Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2021
Randomized Controlled Trial Multicenter Study Pragmatic Clinical Trial[Avoiding Long-term Impairment in Critical Care Using Telemedicine: The ERIC Example].
There is a high demand for critical care, which is forecasted to further grow in the future. Increasing patient morbidity and complexity concurring with a shortage of trained intensivists imposes challenges on critical care clinicians. Weathering these challenges, telemedical programs can help utilize and allocate resources more efficiently as well as foster adherence to best practice, thereby directly impacting quality of care. ⋯ The multicenter, pragmatic, stepped wedge cluster-randomized controlled quality improvement trial Enhanced Recovery after Intensive Care (ERIC) pilots a new form of critical care provision in Germany. With a target study sample size of n = 1431 patients, the study aims to utilize telemedicine to increase adherence to a set of evidence- and consensus-based quality indicators for acute critical care. In an intersectoral case-care management, patients are followed three and six months after discharge from the intensive care unit to be assessed for long-term impairments and post-intensive care syndrome.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2021
[Blended Learning in Critical Care to Improve Quality of Care the ERIC-Training].
Communication and teamwork skills are, besides clinical knowledge, key components of high quality care in modern intensive care units. In light of high staff fluctuations among intensive care unit teams and disparities in clinical experience, an ongoing training is essential to ensure optimal performance in stressfull situations. ⋯ Enhanced Recovery after Intensive Care (ERIC) is a newly developed telemedical intervention targeted at improving evidence-based practice in critical care, guided by quality indicators defined by the German Interdisciplinary Society of Emergency and Critical Care Medicine (DIVI). This telemedical intervention is supplemented with a blended-learning concept combining an e-learning website, simulator-based workshops and on-site training in order to expand the knowledge and practical skills regarding adherence to the quality indicators.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2021
[Central Venous Access in Children: Technique and Complications].
Children with complex diseases often need central venous catheter, not only for intraoperative use, but also for parenteral nutrition, multiple blood draw due to lab examination and to administer drugs that cannot be given via peripheral lines. Whereas the landmark driven vascular access was teached for years, nowadays the routine use of ultrasound based techniques can be called the gold standard. This article highlights standard locations for central venous access like cannulation of the internal jugular vein as well as novel alternatives such as the cannulation of the brachiocephalic vein. ⋯ Several different formulas are available and can be used. Independent of the used formula, you have to make sure that complications due to incorrect depth of central venous line are a topic of the past. Finally, important tips and tricks to avoid failure and serious complications are discussed.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2021
[Inhalation of Flue Gases - Carbon Monoxide Intoxication].
Most intoxications caused by inhalation are due to carbon monoxide (CO). Usually the reasons are fires in buildings from which people cannot escape quickly enough, open fire places or carbon monoxide emissions from combustion plants. In Germany, there are more than 4000 intoxications and over 600 fatalities resulting from CO poisining every year. Although there is a general awareness of the risks associated with CO, the specific risks and especially methods of protection are not sufficiently known.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jan 2021
[Quality Improvement in Intensive Care Through Telemedicine: the TELnet@NRW Example].
The German health care system faces the great challenge of ensuring high-quality and comprehensive health care in the future as the shortage of physicians continues to grow. Telemedicine-supported healthcare networks, which guarantee access to specialized medical expertise close to the patient's home and tailored to their needs, and thus to high-quality patient-centered treatment, could provide a solution. The TELnet@NRW best-practice project provides a blueprint for expert teleconsultations and put them into practice. ⋯ A total of > 150 000 patients were included. With TELnet@NRW, a major step towards future-proof healthcare was taken, and for us this means providing patients with high-quality care close to patients' homes. This is currently being used as the conceptual basis for the Virtuelles Krankenhaus NRW as a possible solution for the continuation of former project services.