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Brunkhorst FM, Weigand MA, Pletz M, Gastmeier P, Lemmen SW, Meier-Hellmann A, Ragaller M, Weyland A, Marx G, Bucher M, Gerlach H, Salzberger B, Grabein B, Welte T, Werdan K, Kluge S, Bone HG, Putensen C, Rossaint R, Quintel M, Spies C, Weiß B, John S, Oppert M, Jörres A, Brenner T, Elke G, Gründling M, Mayer K, Weimann A, Felbinger TW, Axer H, Heller T, Gagelmann N. [S3 guideline sepsis-prevention, diagnosis, treatment, and aftercare : Summary of the strong recommendations]. Med Klin Intensivmed Notfmed 2020; 115:178-188. [PMID: 32185422 DOI: 10.1007/s00063-020-00671-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- F M Brunkhorst
- Zentrum für Klinische Studien, Integriertes Forschungs- und Behandlungszentrum (IFB) Sepsis und Sepsisfolgen, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Salvador-Allende-Platz 27, 07747, Jena, Deutschland.
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Pletz
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S W Lemmen
- Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - A Meier-Hellmann
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Helios-Klinikum Erfurt GmbH, Erfurt, Deutschland
| | - M Ragaller
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Dresden, Dresden, Deutschland
| | - A Weyland
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, Klinikum Oldenburg gGmbH, Oldenburg, Deutschland
| | - G Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum Aachen, Aachen, Deutschland
| | - M Bucher
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Halle, Halle, Deutschland
| | - H Gerlach
- Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - B Salzberger
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - B Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene, Klinikum der Universität München, München, Deutschland
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Klinikum der MLU Halle-Wittenberg, Halle, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - H G Bone
- Zentrum für Anästhesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Deutschland
| | - C Putensen
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Rossaint
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Aachen, Deutschland
| | - M Quintel
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Spies
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - B Weiß
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S John
- Klinik für Innere Medizin 8, Schwerpunkt Kardiologie, Klinikum Nürnberg, Nürnberg, Deutschland
| | - M Oppert
- Klinik für Notfall- und Internistische Intensivmedizin, Klinikum Ernst von Bergmann Potsdam, Potsdam, Deutschland
| | - A Jörres
- Medizinische Klinik I, Klinik für Nephrologie, Transplantationsmedizin und internistische Intensivmedizin, Krankenhaus Merheim, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - T Brenner
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - G Elke
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Kiel, Kiel, Deutschland
| | - M Gründling
- Klinik für Anästhesiologie - Anästhesie, Intensiv‑, Notfall- und Schmerzmedizin, Universitätsklinikum Greifswald, Greifswald, Deutschland
| | - K Mayer
- Medizinische Klinik und Poliklinik II, Klinikum der Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - A Weimann
- Klinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum "St. Georg" Leipzig gGmbH, Leipzig, Deutschland
| | - T W Felbinger
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Städtisches Klinikum München, München, Deutschland
| | - H Axer
- Klinik für Neurologie, Universitätsklinikum Jena, Jena, Deutschland
| | - T Heller
- Universitätsklinikum Jena, Jena, Deutschland
| | - N Gagelmann
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Dickmann P, Scherag A, Coldewey SM, Sponholz C, Brunkhorst FM, Bauer M. [Epistemology in the intensive care unit-what is the purpose of a definition? : Paradigm shift in sepsis research]. Anaesthesist 2018; 66:622-625. [PMID: 28500500 DOI: 10.1007/s00101-017-0315-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/21/2023]
Abstract
The adoption of the new sepsis definition in early 2016 introduced a new paradigm for the clinical picture of sepsis. Up until now, sepsis was defined as a systemic inflammatory reaction (systemic inflammatory response syndrome, SIRS) to an infection. Based on a better understanding of the molecular mechanisms, the focus of the new definition is no longer the inflammatory response, but rather the tissue damage and impairment of organ function which this induces. The paradigm thus moves away from the infection and the systemic inflammatory response, and toward that which makes sepsis so dangerous in terms of both disease dynamics and outcome: organ failure due to a dysregulated host response to an infection. This change of perspective or paradigm enables patients with an increased risk of developing sepsis to be recognized and treated earlier in clinical routine, even outside of the intensive care unit. The new definition also promotes development of new treatment strategies with improved ability to treat sepsis causally.
