Abstract Monitoring inspiratory effort during assisted mechanical ventilation is essential to balance lung protection and respiratory muscle loading. Esophageal pressure monitoring remains the reference standard for estimating inspiratory muscle pressure and work of breathing but is invasive and rarely used in routine clinical practice. Non-invasive alternatives based on routinely available ventilator signals are therefore needed. This monocentric physiological substudy of the ICEBERG observational trial included adult patients with acute hypoxemic respiratory failure undergoing assisted mechanical ventilation. Inspiratory muscle pressure (P mus ) was first estimated non-invasively by linear extrapolation of the airway pressure drop recorded during a standardized end-expiratory occlusion (P0.1 maneuver) into early inspiration (up to 500 ms after occlusion). Using the extrapolated P mus together with airway pressure, airway resistance was calculated during early inspiration, both with and without correction for respiratory system elastance determined by occlusion maneuvers. The resulting resistance and elastance were then used to parameterize the equation of motion of the respiratory system, allowing subsequent reconstruction of the inspiratory P mus waveform over the entire breath. From the reconstructed pressure signal, peak inspiratory P mus , work of breathing, and pressure–time product were calculated. Esophageal pressure–derived measurements served as the reference standard, and agreement was assessed using linear regression and Bland–Altman analysis. Eighteen patients (age 67 ± 12 years, PaO₂/FiO₂ 198 ± 44 mmHg) contributed 33 valid measurements. Based on a patient-average analysis, non-invasively estimated P mus during early inspiration showed statistically significant correlations with esophageal pressure–derived values across all analyzed time points (all p < 0.01), with the highest agreement and lowest bias observed at 100 ms extrapolation time after the end of the P0.1 maneuver. Elastance-corrected airway resistance demonstrated slightly improved agreement compared with uncorrected resistance estimates. Work of breathing derived from non-invasive inspiratory P mus showed good agreement with reference measurements (R 2 = 0.70; bias = − 0.05 J), whereas pressure–time product exhibited greater bias and wider limits of agreement. A P0.1-guided, non-invasive method based on airway pressure extrapolation allows feasible and physiologically meaningful estimation of inspiratory P mus during assisted ventilation. Derived work of breathing shows good agreement with esophageal pressure-based measurements, supporting the potential of this approach for non-invasive monitoring of inspiratory effort in patients with acute hypoxemic respiratory failure.

Abstract Background Transpulmonary pressure, calculated as the difference between airway pressure (Paw) and esophageal pressure (Pes), is an important monitoring parameter during assisted mechanical ventilation, provided Pes is measured via a correctly placed and filled esophageal pressure probe. The reference method to verify Pes accuracy in spontaneously breathing patients requires calculating the ratio of changes in Pes and Paw (ΔPes/ΔPaw) during an inspiratory effort against an occluded airway. We hypothesized that the P0.1 maneuver, a brief and repeatable test, could provide an alternative means to assess ΔPes/ΔPaw during assisted mechanical ventilation. Methods We performed an exploratory secondary analysis of data from a multicenter prospective observational study (ICEBERG study; NCT05203536). In 35 patients receiving assisted mechanical ventilation, ΔPes/ΔPaw obtained during P0.1 maneuvers (RatioP0.1, experimental method) was compared with ΔPes/ΔPaw from prolonged expiratory occlusion maneuvers (Ratioocc, reference method) using linear regression and Bland–Altman analysis. Results Among 25 patients with 65 evaluable measurements, RatioP0.1 showed a moderate correlation (R 2:0.647, p < 0.0001) with Ratioocc. Bland–Altman analysis demonstrated minimal bias and acceptable agreement between methods. Using the occlusion maneuver as reference, RatioP0.1 identified incorrect Pes measurement with a sensitivity of 93% and a specificity for identifying correct Pes measurement of 71%. Results were consistent across patient subgroups. Conclusions Our exploratory analysis suggests that the P0.1 maneuver may support semi-continuous screening of esophageal pressure signal validity during assisted ventilation. While abnormal P0.1 values should prompt confirmatory occlusion testing, values within the expected range may help rule out major measurement errors. These findings provide a rationale for prospective validation studies including different ventilator types. Trial registration: clinicaltrials.gov, NCT05203536. Registered 24. January 2022—Retrospectively registered, https://classic.clinicaltrials.gov/ct2/show/NCT05203536

