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Kalverda KA, Ninaber MK, Wijmans L, von der Thüsen J, Jonkers RE, Daniels JM, Miedema JR, Dickhoff C, Hölters J, Heineman D, Kant M, Radonic T, Shahin G, Cohen D, Boerrigter B, Nijman S, Nossent E, Braun J, Mathot B, Poletti V, Hetzel J, Dijkgraaf M, Korevaar DA, Bonta PI, Annema JT. Transbronchial cryobiopsy followed by as-needed surgical lung biopsy versus immediate surgical lung biopsy for diagnosing interstitial lung disease (the COLD study): a randomised controlled trial. Lancet Respir Med 2024:S2213-2600(24)00074-2. [PMID: 38640934 DOI: 10.1016/s2213-2600(24)00074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND An adequate diagnosis for interstitial lung disease (ILD) is important for clinical decision making and prognosis. In most patients with ILD, an accurate diagnosis can be made by clinical and radiological data assessment, but in a considerable proportion of patients, a lung biopsy is required. Surgical lung biopsy (SLB) is the most common method to obtain tissue, but it is associated with high morbidity and even mortality. More recently, transbronchial cryobiopsy has been introduced, with fewer adverse events but a lower diagnostic yield than SLB. The aim of this study is to compare two diagnostic strategies: a step-up strategy (transbronchial cryobiopsy, followed by SLB if the cryobiopsy is insufficiently informative) versus immediate SLB. METHODS The COLD study was a multicentre, randomised controlled trial in six hospitals across the Netherlands. We included patients with ILD with an indication for lung biopsy as assessed by a multidisciplinary team discussion. Patients were randomly assigned in a 1:1 ratio to the step-up or immediate SLB strategy, with follow-up for 12 weeks from the initial procedure. Patients, clinicians, and pathologists were not masked to the study treatment. The primary endpoint was unexpected chest tube drainage, defined as requiring any chest tube after transbronchial cryobiopsy, or prolonged (>24 h) chest tube drainage after SLB. Secondary endpoints were diagnostic yield, in-hospital stay, pain, and serious adverse events. A modified intention-to-treat analysis was performed. This trial is registered with the Dutch Trial Register, NL7634, and is now closed. FINDINGS Between April 8, 2019, and Oct 24, 2021, 122 patients with ILD were assessed for study participation; and 55 patients were randomly assigned to the step-up strategy (n=28) or immediate SLB (n=27); three patients from the immediate SLB group were excluded. Unexpected chest tube drainage occurred in three of 28 patients (11%; 95% CI 4-27%) in the step-up group, and the number of patients for whom the chest tube could not be removed within 24 h was 11 of 24 patients (46%; 95% CI 2-65%) in the SLB group, with an absolute risk reduction of 35% (11-56%; p=0·0058). In the step-up strategy, the multidisciplinary team diagnostic yield after transbronchial cryobiopsy alone was 82% (64-92%), which increased to 89% (73-96%) when subsequent SLB was performed after inconclusive transbronchial cryobiopsy. In the immediate surgery strategy, the multidisciplinary team diagnostic yield was 88% (69-97%). Total in-hospital stay was 1 day (IQR 1-1) in the step-up group versus 5 days (IQR 4-6) in the SLB group. One (4%) serious adverse event occurred in step-up strategy versus 12 (50%) in the immediate SLB strategy. INTERPRETATION In ILD diagnosis, if lung tissue assessment is required, a diagnostic strategy starting with transbronchial cryobiopsy, followed by SLB when transbronchial cryobiopsy is inconclusive, appears to result in a significant reduction of patient burden and in-hospital stay with a similar diagnostic yield versus immediate SLB. FUNDING Netherlands Organisation for Health Research and Development (ZonMW) and Amsterdam University Medical Centers.
