Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

In cases of severe pneumonia, prone positioning therapy has been shown to have a positive effect in patients receiving invasive mechanical ventilation. In addition, during the COVID-19 pandemic, a positive effect was demonstrated in patients who did not yet require mechanical ventilation (endotracheal intubation) and who received prone positioning therapy before these measures were taken (awake prone positoning). Currently, the influence of awake prone positioning therapy in patients without COVID-19 has not been sufficiently investigated. This recommendation aims to explain the indications, side effects, contraindications, and implementation of awake prone positioning in conscious critically ill patients.

Background: In Germany, the alternative care of patients with ambulatory treatment needs has been discussed for years as a way to relieve emergency departments. This study provides insights into currently implemented models of patient streaming and integrated acute and emergency care.

Methods: Between July 2023 and July 2024 emergency department physicians were surveyed online. One section targeted management personnel and gathered information on care structures and case numbers. Based on this, the potential for relieving emergency departments was calculated. The analysis was descriptive.

Results: Of the 370 participants 28% (n = 105) held management positions in the emergency department and 50% (n = 45) of those with alternative structures reported collaborations with the Association of Statutory Health Insurance Physicians. Standardized patient streaming was implemented in 43% (n = 24), often based on triage. The median indicated relief potential was 21%.

Discussion: The findings reveal a heterogeneous care landscape with varying patient streaming approaches and relevant potential to relieve emergency departments. Due to the small number of cases and a convenience sample, the results should be interpreted as exploratory. Further research could support the evidence-based development of acute and emergency care.

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.

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.