Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie最新文献

In addition to antibiotic stewardship, infection prevention and control (IPC) measures at the hospital are crucial for containing antimicrobial resistance (AMR). Nosocomial infections can be prevented through the consistent application of recommended IPC measures. This reduces the use of antibiotics and therefore the development of AMR. In this way, antibiotic stewardship and IPC go hand in hand.

Breast cancer ranges among the most commonly diagnosed oncological diseases worldwide. Strategies of timely detection and advanced multimodal therapies have significantly improved 10-year survival rates. Hence, breast cancer survivors regularly present for non-cancer related procedures. This challenges the historical practice of complete avoidance of ipsilateral venous catheter placement or blood pressure measurements. While this dogma has evolved from the belief these interventions might increase the risk of breast-cancer related lymphedema, a growing body of evidence has now proven otherwise. Ipsilateral venipunctures and catheters are not associated with increased complications of transitional limb swelling or persistent edema and ipsilateral procedures are therefore not contraindicated. Education of patients and providers are necessary to clarify on this long-standing myth.

The increasing prevalence of multidrug-resistant organisms (MDRO) poses a major threat to healthcare systems. Critically ill patients are at heightened risk to acquire MDRO infections resulting in longer hospital stays and higher mortality rates. This article provides an overview of preventive measures, divided into Infection Prevention and Control (IPC) and Antimicrobial Stewardship (AMS) approaches. IPC measures focus on the prevention of MDRO spread by applying basic and extended hygiene strategies. While basic hygiene such as hand and surface disinfection are effective in stopping any pathogen transmission, extended hygiene strategies including screening approaches, patient isolation and contact precautions are essential to identify MDRO patients and separate them from other susceptible patients. On the one hand, AMS aims at reducing the development of resistances under selective pressure by rational use of antimicrobials. On the other hand, interdisciplinary AMS-teams provide recommendations to optimize targeted MDRO therapy, including the rational use of "new" antibiotics. By pursuing different starting points, both IPC- and AMS-strategies are necessary in the prevention of MDRO development and transmission.

Antibiotic stewardship (ABS) in intensive care units is confronted with challenges that go beyond a rational assessment of the use of anti-infective substances. Regular analyses of anti-infective prescribing are an essential element of ABS and help to identify areas of ABS activity. Even after 10 years of continuous ABS supervision of an intensive care unit, the need for personnel and time remains high. However, the introduction of an electronically managed patient file makes it significantly easier to prepare and perform ward rounds with focus on ABS. The interdisciplinary discussion at the patient's bedside facilitates the recognition of both intensive care as well as infectious and pharmaceutical aspects of anti-infective therapy evolving in a therapeutic consensus. This requires in-depth clinical experience for all ABS team members. Clinically experienced ward pharmacists can improve communication within the treatment team by being available as an on-site contact person for compatibilities, therapeutic drug monitoring, etc. during a pharmaceutical ward round.

Airway management is a core competency in anesthesiology that has significantly evolved in recent years, primarily due to technological innovations. The 2023 update of the S1 guideline on airway management, published by the German Society for Anesthesiology and Intensive Care Medicine (DGAI), offers evidence-based insights into these advancements and provides clear recommendations for clinical practice. More than a theoretical update, the guideline serves as a practical resource for bedside care, addressing a broad spectrum of innovations and clarifications while leaving few questions unanswered. This review article summarizes the key updates and their practical implementation.

After severe trauma, but also perioperatively, massive bleeding is associated with increased morbidity and mortality. In severely injured patients, hemorrhagic shock remains to be the main cause of death in addition to traumatic brain hemorrhage. In non-cardiac surgery, a surgical bleeding complication increases perioperative morbidity (intensive care length of stay, acute renal failure, infections, thromboembolic complications) by a factor of three to four and mortality by a factor of six. In cardiac surgery, postoperative bleeding requiring surgical revision is associated with a 50% increase in mortality. One possible therapeutic approach is the transfusion of erythrocytes to plasma in a fixed ratio. This practice of untargeted coagulation therapy is mainly used in the USA and some Scandinavian countries. Mortality is significantly worse in the USA than in central Europe, particularly in the case of severe injuries. There is increasing evidence that targeted coagulation therapy with coagulation factor concentrates based on the results of point-of-care coagulation diagnostics is more effective and associated with fewer transfusion- and bleeding-related complications.

The aim of red blood cell (RBC) transfusion is to prevent or treat anemic tissue hypoxia in acute or chronic anemia. In 2022, approximately 3.2 million red blood cell transfusions were conducted in Germany. Most blood products are transfused in surgical medicine. RBC units should be used appropriately, based on recent evidence about their indications, profound knowledge on handling, correct documentation as well as possible associated risks of transfusion-associated adverse events and their respective treatments. Blood loss in particular increases the risk of an imbalance between oxygen supply and oxygen demand. Targeted, rational (restrictive) blood transfusion based on physiological transfusion triggers makes it possible to avoid organ injury due to anemic hypoxia.

For two years now, anaesthesia technical assistance has been a state-recognized profession in Germany and entitles graduates to work in all fields of anaesthesiology, with the exception of the intensive care unit. The job profile is comparable to the nurse anesthetist in Great Britain (Operation Department Practitioner) or in the Netherlands (Anesthesiemedewerker). In an initial empirical research project in 2023, the professional field was described and the question of whether graduates are adequately prepared for the fields of anaesthesiology was discussed with the focus particularly on the recovery room. The normative requirements of the theoretical and practical training prepare the trainees well for all fields of the profession. However, the study showed that training should be improved by including practical work in the intensive care unit during schooling. The existing training and examination regulations currently only offer a small amount of scope for an assignment in the intensive care unit. Therefore, the training and in particular the practical assignments should be evaluated and modified in the future.