Der seit Jahren bestehende Fachkräftemangel in der Intensiv- und Anästhesiepflege stellt Einrichtungen vor erhebliche strukturelle und organisationale Herausforderungen. Arbeitsbedingungen, Qualifikationsstrukturen und organisationale Rahmenbedingungen haben dabei zentrale Bedeutung. Trotz zahlreicher Einzelberichte fehlen bislang systematische bundesweite Daten zu Leitungs‑, Team- und Qualifikationsstrukturen in diesen Fachbereichen. Primäres Ziel der bundesweiten Querschnitterhebung war die Erfassung der aktuellen Situation der Pflegeentwicklung in der Intensiv- und Anästhesiepflege in Deutschland. Sekundäres Ziel war u. a., Leitungs‑, Team- und Organisationsstrukturen sowie Strukturen der Aus‑, Fort- und Weiterbildung zu erfassen. Quantitative Online-Querschnittbefragung leitender Personen in der Intensiv- und Anästhesiepflege in Krankenhäusern der Bundesrepublik Deutschland mit 44 Items, die in professionelle Netzwerke versendet wurde. Die Datenanalyse erfolgte deskriptiv und bivariat. Von 749 Teilnehmenden konnten 550 Datensätze (73,4
Anatomical and physiological changes often observed in obese patients increase the risk of difficult tracheal intubation (DTI). In this study, we explored the potential of video-assisted laryngoscopy to prospectively predict DTI in obese patients. Patients scheduled for general anesthesia with a body mass index (BMI) higher than 30 were included in the study. The El-Ganzouri risk index (EGRI) was calculated during routine preoperative bedside evaluations. An EGRI of ≥ 4 was considered indicative of DTI. Following the application of a local anesthetic agent to the airway, the percentage of glottic opening (POGO) score was obtained using preoperative video laryngoscopy. In the POGO score, visibility of 50
BACKGROUND:Postpartum hemorrhage (PPH) remains a clinically significant cause of maternal complications and death. Due to the increasing incidence, international recommendations have been implemented, such as the D‑A-CH algorithm, an interdisciplinary and transnational treatment algorithm for Germany, Austria and Switzerland. This study aims to evaluate both the impact of implementing a hemostaseology working group and adopting the internationally recognized D‑A-CH algorithm on the clinical management of PPH in a university hospital. METHODS:In this single-center retrospective observational study, patient records were reviewed from all patients treated for PPH between March 2003 and July 2021 at the University Hospital Ulm, Germany (n = 341). Data were divided into three groups: (I) patients treated before the implementation of a working group for hemostaseology (n = 40), (II) patients treated after the implementation of a working group for hemostaseology and before the clinical application of the D‑A-CH-algorithm (n = 103) and (III) patients treated after the clinical application of the D‑A-CH algorithm (n = 198). RESULTS:After the implementation of the D‑A-CH-algorithm, a significantly higher amount of fibrinogen (2.0 g, interquartile range, IQR, 0.0-3.0 g in group III vs. 0.0 g, IQR 0.0-2.0 g in group II and 0.0 g, IQR 0.0-0.0 g in group I ; p < 0.0001) and tranexamic acid (1.0 g, IQR 1.0-1.5 g in group III vs. 1.0 g, IQR 0.0-1.0 g in group II and 0.0 g, IQR 0.0-0.0 g in group I; p < 0.0001) was administered. Additionally, transfusion of allogeneic blood products (units of concentrated red cells: 2.0, IQR 0.0-4.0 in group III vs. 3.0, IQR 2.0-5.0 in group II and 3.0, IQR 0.0-7.8 in group I; p = 0.0036), intensive care unit (ICU) stay (3.0 days, IQR 2.0-4.0 days in group III vs. 3.0 days, IQR 2.0-5.0 days in group II and 3.0 days, IQR 2.0-4.3 days in group I; p = 0.0195) and hospital stay (5.0 days, IQR 3.0-7.0 days in group III vs. 7.0 days, IQR 5.0-9.0 days in group II and 7.0 days, IQR 5.0-9.0 days in group I; p < 0.0001) was significantly reduced. Implementation of a hemostaseology working group alone was only associated with increased fibrinogen and tranexamic acid administration. CONCLUSION:In this retrospective study, application of the D‑A-CH algorithm was associated with improved targeted hemostatic therapy and reduced transfusion requirements as well as shorter ICU and hospital stays, whereas implementation of a hemostaseology working group alone was only associated with increased fibrinogen and tranexamic acid administration. Due to the retrospective design of the study and inherent limitations therein, we were unable to draw a causative effect relationship. Nonetheless, our results warrant further study.