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Affiliation(s)
- P Dickmann
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - A Scherag
- Integriertes Forschungs- und Behandlungszentrum (IFB) Sepsis und Sepsisfolgen, Universitätsklinikum Jena, Jena, Deutschland
| | - S M Coldewey
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.,Integriertes Forschungs- und Behandlungszentrum (IFB) Sepsis und Sepsisfolgen, Universitätsklinikum Jena, Jena, Deutschland.,Zentrum für Innovationskompetenz Septomics, Universitätsklinikum Jena, Jena, Deutschland
| | - C Sponholz
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - F M Brunkhorst
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - M Bauer
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland. .,Integriertes Forschungs- und Behandlungszentrum (IFB) Sepsis und Sepsisfolgen, Universitätsklinikum Jena, Jena, Deutschland.
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Hagel S, Ludewig K, Pletz MW, Frosinski J, Moeser A, Wolkewitz M, Gastmeier P, Harbarth S, Brunkhorst FM, Kesselmeier M, Scherag A. Effectiveness of a hospital-wide infection control programme on the incidence of healthcare-associated infections and associated severe sepsis and septic shock: a prospective interventional study. Clin Microbiol Infect 2018; 25:462-468. [PMID: 30036671 DOI: 10.1016/j.cmi.2018.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/27/2018] [Revised: 07/03/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate whether a hospital-wide infection control programme (ICP) is effective at reducing the burden of healthcare-associated infections (HAIs) and associated severe sepsis/septic shock or death (severe HAIs). METHODS Prospective, quasi-experimental study with two surveillance periods (September 2011 to August 2012; May 2013 to August 2014). Starting October 2012, the ICP included hand hygiene promotion and bundle implementation for common HAIs. We applied segmented mixed-effects Poisson regression and multi-state models. We reported adjusted incidence rate ratios (aIRR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI). RESULTS Overall, 62 154 patients were under surveillance, with 1568 HAIs identified in 1170 patients (4.3 per 100 admissions) in the first and 2336 HAIs identified in 1711 patients (4.9 per 100 admissions) in the second surveillance period. No differences were found in the overall HAI incidence rates between the periods in the general wards (aIRR 1.29, 95% CI 0.78-2.15) and intensive care units (ICUs) (aIRR 0.59, 95% CI 0.27-1.31). However, the HAI incidence rate was declining in the ICUs after starting the ICP (aIRR 0.98, 95% CI 0.97-1.00 per 1-week increment), in contrast to general wards (aIRR 1.01, 95% CI 1.00-1.02). A reduction in severe HAIs (aIRR 0.13, 95% CI 0.05-0.32) and a lower probability of HAI-associated in-hospital deaths (aHR 0.56, 95% CI 0.31-0.99) were observed in the second period in the ICUs. CONCLUSIONS There was no overall reduction in HAIs after implementation of the ICP. However, there was a significant reduction in severe HAIs in ICUs. Whether this difference was a consequence of the ICP or improvement in HAI case management is not clear.
