Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

Life in an intensive care unit (ICU) involves the successful use of life-sustaining treatment and patients dying. In intensive care medicine, allowing a patient to die often means discontinuing life-sustaining measures. Together with the severity of the illness, this has a significant impact on the course of the dying process. End of life treatment and support focus on alleviating symptoms. The interprofessional team's task in the ICU is to anticipate, plan and implement palliative measures. A family-centered approach to palliative care requires providing human resources for psychosocial support and spiritual care for those affected. Implementing internal recommendations for action improves the quality of care. Training in the necessary skills to support people at the end of life is an integral component of education and ongoing professional development. This training includes basic knowledge of palliative care as well as specific knowledge about terminating life-sustaining measures.

Background: A complication of stroke is the pusher syndrome (PS). PS results in an altered verticality perception and in a reduced clinical outcome. Effective interventions in the treatment of PS, feasible in nursing care, are lacking to date.

Aim: Examining whether neurophysiological massage has effects on the perception of verticality (primary outcome) and whether effects on the severity of PS can be proved (secondary outcome).

Method: Participants of this multicentered, randomized controlled trial will be recruited in the setting of acute and rehabilitation hospitals. The participants of the intervention group will receive once a day, on eight consecutive days a neurophysiological massage, while the control group will receive usual care including training for selfcare and clothing skills as well as mobilization into the wheelchair. The primary outcome will be evaluated in the sitting position, immediately after conducting the intervention, after 10 minutes, and 3 days after the intervention period ends by measuring the shank deviation angle compared to the body midline. The secondary outcome will be evaluated before starting and after ending the intervention period as well as 3 days after the intervention period ends by using the scale of contraversive pushing (SCP). Furthermore, problem-centered interviews will be conducted pre- and post-interventionally and analyzed using the Witzel method.

Expected results: The hypothesis of whether neurophysiological massage could improve the perception of verticality in patients affected by PS more than usual care will be examined. The study could show an effect of neurophysiological massage on the perception of the subjective postural vertical. Conducting interviews will allow a holistic understanding of PS.

Background: The long-term sequelae of intensive care treatment are summarized as postintensive care syndrome (PICS), which affects physical, cognitive and psychological health and can also impact children (PICS-p) and families (PICS-F).

Objective: Due to the heterogeneous long-term sequelae, an interdisciplinary treatment approach is necessary; however, current healthcare structures in the German-speaking region are not designed for transitional care, including a coordinated outpatient follow-up or care following neurological rehabilitation. The aim of this work is to identify challenges in PICS outpatient diagnostics, treatment and organization and to develop suggestions for improving care.

Material and methods: The Postintensive Care Syndrome Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) provides an overview of the current challenges and addresses them from a healthcare perspective.

Results: Care for PICS patients in German-speaking countries is severely limited due to the absence of ICD-10 codes and billing possibilities, a small number of specialized university outpatient clinics, and insufficient outpatient follow-up care. In particular, the period following rehabilitation is marked by a lack of adequate follow-up care and limited awareness within the outpatient sector.

Conclusion: Future efforts should focus on raising awareness among healthcare professionals about this complex syndrome and establishing a continuous interdisciplinary care pathway from intensive care units to rehabilitation and PICS outpatient clinics. Additionally, the introduction of ICD coding and the creation of reimbursable care structures are necessary.

In cases of severe pneumonia, prone positioning therapy has been shown to have a positive effect in patients receiving invasive mechanical ventilation. In addition, during the COVID-19 pandemic, a positive effect was demonstrated in patients who did not yet require mechanical ventilation (endotracheal intubation) and who received prone positioning therapy before these measures were taken (awake prone positoning). Currently, the influence of awake prone positioning therapy in patients without COVID-19 has not been sufficiently investigated. This recommendation aims to explain the indications, side effects, contraindications, and implementation of awake prone positioning in conscious critically ill patients.

Background: In Germany, the alternative care of patients with ambulatory treatment needs has been discussed for years as a way to relieve emergency departments. This study provides insights into currently implemented models of patient streaming and integrated acute and emergency care.

Methods: Between July 2023 and July 2024 emergency department physicians were surveyed online. One section targeted management personnel and gathered information on care structures and case numbers. Based on this, the potential for relieving emergency departments was calculated. The analysis was descriptive.