Postpartum hemorrhage (PPH) remains a clinically significant cause of maternal complications and death. Due to the increasing incidence, international recommendations have been implemented, such as the D‑A-CH algorithm, an interdisciplinary and transnational treatment algorithm for Germany, Austria and Switzerland. This study aims to evaluate both the impact of implementing a hemostaseology working group and adopting the internationally recognized D‑A-CH algorithm on the clinical management of PPH in a university hospital. In this single-center retrospective observational study, patient records were reviewed from all patients treated for PPH between March 2003 and July 2021 at the University Hospital Ulm, Germany (n = 341). Data were divided into three groups: (I) patients treated before the implementation of a working group for hemostaseology (n = 40), (II) patients treated after the implementation of a working group for hemostaseology and before the clinical application of the D‑A-CH-algorithm (n = 103) and (III) patients treated after the clinical application of the D‑A-CH algorithm (n = 198). After the implementation of the D‑A-CH-algorithm, a significantly higher amount of fibrinogen (2.0 g, interquartile range, IQR, 0.0–3.0 g in group III vs. 0.0 g, IQR 0.0–2.0 g in group II and 0.0 g, IQR 0.0–0.0 g in group I ; p < 0.0001) and tranexamic acid (1.0 g, IQR 1.0–1.5 g in group III vs. 1.0 g, IQR 0.0–1.0 g in group II and 0.0 g, IQR 0.0–0.0 g in group I; p < 0.0001) was administered. Additionally, transfusion of allogeneic blood products (units of concentrated red cells: 2.0, IQR 0.0–4.0 in group III vs. 3.0, IQR 2.0–5.0 in group II and 3.0, IQR 0.0–7.8 in group I; p = 0.0036), intensive care unit (ICU) stay (3.0 days, IQR 2.0–4.0 days in group III vs. 3.0 days, IQR 2.0–5.0 days in group II and 3.0 days, IQR 2.0–4.3 days in group I; p = 0.0195) and hospital stay (5.0 days, IQR 3.0–7.0 days in group III vs. 7.0 days, IQR 5.0–9.0 days in group II and 7.0 days, IQR 5.0–9.0 days in group I; p < 0.0001) was significantly reduced. Implementation of a hemostaseology working group alone was only associated with increased fibrinogen and tranexamic acid administration. In this retrospective study, application of the D‑A-CH algorithm was associated with improved targeted hemostatic therapy and reduced transfusion requirements as well as shorter ICU and hospital stays, whereas implementation of a hemostaseology working group alone was only associated with increased fibrinogen and tranexamic acid administration. Due to the retrospective design of the study and inherent limitations therein, we were unable to draw a causative effect relationship. Nonetheless, our results warrant further study.
Interprofessionelle Lehrveranstaltungen werden generell als sinnvoll erachtet, sind aber bisher selten curriculare Formate in der medizinischen Ausbildung. Ziele dieser Pilotstudie waren es zu erfassen, ob die neu geplante Lehrveranstaltung „interprofessionelle Spätschicht“ die Einstellung der Studierenden in Bezug auf interprofessionelles Arbeiten verbessert, und ob dies nochmals durch eine kurze Intervention zu Veranstaltungsbeginn optimiert werden kann. Die quantitative Begleitung sah vor, dass Studierende vor und nach der Veranstaltung die Fragebogen „International Socialization and Valuing Scale – 9“ (ISVS-9), „University of the West of England Interprofessional Questionnaire German“ (UWE-IP-D) (nur Dimension „Kommunikation und Teamarbeit“) sowie die Skala zur allgemeinen Selbstwirksamkeitserwartung (SWE) ausfüllten. Zudem erfolgte eine kurze Einschätzung der Persönlichkeit vor der Veranstaltung mittels des Big Five Inventory-10. Diese Pilotstudie wurde über zwei Semester durchgeführt. Die Fragebögen lagen von 30 Studierenden vor. Die ISVS-9-Summenwerte stiegen in beiden Gruppen an (p = 0,011). Ein signifikanter Unterschied im Anstieg zwischen Interventions- und Kontrollgruppe konnte allerdings nicht festgestellt werden (p = 0,98). Die UWE-Summenwerte gingen signifikant zurück (p = 0,002), was eine Verbesserung der kommunikativen Fähigkeiten bedeutet. Die Analyse zum Einfluss der Persönlichkeit zeigte einen signifikanten Zusammenhang zwischen dem Anstieg von Selbstwirksamkeit, Neurotizismus (p = 0,018) sowie Verträglichkeit (p = 0,044). Die Ergebnisse der Pilotstudie machen deutlich, dass die neu geplante Lehrveranstaltung „interprofessionelle Spätschicht“ ein wirkungsvolles Instrument sein könnte, die Wertschätzung interprofessioneller Zusammenarbeit von Medizinstudierenden zu stärken. Allerdings konnte die Wertschätzung durch eine kurze Schulung zu Beginn nicht zusätzlich verbessert werden.
