Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Mental distress of intensive care staff in Germany during the COVID-19 pandemic. Results from the VOICE study].","authors":"Alexander Niecke, Michaela Henning, Martin Hellmich, Yesim Erim, Eva Morawa, Petra Beschoner, Lucia Jerg-Bretzke, Franziska Geiser, Andreas M Baranowski, Kerstin Weidner, Sabine Mogwitz, Christian Albus","doi":"10.1007/s00063-024-01164-6","DOIUrl":"10.1007/s00063-024-01164-6","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic posed major challenges to the healthcare system worldwide and led to particular stress among healthcare workers. The aim of this analysis was to investigate the level of global mental stress of direct healthcare workers in Germany during the COVID-19 pandemic.</p><p><strong>Methods: </strong>In this prospective cross-sectional study with four measurement points (T1: 4-5/2020, T2:11/2020-1/2021, 5-7/2021, 2-5/2022), psychological distress symptoms were recorded in an online survey with the Patient Health Questionnaire (PHQ-4) among hospital staff working in direct patient care (N = 5408 datasets). The total dataset was exploratively analyzed according to field of activity, gender, and professional group affiliation.</p><p><strong>Results: </strong>Clinically relevant psychological distress (PHQ-4 ≥ 5) was present in 29.3% (n = 419/1429) of intensive care staff. A comparison of the four cross-sectional surveys showed a significant increase in the rate of clinically relevant mental distress in the first pandemic year (23.2% at T1 vs. 30.6% at T2; p < 0.01), which stabilized at a high level in the second pandemic year (33.6% at T3 and 32.0% at T4). Women did not differ from men in this respect (n = 280/919, 30.4% vs. n = 139/508, 27.4%; p = 0.74). Nursing staff were significantly more often psychologically stressed than physicians (n = 339/1105, 30.7% vs. n = 80/324, 24.7%; p = 0.03). Intensive care staff did not show significantly higher stress than staff working in nonintensive care areas (n = 419/1429, 29.3% vs. n = 1149/3979, 28.7%, p = 0.21).</p><p><strong>Conclusion: </strong>German healthcare workers reported high levels of mental distress during the pandemic, which increased during the course of the pandemic, but no significant difference was found between intensive care and nonintensive care staff in our sample. This may be due to the fact that the pandemic in Germany was comparatively moderate internationally and neither a collapse of the healthcare system in general nor a collapse of intensive care structures in particular took place.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"300-306"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903351","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":"Patient- vs organ-based prognostic tools for older patients in critical care units : An observational study with a 3-month follow-up.","authors":"Melanie Hochleitner, Lena Pickert, Nick A Nolting, Anna Maria Affeldt, Ingrid Becker, Thomas Benzing, Matthias Kochanek, Maria Cristina Polidori","doi":"10.1007/s00063-024-01179-z","DOIUrl":"10.1007/s00063-024-01179-z","url":null,"abstract":"<p><strong>Background: </strong>Anticipating a doubling of older adults in Europe by 2050, healthcare systems face substantial challenges, particularly in critical care units. However, there is still a lack of evidence-based knowledge for treating and assessing mortality risk in older patients. This study compared the predictive accuracy of two assessment tools for long-term outcomes among older patients: the Multidimensional Prognostic Index (MPI) and the Sequential Organ Failure Assessment (SOFA). As the MPI is based on a more holistic assessment, it may provide a more accurate prediction than the organ-based SOFA.</p><p><strong>Objective: </strong>Does the MPI provide a more accurate prediction of mortality risk and quality of life for older patients in critical care units than the organ-based SOFA score?</p><p><strong>Methods: </strong>In a 6-month study, 96 patients aged 65 and older admitted to intensive (ICU) or intermediate care units (IMC) were enrolled to assess 90-day mortality using a comprehensive geriatric assessment-based MPI and the SOFA score. The follow-up (FU) involved telephone assessments 30 and 90 days after admission, focusing on posthospitalization health and quality of life.</p><p><strong>Results: </strong>Both MPI (p = 0.039) and SOFA score (p = 0.014) successfully predicted mortality among older IMC and ICU patients in logistic regressions. Receiver operating characteristic (ROC) analyses demonstrated comparable areas under the curve (AUCs) for MPI (0.618) and SOFA score (0.621), as well as a similar sensitivity and specificity (MPI 61.0% and 52.9%; SOFA score: 68.9% and 45.1%, respectively). The MPI at admission moreover correlated significantly with quality of life (p < 0.001, r = -0.631 at discharge; p = 0.005, r = -0.377 at 30-day FU; p = 0.004, r = -0.409 at 90-day FU) and nursing needs (Mann-Whitney U‑test, p = 0.002 at 30-day FU; p = 0.011 at 90-day FU) at FU, while the SOFA score did not show significant associations with respect to these parameters.