Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Pharmacotherapy in the geriatric intensive care patient: sedation and anti-infective treatment].","authors":"S Schubert, J Hähner, Priyanka Böttger, H Lemm, Michael Buerke","doi":"10.1007/s00063-026-01429-2","DOIUrl":"10.1007/s00063-026-01429-2","url":null,"abstract":"<p><p>Older intensive care unit (ICU) patients are particularly vulnerable to adverse drug reactions, delirium, and treatment failure due to age-related changes in pharmacodynamics (PD) and pharmacokinetics (PK), compounded by the dynamic pathophysiology of critical illness. This review focuses on sedatives/analgesics and anti-infective agents. For analgosedation, an analgesia-first strategy, protocol-based light sedation (awake and cooperative whenever feasible), rigorous delirium management, and avoidance of continuous benzodiazepine infusions are recommended. In anti-infective therapy, key priorities include achieving PK/PD targets, daily dose adjustment to current drug clearance, de-escalation, and early therapeutic drug monitoring (vancomycin, aminoglycosides; selectively also β‑lactams).</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"260-266"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147445796","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":"OMW: Der alte Intensivpatient.","authors":"Michael Buerke, U Janssens","doi":"10.1007/s00063-026-01443-4","DOIUrl":"https://doi.org/10.1007/s00063-026-01443-4","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"121 4","pages":"292"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786698","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":"[ECG interpretation in rescue and emergency medical services in Germany: results of a cross-sectional study].","authors":"Angela Gerhard, Yvonne Treusch, Luis Möckel, Karin Kohlstedt, Thomas Hofmann","doi":"10.1007/s00063-025-01252-1","DOIUrl":"10.1007/s00063-025-01252-1","url":null,"abstract":"<p><strong>Background: </strong>The recording of an electrocardiogram (ECG) is an essential part of basic diagnostics in the emergency medical services (EMS). To provide initial care and make a preliminary diagnosis, paramedics and emergency physicians (EP) need knowledge about the ECG interpretation. Nevertheless, a few studies show that knowledge of ECG interpretation of paramedics and emergency physicians must improve.</p><p><strong>Objectives: </strong>The aim of this study was to analyze the ECG interpretation skills among EMS staff and EP in Germany.</p><p><strong>Materials and methods: </strong>An online survey was conducted to assess these skills from 22 February to 22 March 2023. The survey collected details about gender, age, professional training, years of professional experience, time since the last ECG training, and self-rated ECG interpretation ability. Subsequently, 9 different ECG had to be interpreted in the form of single-choice questions.</p><p><strong>Results: </strong>In all, 908 participants (EMS: 803; EP: 105) were evaluated. The survey identified a knowledge deficit in the interpretation of ECG. On average, 63.3% (EMS: 61.4%; EP: 76.5%) of the ECG were interpreted correctly. The ECG with ST-elevation myocardial infarction (STEMI) of the posterior wall was identified correctly by 79.1% (EMS: 78.1%; EP: 86.7%) of the participants. Specific weak points in interpreting ECG were AV-blocks, tachycardias, atrial fibrillation, bundle branch blocks, pacemaker ECG and determining the ventricular axis. The participants' self-assessment of their ECG skills correlated significantly with the results actually achieved (p ≤ 0.001; p_bonf = 0.016; ρ = 0.378).</p><p><strong>Conclusion: </strong>Based on the lack of diagnostic skills in the interpretation of a 12 lead ECG, continuous education programs should be revised to improve the quality of patient care in prehospital emergency medicine.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"302-309"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494414","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":"[Special ethical aspects in older intensive care patients].","authors":"Jochen Dutzmann","doi":"10.1007/s00063-026-01435-4","DOIUrl":"10.1007/s00063-026-01435-4","url":null,"abstract":"<p><p>With demographic shifts, the proportion of older and very old patients in intensive care units is steadily rising. These patients vary widely in their functional reserves and treatment prospects. Multimorbidity, frailty, and impaired decision-making capacity are prevalent, while advance directives are often unclear or outdated. Consequently, determining the appropriate treatment, establishing the patient's wishes, and defining realistic treatment goals present significant challenges. Chronological age alone is a poor predictor of mortality and functional outcomes. Frailty, functional reserve, and the dynamics of the acute illness are far more decisive factors. However, prognostic uncertainty remains substantial. Given the increasing power and high cost of intensive care medicine, necessary political and clinical decisions on resource allocation must never be based solely on chronological age.