Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Cardiac resuscitation-associated lung edema (CRALE): evaluation of diagnostic and therapeutic approaches by an expert group of the German Cardiac Society].","authors":"Ingo Voigt, Tobias Graf, Tobias Wengenmayer, Dawid L Staudacher, Michael Preusch, Christan Jung, Guido Michels","doi":"10.1007/s00063-025-01268-7","DOIUrl":"https://doi.org/10.1007/s00063-025-01268-7","url":null,"abstract":"<p><p>Sudden cardiac arrest (CA) is one of the leading causes of death in Europe, with over 70,000 cases annually in Germany. This study aims to evaluate diagnostic and therapeutic approaches for pulmonary edema in the post-resuscitation phase among intensive care physicians in Germany. Methods: The Working Group on Cardiopulmonary Resuscitation (AG42) of the German Cardiac Society conducted a web-based survey among its members. The survey assessed diagnostic methods, therapeutic strategies, and risk factors related to pulmonary edema after resuscitation. Results: A total of 77 participants, with a mean age of 43.9 years (±9.6), took part in the survey. Among them, 54.5% had more than 10 years of clinical experience in acute and intensive care medicine. Most clinics have access to radiological and sonographic procedures as well as advanced hemodynamic monitoring. Diagnostic measures are predominantly performed immediately upon admission (49.4%) or within one hour (36.4%) and are typically monitored every eight hours (77.9%). The oxygenation index (paO₂/F_iO₂) is used by 64.9% to assess the severity of pulmonary edema, followed by qualitative evaluation of chest X-rays (46.8%) and B-line scoring via lung ultrasound (33.8%). Therapeutic approaches focus on optimizing ventilation parameters, hemodynamic management, and the use of loop diuretics. To prevent pulmonary edema, participants favor a differentiated therapy involving volume and vasoactive agents, guided by invasive hemodynamic measurements. Conclusion: Pulmonary edema, alongside cardiac and cerebral dysfunctions, represents a significant challenge in managing post-resuscitation syndromes. The survey results reveal substantial variability in diagnostic and therapeutic approaches. Prospective studies are needed to better understand the complex pathological mechanisms and develop standardized protocols.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701964","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 on sustainability in intensive care and emergency medicine].","authors":"M Kochanek, M Berek, S Gibb, C Hermes, H Hilgarth, U Janssens, J Kessel, V Kitz, J Kreutziger, M Krone, D Mager, G Michels, S Möller, T Ochmann, S Scheithauer, I Wagenhäuser, N Weeverink, D Weismann, T Wengenmayer, F M Wilkens, V König","doi":"10.1007/s00063-025-01261-0","DOIUrl":"https://doi.org/10.1007/s00063-025-01261-0","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701968","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":"[Severe hypercalcemia in intensive care medicine].","authors":"Katharina Politt, Christine Gaik, Thomas Wiesmann","doi":"10.1007/s00063-025-01259-8","DOIUrl":"https://doi.org/10.1007/s00063-025-01259-8","url":null,"abstract":"<p><p>Hypercalcemic crisis is a rare but life-threatening complication of severe hypercalcemia. In most cases (> 90%), primary hyperparathyroidism or malignancy are the causes of a hypercalcemic crisis. Prodromes are often nonspecific and can present as nausea, vomiting, or a lack of concentration. The transition from hypercalcemia to a hypercalcemic crisis is often caused by a dysregulated volume status. As rapid treatment is essential, differential diagnostics should not delay treatment. In the human body, there is a complex system that keeps the extracellular calcium concentration within a narrow range (total calcium level: 2.1-2.5 mmol/L), whereby only about 50% of the total extracellular calcium is ionized and, therefore, biologically active. The remaining 50% is mostly bound to albumin and globulins. A hypercalcemic crisis is defined as a (albumin-corrected) total calcium over 3.5 mmol/L with accompanying severe symptoms. In addition to the measurement of the albumin-corrected total calcium concentration and ionized calcium, measuring the (intact) parathyroid hormone level is also crucial, as the causes of the hypercalcemic crisis can be roughly divided into parathyroid hormone (PTH)-dependent and PTH-independent causes. Initially, treatment is primarily symptomatic; in patients with a hypercalcemic crisis, the focus is on evaluation and appropriate emergency treatment according to the ABCDE scheme (e.g., securing the airway). At the same time, the calcium level should be lowered as quickly as possible in a controlled manner. Therefore, differentiated volume therapy is recommended. In addition, treatment with loop diuretics such as furosemide can be considered (after correcting hypovolemia). If therapy is not successful quickly or if there are contraindications to increased fluid administration (e.g., cardiac or renal insufficiency), the start of (calcium-free) dialysis is usually unavoidable. Calcitonin can be used to rapidly reduce calcium levels. Depending on the clinical cause of the severe hypercalcemia, cinacalcet, bisphosphonates, and denosumab are also drugs that can effectively reduce calcium levels within 2-3 days. The long-term prognosis depends on the underlying disease. A cohort of patients with primary hyperparathyroidism showed a 3-year survival rate of 80%.