Objective Aim of the study was to investigate the impact of prehospital care for psychiatric emergencies on doctor-patient relationship in acute psychiatry. Methods A questionnaire-based survey was conducted among 135 psychiatric emergency patients at a university hospital and a district hospital between 2023-2024. Results Negative perception of emergency medical services personnel had a negative impact on the doctor-patient relationship in acute psychiatry (beta = 1.75, p = 0.003). Use of force/coercion by emergency physicians can further deteriorate the doctor-patient relationship (beta = 4.65, p = 0.016). Comparable measures taken by emergency medical services personnel had a weaker effect (p = 0.006) than those taken by emergency physicians (p < 0.001). Conclusion If psychiatric emergency patients perceive prehospital measures as coercive or violent, the doctor-patient relationship in acute psychiatry deteriorates. In this regard, emergency medical measures have a greater impact.

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide and primarily affect older individuals, making CVDs a central concern in age-related and geriatric medicine. Senescent endothelial cells contribute to a pro-inflammatory environment that exacerbates cardiovascular pathology. Therapies targeting senescent cells, hold promise for treating/preventing CVDs and anti-inflammatory regulatory macrophages (Mreg) may represent a novel cell-based therapeutic approach. Here we investigated the impact of Mreg secretory products (SPMreg) on the early and late passage phenotype of human endothelial cells (HUVEC, human umbilical vein endothelial cells), with implications for cardiovascular aging and diseases. Methods HUVEC were classified as early passage (HUVECep, passages 4–6) or late passage (HUVEClp, passages 10–13) and cultured for 10 days with or without SPMreg. Parameters associated with endothelial aging, including cell morphology, size and volume, β-galactosidase activity, CD105 expression, reactive oxygen species (ROS), and senescence-associated secretory phenotype (SASP) factor release, were analyzed. Results HUVECep exhibited a typical cobblestone-like morphology, whereas HUVEClp displayed a spindle-shaped appearance. Both cell types showed an elongated, fibroblast-like cell type after incubation with SPMreg. In HUVEClp, treatment with SPMreg significantly reduced cell size and volume at all time points (P < 0.05). In HUVECep, SPMreg increased β-galactosidase activity and the proportion of ROS-positive cells, while reducing secretion of the SASP factor PAI-1 (P < 0.05 for all). In HUVEClp SPMreg increased β-galactosidase activity, attenuated the time-dependent increase of ROS levels and secretion of SASP factor Activin A (P < 0.05 for all). Conclusion Our findings demonstrate that SPMreg modulate several factors associated with endothelial senescence, highlighting a potential role for Mreg in processes related to cardiovascular aging.

Importance:Albumin supplementation may reduce mortality in patients with septic shock; however, data from randomized clinical trials are limited. Objective:To assess the impact of albumin administration on outcomes in patients with septic shock. Design, Setting, and Participants:This multicenter, open-label randomized clinical trial was conducted between October 21, 2019, and May 2, 2022. Patients from 23 intensive care units in Germany enrolled within 24 hours of the onset of septic shock were followed up for outcome data up to 90 days. The statistical trial report was completed and filed with the federal authorities in December 2023; additional analyses were completed in October 2024. The study was terminated prematurely due to low enrollment rates. Interventions:Protocol group patients received 20% albumin to maintain serum albumin levels of at least 3.0 g/dL for up to 28 days during their intensive care unit admission. The control group received standard fluid administration with crystalloids. Main Outcomes and Measures:The primary end point was 90-day mortality; secondary end points included 28-day, 60-day, intensive care unit and in-hospital mortality, organ dysfunction or failure, total amount of fluid administration and total fluid balance while in the intensive care unit, duration of intensive care and hospital stays, and frequency of adverse events. Results:Of 440 randomized patients (median [IQR] age, 69 [59-78] years; 290 [65.9%] male), 222 received albumin and 218 received standard fluids. Baseline characteristics were comparable. Ninety-day mortality was 43.3% (91 of 210) in the albumin group vs 45.9% (96 of 209) in controls (relative risk, 0.94; 95% CI, 0.76-1.17; P = .71). No significant differences were observed for secondary end points. Conclusions and Relevance:In this randomized clinical trial of patients with septic shock, albumin administration was safe but did not improve 90-day survival. As this trial was prematurely terminated, results remain inconclusive and additional studies are recommended. Trial Registration:ClinicalTrials.gov Identifier: NCT03869385.

