For most cell culture experiments, it is indispensable that the cells are firmly anchored to culture plates, withstanding rinsing steps that can create shear forces and tolerating temperature changes without detaching. For semi-adherent cells such as the common HEK 293 or PC-12 cells, this could so far be obtained by time-consuming plate pre-coating with cationic polymer solutions. We report here, that i) pre-coating with the cheaper poly-ethylenimine (PEI) works as well as the commonly used poly-D-lysine (PDL), but more importantly and novel ii) that simple direct addition of either PEI (1.5 μg/ml) or PDL (2 μg/ml) to the cell culture medium results in strongly anchored HEK 293 cells, indistinguishable from ones seeded on pre-coated plates. Therefore, the replacement of plate pre-coating by direct addition of either PEI or PDL gives comparable excellent results, but is highly labour-, time-, and cost-efficient. Moreover, we could show that addition of PDL or PEI also works similarly well in animal-free culture using human platelet lysate instead of fetal bovine serum. Interestingly, additional experiments showed that strong cell attachment requires only cationic polymers but not fetal bovine serum or human platelet lysate added to the medium.

Background: Intensive care units (ICU) are central facilities of medical care in hospitals world-wide and pose a significant financial burden on the health care system.Objectives: To provide guidance and recommendations for the requirements of (infra)structure, personal, and organization of intensive care units.Design and setting: Development 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.Results: The 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.Conclusion: This document provides a detailed framework for organizing and planning the operation and construction/renovation of ICUs.

Delayed cerebral ischemia (DCI) is a severe complication following aneurysmal subarachnoid hemorrhage (aSAH), linked to poor functional outcomes and prolonged intensive care unit (ICU) stays. Timely DCI diagnosis is crucial but remains challenging. Dysregulated blood glucose, commonly observed after aSAH, may impair the constant glucose supply that is vital for brain function, potentially contributing to DCI. This study aimed to assess whether glucose indices could help identify at-risk patients and improve DCI detection. This retrospective, single-center observational study examined 151 aSAH patients between 2016 and 2019. Additionally, 70 of these (46.4%) developed DCI and 81 did not (no-DCI). To determine the value of glycemic indices for DCI, they were analyzed separately in patients in the period before (pre-DCI) and after DCI (post-DCI). The time-weighted average glucose (TWAG, p = 0.024), mean blood glucose (p = 0.033), and novel time-unified dysglycemic rate (TUDR140, calculated as the ratio of dysglycemic to total periods within a glucose target range of 70–140 mg/dL, p = 0.042), showed significantly higher values in the pre-DCI period of the DCI group than in the no-DCI group. In the time-series analysis, significant increases in TWAG and TUDR140 were observed at the DCI onset. In conclusion, DCI patients showed elevated blood glucose levels before and a further increase at the DCI onset. Prospective studies are needed to confirm these findings, as this retrospective, single-center study cannot completely exclude confounders and limitations. In the future blood glucose indices might become valuable parameters in multiparametric models to identify patients at risk and detect DCI onset earlier.

Zusammenfassung: Hintergrund: Das Ankommen auf der Intensivstation ist für Fachkräfte entscheidend, um hochqualitative Patient:innenversorgung gewährleisten zu können. Dieser Prozess hängt von der Einarbeitungsqualität ab. Ziel der Arbeit: Ziel der Arbeit ist die Erfassung von Art und Umfang der Einarbeitung und der Zufriedenheit von jungen Fachkräften auf der Intensivstation. Material und Methoden: In einer anonymen, berufsgruppenübergreifenden Onlineumfrage wurde die Einarbeitungsstruktur sowie Zufriedenheit untersucht. Ergebnisse: Von 554 Teilnehmenden kamen etwa zwei Drittel aus dem ärztlichen Bereich. Während bei der Pflege 59 % ein schriftliches Einarbeitungskonzept aufwiesen, lag ein solches nur bei 27 % der Ärzt:innen vor. Pflegefachpersonen gaben im Median 30 Tage als Einarbeitungszeit, Ärzt:innen 7 Tage an. Ein Drittel der Pflegefachpersonen stimmte der Aussage zu, ausreichend durch die Einarbeitung auf die intensivmedizinische Tätigkeit vorbereitet worden zu sein. Im ärztlichen Bereich fühlten sich nur 17 % der Teilnehmenden ausreichend durch die Einarbeitung vorbereitet. Mehr als 42 % der Befragten konnten sich vorstellen, noch länger als 3 Jahre in der Intensivmedizin tätig zu sein. Diskussion: Evidenzbasierte Methoden zur Strukturierung der Einarbeitung von neuen Fachkräften sind in deutschen Intensivstationen nur gering verbreitet. Die Einarbeitungszeit liegt weit unter publizierten Empfehlungen. Auch wenn bezüglich der materiellen und personellen Ausstattung Defizite wahrgenommen werden, geben die meisten Befragten Zufriedenheit mit Lernzuwachs und interprofessioneller Zusammenarbeit an.

Diaphragm atrophy is a common side effect of mechanical ventilation and results in prolonged weaning. Electric phrenic nerve stimulation presents a possibility to avoid diaphragm atrophy by keeping the diaphragm conditioned in sedated patients. There is a need of further investigation on how to set stimulation parameters to achieve sufficient ventilation. A prototype system is presented with a systematic evaluation for stimulation pattern adjustments. The main indicator for efficient stimulation was the tidal volume. The evaluation was performed in two pig models. As a major finding, the results for biphasic pulses were more consistent than for alternating pulses. The tidal volume increased for a range of pulse frequency and pulse width until reaching a plateau at 80–120 Hz and 0.15 ms. Furthermore, the generated tidal volume and the stimulation pulse frequency were significantly correlated (0.42–0.84, $$p<0.001$$p < 0.001 ). The results show which stimulation parameter combinations generate the highest tidal volume. We established a guideline on how to set stimulation parameters. The guideline is helpful for future clinical applications of phrenic nerve stimulation.