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Affiliation(s)
- Kirsten A Kalverda
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
| | - Maarten K Ninaber
- Department of Respiratory Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Lizzy Wijmans
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, Netherlands
| | - René E Jonkers
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes M Daniels
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jelle R Miedema
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jürgen Hölters
- Department of Respiratory Diseases, Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
| | - David Heineman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Merijn Kant
- Department of Respiratory Diseases, Amphia Hospital, Breda, Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ghada Shahin
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Bart Boerrigter
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Suzan Nijman
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Esther Nossent
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jerry Braun
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Bas Mathot
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, Netherlands
| | - Venerino Poletti
- Department of Medical Specialties, Giovan Battista Morgagni Hospital, University of Forlì, Forlì, Italy; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Jürgen Hetzel
- Department of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany; Department of Pneumology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Marcel Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Daniel A Korevaar
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Peter I Bonta
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jouke T Annema
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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Smesseim I, Mooij‐Kalverda K, Hessels L, Korevaar DA, Atasever B, de Graaff H, Goorhuis A, Nossent E, Bos L, Bonta P, van den Aardweg J, Boersma W, van der Lee I, Reesink HJ. High flow nasal cannula for acute respiratory failure due to COVID-19 in patients with a 'do-not-intubate' order: A survival analysis. Clin Respir J 2022; 17:115-119. [PMID: 36584670 PMCID: PMC9880618 DOI: 10.1111/crj.13573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 11/07/2022] [Accepted: 12/18/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION High flow nasal cannula (HFNC) reduces the need for intubation in patients with hypoxaemic acute respiratory failure (ARF), but its added value in patients with severe coronavirus disease 2019 (COVID-19) and a do-not-intubate (DNI) order is unknown. We aimed to assess (variables associated with) survival in these patients. MATERIALS AND METHODS We described a multicentre retrospective observational cohort study in five hospitals in the Netherlands and assessed the survival in COVID-19 patients with severe acute respiratory failure and a DNI order who were treated with high flow nasal cannula. We also studied variables associated with survival. RESULTS AND DISCUSSION One-third of patients survived after 30 days. Survival was 43.9% in the subgroup of patients with a good WHO performance status and only 16.1% in patients with a poor WHO performance status. Patients who were admitted to the hospital for a longer period prior to HFNC initiation were less likely to survive. HFNC resulted in an increase in ROX values, reflective of improved oxygenation and/or decreased respiratory rate. CONCLUSION Our data suggest that a trial of HFNC could be considered to increase chances of survival in patients with ARF due to COVID-19 pneumonitis and a DNI order, especially in those with a good WHO performance status.
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Affiliation(s)
- Illaa Smesseim
- Department of Pulmonary Medicine, Amsterdam UMCFree University Amsterdam and University of AmsterdamAmsterdamThe Netherlands
| | - Kirsten Mooij‐Kalverda
- Department of Pulmonary Medicine, Amsterdam UMCFree University Amsterdam and University of AmsterdamAmsterdamThe Netherlands
| | - Lisa Hessels
- Department of Pulmonary DiseasesNoordwest ZiekenhuisgroepAlkmaarThe Netherlands
| | - Daniel A. Korevaar
