Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Development of an infusion regimen to avoid incompatibilities in adult intensive care patients].","authors":"D Meyn, T Hesener, L Kreysing, Z Mittmann, C Hermes, A Kaltwasser, R M Muellenbach, H Hilgarth","doi":"10.1007/s00063-025-01396-0","DOIUrl":"10.1007/s00063-025-01396-0","url":null,"abstract":"<p><p>The concurrent delivery of multiple infusion solutions (Y-site administration) through a single catheter lumen in intensive care patients is often unavoidable. This may lead to physicochemical incompatibilities, significantly affecting the efficacy and safety of drug therapy. The objective of this study is to develop and formulate an infusion regimen that considers the number of access points and avoids incompatibilities for adult intensive care patients. A comprehensive literature search was conducted following the ADKA-DIVI standard concentration list for continuous infusions. Manufacturer information and databases, such as STABILIS, Kingguide, and Trissel's TM 2 IV Compatibility, were used to evaluate compatibility. For frequently used combinations for which no compatibility data were available, stability data on physical compatibility were compiled. Based on this, considering 34 common active ingredients and their standard concentrations, a 4-lumen central venous catheter (CVC) infusion regimen was developed to help avoid incompatibilities in the adult intensive care unit.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"364-371"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960526","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":"[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":"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":"378-385"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212615/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Noroviruses in 2026: red flags and outbreak management in acute care].","authors":"Christoph Lübbert, Priyanka Böttger, Henning Lemm, Michael Buerke","doi":"10.1007/s00063-026-01417-6","DOIUrl":"10.1007/s00063-026-01417-6","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"400-403"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183239","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":"[Management of emergencies in rheumatology].","authors":"Philine Ritter, Stefan M Weiner","doi":"10.1007/s00063-026-01439-0","DOIUrl":"10.1007/s00063-026-01439-0","url":null,"abstract":"<p><p>Emergencies in rheumatology can present with a wide range of symptoms and findings, often requiring rapid diagnostics and treatment to prevent permanent damage or avert life-threatening conditions. This article aims to provide an overview of important differential diagnoses that should be considered in rheumatologic and/or immunosuppressed patients presenting in an emergency setting. It covers conditions such as septic arthritis, giant cell arteritis, acute adrenal insufficiency, the differential diagnosis of respiratory symptoms and acute kidney injury, macrophage activation syndrome, and catastrophic antiphospholipid syndrome. In this article, the clinical presentation, diagnostic approach, and acute management of these conditions are discussed and explained.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"404-415"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678017","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":"Internistisch gedacht – gemeinsam gemacht mit Menschlichkeit und Fachlichkeit.","authors":"Valery Kitz, Sascha David","doi":"10.1007/s00063-026-01445-2","DOIUrl":"https://doi.org/10.1007/s00063-026-01445-2","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"121 5","pages":"331-332"},"PeriodicalIF":1.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036926","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":"[Readmission to the intensive care unit : A rare phenomenon or relevant to clinical practice?]","authors":"Denise Schindele, Irmela Gnass, Marc Moritz Berger","doi":"10.1007/s00063-026-01441-6","DOIUrl":"10.1007/s00063-026-01441-6","url":null,"abstract":"<p><strong>Background: </strong>Unplanned intensive care unit (ICU) readmissions are infrequent but clinically highly relevant. Despite their clinical importance, the underlying risk factors and mechanisms leading to unplanned readmissions remain insufficiently characterized.</p><p><strong>Aim: </strong>This narrative review aims to summarize the current evidence on unplanned ICU readmissions, identify associated risk factors and causes, and contextualize their relevance for mortality and resource utilization.</p><p><strong>Materials and methods: </strong>A systematic literature search was conducted in PubMed and CINAHL. Publications in English or German published within the past 5 years were included to reflect the current state of evidence. Eligible studies investigated unplanned ICU readmissions of adult patients during the same hospital admission. Nine retrospective cohort studies were identified and narratively synthesized due to methodological heterogeneity.</p><p><strong>Results: </strong>Reported ICU readmission rates ranged from 3.6% to 9.1%. The included studies predominantly investigated patient populations treated at university-affiliated centers and acute care hospitals with interdisciplinary or specialized ICUs. ICU readmissions were consistently associated with increased hospital and ICU mortality, as well as prolonged hospital and ICU length of stay. Relevant risk factors included advanced age, functional impairment, cognitive disturbances, persistent organ dysfunction, and prolonged organ support. The most common causes of readmission were respiratory complications, followed by hemodynamic instability and infectious or neurological deterioration.</p><p><strong>Conclusions: </strong>Unplanned ICU readmissions are infrequent but clinically highly relevant. They reflect a complex interaction of patient vulnerability, disease severity, and care-related factors, and are associated with increased mortality.