Little is known about the prognosis and outcome of critically ill patients with a prolonged length of stay (LOS). The aim of this study was to examine mortality and its risk factors in patients requiring intensive care therapy for more than 30 days.A retrospective, single-center analysis of data collected in a surgical intensive care unit (ICU) of a university hospital in Germany from 2005 to 2007 was conducted. All demographic data and clinical variables were collected. A univariate analysis followed by multivariate regression was performed to detect the relevant risk factors for short and long-term mortality.Altogether, 10 737 patients were admitted to the ICU; 136 patients fulfilled the criteria for long-term treatment, 75% (N=102) of whom were discharged from ICU. The one-year survival rate was 61.8% (N=60). The most significant risk factors were pulmonary compromise with prolonged mechanical ventilation and infectious disorders leading to sepsis. However, sepsis was not a predictor of outcome. Weaning failure was present in 67.6% (N=92) at day 30 but was reduced to 37.5% of the cases (N=51) over the total course of the stay. Acute and long-term prognoses were determined by a successful weaning.Although the long-term treatment of critically ill patients requires significant effort, the outcome for this particular cohort was reasonably favorable. Prolonged mechanical ventilation and weaning are the factors that influence mortality independently of sepsis. Because reasonable improvements can be shown even after a prolonged LOS, further attention should be paid to weaning processes.
Fragestellung: Die Frage ob Laien potentiell die Fähigkeit besitzen, intuitiv und ohne vorherige Instruktion, Profiwerkzeuge zur Beatmung zu nutzen, untersuchten wir im Simulatormodell, anhand der intuitiven Anwendung der LMA-Classic™, der LMA-Fastrach™ und eines Prototypen des neuen LaryVent™.
Ein diagnostischer Goldstandard für das Krankheitsbild der Sepsis existiert nicht. In den Jahren 2014 und 2015 erarbeitete eine Taskforce neue internationale Konsensus-Definitionen für Sepsis und septischen Schock (SEPSIS-3). Diese sind zwar deutlich spezifischer als ihre Vorgänger, weisen aber ihrerseits auch einige Schwächen auf.
The use of mobile devices in hospital care constantly increases. However, smartphones and tablets have not yet widely become official working equipment in medical care. Meanwhile, the parallel use of private and official devices in hospitals is common. Medical staff use smartphones and tablets in a growing number of ways. This mixture of devices and how they can be used is a challenge to persons in charge of defining strategies and rules for the usage of mobile devices in hospital care.Therefore, we aimed to examine the status quo of physicians' mobile device usage and concrete requirements and their future expectations of how mobile devices can be used.We performed a web-based survey among physicians in 8 German university hospitals from June to October 2019. The online survey was forwarded by hospital management personnel to physicians from all departments involved in patient care at the local sites.A total of 303 physicians from almost all medical fields and work experience levels completed the web-based survey. The majority regarded a tablet (211/303, 69.6%) and a smartphone (177/303, 58.4%) as the ideal devices for their operational area. In practice, physicians are still predominantly using desktop computers during their worktime (mean percentage of worktime spent on a desktop computer: 56.8%; smartphone: 12.8%; tablet: 3.6%). Today, physicians use mobile devices for basic tasks such as oral (171/303, 56.4%) and written (118/303, 38.9%) communication and to look up dosages, diagnoses, and guidelines (194/303, 64.0%). Respondents are also willing to use mobile devices for more advanced applications such as an early warning system (224/303, 73.9%) and mobile electronic health records (211/303, 69.6%). We found a significant association between the technical affinity and the preference of device in medical care (χs2=53.84, P<.001) showing that with increasing self-reported technical affinity, the preference for smartphones and tablets increases compared to desktop computers.Physicians in German university hospitals have a high technical affinity and positive attitude toward the widespread implementation of mobile devices in clinical care. They are willing to use official mobile devices in clinical practice for basic and advanced mobile health uses. Thus, the reason for the low usage is not a lack of willingness of the potential users. Challenges that hinder the wider adoption of mobile devices might be regulatory, financial and organizational issues, and missing interoperability standards of clinical information systems, but also a shortage of areas of application in which workflows are adapted for (small) mobile devices.
A large number of people throughout Europe are involved in accidents every year. Neurological emergencies as the underlying cause of accidents are poorly investigated. This retrospective chart review study was performed to evaluate the incidence of such events.We retrospectively screened the records of the database of our physician-staffed emergency medical service for a 2-year period of time for patients involved in accidents suspicious of having had a neurological incident leading to the accident. The admission diagnoses of these records were compared with the final diagnosis as taken from the hospital records. Additional demographical (gender, age, time of accident) and medical (Glasgow Coma Scale, Injury Severity Score, National Advisory Committee on Aeronautics-Score) data were evaluated and analyzed.A total of 1545 records associated with accidents were screened, identifying 110 (7.1%) cases eligible for analysis. Fifty-four patients had seizure (49.1%), 7 stroke (6.3%) and 2 suffered from intracerebral hemorrhage (1.8%). The admission diagnosis made by the physician was confirmed in 91.8% of the cases. Accidents with concomitant neurological event happened significantly more frequent between 9 and 12 am. No differences were observed in demographic or medical data for patients with acute neurological event prior to the accident.Neurological emergencies, particularly epilepsy, stroke and intracerebral hemorrhage are causes of accidents which have to be considered more often than expected and happen most frequently in the morning. Other demographical and medical data provide no additional information for emergency medical personnel to specifically identify such patients. Nevertheless, emergency physicians seem to be highly skilled in finding the correct diagnosis.
