Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Action algorithm: assessment of hemoptysis in acute and emergency medicine].","authors":"Guido Michels, Martin Hetzel, Philipp M Lepper","doi":"10.1007/s00063-025-01314-4","DOIUrl":"https://doi.org/10.1007/s00063-025-01314-4","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975649","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":"[S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].","authors":"Frank M Brunkhorst, Michael Adamzik, Hubertus Axer, Michael Bauer, Christian Bode, Hans-Georg Bone, Thorsten Brenner, Michael Bucher, Sascha David, Maximilian Dietrich, Christian Eckmann, Gunnar Elke, Torben Esser, Thomas Felbinger, Christine Geffers, Herwig Gerlach, Béatrice Grabein, Matthias Gründling, Ulf Günther, Stefan Hagel, Andreas Hecker, Stefan Henkel, Babila Janusan, Stefan John, Achim Jörres, Achim Kaasch, Stefan Kluge, Matthias Kochanek, Agnieszka Lajca, Gernot Marx, Konstantin Mayer, Patrick Meybohm, Onnen Mörer, Michael Oppert, Vladimir Patchev, Mathias Pletz, Christian Putensen, Tim Rahmel, Jenny Rosendahl, Rolf Rossaint, Bernd Salzberger, Michael Sander, Stefan Schaller, Christina Scharf-Janssen, Felix Schmitt, Matthias Unterberg, Markus Weigand, Arved Weimann, Sebastian Weis, Björn Weiß, Alexander Wolf, Alexander Zarbock","doi":"10.1007/s00063-025-01317-1","DOIUrl":"10.1007/s00063-025-01317-1","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is an acute, life-threatening multiple organ dysfunction triggered by an infection.</p><p><strong>Methods: </strong>This guideline is an update of the S3 guideline \"Sepsis-prevention, diagnosis, therapy, and follow-up care\" (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaft [AMWF] Registry No. 079-001) of the German Sepsis Society (DSG) dated 31 December 2018. The update of the \"Surviving sepsis campaign (SSC): international guidelines for management of sepsis and septic shock 2021\" dated 4 October 2021, was used as the reference guideline. The DSG Guideline Commission compared each recommendation on the underlying PICO questions of the DSG Guideline 2018 (literature search until December 2018) with those of the SSC Guideline 2021 (literature search until July 2019) and evaluated the newly available published data (literature search until December 2024) by means of systematic update searches and literature reviews in compliance with the rules of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and the AWMF.</p><p><strong>Results: </strong>A total of 88 PICO questions were addressed, including those related to the diagnosis and treatment of infection and organ failure. Of these, two were agreed upon as statements, 29 as expert consensus, and 57 as evidence-based recommendations (26 with a strong and 31 with a weak recommendation grade). Compared to the previous 2018 guideline, 43 recommendations were reviewed but retained, 16 recommendations were modified, and 29 recommendations were newly issued.</p><p><strong>Conclusion: </strong>Given the lack of evidence for numerous measures for the inpatient care of patients with sepsis or septic shock, old and new knowledge gaps were revealed. Among the evidence-based recommendations, the underlying GRADE quality of evidence was high for only 5 recommendations, moderate for 18 recommendations, low for 17 recommendations, and very low for 16. These evidence gaps can only be closed through future multicenter, noncommercial clinical trials. The update to the S3 guideline on sepsis includes some updates to the recommendations of the previous guideline. These updates will need to be incorporated into some of the case- and facility-specific quality assurance indicators of quality assurance (QA) procedure 2025. Impairments in health-related quality of life for survivors must be given greater focus in outpatient care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876400","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":"[Scientific fraud and dubious publication practices].","authors":"Peter Nydahl, Mohamed Chahdi, Pia Goetze, Roland Eßl-Maurer, Carsten Hermes, Andreas Kocks, Anna-Henrikje Seidlein, Susanne Krotsetis","doi":"10.1007/s00063-025-01307-3","DOIUrl":"https://doi.org/10.1007/s00063-025-01307-3","url":null,"abstract":"<p><p>Questionable publication practices and predatory journals pose an increasing challenge to scientific integrity. These publication models advertise rapid publication times but lack essential quality controls such as peer-review processes, transparency, and charge high fees, which facilitates the dissemination of unreliable research findings. There is an increased risk, particularly for less experienced researchers, of unknowingly publishing in such journals or using their content uncritically. This can negatively impact individual career paths, the scientific community, and public perception of scientific knowledge. The article outlines the key characteristics of predatory journals and analyzes their potential consequences for science, as well as the quality and dissemination of research findings. Practical tools, such as checklists and established resources, are also presented to assist researchers in identifying and avoiding dubious publication offers. Finally, the article emphasizes the importance of raising awareness about this issue to uphold scientific standards and ensure the long-term reliability of research.