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Background: Care in the intensive care unit (ICU) often introduces symptoms of post-traumatic stress disorder (post-ICU PTSD) in individuals with prior adverse experiences. General practitioners play an important role in follow-up care. Case report: A 58-year-old woman developed post-ICU PTSD symptoms after she experienced sepsis. She received brief narrative exposure therapy (NET) from her general practitioner and experienced significant improvement of symptoms. Conclusion: A brief version of NET might be appropriate for the treatment of patients with mild to moderate post-ICU PTSD symptoms. [ABSTRACT FROM AUTHOR]

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Background and objective: The Working Group on Ethics in Anesthesia and Intensive Care Medicine of the Austrian Society for Anesthesiology Resuscitation and Intensive Care Medicine (ÖGARI) already developed documentation tools for the adaption of therapeutic goals 10 years ago. Since then the practical implementation of Comfort Terminal Care in the daily routine in particular has raised numerous questions, which are discussed in this follow-up paper and answered in an evidence-based manner whenever possible. Results: The practical implementation of pain therapy and reduction of anxiety, stress and respiratory distress that are indicated in the context of Comfort Terminal Care are described in more detail. The measures that are not (or no longer) indicated, such as oxygen administration and ventilation as well as the administration of fluids and nutrition, are also commented on. Furthermore, recommendations are given regarding monitoring, (laboratory) findings and drug treatment and the importance of nursing actions in the context of Comfort Terminal Care is mentioned. Finally, the support for the next of kin and the procedure in the time after death are presented. Discussion: A change in treatment goals with a timely switch to Comfort Terminal Care enables good and humane care for seriously ill patients and their relatives at the end of life and the appreciation of their previous life with the possibility of positive experiences until the end. [ABSTRACT FROM AUTHOR]

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Thrombotic microangiopathies (TMA) are rare diseases, which are defined by the triad microangiopathic hemolytic anemia, thrombocytopenia and organ damage, and are associated with high morbidity and mortality. The recognition of a TMA and the distinction of important differential diagnoses are key factors, particularly in a perioperative context and in routine clinical intensive care. The further differentiation of the different TMA subtypes, such as thrombotic thrombocytopenic purpura (TTP), Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) and atypical hemolytic uremic syndrome (aHUS), based on the underlying pathophysiology and the development of new targeted treatment options in recent years have significantly improved the prognosis. A close interdisciplinary cooperation between critical care specialists and specialist disciplines experienced in the treatment of TMA, is essential for a prompt diagnosis and the initiation of the appropriate treatment. [ABSTRACT FROM AUTHOR]

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Background: Intensive care unit (ICU) acquired weakness is associated with reduced physical function, increased mortality and reduced quality of life, and affects about 43% of survivors of critical illness. Lacking therapeutic options, the prevention of known risk factors and implementation of early mobilization is essential. Robotic assistance devices are increasingly being studied in mobilization. Objective: This qualitative review synthesizes the evidence of early mobilization in the ICU and focuses on the advantages of robotic assistance devices. Results: Active mobilization should begin early during critical care. Interventions commencing 72 h after admission to the ICU are considered early. Mobilization interventions during critical care have been shown to be safe and reduce the time on mechanical ventilation in the ICU and the length of delirious episodes. Protocolized early mobilization interventions led to more active mobilization and increased functional independence and mobility at hospital discharge. In rehabilitation after stroke, robot-assisted training increases the chance of regaining independent walking ability, especially in more severely impaired patients, seems to be safe and increases muscle strength and quality of life in small trials. Conclusion: Early mobilization improves the outcome of the critically ill. Robotic devices support the gait training after stroke and are the subject of ongoing studies on early mobilization and verticalization in the intensive care setting. [ABSTRACT FROM AUTHOR]

