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Hintergrund Sauerstoff (O2) ist ein Arzneimittel mit spezifischen Eigenschaften, einem definierten Dosis-Wirkungs-Bereich und O2 hat unerwünschte Wirkungen. Im Jahr 2015 wurden 14 % einer Stichprobe von britischen Krankenhauspatienten mit Sauerstoff behandelt, davon hatten nur 42 % eine Verordnung. Gesundheitspersonal ist häufig unsicher über die Relevanz einer Hypoxämie und es besteht ein eingeschränktes Bewusstsein für die Risiken einer Hyperoxämie. In den letzten Jahren wurden zahlreiche randomisierte, kontrollierte Studien zur Sauerstofftherapie veröffentlicht. Methoden Im Rahmen des Leitlinienprogramms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) wurde unter Beteiligung von 10 Fachgesellschaften diese S3-Leitlinie auf Basis einer Literaturrecherche bis zum 01.02.2021 entwickelt. Zur Literaturbewertung wurde das System des Oxford Centre for Evidence-Based Medicine (CEBM; „The Oxford 2011 Levels of Evidence“) verwendet. Die Bewertung der Evidenzqualität erfolgte anhand des Grading of Recommendations Assessment, Development and Evaluation (GRADE) und die Leitlinienempfehlungen wurden formal konsentiert. Ergebnisse Die Leitlinie enthält 34 evidenzbasierte Empfehlungen zu Indikation, Verordnung, Überwachung und Abbruch der Sauerstofftherapie in der Akutversorgung. Die Indikation für Sauerstoff ist hauptsächlich die Hypoxämie. Hypoxämie und Hyperoxämie sollten aufgrund der Assoziation mit einer erhöhten Sterblichkeit vermieden werden. Die Leitlinie empfiehlt Zielbereiche der Sauerstoffsättigung für die Sauerstoff-Akuttherapie ohne Differenzierung zwischen verschiedenen Diagnosen. Zielbereiche sind abhängig vom Hyperkapnierisiko und Beatmungsstatus. Die Leitlinie bietet einen Überblick über verfügbare Sauerstoffzufuhrsysteme und enthält Empfehlungen für deren Auswahl basierend auf Patientensicherheit und -komfort. Fazit Dies ist die erste nationale Leitlinie zum Einsatz von Sauerstoff in der Akutmedizin. Sie richtet sich an medizinisches Fachpersonal, das Sauerstoff außerklinisch und stationär anwendet, und ist bis zum 30.06.2024 gültig.

We totally agree with Deana and Colleagues that missing intermediate care 1) might be an explanation for unexpected unfavorable outcome and 2) strengthening of intermediate care has the potential to lower this high rate of unfavorable outcome after ICU discharge. Yes- mind the gap!

Little is known about patients with Periprosthetic Joint Infection (PJI) admitted to the Intensive Care Unit (ICU). The purpose of this study was threefold: i) To report the microbiological findings of ICUpatients with PJI. ii) To compare the clinical data between Difficult-To-Treat (DTT) and non-DTT PJI. iii) To identify risk factors for mortality. This is a retrospective study from a tertiary healthcare center in Germany from 2012-2016. A total of 124 patients with 169 pathogens were included. The most common bacteria were \(\textit {Staphyloccous aureus}\) (26.6%), \(\textit {Staphyloccus epidermidis}\) (12.4%), \(\textit {Enterococci ssp.}\) and \(\textit {Escherichia coli}\) (respectively 9.4%). DTT PJI was diagnosed in 28 patients (22.6%). The main pathogens of DTT PJI were \(\textit {Staphylococus epidermidis}\) (14.5%), \(\textit {Escherichia coli}\) (12.7%), \(\textit {Staphylococcus aureus}\) and \(\textit {Candida spp.}\) (respectively 9.1%). Polymicrobial PJI, number of pathogens, ICU stay and mortality were significantly differrent between DTT PJI and non-DTT PJI (p\(\leq\)0.05). Multivariate logistic regression identified prolonged ICU stay and DTT PJI as risk factors for mortality. In conclusion, we suggest, that the term of DTT pathogens is useful for the intensivist to assess the clinical outcome in ICU-patients with PJI.

