German Intensive Care Units Research Articles

Assessing the impact of Delta and Omicron in German intensive care units: a retrospective, nationwide multistate analysis

BackgroundThe spread of several severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) variants of concern (VOCs) has repeatedly led to increasing numbers of coronavirus disease 2019 (COVID-19) patients in German intensive care units (ICUs), resulting in capacity shortages and even transfers of COVID-19 intensive care patients between federal states in late 2021. In this respect, there is scarce evidence on the impact of predominant VOCs in German ICUs at the population level.MethodsA retrospective cohort study was conducted from July 01, 2021, to May 31, 2022, using daily nationwide inpatient billing data from German hospitals on COVID-19 intensive care patients and SARS-CoV-2 sequence data from Germany. A multivariable Poisson regression analysis was performed to estimate the incidence rate ratios (IRRs) of transfer (to another hospital during inpatient care), discharge (alive) and death of COVID-19 intensive care patients associated with Delta or Omicron, adjusted for age group and sex. In addition, a multistate approach was used for the clinical trajectories of COVID-19 intensive care patients to estimate their competing risk of transfer, discharge or death associated with Delta or Omicron, specifically concerning patient age.ResultsA total of 6046 transfers, 33256 discharges, and 12114 deaths were included. Poisson regression analysis comparing Omicron versus Delta yielded an estimated adjusted IRR of 1.23 (95% CI 1.16–1.30) for transfers, 2.27 (95% CI 2.20–2.34) for discharges and 0.98 (95% CI 0.94–1.02) for deaths. For ICU deaths in particular, the estimated adjusted IRR increased from 0.14 (95% CI 0.08–0.22) for the 0–9 age group to 4.09 (95% CI 3.74–4.47) for those aged 90 and older compared to the reference group of 60-69-year-olds. Multistate analysis revealed that Omicron was associated with a higher estimated risk of discharge for COVID-19 intensive care patients across all ages, while Delta infection was associated with a higher estimated risk of transfer and death.ConclusionsRetrospective, nationwide comparisons of transfers, discharges and deaths of COVID-19 intensive care patients during Delta- and Omicron-dominated periods in Germany suggested overall less severe clinical trajectories associated with Omicron. Age was confirmed to be an important determinant of fatal clinical outcomes in COVID-19 intensive care patients, necessitating close therapeutic care for elderly people and appropriate public health control measures.

Critical care nurses' decision-making regarding verification of blindly inserted gastric tubes: A cross-sectional questionnaire study

Critical care nurses' decision-making regarding verification of blindly inserted gastric tubes: A cross-sectional questionnaire study Abstract: Background: The placement and verification of the correct position of blindly applied gastric tubes is regularly performed by nurses in clinical practice. International guidelines recommend a radiological verification as a "first-line" method or if pH measurement is not possible. For Germany, neither evidence-based recommendations nor current data are available. Question: Which methods are used by nurses in German intensive care units for verification of the correct position of blindly applied gastric tubes and how do they assess the reliability of different methods? Methods: Multicenter questionnaire survey. Intensive care units in a non-probability, citeria-based sampling of hospitals in and around Cologne, Germany were included. One nurse was included per participating ward. Analyses were mostly descriptive. Results: In 22 hospitals, 38 wards agreed to participate and 32 (84%) responded to the survey. Auscultation of the upper abdomen with simultaneous air insufflation and aspiration of gastric secretions are frequently used methods for determining the position of gastric tubes. Participants consider auscultation, aspiration of gastric secretions, and radiological control as reliable methods. Conclusions: The findings are in contrast to international recommendations and support the need for evidence-based best practice recommendations and training. Likewise, there is a need for research on feasible bedside methods.

Application and control of intravenous fluids in German intensive care units : Anational survey among critical care physicians

