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Copyright of Die Anaesthesiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The old definition of sepsis was replaced by Sepsis-3 in February 2016. The new screening diagnostic tools sequential organ failure assessment (SOFA) score and quick SOFA (qSOFA) score were incorporated into the definition. The resulting scientific controversy led to several retrospective and prospective evaluations. In contrast no evaluation of the state of play of national implementation of Sepsis-3 has been conducted so far.Objective: The aim of this study was to capture the current situation in German academic intensive care units 1 year after the implementation of Sepsis-3.Methods: An internet-based questionnaire consisting of 22 items was developed. The identification of eligible departments was performed by an online search of the homepages of all university hospitals located in Germany. Departments regardless of the discipline with an explicit indication of involvement in intensive care were extracted. The link to the internet-based questionnaire was sent to all identified departments on 22 February 2017 and was accessible for 19 days.Results: Out of 259 departments 76 answered the online survey. The response rate was 29.3% from 13 specializations. Anesthesiology, internal medicine and general surgery were the three main participants in this study. The majority of intensive care units (54.75%) treated more than 100 patients with sepsis or septic shock annually and more than 30% treated more than 250 patients. While 76.7% of respondents had a standard operating procedure, 55% of those were based on the Sepsis-3 definition. When asked to rate the usefulness of the Sepsis-3 definition, answers were heterogeneous with a slight tendency towards a higher usefulness and the majority (72.9%) were in favor of Sepsis-3 being included in the national S2K guidelines.Conclusion: The results demonstrate the heterogeneity of Sepsis-3 implementation in German intensive care units. Sepsis-3 is finding its way but there is a need for standardized implementation. [ABSTRACT FROM AUTHOR]

We report the first outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in Germany. The presence of KPC was confirmed by polymerase chain reaction (PCR). The KPC-encoding plasmid was analysed by transconjugation experiments, DNA sequencing, Southern blotting and isoelectric focussing. Typing was performed by pulsed-field gel electrophoresis (PFGE). An ertapenem-resistant K. pneumoniae with low minimum inhibitory concentrations (MIC) to other cabapenems (tested by the Vitek system) was isolated from the index patient in January 2008. A KPC-2 was identified after K. pneumoniae with identical susceptibility patterns had been isolated from two more patients. Despite the introduction of infection control measures, transmission occurred in five additional patients and three of the patients died from infections. The source of the outbreak strain remained unclear; however, the Tn 4401-containing blaKPC-2 gene was similar to previously described isolates from Greece. Five months after the end of the outbreak, a KPC- K. pneumoniae was isolated from a patient who had been treated in Greece previously. Retrospectively, this patient was treated in November 2007 on the same unit as the index case. Typing revealed that all patients were colonised by the same strain. KPC- K. pneumoniae has been introduced to Germany possibly from Greece and transmission to other institutions is likely. [ABSTRACT FROM AUTHOR]

The question " which city is the greenest " sounds trivial, but in reality, this question contains statistical ambiguities. In this study, we approach this issue by ranking cities by green space shares. However, we do not base our ranking only on one green parameter and the commonly used administrative boundaries. Instead, we broaden access to rankings through several approaches: First, we calculate two parameters, i.e. green space shares and green space per capita. Second, we apply these parameters for two cases: for all green areas as well as for green areas with a minimum size of one hectare. The latter are considered to have an impact on near-home recreation and the local climate. Third, we relate these parameters on the one hand to administrative spatial units constituting the entity 'city', but juxtapose these on the other hand with two alternative spatial reference units: a morphological spatial unit that closely encompasses the built-up pattern of the city, and a standardized buffer unit around the city centers. The variability of these manifold rankings obtained by this study makes clear: the rank of one city in a relational system to other cities depends strongly on these parameters and spatial units applied. In our experiments we rank and compare the 80 major cities in Germany. The diversity of results allows to discuss the susceptibility of spatial statistics to ambiguities that may arise from the use of different concepts. By integrating these multidimensional concepts into one final ranking, we propose a strategy for a more holistic and robust approach while revealing uncertainties. • A multi-dimensional concept for the comparison of green spaces shares across cities. • A uniform data basis based on remote sensing data. • Systematic test of different green indicators and spatial reference units. • A critical discussion on city rankings and their spatial-statistical vulnerability and ambiguity. • a ranking of the 80 largest German cities. [ABSTRACT FROM AUTHOR]

Background: The old definition of sepsis was replaced by Sepsis-3 in February 2016. The new screening diagnostic tools sequential organ failure assessment (SOFA) score and quick SOFA (qSOFA) score were incorporated into the definition. The resulting scientific controversy led to several retrospective and prospective evaluations. In contrast no evaluation of the state of play of national implementation of Sepsis-3 has been conducted so far., Objective: The aim of this study was to capture the current situation in German academic intensive care units 1 year after the implementation of Sepsis-3., Methods: An internet-based questionnaire consisting of 22 items was developed. The identification of eligible departments was performed by an online search of the homepages of all university hospitals located in Germany. Departments regardless of the discipline with an explicit indication of involvement in intensive care were extracted. The link to the internet-based questionnaire was sent to all identified departments on 22 February 2017 and was accessible for 19 days., Results: Out of 259 departments 76 answered the online survey. The response rate was 29.3% from 13 specializations. Anesthesiology, internal medicine and general surgery were the three main participants in this study. The majority of intensive care units (54.75%) treated more than 100 patients with sepsis or septic shock annually and more than 30% treated more than 250 patients. While 76.7% of respondents had a standard operating procedure, 55% of those were based on the Sepsis-3 definition. When asked to rate the usefulness of the Sepsis-3 definition, answers were heterogeneous with a slight tendency towards a higher usefulness and the majority (72.9%) were in favor of Sepsis-3 being included in the national S2K guidelines., Conclusion: The results demonstrate the heterogeneity of Sepsis-3 implementation in German intensive care units. Sepsis-3 is finding its way but there is a need for standardized implementation.