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Affiliation(s)
- S Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
| | - K Ludewig
- Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Anaesthesiology and Intensive Care Therapy, Jena University Hospital, Jena, Germany
| | - M W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - J Frosinski
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - A Moeser
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, Jena University Hospital, Jena, Germany
| | - M Wolkewitz
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Centre-University of Freiburg, Freiburg, Germany; Freiburg Centre of Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - S Harbarth
- Infection Control Programme, Geneva University Hospitals and Medical School and WHO Collaborating Centre, Geneva, Switzerland
| | - F M Brunkhorst
- Centre for Clinical Studies Jena, Jena University Hospital, Jena, Germany
| | - M Kesselmeier
- Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Research Group Clinical Epidemiology, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - A Scherag
- Research Group Clinical Epidemiology, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany
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Friesecke S, Träger K, Schittek GA, Molnar Z, Bach F, Kogelmann K, Bogdanski R, Weyland A, Nierhaus A, Nestler F, Olboeter D, Tomescu D, Jacob D, Haake H, Grigoryev E, Nitsch M, Baumann A, Quintel M, Schott M, Kielstein JT, Meier-Hellmann A, Born F, Schumacher U, Singer M, Kellum J, Brunkhorst FM. International registry on the use of the CytoSorb® adsorber in ICU patients : Study protocol and preliminary results. Med Klin Intensivmed Notfmed 2017; 114:699-707. [PMID: 28871441 DOI: 10.1007/s00063-017-0342-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of this clinical registry is to record the use of CytoSorb® adsorber device in critically ill patients under real-life conditions. METHODS The registry records all relevant information in the course of product use, e. g., diagnosis, comorbidities, course of the condition, treatment, concomitant medication, clinical laboratory parameters, and outcome (ClinicalTrials.gov Identifier: NCT02312024). Primary endpoint is in-hospital mortality as compared to the mortality predicted by the APACHE II and SAPS II score, respectively. RESULTS As of January 30, 2017, 130 centers from 22 countries were participating. Data available from the start of the registry on May 18, 2015 to November 24, 2016 (122 centers; 22 countries) were analyzed, of whom 20 centers from four countries provided data for a total of 198 patients (mean age 60.3 ± 15.1 years, 135 men [68.2%]). In all, 192 (97.0%) had 1 to 5 Cytosorb® adsorber applications. Sepsis was the most common indication for CytoSorb® treatment (135 patients). Mean APACHE II score in this group was 33.1 ± 8.4 [range 15-52] with a predicted risk of death of 78%, whereas the observed mortality was 65%. There were no significant decreases in the SOFA scores after treatment (17.2 ± 4.8 [3-24]). However interleukin-6 levels were markedly reduced after treatment (median 5000 pg/ml before and 289 pg/ml after treatment, respectively). CONCLUSIONS This third interim report demonstrates the feasibility of the registry with excellent data quality and completeness from 20 study centers. The results must be interpreted with caution, since the numbers are still small; however the disease severity is remarkably high and suggests that adsorber treatment might be used as an ultimate treatment in life-threatening situations. There were no device-associated side effects.
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Affiliation(s)
- S Friesecke
- Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, Greifswald, Germany
| | - K Träger
- Kardioanästhesiologie, Universitätsklinikum Ulm, Ulm, Germany
| | - G A Schittek
- Klinik für Anästhesiologie, Intensivtherapie und Palliativmedizin, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - Z Molnar
- Department of Anesthesiology and Intensive Care, University of Szeged, Szeged, Hungary
| | - F Bach
- Klinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany
| | - K Kogelmann
- Klinik für Anästhesiologie und Intensivmedizin, Hans-Susemihl-Krankenhaus gGmbH, Emden, Germany
| | - R Bogdanski
- Klinik für Anästhesiologie, AG Hämodynamik, Klinikum rechts der Isar TU München, München, Germany
| | - A Weyland
- Universitätsklinik für Anästhesiologie/Intensiv‑/Notfallmedizin/Schmerztherapie, Klinikum Oldenburg gGmbH, Carl von Ossietzky Universität, Oldenburg, Germany
| | - A Nierhaus
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - F Nestler
- Anästhesie und Intensivmedizin, Kliniken Erlabrunn gGmbH, Breitenbrunn, Germany
| | - D Olboeter
- Anästhesie und Intensivmedizin, Krankenhaus Herzberg, Elbe-Elster-Klinikum GmbH, Herzberg, Germany
| | - D Tomescu
- Fundeni Clinical Institute, Bucharest, Romania
| | - D Jacob
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - H Haake
- Klinik für Kardiologie und Intensivmedizin, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - E Grigoryev
- Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
| | - M Nitsch
- Klinik für Anästhesie, Intensiv‑, Notfallmedizin und Schmerztherapie, Krankenhaus St. Elisabeth und St. Barbara Halle, Halle, Germany
| | - A Baumann
- Klinik für Anästhesie, Intensiv‑, Palliativ- und Schmerzmedizin, Berufsgenossensch. Uniklinik Bergmannsheil, Bochum, Germany
| | - M Quintel
- Zentrum Anästhesiologie, Rettungs-und Intensivmedizin, Universitätsklinikum Göttingen, Göttingen, Germany
| | - M Schott
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Region Hannover Nordstadt, Hannover, Germany
| | - J T Kielstein
- Medizinische Klinik V, Klinikum Braunschweig, Braunschweig, Germany
| | - A Meier-Hellmann
- Anästhesie, Intensivmedizin und Schmerztherapie, HELIOS Klinikums Erfurt, Erfurt, Germany
| | - F Born
- Herzchirurgische Klinik und Poliklinik, LMU München, München, Germany
| | - U Schumacher
- Center for Clinical Studies Jena (ZKS), Jena, Germany
| | - M Singer
- Intensive Care Medicine, University College London, London, UK
| | - J Kellum
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - F M Brunkhorst
- Center for Clinical Studies Jena (ZKS), Jena, Germany. .,Center for Sepsis Control and Care (CSCC), Jena, Germany. .,Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany.