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795950","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":"[Future-oriented further development and approaches to \"individualised\" cardiopulmonary resuscitation].","authors":"Simon Weißler, Clemens Kill, Matthias Fischer, Jürgen Knapp, Christian Jung, Peter Kienbaum, Daniel Scheyer, Michael Bernhard","doi":"10.1007/s00063-025-01305-5","DOIUrl":"10.1007/s00063-025-01305-5","url":null,"abstract":"<p><p>Resuscitation research plays a crucial role in improving survival rates and neurological outcomes following cardiac arrest. This review highlights essential aspects of current resuscitation research and examines the integration of various treatment approaches into existing resuscitation protocols, with a particular focus on individualized resuscitation. The current literature on several key topics in resuscitation is presented. High-quality chest compressions are a central quality feature of cardiopulmonary resuscitation (CPR). Capnography is a proven tool for quantifying hemodynamics during CPR. Diastolic blood pressure (DBP) appears to be a superior parameter compared to end-tidal carbon dioxide, as it reflects coronary perfusion more precisely. Target values for diastolic blood pressure (DBP) should >25 mmHg, as they correlate with improved survival rates and better neurological outcomes. Continuous administration of adrenaline and fluids can increase DBP and improve the chances of return of spontaneous circulation. Additionally, ultrasound, particularly transesophageal echocardiography, can help identify the optimal compression point for chest compressions, thereby increasing CPR effectiveness. Pulse checks are not optimally suited for detecting cardiac arrest or return of spontaneous circulation and prolong the \"no-flow\" time. A significantly better alternative may be the use of ultrasound for pulse checks. If conventional resuscitation fails, extracorporeal CPR can be considered.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785770","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":"[Emergency physician interventions in the care of patients with acute coronary syndrome : Comparative, retrospective, observational study].","authors":"Thomas Hofmann, Lena Himmelreich, Roland Kirschenlohr, Toni Fredrich, Patrick Andreas Eder, Frank Flake, Katrin Bagdahn, Jan Orendt, Melanie Reuter-Oppermann, Rolf Lefering","doi":"10.1007/s00063-025-01306-4","DOIUrl":"https://doi.org/10.1007/s00063-025-01306-4","url":null,"abstract":"<p><strong>Background: </strong>The prehospital emergency care of patients with acute coronary syndrome (ACS) is highly relevant as such interventions have required an above-average involvement of emergency physicians to date. The aim of this study was to investigate the incidence of physicians' interventions in the context of ACS care and to identify predictors that indicate the need for such interventions at the time of the emergency call.</p><p><strong>Methods: </strong>A retrospective observational study was conducted based on 10,833 emergency department protocols from three regions in Germany. Protocols with (suspected) diagnoses such as STEMI, NSTEMI, unclear chest pain, or cardiogenic shock were included. After extensive data cleaning and coding of interventions, a descriptive analysis was performed to determine the incidence of physicians' measures and a logistic regression to determine predictors for physicians' interventions.</p><p><strong>Results: </strong>Interventions requiring the presence of an emergency physician were performed in 2.5% of cases. Significant predictors for physicians' interventions were undocumented (odds ratio [OR] 2.7), reduced (OR 7.77) or absent consciousness (OR 24.5), undocumented breathing (OR 5.13), dyspnea (OR 2.1), cyanosis (OR 4.48), apnea (OR 8.82) or cold sweats (OR 3.2).</p><p><strong>Conclusion: </strong>The incidence of physicians' interventions in ACS patients is low. The results suggest that not all ACS cases require physicians on scene. However, patients with reduced consciousness, cyanosis or respiratory arrest should continue to be treated primarily by emergency physicians. Prospective studies could further improve prehospital care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765704","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 : Challenges regarding interdisciplinary collaboration in intensive care units].","authors":"Lena Glißmann, Katrin Bangert-Tobies","doi":"10.1007/s00063-025-01304-6","DOIUrl":"https://doi.org/10.1007/s00063-025-01304-6","url":null,"abstract":"<p><strong>Background: </strong>Postextubation dysphagia (PED) represents a significant morbidity and mortality factor even in nonneurological intensive care units (ICU), potentially prolonging both ICU and overall hospital stays.</p><p><strong>Methods: </strong>A literature review was conducted to access the relevance, diagnostic approaches, and therapeutic options for PED, which were then placed in context using a clinical case study.</p><p><strong>Results: </strong>Although evidence-based guidelines for PED are lacking in the literature, several articles and recommendations addressing multiprofessional treatment strategies were identified. In addition to the necessity of systematic dysphagia screening and early therapeutic interventions, particular attention should be paid to predictors that can be identified early-for example, through the use of checklists-and addressed by a multiprofessional care team.</p><p><strong>Conclusion: </strong>Interdisciplinary collaboration is essential for the effective diagnosis and management of PED with the potential to improve both clinical outcomes and quality of life in affected patients. In particular, early screening, daily activation of orofacial functions within nursing care, targeted swallowing therapy, mobilization, respiratory therapy and device-supported respiratory therapy may contribute to improved patient trajectories following extubation.