Studies from recent years paint a picture of qualitatively deficient treatment in pain medicine. In order to improve the situation knowledge on targeted diagnostics and effective therapy should be imparted at an early stage during undergraduate studies. For this reason the cross-sectional field Q14 - pain medicine was newly created in the revision of the medical physician licencing regulations. The Q14 was then established in a longitudinal, multidisciplinary form at the medical faculty in Heidelberg, whereby the complete Kern cycle was run through. The present project report describes and discusses the establishment. The results of the first multiple choice examination and an online-based evaluation by the students are presented. The latter show that the students recognized the relevance of the teaching program for their future professional career; however, the presentation of the interdisciplinary aspect must still be improved. The students were critical of the longitudinal structure and this does indeed involve a great deal of organization for the faculty and students. On the other hand this corresponds to the basic conception of a cross-sectional field and gives a good depiction of the multidisciplinary character. The first evaluation results set the precedent for further fine adjustments of the cross-sectional field. A continuous further development is generally needed with respect to the Kern cycle.

Background: Laryngeal mask insertion (LMI) represents a fundamental skill for anesthesiologists in routine management as well as in difficult airway situations. This study aimed to evaluate the time needed by first year anesthesiology residents to perform 40 LMIs and assessed the associated success rates and the number of attempts needed for successful LMI., Methods: This prospective single center study evaluated the number of work days, the success rate and the attempts needed for successful LMI (LMA ProSeal™) in consecutive blocks of five LMI procedures and the related difficulties and complications., Results: From 2007 to 2010 a total of 10 anesthesiology resident physicians were evaluated consecutively. These residents needed a mean of 18.3 ± 4.1 (mean ± standard deviation) working days to successfully perform 40 LMIs. The LMI success rate after the first 5 LMIs increased steadily up to the results after 40 LMIs per resident (LMI success rate within 1 attempt 72 versus 86 %, p = 0.09, LMI success rate within all LMI attempts 74 versus 96 %, p = 0.001). The mean number of attempts required until successful LMI decreased from 1.45 ± 0.82 after the first 5 LMIs to 1.16 ± 0.37 after 40 LMIs (p = 0.03). The most common difficulties associated with unsuccessful LMI by residents that led to handing over to an experienced colleague were small oral aperture (9.8 %), short thick neck, large tongue, blood/mucus in the mouth or throat (each 7.3 %) and retrognathy (4.9 %)., Conclusions: The increasing LMI success rate and the decreasing rate of LMI attempts for successful airway management correlated to a learning curve and development of LMI dexterity over time.

Surgery and anesthesiology have always been closely connected. Within the increasing complexity of therapies and technical capabilities both subjects overlap in certain areas. This article deals with the question whether anesthesiology is acting as a partner or competitor in the cooperation with the various operative specialties. In several studies it has been shown that the outcome of surgical patients can be improved by communication and interaction with anesthesiology and that forming multidisciplinary teams will be highly beneficial for patients in intensive care units.

The use of prophylactic perioperative antibiotic therapy if indicated could successfully and safely prevent surgical wound infections. The current guidelines (S1) for prophylactic perioperative antibiotic therapy of the Study Group of the Scientific Medical Associations (AWMF) of 2004 was replaced by a recommendation of the study group of the Paul-Ehrlich-Gesellschaft for Chemotherapy (PEG) in 2010. This recommendation includes recent research data from 2000 to 2008. Indications and choice of antibiotic agent depend on specific risk factors of the patient and the operation performed. The aim of this article is to describe the current recommendations of the PEG for general and visceral surgery.

The treatment of severely injured trauma patients (polytrauma) is one of the outstanding challenges in medical care. Early in the initial course the patient's diagnostics have to be scrupulously reevaluated by an interdisciplinary team (tertiary trauma survey) to reduce deleterious sequelae of missed injuries after the initial assessment. Severely injured patients stay in intensive care for an average of 11 days. During this time the patient's therapy has to ensure a high quality evidence-based intensive care treatment and simultaneously has to be tailored to the current individual injuries. Because of the fact that the damage control strategy is gaining increasing acceptance, the intensive care unit plays a pivotal role in the critical time between emergency and elective surgery. Therefore a close cooperation between physicians of the intensive care unit and all surgical disciplines involved is essential to reach the aim of therapeutic efforts. After survival of emergency treatment patients with severe trauma should be reintegrated into social and occupational life as soon as possible.