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Weis S, Hagel S, Schmitz RPH, Scherag A, Brunkhorst FM, Forstner C, Löffler B, Pletz MW. Study on the utility of a statewide counselling programme for improving mortality outcomes of patients with Staphylococcus aureus bacteraemia in Thuringia (SUPPORT): a study protocol of a cluster-randomised crossover trial. BMJ Open 2017; 7:e013976. [PMID: 28391236 PMCID: PMC5775453 DOI: 10.1136/bmjopen-2016-013976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Staphylococcus aureus bacteraemia (SAB) is a frequent infection with high mortality rates. It requires specific diagnostic and therapeutic management such as prolonged intravenous administration of antibiotics and aggressive search for and control of infectious sources. Underestimation of disease severity frequently results in delayed or inappropriate management of patients with SAB leading to increased mortality rates. According to observational studies, patient counselling by infectious disease consultants (IDC) improves survival and reduces the length of hospital stay as well as complication rates. In many countries, IDC are available only in some tertiary hospitals. In this trial, we aim to demonstrate that the outcome of patients with SAB in small and medium size hospitals that do not employ IDC can be improved by unsolicited ID phone counselling. The SUPPORT trial will be the first cluster-randomised controlled multicentre trial addressing this question. METHODS AND ANALYSIS SUPPORT is a single-blinded, multicentre interventional, cluster-randomised, controlled crossover trial with a minimum of 15 centres that will include 250 patients with SAB who will receive unsolicited IDC counselling and 250 who will receive standard of care. Reporting of SAB will be conducted by an electronic real-time blood culture registry established for the German Federal state of Thuringia (ALERTSNet) or directly by participating centres in order to minimise time delay before counselling. Mortality, disease course and complications will be monitored for 90 days with 30-day all-cause mortality rates as the primary outcome. Generalised linear mixed modelling will be used to detect the difference between the intervention sequences. We expect improved outcome of patients with SAB after IDC. ETHICS AND DISSEMINATION We obtained ethics approval from the Ethics committee of the Jena University Hospital and from the Ethics committee of the State Chamber of Physicians of Thuringia. Results will be published in a peer-reviewed journal and additionally disseminated through public media. TRIAL REGISTRATION NUMBER DRKS00010135.
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Affiliation(s)
- S Weis
- Center for Infectious Disease and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
| | - S Hagel
- Center for Infectious Disease and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - R P H Schmitz
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - A Scherag
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - F M Brunkhorst
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - C Forstner
- Center for Infectious Disease and Infection Control, Jena University Hospital, Jena, Germany
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - B Löffler
- Institute for Medical Microbiology, Jena University Hospital, Jena, Germany
| | - M W Pletz
- Center for Infectious Disease and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
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Reiser M, Scherag A, Forstner C, Brunkhorst FM, Harbarth S, Doenst T, Pletz MW, Hagel S. Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery. J Hosp Infect 2016; 95:137-143. [PMID: 28109620 DOI: 10.1016/j.jhin.2016.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 10/04/2016] [Accepted: 11/11/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the effect of pre-operative octenidine (OCT) decolonization on surgical site infection (SSI) rates. DESIGN Before-and-after cohort study. PATIENTS Patients undergoing an elective isolated coronary artery bypass graft (CABG) procedure: control group (1st January to 31st December 2013), N=475; intervention group (1st January to 31st December 2014), N=428. INTERVENTIONS The intervention consisted of nasal application of OCT ointment three times daily, beginning on the day before surgery, and showering the night before and on the day of surgery with OCT soap. RESULTS A median sternotomy was performed in 805 (89.1%) patients and a minimally invasive direct coronary artery bypass procedure was performed in 98 (10.9%) patients. Overall, there was no difference in SSI rates between the control and intervention groups (15.4% vs 13.3%, P=0.39). The rate of harvest site SSIs was significantly lower in patients in the intervention group (2.5% vs 0.5%, P=0.01). Patients who had undergone a median sternotomy in the intervention group had a significantly lower rate of organ/space sternal SSIs (1.9% vs 0.3%, P=0.04). However, there was a trend towards an increased rate of deep incisional sternal SSIs (1.2% vs 2.9%, P=0.08). Multi-variate analysis did not identify a significant protective effect of the intervention (odds ratio 0.79, 95% confidence interval 0.53-1.15, P=0.27). CONCLUSIONS Pre-operative decolonization with OCT did not reduce overall SSI rates in patients undergoing an elective isolated CABG procedure, but significantly decreased harvest site and organ/space sternal SSIs. Randomized controlled trials, including controlled patient adherence to the intervention, are required to confirm these observations and to determine the clinical utility of OCT in pre-operative decolonization.
