[Comfort Terminal Care in the intensive care unit: recommendations for practice].

Background And Objective: The Working Group on Ethics in Anesthesia and Intensive Care Medicine of the Austrian Society for Anesthesiology Resuscitation and Intensive Care Medicine (ÖGARI) already developed documentation tools for the adaption of therapeutic goals 10 years ago. Since then the practical implementation of Comfort Terminal Care in the daily routine in particular has raised numerous questions, which are discussed in this follow-up paper and answered in an evidence-based manner whenever possible.

Results: The practical implementation of pain therapy and reduction of anxiety, stress and respiratory distress that are indicated in the context of Comfort Terminal Care are described in more detail.

Incidence, risk factors and outcome of acute kidney injury in critically ill COVID-19 patients in Tyrol, Austria: a prospective multicenter registry study.

Introduction: Acute kidney injury is a frequent complication in critically ill patients with and without COVID-19. The aim of this study was to evaluate the incidence of, and risk factors for, acute kidney injury and its effect on clinical outcomes of critically ill COVID-19 patients in Tyrol, Austria.

Methods: This multicenter prospective registry study included adult patients with a SARS-CoV-2 infection confirmed by polymerase chain reaction, who were treated in one of the 12 dedicated intensive care units during the COVID-19 pandemic from February 2020 until May 2022.

The Austrian ICU survey : A questionnaire-based evaluation of intensive care medicine in Austria.

Background: While structures of intensive care medicine in Austria are well defined, data on organisational and medical practice in intensive care units (ICUs) have not been systematically evaluated.

Methods: In this explorative survey, organisational and medical details of ICUs in Austria were collected using an online questionnaire consisting of 147 questions.

Results: Out of 249 registered ICUs 73 (29.

SARS-CoV-2: recommendations for treatment in intensive care medicine.

Coronavirus disease 2019 (COVID-19) progresses mildly in most of the cases; however, about 5% of the patients develop a severe acute respiratory distress syndrome (ARDS). Of all COVID-19 patients 3% need intensive care treatment, which becomes a great challenge for anesthesiology and intensive care medicine, medically, hygienically and for technical safety requirements. For these reasons, only experienced medical and nursing staff in the smallest grouping possible should be assigned.

Vasopressin in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials.

Objective: To summarize the results of randomized controlled trials on the use of vasopressin as a vasopressor agent in cardiac surgery.

Design: Meta-analysis.

Participants: Six-hundred-twenty-five adult patients undergoing elective or emergency cardiac surgery.

The impact of endotoxin on jejunal tissue oxygenation.

Objective: We examined the effects of systemic ETX on jejunal mucoal microcirculatory parameters in anesthetized pigs.

Methods: Jejunal mucosal tissue PO was measured employing Clark-type surface oxygen electrodes. Oxygen saturation of jejunal microvascular hemoglobin was determined by tissue reflectance spectrophotometry.

Candida peritonitis.

Background: Fungal infections including Candida peritonitis (CP) are being observed with increasing frequency in the ICU. We summarize current knowledge on epidemiology, risk factors, diagnostic tests and treatment options in the previously immunocompetent patient suffering from CP.

Methods: An electronic medical database search using "Candida" and "Peritonitis" as main search terms in conjunction with specific key words relevant to the topic.

Re-evaluating currently available data and suggestions for planning randomised controlled studies regarding the use of hydroxyethyl starch in critically ill patients - a multidisciplinary statement.

Introduction: Hydroxyethyl starch (HES) is a commonly used colloid in critically ill patients. However, its safety has been questioned in recent studies and meta-analyses.

Methods: We re-evaluated prospective randomised controlled trials (RCT) from four meta-analyses published in 2013 that compared the effect of HES with crystalloids in critically ill patients, focusing on the adherence to 'presumably correct indication'.

[Definitions, decision-making and documentation in end of life situations in the intensive care unit].

The present work provides assistance for physicians concerning decision making in clinical borderline situations in the ICU. Based on a structured checklist the two fundamental aspects of any medical decision, the medical indication and the patient's preference are queried in a systematic way. Four possible steps of withholding and/or withdrawing therapy are discussed.

Histologic pathologies of the myocardium in septic shock: a prospective observational study.