</p><p><strong>Conclusions: </strong>In geriatric critical care, both the MPI and the SOFA score effectively predict mortality risk. While the SOFA score may appear more practical due to its simpler and faster implementation, only the MPI demonstrated significant correlations with quality of life and nursing needs in the FU after 30 and 90 days.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"322-328"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330671","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":"Passive leg raising test versus rapid fluid challenge in critically ill medical patients.","authors":"Natascha Majunke, Dan Philipp, Lorenz Weidhase, Bastian Pasieka, Kevin Kunz, Frank Seidel, Robert Scharm, Sirak Petros","doi":"10.1007/s00063-024-01176-2","DOIUrl":"10.1007/s00063-024-01176-2","url":null,"abstract":"<p><strong>Background: </strong>The passive leg raising (PLR) test is a simple test to detect preload responsiveness. However, variable fluid doses and infusion times were used in studies evaluating the effect of PLR. Studies showed that the effect of fluid challenge on hemodynamics dissipates in 10 min. This prospective study aimed to compare PLR and a rapid fluid challenge (RFC) with a 300-ml bolus infused within 5 min in adult patients with a hemodynamic compromise.</p><p><strong>Materials and methods: </strong>Critically ill medical patients with signs of systemic hypoperfusion were included if volume expansion was considered. Hemodynamic status was assessed with continuous measurements of cardiac output (CO), when possible, and mean arterial pressure (MAP) at baseline, during PLR, and after RFC.</p><p><strong>Results: </strong>A total of 124 patients with a median age of 65.0 years were included. Their acute physiology and chronic health evaluation (APACHE) II score was 19.7 ± 6.0, with a sequential organ failure assessment (SOFA) score of 9.0 ± 4.4. Sepsis was diagnosed in 73.3%, and 79.8% of the patients were already receiving a norepinephrine infusion. Invasive MAP monitoring was established in all patients, while continuous CO recording was possible in 42 patients (33.9%). Based on CO changes, compared with those with RFC, the false positive and false negative rates with PLR were 21.7 and 36.8%, respectively, with positive and negative predictive values of 70.6 and 72.0%, respectively. Based on MAP changes, compared with those with RFC, the false positive and false negative rates with PLR compared to RFC were 38.2% and 43.3%, respectively, with positive and negative predictive values of 64.4 and 54.0%, respectively.</p><p><strong>Conclusion: </strong>This study demonstrated a moderate agreement between PLR and RFC in hemodynamically compromised medical patients, which should be considered when testing preload responsiveness.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"316-321"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141500","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":"[Max Reger and his early death: could it have been avoided? : Would he have lived longer with adequate intensive care?]","authors":"Hans-Joachim Trappe","doi":"10.1007/s00063-024-01144-w","DOIUrl":"10.1007/s00063-024-01144-w","url":null,"abstract":"<p><strong>Background: </strong>Max Reger was an organist, university teacher and composer whose life, illnesses, death and dying are not or hardly known to many.</p><p><strong>Objectives: </strong>Which illnesses determined Reger's life and did his lifestyle and illnesses influence his compositional work? Could his early death have been avoided? From today's point of view, could modern intensive care medicine have helped him?</p><p><strong>Material and methods: </strong>A detailed analysis of Reger's diseases was performed using scientific databases (medline, pubmed). All published articles were evaluated and examined in detail.</p><p><strong>Results: </strong>Max Reger was born in Brand in 1873 and received early lessons in violin, piano and organ playing. From 1890 he studied at the conservatory in Sondershausen, later at the conservatory in Wiesbaden. In 1901 he moved to Munich, and in 1907 to Leipzig, where he became university director and professor at the conservatory. Four years later he took over the court chapel in Meiningen, but ended this activity again in 1914. A year later he moved to Jena and wrote his late works in the \"Jenaish style\". Reger suffered from many illnesses, especially bipolar disorder with manic and depressive phases. He had metabolic syndrome with arterial hypertension, was overweight and smoked incredibly heavily. Overeating (\"binge eating\" syndrome) and polydipsia were other prominent findings. Reger's life was characterized by alcohol abuse, often aggravated by professional and/or human crises. In 1916 Reger died suddenly and unexpectedly in Leipzig of cardiovascular failure.