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3. Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI))

Author

Reinhart, K., Brunkhorst, F. M., Bone, H.-G., Bardutzky, J., Dempfle, C.-E., Forst, H., Gastmeier, P., Gerlach, H., Gründling, M., John, S., Kern, W., Kreymann, G., Krüger, W., Kujath, P., Marggraf, G., Martin, J., Mayer, K., Meier-Hellmann, A., Oppert, M., Putensen, C., Quintel, M., Ragaller, M., Rossaint, R., Seifert, H., Spies, C., Stüber, F., Weiler, N., Weimann, A., Werdan, K., and Welte, T.

Subjects
guideline, German Sepsis Society, German Sepsis Aid, severe sepsis, septic shock, prevention, diagnosis, treatment, follow-up care, Medicine
Abstract

Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1st revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the “German Instrument for Methodological Guideline Appraisal” of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.

Published
2010

4. S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system

Author

Schmitt, D. V., Schirmer, U., Markewitz, A., Reuter, D., Marggraf, G., Loer, S. A., Kroener, A., Kastrup, M., Heringlake, M., Heller, A. R., Gogarten, W., Grosse, J., Goepfert, M., Goetz, A., Erb, J., Dongas, A., Braun, J., Alms, A., Carl, M., Wiesenack, C., Zwissler, B., and Spies, C.

Subjects
intensive care medicine, cardiothoracic surgery, monitoring, volume therapy, positive inotropic and vasoactive drugs, Medicine
Abstract

Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG) and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI) made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF).

Published
2010

11. Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors

Author

Milling, Truman J., Jr, Middeldorp, Saskia, Xu, Lizhen, Koch, Bruce, Demchuk, Andrew, Eikelboom, John W., Verhamme, Peter, Cohen, Alexander T., Beyer-Westendorf, Jan, Michael Gibson, C., Lopez-Sendon, Jose, Crowther, Mark, Shoamanesh, Ashkan, Coppens, Michiel, Schmidt, Jeannot, Albaladejo, Pierre, Connolly, Stuart J., Anand, R., Bastani, A., Clark, C., Concha, M., Cornell, J., Dombrowski, K., Fermann, G., Fulmer, J., Goldstein, J., Kereiakes, D., Milling, T., Pallin, D., Patel, N., Refaai, M., Rehman, M., Schmaier, A., Schwarz, E., Shillinglaw, W., Spohn, M., Takata, T., Venkat, A., Welker, J., Welsby, I., Wilson, J., Van Keer, L., Verschuren, F., Blostein, M., Eikelboom, J., Althaus, K., Berrouschot, J., Braun, G., Doeppner, T., Dziewas, R., Genth-Zotz, S., Greinacher, P., Hamann, F., Hanses, F., Heide, W., Kallmuenzer, B., Kermer, P., Poli, S., Royl, G., Schellong, S., Schnupp, S., Schwarze, J., Spies, C., Thomalla, G., von Mering, M., Weissenborn, K., Wollenweber, F., Gumbinger, C., Jaschinski, U., Maschke, M., Mochmann, H-C., Pfeilschifter, W., Pohlmann, C., Zahn, R., Bouzat, P., Schmidt, J., Vallejo, C., Floccard, B., Coppens, M., van Wissen, S., Arellano-Rodrigo, E., Valles, E., Alikhan, R., Breen, K., Hall, R., Crowther, M., Albaladejo, P., Cohen, A., Demchuk, A.M., Schmidt, J., Wyse, D.G., Garcia, D.A., Prins, M., Nakamya, J., Büller, H.R., Mahaffey, K. W., Alexander, J. H., Cairns, J.A., Hart, R.G., Joyner, C.D., Raskob, G.E., Schulman, S., Veltkamp, R., Meeks, B., Zotova, E., Ahmad, S., Pinto, T., Baker, K., Dykstra, A., Holadyk-Gris, I., Malvaso, A., and Demchuk, A.M.

Published
2023
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12. Telemedizin in der Intensivmedizin - Analyse einer deutschlandweiten Mixed-Method-Befragung zum Praxisstand.

Author

Dohmen, S., Marx, G., Spies, C., Jungwirth, B., Balzer, F., Sperling, K., Weiss, B., and Edel, A.

Subjects
DATABASE management, QUESTIONNAIRES, DESCRIPTIVE statistics, TELEMEDICINE, SURVEYS, MEDICAL consultation, INTENSIVE care units, RESEARCH methodology, QUALITY assurance
Abstract

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.)

Published
2024
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47. Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement.

Author

Knauert, MP, Ayas, NT, Bosma, KJ, Drouot, X, Heavner, MS, Owens, RL, Watson, PL, Wilcox, ME, Anderson, BJ, Cordoza, ML, Devlin, JW, Elliott, R, Gehlbach, BK, Girard, TD, Kamdar, BB, Korwin, AS, Lusczek, ER, Parthasarathy, S, Spies, C, Sunderram, J, Telias, I, Weinhouse, GL, Zee, PC, Knauert, MP, Ayas, NT, Bosma, KJ, Drouot, X, Heavner, MS, Owens, RL, Watson, PL, Wilcox, ME, Anderson, BJ, Cordoza, ML, Devlin, JW, Elliott, R, Gehlbach, BK, Girard, TD, Kamdar, BB, Korwin, AS, Lusczek, ER, Parthasarathy, S, Spies, C, Sunderram, J, Telias, I, Weinhouse, GL, and Zee, PC

