Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献_第6页

[Early warning scores: a rapid umbrella review]. [早期预警分数：快速总括审查]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-27 DOI: 10.1007/s00063-025-01294-5

Peter Nydahl, Marie-Madlen Jeitziner, Susanne Krotsetis, Koroush Kabir, Ralf Kuhlen, Jan-Peter Braun

{"title":"[Early warning scores: a rapid umbrella review].","authors":"Peter Nydahl, Marie-Madlen Jeitziner, Susanne Krotsetis, Koroush Kabir, Ralf Kuhlen, Jan-Peter Braun","doi":"10.1007/s00063-025-01294-5","DOIUrl":"https://doi.org/10.1007/s00063-025-01294-5","url":null,"abstract":"Background: Early warning scores (EWS) are used for monitoring and evaluating vital signs in hospitalized patients. With EWS, escalating measures for monitoring, consultation, and admission to intensive care units (ICU) can be initiated based on point values, potentially improving patient outcomes, (mostly mortality, ICU admission, sepsis, cardiac arrest). It remains unclear in which areas the implementation of EWS is most appropriate.Methods: A rapid umbrella review including systematic reviews and meta-analyses, with searches conducted in CINAHL via EBSCO, OVID via Medline, Cochrane via Cochrane Library and LIVIVO via University Library Cologne, and data extraction in May 2024.Results: A total of 44 systematic reviews and 15 meta-analyses covering 542 individual studies with 57 different EWS versions in various settings/aspects such as methodology, patient outcome (sepsis, emergency departments, obstetrics, pediatrics), implementation, performance, and others were identified. Both the analysis results and the level of evidence from the analyses appear heterogeneous. EWS seem to be most effective in reducing risks in high-risk populations such as in emergency departments, geriatric trauma, medicine, and surgery, and possibly post-ICU patients. However, implementation requires extensive resources in terms of staff, structures, and processes to ensure quality improvement. Electronic aids such as monitoring systems, red flags in electronic patient records, and the use of artificial intelligence could significantly support implementation.Conclusion: There is no general recommendation for or against the widespread introduction of EWS. EWS should first be implemented in high-risk areas, considering available staffing and material resources. Electronic systems could assist in implementation.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508973","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

[Predictability of patient disposition from emergency medical services triage categories: exploratory analysis of routine data]. [从紧急医疗服务分类类别中预测患者处置：常规数据的探索性分析]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-25 DOI: 10.1007/s00063-025-01300-w

Torben Brod, Uta Hillebrand, Christoph Schröder, Andreas Flemming, Nils Schneider, Tanja Schleef

{"title":"[Predictability of patient disposition from emergency medical services triage categories: exploratory analysis of routine data].","authors":"Torben Brod, Uta Hillebrand, Christoph Schröder, Andreas Flemming, Nils Schneider, Tanja Schleef","doi":"10.1007/s00063-025-01300-w","DOIUrl":"https://doi.org/10.1007/s00063-025-01300-w","url":null,"abstract":"Background: Efficient and patient-centered emergency care requires early control of patient flow. It is unclear whether this is already possible in the prehospital phase by emergency medical services (EMS) and whether this can contribute to relieving pressure on emergency departments (EDs).Objectives: To examine the correlation between prehospital triage categories by EMS personnel and patient admission/discharge after treatment in the ED, and to assess the use of hospital resources for patients who remained outpatients.Methods: Retrospective analysis of routine preclinical and clinical data from all patients presenting to the ED of a university hospital by EMS over a 2-week period. Analyses were performed descriptively and using the Mann-Whitney U test and the χ2 test. Positive and negative predictive values were also calculated.Results: During the observation period, 570 EMS patients were seen in the ED, of whom 307 (53.9%) remained as outpatients. For 309 (54.2%) of the patients, the triage category assigned by the EMS corresponded to the type of subsequent care (outpatient/inpatient); in 249 cases (43.7%) the need for inpatient care was overestimated. In addition, 262 patients (85.3%) received at least one diagnostic or therapeutic resource prior to discharge, the most common being X‑rays (118/38.4%).Conclusion: In only about half of the cases was the EMS personnel's prognosis consistent with the subsequent decision to admit or discharge the patient from the ED. Patients who remained as outpatients tended to require further diagnostic and therapeutic resources. Therefore, direct transfer of EMS patients to alternative care structures seems risky in the current environment.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498820","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

[S3 guideline on renal replacement therapy in intensive care medicine : Evidence-based implementation of renal replacement therapy in critically ill patients]. [S3重症医学肾替代治疗指南：危重患者肾替代治疗的循证实施]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-23 DOI: 10.1007/s00063-025-01293-6

