Erwartungen, Training und Evaluation von intensivmedizinischem Krankenhauspersonal in Bezug auf Simulationskurse in Deutschland - Entwicklung eines relevanten Trainingskonzeptes

Objective: Increasingly, intensive care units (ICU) are operated by teams of physicians and nurses with specialist training in anaesthesia and intensive care. The aims of our study were to evaluate any prior experience, expectations and the requisites for interprofessional ICU simulation-based training (SBT), and to evaluate a newly designed training course incorporating these findings.Methods: The study was laid out as a cross-sectional study and is projected in three steps. First, questionnaires were sent out to ICU nurses and physicians from 15 different hospitals in a greater metropolitan area (> million citizens). Based upon this survey a one-day ICU simulator course designed for 12 participants (6 nurses and 6 physicians) was developed, with evaluation data from four subsequent courses being analysed.Results: In the survey 40% of nurses and 57% of the physicians had had prior exposure to SBT. Various course formats were explored with respect to duration, day of the week, and group composition. After completing the course, the majority deemed a full working day in interprofessional setting to be most appropriate (p1 Millionen Einwohner Versorgungsgebiet) geschickt. Auf Basis der Ergebnisse wurde ein Simulationskurs mit dem Schwerpunkt "Arbeit auf der Intensivstation" für je 12 Teilnehmer (6 Pflegekräfte und 6 Ärzte) entwickeln und schließlich mit Hilfe der Teilnehmer evaluiert.Ergebnisse: In der Befragung gaben 40% des Pflegepersonals und 57% der Ärzte Vorerfahrungen mit Simulationstrainings an. Verschiedene Kursformate hinsichtlich Dauer, Veranstaltungstag und Zusammensetzung des Teilnehmerfeldes zur Bewertung vorgeschlagen. Die Teilnehmer bewerteten die Organisation als Ein-Tages-Kurs mit einer interprofessionellen Zusammensetzung als adäquat. Die vorgeschlagenen Szenarios wurden als relevant beurteilt und ein positiver Einfluss auf Kommunikation, Arbeitsabläufe und Stressverarbeitung angenommen.Schlussfolgerung: Aktuell ist ein Simulationstraining kein regelhaft eingesetztes Trainingsinstrument auf deutschen Intensivstationen für die Weiter- und Fortbildung des Personals. Die geringe Erfahrung des Personals muss in die Trainingsplanung und Vorbereitung der Kurse berücksichtigt werden. Wir haben einen Trainingskurs mit Bezug zu non-technical Skills für Intensivstationen und klinisch relevanten Inhalten entwickelt. Die Teilnehmer werteten den Kurs als relevant für die tägliche Arbeit, schätzen den Einfluss auf Arbeitsabläufe positiv ein und wünschten sich längere Trainingseinheiten

The beta-adrenergic receptor agonist, terbutaline, reduces UVB-induced mechanical sensitization in humans

Objectives Previously, we found in cultures of primary neurons and in animals that sensitized primary neurons can be desensitized by treatment with e.g. beta-adrenergic receptor agonists. We now tested whether also in human sensitization such as UVB-radiation induced sunburn-like hyperalgesia can be reduced by intradermal injection of the beta-adrenergic receptor agonist terbutaline. Methods In our prospective randomized study, 17 participants received an individual UVB dose to cause a defined local sunburn-like erythema at four locations, two on each forearm. Twenty-four hours later, the sensitized four areas were injected intradermally with terbutaline pH 4.3, terbutaline pH 7.0, saline pH 4.3 or saline pH 7.0, respectively. Pain thresholds were examined before and after induction of UVB-sensitization, and 15, 30 and 60 min after injection of the respective solution. Mechanical pain thresholds of the skin and of deeper tissues were determined by pinprick and pressure algometer measurements, respectively. Results UVB-irradiation decreased mechanical pain thresholds for pinprick and pressure algometer measurements demonstrating a successful sunburn-like sensitization. Intradermal injection of terbutaline pH 7.0 into the sensitized skin reduced the sensitization for all measured timepoints as determined by pinprick measurements. Pinprick measurements of sensitization were not reduced by injection of terbutaline pH 4.3, saline solution pH 7.0 or saline solution pH 4.3. Also, sensitization of deeper tissue nociceptors were not altered by any of the injections as measured with the pressure algometer. Conclusions Similar to our cellular observations, also in humans beta-adrenergic agonists such as terbutaline can reduce the sensitization of primary neurons in the skin. Significance We previously showed in model systems that beta-adrenergic stimulation can not only sensitize but also desensitize nociceptors. Our study shows that also in humans beta-adrenergic agonists desensitize if injected into UVB-sensitized skin. This indicates an analgesic activity of adrenergic agonists in addition to their vasoconstrictory function

Adrenoceptor stimulation does not affect ICAM-1 and VCAM-1 expression in vitro

BACKGROUND: Endothelial adhesion molecules ICAM-1 (CD54) and VCAM-1 (CD106) mediate cellular adhesion and transcellular migration. Cell adhesion and diapedesis have a key role in the course of shock and sepsis. During severe sepsis, adrenoceptor agonist levels may be increased due to endogenous production or due to intensive care treatment. As yet, the influence of β1 or β2 agonists on adhesion molecule formation on endothelial cells has remained unclear. METHODS: Cultured human umbilical vein endothelial cells were stimulated with E. coli. Following bacterial stimulation the cells were incubated with either β2 receptor agonist terbutaline or β1 agonist norepinephrine. ICAM-1 and VCAM-1 expression were examined using flow cytometry. RESULTS: Administration of norepinephrine did not cause increases of both CD54 and CD106 in stimulated HUVEC. Compared to negative controls the bacterial stimulation itself led to an increase of adhesion molecules. Following administration of terbutaline no significant increase in CD54 expression was found. CONCLUSIONS: Bacterial stimulation led to an increase of adhesion molecule expression. Adrenoceptor stimulation of activated endothelial cells did not cause significant increases of cellular adhesion molecules