Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

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.

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: 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.