BACKGROUND:A novel automated system for the control of the inspired fraction of oxygen, named LeoClac, has been implemented on a mechanical ventilator. The system uses a separate sensor for the measurement of peripheral oxygen saturation which is connected directly to the ventilator. We hypothesise that LeoClac will be superior to manual control in keeping critically ill and mechanically ventilated patients in a SpO2-target range (93-96%). METHODS:This is a randomised controlled, single-centre superiority study with two parallel groups including 40 patients. Mechanically ventilated patients treated on the intensive care unit (ICU) will be screened for eligibility and included in the study after written informed consent. Patients in the intervention group will be treated with LeoClac. In the control group, FiO2 will be controlled manually by the intensive care team. The primary endpoint of the study is the proportion of time in the target zone for peripheral oxygen saturation within the first 24 hours following randomisation. Secondary endpoints include the analysis of hyperoxia and hypoxia, number of changes in FiO2, number and reasons for self-aborts and manual overrides of the automated system, proportion of time in target zone for peripheral oxygen saturation in the subgroups of patients with hypoxemic respiratory failure and acute hypercapnic respiratory failure. Furthermore, ventilator-free days and ICU mortality at day 28 will be analysed. ANALYSIS:The precise control of FiO2 with the aim of avoiding both hyperoxia and hypoxia is a fundamental challenge in the highly technical field of mechanical ventilation. Incorporation of patient heterogeneity, the benefits of reduced manual intervention and the potential to optimise treatment outcomes underscore the importance of this research. By addressing the complexities of precise oxygen control in adults, this study contributes to the advancement of critical care practices and may improve patient outcomes. ETHICS:The study protocol was approved by the ethics committee of the Christian-Albrechts-University Kiel, Germany, on 17 May 2023. TRIAL REGISTRATION NUMBER:DRKS00032113.

There is increasing evidence that use of ECMO is beneficial in major trauma patients with refractory organ failure. Hence, increased numbers of ECMO support following major trauma are reported. We set out to determine the use of ECMO among major trauma patients submitted to the TraumaRegister DGUr® as well as patient features associated with ECMO support. The TraumaRegister DGU® is a multinational database compiling trauma related health care data from point-of-injury, initial and critical care to outcome. Major trauma cases (AIS ≥ 3 irrespective of injury location) with subsequent critical care as well as respiratory and/or circulatory failure (SOFA score ≥ 3 per respective category) enrolled in the TraumaRegister DGU® between 2015 and 2022 were reviewed. A logistic regression model was carried out to evaluate patient features associated with ECMO support. 410/ 22,548 individuals (1.8