</p><p><strong>Discussion: </strong>Reger was an outstanding personality who left behind an extensive oeuvre. Among the highlights of Max Reger's oeuvre are his chorale fantasies such as on \"Ein' feste Burg ist unser Gott\" (op. 27) or also the \"Fantasia and Fugue on B A C H\" (op. 46), but other compositions such as the Mozart Variations (op. 132) and the Clarinet Quintet (op. 146) are also world-famous. His lifestyle certainly favored coronary heart disease, the consequences of which caused Reger's sudden, unexpected and much too early death. Today's modern intensive care medicine could probably have prolonged his life.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"329-336"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861158","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":"[Headaches following childbirth-severe ARDS in postpartum eclampsia].","authors":"Fiona Crossey, Lucas Zum Hebel, Daniel Wastl, Burc Bassa","doi":"10.1007/s00063-024-01222-z","DOIUrl":"10.1007/s00063-024-01222-z","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"352-354"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802945","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 without artificial airway].","authors":"Franziska Wefer, Lars Krüger, Carsten Hermes, Peter Nydahl, Amrei Mehler-Klamt, Anett Henck, Marina Ufelmann, Jutta Tewesmeier, Jan Gummert, Sascha Köpke","doi":"10.1007/s00063-025-01251-2","DOIUrl":"10.1007/s00063-025-01251-2","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"337-339"},"PeriodicalIF":1.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366323","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":"[Palliative extubation after ROSC in the emergency setting-a guideline for emergency physicians].","authors":"Christian Volberg, Katharina Politt, Sebastian Passon, Nils Heuser, Elena Hofacker, Hinnerk Wulf","doi":"10.1007/s00063-025-01271-y","DOIUrl":"10.1007/s00063-025-01271-y","url":null,"abstract":"<p><p>In the prehospital emergency setting, resuscitation following cardiac arrest is initiated as soon as possible after arrival of the emergency services in order to minimize the no-flow time, i.e., the period during which there is no blood circulation and therefore no oxygen supply to the organs. There is frequently no opportunity to ask relatives about the prespecified or presumed wishes of the patient, e.g., in the form of a living will, until after initiation of emergency medical interventions. If an advance directive stipulates \"do not resuscitate\" (DNR), then this wish is legally binding for treatment. However, if return of spontaneous circulation (ROSC) has been achieved in the meantime, the treating emergency team faces an ethical dilemma, and patients are often taken to hospital against their prespecified will. This leads to unwanted overtreatment. Based on three case reports, the following article discusses the ethical and legal aspects of palliative extubation after ROSC in patients with a predefined DNR status.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036008","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":"[Onboarding in emergency medicine : Methods, challenges and opportunities].","authors":"Robert Girshausen, Sebastian Graf, Theresa Holz, Julia Lorenz, Thorsten Masson, Justus Wolff, Navid Azad","doi":"10.1007/s00063-025-01281-w","DOIUrl":"https://doi.org/10.1007/s00063-025-01281-w","url":null,"abstract":"<p><p>Emergency medicine places high demands on all specialized healthcare professionals. A structured onboarding process is essential for high-quality care and effective interprofessional collaboration. Current onboarding concepts in emergency departments are heterogeneous and often insufficient. Organizational measures, such as reliable rotation schedules, evaluation meetings and the integration of interprofessional perspectives create the foundation for effective onboarding. Investing in induction concepts promotes employee loyalty, team dynamics and efficiency of patient care in the long term.A wide range of methods can be utilized for knowledge transfer, including the use of digital media and low-threshold learning units in everyday working life. Simulation plays a particularly important role, enabling realistic, interprofessional and interdisciplinary training of emergency situations. Internal standards should be actively included and communicated during induction. Mentoring programs for new professionals provide orientation and enable regular, personalized feedback. An open error culture that views mistakes as an opportunity for improvement should be communicated from the outset and practiced within the team. In addition, biopsychosocial stresses such as shift work, moral distress and emotional exhaustion must be addressed. Digital learning platforms and artificial intelligence (AI)-supported tools will increasingly enable new, personalized learning pathways. The development of uniform (inter)national standards could improve onboarding on a broad scale and promote the exchange between emergency departments.