Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

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.

Following initially successful resuscitation and the achievement of a spontaneous rhythm, patients are mostly comatose and are transferred to the intensive care unit. The brain is particularly vulnerable for injuries under global ischemia or hypoxia and therefore severe brain damage without damage to other organs is a frequent occurrence. This is referred to as hypoxic-ischemic encephalopathy (HIE) and preferentially affects neurons in the cerebral cortex, the basal ganglia and the cerebellum. The brain stem is less vulnerable. The unresponsive wakefulness syndrome (UWS), previously known as apallic syndrome or vegetative state, is a frequent form of HIE and can persist for years in a ventilation nursing home. In many patients multimodal neurological prognostication enables a reliable prediction on whether a relevant recovery of cerebral function is likely or impossible, even during the stay in the intensive care unit. These include the clinical neurological examination after a sufficiently long observational time of mostly at least 72h, cerebral imaging, i.e., cranial computed tomography (cCT), if necessary cranial magnetic resonance imaging (cMRI), electrophysiological examinations (electroencephalography, EEG), median nerve somatosensory evoked potentials (SSEP) and determination of blood biomarkers (neuron-specific enolase, NSE, neurofilament light chains, NFL). Findings that make a severe HIE very likely are a bilateral lack of pupillary light reflex 72h after resuscitation, bilateral absence of cortical median nerve SSEP, highly malignant EEG pattern, NSE levels > 90 ng/ml and a lack of gray-white differentiation of the cerebrum in cCT. A normal NSE or NFL level 48-96h after resuscitation, an early continuous EEG with responses to external stimuli, high amplitudes of the median nerve SSEP and a normal cMRI make a severe HIE improbable. If the short-term clinical course and the prognostic investigations do not provide a clear determination of the extent of the HIE, a time-limited trial of a neurological early rehabilitation can clarify the question whether regaining consciousness with relevant cognitive functions occurs or not.

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.

Critically ill patients are at high risk of adverse drug-drug interactions. Pharmacodynamic drug-drug interaction may cause organ damage. Pharmacokinetic interactions are usually caused by inhibition or induction of enzymes of drug metabolism such as cytochrome P-450 isoenzymes or transporter proteins such as P‑glycoprotein. Inhibitors of such molecules can cause toxic levels of the corresponding substrates, while inducers might produce subtherapeutic concentrations. Amiodarone, macrolides, antifungal azoles, direct-acting anticoagulants, vitamin K antagonists, immunosuppressants, rifampicin, and some central nervous system (CNS)-active substances are frequently involved in drug-drug interactions. Sound risk and benefit assessment of the applied medication, therapeutic drug monitoring, the use of electronic alert systems and databases along with clinical evaluation will contribute to avoiding adverse drug-drug interactions.

Background: Sustainability in emergency medicine constitutes a nascent area of inquiry that has thus far attracted limited scholarly attention; however, it is experiencing burgeoning interest. To date, there are no empirical studies examining how emergency medical personnel evaluate the concept of sustainability or what specific aspects and propositions they may have regarding the topic.

Objectives: The primary objective of this study was to investigate the perspectives of emergency medical employees concerning the concept of sustainability in prehospital emergency medicine.

Materials and methods: An online survey comprising 23 questions was administered. Participation was voluntary and conducted anonymously.

Results: A total of 462 participants participated in the survey, predominantly consisting of paramedics (74% male, 26% female), aged between 25 and 44. Approximately 70% of respondents expressed that they had contemplated the potential for enhancing sustainability within emergency medicine. Participants deemed the separation of packaging as a practical measure, particularly concerning syringes, cannulas and infusion systems. The estimated incidence of contamination for these materials is less than 50%. Nevertheless, factors such as insufficient time, space or motivation are cited as barriers to effective waste separation. Packaging, especially for patient blankets, cervical collars and infection protection gowns, is identified as potentially superfluous. Participants indicated that the majority of waste is attributed to plastic packaging and disposable gloves.