INTRODUCTION:Lung-protective ventilation is essential for preventing postoperative pulmonary complications. While maintaining a low driving pressure and optimising PEEP is of importance, the ideal strategy remains contentious. This study evaluated whether adjusting PEEP based on BMI, compared with standard PEEP, could reduce driving pressure and peri-operative loss of lung aeration. METHODS:We conducted a randomised controlled, patient-blinded, single-centre superiority trial with two parallel groups. Adult patients undergoing surgery with general anaesthesia who required tracheal intubation were assigned randomly to either standardised PEEP (PEEP = 5 cmH2O; group PEEP-5) or PEEP set according to BMI (PEEP = BMI/3 cmH2O; group PEEP-BMI/3). Patients' lungs were ventilated using a volume-controlled mode with tidal volumes of 7 ml.kg-1 predicted body weight. Lung aeration scores were assessed using ultrasound pre- and postoperatively. RESULTS:Sixty patients were enrolled and allocated randomly. Adjustment of PEEP according to BMI/3 was associated with a significantly lower driving pressure, with a median (IQR [range]) of 8.9 (7.1-10.4 [5.2-14.9]) cmH2O in group PEEP-5 and 7.9 (7.2-8.5 [5.9-14.1]) cmH2O in group PEEP-BMI/3 (p = 0.027) and higher mean (SD) respiratory system compliance (group PEEP-5, 0.83 (0.20) ml cmH2O-1 kg-1 predicted body weight vs. group PEEP-BMI/3, 0.95 (0.17) ml cmH2O-1 kg-1 predicted body weight; p = 0.020). Lung ultrasound revealed a reduced postoperative loss of lung aeration in patients allocated to the BMI/3 group. Patients allocated to the BMI-adjusted group required less supplemental oxygen, had less newly developed atelectasis and had higher oxygen saturations upon arrival in the post-anaesthesia care unit. DISCUSSION:In patients without major pulmonary disease who were undergoing non-cardiothoracic surgeries with tracheal intubation, adjusting PEEP based on a calculation of BMI/3 improved lung mechanics and reduced postoperative loss of lung aeration. This approach provides a straightforward and pragmatic method for individualising PEEP in patients undergoing general anaesthesia.

To describe and compare cases of resuscitation after out-of-hospital cardiac arrest (OHCA) attributed to drowning (D-OHCA) versus other causes (ND-OHCA). Retrospective, descriptive and comparative analysis of D-OHCA vs. ND-OHCA patients registered in the German Resuscitation Registry from January 2013 to December 2023 using Chi-square, Mann-Whitney U tests and regression analysis. Key variables included 10-year age groups, body temperature measured at the scene, prehospital factors (e.g., bystander CPR, initial rhythm), and outcomes such as survival and neurological status (CPC, mRS) at hospital discharge. Of the 68,719 included patients 316 (0.5

Atemwegsmanagement und Notfallnarkose sind essenzielle Maßnahmen der Akut- und Notfallmedizin und nehmen direkten Einfluss auf Morbidität und Mortalität der Patienten. Im Rahmen eines notfallmäßigen Atemwegsmanagements ist aufgrund patienten- und einsatzseitiger Einflussfaktoren und des kritischen Patientenzustands jeder Atemweg als schwierig zu betrachten. Auch wenn die Videolaryngoskopie zu einer Erleichterung der notfallmäßigen Atemwegssicherung beiträgt, ist das Beherrschen eines Difficult-airway-Algorithmus sowie alternativer Methoden der Atemwegssicherung unabdingbar. Neben der Atemwegssicherung kann auch eine inadäquat durchgeführte Notfallnarkose negative Auswirkungen auf den Patientenzustand haben. Die korrekte Indikationsstellung, Vorbereitung des Patienten und Wahl der Narkosemedikamente sind entscheidend für die patientensichere Durchführung dieses komplexen Maßnahmenbündels. Vor dem Hintergrund der multiprofessionellen und interdisziplinären Zusammensetzung von Notfallteams wird die Bedeutung einer standardisierten Ausbildung für prähospitale Situationen und die Notaufnahme deutlich. Der vorliegende Beitrag behandelt Ausbildungsansätze sowie die Rolle von Simulations- und Szenariotrainings für das Atemwegsmanagement in Notfällen sowie für die Notfallnarkose.

ZusammenfassungDie prähospitale Notfallversorgung erfährt seit Jahren zunehmende Einsatzbelastungen. Der Einfluss des demografischen Wandels auf regionalspezifische Unterschiede von Notärzt*innen sowie deren Motivation zum Verbleib im aktiven Notarztdienst ist unklar.Deutschlandweite Umfrage unter Notärzt*innen zu demografischen und weiteren, für den Notarztdienst relevanten Angaben.Der Anteil an Notärzt*innen ≥ 60 Jahren (10,1 vs. 4,5% [städtisch], p < 0,001) sowie derer, die angaben, binnen 5 Jahren den Notarztdienst beenden zu wollen (19,8 vs. 14,7%, p = 0,006), war in ländlichen Rettungsdienstbereichen höher. Die multivariate Analyse ergab eine angemessene Vergütung (p = 0,002) und eine Zufriedenheit mit den Arbeitsbedingungen (p < 0,001) als Motivatoren für einen längeren Verbleib als aktive Notärzt*innen.Unterschiede zwischen Notärzt*innen im ländlichen und städtischen Raum sind bei der Personalbindung zu berücksichtigen. Als mögliche Steuerungsinstrumente konnten Vergütung und Zufriedenheit mit den Berufsbedingungen identifiziert werden, um einem absehbaren Notarztmangel zu begegnen.