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Affiliation(s)
- M Reiser
- Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - A Scherag
- Integrated Research and Treatment Centre, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Research Group Clinical Epidemiology, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - C Forstner
- Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - F M Brunkhorst
- Centre for Clinical Studies Jena, Jena University Hospital, Jena, Germany
| | - S Harbarth
- Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - T Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - M W Pletz
- Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - S Hagel
- Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Integrated Research and Treatment Centre, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
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Hagel S, Ludewig K, Moeser A, Pausch C, Scherag A, Gastmeier P, Harbarth S, Brunkhorst FM. Effectiveness of a hospital-wide educational programme for infection control to reduce the rate of healthcare associated infections and related sepsis (ALERTS). Antimicrob Resist Infect Control 2015. [PMCID: PMC4474613 DOI: 10.1186/2047-2994-4-s1-o17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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10
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Karch A, Castell S, Geffers C, Schwab F, Brunkhorst FM, Gastmeier P, Mikolajczyk RT. Defining Reference Range for Blood Culture Rates – an Analysis within the German Hospital Infection Surveillance System (KISS). Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.357] [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: 11/14/2022] Open
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Schmitz M, Heering PJ, Hutagalung R, Schindler R, Quintel MI, Brunkhorst FM, John S, Jörres A. [Treatment of acute renal failure in Germany: Analysis of current practice]. Med Klin Intensivmed Notfmed 2015; 110:256-63. [PMID: 25820934 DOI: 10.1007/s00063-015-0014-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/16/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES There are currently no reliable data on the differential use of renal replacement therapy (RRT) options for critically ill patients with acute renal failure in Germany. PATIENTS AND METHODS A questionnaire-based survey was delivered to 2265 German intensive care units. The questionnaire contained 19 questions regarding RRT. RESULTS A total of 423 German intensive care units participated in the survey. The offered modalities of RRT varied significantly: the smaller the facility, the fewer different RRT options were available. Intermittent dialysis procedures were available in only 35% of hospitals with up to 400 beds. In university hospitals, hemodynamically unstable patients were exclusively treated by continuous RRT, whereas in hospitals with up to 400 beds, intermittent RRT was also used. In addition, treatment practice was also dependent on the specialization of the treating physicians: Isolated acute renal failure was treated more often intermittently by nephrologists compared to anesthesiologists (79.7 vs. 43.3%). Nephrologists also used extracorporeal RRT more often in cardiorenal syndrome (54.3 vs. 35.8%), whereas anesthesiologists preferred them in sepsis (37.3 vs. 23.1%). The choice of anticoagulant varied as well: Hospitals with up to 400 beds offered regional citrate anticoagulation in only 50% compared to 90% of university hospitals. CONCLUSIONS Currently, RRT treatment in acute renal failure on German intensive care units seems to be dependent on the size, local structures, and education of the intensivists rather than patient needs. Our results demonstrate the necessity to establish cross-disciplinary standards for the treatment of acute renal failure in German intensive care units.