Conclusion: The findings of this study indicate that emergency medicine employees are aware of sustainability issues. Participants identified pragmatic avenues for waste separation and reduction in prehospital patient care, while also acknowledging potential challenges. Further research is needed to elucidate sustainability opportunities within prehospital emergency medicine.

Intensive care medicine symbolizes a form of medicine that seeks to prevent or overcome illness and life-threatening situations in order to enable a life that is acceptable to the patient. Despite the curative goal, dying and death are unavoidable. For ethically founded intensive care medicine, treatment goals must be agreed upon. The use of all resources is justified by their alignment with these goals and their desire for the patient. The indication and patient consent must be continually reviewed. If the goals are no longer achievable or desired by the patient, dying must be permitted. Then the steps for withholding treatment and palliative care must be organized, and end-of-life-care must be facilitated by relatives and the team. These decisions require not only professional but also communicative competence. Advance directives and ethics advice can be helpful. A case study illustrates this.

Background: The persistently low number of postmortem organ donations in Germany has repeatedly led to political discussions and most recently to the amendment of the Transplantation Act with the strengthening of the role of the transplantation officer and the introduction of a register to document the will to donate. The background to these decisions was the assumption that a relevant proportion of potential organ donors in hospitals were being overlooked and not reported. However, due to the lack of guidelines as to when a potential organ donor must be reported to the DSO ("Deutsche Stiftung Organspende"), the existing data is only of limited validity.

Objectives: The transplantation officers of the university hospitals in North Rhine-Westphalia (NRW) therefore agreed on the HEW score (brain function loss-suitability-will) presented here as a shared standard for reporting potential organ donors.

Materials and methods: Assigning the scores from 1 to 3 to each of the three included attributes results in a score of 111 to 333, and reporting to the DSO is recommended if the threshold value of 213 is exceeded. For implementation, the HEW scores of the cases determined by TransplantCheck from the university hospitals in Bonn, Essen and Düsseldorf from 2022 were collected retrospectively and presented in this paper.

Results: Overall, the number of cases to be reported according to the HEW score was 13.5% below the number of cases actually reported at all three sites (126 vs. 109). In all three centres, the refusal rate was high at 54.5-64.9%.

Conclusion: The HEW score represents a tool for the detailed recording and standardised reporting of potential organ donors and can enable homogenised reporting behaviour as a data basis for future improvement approaches.

Over 1391 patients presented to the emergency department (ED) of a German university hospital with primary diagnosis of syncope from 2019-2022. This monocentric, retrospective study aims to characterize this cohort regarding secondary diagnoses and blood laboratory parameters. Principal focus lay on the differentiation between inpatients (n = 190; 13.7%) and outpatients (n = 1201; 86.3%). Most common secondary diagnoses comprised head injury (n = 188; 13.5%), infection (n = 126; 9.1%), body injury (n = 124; 8.9%), neurological disease (n = 85; 6.1%), arrhythmogenic heart failure (n = 76; 5.5%), cardiovascular risk factors (n = 75; 5.4%), metabolic/nephrological disease (n = 69; 5.0%), and structural heart disease (n = 68; 4.9%). Surgical interventions were performed using catheter (n = 16; 1.2%), percutaneous coronary interventions (n = 15; 1.1%), and pacemaker/defibrillator/event recorders (n = 12; 0.9%). Inpatients had significantly more secondary diagnoses (3.5 vs. 0.3) and higher incidences of abnormal laboratory parameters compared to outpatients. Secondary diagnoses more common in inpatients included cardiovascular risk factors (37.9 vs. 0.2%), arrhythmogenic heart failure (35.3 vs. 0.7%), infection (57.9 vs. 1.3%), and lung disease (6.3 vs. 0.2%). Abnormal blood laboratory values more frequent in inpatients included elevated levels of highly sensitive (hs) troponin T (58.8 vs. 25.7%), creatinine (36.2 vs. 14.8%), leukocytes (43.4 vs. 36.3%), besides decreased hemoglobin (33.3 vs. 16.0%), potassium (5.3 vs. 1.2%), and sodium (2.1 vs. 0.6%).