Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"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}

{"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}

{"title":"[Hemodynamic monitoring in acute pancreatitis: keep it simple!]","authors":"Guido Michels, Philipp Kasper","doi":"10.1007/s00063-025-01287-4","DOIUrl":"https://doi.org/10.1007/s00063-025-01287-4","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":"144112420","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":"Erratum zu: Handlungsalgorithmus: Management der akuten Pankreatitis in der klinischen Akut- und Notfallmedizin.","authors":"Philipp Kasper, Guido Michels","doi":"10.1007/s00063-025-01289-2","DOIUrl":"https://doi.org/10.1007/s00063-025-01289-2","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103216","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":"A team without a name: emergency medicine recognition and its impact on working conditions and well-being.","authors":"Megan Gates Kemnitz, Eugenia-Maria Lupan-Muresan, Francis Somville, Bruno Barcella, Noaa Shopen, María de Los Angeles López Hernández, Eric P Heymann","doi":"10.1007/s00063-025-01275-8","DOIUrl":"https://doi.org/10.1007/s00063-025-01275-8","url":null,"abstract":"<p><p>Emergency medicine (EM) has evolved significantly over the past 50 years, transitioning from a focus on acute injuries and illnesses to include primary and specialty care, disaster response, and social issues. To date, nearly 60 countries have officially recognized EM as a medical specialty. However, growing patient demands, healthcare staff shortages, and an aging population have strained emergency departments, worsening working conditions for EM professionals and compromising patient care. To address these challenges, formal recognition of EM as a specialty is crucial.As a specialty, EM offers significant benefits. It improves patient outcomes by ensuring structured, standardized training that equips specialists with the skills to manage acute conditions such as trauma, stroke, and myocardial infarction. Countries with recognized EM specialties have reported reduced morbidity and mortality and enhanced healthcare resilience during crises like pandemics and mass casualty events. Additionally, professional recognition aids in recruitment, retention, and reducing burnout among EM practitioners by establishing clear career pathways. Furthermore, it ensures specific paraclinical training in areas such as patient flow, and it strengthens healthcare systems. However, despite these benefits, challenges remain. Resource diversion from primary care, increased healthcare costs, and the initial investment required for training programs are potential drawbacks to EM specialty recognition. Achieving EM recognition will require a strategic collaborative approach, focusing on education, professional support, and collaboration across healthcare sectors.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054812","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":"10.1007/s00063-025-01265-w","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"271-289"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","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":"[Postextubation dysphagia in intensive care unit : Epidemiology, clinical course, and management].","authors":"Daniela Bertschi, Jan Waskowski, Philipp Venetz, Carmen A Pfortmueller, Joerg C Schefold","doi":"10.1007/s00063-025-01266-9","DOIUrl":"https://doi.org/10.1007/s00063-025-01266-9","url":null,"abstract":"<p><p>Postextubation dysphagia (PED) is common in intensive care units (ICU), affecting about 20% of patients of mixed medical surgical ICU populations. PED is an independent risk factor for increased 28-day and 90-day mortality in both neurological and nonneurological ICU patients (28-day mortality: plus 9%). The increased mortacity risk can be demonstrated for up to approximately one year after the ICU stay. Due to the consequences of PED, all ICU patients should undergo systematic dysphagia screening after extubation/decannulation (e.g., water swallow test) and fiberoptic endoscopic evaluation of the swallowing (FEES) to confirm the diagnosis. Treatment is interdisciplinary with nutrition adaptation/nutrition introduction or food restriction, physical/speech therapy and, if necessary, interventional procedures in the future.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"120 4","pages":"355-365"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051573","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":"Evaluation of score-based tertiary triage policies during the COVID-19 pandemic: simulation study with real-world intensive care data.","authors":"Christina C Bartenschlager, Jens O Brunner, Michael Kubiciel, Axel R Heller","doi":"10.1007/s00063-024-01162-8","DOIUrl":"10.1007/s00063-024-01162-8","url":null,"abstract":"<p><strong>Objective: </strong>The explicit prohibition of discontinuing intensive care unit (ICU) treatment that has already begun by the newly established German Triage Act in favor of new patients with better prognoses (tertiary triage) under crisis conditions may prevent saving as many patients as possible and therefore may violate the international well-accepted premise of undertaking the \"best for the most\" patients. During the COVID-19 pandemic, authorities set up lockdown measures and infection-prevention strategies to avoid an overburdened health-care system. In cases of situational overload of ICU resources, when transporting options are exhausted, the question of a tertiary triage of patients arises.</p><p><strong>Methods: </strong>We provide data-driven analyses of score- and non-score-based tertiary triage policies using simulation and real-world electronic health record data in a COVID-19 setting. Ten different triage policies, for example, based on the Simplified Acute Physiology Score (SAPS II), are compared based on the resulting mortality in the ICU and inferential statistics.</p><p><strong>Results: </strong>Our study shows that score-based tertiary triage policies outperform non-score-based tertiary triage policies including compliance with the German Triage Act. Based on our simulation model, a SAPS II score-based tertiary triage policy reduces mortality in the ICU by up to 18 percentage points. The longer the queue of critical care patients waiting for ICU treatment and the larger the maximum number of patients subject to tertiary triage, the greater the effect on the reduction of mortality in the ICU.</p><p><strong>Conclusion: </strong>A SAPS II score-based tertiary triage policy was superior in our simulation model. Random allocation or \"first come, first served\" policies yield the lowest survival rates, as will adherence to the new German Triage Act. An interdisciplinary discussion including an ethical and legal perspective is important for the social interpretation of our data-driven results.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"307-315"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876456","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}