Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

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.

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.

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.

Background: Studies indicate that patients with delirium require more nursing care. However, the extent of this additional nursing workload is unclear. Bundles of measures for delirium prevention and treatment measures to prevent and treat delirium cause a substantial and particularly high nursing workload.

Research question: What is the nursing workload involved in caring for patients with delirium compared to patients without delirium, and to what extent does it differ?

Method: A systematic literature search was conducted in the PubMed, CINAHL, and Cochrane Library databases. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS).

Results: Eight studies conducted in hospitals over the past 15 years were included. The mean quality of the studies was 6.1 out of a possible 9 NOS points (standard deviation 0.8). The nursing workload for patients with delirium is consistently higher when indices are applied and when workload recording tools are used. Patients with delirium require more frequently nursing interventions with two nurses and more time for observation, monitoring, and nursing care because of falls.

Conclusion: Patients with delirium require more nursing care than patients without delirium, regardless of the hospital setting. The delirium screening and (nursing) workload recording tools used in the eight studies showed a wide variation and, thus, limit standardized quantitative statements on nursing workload. The higher nursing workload of patients with delirium should be considered prospectively in nursing staff planning. In addition to the increased nursing workload, increased workloads for other health professional groups can also be assumed.

Background: CAR-T cell (chimeric antigen receptor T) therapy is now part of standard of care treatment of B‑cell lineage malignancies. Although it is an effective treatment, it comes along with adverse side effects and toxicities that may require intensive care therapy. The costs related to critical care therapy in critically ill patients after CAR‑T administration have not been evaluated.

Patients and methods: Retrospective analysis of all patients who had received CAR‑T therapy and were admitted to the intensive care unit (ICU) of a tertiary care university medical centre in Germany between 1 January 2019 and 31 December 2022. Cause of admission and ICU therapy as well as treatment and total hospitals costs were evaluated.

Results: Thirty patients with a history of CAR-T cell therapy for underlying haematological malignancy were included. The median age of all patients was 60 years (interquartile range [IQR] 50-70) and 37% (n = 11) were female. 93% (n = 28) of patients had non-Hodgkin lymphoma and 7% (n = 2) had multiple myeloma. The cohort was stratified whether the ICU admission was CAR‑T therapy related (i.e. within 30 days after CAR‑T therapy; 73%, n = 22) or the admission was of an other cause (> 30 days after CAR‑T therapy) (27%, n = 8). The median duration from CAR‑T therapy to ICU admission was 6 (range 5-8) days in CAR-T cell therapy associated ICU admissions compared with 52 (range 31-126) days in other admissions. The overall illness severity on admission was numerically higher in CAR-T-related ICU admission compared to other admissions (46 vs. 43 points, p = 0.18). Vasopressor therapy (50% vs. 75%; p = 0.19), invasive mechanical ventilation (27% vs. 50%; p = 0.24) and renal replacement therapy (14% vs. 50%; p < 0.05) were used in CAR-T-associated admission compared to other admissions, respectively. The ICU mortality (23% vs. 50%; p = 0.15) was higher in patients with other ICU admission. Median total costs of the entire inpatient stay in hospital were € 27,845 (range 8661-368,286 €) in CAR-T-associated ICU admissions compared to € 59,234 (range 23,182-127,044 €) in the group of other ICU admissions (costs of the CAR‑T product not included).

Conclusion: In relation to the total costs of CAR-T-cell therapy (production of the CAR‑T product), therapy-associated complications have a relatively low impact on the costs and utilization of ICU resources.

In addition to intensive care medicine, focused transesophageal echocardiography (fTEE) is increasingly being used in emergency departments. fTEE should only be performed as part of advanced cardiopulmonary resuscitation or in cases of unclear shock if a particular issue cannot be clarified using focused transthoracic echocardiography (cardiac point-of-care ultrasound [cPOCUS]). The conditions, indications and performance of fTEE are summarized in this consensus paper in terms of quality management in echocardiography in clinical acute and emergency medicine.