[Analysis of injury incidences in a trauma surgery university hospital during the SARS-CoV­2 pandemic]. / Analyse des Trauma-Aufkommens in einer unfallchirurgischen Universitätsklinik während der SARS-CoV­2-Pandemie.

INTRODUCTION: The corona crisis of 2020 posed previously unknown challenges to hospitals providing acute care. In addition to the treatment of COVID-19 patients, universities and other acute care hospitals had to provide emergency medical care, including for patients undergoing trauma surgery. The challenge was that no reliable planning figures were available regarding the expected volume for such a crisis situation and therefore no reliable resource planning was possible in this respect. Therefore, the aim of this work was to record the incidence of polytrauma and other injuries during the pandemic crisis in a university trauma surgery clinic and to compare it with the years 2017-2019. METHODS: In this single-center study, a retrospective analysis of the injury incidence during calendar weeks with existing exit restrictions (12th-19th week) for the year 2020 for trauma surgery patients of a university hospital was performed. At first, the treatment of COVID-19 patients was recorded daily in order to objectify the burden and expenditure of inpatient treatment for these patients. Then, for the evaluation period from 20.03.2020 to 06.05.2020, the numbers of 1. polytrauma, 2. work-related accidents and 3. leisure-related trauma patients were recorded and compared with the numbers from 2017-2019 during the same period. RESULTS: In total, 118 patients were treated with COVID-19 as inpatients during the period under study, of which up to 43 patients had to be treated simultaneously in intensive care on 1 day. Overall, the number of polytrauma, work-related accidents and leisure-time accident patients was lower in 2020 than in the previous years. Nevertheless, with a decline of only -28% (22 ± 4.9 vs. 16), a considerable number of polytrauma patients were recorded, while all work-related accidents (44%, 304 ± 31.3 vs. 170) and also leisure-time accidents (39%, 173 ± 22.7 vs. 106) considerably decreased. In the group of leisure-time accidents, there was initially a remarkable decline in the number of cases per week after the initial restrictions began, but as the duration of the restrictions increased, the number per week has risen to the level of previous years. DISCUSSION: Even in exceptional situations such as the corona pandemic, there were a significant number of patients in need of acute treatment, especially polytrauma patients. This should be considered in the future in the event of similar exceptional situations in the inpatient care framework when providing trauma surgery care capacities.

[Case report: Aneurysmatic subarachnoid hemorrhage -- complicated course due to coincidental manifestation of an inverted Tako-Tsubo-cardiomyopathy]. / Kasuistik: Aneurysmatische Subarachnoidalblutung - Komplizierter Verlauf mit inverser Tako-Tsubo-Kardiomyopathie.

We report the case of a patient who suffered a serious subarachnoid hemorrhage with a cardialaffection and development of an inverted Tako-Tsubo-cardiomyopathy. To avoid apparent cerebral ischemia due to severe cerebral vasospasm after exhaustion of conservative therapeutic options a temporarily endovascular therapy with continuous intra-arterial application of Nimodipine was necessary. In the overall protracted and complicated course the special challenge were the therapeutic efforts to avoid apparent cerebral ischemia in context to the significant cardial affection.

Impact of bedside percutaneous dilational and open surgical tracheostomy on intracranial pressure, pulmonary gas exchange, and hemodynamics in neurocritical care patients.

Aim was to compare the impact of bedside percutaneous dilational tracheostomy (PDT) and open surgical technique (ST) on intracranial pressure (ICP), pulmonary gas exchange and hemodynamics.We retrospectively analyzed data of 92 neurocritical care patients with invasive ICP monitoring during either PDT (43 patients) or ST (49 patients).Peak ICP levels were higher during PDT (22 [17-38] mm Hg vs 19 [13-27] mm Hg, P = .029). Mean oxygen saturation (SpO2) and end-tidal carbon dioxide partial pressure (etCO2) did not differ. Episodes with relevant desaturation (SpO2 < 90%) or hypercapnia (etCO2 > 50 mm Hg) occurred rarely (5/49 during ST vs 3/43 during PDT for SpO2 < 90%; 2/49 during ST vs 5/43 during PDT for hypercapnia). Drops in mean arterial pressure (MAP) below 60 mm Hg were seen more often during PDT (8/43 vs 2/49, P = .026). Mean infusion rate of norepinephrine did not differ (0.52 mg/h during ST vs 0.45 mg/h during PDT). No fatal complications were observed.Tracheostomy can be performed as ST and PDT safely in neurocritical care patients. The impact on ICP, pulmonary gas exchange and hemodynamics remains within an unproblematic range.

Standardized application of laxatives and physical measures in neurosurgical intensive care patients improves defecation pattern but is not associated with lower intracranial pressure.

Background. Inadequate bowel movements might be associated with an increase in intracranial pressure in neurosurgical patients. In this study we investigated the influence of a structured application of laxatives and physical measures following a strict standard operating procedure (SOP) on bowel movement, intracranial pressure (ICP), and length of hospital stay in patients with a serious acute cerebral disorder. Methods. After the implementation of the SOP patients suffering from a neurosurgical disorder received pharmacological and nonpharmacological measures to improve bowel movements in a standardized manner within the first 5 days after admission to the intensive care unit (ICU) starting on day of admission. We compared mean ICP levels, length of ICU stay, and mechanical ventilation to a historical control group. Results. Patients of the intervention group showed an adequate defecation pattern significantly more often than the patients of the control group. However, this was not associated with lower ICP values, fewer days of mechanical ventilation, or earlier discharge from ICU. Conclusions. The implementation of a SOP for bowel movement increases the frequency of adequate bowel movements in neurosurgical critical care patients. However, this seems not to be associated with reduced ICP values.