaluation study in an intensive care unit]. [护理访视对基础护理的影响：重症监护病房的评估研究]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-10-01 Epub Date: 2024-06-25 DOI: 10.1007/s00063-024-01163-7

Dirk Johnen, Lars Krüger, Thomas Mannebach, Francesco Squiccimarro, Gero Langer, Elke Hotze

{"title":"[Effects of nursing visits on primary nursing : An evaluation study in an intensive care unit].","authors":"Dirk Johnen, Lars Krüger, Thomas Mannebach, Francesco Squiccimarro, Gero Langer, Elke Hotze","doi":"10.1007/s00063-024-01163-7","DOIUrl":"10.1007/s00063-024-01163-7","url":null,"abstract":"Background: After a pilot phase in 2017, nursing visits (PV) were implemented in an intensive care unit (ICU) at a university hospital. So far, published findings on the impact of PV on the primary nursing organisation system (process-responsible nursing [PP]) could not be identified.Aim: Primary aim was to investigate the effects of PV on PP from the nurses perspective. Secondary aims included comparison with the results of the pilot phase (t0) to determine further effects, general conditions of the PP and the overall evaluation.Methods: A quantitative evaluation study using a standardised questionnaire was used.Results: The survey was conducted in September to October 2023 (t1) with a response rate of 74.6% (n = 47). On a scale of 1-6 (strongly agree; strongly disagree), 100.0% of the process-responsible nurses (PP; n = 8) and 77.0% of the nurses without process responsibility (P; n = 30) rated the PV at levels 1-3 (p = 0.328) as contributing to the evaluation of care planning for patients with process responsibility. PV provided support for the implementation of PP (PP: 100.0%, n = 8; P: 79.5%, n = 31; p = 0.318) and had a statistically significant effect (r = 0.97, p = 0.035) on improving the quality of care and care planning for patients with procedural responsibility. The nurses indicated with levels 1-3 that the patients were more consciously brought into the focus of nursing care through the PV (t1: 74.4%, n = 35; t0: 86.4%, n = 38; p = 0.953). The PV should take place weekly and was rated with a median of 2 (IQR t1: 1-3; t0:1-2).Conclusion: PV support the implementation of PP and patient-centred care in the ICU.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447393","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

[Treatment algorithm: prone position in critically ill patients]. [治疗算法：重症患者的俯卧位]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-10-01 Epub Date: 2024-05-08 DOI: 10.1007/s00063-024-01146-8

Carsten Hermes, Lars Krüger, Tobias Ochmann, Vanessa Erbes, Detlef Eggers, Anke Kany, Ricardo Klimpel, Victoria König, Marcel Ansorge, Anett Henck, Tobias Wittler, Thomas Bein, Stefan J Schaller

引用次数: 0

[Therapeutic healthcare professional staffing requirements in intensive care units]. [重症监护室的治疗保健专业人员配备要求]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-10-01 Epub Date: 2024-03-28 DOI: 10.1007/s00063-024-01125-z

Silke Klarmann, Anke Hierundar, Teresa Deffner, Andreas Markewitz, Christian Waydhas

{"title":"[Therapeutic healthcare professional staffing requirements in intensive care units].","authors":"Silke Klarmann, Anke Hierundar, Teresa Deffner, Andreas Markewitz, Christian Waydhas","doi":"10.1007/s00063-024-01125-z","DOIUrl":"10.1007/s00063-024-01125-z","url":null,"abstract":"Background: Therapeutic healthcare professionals in the multiprofessional intensive care unit (ICU) team are important for early mobilization, dysphagia therapy, and psychosocial care of critically ill patients.Objective: Despite the high relevance of therapeutic healthcare professions for care in ICUs, there are no recommendations on the specific staffing of therapists in ICUs.Results: Considering the main areas of activity of the individual professional groups and based on productivity time, a requirements analysis for staffing ICUs of different care levels with physiotherapists, occupational therapists, speech therapists, and psychologists was performed. For every 10 beds in the highest care level (LoC3), 1.28 full-time equivalent (FTE) physiotherapists, 0.91 FTE occupational therapists and speech therapists, and 0.80 FTE psychologists should be employed.Conclusion: In order to implement multiprofessional patient treatment and support for relatives in the ICU, it is essential to employ a proportionate number of therapeutic healthcare professionals.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319573","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

Erratum zu: Lebertransplantation bei akutem und akut-auf-chronischem Leberversagen. 勘误：急性和急性-慢性肝功能衰竭的肝移植。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-10-01 DOI: 10.1007/s00063-024-01188-y

Jonathan F Brozat, Julian Pohl, Cornelius Engelmann, Frank Tacke

引用次数: 0

[Stress ulcer prophylaxis with proton pump inhibitors in intensive care medicine]. [重症监护医学中使用质子泵抑制剂预防应激性溃疡]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-10-01 Epub Date: 2024-08-09 DOI: 10.1007/s00063-024-01172-6