The administration of intravenous fluids includes various indications, e.g., fluid replacement, nutritional therapy or as asolvent for drugs and is acommon routine in the intensive care unit (ICU); however, overuse of intravenous fluids can lead to fluid overload, which can be associated with a poorer outcome in critically ill patients. The aim of this survey was to find out the current status of the use and management of intravenous fluids as well as the interprofessional cooperation involving clinical pharmacists on German ICUs. An online survey with 33questions was developed. The answers of 62participants from the Scientific Working Group on Intensive Care Medicine of the German Society for Anesthesiology and Intensive Care Medicine were evaluated. Fluid overload occurs "frequently" in 62.9% (39/62) and "very frequently" in 9.7% (6/62) of the ICUs of respondents. An established standard for an infusion management system is unknown to 71.0% (44/62) of participants and 45.2% of the respondents stated that they did not have apatient data management system. In addition, the participants indicated how they define fluid overload. This was defined by the presence of edema by 50.9% (28/55) and by positive fluid balance by 30.9% (17/55). According to the participants septic patients (38/60; 63.3%) and cardiological/cardiac surgical patients (26/60; 43.3%) are most susceptible to the occurrence of fluid overload. Interprofessional collaboration among intensive care physicians, critical care nurses, and clinical pharmacists to optimize fluid therapy was described as "relevant" by 38.7% (24/62) and "very relevant" by 45.2% (28/62). Participants with clinical pharmacists on the wards (24/62; 38.7%) answered this question more often as "very relevant" with 62.5% (15/24). Fluid overload is afrequent and relevant problem in German intensive care units. Yet there are few established standards in this area. There is also alack of validated diagnostic parameters and aclear definition of fluid overload. These are required to ensure appropriate and effective treatment that is tailored to the patient and adapted to the respective situation. Intravenous fluids should be considered as drugs that may exert side effects or can be overdosed with severe adverse consequences for the patients. One approach to optimize fluid therapy could be achieved by afluid stewardship corresponding to comparable established procedures of the antibiotic stewardship. In particular, fluid stewardship will contribute to drug safety of intravenous fluids profiting from joined expertise in asetting of interprofessional collaboration. An important principle of fluid stewardship is to consider intravenous fluids in the same way as medication in terms of their importance. Furthermore, more in-depth studies are needed to investigate the effects of interprofessional fluid stewardship in aprospective and controlled manner.

Onboarding of young professionals in the intensive care unit : Nationwide online survey by young DIVI-an initiative of the German interdisciplinary association for intensive and emergency medicine (DIVI)

Onboarding of junior staff in the intensive care unit is vital to ensure high-quality critical care treatment. This process depends on beginner's training. We aimed to determine structure and duration of intensive care onboarding and the job satisfaction of junior professionals in German intensive care units. We conducted an anonymous, interprofessional online survey regarding quality of onboarding and job satisfaction among young professionals. A total of 554 young professionals participated, about two thirds were physicians. Awritten concept was used in 59% of the nurse's and 27% of physicians' training. Median duration of training before taking full charge of patient treatment was 30days among nurses and 7days among physicians. About one third of nurses and 17% of physicians stated that they were sufficiently prepared after the training period, whereby 49% of physicians often felt overwhelmed. More than 42% can imagine working in critical care longer than the next 3years. Fundamental methods for training of critical care professionals starting their intensive care career are underused in Germany and the duration of training blatantly differs from national guideline recommendations. Although there seem to be deficits concerning material and staff resources, participants are satisfied with learning progress and teamwork.

COVID-19 crisis management of German ICU clinicians in leadership - a metaphor analysis.

The COVID-19 pandemic coincided with an already long-standing crisis in health systems around the world characterized by economic pressure and increasing staff shortage. "Crisis" became a global metaphor to convey collective experiences of the COVID-19 threat. Little is known on how crisis metaphors influence thought and speech on crisis management and the challenging staff situation of intensive care unit (ICU) clinicians in leadership positions and how they act. Therefore, we were interested in (1) which metaphorical concepts ICU clinicians in leadership use to express experiences and strategies in dealing with coinciding crises, (2) how these change over time, and (3) how metaphors in speech reveal self-images of crisis management. We conducted a systematic metaphor analysis focusing on data from three participants of a qualitative interview study with twenty-four healthcare professionals in ICUs in Germany. The participants were interviewed at two time points between April 2020 and March 2021. We identified and reconstructed metaphorical concepts of three interviewees (ICU clinicians in leadership) with regard to the pandemic management, and developed a typology based on the dimensions of mood, modus operandi, location, and scope. The typology consists of eight self-images (protagonists) for the crisis management of ICU clinicians in leadership, such as the figure of the soldier ("to unite everyone behind this flag"), the distributor ("sometimes it is a crazy patchwork [wahnsinniges Gestückel]") or the critic ("we are the fool for everything"). They embody different qualities of a leader and refer to intra- and inter-role conflicts within multiple crisis conditions. Metaphor analysis reveals different self-images of ICU leadership clinicians in relation to crisis management. This illustrates that thinking and perceptions of crisis management may strongly differ between and within leaders and may change over the course of crises. Our findings highlight the need both to improve knowledge on challenges associated with leadership in crises and preparedness, and to support clinicians in their leadership by recognizing and addressing differences and changes in leaders' self-image.