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An effective patient handover is a core element of high-quality patient care. Communication during patient handover in the intensive care unit is particularly challenging due to the clinical complexity and rapid changes in patient trajectories, complex interdisciplinary and interprofessional interfaces, linguistic barriers, situational and structural disruptive factors, personnel stress factors as well as the communication and error culture of the teams. In addition to avoiding disruptive factors and creating optimal communication conditions and human resources, the use of standardized and structured handovers with the help of protocols and checklists, as recommended in the literature, plays a decisive role as part of a bundle of measures for effective and safe patient care., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Structured procedures have been established internationally for the initial clinical care of patients with traumatic injuries. Comparable concepts have not yet been applied to the initial clinical care of life-threatening nontraumatic emergencies. In 2022, a working group of the German Society for Acute and Emergency Medicine (DGINA) presented the Advanced Critical Illness Life Support (ACiLS) concept for the care of nontraumatic emergencies and offers corresponding training courses., Objective: To present systematic clinical first aid for patients with the leading symptom of shock according to the ACiLS concept., Result: The (PR_E-)AUD 2 IT basic algorithm used in the ACiLS concept divides the initial care of a critically ill patient into the elements of preparation, resources, initial care, medical history, examination, differential diagnosis, diagnostics, interpretation and to do, interrupted by three team time-out elements for structured communication. The use of this concept is demonstrated here using the example of shock., Conclusion: The ACiLS concept has the potential to improve the quality of initial care of nontraumatic emergencies in emergency department shock rooms and intensive care units. Further evaluations in practice and training capacities are essential., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The importance of music in intensive care medicine is still controversial and the mechanisms of music are unclear. It is important whether different music styles (classical music [CM], Heavy Metal [HM] show measurable effects on blood pressure (BP) or heart rate (HR) in humans or not. It is also unclear whether behavioral patterns are influenced by music (CM, HM) in animals., Methods: We studied the influence of CM (Bach, Orchestral Suite No. 3, BWV 1068) and HM (Band Disturbed: Indestructible) compared to a control group (CO) without music exposure in 120 healthy subjects (60 study subjects, 60 control subjects) and 36 young pigs (18 Pietrains, 18 Wiesenauer Minipigs) according to an identical study protocol (21 minutes of music exposure (CM, HM) or 21 minutes of no music (C0)., Results: We were able to clearly demonstrate in 36 pigs that CM led to significantly more activity behavior than HM or CO (p<0,01). HM caused significantly more stress behavior than CM or CO (p<0,01). In humans, there was a decrease in BP syst , BP diast or HR (beats per minute [bpm]) among CM: decrease BP syst -7,5±9,1 mm Hg, BP diast -4,9±7,5 mm Hg, HR -7,2±10,2 bpm. This was observed less frequently in HM: BP syst -3,6±7,1 mm Hg, BP diast -2,7±6,9 mm Hg, HR -5,9±9,0 bpm. The influence of BP and HR was significantly lower in CO compared to music: BP syst -2,3±7,2 mm Hg, BP diast -2,0±7,3 mm Hg, HR -5,8±12,3 bpm., Conclusions: BP and HR in humans and behavioral patterns in animals are clearly influenced by music. CM leads more frequently to activity behavior in animals and to lower BP and HR in humans compared to HM or CO. In both animal breeds, stress behavior was observed more frequently in HM compared to CM or CO. Therefore, music may play a role in intensive care medicine., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The treatment of acute life-threatening conditions in intensive care and emergency medicine requires in-depth training and education, with initial training playing a key role., Research Question: What is the structure and quality of the initial training of physicians and nurses in intensive care units and emergency departments in Germany?, Methods: With the help of survey software, an online questionnaire comprising 40 questions in German on the aforementioned topic was designed. It was distributed via the website of the German Society for Internal Intensive Care and Emergency Medicine (DGIIN) and via pertinent social media channels., Results: In total, 103 nurses and 125 physicians participated in the survey. The average work experience of the participating nurses and physicians was 8.5 ± 5.1 and 3.0 ± 3.1 years, respectively. The majority of participants worked primarily in intensive care units (59%) or in emergency departments (22%). On average, the initial training lasted 45 ± 27 and 13 ± 13 days for nurses and physicians, respectively. Only 20% of the initial training comprised seminars or hands-on workshops taught outside of routine clinical care. In all, 47% of the participants stated that they were not able to complete the entire initial training period. Only 49% had been officially certified for usage of the technical equipment in their department. A total of 35% reported feeling confident or somewhat confident in handling predictable tasks after initial training, but only 15% in handling acute emergencies., Discussion: The present study revealed that initial training in intensive care and emergency medicine is frequently incomplete, unstructured, as well as inadequate and bears both safety and liability risks. New concepts are needed to improve the initial training across clinics., (© 2024. The Author(s).)

