Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Geriatric care assistance in emergency departments: position paper of DGIIN, DGINA, and DGG].","authors":"Guido Michels, Susanne Schuster, Patrick Dormann, Kevin Lehmann, Margot Dietz-Wittstock, Carsten Hermes, Philipp Kasper, Hans-Jörg Busch, Christian Wrede, Markus Gosch, Katrin Singler","doi":"10.1007/s00063-026-01457-y","DOIUrl":"https://doi.org/10.1007/s00063-026-01457-y","url":null,"abstract":"<p><p>Older adults with multimorbidity and complex needs account for a large proportion of patients treated in emergency departments. Since the management of geriatric patients is associated with a high retention time for nursing staff, the German Society for Internal Intensive Care and Emergency Medicine (DGIIN), the German Society for Emergency Medicine (DGINA), and the German Society for Geriatrics (DGG) recommend exploring the use of specially trained care assistants to reduce the workload of nursing staff in emergency departments. A monocenter case study (n = 145) demonstrated that a high frailty score is associated with longer retention times for nurses.</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":"147976640","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":"[Evaluation of the TriageClient digital decision support system for the sectoral allocation of emergency patients in an integrated emergency center : A secondary data analysis].","authors":"Anna Slagman, Michael C Röttger, Jan Krug, Matthias Kühn, Matthias Roth, Hans-Jörg Busch, Sarah Eschbacher, Felix P Hans, Leo Benning","doi":"10.1007/s00063-026-01455-0","DOIUrl":"https://doi.org/10.1007/s00063-026-01455-0","url":null,"abstract":"<p><strong>Background: </strong>Integrated emergency centers (INZ) in Germany use centralized initial assessment units to triage patients with structured digital tools and allocate them to the appropriate care setting (emergency department vs. out-of-hours primary care clinic). At the University Medical Center Freiburg, an INZ has operated routinely since October 2023. We evaluated the clinical decision support system TriageClient (Blackpine Medical GmbH, Freiburg, Germany) regarding safety, effectiveness, efficiency, and timeliness.</p><p><strong>Methods: </strong>Anonymized routine data of all emergency presentations in 2024 were analyzed. Primary endpoints were 7‑day in-hospital mortality and tracer diagnoses. The secondary endpoint was hospital admission ≥ 24 h. Efficiency was measured as sector switches from the primary care clinic into the emergency department, and effectiveness as concordance with family-practice-sensitive conditions. Noninferiority was assessed against external references. Timeliness was quantified as defects per million opportunities (DPMO) for a triage duration > 10 min.</p><p><strong>Results: </strong>Of 67,552 presentations, 50,047 (74.1%) self-presenting patients were assessed with TriageClient. Final allocation was 38.5% to the primary care clinic and 61.5% to the emergency department. In Emergency Severity Index (ESI) levels 4/5 and in the primary care sector, mortality and tracer diagnoses were lower than in higher-acuity cohorts. Noninferiority/superiority was achieved for primary endpoints. The secondary endpoint met these criteria only after final nurse allocation. The sector-switch rate was 12.3%. DPMO for triage duration > 10 min was 1.36% (13,573 DPMO).</p><p><strong>Conclusion: </strong>Digital initial assessment with TriageClient showed high safety, efficiency, effectiveness, and timeliness in routine INZ operation. Multicenter studies should validate these findings.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976670","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":"[One Minute Wonder: on the job training].","authors":"Lars Krüger, Carsten Hermes, Valery Maurice Kitz, Matthias Kochanek, Sascha David","doi":"10.1007/s00063-026-01444-3","DOIUrl":"10.1007/s00063-026-01444-3","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"121 4","pages":"290-291"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786733","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":"[Anticoagulation in critical care].","authors":"Bernd Pötzsch, Hannah L McRae, Heiko Rühl","doi":"10.1007/s00063-026-01432-7","DOIUrl":"10.1007/s00063-026-01432-7","url":null,"abstract":"<p><p>Anticoagulation is used in intensive care medicine to prevent and treat thromboembolism. The increased risk of bleeding in this patient population requires a personalized approach to management including individualized anticoagulant selection and dose adjustment. While low-molecular-weight heparins are equivalent or superior to unfractionated heparin for thromboprophylaxis, unfractionated heparin is the preferred therapy for the treatment of thromboembolism. Its advantages include a relatively short half-life, the ability to monitor therapy using the activated partial thromboplastin time and the possibility of rapid and effective reversal. The direct thrombin inhibitor argatroban is a reserve anticoagulant used to treat patients with heparin-induced thrombocytopenia. The advantages of argatroban are its short half-life, hepatic clearance, and the ability to monitor therapeutic levels using the activated partial thromboplastin time.