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023755","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 geriatric syndrome frailty in the context of readmission to the intensive care unit : Study protocol of a mixed-methods study].","authors":"Denise Schindele, Marc Moritz Berger, Irmela Gnass","doi":"10.1007/s00063-025-01280-x","DOIUrl":"https://doi.org/10.1007/s00063-025-01280-x","url":null,"abstract":"<p><strong>Background: </strong>Frailty syndrome is characterized by a decline in physiological reserves and a reduced resistance to internal and external stressors. In addition to a higher mortality rate, patients who are frail are more prone to complications during hospitalization, including admission to an intensive care unit (ICU). Studies indicated that frailty syndrome may serve as a predictor of readmission to the ICU. The impact of frailty syndrome on readmission to an ICU in Germany remains to be elucidated, as extant research primarily originates from non-German-speaking countries and is only partially transferable.</p><p><strong>Aim: </strong>The primary objective of this study is to characterize the syndrome of frailty (measured using the Clinical Frailty Scale [CFS] ≥ 5) as a potential risk factor for readmission to the ICU. Secondly, the study will examine which factors, specifically nursing and medical measures on intermediate care and normal wards, can influence readmissions to the ICU.</p><p><strong>Method: </strong>The study employs an explanatory sequential mixed-methods design, comprising a quantitative and a qualitative research phase. In the quantitative phase, a prospective cohort study will be conducted to investigate the association between frailty syndrome and ICU readmissions (≤ 30 days after discharge or during the same hospital stay) in patients ≥ 65 years of age. Concurrently, a document analysis will be conducted in the qualitative phase to identify care measures that could influence readmission.</p><p><strong>Expected results: </strong>The primary hypothesis of this study is that patients diagnosed with frailty syndrome (CFS ≥ 5) exhibit a higher risk of readmission to the ICU compared to non-frail patients. This inquiry will be conducted in the quantitative phase of the study. The qualitative research component is designed to elucidate non-intensive care measures that may influence readmission.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064676","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":"Diaphragm ultrasound monitoring and sequential muscle training for weaning elderly COPD patients from mechanical ventilation.","authors":"Huazuo Liu, Qin Su, Linyuan Zhu","doi":"10.1007/s00063-025-01270-z","DOIUrl":"https://doi.org/10.1007/s00063-025-01270-z","url":null,"abstract":"<p><strong>Background: </strong>Weaning elderly patients with chronic obstructive pulmonary disease (COPD) from mechanical ventilation is a complex and critical process. This study aims to assess the efficacy of ultrasound monitoring of diaphragm function combined with sequential muscle training in predicting and facilitating this weaning process.</p><p><strong>Methods: </strong>In this randomized controlled trial, 100 elderly COPD patients on mechanical ventilation were divided into two groups: an intervention group receiving sequential muscle training and a control group with standard care. The training regimen targeted the diaphragm and accessory respiratory muscles. Diaphragmatic ultrasonography was performed on participants to measure the right diaphragm excursion (DE), contraction velocity, diaphragm thickening fraction (DTF), and respiratory rate (RR)/DTF.</p><p><strong>Results: </strong>The intervention group demonstrated significant improvements in diaphragmatic function, with mean DE increasing to 2.40 ± 0.46 cm, CV to 1.99 ± 0.37 cm/s, DTF to 0.35 ± 0.05, and RR/DTF 61.0 ± 8.0, compared to the control group's DE of 2.06 ± 0.46 cm, CV of 1.54 ± 0.44 cm/s, DTF of 0.30 ± 0.06, and RR/DTF 55.7 ± 7.3. Notably, the weaning success rate was higher in the intervention group (58.33%) compared to the control group (43.75%).</p><p><strong>Conclusion: </strong>Sequential muscle training, alongside standard care, significantly improves diaphragmatic function and increases weaning success rates in elderly COPD patients. These findings suggest that incorporating targeted respiratory muscle training into the care regimen could facilitate the weaning process, highlighting the potential for improving patient outcomes in critical care settings.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023682","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}