The structural and spatial design of German intensive care units from the point of view of infection control measures : Survey among ICU-KISS participants

Intensive care unit (ICU) structural and spatial design may play arole in infection prevention and control. Between 09/2021 and 11/2021 we performed an online survey among ICUs in Germany, Austria and Switzerland. A total of 597 (40%) of the invited ICUs answered the survey; 20% of the ICUs were built before 1990. The median number of single rooms with interquartile range is 4(IQR 2-6). The median total room number is 8(IQR 6-12). The median room size is 19(IQR 16-22) m2 for single rooms and 31(26-37.5) m2 for multiple bed rooms. Furthermore, 80% of ICUs have sinks and 86.4% have heating, ventilation, air conditioning (HVAC) systems in patient rooms. 54.6% of ICUs must store materials outside of storage rooms due to lack of space and only 33.5% have aroom dedicated to disinfection and cleaning of used medical devices. Comparing ICUs built before 1990 and after 2011 we could show aslightly increase of single rooms (3[IQR 2-5] before 1990vs. 5[IQR 2-8] after 2011; p < 0.001). Alarge proportion of German ICUs do not meet the requirements of German professional societies regarding the number of single rooms and size of the patient rooms. Many ICUs lack storage space and other functional rooms. There is an urgent need to support the construction and renovation of intensive care units in Germany with adequate funding.

Influence of working conditions and salary on agency work for intermediate and intensive care units : Part2: Partial results of a nationwide survey.

Agency work in nursing is used as aform of labor to counter vacant staff positions in hospitals. Both hospital owners and nurses view this critically for different reasons. The aim of this study was to assess what personal net income nurses in German intensive care units and intermediate care units consider "fair and sufficient" for their work (addressed in Part1 of the survey) and what influence-aside from the salary-the working conditions have on the willingness to change to temporary work or back to apermanent position. From September to October 2020, an anonymous online survey was conducted among nurses of intermediate care units, intensive care units, and special care units in German-speaking countries. Descriptive statistics were used for the analysis. Of 1203 participants, 86% (n = 1036) could be evaluated. None of the job satisfaction factors queried received four or five stars (maximum five stars) from those participating in the survey. The most unsatisfied group proved to be regularly employed nurses with an additional part-time job. Key job satisfaction factors differed markedly between the groups, with regular employees favoring consistency and stability. Agency workers prefer gaining experience in abroader range of tasks. Unreliable duty rosters and poor nurse to patient ratios were common points of criticism. For job satisfaction, making nurses feel appreciated and respected is essential. This includes aguaranteed nurse to patient ratio and reliable duty rosters that also include tasks outside direct patient care. In order for nurses to leave agency work, it is necessary to take into account the differences in interests in terms of the focus of activity.

Safety management in times of crisis: Lessons learned from a nationwide status-analysis on German intensive care units during the COVID-19 pandemic

BackgroundThe status of Safety Management is highly relevant to evaluate an organization's ability to deal with unexpected events or errors, especially in times of crisis. However, it remains unclear to what extent Safety Management was developed and sufficiently implemented within the healthcare system during the COVID-19 pandemic. Providing insights of potential for improvement is expected to be directional for ongoing Safety Management efforts, in times of crisis and beyond.MethodA nationwide survey study was conducted among healthcare professionals and auxiliary staff on German Intensive Care Units (ICUs) evaluating their experiences during the first wave of the COVID-19 pandemic. Error Management and Patient Safety Culture (PSC) measures served to operationalize Safety Management. Data were analyzed descriptively and by using quantitative content analysis (QCA).ResultsResults for n = 588 participants from 53 hospitals show that there is a gap between errors occurred, reported, documented, and addressed. QCA revealed that low quality of safety culture (27.8%) was the most mentioned reason for errors not being addressed. Overall, ratings of PSC ranged from 26.7 to 57.9% positive response with Staffing being the worst and Teamwork Within Units being the best rated dimension. While assessments showed a similar pattern, medical staff rated PSC on ICUs more positively in comparison to nursing staff.ConclusionThe status-analysis of Safety Management in times of crisis revealed relevant potential for improvement. Human Factor plays a crucial role in the occurrence and the way errors are dealt with on ICUs, but systemic factors should not be underestimated. Further intensified efforts specifically in the fields of staffing and error reporting, documentation and communication are needed to improve Safety Management on ICUs. These findings might also be applicable across nations and sectors beyond the medical field.

End-of-life practices in 11German intensive care units : Results from the ETHICUS-2 study.