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"322-329"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610132","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: Verification of nasogastric feeding tube position].","authors":"Peter Nydahl, Olaf Boenisch, Susanne Krotsetis, Lars Krüger, Fridolin Streibert","doi":"10.1007/s00063-025-01403-4","DOIUrl":"10.1007/s00063-025-01403-4","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"318-321"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971549","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":"[Spotlight on chikungunya-current diagnostics and treatment].","authors":"Priyanka Boettger, Henning Lemm, Christoph Lübbert, Michael Buerke","doi":"10.1007/s00063-025-01379-1","DOIUrl":"10.1007/s00063-025-01379-1","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"310-313"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764488","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":"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":"293-301"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133210/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Exercise-induced ST-segment elevation and ventricular fibrillation].","authors":"Sascha Macherey-Meyer, Daniel Steven, Maria Isabel Koerber","doi":"10.1007/s00063-025-01346-w","DOIUrl":"10.1007/s00063-025-01346-w","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"314-317"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543707","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":"[Intensive care of elderly patients : Core nursing responsibilities and central care priorities].","authors":"Denise Schindele, Carsten Hermes, Tilmann Müller-Wolff","doi":"10.1007/s00063-026-01431-8","DOIUrl":"10.1007/s00063-026-01431-8","url":null,"abstract":"<p><strong>Background: </strong>Older adults represent a growing and highly vulnerable intensive care unit (ICU) population due to geriatric syndromes, functional decline, and multimorbidity. These factors increase the complexity of care and require nursing interventions that support functional stability, prevent complications and address age-related needs.</p><p><strong>Objectives: </strong>To summarize key care components relevant for older ICU patients and to identify the core nursing responsibilities within these care structures.</p><p><strong>Materials and methods: </strong>A systematic literature search in PubMed (U.S. National Library of Medicine) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) identified 11 studies and recommendations addressing the care of critically ill adults aged ≥ 65 years. Relevant care components were thematically clustered and the associated nursing responsibilities narratively synthesized.</p><p><strong>Results: </strong>Several central care priorities were identified, including delirium and cognitive management, pain management, early mobilization, geriatric assessment, nutritional support and medication management, and sleep/comfort support. These components can be grouped into thematic clusters that highlight the central role of nursing in continuous monitoring, nonpharmacological interventions, functional support, and contributing to clinical decision-making.</p><p><strong>Conclusion: </strong>Age-friendly ICU concepts may support functional preservation and reduce complications such as delirium. Structured, evidence-based processes and clearly defined nursing roles are essential for high-quality, age-appropriate care of older intensive care patients.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"281-289"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575986","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":"[Frailty in intensive care medicine].","authors":"Uwe Janssens","doi":"10.1007/s00063-026-01428-3","DOIUrl":"10.1007/s00063-026-01428-3","url":null,"abstract":"<p><strong>Background: </strong>Demographic ageing results in a continuous increase in very old patients admitted to intensive care units (ICUs). Chronological age alone is insufficient as a predictor of mortality and functional recovery following critical illness. Frailty, as an expression of biological vulnerability, enables more precise risk stratification.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed (U.S. National Library of Medicine, Bethesda, MD, USA), Scopus (Elsevier, Amsterdam, the Netherlands), and the Web of Science (Clarivate Analytics, Boston, MA, USA), focusing on frailty definition, pathophysiology, assessment instruments, epidemiological data, and clinical management in intensive care medicine.</p><p><strong>Results: </strong>Frailty is a multidimensional geriatric syndrome with a prevalence of 26.6-43.1% upon ICU admission. The clinical frailty scale (CFS) has established itself as a practical assessment instrument for acute and intensive care medicine. Frailty emerges as a robust independent predictor of increased mortality, ventilator weaning failure, delirium development, and persistent functional dependence. Structured frailty management across the entire patient pathway-including prehabilitation, early mobilization, nutritional support, and specialized rehabilitation-aims to address these functional risks.</p><p><strong>Conclusion: </strong>Systematic assessment of frailty forms the basis of realistic prognostic evaluation and patient-centered setting of treatment goals (shared decision-making). It enables the identification of high-risk patients who may benefit from targeted function-preserving interventions, serving as a prerequisite for adapted care without directly influencing mortality or functional recovery.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"267-273"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476054","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}