Results: Of the 370 participants 28% (n = 105) held management positions in the emergency department and 50% (n = 45) of those with alternative structures reported collaborations with the Association of Statutory Health Insurance Physicians. Standardized patient streaming was implemented in 43% (n = 24), often based on triage. The median indicated relief potential was 21%.

Discussion: The findings reveal a heterogeneous care landscape with varying patient streaming approaches and relevant potential to relieve emergency departments. Due to the small number of cases and a convenience sample, the results should be interpreted as exploratory. Further research could support the evidence-based development of acute and emergency care.

Background: Weaning critically ill patients from mechanical ventilation (MV) is an important challenge of intensive care unit (ICU) management. Internationally, MV is often supported by respiratory therapists (RT) as specially trained nurses and advanced practice nurses (APN) with a master's degree, all functioning within an interdisciplinary treatment team. Currently, there is limited research focusing on the process and effectiveness of collaboration between RT and APN as a nursing competence team (NCT) in the context of the weaning process in MV.

Aim: To identify factors that promote and inhibit the feasibility of an NCT team to improve the MV weaning process in ICUs and to assess the feasibility of a future confirmatory study applying patient- and nursing-sensitive outcomes.

Methods: A single-center, mixed methods, two-phase feasibility study will be carried out on two ICUs with 48 beds at the Clinic for Thoracic and Cardiovascular Surgery in a university hospital. In study phase I, six focus-group interviews (FGs) will be conducted with nurses, physicians, and physiotherapists at three measuring points (t₀: before implementation; t₁ and t₂: 6 and 12 months, respectively, after implementation of the NCT). Three separate FGs will be conducted with the NCT team at the same measuring points. Data will be analyzed using Kuckartz's content analysis method. Study phase II will be carried out as a before-and-after study over 12 months by, e.g., assessing patients' duration of MV, delirium, pain, anxiety, and mobilization. Retrospective patient data for the period 2022-2023 will be used from the hospital documentation system. In the after-study, data will be prospectively collected.

Expected results: Our two-phase feasibility study will generate important information on the feasibility of an NCT focusing on the implementation process and weaning outcomes in patients with MV, providing an important basis for future studies.

In 2025, intensive care and emergency medicine in Germany face profound structural and political transformation. The new Hospital Care Improvement Act (KHVVG) introduces a three-pillar financing model consisting of standby budgets, nursing reimbursement, and residual DRGs, aiming to reduce economic incentives and strengthen quality, safety, and specialization. At the same time, workforce shortages in medicine and nursing, as well as the integration of new roles such as Advanced Practice Nurses and Physician Assistants, pose major challenges. Structural reforms, regionalization, and the establishment of specialized centers are designed to ensure efficient resource allocation. Digitalization, telemedicine, and artificial intelligence offer opportunities for process optimization, cost management, and improved care quality, but require standardized frameworks and effective change management. In addition, sustainability initiatives, outpatient shifts, and quality-oriented payment models are gaining relevance. Overall, these developments mark a paradigm shift intended to secure high-quality, safe, and sustainable care for critically ill and emergency patients.

Background: Severe yew (Taxus) intoxication is a rare condition that can lead to life-threatening cardiac arrhythmia. The survival of patients requires highly specialized emergency and intensive care treatment.

Objectives: Systematic overview of the clinical picture and important treatment options.

Methods: Case report of severe yew intoxication with subsequent literature review of comparable case reports. Analysis of 33 case reports with a total of 37 critically intoxicated patients from the years 2000-2024 from Europe and North America.

Results: Severe yew intoxications were almost exclusively the result of suicidal intent. Patients average age was 33 (± 14.5) years. The use of antiarrhythmic drugs and electrical stimulation of the heart often proved to be ineffective or deteriorating in its effect over time. The use of lipid emulsion and/or digoxin-specific Fab fragments has little evidence. The average duration of a clinically relevant arrhythmogenic effect was 22±11.7 h.

Conclusions: The management of yew intoxication is primarily limited to symptomatic treatment. The availability of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in a "bridge-to-recovery" concept appears to be of utmost importance.