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"334-342"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730468","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":"[Nausea, generalized abdominal pain and diarrhea in a haemodialysis patient].","authors":"Rolf Dario Frank, Mohamed Abdelfattah, David Bakker","doi":"10.1007/s00063-026-01459-w","DOIUrl":"https://doi.org/10.1007/s00063-026-01459-w","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057762","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":"[Interhospital intensive care transport in Germany: current state in 2023-results of a stakeholder survey].","authors":"Sebastian Gorgonius Passon, Oliver Schuler, Christian Volberg","doi":"10.1007/s00063-026-01454-1","DOIUrl":"https://doi.org/10.1007/s00063-026-01454-1","url":null,"abstract":"<p><strong>Background: </strong>In recent years, the demand for interhospital intensive care transport in Germany has steadily increased. These transports, particularly elective transfers, are predominantly carried out by specialized transport units, such as intensive care ambulances and helicopters. National standards (DIN) and recommendations from the German Interdisciplinary Association for Intensive Care Medicine set out requirements for the equipment and personnel of rescue vehicles.</p><p><strong>Objective: </strong>The goal of this study is to examine organizational structures, personnel and equipment standards, and deployment volumes in 2023.</p><p><strong>Materials and methods: </strong>Between August 2024 and January 2025, a paper-based survey was distributed to all medical directors of emergency medical services, service providers operating specialized intensive care transport units, relevant dispatch centers and the responsible ministries of the German federal states.</p><p><strong>Results: </strong>Of the 464 questionnaires distributed, the overall response rate was 15.5%, with service providers achieving the highest response rate of 20.8%. Each specialized transport unit conducted a median of 384 (interquartile range [IQR]: 109-825) emergency service operations in 2023, including 115 (IQR: 18-416) secondary transports. The reported data indicate broad compliance with established standards for minimum personnel qualifications and technical equipment. However, only 58-61 % of responding organizations implement mandatory regular continuing education.</p><p><strong>Conclusion: </strong>This nationwide survey reveals significant variations in the German intensive care transport system, particularly in terms of resource allocation and deployment frequency. In 2023, only 58-61 % reported mandatory regular continuing education, which should be addressed in further studies and guidelines.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006245","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":"[GiftIQ: status quo of poisoning care in Germany : A nationwide survey assessing the current status in emergency and critical care medicine].","authors":"Christoph Hüser, Matthias Baumgärtel, Oliver Fröhlich, Stefanie Hangbers, Tobias Hübner, Mark Michael, David Steindl, Stefanie Bentele","doi":"10.1007/s00063-026-01458-x","DOIUrl":"https://doi.org/10.1007/s00063-026-01458-x","url":null,"abstract":"<p><strong>Background: </strong>Poisoned patients represent a substantial proportion of cases in emergency medicine and critical care.</p><p><strong>Objective: </strong>This study aimed to assess the perceived current practice of managing poisoned patients in German prehospital emergency services, emergency departments, and intensive care units from the perspective of frontline staff.</p><p><strong>Materials and methods: </strong>A prospective cross-sectional survey was conducted among personnel in German prehospital emergency services, emergency departments, and intensive care units from 3-19 October 2025.</p><p><strong>Results: </strong>A total of 563 participants, predominantly from hospital-based and prehospital emergency care, estimated that poisoned patients accounted for a median of 5% (interquartile range [IQR] 3-10) of all cases in their clinical practice and required monitoring in 70% (IQR 40-90) of cases. Alcohol- and drug-related intoxications were most commonly encountered, whereas poisonings involving medications, chemicals, plants/mushrooms, and animals were less frequent. Most participants rated their formal training in the management of poisoned patients as insufficient. Many expressed a need for further education, specifically trained clinical staff, and a German-language digital information platform. Information was commonly obtained through independent internet searches or poison information centers. However, poison information centers were contacted in only about 30% of cases.</p><p><strong>Conclusion: </strong>The findings point to a perceived gap in toxicological training and knowledge transfer in emergency and critical care. Poison information centers were regarded as valuable but not sufficient as the only source of expertise. Strengthening toxicological competencies through structured training and digital information resources may support acute care practice.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984090","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":"[Cardio-oncology in intensive care medicine : Management of therapy-associated cardiac dysfunction, immune checkpoint inhibitor-associated myocarditis, and arrhythmias].","authors":"C P E Rau, H Lemm, E Mack, M Buerke","doi":"10.1007/s00063-026-01450-5","DOIUrl":"https://doi.org/10.1007/s00063-026-01450-5","url":null,"abstract":"<p><strong>Background: </strong>Advances in oncology and demographic changes are leading to a growing number of critically ill patients with malignancies. In addition to classical indications for intensive care, cardiovascular complications increasingly occur as therapy- or tumor-associated organ manifestations.</p><p><strong>Objective: </strong>To describe typical clinical presentations and a pragmatic diagnostic and therapeutic approach, exemplified by acute cardiac dysfunction, arrhythmias, and immune checkpoint inhibitor (ICI)-associated myocarditis.</p><p><strong>Methods: </strong>Narrative synthesis of current guidelines, consensus statements, and selected studies with a focus on applicability in the intensive care setting.</p><p><strong>Results: </strong>Common complications include acute cardiac dysfunction, thromboembolic events, and arrhythmias. ICI-associated myocarditis is less frequent but highly lethal and requires early recognition and treatment. Early identification based on typical clinical warning signs, structured diagnostics (biomarkers, ECG, echocardiography), consistent trigger control (e.g., sepsis, anemia, electrolyte disturbances, drug interactions), and risk-adapted, guideline-based interdisciplinary management are crucial for patient outcomes.</p><p><strong>Conclusion: </strong>Cardio-oncological critical care benefits from standardized pathways, close monitoring, and early goal setting to reduce complications and enable the safe continuation of curative or life-prolonging cancer therapies whenever possible.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976667","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}