Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

Purpose: This study aimed to translate the ICU Mobility Scale (IMS) into German, creating a cross-culturally adapted version for use in Germany.

Material and methods: Researchers from Charité - Universitätsmedizin Berlin and University Medical Center Hamburg-Eppendorf (UKE) translated the scale independently, resulting in two preliminary versions of the IMS. The UKE group incorporated a clinical perspective from a German nurse and used a forward-backward translation approach. The Charité group included a physician and a medical student for forward translation, followed by a cognitive debriefing with medical staff and backward translation. To merge the two German versions of the IMS, a translator from Charité compared the versions and determined which was more comprehensible. The updated IMS was then sent to the UKE, where researchers revised and commented on the updated version. Researchers from both institutions discussed the updated version, resulting in a final German IMS.

Results: The translation and back-translation process at UKE identified minimal deviations from the original wording, advancing the preliminary German translation to the expert review stage without additional loops. The expert review committee confirmed cultural equivalence, eliminating the need for further changes. At Charité, 30 medical professionals (including nurses, medical students, physiotherapists, and physicians) approved the structure and translation of 11 items with minor changes during cognitive debriefing. Only slight differences were identified and merged during the final integration of both versions. A final version was created by incorporating phonetically advantageous elements.

Conclusion: The final version of the German IMS aligns with the cultural and linguistic characteristics of the German healthcare context. It is essential to note that validation is still necessary.

Background: Intensive care units (ICU) are primarily focused on maximum therapy and life extension. Changes of goals-of-care in favor of quality of life and a dignified dying process remain a particular challenge.

Objectives: To analyze the implementation of changes of goal-of-care in a cardiology ICU.

Methods: Retrospectively assessed were medical records from 40 randomly selected patients who died between July 2019 and August 2021 in the cardiology ICU at University Hospital Cologne. Descriptive statistics were performed using SPSS (IBM, Armonk, NY, USA) software.

Results: The median age of the patients was 70.5 years; 75% were male and average length of stay was 4 days (median). Cause of death was mostly due to cardiac or pulmonary causes (30/40 medical records). Changes of goal-of-care were documented for 65% of patients; this group was generally older and had a longer stay. Changes of goal-of-care mostly occurred within the last 24 h of life (81%). Decisions were mostly made together with relatives, as patients were often no longer able to communicate (85%). Avoidance of escalation of measures was more common than de-escalation.

Conclusion: We identified two groups of patients with different challenges regarding changes of goal-of-care: (1) Patients with sudden death within 72 h, for whom changes of goal-of-care is rarely possible, making resilience in dealing with dying patients and communication with relatives crucial for the treating personnel. (2) Patients with longer stays, where changes of goal-of-care are more frequently implemented. For this group, continuous re-evaluation of goal-of-care and, in this context, medical indications and patient wishes are particularly important.

Background: With an incidence of 64.9/100,000 inhabitants in Germany, out-of-hospital cardiac arrest is a frequent reason for emergency medical services (EMS) deployment. Advanced airway management is a key part of advanced life support (ALS), enabling adequate ventilation and continuous chest compressions. Video laryngoscopy (VL), which is increasingly being used, is expected to lead to better success rates and shorter interruptions in chest compressions during airway management. Thus, this article focuses on type of airway management and the devices used and how they relate to the likelihood of achieving return of spontaneous circulation (ROSC) and the resulting survival and neurological outcome.

Methods: Between January 2020 and June 2024, EMS personnel and emergency physicians received questionnaires on airway management of out-of-hospital resuscitations in which they were involved. The data were supplemented by emergency protocols and defibrillator recordings. The analysis was conducted descriptively and statistically at a significance level of α ≤ 0.05.

Results: A total of 301 questionnaires were assessed: 35% of patients who received endotracheal intubation (ETI) achieved ROSC compared with 21.1% with the use of a supraglottic airway device (SGA; p = 0.09). With the McGrath VL, the ROSC rate was 43.6%, compared to 33.3% with the C‑MAC (p = 0.24). Following 1-2 intubation attempts, ROSC was achieved in 33.8% of cases, and in 28.6% of cases after more than two attempts. The survival rate was 9.1% after ETI and 2.6% after SGA (p = 0.17). With VL, 10.9% of patients survived, 64.7% with a good neurological outcome (cerebral performance category [CPC] 1-2). With direct laryngoscopy, 6.1% survived, 57.1% with CPC 1-2 (p = 0.19/p = 0.73).

Conclusion: The results show a potential advantage of video laryngoscopy for endotracheal intubation, whereby > 2 intubation attempts are associated with poorer outcomes. Significant effects on ROSC, survival or an improved neurological outcome were not observed. Larger studies are necessary to verify the results. Increased use of video laryngoscopy could be beneficial regardless of the user.

Patients with chronic kidney disease who undergo kidney transplantation are at risk of acute illness, acute graft failure, and intensive care admission in the years following transplantation. To identify individual risk factors, assess the effect of immunosuppression, and evaluate outcomes including loss of graft function in a European setting, we analyzed 266 intensive care unit (ICU) admissions of kidney transplant recipients (KTRs) with severe illness between 2005 and 2019. Admission to the ICU occurred predominantly 12 months or later after transplantation, with a median time of 52.7 months. Overall mortality was 12.8% and was associated with infections in 70.6% of cases. Acute immunosuppressive therapy for rejection, rather than primary induction or immunosuppressive regimens, correlated with critical illness in 53% of cases. The median time to ICU admission was 1.2 years. Of the survivors, 12.1% lost graft function and remained on dialysis at discharge. In univariate and multivariate analyses, we found that SAPS (Simplified Acute Physiology Score) II values and vasopressor use were significantly associated with mortality. Overall, KTRs are at risk of critical illness, especially beyond 1 year post-transplant. Rejection therapy and older age increase the risk of critical illness.