Background: During the SARS-CoV‑2 pandemic, the TeleCOVID application was developed in Hessen to connect the intensive care units via telemedicine. After successful implementation, the application should be extended to other indication areas in intensive care medicine., Objectives: The purpose of this study was to evaluate other indications for which the application can be used and which technical requirements are associated with this., Materials and Methods: To answer these questions, guideline-based expert interviews were conducted, which were evaluated using a qualitative content analysis., Results: The survey showed that TeleCOVID can be extended to other indication areas in intensive care. Numerous technical requirements were formulated that should be specifically considered when the application is further developed., Conclusions: The telemedical networking of intensive care units generates added value for the actors involved. However, it is important that the data is collected in the best possible standardized and structured way. The communication process should be automated wherever possible to minimise the workload for the participating persons., (© 2024. The Author(s).)

The frequency of liver diseases in the intensive care unit has increased significantly in recent years and is now observed in up to 20% of critically ill patients. The occurrence of liver disease is associated with significantly increased morbidity and mortality. Two groups of liver diseases in the intensive care unit can be distinguished. First, the group of "primary hepatic dysfunctions", which includes primary acute liver failure as well as acute-on-chronic liver failure in patients with pre-existing liver cirrhosis. The second group of "secondary or acquired liver diseases" includes cholestatic liver diseases, as well as hypoxic liver injury and mixed forms, as well as other rarer liver diseases. Due to the diversity of liver diseases and the very different triggers, sufficient knowledge of the underlying changes (including hemodynamic changes, inflammatory states or drug-related) is essential. Early recognition, diagnosis, and treatment of the underlying disease are essential for all liver dysfunction in critically ill patients in the intensive care unit. This review article aims to take a closer look at liver diseases in the intensive care unit and provides insight into diagnostics and treatment options., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Liver diseases are a significant global cause of morbidity and mortality. Liver cirrhosis can result in severe complications such as bleeding, hepatic encephalopathy (HE), and infections. Implementing a clear strategy for intensive care unit (ICU) admission management improves patient outcomes. Hemodynamically significant esophageal/gastric variceal bleeding (E/GVB) and grade 4 HE, when accompanied by the need for renal replacement therapy (RRT), are definitive indications for ICU admission. E/GVB, spontaneous bacterial peritonitis (SBP), and infections with multidrug-resistant organisms (MDRO) require close and stringent critical assessment. Patients with severe hepatorenal syndrome (HRS) or respiratory failure have increased baseline mortality and most likely benefit from early ICU treatment. Rapid identification of sepsis in patients with liver cirrhosis is a crucial criterion for ICU admission. Prioritizing cases based on mortality risk and clinical urgency enables efficient resource utilization and optimizes patient management. In addition, "Liver Units" provide an intermediate care (IMC) level for patients with liver diseases who require close monitoring but do not need immediate intensive care., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The controversy surrounding ventilation in coronavirus disease 2019 (COVID-19) continues. Early in the pandemic it was postulated that the high intensive care unit (ICU) mortality may have been due to too early intubation. As the pandemic progressed recommendations changed and the use of noninvasive respiratory support (NIRS) increased; however, this did not result in a clear reduction in ICU mortality. Furthermore, large studies on optimal ventilation in COVID-19 are lacking. This review article summarizes the pathophysiological basis, the current state of the science and the impact of different treatment modalities on the outcome. Potential factors that could undermine the benefits of noninvasive respiratory support are discussed. The authors attempt to provide guidance in answering the difficult question of when is the right time to intubate? [ABSTRACT FROM AUTHOR]

