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Background: Fast-track concepts have fundamentally changed the perioperative care of patients in the last 30 years. Sufficient evidence is available for these concepts. Objective: The aim of this article is to evaluate the dissemination of fast-track concepts in Germany based on routine data. Material and methods: A retrospective analysis of all colorectal resections performed at the Helios Clinics in 2016–2021 was carried out. These were analyzed with respect to the length of hospital stay, intensive care unit occupancy, ventilation proportion, mortality, complication rate and access approach. Results and discussion: A transfer to the intensive medical care unit is still the standard in Germany after colorectal resection. For oncological colorectal resection, in particular, two thirds of the patients are still perioperatively treated on the intensive care unit. The duration of inpatient hospital stay for colorectal resection is still excessively long in international comparisons and has also only diminished slowly in recent years (e.g. colon cancer 2016: 18.6 ± 11.9 days and 2021: 13.8 ± 9.3 days). The proportion of open surgical interventions is declining but still accounts for a relevant proportion even 30 years after the implementation of laparoscopy (e.g. colon cancer 2016: 71.10% and 2021: 56.44%). Therefore, the care of patients with colorectal resection still does not seem to be implemented according to the fast-track principle [ABSTRACT FROM AUTHOR]

Due to the comprehensive establishment of modern techniques, tracheostomy has become a routine procedure in intensive care units (ICU). The negative effects of prolonged translaryngeal intubation on the laryngeal and tracheal mucosa up to tracheal stenosis can be reduced by tracheostomy. Furthermore, long-term ventilation is facilitated; however, there is no clear evidence on the optimal timing of tracheostomy in critically ill patients. The specific indications and contraindications of surgical as well as percutaneous tracheostomy must be strictly observed for a safe and successful intervention. Exchanging the tracheostomy tube may lead to potentially dangerous situations especially after percutaneous tracheostomy. A standardized and structured approach is therefore recommended. [ABSTRACT FROM AUTHOR]

The attitude of humility in the context of surgical intensive care medicine incorporates a serving attitude towards the patient and the recognition of limitations in intensive care medicine. Limitations are set in the indications for intensive care medicine, in that which is medically possible and reasonable as well as ethically by the will of the patient which is binding for physicians. Furthermore, there are limitations due to available resources, due to the personal knowledge and abilities of the physician and the intensive care treatment team and due to the equipment in the intensive care ward. It is absolutely necessary to recognize and avoid futile care because this involves the use of resources which will be lost for the care of other patients who would profit from intensive care. The formal difficulties in the definition and determination of futile care are discussed. [ABSTRACT FROM AUTHOR]

The dominant role for the emergence and establishment of intensive care medicine can be attributed to surgery. The first critical care units were developed in surgical university hospitals. Numerous scientific findings and interventional procedures have been contributed to intensive care medicine by surgeons and surgical disease symptoms shaped the character of the intensive care units. Currently 40% of the intensive care beds in Germany are assigned to surgical disciplines and surgery is the prerequisite for this operative intensive care. Nevertheless, both the human and ideational impact of surgery on intensive care medicine has decreased in recent decades. Through the formation of large interdisciplinary intensive care units, surgery continues to be threatened with losing its influence even further. Now and in the future, the role of surgery has to be the maintenance and enhancement of surgical specialized intensive care medicine. Surgery has to make surgical intensive care medicine interesting and attractive for physicians again. [ABSTRACT FROM AUTHOR]

Hemorrhage is frequently seen during the early phases of polytrauma management and intensive care treatment of the severely injured. Traumatic coagulopathy as well as the sometimes overlooked hyperfibrinolysis may lead to further complications. Therefore, transfusion of blood products and coagulation factors is often crucial. Jehova's Witnesses reject transfusions of blood and blood products due to religious convictions. In this case report a therapeutic approach of a multiple trauma patient suffering from traumatic brain injury, blunt chest trauma and liver laceration is described, who has been treated without blood products. As one main focus, ethical as well as legal aspects are discussed. Beside therapeutic concepts, such as the administration of coagulation factors, recombinant erythropoietin and iron, ethical and legal aspects remain part of the controversial discussion. [ABSTRACT FROM AUTHOR]

Percutaneous tracheostomy has become an established procedure in airway management of critically ill patients. It offers advantages over prolonged tracheal intubation and conventional tracheotomy. Nowadays six different techniques are available in Germany, all of which are based on Seldinger's technique. Even though these techniques are technically simple and the complication rates low, specific indications for the conventional surgical technique remain. It must be noted further that despite its minimally invasive nature percutaneous tracheostomy is still a surgical manipulation on the airway of a critically ill patient. Immediate recognition and adequate treatment of any complications are of primary importance. To reduce airway complications bronchoscopic surveillance is absolutely necessary. [ABSTRACT FROM AUTHOR]

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