The measurement of quality indicators supports quality improvement initiatives. The German Interdisciplinary Society of Intensive Care Medicine (DIVI) has pub lished quality indicators for intensive care medicine for the fourth time now. After a scheduled evaluation after three years, changes in several indicators were made. Other indicators were not changed or only minimally. The focus remained strongly on relevant treatment processes like management of analgesia and sedation, mechanical ventilation and weaning, and infections in the ICU. Another focus was communication inside the ICU. The number of 10 indicators remained the same. The development method was more structured and transparency was increased by adding new features like evidence levels or author contribution and potential conflicts of interest. These quality indicators should be used in the peer review in intensive care, a method endorsed by the DIVI. Other forms of measurement and evaluation are also reasonable, for example in quality management. This fourth edition of the quality indicators will be updated in the future to reflect the recently published recommendations on the structure of intensive care units by the DIVI.

In most cases infection with the new coronavirus 2 involves the lung, but it also has the potential to affect other organ systems such as the heart, the intestines and especially the vascular system. In the context of diagnostics, computed tomography is the imaging method of choice, although it requires a hygienically problematic transport of the patient for examination, does not provide any information about functional restrictions in the organ systems affected by the infection, and, moreover, until today only limited experience in the diagnosis of the infected lungs is available. The concept of focused symptom-oriented multi-organ sonography describes a bedside imaging method ubiquitously available to all areas of acute medicine. The present work provides an overview of the cross-organ possibilities of sonographic imaging for diagnosis and therapy optimisation in patients who have to be hospitalised due to a coronavirus infection.

Providing medical care to patients suffering from the coronavirus disease 2019 (COVID-19) pandemic is a major challenge for government healthcare systems around the world. The new coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), shows a high organ specificity for the lower respiratory tract. Since there is so far no effective treatment or vaccination against the virus, early diagnostic recognition is of great importance. Due to the specific aspects of the infection, which mainly begins in the peripheral lung parenchyma, lung ultrasonography is suitable as a diagnostic imaging method to identify suspected cases as such in the early stages of the disease. Serial ultrasound examinations on patients with confirmed COVID-19 can promptly detect changes in the affected lung tissue at the bedside. This article summarizes the diagnostic potential of lung ultrasound with respect to screening and therapeutic decision-making in patients with suspected or confirmed SARS-CoV‑2 pneumonia.

In 2011, the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) for the first time published standards for sonography training courses, with a focus on anaesthesiology related ultrasound techniques (AFS Course System). Meanwhile, perioperative sonography has become an essential component in the educational curriculum of anaesthesia, intensive care and emergency medicine. The need for re-designing the course system originally derived from the growing sonographic experience of the anaesthesiological community, but is currently strongly supported by the course restrictions associated with the Corona pandemic. The DGAI is now publishing the new standards for AFS training courses that implement various e-learning modules. The society leaves it to the course organisers, whether they offer a traditional course format or rather present a practical training course introduced by an e-learning course that can be attended from any place. In addition, a sonography certificate is introduced, based on the attendance of the AFS courses, and the successfull participation in e-learning tests.

Die medizinische Versorgung von Patienten, die im Zusammenhang mit der pandemischen Coronaviruserkrankung 2019 („coronavirus disease 2019“, COVID-19) erkrankt sind, stellt für die staatlichen Gesundheitssysteme weltweit eine große Herausforderung dar. Das Virus mit dem Namen „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) zeigt eine hohe Organspezifität zu den unteren Atemwegen. Da bislang weder eine wirksame Therapie noch Impfung gegen das Virus existieren, kommt der diagnostischen Früherkennung eine große Bedeutung zu. Durch den spezifischen Aspekt der überwiegend im peripheren Lungenparenchym beginnenden Infektion ist die Lungensonographie als bildgebende Diagnostikmethode geeignet, Verdachtsfälle bereits im Frühstadium der Erkrankung als solche zu identifizieren. Serielle Ultraschalluntersuchungen an Patienten mit bestätigter Infektion können bettseitig und zeitnah Veränderungen im betroffenen Lungengewebe nachweisen. Dieser Artikel fasst das diagnostische Potenzial der Lungensonographie im Hinblick auf Screening und therapeutische Entscheidungsfindung bei Patienten mit vermuteter oder bestätigter SARS-CoV-2-Pneumonie zusammen.

