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Schneider H, Hertel F, Kuhn M, Ragaller M, Gottschlich B, Trabitzsch A, Dengl M, Neudert M, Reichmann H, Wöpking S. Decannulation and Functional Outcome After Tracheostomy in Patients with Severe Stroke (DECAST): A Prospective Observational Study. Neurocrit Care 2018; 27:26-34. [PMID: 28324263 DOI: 10.1007/s12028-017-0390-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Tracheostomy is performed in ventilated stroke patients affected by persisting severe dysphagia, reduced level of consciousness, or prolonged mechanical ventilation. The study aim was to determine the frequency and predictors of successful decannulation and long-term functional outcome in tracheotomized stroke patients. METHODS A prospective single-center observational study recruited ventilated patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Follow-up visits were performed at hospital discharge, 3, and 12 months. Competing risk analyses were performed to identify predictors of decannulation. RESULTS We included 53 ventilated stroke patients who had tracheostomy. One year after tracheostomy, 19 patients were decannulated (median [IQR] time to decannulation 74 [58-117] days), 13 patients were permanently cannulated, and 21 patients died without prior removal of the cannula. Independent predictors for decannulation in our cohort were patient age (HR 0.95 [95% CI: 0.92-0.99] per one year increase, p = 0.003) and absence of sepsis (HR 4.44 [95% CI: 1.33-14.80], p = 0.008). Compared to surviving patients without cannula removal, decannulated patients had an improved functional outcome after one year (median modified Rankin Scale score 4 vs. 5 [p < 0.001]; median Barthel index 35 vs. 5 [p < 0.001]). CONCLUSIONS Decannulation was achieved in 59.4% of stroke patients surviving the first 12 months after tracheostomy and was associated with better functional outcome compared to patients without decannulation. Further prospective studies with larger sample sizes are needed to confirm our results.
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Affiliation(s)
- Hauke Schneider
- Department of Neurology and Dresden University Stroke Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Franziska Hertel
- Department of Neurology and Dresden University Stroke Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Matthias Kuhn
- Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Maximilian Ragaller
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Birgit Gottschlich
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Anne Trabitzsch
- Surgery Center, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Markus Dengl
- Department of Neurosurgery, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Marcus Neudert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology and Dresden University Stroke Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Sigrid Wöpking
- Department of Neurology and Dresden University Stroke Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Juratli TA, Zang B, Litz RJ, Sitoci KH, Aschenbrenner U, Gottschlich B, Daubner D, Schackert G, Sobottka SB. Early hemorrhagic progression of traumatic brain contusions: frequency, correlation with coagulation disorders, and patient outcome: a prospective study. J Neurotrauma 2014; 31:1521-7. [PMID: 24738836 DOI: 10.1089/neu.2013.3241] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The focus of this paper is to identify and quantify risk factors for early hemorrhagic progression of brain contusions (HPC) in patients with traumatic brain injury (TBI) and to evaluate their impact on patients' outcome. Further, based on abnormal values in routine blood tests, the role of trauma-induced coagulopathy is analyzed in detail. Therefore, a prospective study of 153 TBI patients was completed at one institution between January 2008 and June 2012. The collected data included demographics, initial Glasgow Coma Scale pupillary response, initial and 6 h follow-up computed tomography scan findings, coagulation parameters (international normalized ratio, partial thromboplastin time, platelet count, fibrinogen, D-dimer and factor XIII), as well as outcome data using the modified Rankin score at discharge and after one year. The overall rate of early HPC within the first 6 h was 43.5%. The frequency of coagulopathy was 47.1%. When analyzing for risk factors that independently influenced outcome in the form of mRS ≥4 at both points, the following variables appeared: elevated D-dimer level (≥10,000 μg/L), HPC, and initial brain contusions ≥3 cm. Patients sustaining early HPC had a hazard ratio of 5.4 for unfavorable outcome at discharge (p=0.002) and of 3.9 after one year (p=0.006). Overall, patients who developed early HPC were significantly more likely to be gravely disabled or to die. Unfavorable neurological outcome after an isolated TBI is determined largely by early HPC and coagulopathy, which seem to occur very frequently in TBI patients, irrespective of the severity of the trauma.
