[Team-specific impacts of the corona pandemic on intensive care medicine personnel of a maximum care hospital]. / Teamspezifische Auswirkungen der Corona-Pandemie auf Mitarbeiter:innen der Internistischen Intensivmedizin eines Krankenhauses der Maximalversorgung.

The ongoing strain on personnel in the healthcare system during the COVID-19 pandemic is considerable and poses major emotional and psychological challenges for the personnel. In a team evaluation (physicians and nurses), team-specific stress, possible relief strategies, positive and negative experiences, and wishes for improvement of the situation in an intensive care unit were collected. While both occupational groups perceived equally high emotional stress intensities, nursing additionally perceived high stress intensities in the organizational and physical areas. Thus, the occupational group of nurses proves to be the most stressed by the COVID-19 pandemic. The findings presented here can be used to derive instructions for future actions.

[Interdisciplinary and interprofessional communication in intensive and emergency care]. / Interdisziplinäre und interprofessionelle Kommunikation im Team.

BACKGROUND: Due to acuteness, time constraints, and psychological pressure as well as changing team compositions, professional communication constitutes a key challenge in the treatment of critically ill patients. OBJECTIVES: The aim of this narrative review is to present the current literature on clinical relevance and current developments of interdisciplinary and interprofessional communication in intensive care and emergency medicine. RESULTS: Effective communication is of great importance in intensive care and emergency medicine, both for ensuring high-quality patient care and work satisfaction as well as mental health of the medical practitioners. Most conflicts occur between the medical and nursing staff, with communicative conflicts predominantly being related to discussions about the patient's prognosis and end-of-life decision-making. Structural measures such as regular team meetings and trainings seem suitable to specifically improve communication. However, the topic is commonly inadequately represented in everyday clinical practice as well as in research. CONCLUSIONS: Even though the importance of interprofessional and interdisciplinary communication for high-quality patient care and workload reduction is increasingly being recognized, its routine application in everyday clinical practice is still scarce, particularly in intensive care and emergency medicine. Due to the specific structure and patient population of these fields of patient care, they can benefit more than other specialties from targeted measures to improve communication.

[Batten down the hatches: CAR T-cells - immuno-oncology meets intensive care medicine]. / Nichts für Schönwetterkapitäne: CAR-T-Zellen ­ Immunonkologie trifft Intensivmedizin.

CAR T-cell treatment has brought a significant benefit for patients with relapsed and refractory lymphoma and even long lasting remissions seem to be possible. Despite the good results CAR T-cell treatment is associated with severe and potentially life-threatening adverse effects. Patients regularly develop Cytokine Release Syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) after the transfusion of CAR T-cells. In addition to these immunological reactions patients can develop severe and life-threatening infections and other related adverse effects. Due to the increasing number of patients receiving CAR T-cells and the upcoming clinical trials more and more patients will potentially require intensive care treatment for the adverse effects after CAR T-cell treatment. The management of these patients requires an extensive diagnostic workup and complex treatment. An interdisciplinary team of hematologist, intensivist and others like neurologist and palliative medicine consultants is crucial for the best treatment of these patients. Together with the increasing number of patients this can lead to logistical issues for the intensive care departments of centers offering CAR T-cell therapies.

[Immuno-Oncology Meets Intensive Care Medicine: CAR-T cells]. / Immunonkologie trifft Intensivmedizin: CAR-T-Zellen.

CAR-T cells, genetically modified tumor-targeted t-cells, revolutionized the treatment of refractory B-cell malignancies. CAR-T cell treatment however, is invariably associated with severe immune-mediated toxicities, namely Cytokine Release Syndrome (CRS) and neurological toxicity (CRES/ICANS). Although knowledge on the pathomechanism of these toxicities is still very limited, recent findings including mouse models might allow prediction, earlier recognition and targeted treatment of patients suffering from these potentially life-threatening side effects. This article summarizes current knowledge and recent findings on the management of severe CAR-T associated toxicities and gaps of knowledge stressing the importance of an interdisciplinary approach including hematology-oncology and Intensive Care Medicine.