Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS最新文献

{"title":"[Handling Sterile Materials and Medications in Anesthesia and Functional Areas].","authors":"Sebastian Schulz-Stübner, Stefan Bushuven","doi":"10.1055/a-2521-1221","DOIUrl":"10.1055/a-2521-1221","url":null,"abstract":"<p><p>Bacterial contamination at the anesthesia workstation is common and correlates with an increased rate of postoperative infections. This article emphasizes the importance of strict hygiene regulations in anesthesia and functional areas to prevent nosocomial infections. It summarizes scientific findings and practical recommendations for minimizing contamination of work areas, instruments, and medications. Important measures include organizing the anesthesia workplace into \"clean\" and \"unclean\" areas, using hand disinfectants, wearing disposable gloves, and disinfecting hand contact surfaces. Special recommendations apply to invasive procedures such as central venous catheterization and regional anesthesia. The \"one-hour rule\" for preparing medications is critically discussed and translated into a practical approach for providing repeated medications during a procedure. A case study shows the application of these principles in a knee TEP revision. Mechanical cleaning and disinfection of surfaces at the end of the case and reprocessing of medical equipment by qualified personnel are also important aspects.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 3","pages":"197-210"},"PeriodicalIF":0.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147506013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[AI in Intensive Care Medicine - Focus on Early Detection of Sepsis].","authors":"Hartmuth Nowak, Michael Adamzik","doi":"10.1055/a-2683-3007","DOIUrl":"10.1055/a-2683-3007","url":null,"abstract":"<p><p>Sepsis remains the third leading cause of death worldwide after cardiovascular and malignant diseases, claiming approximately 11 million lives annually. In Germany alone, around 280000 people develop sepsis each year, with more than 150 deaths daily. Despite advances in therapy, survival still depends primarily on one factor: time. Early initiation of antimicrobial therapy and source control remain critical. Artificial intelligence (AI) promises to identify subtle, pre-symptomatic physiological changes that precede overt clinical signs of sepsis. By continuously analyzing vast streams of data from monitors, laboratory results, and electronic health records, AI models can detect complex, subclinical patterns beyond human perception, potentially predicting sepsis hours in advance.Machine learning (ML) algorithms, particularly supervised learning models, are trained on historical patient data (vital signs, laboratory values, and clinical notes) paired with outcomes indicating whether and when sepsis occurred. Once validated on unseen cases, these models can provide real-time risk assessments in clinical practice. Compared with traditional scores such as SIRS, qSOFA, MEWS, or NEWS, AI systems can integrate multiple variables dynamically and adjust risk estimates continuously.Several studies have shown that ML-based models outperform classical scores in prediction accuracy, identifying sepsis significantly earlier. However, challenges remain: lack of generalizability across hospitals, risk of false alarms, limited interpretability, and insufficient clinical validation. While early implementations demonstrate improved patient outcomes, robust randomized controlled trials are still needed to confirm that AI-driven sepsis prediction truly saves lives and merits integration into clinical guidelines.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 3","pages":"173-183"},"PeriodicalIF":0.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Correction: Physiological and Pharmacological Characteristics of Women].","authors":"Johanna Wohlfart, Vivienne Theobald, Dania Fischer","doi":"10.1055/a-2818-7753","DOIUrl":"10.1055/a-2818-7753","url":null,"abstract":"","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":" ","pages":"160"},"PeriodicalIF":0.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147314371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Artificial Intelligence in Emergency Medicine - Efficient Logistics by Data-driven Systems].","authors":"Julia Pagels, Lena Böttjer, Leonie Hannappel, Janina Bathe, Jan Wnent, Jan-Thorsten Gräsner","doi":"10.1055/a-2683-3053","DOIUrl":"10.1055/a-2683-3053","url":null,"abstract":"<p><p>Emergency medicine is facing increasing logistical pressure due to rising case numbers, demographic change, staff shortages, the ongoing hospital reform and new threat scenarios such as pandemics or infrastructure failures. While artificial intelligence (AI) in anesthesiology and intensive care mainly supports diagnostic and prognostic tasks, its main potential in emergency medicine lies in improving logistics. Efficient coordination of transport decisions, real-time knowledge of treatment capacities and predictive resource allocation can directly influence response times and patient outcomes.This