Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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).

Background: As a neuropsychiatric syndrome, delirium worsens the prognosis of critically ill patients in the intensive care unit (ICU). Risk factors such as sleep deprivation increase the incidence of delirium. Targeted light exposure influences the circadian rhythm, and daylight interventions can help to restore the natural daily rhythm. To date, a review of daylight therapy for German-speaking countries is lacking.

Objective: This work aims to provide an overview of the currently available evidence on the use of daylight therapy in critically ill patients on the ICU, with a medical focus on cardiology or thoracic and cardiovascular surgery. The potential effects of daylight therapy on delirium and sleep are discussed.

Materials and methods: A systematic literature search was conducted in the databases CareLit (hpsmedia, Hungen, Germany), Cochrane Library (The Cochrane Collaboration, London, U.K.), Livivo (German National Library of Medicine - Information Centre for Life Science, Cologne, Germany), and Medline via PubMed (U.S. National Library of Medicine, Bethesda, MD, USA). German- and English-language literature involving ICU patients at least 18 years of age in the context of light therapy was included. A critical appraisal was performed using the assessment tools developed by Behrens and Langer.

Results: Fourteen full texts were included, most of which involved multiple nonpharmacological interventions. The studies varied in terms of light application mode, timing, and duration. No significant effects on the delirium incidence were found, but positive effects on sleep promotion and psychological outcomes were observed.

Conclusion: There are few conclusive studies on daylight therapy in the ICU. Most involved multicomponent intervention strategies. The prevailing evidence suggests beneficial effects on sleep promotion and psychological outcomes, which could contribute to delirium prevention strategies. Further research is needed.

An endocrine crisis is a hormonal disorder that leads to death if left untreated. The fundamental importance of endocrine regulatory circuits for homeostasis is also evident in critical illnesses-as a consequence of another disease or as a cause. In fact, the clinical presentation of a crisis is often nonspecific and therefore differs from the classical presentation of endocrine disorders. This review summarizes intensive care aspects of crises due to glucocorticoid deficiency (adrenal crisis) or excess (Cushing's crisis), excess thyroid hormone (thyroid storm), and hypercalcemic crisis (parathyroid crisis). The focus is on differential diagnostic classification, stabilization as a primary intensive care task, and differentiation from detailed endocrinological differential diagnostics.

Background: The directives of the Federal Joint Committee (G-BA) define tiered emergency care structures, but their influence on patient decision-making has not been sufficiently studied.

Objective (research question): This study examined patient-related determinants of utilising emergency departments (ED) of different emergency levels in Bavaria.

Materials and methods: From September to November 2024, we carried out a standardised, cross-sectional survey in 18 ED at basic, extended and comprehensive care levels (n = 7527 participants). Data were analysed descriptively and with multinomial logistic regression. Subjective urgency, reason for visit, travel time and mode of arrival were included as influencing factors.

Results: 15.4% of respondents who visited the ED independently (n = 5300) chose to do so because of the expected specialization. Patients in comprehensive EDs used emergency medical services significantly more often, rated their urgency higher and more frequently reported neurological, urological or ophthalmological complaints. They accepted longer travel times and were less likely to have sought outpatient care beforehand.

Discussion: The choice of emergency level is chiefly influenced by subjective urgency, specialty-related complaint types, mode of arrival and institutional structure. Even the existing heterogeneity among institutions exerts a steering effect. Future management concepts-such as integrated emergency centres-should incorporate these patient preferences and regional care realities to enable need-oriented direction without undersupply.

Daily ward rounds are a central element of intensive care, but exhibit significant differences in procedure, duration, and team composition. Unstructured ward rounds carry risks of communication errors, incomplete decisions, and avoidable patient harm. Structured, interprofessional ward rounds are increasingly considered a quality indicator, as they improve communication, safety and outcome quality. The aim of this work is to present the evidence, benefits, and implementation strategies of structured, interprofessional ward rounds in internal medicine intensive care units and to evaluate their impact on quality of care and clinical outcomes. Based on current literature (guidelines, systematic reviews, meta-analyses, primary studies), the effectiveness of structured ward rounds as well as process and outcome indicators (mortality, length of stay, patient safety) are analyzed. Structured ward rounds with checklists, clear procedures, and interprofessional participation significantly reduce in-hospital and 30-day mortality (OR 0.84), reduce ventilation duration, infection rates (ventilator-associated pneumonia, catheter-associated urinary tract infection, central line-associated bloodstream infection), and length of stay in the intensive care unit. They improve communication, team dynamics, safety culture, and patient satisfaction. Studies show efficiency gains through less miscommunication and faster decision-making. The positive effects of structured ward rounds are based on improved process quality, collaborative decision-making, and transparent documentation. Successful implementation requires leadership, training, and site-specific adaptation. Challenges include hierarchies, resource constraints, and cultural acceptance. Structured ward rounds are an evidence-based instrument of clinical excellence that sustainably strengthens patient safety, outcomes, and teamwork.