- Department of Pulmonary Medicine, Amsterdam UMCFree University Amsterdam and University of AmsterdamAmsterdamThe Netherlands
| | - Burak Atasever
- Department of Pulmonary DiseasesSpaarne GasthuisHaarlemThe Netherlands
| | - Hjalmar de Graaff
- Department of Pulmonary DiseasesOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
| | - Abraham Goorhuis
- Department of Infectious DiseasesAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Esther Nossent
- Department of Pulmonary Medicine, Amsterdam UMCFree University Amsterdam and University of AmsterdamAmsterdamThe Netherlands,Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMCAmsterdamThe Netherlands
| | - Lieuwe Bos
- Department of Pulmonary Medicine, Amsterdam UMCFree University Amsterdam and University of AmsterdamAmsterdamThe Netherlands,Intensive CareAmsterdam University Medical Centers—location AMCAmsterdamThe Netherlands
| | - Peter Bonta
- Department of Pulmonary Medicine, Amsterdam UMCFree University Amsterdam and University of AmsterdamAmsterdamThe Netherlands
| | | | - Joost van den Aardweg
- Department of Pulmonary Medicine, Amsterdam UMCFree University Amsterdam and University of AmsterdamAmsterdamThe Netherlands
| | - Wim Boersma
- Department of Pulmonary DiseasesNoordwest ZiekenhuisgroepAlkmaarThe Netherlands
| | - Ivo van der Lee
- Department of Pulmonary DiseasesSpaarne GasthuisHaarlemThe Netherlands
| | - Herre J. Reesink
- Department of Pulmonary DiseasesOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
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Smeele P, Vermunt L, Duitman J, Heunks L, Blok S, Horn J, Boogaard H, Nossent E, Teunissen CE. Plasma NfL trajectory during ICU‐treatment of COVID‐19 patients: A prospective cohort study. Alzheimers Dement 2021. [PMCID: PMC9011694 DOI: 10.1002/alz.057841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background COVID‐19 is a respiratory disease where neurological sequelae are frequently reported. Neurofilament light (NfL) in plasma is a validated biomarker for neuronal damage. We assessed the trajectory of NfL levels in intensive care unit (ICU) patients diagnosed with COVID‐19, and studied its relationship to clinical outcomes and markers of hypothesized pathophysiological mechanisms. Method As part of the Art‐Deco study and Amsterdam UMC COVID‐biobank, longitudinal samples and clinical data were collected weekly from a cohort of 31 prospectively admitted ICU patients with a minimum of 7 days of ventilation. The mean±sd age was 63±11 years. Admission duration ranged from 14‐35 days and 156 samples were collected. We evaluated the NfL trajectory over time, and whether this trajectory differed by 90‐day mortality outcome. Due to the non‐linear trajectory of NfL, we applied linear mixed models including cubic splines for the time variable. Secondly, we tested whether baseline or peak NfL levels predicted mortality (n=7/31), delirium incidence after detubation (n=18/22), and duration of delirium (6±6 days). Third, we assessed if disease severity (day 7 Sequential Organ Failure Assessment [SOFA] score) and baseline hypoxemia (pAO2 before intubation), inflammation (IL1‐b, IL‐6, IL‐8, TNF‐α), and coagulopathy (d‐dimer, presence of pulmonary embolism) were predictive of the NfL trajectory. For the latter models, we included an interaction term for the pathophysiological markers in the linear mixed models. All models were adjusted for age. Result NfL increased during ICU admission (p<001), and persisted longer in the non‐survivors (p<0.05;Figure 1). Baseline or maximum NfL was not predictive of mortality or delirium incidence. However, maximum NfL correlated to the duration of delirium (r=0.5;p=0.02). From the pathophysiological markers, SOFA scores (p<0.05) and baseline TNF‐α (p<0.05) were related to a stronger increase of NfL over time. Conclusion NfL levels increased over time and plateaued after 2‐3 weeks in most COVID‐19 patients at the ICU. Peak levels of NfL were predictive of delirium persistence. Repeated NfL levels may provide a future method for monitoring neurological outcomes in sedated ICU patients. Disease severity and specific inflammatory components appear important predictors of the NfL trajectory reflecting axonal damage in severe COVID‐19 patients.