End-of-life care is common in German intensive care units (ICUs) but little is known about daily practice. To study the practice of end-of-life care. Prospectively planned, secondary analysis comprising the German subset of the worldwide Ethicus‑2 Study (2015-2016) including consecutive ICU patients with limitation of life-sustaining therapy or who died. Among 1092 (13.7%) of 7966 patients from 11multidisciplinary ICUs, 967 (88.6%) had treatment limitations, 92 (8.4%) died with failed CPR, and 33 (3%) with brain death. Among patients with treatment limitations, 22.3% (216/967) patients were discharged alive from the ICU. More patients had treatments withdrawn than withheld (556 [57.5%] vs. 411 [42.5%], p < 0.001). Patients with treatment limitations were older (median 73years [interquartile range (IQR) 61-80] vs. 68years [IQR 54-77]) and more had mental decision-making capacity (12.9vs. 0.8%), advance directives (28.6vs. 11.2%), and information about treatment wishes (82.7 vs 33.3%, all p < 0.001). Physicians reported discussing treatment limitations with patients with mental decision-making capacity and families (91.3and 82.6%, respectively). Patient wishes were unknown in 41.3% of patients. The major reason for decision-making was unresponsiveness to maximal therapy (34.6%). Treatment limitations are common, based on information about patients' wishes and discussion between stakeholders, patients and families. However, our findings suggest that treatment preferences of nearly half the patients remain unknown which affects guidance for treatment decisions.

Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC

BackgroundNeurologic manifestations are increasingly reported in patients with coronavirus disease 2019 (COVID-19). Yet, data on prevalence, predictors and relevance for outcome of neurological manifestations in patients requiring intensive care are scarce. We aimed to characterize prevalence, risk factors and impact on outcome of neurologic manifestations in critically ill COVID-19 patients.MethodsIn the prospective, multicenter, observational registry study PANDEMIC (Pooled Analysis of Neurologic DisordErs Manifesting in Intensive care of COVID-19), we enrolled COVID-19 patients with neurologic manifestations admitted to 19 German intensive care units (ICU) between April 2020 and September 2021. We performed descriptive and explorative statistical analyses. Multivariable models were used to investigate factors associated with disorder categories and their underlying diagnoses as well as to identify predictors of outcome.ResultsOf the 392 patients included in the analysis, 70.7% (277/392) were male and the mean age was 65.3 (SD ± 3.1) years. During the study period, a total of 2681 patients with COVID-19 were treated at the ICUs of 15 participating centers. New neurologic disorders were identified in 350 patients, reported by these centers, suggesting a prevalence of COVID-19-associated neurologic disorders of 12.7% among COVID-19 ICU patients. Encephalopathy (46.2%; 181/392), cerebrovascular (41.0%; 161/392) and neuromuscular disorders (20.4%; 80/392) were the most frequent categories identified. Out of 35 cerebrospinal fluid analyses with reverse transcriptase PCR for SARS-COV-2, only 3 were positive. In-hospital mortality was 36.0% (140/389), and functional outcome (mRS 3 to 5) of surviving patients was poor at hospital discharge in 70.9% (161/227). Intracerebral hemorrhage (OR 6.2, 95% CI 2.5–14.9, p < 0.001) and acute ischemic stroke (OR 3.9, 95% CI 1.9–8.2, p < 0.001) were the strongest predictors of poor outcome among the included patients.ConclusionsBased on this well-characterized COVID-19 ICU cohort, that comprised 12.7% of all severe ill COVID-19 patients, neurologic manifestations increase mortality and morbidity. Since no reliable evidence of direct viral affection of the nervous system by COVID-19 could be found, these neurologic manifestations may for a great part be indirect para- or postinfectious sequelae of the infection or severe critical illness. Neurologic ICU complications should be actively searched for and treated.

Standardized concentrations for continuous infusion-results of anationwide survey in German intensive care units