The current S2k guidelines on treatment of thermal injuries in adults are summarized in this article from the perspective of anesthesiology, emergency medicine and intensive care medicine. The guidelines were prepared under the auspices of the German Society for Burn Medicine with the participation of other professional societies and interest groups and were published last year in revised form by the AWMF. [ABSTRACT FROM AUTHOR]

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In the case of septic shock, recent studies show benefits from a combination of hydrocortisone and fludrocortisone, but clear guideline recommendations are still lacking. For severe community-acquired pneumonia, early corticosteroid therapy is recommended. Corticosteroid therapy should not be used in influenza-associated community-acquired pneumonia. In contrast, a significantly lower 28-day mortality rate was observed for COVID-19 by the use of dexamethasone. Current guidelines also recommend the use of corticosteroids in Acute Respiratory Distress Syndrome. These recommendations are based primarily on studies that started steroid therapy early. However, many questions such as the type of corticosteroid, the timing and duration of therapy, and the dosage still remain unanswered., Competing Interests: Axel Nierhaus: Biotest AG, Fresenius Medical Care, CytoSorbents Stefan Kluge: Forschungsunterstützung: CytoSorbents, DaiichiSankyo. Vortragstätigkeit: ADVITOS, Biotest, Daiichi Sankyo, Fresenius Medical Care, Gilead, Mitsubishi Tanabe Pharma, MSD, Pfizer, Shionogi, Zoll. Beratertätigkeit: Fresenius, Gilead, MSD, Pfizer., (Thieme. All rights reserved.)

Good knowledge of echocardiography is essential for modern intensive care medicine. A standardized curriculum for acquiring the expertise to perform TTE and TEE is a good way to strengthen one's own diagnostic skills.The EDEC curriculum from ESICM, which has been established for years, offers a good opportunity for structural further training at the advanced level in combination with gaining a high level of professional competence., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: The frequency and intensity of heat waves are currently increasing due to climate change. Hence more cases of heat illness are being observed, a potentially life-threatening disease, which requires rapid and expert management., Objectives: An overview of the pathophysiology and acute management of heat illness is presented., Materials and Methods: Analysis and evaluation of important, recently published contributions, studies, and reviews regarding heat illness without claim for completeness or fulfilling the criteria for a 'systematic meta-analysis'. Presentation of a recommended clinical-practical classification and management of heat illness in emergency departments or intensive care units., Results: The manifestation of heat illness arising from prolonged exposure to heat prevaries (heat cramps, heat edema, heat exhaustion, heat stroke). The main pathophysiologic mechanisms are disruption of thermoregulation, peripheral vasodilation of the skin surface, hypoperfusion of visceral organs, and brain, and cardiac stress. Uncompensated heat stress can result in multiorgan dysfunction/failure syndrome due to the initiation of cytokine pathways, specifically in at-risk and/or chronically ill patients. The manifestation of uncompensated heat stroke is associated with a hospital mortality > 50%. Rapid identification, classification and targeted management are crucial for the outcome, in particular the initiation of adequate cooling measures., Conclusion: In the future, increasing numbers of patients suffering from prolonged heat exposure will require treatment in emergency departments and intensive care units. Sufficient professional knowledge regarding pathophysiology and management are decisive for successful therapy. Hence, the topic heat illness should be implemented in training and education., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Nurses' common experiences of old age and intensive care: A qualitative study Abstract. Increasingly more people in the 80+ age group are receiving treatment in the ICU-setting. The related critical care nurses' experience has been the subject of very few studies. Background: To better understand the everyday nursing practice in the care of old patients in the ICU setting, the knowledge of critical care nurses that guides their actions will be examined and presented in terms of their orientations and typologies. Aim: Within the interpretative paradigm, three guideline-based group discussions were conducted with a total of 14 critical care nurses from an Austrian clinic. Data was analyzed using the documentary method according to Bohnsack. Method: Five orientations characterize the knowledge and the actions of critical care nurses relating to old patients: the respect for the patients' will, the search for ethical justification, the beauty of the job, the own reflection of professional actions as well as the perception of a partly misguided health care system. The superior action-guiding typology is advocacy in the representation of the very old patients' interests. Results: The multi-faceted experiences of critical care nurses are characterized by personal, interpersonal, and structural challenges, but also by positive experiences. The findings offer approaches to improve the care situation for nurses as well as for old people in intensive care units.Conclusions: The multi-faceted experiences of critical care nurses are characterized by personal, interpersonal, and structural challenges, but also by positive experiences. The findings offer approaches to improve the care situation for nurses as well as for old people in intensive care units.