Abstract Background Macrophages are involved in tissue homeostasis, angiogenesis and immunomodulation. Proangiogenic and anti-inflammatory macrophages (regulatory macrophages, Mreg) can be differentiated in-vitro from CD14+ monocytes by using a defined cell culture medium and a stimulus of IFNγ. Aim of the study To scrutinize the potential impact of temporal IFNγ exposure on macrophage differentiation as such exposure may lead to the emergence of a distinct and novel macrophage subtype. Methods Differentiation of human CD14+ monocytes to Mreg was performed using a GMP compliant protocol and administration of IFNγ on day 6. Monocytes from the same donor were in parallel differentiated to MregIFNγ0 using the identical protocol but with administration of IFNγ on day 0. Cell characterization was performed using brightfield microscopy, automated and metabolic cell analysis, transmission electron microscopy, flow cytometry, qPCR and secretome profiling. Results Mreg and MregIFNγ0 showed no differences in cell size and volume. However, phenotypically MregIFNγ0 exhibited fewer intracellular vesicles/vacuoles but larger pseudopodia-like extensions. MregIFNγ0 revealed reduced expression of IDO and PD-L1 (P < 0.01 for both). They were positive for CD80, CD14, CD16 and CD38 (P < 0.0001vs. Mreg for all), while the majority of MregIFNγ0 did not express CD206, CD56, and CD103 on their cell surface (P < 0.01 vs. Mreg for all). In terms of their secretomes, MregIFNγ0 differed significantly from Mreg. MregIFNγ0 media exhibited reduced levels of ENA-78, Osteopontin and Serpin E1, while the amounts of MIG (CXCL9) and IP10 were increased. Conclusion Exposing CD14+ monocytes to an alternatively timed IFNγ stimulation results in a novel macrophage subtype which possess additional M1-like features (MregIFNγ0). MregIFNγ0 may therefore have the potential to serve as cellular therapeutics for clinical applications beyond those covered by M2-like Mreg, including immunomodulation and tumor treatment.

OBJECTIVES:Current European guidelines for pediatric cardiopulmonary resuscitation (CPR) recommend the lower half of the sternum as the chest compression point (CP). In this study, we have used thoracic CT scans to evaluate recommended and optimal CP in relation to cardiac anatomy and structure. DESIGN:Analysis of routinely acquired thoracic CT scans acquired from 2000 to 2020. SETTING:Single-center pediatric department in a German University Hospital. PATIENTS:Imaging data were obtained from 290 patients of 3-16 years old. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:We measured and analyzed 14 thoracic metrics in each thoracic CT scan. In 44 of 290 (15.2%) scans, the recommended CP did not match the level of the cardiac ventricles. Anatomically, the optimal CP was one rib or one vertebral body lower than the recommended CP, that is, the optimal CP was more caudal to the level of the body of the sternum in 67 of 290 (23.1%) scans. The recommended compression depth appeared reasonable in children younger than 12 years old. At 12 years old or older, the maximum compression depth of 6 cm is less than or equal to one-third of the thoracic depth. CONCLUSIONS:In this study of thoracic CT scans in children 3-16 years old, we have found that optimal CP for CPR appears to be more caudal than the recommended CP. Therefore, it seems reasonable to prefer to use the lower part of the sternum for CPR chest compressions. At 12 years old or older, a compression depth similar to that used in adults-6 cm limit-may be chosen.