HintergrundIntensivpatienten erhalten zahlreiche Arzneimittel (AM) als Dauerinfusion appliziert. In Deutschland fehlt bisher für die als Dauerinfusion applizierten AM eine einheitliche Liste mit Standardkonzentrationen.Ziel der ArbeitZiel war es, bundesweit repräsentative Informationen zu Standardkonzentrationen von als Dauerinfusion mittels Spritzenpumpe oder Infusionspumpe applizierten AM auf den Intensivstationen zu gewinnen.Material und MethodenZur Ermittlung der Akzeptanz und Präferenz für Dauerinfusionen von ausgewählten AM wurde ein Fragenkatalog in einem online- Umfragetool entwickelt und von der DIVI an die jeweils verantwortlichen Leiter*innen von 1816 Intensivstationen versendet. Die Umfrage umfasste Vorschläge zu 59 AM mit insgesamt 73 Konzentrationen. Ergänzend konnten die Teilnehmer in Freitextfeldern eigene Vorschläge zu AM und entsprechenden Konzentrationen angeben. Die Häufigkeit der Verwendung der Arzneimittel als Dauerinfusion und der präferierten Standardkonzentrationen wurde bezogen auf die Zahl der Antworten pro Arzneimittel berechnet.ErgebnisseDie Umfrage wurde von 312 (17 %) Intensivstationen beantwortet. Die Akzeptanzrate für das Prinzip der geschwindigkeitsgesteuerten Dauerinfusion in Standardkonzentrationen ist deutschlandweit sehr hoch, Die Top 10 bzw. 25 der vorgeschlagenen AM werden von über 90 % bzw. 50 % der Teilnehmer regelmäßig als Dauerinfusion eingesetzt. Für viele dieser AM konnte eine oder mehrere präferierte Konzentrationen identifiziert werden.DiskussionDie Top-37-Arzneimittel und die präferierten Konzentrationen sind als Grundlage für eine bundesweit geltende Standardliste mit Standardkonzentrationen für Dauerinfusionen (in der Regel 50 ml) geeignet. Die damit befassten Fachgesellschaften können basierend auf den Umfrageergebnissen eine bundeseinheitliche Standardliste konsentieren.

COVID-19 Intensive Care-Evaluation of Public Information Sources and Current Standards of Care in German Intensive Care Units: A Cross Sectional Online Survey on Intensive Care Staff in Germany.

Backround: In February 2021, the first formal evidence and consensus-based (S3) guidelines for the inpatient treatment of patients with COVID-19 were published in Germany and have been updated twice during 2021. The aim of the present study is to re-evaluate the dissemination pathways and strategies for ICU staff (first evaluation in December 2020 when previous versions of consensus-based guidelines (S2k) were published) and question selected aspects of guideline adherence of standard care for patients with COVID-19 in the ICU. Methods: We conducted an anonymous online survey among German intensive care staff from 11 October 2021 to 11 November 2021. We distributed the survey via e-mail in intensive care facilities and requested redirection to additional intensive care staff (snowball sampling). Results: There was a difference between the professional groups in the number, selection and qualitative assessment of information sources about COVID-19. Standard operating procedures were most frequently used by all occupational groups and received a high quality rating. Physicians preferred sources for active information search (e.g., medical journals), while nurses predominantly used passive consumable sources (e.g., every-day media). Despite differences in usage behaviour, the sources were rated similarly in terms of the quality of the information on COVID-19. The trusted organizations have not changed over time. The use of guidelines was frequently stated and highly recommended. The majority of the participants reported guideline-compliant treatment. Nevertheless, there were certain variations in the use of medication as well as the criteria chosen for discontinuing non-invasive ventilation (NIV) compared to guideline recommendations. Conclusions: An adequate external source of information for nursing staff is lacking, the usual sources of physicians are only appropriate for the minority of nursing staff. The self-reported use of guidelines is high.

Influence of working conditions and salary on temporary agency work for intermediate care and intensive care units : Partial results of anationwide survey

HintergrundLeiharbeit in der Pflege wird als Arbeitsform verwendet, um offenen Personalstellen in Kliniken zu begegnen. Sowohl Krankenhausträger als auch Pflegekräfte sehen dies aus unterschiedlichen Gründen kritisch.ZielZweck dieser Untersuchung war es herauszufinden, welches persönliche Nettoeinkommen Pflegekräfte von deutschen Intensivstationen und Intermediate-Care-Stationen als „gerecht und ausreichend“ für ihre Tätigkeit empfinden und welchen Einfluss das Gehalt auf die Wechselwilligkeit in die Leih‑/Zeitarbeit bzw. wieder zurück in eine Festanstellung haben.MethodeVon September bis Oktober 2020 wurde eine anonymisierte Onlineumfrage unter Pflegenden von Intermediate-Care-Stationen, Intensivstationen und Funktionsbereichen im deutschsprachigen Raum durchgeführt. Die Auswertung erfolgte mittels deskriptiver Statistik.ErgebnisVon 1203 Teilnehmer_innen (TN) konnten 1036 (86 %) in Deutschland Arbeitende ausgewertet werden. Die Frage nach dem persönlichen Nettoeinkommen wurde von 1032 (99 %) TN beantwortet. Der überwiegende Anteil der Befragten (n = 522) gibt an, über ein persönliches Nettoeinkommen von 2000–2999 €/Monat zu verfügen. Der Wunsch, in die Leiharbeit zu gehen, ist in der untersuchten Stichprobe geringer, je höher das persönliche Nettoeinkommen ist. Die TN in Festanstellung ohne Nebenerwerb empfinden ein persönliches Nettoeinkommen von 3200 €/Monat (Median 3200 €; IQR 2800–3800 €) als ausreichend und gerecht für ihre Tätigkeit. Von den Leiharbeiter_innen gaben 142 Personen an, dass ein persönliches Nettoeinkommen von 3200 €/Monat (Median 3200 €; Interquartilsabstand 3000–3950 €) ausreichend wäre, um von der Leiharbeit zurück in eine Festanstellung zu wechseln.SchlussfolgerungDie Intensivpflegenden dieser Umfrage empfinden ein Gehalt von 3200 €/Monat netto als ausreichend und gerecht für ihre Tätigkeit. Die Gehaltshöhe kann ein Parameter für die Entscheidung sein, in die Leiharbeit zu gehen, aber auch um wieder in die Festanstellung zu wechseln. Unabhängig vom Gehalt wurden bessere Arbeitsbedingungen für alle befragten Gruppen als essenzieller Bestandteil in Bezug auf die Arbeitszufriedenheit angegeben.