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Affiliation(s)
- Patrick Smeele
- Neurochemistry Lab, Amsterdam Neuroscience, Amsterdam UMC Amsterdam Netherlands
| | - Lisa Vermunt
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, VU University Amsterdam Netherlands
| | | | - Leo Heunks
- Department of Intensive Care Medicine, Amsterdam UMC Amsterdam Netherlands
| | - Siebe Blok
- Department of Intensive Care Medicine, Amsterdam UMC Amsterdam Netherlands
| | - Janneke Horn
- Department of Intensive Care Medicine, Amsterdam UMC Amsterdam Netherlands
| | | | - Esther Nossent
- Department of Pulmonology, Amsterdam Neuroscience, Amsterdam UMC Amsterdam Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, VU University Amsterdam Netherlands
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Finazzi T, Ronden M, Nossent E, Tekatli H, Bahce I, Slotman B, Spoelstra F, Senan S. MA02.02 Toxicity of Lung SABR in Patients with Coexisting Interstitial Lung Disease. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.503] [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: 11/27/2022]
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van Leeuwen NM, Ramiro S, Ninaber MK, Nossent E, de Vries-Bouwstra JK. Pulmonary veno-occlusive disease in a patient with recently diagnosed systemic sclerosis. Journal of Scleroderma and Related Disorders 2019; 5:NP1-NP4. [PMID: 35382026 PMCID: PMC8922610 DOI: 10.1177/2397198319852194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 05/01/2019] [Indexed: 11/22/2022]
Abstract
Pulmonary veno-occlusive disease is a rare cause of pulmonary hypertension in patients with systemic sclerosis that can be misclassified as pulmonary arterial hypertension. Differentiation between pulmonary veno-occlusive disease and pulmonary arterial hypertension is challenging because of the similar clinical picture. Nevertheless, discrimination is important because pulmonary veno-occlusive disease has a worse prognosis. Vasodilators including phosphodiesterase type 5 inhibitors and endothelin receptor antagonists should be started with caution and often in combination with diuretics to prevent pulmonary edema.
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Affiliation(s)
- Nina M van Leeuwen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Maarten K Ninaber
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther Nossent
- Department of Pulmonology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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6
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Chen H, Louie A, Nossent E, Boldt G, Palma D, Senan S. P1.05-061 Increased Treatment-Related Toxicity in Patients with Early-Stage Non-Small Cell Lung Cancer and Co-Existing Interstitial Lung Disease. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.846] [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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7
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Montani D, Lau EM, Dorfmüller P, Girerd B, Jaïs X, Savale L, Perros F, Nossent E, Garcia G, Parent F, Fadel E, Soubrier F, Sitbon O, Simonneau G, Humbert M. Pulmonary veno-occlusive disease. Eur Respir J 2016; 47:1518-34. [DOI: 10.1183/13993003.00026-2016] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/04/2016] [Indexed: 12/11/2022]
Abstract
Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary hypertension (PH) characterised by preferential remodelling of the pulmonary venules. In the current PH classification, PVOD and pulmonary capillary haemangiomatosis (PCH) are considered to be a common entity and represent varied expressions of the same disease. The recent discovery of biallelic mutations in the EIF2AK4 gene as the cause of heritable PVOD/PCH represents a major milestone in our understanding of the molecular pathogenesis of PVOD. Although PVOD and pulmonary arterial hypertension (PAH) share a similar clinical presentation, with features of severe precapillary PH, it is important to differentiate these two conditions as PVOD carries a worse prognosis and life-threatening pulmonary oedema may occur following the initiation of PAH therapy. An accurate diagnosis of PVOD based on noninvasive investigations is possible utilising oxygen parameters, low diffusing capacity for carbon monoxide and characteristic signs on high-resolution computed tomography of the chest. No evidence-based medical therapy exists for PVOD at present and lung transplantation remains the preferred definitive therapy for eligible patients.