Myocardial depression in septic shock is well known, but its pathophysiological genesis is incompletely understood. To assess the incidence and extent of stress-induced histologic myocardial alterations in septic shock, a prospective, observational, combined clinical and postmortem study was conducted, and 20 patients dying from septic shock were included. Exclusion criteria were younger than 18 years, pregnancy, open heart surgery or cardiopulmonary resuscitation, acute neurologic diseases, pheochromocytoma, and forensic autopsy.

The relationship between extravascular lung water and oxygenation in three patients with influenza A (H1N1)-induced respiratory failure.

This case series reports the correlation between extravascular lung water (EVLW) and the partial arterial oxygen pressure/fractional inspiratory oxygen (PaO(2)/FiO(2)) ratio in three patients with severe influenza A (H1N1)-induced respiratory failure. All patients suffered from grave hypoxia (PaO(2), 26-42 mmHg) and were mechanically ventilated using biphasic airway pressure (PEEP, 12-15 mmHg; FiO(2), 0.8-1) in combination with prone positioning at 12 hourly intervals.

Early fish oil supplementation and organ failure in patients with septic shock from abdominal infections: a propensity-matched cohort study.

Background: Fish oil (FO) has immunomodulating effects and may improve organ function and outcome in critically ill patients. This retrospective, propensity-matched cohort study investigates the effects of early intravenous FO supplementation on organ failure in patients with septic shock from abdominal infection.

Methods: A medical database was retrospectively searched for critically ill patients admitted because of septic shock from abdominal infection (n = 194).

Does standardization of critical care work?

Purpose Of Review: This article discusses how standardization of intensive care work may decrease morbidity and mortality in the intensive care unit (ICU) by reducing practice variation and improving the overall quality of care. In this context, standardization should not only apply to the specific medical management of certain high-volume ICU diagnoses but should also be established for daily ICU procedures and information transmission during ward rounds and at the interface of interdisciplinary work.

Recent Findings: Standardized procedures for placement of central venous catheters, implementation of strict hand hygiene and treatment of specific high volume ICU diagnoses using protocol-guided treatment algorithms or treatment bundles have convincingly demonstrated to decrease patient morbidity and mortality and healthcare expenditures.

Plasma copeptin levels before and during exogenous arginine vasopressin infusion in patients with advanced vasodilatory shock.

Background: Plasma copeptin levels before and during exogenous arginine vasopressin infusion (AVP) were evaluated, and the value of copeptin levels before AVP therapy to predict complications during AVP therapy and outcome in vasodilatory shock patients was determined.

Methods: This prospective, observational study was nested in a randomized, controlled trial investigating the effects of two AVP doses (0.033 vs.

The association between body-mass index and patient outcome in septic shock: a retrospective cohort study.

Background: It is unknown whether body-mass index (BMI) and commonly defined BMI categories are associated with mortality in patients with septic shock.

Methods: The database of a multidisciplinary intensive care unit (ICU) was retrospectively screened for adult patients with septic shock. BMI, demographic, clinical and laboratory variables together with outcome measures were collected in all patients.

How to protect the heart in septic shock: a hypothesis on the pathophysiology and treatment of septic heart failure.

Heart failure is a well-recognized manifestation of organ failure in sepsis and septic shock. The pathophysiology of septic heart failure is complex and currently believed to involve several mechanisms. So far, the contributory role of high plasma catecholamine levels has not been investigated.

Arginine-vasopressin attenuates beneficial norepinephrine effect on jejunal mucosal tissue oxygenation during endotoxinaemia.

Background: The objective of the present study was to investigate the effects of increasing doses of norepinephrine (NE) with or without arginine-vasopressin (AVP) on intestinal oxygen supply and jejunal mucosal tissue oxygen tension in an acute endotoxic pig model.

Methods: In this prospective, randomized, experimental study on 24 domestic pigs, jejunal mucosal tissue PO2 (PO2muc) was measured using two Clark-type surface oxygen electrodes. Oxygen saturation of jejunal microvascular haemoglobin (HbO2j) was determined by tissue reflectance spectrophotometry.

Sympathetic overstimulation during critical illness: adverse effects of adrenergic stress.

The term ''adrenergic'' originates from ''adrenaline'' and describes hormones or drugs whose effects are similar to those of epinephrine. Adrenergic stress is mediated by stimulation of adrenergic receptors and activation of post-receptor pathways. Critical illness is a potent stimulus of the sympathetic nervous system.