Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

Background: Intensive care medicine is one of the most resource-intensive areas of the hospital. As a result, nurses have a crucial role to play in adapting processes to promote sustainability in the intensive care unit. This represents a significant contribution to creating a more climate-friendly hospital. This paper aims to provide an overview of the opportunities for nurses in the multiprofessional team to exert influence in their daily practice in order to promote sustainability on their ward.

Methods: The authors summarize further results of the online survey of the DGIIN (Deutschen Gesellschaft für Internistische Intensiv- und Notfallmedizin) sustainability working group. In addition, a systematic literature search was carried out in the PubMed (U.S. National Library of Medicine, Bethesda, MD, USA) database and in the internet.

Results: Nurses are able to identify an influence on the consumption of materials and the possibility of using them according to indication. The willingness to develop strategies and involvement in process changes are essential.

Conclusion: The lack of structures that deal exclusively with sustainability and the lack of knowledge on this topic lead to a general lack of knowledge and uncertainty. This situation can be improved by targeted measures of education and training, e.g., by Green Teams.

Background: The need for interhospital transport (IHT) of intensive care patients is increasing due to changes in the hospital environment. Interhospital transports are challenging and require careful operational planning of personnel and rescue vehicles.

Objective: To investigate the need for IHT, an analysis was conducted in the service area of the emergency medical service central dispatch center (IRLS) in Schleswig-Holstein.

Material and methods: Emergency physician-assisted IHT were analyzed in the period from 01.10.2021 to 30.09.2022.

Results: Of a total of 158,823 documented IRLS missions, 2264 (1.4%) records could be identified and included as IHT: 1389 IHT (61.4%) were managed by specialized ambulances, 875 (38.6%) by primary care ambulances. Primary care ambulances were mainly used for time-critical transfers and outside the duty hours of the intensive care ambulances, 21.2 % were by air. Of all IHT, 43.1% were required to hospitals with a higher level of medical care.

Conclusion: Emergency physician-assisted IHT are a relevant part of the emergency service's operational spectrum and concern both primary care and specialized rescue vehicles. A relevant number of urgent IHT were recorded outside the duty hours of the intensive care ambulances. For emergency transports during nighttime, an expansion of air-based transfer capacities should be considered due to the time advantage. For less urgent IHT, an adjustment of the capacities of specialized ground-based vehicles in Schleswig-Holstein seems reasonable.

Background: When the workload for critical care nurses becomes too high, this can have consequences for both personal health as well as patient care. During the COVID-19 pandemic, critical care nurses were confronted with new and dynamic changes.

Objective: The aim of this study was to describe the experiences of critical care nurses regarding the ad hoc measures taken and the perceived physical and psychological burden experienced during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: This was a cross-sectional study conducted at two hospitals using an online survey. The open questions addressing the challenges faced during the COVID-19 pandemic were subjected to content analysis according to Mayring.

Results: A total of 179 critical care nurses participated in the online survey. From the results, the following four categories were developed: "not meeting one's own quality of care requirements," "uncertainties in everyday professional and private life," "increased responsibility with lack of relief," and "insufficient coping strategies for physical and psychological burden."

Conclusion: Critical care nurses require structures and processes which support them in situations of high workload. The focus should be on the self-imposed requirements of quality of care as well as potentially relieving measures.

This review examines the issue of overtreatment and overdiagnosis in the context of intensive care and emergency medicine and its relationship to sustainability. It shows that the intensive use of resources, both human and technology, is often associated with risks of overuse, especially in critical medical situations. More diagnostic and therapeutic measures are often taken than necessary, leading to both stress for the patient and a high consumption of resources. One of the main problems is the often difficult distinction between necessary and excessive treatment. Uncertainty in acute care, coupled with legal concerns, often leads to defensive medicine. This means that, for safety reasons, physicians initiate more diagnostic tests and treatments than are clinically necessary. There are also economic disincentives in the healthcare system that encourage overtreatment. The paper also discusses the role of guidelines, particularly with respect to patient preferences. These can help to avoid unnecessary admissions to the intensive care unit and thus contribute to sustainability. The discussion shows that sustainability should not be at odds with high-quality patient care. Rather, treatment options should also be considered in terms of their contribution to sustainability, without neglecting the individual needs of patients.

Background and objectives: The timely determination and evaluation of laboratory parameters in patients with acute life- or organ-threatening diseases and disease states in the emergency room or intensive care units can be essential for diagnosis, initiation of therapy, and outcome. The aim of the position paper is to define the time requirements for the provision of laboratory results in emergency and intensive care medicine. Requirements for point-of-care testing (POCT) and the (central) laboratory can be derived from the urgency.

