Der Anaesthesist
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There is a worldwide consensus among experts that guidelines and algorithms on airway management contribute to improved patient safety in anesthesia. The present study aimed to determine the current practice of airway management of German anesthesiologists and assess the safety gap, defined as the difference between observed and recommended practice, amongst these practitioners. ⋯ Current practice of airway management showed overall adherence to the current German guidelines on airway management, yet certain areas need to be improved.
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Meta Analysis
[Mortality in sepsis and septic shock in Germany. Results of a systematic review and meta-analysis].
The reported mortality for sepsis and septic shock varies between 15% and 59% in international comparison. For Germany, the number of studies is limited. Previous estimations of mortality in Germany are outdated or based on claims data analyses. Various authors discuss whether lacking quality initiatives and treatment standards in Germany could cause higher mortality for sepsis. This contrasts with the internationally well-recognized performance of the German intensive care infrastructure during the COVID-19 pandemic. ⋯ Our analysis does not support the notion that mortality related to sepsis and septic shock in Germany is higher in international comparison. A higher mortality would not be obvious either, since intensive care, for example also during the COVID-19 pandemic, is regarded as exemplary in Germany and the structural quality, such as the number of intensive care beds per 100,000 inhabitants, is high in international comparison. Nevertheless, deficits could also exist outside intensive care medicine. A comparison of international individual studies should take greater account of the structure of healthcare systems, the severity of disease and the limitations resulting from the data sources used.
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Nonopioid analgesics are frequently used for perioperative analgesia; however, insufficient research is available on several practical issues. Often hospitals have no strategy for how to proceed, e.g., for informing patients or for the timing of perioperative administration of nonopioid analgesics. ⋯ The use of nonopioid analgesics as part of a perioperative multimodal concept should be approved and established as an interdisciplinary and interprofessional concept for the adequate treatment of postoperative pain.
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In the context of sepsis and septic shock, coagulopathy often occurs due to the close relationship between coagulation and inflammation. Sepsis-induced coagulopathy (SIC) is the most severe and potentially fatal form. Anticoagulants used in prophylactic or therapeutic doses are discussed to potentially exert beneficial effects in patients with sepsis and/or SIC; however, due to the lack of evidence recent guidelines are limited to recommendations for drug prophylaxis of venous thromboembolism (VTE), while treatment of SIC has not been addressed. ⋯ The heterogeneity of answers collected in the survey suggests that a systematic approach to this topic via clinical trials is urgently needed to underline individualized patient care with the necessary evidence.
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During the peak of the COVID-19 pandemic in spring 2020, the entire emergency rescue system was confronted with major challenges. Starting on 15 March, all tourists were asked to leave the State of Tyrol, Austria. The main goal of the efforts was to ensure the usual quality of emergency medical care while reducing the physical contact during emergency interventions on site. ⋯ It was possible to achieve the primary goal of reducing the physical contact with patients; however, before keeping these reductions of the dispatching order regarding. EPs for the routine operation, adaptions in these reductions as well as deeper evaluations under consideration of the data from hospitals and GPs would be necessary. Also, different options to reduce physical contact should be evaluated, e.g. building an EMT-led scout team to evaluate the patient's status while the EP team is waiting outside.