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8
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Tekatli H, Haasbeek N, Dahele M, De Haan P, Verbakel W, Bongers E, Hashemi S, Nossent E, Spoelstra F, de Langen AJ, Slotman B, Senan S. Outcomes of Hypofractionated High-Dose Radiotherapy in Poor-Risk Patients with "Ultracentral" Non-Small Cell Lung Cancer. J Thorac Oncol 2016; 11:1081-9. [PMID: 27013408 DOI: 10.1016/j.jtho.2016.03.008] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We defined "ultracentral" lung tumors as centrally located non-small cell lung cancers with planning target volumes overlapping the trachea or main bronchi. Increased toxicity has been reported after both conventional and stereotactic radiotherapy for such lesions. We studied outcomes after 12 fractions of 5 Gy (BED10 = 90 Gy, heterogeneous dose distribution) to ultracentral tumors in patients unfit for surgery or conventional chemoradiotherapy. METHODS Clinical outcomes and dosimetric details were analyzed in 47 consecutive patients with single primary or recurrent ultracentral non-small cell lung cancer treated between 2010 and 2015. Those irradiated previously or with metastasis to sites other than the brain and adrenal glands were excluded. Treatments were delivered using volumetric modulated arc therapy. RESULTS The median age was 77.5 years, 49% of patients had a World Health Organization performance score of 2 or higher, and the median planning target volume was 104.5cm(3) (range 17.7-508.5). At a median follow-up of 29.3 months, median overall survival was 15.9 months, and 3-year survival was 20.1%. No isolated local recurrences were observed. Grade 3 or higher toxicity was recorded in 38% of patients, with 21% scored as having a "possible" (n = 2) or "likely" (n = 8) treatment-related death between 5.2 and 18.2 months after treatment. Fatal pulmonary hemorrhage was observed in 15% of patients. CONCLUSIONS Unfit patients with ultracentral tumors who were treated using this scheme had a high local control and a median survival of 15.9 months. Despite manifestation of rates of a fatal lung bleeding comparable to those seen with conventional radiotherapy for endobronchial tumors, the overall rate of G5 toxicity is of potential concern. Additional work is needed to identify tumor and treatment factors related to hemorrhage.
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Affiliation(s)
- Hilâl Tekatli
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels Haasbeek
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Patricia De Haan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Wilko Verbakel
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Bongers
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sayed Hashemi
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Esther Nossent
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Femke Spoelstra
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Adrianus J de Langen
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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Elbers P, Rodrigus T, Nossent E, Malbrain MLNG, Vonk-Noordegraaf A. Fluid therapy in critically ill patients: perspectives from the right heart. Anaesthesiol Intensive Ther 2015; 47 Spec No:s38-43. [PMID: 26578396 DOI: 10.5603/ait.a2015.0080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/17/2015] [Indexed: 11/25/2022] Open
Abstract
As right heart function can affect outcome in the critically ill patient, a thorough understanding of factors determining right heart performance in health and disease is pivotal for the critical care physician. This review focuses on fluid therapy, which remains controversial in the setting of impending or overt right heart failure. In this context, we will attempt to elucidate which patients are likely to benefit from fluid administration and for which patients fluid therapy would likely be harmful. Following a general discussion of right heart function and failure, we specifically focus on important causes of right heart failure in the critically ill, i.e. sepsis induced myocardial dysfunction, the acute respiratory distress syndrome, acute pulmonary embolism and the effects of positive pressure ventilation. It is argued that fluid therapy should always be cautiously administered with the right heart in mind, which calls for close multimodal monitoring.
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Affiliation(s)
- Paul Elbers
- Department of Intensive Care Medicine, VU University Medical Center Amsterdam, Netherlands.
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Post JP, Westgeest HM, Blankensteijn JD, van der Meijs B, Klaassen RJL, Nossent E, Grünberg K, Buter J, Serné EH. Recurrent dyspnea following a swollen leg in a 46-year-old man. Chest 2013; 144:1402-1405. [PMID: 24081354 DOI: 10.1378/chest.13-0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Judith P Post
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Hans M Westgeest
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan D Blankensteijn
- Department of Vascular Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Bram van der Meijs
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rob J L Klaassen
- Department of Internal Medicine, Zaans Medical Center, Zaandam, The Netherlands
| | - Esther Nossent
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Katrien Grünberg
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan Buter
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik H Serné
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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