Methods: Expert groups from the DGKL (Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) developed a classification about the urgency for the determination of laboratory parameters as well as recommendations on the necessary organizational framework and quality assurance measures using national and international guidelines, review articles, and original papers.

Results: Three levels of urgency are defined, based on the turnaround time of the most common laboratory parameters: emergency 1, with a turnaround time of no more than 15 min; emergency 2, with a turnaround time of a maximum of 60 min; urgent case, with a turnaround time within 4 h. In addition, a recommendation is made when to provide the results for the main ward rounds in the intensive care unit and the emergency department.

Conclusions: The recommendations allow the organizational and technical regulations for each hospital to be aligned with the urgency of the provision of the test results to the medical team based on the medical requirements.

Background: Climate change with global warming, natural disasters, species extinction and soil erosion is doubly relevant for medicine: On the one hand, heat waves, floods and other natural disasters lead to new disease patterns to which healthcare systems must adapt. On the other hand, the global healthcare system itself contributes to these effects, as it is estimated that the CO₂ footprint of all healthcare facilities accounts for around 5% of global greenhouse gas emissions.

Objectives: National and international initiatives to promote sustainability concepts in intensive care and emergency medicine.

Materials and methods: Research on homepages of national and international (specialist) societies dealing with intensive and emergency care medicine and corresponding PubMed search (sustainability and climate change and emergency or intensive care medicine).

Results: Six of the 12 national specialist societies surveyed have taken initiatives on sustainability, notable among them the initiative of Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) for a new registration of the S1 guideline "Sustainability in intensive care and emergency medicine". On the international scene, the activities of the Australian and New Zealand Intensive Care Society (ANZICS) with numerous publications on the topic of sustainability in intensive care medicine and the practical guide "A beginners guide to sustainability in intensive care medicine" as well as the European Society of Anaesthesiology and Intensive Care (ESAIC) with a consensus paper on sustainability should be highlighted.

Conclusions: At the national level, initiatives on sustainability (guidelines, working groups, forums) are emerging and are attracting increasing attention and activity. The umbrella organization of German Intensive Care Medicine, the Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), has so far shown no (discernible) activity; there is an urgent need for action here, and health policy and the German Medical Association should also become (even) more involved in reducing the CO₂ footprint in the healthcare sector. Internationally, there are a number of societies and institutions that are promoting the topic of "sustainability", although a stronger focus on the area of intensive care and emergency medicine would also be desirable here.

Tropical diseases are becoming increasingly important in medical care in Germany due to climate change and the spread of vectors and viruses. The widely distributed Culex mosquitoes in Germany can transmit the West Nile virus, which causes West Nile fever. Severe neuroinvasive disease courses with acute flaccid paralysis, meningitis, and encephalitis are possible. The invasive tiger mosquito (Aedes albopictus) is increasingly establishing itself in Germany and is a potent vector of viruses that have so far occurred mainly in tropical-subtropical areas, including dengue and chikungunya virus. Severe dengue cases can manifest with hemorrhagic dengue fever, shock, or organ involvement. Dengue fever is currently still a travel-related disease in Germany. However, this may change in the context of climate change and increasing vector populations. Enhanced training and continuing education programs, as well as an expansion of diagnostic infrastructure and networking of health authorities and mosquito control, are crucial for optimal patient care.

Background: Man-made climate change is one of the greatest challenges of the future. The course is being set in the current generation. As the healthcare sector contributes a considerable proportion of greenhouse gas emissions, measures to counteract this must be introduced as a matter of urgency. A guideline is therefore necessary as an initial recommendation for action in the intensive care and emergency medicine sector.

Methods: As part of the guideline program of the Association of the Scientific Medical Societies in Germany (AWMF e. V.), an S1 guideline was developed with the participation of 12 professional societies and initiatives, and published in October 2024. The guideline group defined relevant key topics and carried out a systematic search of the literature; due to the S1 classification, no separate evidence review was carried out. The classification of the recommendations took place in a formal consensus-building process.

Results: The guideline contains 73 recommendations for the implementation of sustainable approaches in intensive care and emergency medicine. These are recommendations that concern both the interprofessional team in the departments and the organizational structure of the hospital.

Conclusion: The guideline shows that there are already relevant and concrete possibilities for more sustainable work in intensive care and emergency medicine. However, there is a need for further research (e.g., detailed analyses, such as life cycle assessment) on how exactly to reduce the environmental impact of medical facilities, while maintaining high-quality patient care.