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Affiliation(s)
- M Schmitz
- Klinik für Nephrologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen gGmbH, Akademisches Lehrkrankenhaus Universität Köln, Gotenstraße 1, 42653, Solingen, Deutschland,
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Brunkhorst FM, Patchev V. [Sepsis-associated Purpura Fulminans International Registry--Europe (SAPFIRE)]. Med Klin Intensivmed Notfmed 2014; 109:591-5. [PMID: 25348051 DOI: 10.1007/s00063-014-0402-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Purpura fulminans is a rare life-threatening condition which is characterized by disseminated thrombosis in dermal and systemic microcirculation, cutaneous hemorrhages with progressing necrosis and multiple organ failure. The underlying pathogenesis is based on the disruption of the intrinsic anticoagulation cascade, with protein C deficiency being considered the leading factor in this process. In the majority of cases, the condition emerges as consumptive coagulopathy associated with severe sepsis. OBJECTIVES Epidemiological data on sepsis-associated purpura fulminans (SAPF) are scarce and evidence-based treatment guidelines have not been established yet. While restoration of the balance in the coagulation cascade is a declared therapeutic goal, evaluations of the efficacy of different therapeutic approaches in randomized clinical trials are still lacking. The causal role of individual microbial pathogens also requires comprehensive evaluation. METHODS A prospective multicenter Sepsis-Associated Purpura Fulminans International Registry-Europe (SAPFIRE) will be established in the first quarter of 2015. For the first time, participating centers will systematically collect information on etiology, clinical course, biomarkers, treatment, morbidity, and mortality of SAPF. RESULTS The SAPFIRE data will be periodically evaluated and disseminated. Retrospective analysis of each center's data and regular access to aggregated information collected by other centers will enable the participants to monitor and update care quality standards.
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Affiliation(s)
- F M Brunkhorst
- Center of Sepsis Control and Care (CSCC), Klinik für Anaesthesiologie und Intensivtherapie, Universitätsklinikum Jena, Salvador-Allende-Platz 29, 07747, Jena, Deutschland,
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Schindler R, Hutagalung R, Jörres A, John S, Quintel MI, Brunkhorst FM, Heering P. [Treatment of acute renal failure in Germany: a structural analysis]. Dtsch Med Wochenschr 2014; 139:1701-6. [PMID: 25116018 DOI: 10.1055/s-0034-1370272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION There are no reliable data on the structure and practice of the care of critically ill patients with acute renal failure in Germany. METHODS We carried out a detailed survey by sending a questionnaire to 2265 German Intensive Care Units. The questionnaire contained 19 questions regarding renal replacement therapy. RESULTS 423 German intensive care units participated in the survey. Most of the ICUs are headed interdisciplinary (47%) or by anesthesiologists (30%), with significant differences depending on the size of the clinic, with primarily interdisciplinary management in smaller clinics. The offered type of renal replacement therapy varies significantly, the smaller the house the fewer methods are available. Thus, intermittent dialysis procedures are offered only in 35% of hospitals with up to 400 beds. The indication for the initiation of acute renal replacement therapy in intensive care is provided predominantly (53%) by an anesthesiologist. A nephrologist is only involved in 22% of all intensive care units. The indication is based primarily on a "clinical criteria", but these are poorly defined. CONCLUSION Our results demonstrate the need for cross-disciplinary standards for the treatment of acute renal failure in German intensive care units.
