Evidence regarding the health burden of chronic venous insufficiency (CVI), its clinical determinants, and impact on outcome is scarce. Systematic phenotyping of CVI according to established CEAP (Clinical-Etiologic-Anatomic-Pathophysiologic) classification was performed in 12 423 participants (age range: 40–80 years) of the Gutenberg Health Study from April 2012 to April 2017. Prevalence was calculated age- and sex-specifically. Multivariable Poisson regression models were calculated to evaluate the relation of CVI with cardiovascular comorbidities. Survival analyses were carried out to assess the CVI-associated risk of death. Replication of findings was done in an independent cohort study (MyoVasc, NCT04064450). The prevalence of telangiectasia/reticular, varicose veins, and CVI was 36.5% [95% confidence interval (CI), 35.6–37.4%], 13.3% [12.6–13.9%], and 40.8% [39.9–41.7%], respectively. Age, female sex, arterial hypertension, obesity, smoking, and clinically overt cardiovascular disease were identified as clinical determinants of CVI. Higher CEAP classes were associated with a higher predicted 10-year risk for incident cardiovascular disease in individuals free of cardiovascular disease (n = 9923). During a mean follow-up of 6.4 ± 1.6 years, CVI was a strong predictor of all-cause death independent of the concomitant clinical profile and medication [hazard ratio (HR) 1.46 (95% CI 1.19–1.79), P = 0. 0003]. The association of CVI with an increased risk of all-cause death was externally validated in the MyoVasc cohort [HR 1.51 (95% CI 1.11–2.05), P = 0.009]. Chronic venous insufficiency is highly prevalent in the population and is associated with the presence of cardiovascular risk factors and disease. Individuals with CVI experience an elevated risk of death, which is independent of age and sex, and present cardiovascular risk factors and comorbidities. Chronic venous insufficiency is highly prevalent in the general population and associated with arterial cardiovascular disease and an increased risk of all-cause mortality.

Zusammenfassung: Das Mutterschutzgesetz soll die Mutter und das Kind vor Gefahren, Überforderung und Gesundheitsschädigung am Arbeitsplatz ebenso wie vor finanziellen Einbußen und dem Verlust des Arbeitsplatzes schützen. Allerdings werden die mit dem Mutterschutzgesetz definierten Ziele der Sicherheit und Gesundheit der schwangeren Mitarbeiterin einerseits und der Verhinderung von Benachteiligungen im Berufsleben andererseits derzeit auf der Intensivstation noch nicht ausreichend erfüllt. Es sollte eine für alle Beteiligten gewinnbringende Umsetzung des Mutterschutzgesetzes auch in den in der DIVI vertretenen Fachbereichen vorangetrieben werden, insbesondere das Arbeiten von Schwangeren im ärztlichen und Pflegefachpersonal sowie in weiteren Gesundheitsfachberufen (Atmungstherapie, Physiotherapie, Logopädie, Psychologie und Sozialdienst) auf Intensivstationen. Es soll dafür sensibilisiert werden, jede schwangere und stillende Mitarbeiterin individuell zu betrachten und gemeinsam eine persönliche Lösung für die Weiterbeschäftigung auch während der Schwangerschaft auf der Intensivstation zu erarbeiten. Es werden mögliche Wege und Lösungen zur Erreichung dieses Ziels skizziert und Praxisbeispiele zur Umsetzung im klinischen Alltag gegeben. Diese basieren auch auf einer umfangreichen Darstellung von Tätigkeiten nach einem Ampelsystem für alle Berufsgruppen. Aspekte, die gegen die Beschäftigung einer schwangeren Mitarbeiterin auf der Intensivstation sprechen oder diese einschränken, werden diskutiert und potenzielle Lösungsoptionen aufgezeigt.

Background: The use of veno-venous extracorporeal membrane oxygenation (vv-ECMO) in acute lung failure has witnessed a notable increase. The PiCCO system is frequently used for advanced hemodynamic monitoring in this cohort. Our study aimed to investigate whether the choice of indicator injection site (jugular vs. femoral) in patients undergoing vv-ECMO therapy affects transpulmonary thermodilution (TPTD) measurements using the PiCCO^® device (Pulsion Medical Systems SE, Munich, Germany). Methods: In a retrospective single-center analysis, we compared thermodilution-derived hemodynamic parameters after simultaneous jugular and femoral injections in 28 measurements obtained in two patients with respiratory failure who were undergoing vv-ECMO therapy. Results: Elevated values of the extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end-diastolic volume index (GEDVI) were observed following femoral indicator injection compared to jugular indicator injection (EVLWI: 29.3 ± 10.9 mL/kg vs. 18.3 ± 6.71 mL/kg, p = 0.0003; ITBVI: 2163 ± 631 mL/m² vs. 806 ± 125 mL/m², p < 0.0001; GEDVI: 1731 ± 505 mL/m² vs. 687 ± 141 mL/m², p < 0.0001). The discrepancy between femoral and jugular measurements exhibited a linear correlation with extracorporeal blood flow (ECBF). Conclusions: In a PiCCO®-derived hemodynamic assessment of patients on vv-ECMO, the femoral indicator injection, as opposed to the jugular injection, resulted in an overestimation of all index parameters. This discrepancy can be attributed to mean transit time (MTt) and downslope time-dependent (DSt) variations in GEDVI and cardiac function index and is correlated with ECBF.

Peripartum cardiomyopathy (PPCM) is a life-threatening disease characterized by the clinical symptoms of acute heart failure with reduced ejection fraction in women at the end of their pregnancy or in the first months after delivery. A 26-year-old woman was delivered by cesarean section at 29 weeks due to increasing intracranial pressure from a newly diagnosed clivus chordoma. She was transferred to ICU after septic deterioration, presenting with hemodynamic instability, tachycardia, high catecholamine support, oxygen needs, and signs of cardiac decompensation. We found a significant impairment of the left and as well as the right ventricular function (LVEF 30–35%, FAC 30%) combined with pericardial effusion and a septal myocardial edema (cardiac MRI). There were no signs of myocardial inflammation and no hint for a Takotsubo cardiomyopathy neither but in total pointing to a PPCM. Left and right cardiac function improved stepwise after breastfeeding was stopped and bromocriptine was started, supporting our theory that the patient suffered from a peripartum cardiomyopathy involving both ventricles. Although right ventricular function was also reduced, which is a marker of a severe process, cardiac function improved quickly. This case shows that even in complex intensive care cases in postpartum patients, a cardiac genesis of the hemodynamic deterioration should always be considered and clarified to be able to provide these patients with adequate therapy and regulate the cardiac course of PPCM.