Carsten Willam, Mariam Abu-Tair, Matthias Bayer, Romuald Bellmann, Frank Brunkhorst, Florian Custodis, Jan Galle, Carsten Hermes, Michael Joannidis, Stefan John, Achim Jörres, Thomas Kerz, Detlef Kindgen-Milles, Martin Koczor, Rainer Kram, Martin K Kuhlmann, Michael Oppert, Georg Schlieper, Michael Schmitz, Alexander Zarbock, Melanie Meersch

{"title":"[S3 guideline on renal replacement therapy in intensive care medicine : Evidence-based implementation of renal replacement therapy in critically ill patients].","authors":"Carsten Willam, Mariam Abu-Tair, Matthias Bayer, Romuald Bellmann, Frank Brunkhorst, Florian Custodis, Jan Galle, Carsten Hermes, Michael Joannidis, Stefan John, Achim Jörres, Thomas Kerz, Detlef Kindgen-Milles, Martin Koczor, Rainer Kram, Martin K Kuhlmann, Michael Oppert, Georg Schlieper, Michael Schmitz, Alexander Zarbock, Melanie Meersch","doi":"10.1007/s00063-025-01293-6","DOIUrl":"https://doi.org/10.1007/s00063-025-01293-6","url":null,"abstract":"Besides mechanical ventilation, renal replacement therapy is the most frequently performed organ replacement therapy in intensive care medicine. However, there is a lack of consensus- and evidence-based recommendations for the implementation of renal replacement therapy according to the best current knowledge and evidence. This guideline describes the topics of starting a renal replacement therapy, modality (diffusion or convection, continuous or intermittent procedures), anticoagulation, adequate dose, and criteria for stopping renal replacement therapy. In addition, the current evidence on adequate anti-infective therapy is presented under the special features of acute kidney injury and renal replacement therapy.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477550","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

[Yeasts in the lung-colonization or catastrophe? : An infectious disease complication in a patient with acute myeloid leukemia]. [真菌在肺部——定植还是灾难？]急性髓性白血病患者的感染性疾病并发症[j]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-20 DOI: 10.1007/s00063-025-01301-9

Christian Hohmann, Ludwig Abel-Andrée, Dariusz Peszko, Tanja Knoll, Rolf Dembinski

引用次数: 0

[Intraosseous access in infants-development of an anatomical training model]. [婴儿骨内通路-解剖学训练模型的发展]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-19 DOI: 10.1007/s00063-025-01295-4

Dietrich Stoevesandt, Lina Woydt, Joachim Koppenberg, Michael Wolf, Dmitrij Pinekenstein, Stefan Watzke, Thomas Lange, Sascha Kolokowsky, Simone Hettmer, Hartmut Stefani, Franz Stangl, Martin R Fischer

{"title":"[Intraosseous access in infants-development of an anatomical training model].","authors":"Dietrich Stoevesandt, Lina Woydt, Joachim Koppenberg, Michael Wolf, Dmitrij Pinekenstein, Stefan Watzke, Thomas Lange, Sascha Kolokowsky, Simone Hettmer, Hartmut Stefani, Franz Stangl, Martin R Fischer","doi":"10.1007/s00063-025-01295-4","DOIUrl":"https://doi.org/10.1007/s00063-025-01295-4","url":null,"abstract":"Background: Safe intraosseous (i.o) access as an alternative to intravenous (i.v.) access is essential in the treatment of infants and young children in emergency medicine. However, the literature shows high misplacement rates and insufficient training opportunities for potential users. The aim of this study was to analyze malpunctures in postmortem computed tomography (CT) imaging and to develop and evaluate a realistic, cost-effective three-dimensionally (3D) printed training model for i.o. punctures in children under 2 years of age.Materials and methods: The CT data from 25 deceased children under 2 years of age were retrospectively analyzed to document the frequency and type of malpunctures. Based on the findings, a three-part model was produced using filament 3D printing and silicone moulding. The realistic representation of skin, connective tissue, and bone was evaluated by 55 experienced users on a Likert scale.Results: In 40% of the punctures analyzed, there was incorrect placement, often due to inadequate anatomical assessment. The model developed was rated by the interviewees as suitable for beginner training. Suggestions for improvement mainly concerned haptic skin characteristics and the simulation of the loss of resistance after cortical penetration. Material costs for the training model were around 50 cents per puncture.Conclusion: The 3D printed model offers a cost-effective, anatomically precise training option for intraosseous punctures in infants. It can contribute to the improvement of competence and safety during i.o. access, provided it is supplemented by regular training. Future enhancements should further optimize haptic skin characteristics and should provide better feedback on puncture success.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327489","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

[Lipid rescue as a bail-out strategy in a repeatedly resuscitated patient]. [在反复复苏的病人中，脂质拯救是一种救市策略]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-18 DOI: 10.1007/s00063-025-01292-7

Jana Ackmann, Judit Grans-Siebel, Christoph Hüser, Volker Burst, Christoph Adler

引用次数: 0

[Anisocoria in the intensive care unit]. [在加护病房的阿尼索科里亚]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-10 DOI: 10.1007/s00063-025-01283-8