A beginner’s view of end of life care on German intensive care units

BackgroundLittle is known about importance and implementation of end-of-life care (EOLC) in German intensive care units (ICU). This survey analyses preferences and differences in training between “medical” (internal medicine, neurology) and “surgical” (surgery, anaesthesiology) residents during intensive care rotation.MethodsThis is a point-prevalence study, in which intensive care medicine course participants of one educational course were surveyed. Physicians from multiple ICU and university as well as non-university hospitals and all care levels were asked to participate. The questionnaire was composed of a paper and an electronic part. Demographic and structural data were prompted and EOLC data (48 questions) were grouped into six categories considering importance and implementation: category 1 (important, always implemented), 2 (important, sometimes implemented), 3 (important, never implemented) and 4–6 (unimportant, implementation always, sometimes, never). The trial is registered at the “Deutsches Register für klinische Studien (DRKS)”, Study number DRKS00026619, registered on September 10th 2021, www.drks.de.ResultsOverall, 194/ 220 (88%) participants responded. Mean age was 29.7 years, 55% were female and 60% had scant ICU working experience. There were 64% medical and 35% surgical residents. Level of care and size of ICU differed significantly between medical and surgical (both p < 0.001). Sufficient implementation was stated for 66% of EOLC questions, room for improvement (category 2 and 3) was seen in 25, and 8% were classified as irrelevant (category 6). Areas with the most potential for improvement included prognosis and outcome and patient autonomy. There were no significant differences between medical and surgical residents.ConclusionsEven though EOLC is predominantly regarded as sufficiently implemented in German ICU of all specialties, our survey unveiled still 25% room for improvement for medical as well as surgical ICU residents. This is important, as areas of improvement potential may be addressed with reasonable effort, like individualizing EOLC procedures or setting up EOLC teams. Health care providers as well as medical societies should emphasize EOLC training in their curricula.

No increase of device associated infections in German intensive care units during the start of the COVID-19 pandemic in 2020

BackgroundThe COVID-19 pandemic may have had a substantial impact on the incidence of device-associated healthcare-associated infections (HAI), in particular in intensive care units (ICU). A significant increase of HAI was reported by US hospitals when comparing incidence rates from 2019 and 2020. The objective of this study was to investigate the development of the most relevant device-associated HAI in German ICUs during the year 2020 as compared to 2019.MethodsWe utilized the data of the ICU component of the German National Reference Center for Surveillance of Nosocomial Infections (KISS = Krankenhaus-Infektions-Surveillance-System) for the period 2019–2020. We focused on central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated lower respiratory infections (VALRTI) and bloodstream infections associated with the use of Extracorporeal-Life-Support-Systems (ECLSABSI). Device use was defined as the number device days per 100 patient days; device-associated infection rates as the number of device-associated infections per 1000 device days. To compare the pooled means between the years and quarters we calculated rate ratios of device-associated infection rates with 95% confidence intervals by Poisson regression models.ResultsThe number of participating ICUs in the surveillance system decreased from 982 in 2019 to 921 in 2020 (6.2%). Device utilization rates increased significantly for central lines and ventilator use. VALRTI rates and CAUTI rates decreased in 2020 compared with 2019, however, no increase was shown for CLABSI or ECLSABSI. This result was also confirmed when the corresponding quarters per year were analyzed.ConclusionsThe lack of an increase in device-associated healthcare associated infections (HAI) in German ICUs may be due to the lower overall incidence of COVID-19 cases in Germany in 2020 compared with US, to a very high availability of ICU beds per 100,000 inhabitants compared with many other countries, and a change in the ICU patient mix due to numerous elective procedures that were postponed during the first two waves. The primary reason seems to be that only 7% of all ICU patients in Germany in 2020 were COVID-19 patients.