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674682","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":"Preventive effects of early mobilisation on delirium incidence in critically ill patients: systematic review and meta-analysis.","authors":"Li Zhou, Fei Xie, Yangyang Zeng, Xi Xia, Rui Wang, Yongjie Cai, Yu Lei, Fengjiao Xu, Xi Li, Bing Chen","doi":"10.1007/s00063-024-01243-8","DOIUrl":"https://doi.org/10.1007/s00063-024-01243-8","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether early mobilisation can reduce the incidence of delirium in critically ill patients and to assess the methodological quality of published studies.</p><p><strong>Methods: </strong>Three electronic databases, PubMed, Embase and the Cochrane Library, were searched for relevant studies published up to 2 March 2024. Articles were screened independently by two reviewers, based on inclusion and exclusion criteria, and a meta-analysis was performed using RevMan 5.3 software with a random-effects model.</p><p><strong>Results: </strong>A total of 18 studies (intervention group: 1794 participants, control group: 2129 participants) were included in the systematic review, with 18 studies included in the meta-analysis. Early mobilisation was found to reduce the risk of delirium in critically ill populations, with a pooled odds ratio of 0.65 (95% confidence interval [CI] 0.49-0.86; P = 0.003; I² = 59%). Additionally, two studies found that early mobilisation did not change the duration of delirium in critically ill populations, with a pooled mean difference of -1.53 (95% CI -3.48 to 0.41; P = 0.12; I² = 37%). Subgroup analysis revealed that early mobilisation maintained its preventive effect on delirium in the before/after intervention studies, studies published before 2018 and studies with a moderate methodological rating.</p><p><strong>Conclusion: </strong>As a nonpharmacological intervention, early mobilisation may help reduce the risk of delirium and shorten its duration in critically ill patients compared with standard treatment and may potentially become a novel strategy for delirium prevention in future intensive care unit settings.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630476","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":"[Children and adolescents in German emergency departments : The most common reasons for presentation throughout the day-current insights from the AKTIN emergency department registry].","authors":"Johanna Bergmann, Alina Balandin, Susanne Drynda, Gunnar Elke, Marcus Klein, Ronny Otto, Domagoj Schunk","doi":"10.1007/s00063-025-01254-z","DOIUrl":"https://doi.org/10.1007/s00063-025-01254-z","url":null,"abstract":"<p><strong>Background: </strong>The planned hospital and emergency care reform in Germany aims, among other things, to restructure emergency services towards integrated emergency centers (INZ) and integrated emergency centers for children and adolescents (KINZ). There is a gap in current data on the reasons for presentation and the use of emergency departments by patients under 18 years of age. This study provides a multicenter analysis of the most common reasons for presentation among children and adolescents in German emergency departments.</p><p><strong>Methods: </strong>In a retrospective, descriptive cross-sectional analysis, data were collected from 251,570 emergency patients under 18 years of age from January 1, 2019, to June 30, 2022, across 22 emergency departments (including three pediatric emergency departments). Reasons for presentation were categorized according to the Canadian Emergency Department Information System-Presenting Complaint List (CEDIS-PCL) and analyzed by age group, gender, and mode of arrival.</p><p><strong>Results: </strong>Over 64.1% of children and adolescents presented with one of the ten most common reasons. In pediatric emergency departments, nontrauma-related reasons, such as respiratory infections and abdominal pain, were predominant, while trauma-related reasons were more frequent in general emergency departments. The gender distribution showed a majority of male patients for trauma-related reasons, whereas some nontrauma-related reasons, like abdominal and headache complaints, were more common among females. Most patients (85.5%) arrived at the emergency department independently; only for seizures did ambulance transport prevail. During the day, 67% of patients presented between 06:00 and 18:00, with 33% presenting in the evening and nighttime hours.</p><p><strong>Conclusions: </strong>The results show that more than half of children and adolescents present to emergency departments with one of the ten most common chief complaints. Notably, nontraumatological presentations in emergency departments (EDs) highlight that pediatric care also takes place in facilities primarily serving adults. In the future, staff and infrastructure should be appropriately equipped to efficiently ensure the quality of pediatric emergency care on a broad scale. An important approach in this regard is health education and the optimization of access to outpatient care structures.