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692108","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":"[Survey of staffing structures and equipment in 176 German emergency departments].","authors":"Uwe Janssens, Torben Brod, Florian Hoffmann, Martin Pin, Christian Wrede, Christian Karagiannidis, Felix Walcher, Thomas van den Hooven, Gernot Marx, Christian Waydhas","doi":"10.1007/s00063-025-01299-0","DOIUrl":"https://doi.org/10.1007/s00063-025-01299-0","url":null,"abstract":"<p><strong>Background and research question: </strong>Adequate staffing, especially with physicians and emergency nursing staff, is essential for high-quality emergency care. The aim of this study was to compare the current staffing situation in German emergency departments with recommended standards.</p><p><strong>Methods: </strong>A questionnaire was developed based on the minimum standards of the German Interdisciplinary Association for Intensive and Emergency Medicine and the German Society for Interdisciplinary Emergency and Acute Medicine. Both the actual staffing and the perceived adequacy were assessed. The anonymous online survey was sent via the joint emergency department registry to the management of 1008 emergency departments.</p><p><strong>Results: </strong>Between 1 June and 31 July 2023, 176 emergency departments (18% response rate) participated. Annual patient numbers ranged from 17,610 to 37,251 depending on the level of care. Qualified nursing and medical leadership was mostly present (about 90%, medical leadership in level 1: 68%). Continuous physician presence was 76%, specialist presence 50%. Specialists with additional emergency medicine training were available in level 1 (one physician) and in levels 2 and 3 (two physicians each). Only 50% of hospitals offered the full 24-month training period. A nurse-to-patient ratio of 1:1200 was met in 40-63% of departments; triage nurses met requirements in 54% of cases.</p><p><strong>Conclusion: </strong>The survey shows that significant staffing deficits persist in German emergency departments at all levels of care-especially regarding the presence and qualifications of physicians, nursing staff, social services, and case management. At the same time, a positive trend in equipment, infrastructure, and staff qualifications is evident.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683527","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":"[Blast injuries - mechanisms and management].","authors":"Philipp Quintin, Priyanka Boettger, Henning Lemm, Frederic Bludau, Christian S Brülls, Michael Buerke","doi":"10.1007/s00063-025-01298-1","DOIUrl":"https://doi.org/10.1007/s00063-025-01298-1","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643952","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":"[Consensus paper on focused transesophageal echocardiography (fTEE) in clinical acute and emergency medicine : From the Commission for Clinical Cardiovascular Medicine of the DGK in cooperation with the DGINA, DGIIN and DGIM].","authors":"Guido Michels, Roland R Brandt, Hans-Jörg Busch, Katrin Fink, Andreas Franke, Stefan Frantz, Christian Jung, Martin Möckel, Caroline Morbach, Kevin Pilarczyk, Dorothea Sauer, Sebastian Wolfrum, Andreas Helfen","doi":"10.1007/s00063-025-01309-1","DOIUrl":"https://doi.org/10.1007/s00063-025-01309-1","url":null,"abstract":"<p><p>In addition to intensive care medicine, focused transesophageal echocardiography (fTEE) is increasingly being used in emergency departments. fTEE should only be performed as part of advanced cardiopulmonary resuscitation or in cases of unclear shock if a particular issue cannot be clarified using focused transthoracic echocardiography (cardiac point-of-care ultrasound [cPOCUS]). The conditions, indications and performance of fTEE are summarized in this consensus paper in terms of quality management in echocardiography in clinical acute and emergency medicine.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610119","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":"[Intensive care diaries to reduce of posttraumatic stress disorder for critical care patients-a systematic review with meta-analysis].","authors":"Ella Peschel, Martin Hölzl, Joachim Schulze, Peter Nydahl","doi":"10.1007/s00063-025-01296-3","DOIUrl":"https://doi.org/10.1007/s00063-025-01296-3","url":null,"abstract":"<p><strong>Background: </strong>Survivors of critical illness have an increased risk of psychological disorders such as posttraumatic stress disorder (PTSD), anxiety disorders or depression. A possible preventive intervention is an intensive care diary. The effect of intensive care diaries on the prevention of these psychosocial disorders remains unclear.</p><p><strong>Methods: </strong>In May 2024, a literature search with following metaanalysis was performed in PubMed, CINAHL, Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL) and PsychInfo databases based on the metaanalysis of Nydahl et al. (2018). Studies included were studies on intensive diaries with PTSD as the primary outcome and anxiety and depression as secondary outcomes. Study quality was assessed using the Cochrane Risk of Bias Tool 2 and the metaanalysis was performed with RevMan 5.4.1.</p><p><strong>Results: </strong>After reviewing 539 titles, 10 studies were included. The studies were of low to good quality. A total of three metaanalyses were performed. The metaanalysis for PTSD of intensive care patients (n = 1081; 9 studies) showed a significant reduction (OR 0.52 [95% CI: 0.28-0.98] p = 0.04; I² = 65%, τ² = 0.46, p = 0.005). Three studies with 427 patients were included in the metaanalyses of anxiety and depression. These showed no significant reduction in the HADS (anxiety: OR 0.55 [95% CI: 0.14-2.18] p = 0.40; I² = 74%, τ² = 1.08, p = 0.02; depression: OR 0.50 [95% CI 0.24-1.07] p = 0.08; I² = 34%, τ² = 0.17, p = 0.22).</p><p><strong>Conclusions: </strong>Intensive care diaries may reduce the incidence of PTSD for patients after an ICU stay. However, no significant reduction can currently be shown for anxiety or depression.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610120","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}