Background: The COVID-19 pandemic challenges hospital clinicians by additional burdens. Key questions are whether hospital clinicians have experienced more stress in the care of COVID-19 patients and whether patient safety and quality of care have changed.Methods: Cross-sectional study using an online survey with clinicians in German hospitals on working conditions and quality of care during the COVID-19 pandemic, comparing clinicians with (MmK) vs. without direct contact (MoK) to COVID-19 patients.Results: In total, 2122 clinicians participated. Most clinicians were physicians (15.4%, n = 301) or nurses (77.0%, n = 1505) working in major acute care hospitals (46.0%, n = 899). Every second respondent stated that they worked more than usual (46.4%, n = 907) and took on additional activities (47.7%, n = 932). A quarter of the participants did not receive any training or get instructions in devices (21.5%, n = 421). Only 51.5% (n = 1006) of the respondents were provided with sufficient personal protective equipment. More than 30% (32.7%, n = 639) were more satisfied than usual. The comparing clinicans with vs. without direkt contact to Covid-19 patients worked more shifts than usual (> 2 shifts: 24.1%, n = 306 vs. 13.7%, n = 63, p < 0.001) and without instruction (27.9%, n = 364 vs. 17.1%), n = 57, p < 0.001). In terms of patient safety, there were more deficiencies in the care, mechanical ventilation and nursing (all p < 0.001).Conclusion: The cross-sectional study indicates an increased burden on clinicians and a restricted quality of care for patients with COVID-19. A risk to patients or clinicians cannot be excluded. [ABSTRACT FROM AUTHOR]

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Background: The study aimed to assess the mental well-being of healthcare professionals at a German department of anesthesiology and critical care with a specialized ICU for treatment of COVID-19 patients during the first two peaks of the 2020 pandemic, and identifying risk and protective factors.Methods: A single-center longitudinal, online-based survey was conducted in healthcare workers from a department of anesthesiology and critical care in Bavaria, the most affected federal state in Germany at the time of assessment. Validated scores for depression, anxiety, somatic disorders, burnout, resilience, and self-management were used and complemented by questions about perceived COVID-19-related stressors. In parallel, patient characteristics in the ICU were collected.Results: 24 and 23 critically ill COVID-19 patients were treated during both observation periods in April/May and November/December 2020, respectively. 87.5% and 78.2% of patients had moderate to severe acute respiratory distress syndrome. From March 6, 2020 onwards, the hospital had switched to a command and control-based hospital incident command system (HICS) and increased work forces. Point prevalence of depression-like symptoms (13.6% and 12.8%) and burnout (21.6% and 17.4%) in the department’s healthcare professionals was high. Exposure to SARS-CoV-2 did not increase psychological burden. Consequences of the lockdown were rated as highly distressing by a majority of all ICU personnel. High self-reported trait resilience was protective against signs of depression, generalized anxiety, and burnout.Conclusions: During the pandemic, healthcare professionals have been suffering from increased psychological distress compared to reference data for both the general population and ICU personnel. General effects of the lockdown appear more relevant than actual COVID-19 patient contact. High trait resilience has a protective effect, yet vulnerable individuals may require specific support. Prevention against potential after effects of the lockdown, and in particular measures allowing to avoid another lockdown, appear warranted.