article focuses on the role of data-driven systems in emergency medical logistics. Using practical examples and current research projects, it illustrates how digital tools can support dispatch decisions, optimize patient transfers and improve system-wide coordination. The simulation model SCATTER is presented as an example of how structural, process and patient data can be combined to analyze transfer strategies and evaluate their system effects. In addition, the concept of a National Control Centre is discussed as a future platform to integrate real-time information, simulation results and decision support.In conclusion, AI in emergency medicine should be understood primarily as a tool for strengthening logistics and system resilience. Its effectiveness depends largely on the availability of reliable, interoperable data and on the integration of digital platforms across institutional boundaries.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 3","pages":"184-196"},"PeriodicalIF":0.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147506008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Intraoperative Ventilation].","authors":"Franziska M Konrad","doi":"10.1055/a-2666-4547","DOIUrl":"10.1055/a-2666-4547","url":null,"abstract":"<p><p>Mechanical ventilation is mandatory for general anesthesia. Thereby, many parameters have to be chosen wisely by the anaesthesist. Essentials are the peak pressure, which should be below 30 mmHg and the PEEP (positive endexpiratory pressure) - in healthy adults at least 5 mmHg. The driving pressure is the pressure difference between the plateau-pressure and the PEEP. The driving pressure has a higher association with postoperative pulmonary complications than the peak pressure and should be below 15 mmHg. The tidal volume for the patient should be calculated with 6 to 8 ml per kg ideal body weight. High inspiratory oxygen causes atelectasis and for the emergence of anesthesia 0,6 to 0,8 FiO₂ should be considered. Atelectasis develops during every general anesthesia, nevertheless recruitment can not be recommended generally since it can damage the lung in the sense of a volume- or barotrauma. There is no statistical significant difference between pressure and volume controlled ventilation based on postoperative pulmonary complications. During a reanimation, volume-controlled ventilation is beneficial because of the high variation of the necessary pressure needed to apply a constant tidal volume. The inspiratory flow is an indication for the speed with which the volume is administered into the lung. High inspiratory flows can damage the lung and are often underestimated. Mechanical ventilation is necessary but has the potential to harm the lung. Every single parameter has to be chosen carefully and the ventilation chosen and adapted individually for each patient in different operation setting with changing requirements.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 2","pages":"86-101"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Weaning from Ventilation].","authors":"Larissa Nerz, Helene Häberle","doi":"10.1055/a-2666-2780","DOIUrl":"10.1055/a-2666-2780","url":null,"abstract":"<p><p>Weaning from invasive mechanical ventilation is a central task in intensive care medicine and has gained increasing importance due to the rising number of patients requiring prolonged or even long-term ventilatory support. Early identification of patients at risk for difficult or prolonged weaning is crucial to improve outcomes and avoid long-term ventilation. Recent evidence highlights the growing role of predictive parameters such as ultrasound-based diaphragm assessment, mechanical power density, and biomarkers of respiratory effort. Emerging approaches, including automated ventilator-supported weaning algorithms and artificial intelligence-assisted analysis of diaphragm ultrasound combined with clinical data, show promise in reducing prolonged weaning failure.Successful weaning is a multifactorial and interprofessional process that should be initiated as early as possible once contraindications are excluded. Core elements include structured daily weaning assessments, spontaneous breathing trials (SBT), optimization of sedation strategies within the ABCDEF bundle, and individualized adaptation of ventilatory modes. Pressure support ventilation remains the most commonly used mode in Europe, while newer modalities such as neurally adjusted ventilatory assist and proportional assist ventilation offer potential benefits in selected patients but require expertise and further validation.Diaphragm dysfunction plays a key role in weaning failure. Controlled ventilation can rapidly induce diaphragmatic atrophy and myotrauma, emphasizing the importance of monitoring respiratory drive and effort, for instance via P0.1 measurements and diaphragm ultrasound. Noninvasive ventilation after extubation has demonstrated efficacy in reducing reintubation rates in high-risk patients when applied adequately.Tracheostomy is an important option in patients with anticipated prolonged weaning, facilitating airway management, reducing sedation needs, and enabling rehabilitation, although optimal timing must be individualized. Overall, successful weaning requires a structured, protocol-based, and interprofessional approach that integrates physiological monitoring, early mobilization, and targeted therapies to improve patient-centered outcomes and quality of life.