\(\bf Background\) Most trauma patients admitted to the hospital alive and die later on, decease during the initial care in the emergency department or the intensive care unit (ICU). However, a number of patients pass away after having been discharged from the ICU during the initial hospital stay. On first sight these cases could be seen as “failure to rescue” of potentially salvageable patients. A low rate of such patients might be a potential indicator of quality for trauma care on ICUs and surgical wards. \(\bf Methods\) Retrospective analysis of the TraumaRegister DGU® with data from 2015 to 2017. Patients that died during the initial ICU stay were compared to those who were discharged from the initial ICU stay for at least 24 h but died later on. \(\bf Results\) A total of 82,313 trauma patients were included in the TraumaRegister DGU®. In total, 6576 patients (8.0%) died during their hospital stay. Out of those, 5481 were admitted to the ICU alive and 972 patients (17.7%) were discharged from ICU and died later on. Those were older (mean age: 77 vs. 68 years), less severely injured (mean ISS: 23.1 vs. 30.0 points) and had a longer mean ICU length of stay (10 vs. 6 days). A limitation of life-sustaining therapy due to a documented living will was present in 46.1% of all patients who died during their initial ICU stay and in 59.9% of patients who died after discharge from their initial ICU stay. \(\bf Conclusions\) 17.7% of all non-surviving severely injured trauma patients died within the hospital after discharge from their initial ICU treatment. Their death can partially be explained by a limitation of therapy due to a living will. In conclusion, the rate of such late deaths may partially represent patients that died of potentially avoidable or treatable complications.

\(\bf Purpose\) An injury severity score (ISS) ≥ 16 alone, is commonly used post hoc to define the correct activation of a trauma team. However, abnormal vital functions and the requirement of life-saving procedures may also have a role in defining trauma team requirement post hoc. The aim of this study was to describe their prevalence and mortality in severely injured patients and to estimate their potential additional value in the definition of trauma team requirement as compared to the definition based on ISS alone. \(\bf Methods\) Retrospective analysis of a trauma registry including patients with trauma team activation from the years 2009 until 2015, who were 16 years of age or older and were brought to the trauma center directly from the scene. Patients were divided into a group with an ISS ≥ 16 vs. ISS

\(\bf Background\) Even though surgical techniques and implants have evolved, periprosthetic joint infection (PJI) remains a serious complication leading to poor postoperative outcome and a high mortality. The literature is lacking in studies reporting the mortality of very elderly patients with periprosthetic joint infections, especially in cases when an intensive care unit (ICU) treatment was necessary. We therefore present the first study analyzing patients with an age 80 and higher suffering from a periprosthetic joint infection who had to be admitted to the ICU. \(\bf Methods\) All patients aged 80 and higher who suffered from a PJI (acute and chronic) after THR or TKR and who have been admitted to the ICU have been included in this retrospective, observational, single-center study. \(\bf Results\) A total of 57 patients met the inclusion criteria. The cohort consisted of 24 males and 33 females with a mean age of 84.49 (\(\pm\) 4.0) years. The mean SAPS II score was 27.05 (\(\pm\) 15.7), the mean CCI was 3.35 (\(\pm\) 2.28) and the most patient had an ASA score of 3 or higher. The PJI was located at the hip in 71.9% or at the knee in 24.6%. Two patients (3.5%) suffered from a PJI at both locations. Sixteen patients did not survive the ICU stay. Non-survivors showed significantly higher CCI (4.94 vs. 2.73; \(\it p\) = 0.02), higher SAPS II score (34.06 vs. 24.32; \(\it p\) = 0.03), significant more patients who underwent an invasive ventilation (132.7 vs. 28.1; \(\it p\) = 0.006) and significantly more patients who needed RRT (4.9% vs. 50%; \(\it p\)