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574614","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":"[Ten key statements on the guideline \"Peripheral administration of vasopressors\"].","authors":"Silke Fortenbacher, Stefan John","doi":"10.1007/s00063-024-01201-4","DOIUrl":"10.1007/s00063-024-01201-4","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"135-137"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631055","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":"Mitteilungen der DGIIN.","authors":"","doi":"10.1007/s00063-025-01257-w","DOIUrl":"https://doi.org/10.1007/s00063-025-01257-w","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"120 2","pages":"183"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525022","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":"[Skill-grade mix and shared governance in the intensive care unit: development of a management triangle and the advancement of nursing roles].","authors":"Christian Siegling, Esther Mertins, Franziska Wefer, Christina Bolte, Lars Krüger","doi":"10.1007/s00063-024-01175-3","DOIUrl":"10.1007/s00063-024-01175-3","url":null,"abstract":"<p><strong>Background: </strong>In the Federal Republic of Germany, it has been possible for some years to study (intensive) nursing care alongside further training in intensive care and anaesthesia. This results in a nursing skill-grade mix in the intensive care unit (ICU), which nursing management must consider.</p><p><strong>Objectives: </strong>The aim is to show the development and implementation of a new nursing management structure in the ICU and also provide an overview of the parallel role development with preliminary results at a university hospital.</p><p><strong>Materials and methods: </strong>Within a working group of nursing management, a narrative analysis of the current situation was carried out with close involvement of the ICU ward managers and the staff units for nursing development, further education and nursing education. The content was organized into subject areas and a new management model was subsequently developed. The evaluation took place narratively within the context of employee interviews.</p><p><strong>Results: </strong>The management model in the ICU was divided into the areas of nursing management, nursing education, and nursing science as a management triangle. Nursing management is staffed by at least two people as ward managers and deputies, while the nursing education and science team leaders have equal decision-making powers in terms of shared governance. The respective specialist departments work together within the hospital in networks with other ICUs. Other specialist roles such as primary nurses, advanced practice nurses, heart failure nurses or practical instructors are given specific contact persons in the management team to match their tasks, which was viewed positively.</p><p><strong>Conclusions: </strong>The development of nursing practice can be promoted through close co-operation within the management team.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"153-161"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134187","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":"[Acute ischemic stroke treatment].","authors":"Muadh Hussain, Jan Purrucker, Peter Ringleb, Silvia Schönenberger","doi":"10.1007/s00063-024-01233-w","DOIUrl":"10.1007/s00063-024-01233-w","url":null,"abstract":"<p><p>Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are the cornerstones of acute ischemic stroke treatment. While IVT has been an integral part of acute therapy since the mid-1990s, EVT has evolved as one of the most effective treatments in medicine over the past decade. Traditionally, systemic thrombolysis has been performed with alteplase (rtPA). More recently, tenecteplase (TNK) has been shown to be non-inferior to rtPA. TNK has some pharmacological advantages over rtPA and may lead to earlier recanalization, particularly in large vessel occlusions. All recanalization therapies are highly time dependent. To ensure rapid treatment, standard operating procedures (SOPs) should be established and followed in clinical practice. The optimal time window for IVT is 4.5 h after symptom onset and can be extended up to 9 h using specialized imaging techniques. For EVT, studies suggest a time window up to 24 h after symptom onset. In some cases, EVT has been successfully performed beyond this time window. To select patients for EVT, advanced imaging identifying salvageable brain tissue might be necessary. Even in large ischemic stroke, EVT can still improve outcome. Compared to EVT, IVT requires fewer technical and human resources, so more stroke patients can potentially be treated. In contrast, EVT requires highly trained personnel with sophisticated equipment and can, therefore, only be performed in specialized centers. Both procedures should be combined within the 4.5 h time window for patients without contraindications.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"120-128"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957403","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":"[Overlooked threat: Sepsis with an uncommon source of infection].","authors":"Tanja Knoll, Christian Hohmann, Oliver Kemper, Rolf Dembinski","doi":"10.1007/s00063-024-01205-0","DOIUrl":"10.1007/s00063-024-01205-0","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"166-169"},"PeriodicalIF":1.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631053","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}