Drug therapy safety supported by interprofessional collaboration between ICU physicians and clinical pharmacists in critical care units in Germany : Results of asurvey

Critically ill patients are particularly susceptible to adverse drug events. International studies show that pharmaceutical care has apositive impact on patient and drug therapy safety. Nationally, the integration of pharmacists into the multidisciplinary team and participation in ward rounds is required. The aim of this work is to assess the scope and extent of pharmaceutical care in intensive care units (ICU) in Germany. In aliterature and database search, 13relevant pharmaceutical activities were identified. Based on this, an online survey with 27questions on the implementation of pharmaceutical care in ICU was prepared by apanel of experts. The survey was sent to heads of German ICUs. Of the participants, 35.3% (59/167) have established regular pharmaceutical care. Drug information (89.7% [52/58]), pharmaceutical interventions with change of therapy (e.g., ward rounds; 67,2% [39/58]), regular evaluation of prescriptions (medication analysis; 65.5% [38/58]) as well as the monitoring of medication (e.g., side effects, effectiveness, costs; 63.8% [37/58]) were most frequently mentioned. The participants with pharmaceutical care (58/168) graded 7of13 but those without (104/168) only two activities as 'essential/indispensable'. Only afew ICU in Germany have already integrated ward pharmacists into the multidisciplinary team. Once apharmaceutical service has been established, agreater role/importance is assigned to several pharmaceutical activities.

IGNITE Status Epilepticus Survey: A Nationwide Interrogation about the Current Management of Status Epilepticus in Germany.

We aimed to evaluate the current management of status epilepticus (SE) in intensive care units (ICUs) in Germany, depending on the different hospital levels of care and the ICU specialty. We performed a nationwide web-based anonymized survey, including all German ICUs registered with the German Society for Neurointensive and Emergency Care (Deutsche Gesellschaft für Neurointensiv- und Notfallmedizin; DGNI). The response rate was 83/232 (36%). Continuous EEG monitoring (cEEG) was available in 86% of ICUs. Regular written cEEG reports were obtained in only 50%. Drug management was homogeneous with a general consensus regarding substance order: benzodiazepines—anticonvulsants—sedatives. Thereunder first choice substances were lorazepam (90%), levetiracetam (91%), and propofol (73%). Data suggest that network structures for super-refractory SE are not permeable, as 75% did not transfer SE patients. Our survey provides “real world data” concerning the current management of SE in Germany. Uniform standards in the implementation of cEEG could help further improve the overall quality. Initial therapy management is standardized. For super-refractory SE, a concentration of highly specialized centers establishing network structures analogous to neurovascular diseases seems desirable to apply rescue therapies with low evidence carefully, ideally collecting data on this rare condition in registries and clinical trials.

Intensive Care Unit-Acquired Weakness : Anationwide survey on diagnostics, monitoring and treatment strategies on German intensive care units

HintergrundDie „Intensive Care Unit-Acquired Weakness“ (ICU-AW) ist eine der häufigsten Ursachen für eine neuromuskuläre Dysfunktion in der Intensivmedizin. Gegenwärtig fehlen evidenzbasierte Empfehlungen zur Diagnostik, zum Monitoring und zu therapeutischen Maßnahmen.Ziel der ArbeitDie Erfassung des derzeitigen Vorgehens bei Diagnostik, Monitoring und präventiven und therapeutischen Ansätzen bei der ICU-AW auf deutschen Intensivstationen.Material und MethodenOnlinebefragung von 448 Mitgliedern des Wissenschaftlichen Arbeitskreises Intensivmedizin (WAKI) und des Wissenschaftlichen Arbeitskreises Neuroanästhesie (WAKNA).ErgebnisseInsgesamt wurden 68/448 (15,2 %) Fragebogen ausgewertet. Bei 13,4 % (9/67) der Befragten existiert ein strukturiertes diagnostisches Vorgehen zur Detektion der ICU-AW. Für Screening (60/68; 88,2 %) und Verlaufsbeurteilung (57/65; 87,7 %) wird die klinische Untersuchung präferiert. Etablierte Scores, wie der „Medical Research Council sum score“ (MRC-SS) spielen für Screening und Verlaufskontrolle der ICU-AW eine untergeordnete Rolle (7/68; 10,3 % und 7/65; 10,8 %). Mobilisation (45/68; 66,2 %) und Sedativareduktion (38/68; 55,9 %) stellen die häufigsten präventiven und therapeutischen Ansätze dar. Ein Mangel an Physiotherapeuten (64/68; 94,1 %) und Pflegekräften (57/68; 83,8 %) wird als Hauptdefizit bei der Versorgung von Patienten mit ICU-AW identifiziert. Insgesamt 91,2 % (62/68) der Befragten befürworten die Erstellung evidenzbasierter Empfehlungen zur Diagnostik, zum Monitoring und zu therapeutischen Ansätzen bei ICU-AW.DiskussionEin einheitliches Konzept für Diagnostik, Monitoring, Prävention und Therapie der ICU-AW auf deutschen Intensivstationen fehlt weitgehend. Innovative diagnostische Ansätze könnten in Zukunft helfen, Patienten mit einem hohem Risiko für eine ICU-AW frühzeitig zu detektieren, präventive Maßnahmen einzuleiten sowie wertvolle prognostische Informationen zu gewinnen.Zusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00101-022-01089-9) enthält den der Studie zugrunde liegenden Fragebogen.