Abstract

Background: Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD. Methods: We convened a multidisciplinary group with relevant expertise to participate in an American Thoracic Society Workshop. Workshop objectives included identifying ICU SCD subtopics of interest, key knowledge gaps, and research priorities. Members attended remote sessions from March to November 2021. Recorded presentations were prepared and viewed by members before Workshop sessions. Workshop discussion focused on key gaps and related research priorities. The priorities listed herein were selected on the basis of rank as established by a series of anonymous surveys. Results: We identified the following research priorities: establish an ICU SCD definition, further develop rigorous and feasible ICU SCD measures, test associations between ICU SCD domains and outcomes, promote the inclusion of mechanistic and patient-centered outcomes within large clinical studies, leverage implementation science strategies to maximize intervention fidelity and sustainability, and collaborate among investigators to harmonize methods and promote multisite investigation. Conclusions: ICU SCD is a complex and compelling potential target for improving ICU outcomes. Given the influence on all other research priorities, further development of rigorous, feasible ICU SCD measurement is a key next step in advancing the field.

Published
2023

49. Perzeption der „natural orifice surgery“

Author

Benhidjeb, T., Gericke, C., Spies, C., Miller, K., Schneider, A., and Müller, F.

Abstract

Zusammenfassung: Hintergrund: Auf den Erfahrungen der laparoskopischen Chirurgie basierend und bei dem Bestreben, eine weitere Reduzierung des chirurgischen Traumas und der damit assoziierten Morbidität zu erzielen, wurde die Chirurgie über natürliche Körperöffnungen, die sog. „natural orifice surgery“ (NOS) eingeführt. Um die Sichtweise der Frauen und ihre Bereitschaft, diesen operativen Zugangsweg anzunehmen, zu erfassen, haben wir eine Umfrage unter weiblichen Mitarbeiterinnen in chirurgisch orientierten Abteilungen durchgeführt. Material und Methoden: Ein Fragebogen mit 14 Items wurde unter 500 Mitarbeiterinnen des Pflege- und Ärztepersonals der Charité verteilt. Der Rücklauf von 118 Bögen erfolgte vollständig anonym. Die erhobenen Daten wurden mittels SPSS 16.0 ausgewertet. Ergebnisse: In der Methodenwahl zur Entfernung der Eierstöcke wählten die Befragten in 55% der Fälle die transvaginale Operationstechnik und in 44% das laparoskopische Operationsverfahren. Lediglich 1% konnte sich den transgastrischen Zugangsweg vorstellen. Bei der Frage nach der operativen Methodenwahl zur Entfernung der Gallenblase entschieden sich dagegen lediglich 31% für das transvaginale Vorgehen und 61% für das laparoskopische Verfahren. Am häufigsten geäußerte Einwände gegen den transvaginalen Zugang waren die Angst vor postoperativen Sexualstörungen und Schwangerschaftsproblemen, wobei nur letzteres signifikant war. Häufigste Gründe für die Wahl eines NOS-Verfahrens sind der fehlende Wundschmerz und die fehlende Narbe. Schlussfolgerung: Der traditionelle und überschaubare transvaginale Zugang wird unter Sicherheitsgesichtspunkten zurzeit favorisiert. Damit assoziierte Ängste und Barrieren sind anhand der Datenlage ungerechtfertigt. Es ist deshalb eine unserer Hauptaufgaben, diese Bedenken durch entsprechende interdisziplinäre, professionelle und evidenzbasierte Aufklärung zu überwinden, um eine bessere Akzeptanz von NOS zu erreichen.

Published
2024
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50. Gelenkinfektionen der Hand

Author

Unglaub, F., Langer, M., Unglaub, J., Hohendorff, B., Müller, L., Hahn, P., Löw, S., and Spies, C.

Abstract

Gelenkinfektionen der Hand können aufgrund einer frühzeitigen Knorpelschädigung zu irreversiblen Schäden und damit eingeschränkter Funktion führen. Bei persistierenden, nicht sofort behandelten Infektionen kann zudem eine Osteitis und/oder eine systemische Streuung resultieren. Während die Fingergelenke aufgrund ihrer Exposition meist durch Verletzungen, wie z. B. Bisse, Quetsch- oder Stichwunden, infiziert werden, ist das Handgelenk oft bei Patienten mit Immunsuppression oder internistischen Erkrankungen, wie z. B. Diabetes mellitus, betroffen. Bei verzögerter Diagnostik und Therapie können bleibende Gelenkschäden häufig nicht verhindert werden. Aus diesem Grund ist die notfallmäßige Behandlung des infizierten Gelenks zum Erhalt der Funktion der Hand zwingend notwendig. In diesem Beitrag werden die aktuelle Diagnostik und Therapie der Gelenkinfektionen dargestellt. Joint infections of the hand may lead to irreversible lesions and impairment of hand function due to early cartilage damage. Furthermore, persistent infections which are not treated immediately can cause osteitis and/or spread systemically. Finger joints are prone to infection due to bite wounds or crush and sharp injuries. Whereas the wrist is often affected in patients with immunosuppression or chronic diseases, such as diabetes mellitus. If diagnosis and therapy are delayed, joint damage may be inevitable. Therefore, urgent treatment of the infected joint is imperative to preserve the function of the hand. This article reviews the current diagnostics and treatment of joint infections of the hand.

Published
2024
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