[Career perspectives for intensive care and emergency medicine physicians].

Background: Emergency departments and intensive care units are of great importance for patient care and require qualified and competent medical staff.

Objective: To present the range of tasks and career paths in emergency and intensive care medicine that make further training and long-term employment in these areas attractive.

Methods And Results: Emergency and intensive care medicine are characterized by a wide range of clinical tasks, but also by stresses resulting from, for example, shift work.

[Recommendation for medical onboarding and training on internal medicine intensive care units].

The medical onboarding process for physicians in internal medicine intensive care units in Germany reveals significant deficiencies, as highlighted by a 2023 survey from YDGIIN. Many physicians report feeling insecure and inadequately prepared after their onboarding phase. The study identifies core issues such as heterogeneous levels of training, unstructured onboarding processes, and a lack of support and competency checks in daily clinical practice.

Retrospective analysis of amantadine response and predictive factors in intensive care unit patients with non-traumatic disorders of consciousness.

Background: Disorders of consciousness (DoC) in non-traumatic ICU-patients are often treated with amantadine, although evidence supporting its efficacy is limited.

Methods: This retrospective study analyzed non-traumatic DoC-patients treated with amantadine between January 2016 and June 2021. Data on patient demographics, clinical characteristics, treatment specifications, and outcomes were extracted from electronic medical records.

[Initial diagnosis and treatment of shock].

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.

[Clinical acute and emergency medicine curriculum-focus on internal medicine : Recommendations for advanced training in internal medicine in the emergency department].

In Germany, physicians qualify for emergency medicine by combining a specialty medical training-e.g. internal medicine-with advanced training in emergency medicine according to the statutes of the State Chambers of Physicians largely based upon the Guideline Regulations on Specialty Training of the German Medical Association.

[The center for intensive care medicine: a model for interdisciplinary and interprofessional collaboration].

Background: The Federal Joint Committee has established requirements for centers for intensive care medicine which, in cooperation with other clinics, are to take on special tasks for intensive care medicine in a region. High demands are placed on these centers, which it may not be possible to meet without restructuring the existing intensive care structures.

Objective: In this study, an organizational model for a center for intensive care medicine based on broad interdisciplinary and interprofessional cooperation is presented for discussion.

[Functional requirements of patient data management systems in intensive care medicine].

Background: As part of the German government's digitization initiative, the paper-based documentation that is still present in many intensive care units is to be replaced by digital patient data management systems (PDMS). In order to simplify the implementation of such systems, standards for basic functionalities that should be part of basic configurations of PDMS would be of great value.

Purpose: This paper describes functional requirements for PDMS in several categories.

Amantadine for NeuroenhaNcement in acutE patients Study - a protocol for a prospective pilot proof of concept phase IIb study in intensive and intermediate care unit patients (ANNES).

Background: Persisting coma is a common complication in (neuro)intensive care in neurological disease such as acute ischemic stroke, intracerebral hemorrhage or subarachnoid hemorrhage. Amantadine acts as a nicotinic receptor antagonist, dopamine receptor agonist and non-competitive N-Methyl-D-aspartate receptor antagonist. Amantadine is a long-known drug, originally approved for treatment of influenza A and Parkinson`s Disease.

Quality indicators in intensive care medicine for Germany - fourth edition 2022.

The measurement of quality indicators supports quality improvement initiatives. The German Interdisciplinary Society of Intensive Care Medicine (DIVI) has published quality indicators for intensive care medicine for the fourth time now. After a scheduled evaluation after three years, changes in several indicators were made.

Recommendations on the structure, personal, and organization of intensive care units.

Background: Intensive care units (ICU) are central facilities of medical care in hospitals world-wide and pose a significant financial burden on the health care system.

Objectives: To provide guidance and recommendations for the requirements of (infra)structure, personal, and organization of intensive care units.

Design And Setting: Development of recommendations based on a systematic literature search and a formal consensus process from a group of multidisciplinary and multiprofessional specialists from the German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI).

Sepsis and underlying comorbidities in intensive care unit patients : Analysis of the cause of death by different clinicians-a pilot study.

Background: There is an ongoing debate as to whether death with sepsis is primarily caused by sepsis or, more often, by the underlying disease. There are no data on the influence of a researcher's background on such an assessment. Therefore, the aim of this analysis was to assess the cause of death in sepsis and the influence of an investigator's professional background on such an assessment.

[DIVI-Recommendations on the infrastruture of adult intensive care units].