In Germany, organ allocation is based on the MELD-system and lab-MELD is usually low in patients with hepatocellular carcinoma (HCC) in cirrhosis. Higher medical urgency can be achieved by standard exception for HCC (SE-HCC), if Milan criteria (MC) are met. Noteworthy, UNOS T2 reflects MC, but excludes singular lesions < 2 cm. Thus, SE-HCC is awarded to patients with one lesion between 2 and 5 cm or 2 to 3 lesions between 1 and 3 cm. These criteria are static and do not reflect biological properties of HCC.We present a retrospective cohort of 111 patients, who underwent liver transplantation at UKSH, Campus Kiel between 2007 and 2017. No difference was found in overall survival for patient cohorts using Milan, UCSF, up-to-seven, and French-AFP criteria. However, there was a significantly reduced survival, if microvascular invasion was detected in the explanted organ and in patients with HCC-recurrence. The exclusive use of static selection criteria including MC appear to limit the access to liver transplantation.

Abstract Background Psychiatric emergencies pose a special challenge for emergency physicians. It is known from other areas of medicine that the influence of a doctor’s gender can have an impact on the type of treatment and quality of patient care. However, this has not yet been investigated in the context of prehospital care in psychiatric emergencies. Objectives To identify whether the gender of the prehospital emergency physicians has an influence on the “on-scene” time, treatment strategy and on the potential escalation of interventions for patients with a psychiatric diagnosis. Methods A retrospective cohort analysis of emergency missions with a psychiatric diagnosis was performed between January 1, 2015 and December 31, 2021 at the Department of Emergency Medicine, Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Germany. Results 2882 emergency missions with a psychiatric indication/prehospital psychiatric diagnosis were studied and divided into: intoxication (n = 1343, 46.6%), suicidal behavior (n = 488, 16.9%), exceptional mental situation (n = 282, 9.8%), agitation (n = 262, 9.1%), anxiety and panic disorders (n = 262, 9.1%) and “psychiatric miscellaneous” (n = 245, 8.5%). Inpatient hospitalization occurred in 67.9% (n = 1958) of emergency missions. Of these, 20.3% (n = 392) were admitted directly to a psychiatric hospital. Male emergency physicians had a slightly longer "on-scene" time for psychiatric emergencies than female emergency physicians (p = 0.024). However, the variance in "on-scene" time for all interventions was significantly greater for female emergency physicians than for male emergency physicians (p = 0.025). Male emergency physicians were significantly more likely than their female counterparts to administer intravenous hypnotics in prehospital psychiatric emergencies (p = 0.001). For psychiatric patients who refused medically indicated inpatient psychiatric admission (“involuntary psychiatric admission”), male and female emergency physicians were equally likely to take the required action (p = 0.522). However, male emergency physicians were significantly more likely to administer an intravenous hypnotic to enforce involuntary admission (p = 0.009). Conclusions Similar to other medical specialties where the influence of physician gender on patient care is certainly relevant, the gender of prehospital emergency physicians also appears to influence their prehospital management strategy in psychiatric emergencies. The influence of gender is sometimes subtle and limited to specific aspects, such as the administration of hypnotics. Prospective study designs are needed to thoroughly investigate the influence of the gender of the prehospital emergency physician on the quality of care in psychiatric emergencies. Trial registration The study was approved by the ethics committee of the University Ulm, Trial-Code No. 110/22 and was prospectively registered in the German Clinical Trials Register (DRKS-ID: DRKS00031237). Patient information was not required for retrospective data analysis.

Airway management and rapid sequence induction are critical measures in emergency medicine that directly affect patient morbidity and mortality. As a result of patient- and emergency response-related factors and the critical patient state, securing the airway in emergencies should always be considered difficult. Although videolaryngoscopy contributes to safety in airway management, provider teams should be confident in using airway management strategies other than endotracheal intubation as directed by a "difficult airway algorithm." Besides securing the airway, inadequately performing rapid sequence induction in critically ill or injured patients might have a detrimental effect on the patient's condition. Therefore, proper decision making and establishment of the indication as well as structured preparation of patient, medication, and devices is of utmost importance for safe performance. Taking the interdisciplinary and multiprofessional composition of emergency medical response teams into account, the need for a standardized educational approach to prehospital emergency care is identified. This manuscript describes educational approaches as well as the role of simulation- and scenario-based training in airway management and rapid sequence induction for emergency medicine providers.

