Recommendations on the structure, personal, and organization of intensive care units

BackgroundIntensive care units (ICU) are central facilities of medical care in hospitals world-wide and pose a significant financial burden on the health care system.ObjectivesTo provide guidance and recommendations for the requirements of (infra)structure, personal, and organization of intensive care units.Design and settingDevelopment of recommendations based on a systematic literature search and a formal consensus process from a group of multidisciplinary and multiprofessional specialists from the German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI). The grading of the recommendation follows the report from an American College of Chest Physicians Task Force.ResultsThe recommendations cover the fields of a 3-staged level of intensive care units, a 3-staged level of care with respect to severity of illness, qualitative and quantitative requirements of physicians and nurses as well as staffing with physiotherapists, pharmacists, psychologists, palliative medicine and other specialists, all adapted to the 3 levels of ICUs. Furthermore, proposals concerning the equipment and the construction of ICUs are supplied.ConclusionThis document provides a detailed framework for organizing and planning the operation and construction/renovation of ICUs

Psychotraumatological aspects in intensive care medicine

In the context of intensive care medicine, patients, their relatives, and more infrequently members of the ICU team can be affected by potential trauma. Acute stress disorder often results. Psychological symptoms of critically ill patients should therefore be regularly screened in a standardized manner in order to be able to identify and treat patients with a high symptom burden. Some traumatic stressors in intensive care medicine can be reduced using trauma-sensitive communication. Psychological and psychotherapeutic interventions can complement this basic care. High quality communication with relatives contributes to a risk reduction with regard to their subsequent psychological stress. On the part of the ICU team, stress should be differentiated from potentially traumatizing events and both problem areas should be dealt with preventively. After experiencing a traumatic event during work, a procedure analogous to physical work accidents is recommended

Psychotraumatological aspects in intensive care medicine

In the context of intensive care medicine, patients, their relatives, and more infrequently members of the ICU team can be affected by potential trauma. Acute stress disorder often results. Psychological symptoms of critically ill patients should therefore be regularly screened in a standardized manner in order to be able to identify and treat patients with a high symptom burden. Some traumatic stressors in intensive care medicine can be reduced using trauma-sensitive communication. Psychological and psychotherapeutic interventions can complement this basic care. High quality communication with relatives contributes to a risk reduction with regard to their subsequent psychological stress. On the part of the ICU team, stress should be differentiated from potentially traumatizing events and both problem areas should be dealt with preventively. After experiencing a traumatic event during work, a procedure analogous to physical work accidents is recommended

Hypnotic suggestions of safety improve well-being in non-invasively ventilated patients in the intensive care unit

Patients in the intensive care unit (ICU) are facing a threatening environment while their health is at risk. In addition, the non-invasive ventilation procedure causes stress and anxiety which reduce cooperation. We developed an intervention containing hypnotic suggestions to improve patients well-being during non-invasive ventilation in the ICU. The aim of this study was to test the feasibility, safety, and acceptance of this intervention

Empfehlungen zur Unterstützung von belasteten, schwerstkranken, sterbenden und trauernden Menschen in der Corona-Pandemie aus palliativmedizinischer Perspektive