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Affiliation(s)
- R Schindler
- Medizinische Klinik m.S. Nephrologie und Internistische Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum
| | - R Hutagalung
- Zentrum für Klinische Studien, Paul-Martini-FG Klinische Sepsisforschung; Klinik für Anästhesiologie, und Intensivtherapie, Universitätsklinikum Jena
| | - A Jörres
- Medizinische Klinik m.S. Nephrologie und Internistische Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum
| | - S John
- Medizinische Klinik 4, Universität Erlangen-Nürnberg, Intensivmedizin, Klinikum Nürnberg-Süd
| | - M I Quintel
- Abteilung für Anästhesie, Universitätsmedizin Göttingen, Georg-August-Universität
| | - F M Brunkhorst
- Zentrum für Klinische Studien, Paul-Martini-FG Klinische Sepsisforschung; Klinik für Anästhesiologie, und Intensivtherapie, Universitätsklinikum Jena
| | - P Heering
- Nephrologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen
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Götz T, Huonker R, Brunkhorst FM, Witte O, Günther A. Impairment of oscillatory activity in survivors of severe sepsis: a magnetoencephalography study. KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1371296] [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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Frosinski JJ, Brunkhorst FM. [Peripheral venous catheter-related E. faecalis sepsis with fatal outcome]. Dtsch Med Wochenschr 2013; 138:1723-6. [PMID: 23934591 DOI: 10.1055/s-0033-1349434] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 82 year-old man was admitted with a facial Herpes zoster reactivation and a zoster-related meningoencephalitis. He was treated with Aciclovir over a peripheral venous catheter that was placed in the right elbow pit. The meningoencephalitis subsided without neurological deficits, but the patient developed a catheter-associated phlebitis. An oral cephalosporin was prescribed and the patient discharged. After developing a fever and general discomfort he was readmitted to hospital three days later. INVESTIGATIONS A 3 × 3 cm abscess in the elbow pit was incised and drained, but no swab or blood cultures were taken. When the patient's condition got worse an echocardiogram was ordered. It showed vegetations on the aortic and mitral valves as well as on the cardiac pacemaker wires. TREATMENT AND COURSE Blood cultures were positive for Enterococcus faecalis. Although a therapy with vancomycin and ampicillin was started, the patient's condition impaired. Surgical valve replacement was initiated, but the patient expired 5 weeks later due to septic multi-organ failure. CONCLUSION The danger of peripheral venous catheter infections is frequently underrated, early identification of the causing pathogen, sensitivity testing and proper antibiotic treatment are of tremendous importance. Clinical sings of sepsis must under no circumstances be overlooked.
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Affiliation(s)
- J J Frosinski
- Integriertes Forschungs- und Behandlungszentrum Sepsis und Sepsisfolgen, CSCC, Universitätsklinikum Jena, Jena
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Hagel S, Ludewig K, Frosinski J, Hutagalung R, Porzelius C, Gastmeier P, Harbarth S, Pletz MW, Brunkhorst FM. [Effectiveness of a hospital-wide educational programme for infection control to reduce the rate of health-care associated infections and related sepsis (ALERTS)--methods and interim results]. Dtsch Med Wochenschr 2013; 138:1717-22. [PMID: 23934590 DOI: 10.1055/s-0033-1349481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Health care associated infections (HAIs) are one of the most frequent complications of hospital care, associated with increased morbidity, mortality and considerable extra costs for the health care system. The overarching objective of the ALERTS study is to demonstrate the feasibility of a hospitalwide programme to reduce the burden of HAIs and related sepsis of at least 20 %. METHODS Prospective, quasi-experimental study covering all acute care units (27 general wards, 4 ICUs, overall 809 beds) at Jena University Hospital. Surveillance for HAIs is performed by computerized antibiotic monitoring in patients with risk factors for HAIs (i. e. intravenous and urinary catheters, surgery) on a daily basis. Following the first surveillance period a multifaceted, pragmatic infection control programme, aimed at proper hand hygiene and bundles for the prevention of the four most common HAIs will be implemented. Subsequently, a second surveillance period lasting 18 months will be conducted to measure the effect of the infection control programme, starting in May 2013. RESULTS Interim results for the first surveillance period (09/2011 to 08/2012) are presented. During this period, 30,631 patients were admitted to the participating departments. According to CDC definitions we identified 1,637 HAIs, resulting in an overall incidence of 5.3 %. Based on clinical evaluation only, irrespective of the CDC definitions, an additional 944 HAIs were detected (overall HAI rate, 8.4 % [n =2581]). A substantial proportion of patients had HAI associated severe sepsis or septic shock (lower respiratory tract infection, n = 279 [37 %]; surgical site infection, n = 114 [25 %]; primary sepsis, n = 110 [32 %]; urinary tract infection, n = 46 [8 %]; other, n = 87 [22 %]). CONCLUSION Our numbers reveal that a high number of HAIs are missed using CDC-definitions and therefore the magnitude of the problem might be underestimated. Furthermore, a high percentage of HAIs progress from localized infection to severe sepsis or septic shock, requiring ICU treatment.
