Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

Background and objectives: Transfer of critically ill, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients to a tertiary care center in combination with mortality prediction using the Simplified Acute Physiology Score (SAPS II) score has not been investigated in detail so far, in Germany.

Materials and methods: A retrospective analysis of SARS-CoV-2 patients receiving intensive care unit (ICU) treatment at a tertiary care center between 1 March 2020 and 31 December 2021 was performed. Patients directly admitted through the emergency room (PA) and patients admitted later-on from hospitals with lower level of care (SA) were compared.

Results: In all, 165 SARS-CoV-2 patients with a SAPS II score received intensive care during the period described. SA patients were significantly younger (SA 62.2 years [IQR 51.9-72.4] vs. PA 70.8 years [IQR 58.3-79.9], p = 0.002), were ventilated longer (SA 16.5 days [IQR 7-31] vs. PA 7 days [IQR 4-11], p < 0.001) but had the same hospital mortality (SA 53.3% vs. PA 45.7%, p = 0.41). Predicted mortality through SAPS II score underestimated true mortality in both patient collectives (SA 15.2% [IQR 7.9-26.6] vs. PA 19.6% [IQR 9.2-34.7], p = 0.17).

Conclusion: The prognostic value of SAPS II is limited for patients suffering from SARS-CoV‑2. Interhospital transfer of critically ill patients seems reasonable since mortality is not different between patients primarily admitted to a tertiary center and patients admitted later-on during disease course.

The concurrent delivery of multiple infusion solutions (Y-site administration) through a single catheter lumen in intensive care patients is often unavoidable. This may lead to physicochemical incompatibilities, significantly affecting the efficacy and safety of drug therapy. The objective of this study is to develop and formulate an infusion regimen that considers the number of access points and avoids incompatibilities for adult intensive care patients. A comprehensive literature search was conducted following the ADKA-DIVI standard concentration list for continuous infusions. Manufacturer information and databases, such as STABILIS, Kingguide, and Trissel's TM 2 IV Compatibility, were used to evaluate compatibility. For frequently used combinations for which no compatibility data were available, stability data on physical compatibility were compiled. Based on this, considering 34 common active ingredients and their standard concentrations, a 4-lumen central venous catheter (CVC) infusion regimen was developed to help avoid incompatibilities in the adult intensive care unit.

Animal-assisted interventions (AAI) are increasingly recognized as nonpharmacological adjuncts to intensive care medicine. The aim of this paper by the German Society of Internal Intensive Care and Emergency Medicine (DGIIN) is to summarize the scientific rationale, safety considerations, and implementation recommendations for the use of AAI in intensive care units. Therapeutic effects are attributed to neuroendocrine mechanisms, particularly activation of the oxytocin system and reduction of cortisol levels, which can alleviate anxiety, pain perception, and psychological stress in critically ill patients. Early studies have reported significant reductions in anxiety without an associated increase in nosocomial infections. However, clinical implementation requires well-defined structural, hygienic, and ethical frameworks, including standardized risk analyses, binding hygiene and animal welfare standards, and multiprofessional collaboration integrating intensive care, nursing, infection control, and animal therapy. This paper presents the first systematic recommendations in Germany for the safe and quality-assured integration of animal-assisted interventions into intensive care practice and calls for scientifically accompanied implementation focusing on patient safety, animal welfare, and team well-being.

Dealing with dying and death is an integral part of working in an intensive care unit, yet time pressure and workload often leave little room for emotional processing. A shared moment of silence offers intensive care staff the opportunity to pause after a patient's death, to uphold dignity, and to foster team reflection. This article explores the origin and significance of the ritual, summarizes the current evidence, and provides practical recommendations for its implementation-including appropriate language, involvement of relatives, framework conditions, and evaluation. The moment of silence does not replace structural support measures (e.g., supervision or ethical consultations) but can serve as a meaningful complement to them.

The planned introduction of integrated emergency centres (INZ) represents a pivotal decision for the future of emergency care in Germany. The aim is cross-sectoral management of patients, integrating the hospital emergency department as the inpatient sector and the ambulatory on-call medical service. Previous recommendations by DIVI (German Interdisciplinary Association for Intensive and Emergency Medicine) and DGINA (German Society for Emergency Medicine) primarily addressed emergency departments without an integrated on-call practice. With these recommendations, DGIIN (German Society for Internal Medicine Intensive and Emergency Medicine) and DGINA present a concept for the structure, staffing, and quality assurance of INZ. The central element is the central point of assessment as the common point of entry. Using validated instruments, a standardized assessment of urgency is performed there, followed by allocation to the appropriate sector. This requires digital, interoperable documentation and management systems ensuring information flow to the emergency department, the on-call practice, and the 116117 and 112 dispatch centres. The on-call practice within the INZ must cover a broad general medical spectrum, including basic diagnostic equipment (echocardiography [ECG], ultrasound, point-of-care testing [POCT] laboratory), and must be staffed with physicians with clinical experience as well as clearly defined qualification profiles for nursing and administrative staff. For the emergency department within the INZ, the structural requirements of the German Federal Joint Committee (G-BA) apply. In addition, specific nursing qualifications (e.g. emergency nursing, triage) and INZ-adapted staff-to-patient ratios are required. Digital management tools, waiting time management, and central bed management are mandatory in INZ. In these recommendations, DGIIN and DGINA emphasize that INZ must be established as an independent model of care with binding structural and staffing standards in order to ensure safe and efficient emergency care also for resource-intensive "hybrid" cases at the interface between in- and outpatient care.

Background and objective: Violence against healthcare workers in emergency departments and intensive care units has increased significantly in recent years, posing a substantial threat to staff safety. In German emergency departments, 97% of staff report verbal violence and 76% report physical violence. The German Society for Medical Intensive Care and Emergency Medicine (DGIIN) presents the first comprehensive position paper on violence prevention and protective measures.

Methods: The position paper was developed by an interprofessional author group of the DGIIN based on current research data, international literature, and clinical practice experience. It analyzes forms, frequency, causes, and consequences of violence in the hospital setting and develops concrete recommendations for action.

Results: Violence manifests as verbal, physical, sexual, and racist assaults, with patient-related violence (type II) being most common. Main causes are intoxication (45%), long waiting times, staff shortages, and existential fears. Consequences include work disability to posttraumatic stress disorder (PTSD, 15.8%). The position paper defines eight action areas: standard operating procedures (SOPs), leadership responsibility, systematic incident reporting, mandatory training and de-escalation programs with emphasis on verbal and nonverbal communication techniques (active listening, body language), structured psychosocial support (acute care and peer support), staffing, security measures (services, structural modifications, alarm systems, video surveillance), legal protection.

Conclusion: Violence prevention and staff protection are essential to patient safety. Professional communication competencies are central de-escalation instruments. The DGIIN demands systematic implementation of all measures in hospitals and their integration into financing. A zero-tolerance culture toward violence, combined with preventive, intervening, and follow-up structures, secures workforce capacity and qualified personnel retention.

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.