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Affiliation(s)
- Tareq A Juratli
- 1 Department of Neurosurgery, University Hospital Dresden , Dresden, Germany
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Spieth PM, Güldner A, Huhle R, Beda A, Bluth T, Schreiter D, Ragaller M, Gottschlich B, Kiss T, Jaber S, Pelosi P, Koch T, Gama de Abreu M. Short-term effects of noisy pressure support ventilation in patients with acute hypoxemic respiratory failure. Crit Care 2013; 17:R261. [PMID: 24172538 PMCID: PMC4056040 DOI: 10.1186/cc13091] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 10/11/2013] [Indexed: 01/12/2023]
Abstract
Introduction This study aims at comparing the very short-term effects of conventional and noisy (variable) pressure support ventilation (PSV) in mechanically ventilated patients with acute hypoxemic respiratory failure. Methods Thirteen mechanically ventilated patients with acute hypoxemic respiratory failure were enrolled in this monocentric, randomized crossover study. Patients were mechanically ventilated with conventional and noisy PSV, for one hour each, in random sequence. Pressure support was titrated to reach tidal volumes approximately 8 mL/kg in both modes. The level of positive end-expiratory pressure and fraction of inspired oxygen were kept unchanged in both modes. The coefficient of variation of pressure support during noisy PSV was set at 30%. Gas exchange, hemodynamics, lung functional parameters, distribution of ventilation by electrical impedance tomography, breathing patterns and patient-ventilator synchrony were analyzed. Results Noisy PSV was not associated with any adverse event, and was well tolerated by all patients. Gas exchange, hemodynamics, respiratory mechanics and spatial distribution of ventilation did not differ significantly between conventional and noisy PSV. Noisy PSV increased the variability of tidal volume (24.4 ± 7.8% vs. 13.7 ± 9.1%, P <0.05) and was associated with a reduced number of asynchrony events compared to conventional PSV (5 (0 to 15)/30 min vs. 10 (1 to 37)/30 min, P <0.05). Conclusions In the very short term, noisy PSV proved safe and feasible in patients with acute hypoxemic respiratory failure. Compared to conventional PSV, noisy PSV increased the variability of tidal volumes, and was associated with improved patient-ventilator synchrony, at comparable levels of gas exchange. Trial registration ClinicialTrials.gov, NCT00786292
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Blankenburg T, Gottschlich B, Schütte W, Neef H, Haerting J. Prognostische Relevanz der Metastasenlokalisation bei nicht kleinzelligem Bronchialkarzinom im Tumorstadium IV – Ergebnisse einer prospektiven epidemiologischen Studie. Pneumologie 2010; 64:679-85. [DOI: 10.1055/s-0029-1244238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hermann A, Gottschlich B, Schaefer J, Pietsch J, Sinkwitz KD, Haupt S, Geiger KD, Erfurt C, Storch A, Hanisch U. PAINFUL PARAPLEGIA CAUSED BY SPONTANEOUS ABDOMINAL COMPARTMENT SYNDROME. Neurology 2010; 74:1833-4. [DOI: 10.1212/wnl.0b013e3181e0f772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hermann A, Gottschlich B, Schäfer J, Pietsch J, Sinkwitz KD, Haupt S, Geiger KD, Erfurt C, Hanisch U. Painful paraplegia caused by spontaneous intraabdominal compartment syndrome: a new differenzial diagnosis? Akt Neurol 2009. [DOI: 10.1055/s-0029-1238692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
We report a case of a 62-year-old female patient who developed peritonitis after receiving a renal transplant. Candida glabrata was detected and treated with voriconazole. As the patient did not improve under therapy, laparotomy was performed. Mould-like plaques were found on the peritoneum. Using culture as well as pan-fungal polymerase chain reaction (PCR) followed by DNA microarray hybridisation of the amplicon, the causative agent was identified as Rhizopus microsporus. Despite aggressive surgical treatment, intravenous therapy with amphotericin B and topical administration of Lavasept (polyhexamethylenbiguanide), the patient died.
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Affiliation(s)
- Rainer J Litz
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Technical University Dresden, Germany.
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Heller AR, Rössel T, Gottschlich B, Tiebel O, Menschikowski M, Litz RJ, Zimmermann T, Koch T. Omega-3 fatty acids improve liver and pancreas function in postoperative cancer patients. Int J Cancer 2004; 111:611-6. [PMID: 15239141 DOI: 10.1002/ijc.20291] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Epidemiologic studies have indicated that high intake of saturated fat and/or animal fat increases the risk of colon and breast cancer. Omega-3 PUFAs in fish oil (FO) can inhibit the growth of human cancer cells in vitro and in vivo. These effects are related to the uptake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) into the cellular substrate pool and their competitive metabolism with arachidonic acid (AA) at the cyclooxygenase and 5-lipoxygenase levels. The metabolites of EPA and DHA have less inflammatory and immunosuppressant potency than the substances derived from AA. Based on previous experimental data, we hypothesized that FO supplementation after major abdominal cancer surgery would improve hepatic and pancreatic function. Ours was a prospective, randomized, double-blinded clinical trial on 44 patients undergoing elective major abdominal surgery, randomly assigned to receive total parenteral nutrition (TPN) supplemented with either soybean oil (SO 1.0 g/kg body weight daily, n = 20) for 5 days or a combination of FO and SO (FO 0.2 + SO 0.8 g/kg body weight daily, n = 24). Compared to pure SO supplementation in the postoperative period, FO significantly reduced ASAT [0.8 +/- 0.1 vs. 0.5 +/- 0.1 mmol/(l. sec)], ALAT [0.9 +/- 0.1 vs. 0.6 +/- 0.1 mmol/(l. sec)], bilirubin (16.1 +/- 5.3 vs. 6.9 +/- 0.6 mmol/l), LDH (7.7 +/- 0.4 vs. 6.7 +/- 0.4 mmol/(l. sec) and lipase (0.6 +/- 0.1 vs. 0.4 +/- 0.1 micromol/(l. sec) in the postoperative course. Moreover, patients with increased risk of sepsis (IL-6/IL-10 ratio >8) showed a tendency to shorter ICU stay (18 hr) under omega-3 PUFA treatment. Weight loss as encountered after the SO emulsion of 1.1 +/- 2.2 kg was absent in the FO group. After major abdominal tumor surgery, FO supplementation improved liver and pancreas function, which might have contributed to the faster recovery of patients.
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Affiliation(s)
- Axel R Heller
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, University of Technology, Dresden, Germany.
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Geiger S, Gottschlich B, Siegert G, Ragaller M, Albrecht D. Resonanzthrombographie zur Diagnose von disseminierter intravaskulärer Gerinnung (DIC) und Hyperfibrinolyse: ein Fallbericht. Anasthesiol Intensivmed Notfallmed Schmerzther 2004. [DOI: 10.1055/s-2000-10846-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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