Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

The YoungDGIIN presents its position on the proposed German curriculum for a new Specialist in Emergency Medicine ("Facharzt für Notfallmedizin"). The statement supports the goal of further professionalizing clinical acute and emergency care but considers the current curriculum, in its present form, difficult to implement and in need of revision. Key concerns include the short clinical rotations, which do not realistically allow for the acquisition of the required competencies, and, from the perspective of the YoungDGIIN, the insufficient emphasis on internal medicine despite its central role in emergency care. The YoungDGIIN also calls for a clear definition of responsibilities and boundaries between specialties and, together with the relevant professional societies, advocates a structured further development of clinical emergency medicine to support its continued professionalization.

Frustrating reanimations, ethical dilemmas, or violence occur from time to time in intensive care and emergency medicine and exceed what is "normal" even in the broader professional sense. Such events often trigger existential questions among healthcare professionals, can lead to a feeling of an unjust world, and can shake their hope or even their sense of meaning. Healthcare professionals need the freedom and safety to address these thoughts and feelings. One approach to supporting those affected in coping is peer support, a system that has already worked well in the USA and counteracts the rising absenteeism and fluctuation rates among healthcare professionals.

A high percentage of patient's relatives who require intensive care suffer from psychological stress symptoms after a stay in intensive care. The reasons for this include ward-specific, sociodemographic and relationship factors, as well as the helplessness experienced in the face of prognostic information about a life-threatening illness. From a medical ethics perspective, it is necessary to provide good information, but this also requires accompanying emotional support for the relatives. Hospital chaplaincy services should be consulted for this purpose. The work of hospital chaplains is often a black box for professionals in the healthcare system. This article therefore describes three exemplary situations to illustrate how hospital chaplains work and what their specific perspective is on the existential challenges faced by relatives in an intensive care unit. The article aims to promote the early involvement of hospital chaplains in supporting relatives of patients with life-threatening illnesses.

Background: Hospital disaster response planning (KAEP) is a core component of health security and civil protection. In the context of escalating security threats and climate-related extreme events, its practical implementation is gaining importance. Adequate medical care requires structurally and organizationally resilient healthcare facilities; however, the structural and infrastructural prerequisites in Germany have scarcely been examined systematically.

Objective: To analyze the current status of structural and infrastructural conditions that affect the effectiveness and feasibility of KAEP.

Methods: From January 24 to February 21, 2025, physician leaders of emergency departments (ED) at 1065 German hospitals were surveyed online using a standardized questionnaire. Analyses were descriptive and stratified by levels of care.

Results: Of 313 responses (response rate 29%), 246 questionnaires were eligible for analysis. Structural protective measures were absent in 50% of facilities, and access control to critical areas was lacking in 43%. Dedicated protected areas for contaminated patients existed in 29%. While 95% reported having plans to ensure continuity of critical infrastructures, essential service systems exhibited full redundancy in only 43%. Merely 18% of facilities participated in the Federal Government's medical supplies stockpiling program.

Conclusion: Findings indicate a substantial gap between conceptual preparedness and the structural-infrastructural implementation of KAEP. To strengthen resilience, binding minimum standards, earmarked financing mechanisms, and regular training and exercises are needed to ensure hospitals remain functional under crisis and disaster conditions.

Postcardiac arrest syndrome is characterized by the following: 1) hypoxic-ischemic brain injury, 2) postresuscitation myocardial dysfunction, 3) systemic ischemia/reperfusion injury, and 4) the persistent precipitating pathology. Pathophysiologically, no flow during cardiac arrest leads to global ischemia of all tissues, which already initiates early inflammatory processes. Subsequently, reperfusion (during cardiopulmonary resuscitation and after return of spontaneous circulation) triggers a complex cascade of events, including systemic inflammation, endothelial activation and procoagulant processes and-in the presence of oxygen-the formation of tissue-damaging reactive oxygen species. Taken together this may cause microcirculatory disturbances and myocardial dysfunction leading to shock and hypoperfusion and ultimately to organ failure. Furthermore, disruption of the blood-brain barrier and cerebral autoregulation cause ongoing neuronal death. Ultimately, the exaggerated inflammation may lead to an immunoparalytic state, making survivors susceptible to severe (nosocomial) infections in the postresuscitation course.

The primary goal of intensive care medicine is to overcome a critical phase of illness using all available means and to enable patients to survive and return to an independent life without intensive care. However, this therapeutic goal cannot always be achieved. The possibility of death, the need to alleviate suffering, and respect for the end of life make it necessary to integrate palliative approaches into intensive care medicine. Supporting seriously ill and dying patients and their relatives in intensive care units requires an attitude that holistically recognizes and respects their individuality and is shared by the entire team. In addition to recognizing life and death, reliable structures, clear agreements, and palliative care skills among the respective professional groups are necessary. When implementing these approaches, it is important to remain within the framework of legal requirements and to take the wishes of those affected into account. In addition to the relevant professional expertise, the most important tool is respectful and clear communication with all those involved and affected. Help should be available at all times in cases of uncertainty regarding ethical and palliative issues, as well as in cases of psychological stress.

Objective: To evaluate whether early mobilisation can reduce the incidence of delirium in critically ill patients and to assess the methodological quality of published studies.

Methods: Three electronic databases, PubMed, Embase and the Cochrane Library, were searched for relevant studies published up to 2 March 2024. Articles were screened independently by two reviewers, based on inclusion and exclusion criteria, and a meta-analysis was performed using RevMan 5.3 software with a random-effects model.

Results: A total of 18 studies (intervention group: 1794 participants, control group: 2129 participants) were included in the systematic review, with 18 studies included in the meta-analysis. Early mobilisation was found to reduce the risk of delirium in critically ill populations, with a pooled odds ratio of 0.65 (95% confidence interval [CI] 0.49-0.86; P = 0.003; I² = 59%). Additionally, two studies found that early mobilisation did not change the duration of delirium in critically ill populations, with a pooled mean difference of -1.53 (95% CI -3.48 to 0.41; P = 0.12; I² = 37%). Subgroup analysis revealed that early mobilisation maintained its preventive effect on delirium in the before/after intervention studies, studies published before 2018 and studies with a moderate methodological rating.

Conclusion: As a nonpharmacological intervention, early mobilisation may help reduce the risk of delirium and shorten its duration in critically ill patients compared with standard treatment and may potentially become a novel strategy for delirium prevention in future intensive care unit settings.