Vorgelegt werden Empfehlungen verschiedener einschlägiger Berufs- und Fachverbände zur Unterstützung von belasteten, schwerstkranken, sterbenden und trauernden Menschen in der Corona-Pandemie aus palliativmedizinischer Perspektive. Die mit der Corona-Pandemie einhergehenden Einschränkungen und Verbote sorgen für psychische, soziale und spirituelle Belastungen bei Patientinnen und Patienten mit COVID-19, ihren Zugehörigen und den behandelnden Mitarbeitenden im Gesundheitswesen. Patientinnen und Patienten mit COVID-19 dürfen nicht von ihren Zugehörigen besucht werden, in vielen Krankenhäusern und Pflegeeinrichtungen gelten generelle Besuchsverbote. Viele Unterstützungsangebote sind verringert oder ganz eingestellt worden. Bei anderen Patientinnen und Patienten mit sehr kritischen und/oder lebenslimitierenden Erkrankungen werden notwendige Behandlungsmaßnahmen aufgeschoben, weil die Ressourcen im Krankenhaus für an COVID-19 Erkrankte freigehalten werden. Diese Menschen bedürfen jedoch des Gefühls der sozialen Verbundenheit mit ihren Zugehörigen. Für Palliativpatienten sollten Ausnahmen von Besuchsverboten ermöglicht werden. Besuche bei Sterbenden sind mit entsprechenden Schutzmaßnahmen auch auf Isolier- oder Intensivstationen möglich. Für isolierte Patientinnen und Patienten sollten alternative Möglichkeiten überprüft werden, zum Beispiel via Videotelefonie oder über soziale Medien. Nach dem Versterben sollte den Angehörigen unter ausreichenden Schutzmaßnahmen ein Abschiednehmen ermöglicht oder alternative reale oder virtuelle Wege zum Erinnern und Gedenken angeboten werden. Die Mitarbeitenden in den Behandlungsteams sollten kontinuierlich in der Bewältigung der besonderen Belastungen unterstützt werden. Dazu ist neben klaren Kommunikations- und Entscheidungsstrukturen, Kommunikationsschulungen und psychosozialer Unterstützung vor allem die Bereitstellung der bestmöglichen Rahmenbedingungen für die Arbeit erforderlich

[Children visiting intensive care units and emergency departments : Kids are welcome!].

In this white paper, key recommendations for visitation by children in intensive care units (ICU; both pediatric and adult), intermediate care units and emergency departments (ED) are presented. In ICUs and EDs in German-speaking countries, the visiting policies for children and adolescents are regulated very heterogeneously: sometimes they are allowed to visit patients without restrictions in age and time duration, sometimes this is only possible from the age of teenager on, and only for a short duration. A request from children to visit often triggers different, sometimes restrictive reactions among the staff. Management is encouraged to reflect on this attitude together with their employees and to develop a culture of family-centered care. Despite limited evidence, there are more advantages for than against a visit, also in hygienic, psychosocial, ethical, religious, and cultural aspects. No general recommendation can be made for or against visits. The decisions for a visit are complex and require careful consideration

Sedation, sleep-promotion, and non-verbal and verbal communication techniques in critically ill intubated or tracheostomized patients

$\bf Background:$ The aim of this survey was to describe, on a patient basis, the current practice of sedation, pharmacologic and non-pharmacologic measures to promote sleep and facilitation of communication in critically ill patients oro-tracheally intubated or tracheostomized. $\bf Methods:$ Cross-sectional online-survey evaluating sedation, sleep management and communication in oro-tracheally intubated (IP) or tracheostomized (TP) patients in intensive care units on a single point. $\bf Results:$ Eighty-one intensive care units including 447 patients (IP: $\it n$ = 320, TP: $\it n$ = 127) participated. A score of $\leq$ -2 on the Richmond Agitation Sedation Scale (RASS) was prevalent in 58.2% (IP 70.7% vs. TP 26.8%). RASS -1/0 was present in 32.2% (IP 25.9% vs. TP 55.1%) of subjects. Propofol and alpha-2-agonist were the predominant sedatives used while benzodiazepines were applied in only 12.1% of patients. For sleep management, ear plugs and sleeping masks were rarely used (< 7%). In half of the participating intensive care units a technique for phonation was used in the tracheostomized patients. $\bf Conclusions:$ The overall rate of moderate and deep sedation appears high, particularly in oro-tracheally intubated patients. There is no uniform sleep management and ear plugs and sleeping masks are only rarely applied. The application of phonation techniques in tracheostomized patients during assisted breathing is low. More efforts should be directed towards improved guideline implementation. The enhancement of sleep promotion and communication techniques in non-verbal critically ill patients may be a focus of future guideline development