Background Over recent decades, emergency medical services in Germany experience rising mission numbers. So far, effects on EMS physician staffing in urban and rural areas by demographic changes in Germany remain unclear. Methods Online survey among EMS physicians in Germany evaluating demographic and further parameters critical for EMS physician staffing. Results EMS physicians older than 59 years (10,1 vs. 4,5% [urban], p < 0,001) as well as such physicians who tend to quit service within 5 years (19,8 vs. 14,7%, p = 0,006), are more frequent in rural areas. A multivariate analysis revealed appropriate salaries (p = 0.002) as well as satisfaction with prehospital job settings (p < 0.001) to be associated with longer intended service time. Conclusion This study provides novel insights into demographic differences between EMS physicians in German urban and rural areas. Anticipating factors identified here such as appropriate job settings might improve staff retention.

BackgroundThe need for interhospital transport (IHT) of intensive care patients is increasing due to changes in the hospital environment. Interhospital transports are challenging and require careful operational planning of personnel and rescue vehicles. ObjectiveTo investigate the need for IHT, an analysis was conducted in the service area of the emergency medical service central dispatch center (IRLS) in Schleswig-Holstein. Material and methodsEmergency physician-assisted IHT were analyzed in the period from 01.10.2021 to 30.09.2022. ResultsOf a total of 158,823 documented IRLS missions, 2264 (1.4%) records could be identified and included as IHT: 1389 IHT (61.4%) were managed by specialized ambulances, 875 (38.6%) by primary care ambulances. Primary care ambulances were mainly used for time-critical transfers and outside the duty hours of the intensive care ambulances, 21.2 % were by air. Of all IHT, 43.1% were required to hospitals with a higher level of medical care. ConclusionEmergency physician-assisted IHT are a relevant part of the emergency service's operational spectrum and concern both primary care and specialized rescue vehicles. A relevant number of urgent IHT were recorded outside the duty hours of the intensive care ambulances. For emergency transports during nighttime, an expansion of air-based transfer capacities should be considered due to the time advantage. For less urgent IHT, an adjustment of the capacities of specialized ground-based vehicles in Schleswig-Holstein seems reasonable.

Abstract Background Postoperative respiratory failure is the most frequent complication in postsurgical patients. The purpose of this study is to assess whether pulmonary function testing in high-risk patients during preoperative assessment detects previously unknown respiratory impairments which may influence patient outcomes. Methods A targeted patient screening by spirometry and the measurement of the diffusing capacity of the lung for carbon monoxide (DLCO) was implemented in the anesthesia department of a tertiary university hospital. Patients of all surgical disciplines who were at least 75 years old or exhibited reduced exercise tolerance with the metabolic equivalent of task less than four (MET < 4) were examined. Clinical characteristics, history of lung diseases, and smoking status were also recorded. The statistical analysis entailed t-tests, one-way ANOVA, and multiple linear regression with backward elimination for group comparisons. Results Among 256 included patients, 230 fulfilled the test quality criteria. Eighty-one (35.2%) patients presented obstructive ventilatory disorders, out of which 65 were previously unknown. 38 of the newly diagnosed obstructive disorders were mild, 18 moderate, and 9 severe. One hundred forty-five DLCO measurements revealed 40 (27.6%) previously unknown gas exchange impairments; 21 were mild, 17 moderate, and 2 severe. The pulmonary function parameters of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and DLCO were significantly lower than the international reference values of a healthy population. Patients with a lower ASA class and no history of smoking exhibited higher FVC, FEV1, and DLCO values. Reduced exercise tolerance with MET < 4 was strongly associated with lower spirometry values. Conclusions Our screening program detected a relevant number of patients with previously unknown obstructive ventilatory disorders and impaired pulmonary gas exchange. This newly discovered sickness is associated with low metabolic equivalents and may influence perioperative outcomes. Whether optimized management of patients with previously unknown impaired lung function leads to a better outcome should be evaluated in multicenter studies. Trial registration German Registry of Clinical Studies (DRKS00029337), registered on: June 22nd, 2022.