Philipp Kasper, Frank Tacke, Guido Michels

引用次数: 0

[Preclinical loading in patients with acute chest pain and acute coronary syndrome - PRELOAD survey]. [急性胸痛和急性冠脉综合征患者的临床前负荷- PRELOAD调查]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-10-01 Epub Date: 2023-11-30 DOI: 10.1007/s00063-023-01087-8

Sascha Macherey-Meyer, Simon Braumann, Sebastian Heyne, Max Maria Meertens, Tobias Tichelbäcker, Stephan Baldus, Samuel Lee, Christoph Adler

{"title":"[Preclinical loading in patients with acute chest pain and acute coronary syndrome - PRELOAD survey].","authors":"Sascha Macherey-Meyer, Simon Braumann, Sebastian Heyne, Max Maria Meertens, Tobias Tichelbäcker, Stephan Baldus, Samuel Lee, Christoph Adler","doi":"10.1007/s00063-023-01087-8","DOIUrl":"10.1007/s00063-023-01087-8","url":null,"abstract":"Background: Guidelines on myocardial infarction (MI) recommend antithrombotic and anticoagulatory treatment at time of diagnosis. MI with ST segment elevation (STEMI) is mostly a certain diagnosis. Acute coronary syndrome without ST segment elevation (NSTE-ACS) has diagnostic uncertainty and remains a working diagnosis in the prehospital setting.Objective: Assessment of prehospital loading with aspirin and heparin depending on ACS subtype and pretreatment with oral anticoagulants.Methods: The PRELOAD survey was a nationwide German study. STEMI/NSTE-ACS scenarios were designed and varied in pretreatment: I) no pretreatment, II) new oral anticoagulants (NOAC), III) vitamin K antagonist (VKA). Loading strategy was assessed and included: a) aspirin (ASA), b) unfractionated heparin (UFH), c) ASA + UFH, d) no loading.Results: A total of 708 emergency physicians were included. In NSTE-ACS without pretreatment, 79% chose loading (p < 0.001). ASA + UFH (71.4%) was the preferred option. In corresponding STEMI scenario, 100% chose loading and 98.6% preferred ASA + UFH (p < 0.001). In NSTE-ACS with NOAC pretreatment, 69.8% favored loading (p < 0.001); in VKA pretreatment the corresponding rate was 72.3% (p < 0.001). In each scenario, ASA was the preferred option. In STEMI with NOAC pretreatment, 97.5% chose loading (p < 0.001); analogous rate was 96.8% in STEMI with VKA pretreatment (p < 0.001). ASA was the preferred option again.Conclusions: Prehospital loading was the preferred treatment strategy despite the diagnostic uncertainty in NSTE-ACS and guidelines recommending loading at time of diagnosis. Pretreatment with oral anticoagulants resulted in a strategy shift to loading with only aspirin. In STEMI patients, this indicates potential undertreatment.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463877","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

[Ward-based clinical pharmacists in intensive care medicine: an economic evaluation]. [重症监护病房临床药师：经济评估]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2024-10-01 Epub Date: 2024-01-23 DOI: 10.1007/s00063-023-01102-y

Nadja Liebing, Benjamin Ziehr, Susanne Röber, Lutz Nibbe, Michael Oppert, Ulrich Warnke

{"title":"[Ward-based clinical pharmacists in intensive care medicine: an economic evaluation].","authors":"Nadja Liebing, Benjamin Ziehr, Susanne Röber, Lutz Nibbe, Michael Oppert, Ulrich Warnke","doi":"10.1007/s00063-023-01102-y","DOIUrl":"10.1007/s00063-023-01102-y","url":null,"abstract":"Background: The positive impact of pharmaceutical care in improving medication safety is considered proven. Little is known about the economic benefit of clinical pharmaceutical services in Germany.Objective: In 2020, a pilot project was started at the Ernst von Bergmann Hospital to introduce ward-based clinical pharmacists in intensive care medicine, also in order to determine the economic benefit of the medication management offered.Methods: By a team of experienced intensive care physicians and clinical pharmacists on the basis of a consensus principle, each pharmaceutical intervention (PI) was assigned a probability score (Nesbit probability score) with which an adverse drug event (ADE) would have occurred. Assuming that each ADE results in an increased length of stay, the costs of intensive care treatment/day were used as potential savings. The model thereby combines the findings of two international publications to enable an economic analysis of pharmaceutical services.Results: During the study period, 177 pharmaceutical interventions were evaluated and corresponding probability scores for the occurrence of ADE were determined. From this, annual savings of € 80,000 through avoided costs were calculated.Conclusion: In this project, the economic benefit of pharmaceutical services in intensive care medicine was proven. Ward-based clinical pharmacists are now an integral part of the intensive care treatment team at the Ernst von Bergmann Hospital.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543463","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