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 2","pages":"120-135"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Thieme Teaching Award 2024 - Anesthesia Summerschool].","authors":"Laura Borgstedt, Ursula Kahl, Giovanna Lurati Buse, Robert Werdehausen","doi":"10.1055/a-2795-4938","DOIUrl":"https://doi.org/10.1055/a-2795-4938","url":null,"abstract":"","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 2","pages":"145-147"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ventilation strategies in intensive care medicine].","authors":"Carolin Jung, Peter Markus Spieth","doi":"10.1055/a-2789-0934","DOIUrl":"10.1055/a-2789-0934","url":null,"abstract":"<p><p>Mechanical ventilation is a life-saving intervention in intensive care, ensuring adequate gas exchange and reducing respiratory workload. However, inappropriate ventilation strategies can cause ventilator-induced lung injury (VILI) through mechanisms such as volutrauma, barotrauma, atelectrauma, and biotrauma, which may lead to systemic inflammation and multiorgan failure. This review summarizes evidence-based approaches for managing acute respiratory failure, focusing on both non-invasive and invasive ventilation strategies.Non-invasive techniques (HFNO, CPAP, NIV) are established for COPD exacerbations and cardiogenic pulmonary edema and may be considered in mild to moderate hypoxemia, provided close monitoring. In severe hypoxemia, early intubation and lung-protective ventilation are essential. Invasive ventilation should prioritize low tidal volumes (4-8 ml/kg PBW), limited plateau pressure (< 30 cmH₂O), and adequate PEEP to prevent alveolar collapse while avoiding overdistension. Driving pressure (Δp) has emerged as a key prognostic parameter, with values ≥ 15 cmH₂O linked to increased mortality.Advanced modes such as pressure- and volume-controlled ventilation, partially or fully synchronized assist modes, and adaptive or proportional support (e. g., ASV, NAVA, PAV+) aim to improve patient-ventilator synchrony, though outcome benefits remain unproven. Monitoring respiratory drive and inspiratory effort is crucial to prevent excessive strain during spontaneous breathing. Adjunctive measures for refractory hypoxemia include prone positioning, which significantly reduces mortality in moderate to severe ARDS, and rescue therapies such as inhaled nitric oxide or extracorporeal membrane oxygenation (ECMO) in specialized centers. Optimal oxygenation targets (PaO₂ 60-100 mmHg, SaO₂ 92-96%) should avoid both hypoxemia and hyperoxemia.Understanding physiological principles and individualized ventilation strategies is fundamental to minimizing complications and improving outcomes in critically ill patients with respiratory failure.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 2","pages":"103-119"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rolle der Beatmung in Anästhesie und Intensivmedizin.","authors":"Peter Rosenberger","doi":"10.1055/a-2785-6427","DOIUrl":"https://doi.org/10.1055/a-2785-6427","url":null,"abstract":"","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 2","pages":"84-85"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Perioperative Crew Resource Management: an Example of Interdisciplinary Collaboration].","authors":"Michèle Schöb, Christoph Konrad","doi":"10.1055/a-2441-4396","DOIUrl":"10.1055/a-2441-4396","url":null,"abstract":"<p><p>Emergency interdisciplinary surgeries present major challenges for healthcare teams. We report a case of successful collaboration during emergency resection of a giant solitary fibrous tumor in a 36-year-old woman.Six years after refusing elective surgery for a large right-sided thoracic tumor, the patient presented with dyspnea, facial edema, and signs of venous congestion. Imaging showed a massive tumor displacing the heart and compressing both venae cavae. An open hemiclamshell tumorectomy was performed under veno-arterial ECMO support with a balloon catheter positioned for potential hemostatic control. The surgical intervention was uneventful, and the patient was discharged to rehabilitation 11 days later.This case highlights the importance of structured interdisciplinary collaboration and crisis resource management (CRM) principles in complex, high-risk surgeries. Preoperative joint planning, clear communication, and continuous intraoperative evaluation were the key to achieve a favorable outcome.Interdisciplinary planning and CRM-based communication are essential for the safe and successful management of major emergency surgeries.</p>","PeriodicalId":520554,"journal":{"name":"Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS","volume":"61 2","pages":"137-144"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}