Postoperative delirium (POD) is a common and serious complication. Electroencephalography (EEG)-guided anesthesia has been proposed as a method to minimize excessive depth of anesthesia and potentially reduce the incidence of POD. This study was conducted to evaluate the effect of EEG-guided anesthesia on POD incidence. To identify relevant trials a comprehensive search across several electronic databases was performed. The primary outcome was the incidence of POD, while secondary outcomes included duration of EEG suppression and postoperative cognitive dysfunction (POCD) at 1 week and between 1 and 3 months postoperatively. Pooled relative risk (RR) and standardized mean difference (SMD) were calculated. A total of 18 studies were included in the analysis. The results showed that EEG-guided anesthesia significantly lowered the incidence of POD (RR: 0.77, 95
BACKGROUND:Interprofessional teaching courses are generally considered useful but have rarely been implemented in German medical education curricula to date. OBJECTIVE:The aim of this pilot study was to determine whether the newly planned teaching course "interprofessional late shift" improves students' attitudes towards interprofessional work and whether this can be further optimized by a short intervention at the beginning of the course. MATERIAL AND METHODS:The quantitative assessment involved students completing the "international socialization and valuing scale-9" (ISVS-9), the "University of the West of England Interprofessional Questionnaire German" (UWE-IP-D) (only the "communication and teamwork" dimension) and the scale for general self-efficacy expectations (SWE) before and after the course. In addition, a brief assessment of the personality was carried out before the event using the Big Five Inventory-10. RESULTS:This pilot study was conducted over two semesters. Questionnaires were completed by 30 students. The ISVS‑9 total scores increased in both groups (p = 0.011); however, a significant difference in the increase between the intervention and control groups could not be determined (p = 0.98). The total scores of the UWE-IP‑D decreased significantly (p = 0.002), which indicates an improvement in communication skills. Analyses of the influence of the personality showed a significant correlation between the increase in self-efficacy, neuroticism (p = 0.018) and agreeableness (p = 0.044). CONCLUSION:The results of the pilot study clearly show that the newly planned teaching course "interprofesional late shift" could be an effective tool for enhancing medical students' appreciation of interprofessional collaboration; however, the appreciation could not be additionally improved by a short intervention at the beginning of the course.
BACKGROUND:Postoperative delirium (POD) is a common and serious complication. Electroencephalography (EEG)-guided anesthesia has been proposed as a method to minimize excessive depth of anesthesia and potentially reduce the incidence of POD. OBJECTIVE:This study was conducted to evaluate the effect of EEG-guided anesthesia on POD incidence. METHODS:To identify relevant trials a comprehensive search across several electronic databases was performed. The primary outcome was the incidence of POD, while secondary outcomes included duration of EEG suppression and postoperative cognitive dysfunction (POCD) at 1 week and between 1 and 3 months postoperatively. Pooled relative risk (RR) and standardized mean difference (SMD) were calculated. RESULTS:A total of 18 studies were included in the analysis. The results showed that EEG-guided anesthesia significantly lowered the incidence of POD (RR: 0.77, 95% confidence interval, CI: 0.64-0.92; p = 0.0046), demonstrating a protective effect. Additionally, EEG-guided anesthesia resulted in a significant reduction in the duration of EEG suppression (SMD: -0.57, 95% CI: -0.90 to -0.25; p = 0.0005). For POCD, no significant effects were observed at 1 week (RR: 0.54, 95% CI: 0.19-1.51) or at 1-3 months postoperatively (RR: 0.49, 95% CI: 0.20-1.18). CONCLUSION:The use of EEG-guided anesthesia was associated with a decrease in the incidence of POD and a significant reduction in the duration of EEG suppression; however, its impact on preventing POCD was limited. These findings suggest that although EEG-guided anesthesia can help minimize excessive depth of anesthesia, further research is necessary to identify additional strategies for reducing POD and improving long-term cognitive outcomes.