Sebastian Herren, Jowita Bruno, Victor Speidel

引用次数: 0

[Overcoming boundaries-broadening horizons]. [跨越界限，拓宽视野]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2025-05-26 DOI: 10.1007/s00063-025-01282-9

Georg F Lehner, Michael Joannidis

引用次数: 0

[Multimorbidity as a predictor for inpatient admission in clinical emergency and acute medicine : Single-center cluster analysis]. [临床急诊科住院病人的多病症预测因素：单中心聚类分析]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2024-09-11 DOI: 10.1007/s00063-024-01180-6

E Grüneberg, R Fliedner, T Beißbarth, C A F von Arnim, S Blaschke

{"title":"[Multimorbidity as a predictor for inpatient admission in clinical emergency and acute medicine : Single-center cluster analysis].","authors":"E Grüneberg, R Fliedner, T Beißbarth, C A F von Arnim, S Blaschke","doi":"10.1007/s00063-024-01180-6","DOIUrl":"10.1007/s00063-024-01180-6","url":null,"abstract":"Background: Parallel to demographic trends, an increase of multimorbid patients in emergency and acute medicine is prominent. To define easily applicable criteria for the necessity of inpatient admission, a hierarchical cluster analysis was performed.Methods: In a retrospective, single-center study data of n = 35,249 emergency cases (01/2016-05/2018) were statistically analyzed. Multimorbidity (MM) was defined by at least five ICD-10-GM diagnoses resulting from treatment. A hierarchical cluster analysis was performed for those diagnoses initially summarized into 112 diagnosis subclusters to determine specific clusters of in- and outpatient cases.Results: Hospital admission was determined in 81.2% of all ED patients (n = 28,633); 54.7% of inpatients (n = 15,652) and 0.97% of outpatient cases (n = 64) met the criteria for multimorbidity and the age difference between them was highly significant (68.7/60.8 years; p < 0.001). Using a hierarchical cluster analysis, 13 clusters with different diagnoses were identified for inpatient multimorbid patients (MP) and 7 clusters with primarily hematological malignancies for outpatient MP. The length of stay in the ED of inpatient MP was more than twice as long (max. 8.3 h) as for outpatient MP (max. 3.2 h.).Conclusions: The combination of diagnoses typical for MM were characterized as clusters in this study. In contrast to single or combined single diagnoses, the statistically determined characterization of clusters allows for a significantly more accurate prediction of ED patients' disposition as well as for economic process allocation.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"419-425"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299319","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

[Overdosing of direct oral anticoagulants]. [直接口服抗凝剂用药过量]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-06-01 Epub Date: 2024-06-25 DOI: 10.1007/s00063-024-01154-8

Marie Anne-Catherine Neumann, Noëlle Sieg, Jorge Garcia Borrega, Christoph Hüser, Michael Caspers, Alexander Shimabukuro-Vornhagen, Boris Böll, Matthias Kochanek, Dennis A Eichenauer, Jan-Hendrik Naendrup

{"title":"[Overdosing of direct oral anticoagulants].","authors":"Marie Anne-Catherine Neumann, Noëlle Sieg, Jorge Garcia Borrega, Christoph Hüser, Michael Caspers, Alexander Shimabukuro-Vornhagen, Boris Böll, Matthias Kochanek, Dennis A Eichenauer, Jan-Hendrik Naendrup","doi":"10.1007/s00063-024-01154-8","DOIUrl":"10.1007/s00063-024-01154-8","url":null,"abstract":"Background: Direct oral anticoagulants (DOAC) are increasingly used for prophylaxis and treatment of thromboembolic events. Incorrectly dosed DOAC treatment is associated with excess mortality.Purpose: This article aims at raising awareness of DOAC overdosing and its causes as well as presenting a diagnostic and therapeutic work-up.Material and methods: Based on a case presentation, a structured review of the current literature on DOAC overdosing was performed and treatment recommendations were extracted.Results: In addition to wittingly or unwittingly increased DOAC intake, common causes of overdose are inadequate dose adjustment for concomitant medication or comorbidities. Global coagulation testing should be supplemented with DOAC-specific testing. Severe bleeding and the need for invasive diagnostics or urgent surgery represent indications for treating DOAC overdoses. Based on the cause of an DOAC overdose, active charcoal, endoscopic pill rescue, antagonization with idarucizumab or andexanet alfa and the targeted substitution of coagulation factors represent treatment options.Conclusion: The sensitization of clinicians is important to ensure a timely diagnosis and adequate treatment of DOAC overdosing. This report provides an overview of current knowledge on diagnostics and treatment; however, further studies are necessary to improve the existing algorithms.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"426-433"},"PeriodicalIF":1.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447394","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