The impact of the COVID-19 pandemic on non-COVID induced sepsis survival

BackgroundThe COVID-19 pandemic has taken a toll on health care systems worldwide, which has led to increased mortality of different diseases like myocardial infarction. This is most likely due to three factors. First, an increased workload per nurse ratio, a factor associated with mortality. Second, patients presenting with COVID-19-like symptoms are isolated, which also decreases survival in cases of emergency. And third, patients hesitate to see a doctor or present themselves at a hospital. To assess if this is also true for sepsis patients, we asked whether non-COVID-19 sepsis patients had an increased 30-day mortality during the COVID-19 pandemic.MethodsThis is a post hoc analysis of the SepsisDataNet.NRW study, a multicentric, prospective study that includes septic patients fulfilling the SEPSIS-3 criteria. Within this study, we compared the 30-day mortality and disease severity of patients recruited pre-pandemic (recruited from March 2018 until February 2020) with non-COVID-19 septic patients recruited during the pandemic (recruited from March 2020 till December 2020).ResultsComparing septic patients recruited before the pandemic to those recruited during the pandemic, we found an increased raw 30-day mortality in sepsis-patients recruited during the pandemic (33% vs. 52%, p = 0.004). We also found a significant difference in the severity of disease at recruitment (SOFA score pre-pandemic: 8 (5 - 11) vs. pandemic: 10 (8 - 13); p < 0.001). When adjusted for this, the 30-day mortality rates were not significantly different between the two groups (52% vs. 52% pre-pandemic and pandemic, p = 0.798).ConclusionsThis led us to believe that the higher mortality of non-COVID19 sepsis patients during the pandemic might be attributed to a more severe septic disease at the time of recruitment. We note that patients may experience a delayed admission, as indicated by elevated SOFA scores. This could explain the higher mortality during the pandemic and we found no evidence for a diminished quality of care for critically ill sepsis patients in German intensive care units.

Trauma patients with SARS-CoV-2 in German ICUs during the 2nd wave of the COVID-19 pandemic

PurposeIn January and February 2021, about 4000 severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) positive patients were treated daily in German intensive care units (ICUs). The number of SARS-CoV-2-positive ICU patients with trauma, however, is not known and neither whether the trauma itself or COVID-19 causes the critical illness.MethodsA total of 173 German ICUs, representing 3068 ICU beds, participated in a survey developed by the Trauma Section of the German Interdisciplinary Association of Intensive Care Medicine (DIVI).ResultsParticipating ICUs reported an overall 1-day prevalence of 20 and an overall 7-day prevalence of 35 SARS-CoV-2-positive trauma patients in the ICU. Critical illness was triggered by trauma alone in 50% of cases and by the combination of trauma and COVID-19 in 49% of cases; 70% of patients were older than 65 years and suffered from a single injury, predominantly proximal femur fractures. The distribution of patients was comparable regarding the level of care of the trauma centre (local, regional, and supra-regional).ConclusionThe proportion of trauma patients of all SARS-CoV-2-positive critically ill patients is small (~ 1%) but relevant. There is no concentration of these patients at Level 1 trauma centres. However, the traumatic insult is the most relevant cause for ICU treatment in most of these patients. Regarding a new wave of the pandemic, adequate trauma dedicated resources and perioperative structures and expertise have to be provided for COVID-19 trauma patients.