BACKGROUND:Focused cardiac ultrasound (FOCUS) is a targeted point-of-care echocardiographic approach for rapid assessment of cardiac function and morphology. It is established in emergency and intensive care medicine and increasingly more relevant for making perioperative decisions. Data on its integration into perioperative workflows by anesthesiologists and on the role of training and supervision, remain limited. OBJECTIVE:This nationwide survey assessed FOCUS training, supervision and clinical application among anesthesiologists in Germany and examined how training and supervision were associated with self-reported confidence in performing FOCUS and the extent of its clinical use. MATERIAL AND METHODS:We conducted an anonymized digital cross-sectional survey among physician members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI). The standardized questionnaire comprised 21 items on professional background, echocardiographic training, supervised examinations, clinical integration of FOCUS and self-assessed skills. Training formats were grouped as no course, basic course, or basic plus advanced course. Supervision was recorded as the number of supervised FOCUS examinations after course attendance but the survey did not distinguish between bedside instruction, joint interpretation or image review. Complete datasets were analyzed using Pearson's χ2-test and Wilson 95% confidence intervals. RESULTS:Overall, 645 physicians participated and 469 completed the questionnaire. Senior physicians were overrepresented compared with the DGAI membership structure, whereas residents were underrepresented. More than 80% had completed at least one basic FOCUS course, yet more than 40% reported no supervised examinations before independently performing FOCUS in patients. Approximately 40% used FOCUS regularly, another 40% irregularly and 20% did not use it in practice. The FOCUS examination was used most often in emergency and intensive care situations, followed by intraoperative monitoring and preoperative evaluation. For elective preoperative assessment, cardiology was named most frequently, whereas before emergency surgery anesthesiologists were more often involved. Course participation was significantly associated with more frequent FOCUS use and supervised examinations showed an even stronger association with clinical use. Self-reported confidence in qualitative left ventricular function assessment and quantitative ejection fraction measurement increased with course level and supervision. Lack of qualification, insufficient supervision and time constraints were the main barriers. CONCLUSION:Despite high course participation and broad acceptance of FOCUS, the integration into perioperative practice remains limited. Courses alone appear insufficient for sustainable implementation. Supervision, continuous practice and structured longitudinal training pathways seem central to build confidence and support safe patient use. Beyond image interpretation, training should include correct device handling, suitable presets and exposure to normal and pathological findings. The use of FOCUS should be regarded as an adjunct to clinical assessment, not as a replacement for comprehensive cardiological echocardiography; it requires appropriate indications, technical proficiency and awareness of individual limitations. Interpretation is limited by the cross-sectional design, self-reported outcomes and selection bias towards a more experienced and FOCUS-affine subgroup.
Der fokussierte kardiale Ultraschall (FOCUS) ist eine zielgerichtete Point-of-Care-Echokardiographie zur raschen Beurteilung kardialer Funktion und Morphologie und ist in Notfall- und Intensivmedizin etabliert. Die Studie untersuchte Ausbildungsstand, Supervision und klinische Anwendung von FOCUS durch AnästhesistInnen in Deutschland sowie deren Zusammenhang mit der subjektiven Sicherheit bei der Durchführung von FOCUS. Anonymisierte digitale Querschnittstudie unter ärztlichen DGAI-Mitgliedern mittels standardisiertem Fragebogen zu beruflichen Angaben, Kursausbildung, Supervision, klinischer Integration und Selbsteinschätzung praktischer FOCUS-Fertigkeiten. Insgesamt wurden 469 Rückmeldungen analysiert. Über 80
Die Autoren der nationalen wie auch der internationalen Sepsis-Leitlinien stellen es frei, ob im septischen Schock Hydrokortison durch Fludrokortison ergänzt werden soll oder nicht. Ziel dieser Übersicht ist es, die Datenlage und den Hintergrund der Kombinationstherapie von Hydrokortison und Fludrokortison im Vergleich zur alleinigen Hydrokortison-Gabe bzw. zur Standardtherapie beim septischen Schock darzustellen und zu diskutieren. Neben Ergebnissen klinischer Studien und Metaanalysen werden Argumente für oder gegen die additive Gabe von Fludrokortison diskutiert sowie der pathophysiologische Hintergrund erläutert. Abschließend werden klinisch relevante Hinweise zur praktischen Anwendung von Steroiden bei Sepsis gegeben.