This document on the Structure and Equipment for Intensive Care Units of the German Association for Intensive and Emergency Care (DIVI) aims at providing guidance and recommendations for the requirements of (infra)structure, personal, and organization of intensive care units. The recommendations are based on a systematic literature search and a formal consensus process from a group of multi-disciplinary and multiprofessional specialists from the DIVI. The recommendations comprise a 3-staged level of intensive care units, a 3-staged level of care with respect to severity of illness, the staffing requirement of physicians, nurses, physiotherapists, pharmacists, psychologists, and other specialists.

Sedation, sleep-promotion, and non-verbal and verbal communication techniques in critically ill intubated or tracheostomized patients: results of a survey.

Background: The aim of this survey was to describe, on a patient basis, the current practice of sedation, pharmacologic and non-pharmacologic measures to promote sleep and facilitation of communication in critically ill patients oro-tracheally intubated or tracheostomized.

Methods: Cross-sectional online-survey evaluating sedation, sleep management and communication in oro-tracheally intubated (IP) or tracheostomized (TP) patients in intensive care units on a single point.

Results: Eighty-one intensive care units including 447 patients (IP: n = 320, TP: n = 127) participated.

[Psychosocial care for relatives in the ICU: framework concept].

Family-centered care is an important aspect of care in intensive care medicine. But currently there is no agreement about the implementation in intensive care units (ICUs). Specific concepts of palliative medicine and pediatrics offer a good basis, but contents have to be adapted for the field of intensive care medicine.

Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial.

Background: This study was conducted to determine the effect of hypothermic temperature control after in-hospital cardiac arrest (IHCA) on mortality and functional outcome as compared with normothermia.

Methods: An investigator initiated, open-label, blinded-outcome-assessor, multicenter, randomized controlled trial comparing hypothermic temperature control (32-34°C) for 24 h with normothermia after IHCA in 11 hospitals in Germany. The primary endpoint was all-cause mortality after 180 days.

Comprehensive clinical and virological characterization of three cases of fulminant liver failure owing to HSV1 primary infection.

Herpes simplex virus 1 (HSV-1) is a frequently unrecognized, yet deadly cause of acute liver failure (ALF). We, therefore, analysed three cases of fatal HSV-1-induced ALF. All patients shared clinical (extremely elevated transaminases, LDH and AST/LDH ratio < 1) and virological characteristics (ratio of viral load in plasma versus throat swabs: 60-700-fold, lack of anti-HSV-1-IgG antibodies or low IgG-avidity during primary infection), which may help to identify patients at risk.

[Intensive care monitoring].

Monitoring the function of essential organ systems is a hallmark of critical care. In combination with the medical history, physical examination and selective diagnostic tests. Monitoring facilitates the bed-side diagnosis of many diseases in critical care and guides therapeutic management while providing optimal patient safety.

Course of lactate, pH and base excess for prediction of mortality in medical intensive care patients.

Introduction: As base excess had shown superiority over lactate as a prognostic parameter in intensive care unit (ICU) surgical patients we aimed to evaluate course of lactate, base excess and pH for prediction of mortality of medical ICU patients.

Materials And Methods: For lactate, pH and base excess, values at the admission to ICU, at 24 ± 4 hours, maximum or minimum in the first 24 hours and in 24-48 hours after admission were collected from all patients admitted to the Medical ICU of the University Hospital Tübingen between January 2016 until December 2018 (N = 4067 at admission, N = 1715 with ICU treatment > 48 h) and investigated for prediction of in-hospital-mortality.

Results: Mortality was 22% and significantly correlated with all evaluated parameters.

[Pharmacological therapy of circulatory shock].

Circulatory shock requires treatment of the underlying pathology in addition to supportive pharmacological therapy that is guided by hemodynamic monitoring. Based on the evaluation of the patient's volume, perfusion and cardiac status, the following therapeutic goals should be achieved: (1) Normalization of the intra- and extravascular fluid volume. (2) Provision of sufficient perfusion pressure and organ perfusion.

Structure and concept of ICU rounds: the VIS-ITS survey.

Objective: To gather data about structural and procedural characteristics of patient rounds in the intensive care unit (ICU) setting.

Design: A structured online survey was offered to members of two German intensive care medicine societies.

Measurements And Main Results: Intensivists representing 390 German ICUs participated in this study (university hospitals 25%, tertiary hospitals 23%, secondary hospitals 36%, primary hospitals 16%).