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"274-280"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516128","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":"Der alte Intensivpatient.","authors":"Michael Buerke, Uwe Janssens","doi":"10.1007/s00063-026-01436-3","DOIUrl":"https://doi.org/10.1007/s00063-026-01436-3","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":"121 4","pages":"247-249"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786736","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":"[Specialized geriatric care in intensive care units: from frailty to functional prognosis].","authors":"Henning Lemm, Matthias Janusch, Ursula Müller-Werdan","doi":"10.1007/s00063-026-01434-5","DOIUrl":"10.1007/s00063-026-01434-5","url":null,"abstract":"<p><strong>Background: </strong>Intensive care units (ICUs) increasingly treat very old adults with multimorbidity, frailty, and high medication burden. Chronological age alone is a poor proxy for benefit and prognosis; premorbid function, vulnerability (frailty), and cognitive reserve are pivotal. European cohorts of ICU patients aged ≥ 80 years show a high prevalence of frailty (Clinical Frailty Scale [CFS] ≥ 5 around 43%) and an independent association with 30-day mortality (e.g., hazard ratio [HR] ~1.5 in very old ICU patients [VIP] 1). VIP2 confirmed the prognostic contribution of CFS after adjustment including Sequential Organ Failure Assessment (SOFA) and admission diagnoses. Evidence syntheses and implementation reports suggest that structured bundles (ABCDEF) can improve delirium-related and functional outcomes.</p><p><strong>Methods: </strong>We propose a geriatric ICU bundle integrating frailty assessment, structured goals-of-care (including time-limited trials), delirium prevention, light sedation, early mobilization, protein-adapted nutrition, medication safety, and deprescribing at ICU discharge.</p><p><strong>Conclusion: </strong>Geriatric critical care represents a paradigm shift from isolated physiological stabilization towards trajectory-based treatment with explicit functional goals. Systematic vulnerability assessment, evidence-based bundles, and time-limited trials may reduce both overtreatment and undertreatment and improve the likelihood of meaningful recovery.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"250-259"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595729","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":"[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":"10.1007/s00063-025-01295-4","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"201-207"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038734/pdf/","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":"OA","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":"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":"193-200"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038791/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Triage in crisis situations-a very delicate topic].","authors":"Stefan Kluge, Uwe Janssens","doi":"10.1007/s00063-025-01387-1","DOIUrl":"10.1007/s00063-025-01387-1","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"184-186"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726983","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":"[Animal-assisted interventions (AAI) in intensive care : Position of the German Society for Internal Intensive Care and Emergency Medicine].","authors":"Nadine Weeverink, Carsten Hermes, Sebastian Schulz-Stübner, Tobias Ochmann, Matthias Kochanek, Uwe Janssens","doi":"10.1007/s00063-025-01381-7","DOIUrl":"10.1007/s00063-025-01381-7","url":null,"abstract":"<p><p>Animal-assisted interventions (AAI) are increasingly recognized as nonpharmacological adjuncts to intensive care medicine. The aim of this paper by the German Society of Internal Intensive Care and Emergency Medicine (DGIIN) is to summarize the scientific rationale, safety considerations, and implementation recommendations for the use of AAI in intensive care units. Therapeutic effects are attributed to neuroendocrine mechanisms, particularly activation of the oxytocin system and reduction of cortisol levels, which can alleviate anxiety, pain perception, and psychological stress in critically ill patients. Early studies have reported significant reductions in anxiety without an associated increase in nosocomial infections. However, clinical implementation requires well-defined structural, hygienic, and ethical frameworks, including standardized risk analyses, binding hygiene and animal welfare standards, and multiprofessional collaboration integrating intensive care, nursing, infection control, and animal therapy. This paper presents the first systematic recommendations in Germany for the safe and quality-assured integration of animal-assisted interventions into intensive care practice and calls for scientifically accompanied implementation focusing on patient safety, animal welfare, and team well-being.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"187-192"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935386","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}