Providing medical care to patients suffering from the coronavirus disease 2019 (COVID-19) pandemic is a major challenge for government healthcare systems around the world The new coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), shows a high organ specificity for the lower respiratory tract Since there is so far no effective treatment or vaccination against the virus, early diagnostic recognition is of great importance Due to the specific aspects of the infection, which mainly begins in the peripheral lung parenchyma, lung ultrasonography is suitable as a diagnostic imaging method to identify suspected cases as such in the early stages of the disease Serial ultrasound examinations on patients with confirmed COVID-19 can promptly detect changes in the affected lung tissue at the bedside This article summarizes the diagnostic potential of lung ultrasound with respect to screening and therapeutic decision-making in patients with suspected or confirmed SARS-CoV-2 pneumonia

Die beiden Kasuistiken beschreiben den Einsatz der transthorakalen Echokardiographie bei kardiochirurgischen Patienten, bei denen es während der postoperativen Intensivbehandlung zu einer Einblutung in die Perikardhöhle kam. Zur Abklärung der eintretenden hämodynamischen Instabilität wurde eine fokussierte Echokardiographie durchgeführt, die in beiden Fällen zielführend war und die Ursache der Instabilität aufdeckte. Nach weiterer Bildgebung mittels Computertomographie erfolgte im einen Fall eine chirurgische Intervention, während im anderen Fall bettseitig eine sonographisch kontrollierte Pleurapunktion mit Hämatomentlastung durchgeführt wurde. Die Fälle zeigen, dass intrathorakale Blutungen nach herzchirurgischen Operationen auch nach einer Latenz von Tagen bis Wochen auftreten können. Sie können hämodynamisch relevant werden und eine Intervention erfordern. Eine bettseitig durchgeführte „Point-of-care“-Echokardiographie eröffnet den Weg zur Diagnosesicherung mittels Computertomographie (CT) oder Magnetresonanztomographie (MRT), falls die Kreislaufsituation des Patienten diese vor Durchführung der Hämatomentlastung noch zulässt.

Das akute Rechtsherzversagen wird als Ursache einer kardiopulmonalen Insuffizienz häufig übersehen. Die verschiedenen Krankheitsbilder, die dem Rechtsherzversagen ätiologisch auf den Ebenen der Nach‑, Vorlast und Kontraktilität zugrunde liegen, können mithilfe einer zielgerichteten Diagnostik abgeklärt werden. Neben klinischen Symptomen und laborchemischen Parametern ist v. a. die Echokardiographie für die Diagnosestellung relevant. Die symptomatische Behandlung des akut vital bedrohten Patienten ist essenziell. Im Vordergrund stehen die Senkung des rechtsventrikulären Drucks und der Nachlast, eine Korrektur der systemischen Hypotension und die positiv-inotrope Unterstützung des Ventrikels. Mechanische Organersatz- bzw. Unterstützungsverfahren kommen zunehmend bei anhaltendem Rechtsherzversagen zum Einsatz und erweitern die Behandlungsmöglichkeiten. Prognostisch entscheidend ist eine auf die auslösende Grunderkrankung abgestimmte kausale Therapie.

Quality improvement in medicine is depending on measurement of relevant quality indicators. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI) from the year 2013 underwent a scheduled evaluation after three years. There were major changes in several indicators but also some indicators were changed only minimally. The focus on treatment processes like ward rounds, management of analgesia and sedation, mechanical ventilation and weaning, as well as the number of 10 indicators were not changed. Most topics remained except for early mobilization which was introduced instead of hypothermia following resuscitation. Infection prevention was added as an outcome indicator. These quality indicators are used in the peer review in intensive care, a method endorsed by the DIVI. A validity period of three years is planned for the quality indicators.

These two case reports describe the use of transthoracic echocardiography in cardiac surgery patients during postoperative intensive care, when a pericardial hematoma developed. A focused echocardiographic examination was performed, which in both cases led to the correct diagnosis and revealed the cause for hemodynamic instability. Following additional computed tomography (CT) scans, cardiac surgery was performed on one patient, while in the other, bedside sonography was used for controlled pleural puncture and drainage of the pericardial hematoma. The case reports demonstrate that intrathoracic bleeding after cardiac surgery may develop with a latency of days to weeks, which can become hemodynamically relevant and require an intervention. Bedside point of care echocardiography opens the way for securing the diagnosis by means of CT or magnetic resonance imaging (MRI) if the circulatory state of the patient allows this prior to hematoma drainage or evacuation.

Acute right heart failure is often overlooked as a cause of cardiopulmonary insufficiency. The various pathologies underlying right heart failure at the level of afterload, preload and contractility, make rapid, targeted diagnostics necessary. In addition to clinical symptoms and laboratory chemical parameters, echocardiography in particular is relevant for making a diagnosis. Symptomatic treatment of the endangered patient is essential. The focus is on a reduction of right ventricular pressure and afterload, a correction of systemic hypotension and positive inotropic support of the right ventricle. Mechanical organ replacement and support procedures are increasingly being used in the case of persistent right heart failure and expand the possibilities for treatment. Decisive for the prognosis is a causal treatment adapted to the underlying triggering disease.