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Affiliation(s)
- S Hagel
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena
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Hagel S, Ludewig K, Frosinski J, Hutagalung R, Gastmeier P, Harbarth S, Brunkhorst FM. P173: Effectiveness of a hospital-wide educational programme for infection control to reduce the rate of health-care associated infections and related sepsis (alerts) – first results. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687981 DOI: 10.1186/2047-2994-2-s1-p173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kaasch AJ, Rieg S, Kuetscher J, Brodt HR, Widmann T, Herrmann M, Meyer C, Welte T, Kern P, Haars U, Reuter S, Hübner I, Strauss R, Sinha B, Brunkhorst FM, Hellmich M, Fätkenheuer G, Kern WV, Seifert H. Delay in the administration of appropriate antimicrobial therapy in Staphylococcus aureus bloodstream infection: a prospective multicenter hospital-based cohort study. Infection 2013; 41:979-85. [DOI: 10.1007/s15010-013-0428-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 02/09/2013] [Indexed: 10/27/2022]
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Brunkhorst FM. [Volume therapy: hydroxyethyl starch or saline? Hydroxyethyl starch in intensive care patients: there's an end of it!]. Dtsch Med Wochenschr 2013; 138:66. [PMID: 23299339 DOI: 10.1055/s-0032-1329033] [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: 10/27/2022]
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Bohne S, Schelhorn-Neise P, Brunkhorst FM, Guntinas-Lichius O. [Severe organic dysphagia after long-term ventilation in a patient with sepsis and multiorgan failure]. Med Klin Intensivmed Notfmed 2012; 107:564-6. [PMID: 22961003 DOI: 10.1007/s00063-012-0148-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/02/2012] [Accepted: 07/04/2012] [Indexed: 10/27/2022]
Abstract
A case of severe chronic dysphagia lasting more than 1 year after long-term ventilation due to sepsis is presented. Fiber optic endoscopic examination of swallowing (FEES) revealed retention of food on both sides of the base of the tongue and in both valleculae combined with severe penetration and postglutitive aspiration into the larynx. The reason was a broad-based scarred adhesion between the lingual side of the epiglottis and the tongue base. The adhesion was resected using a CO(2) laser. The final examination 3 months later showed complete recovery of normal swallowing function.
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Affiliation(s)
- S Bohne
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Lessingstraße 2, Jena, Germany
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Weimann A, Kern BR, Löffler M, Sablotzki A, Thiele F, Brunkhorst FM. [Enrolment of intensive care patients in clinical studies. Ethical, legal and organizational problems from an interdisciplinary point of view]. Med Klin Intensivmed Notfmed 2012; 108:303-10. [PMID: 22961004 DOI: 10.1007/s00063-012-0153-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/04/2012] [Accepted: 08/07/2012] [Indexed: 10/27/2022]
Abstract
Nowadays, most patients in hospital die in the intensive care unit from sepsis and multiple organ failure. Clinical research in this critically ill and vulnerable patient population bears a lot of ethical and legal problems; however, it remains a must in order to develop evidence-based diagnostic and therapeutic strategies for life-threatening diseases with special respect to limited health care resources. With regard to the Declaration of Helsinki, good clinical practice guidelines (GCP) from the European Medicines Agency (EMA) and the German medical drug law (AMG) this article discusses ethical and legal aspects of patient inclusion for clinical trials as well as incentives for appropriate patient recruitment from an interdisciplinary point of view.
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Affiliation(s)
- A Weimann
- Klinik für Allgemein- und Visceralchirurgie, Klinikum St. Georg gGmbH, Delitzscher Str. 141, 04129, Leipzig.
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Knapp J, Marx G, Weismüller K, Steinebach S, Lichtenstern C, Popp E, Mayer K, Brunkhorst FM, Weigand MA, Bernhard M. [Update: studies in intensive care medicine. Results of the last 12 months]. Anaesthesist 2012; 60:1041-56. [PMID: 22071875 PMCID: PMC7095879 DOI: 10.1007/s00101-011-1948-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Die Intensivmedizin spielt eine bedeutende Rolle sowohl für den medizinischen als auch den ökonomischen Erfolg eines Krankenhauses. Eine qualitativ hochwertige Intensivmedizin setzt die Kenntnis und die Umsetzung relevanter neuer klinischer Studien voraus. Die vorliegende Arbeit gibt einen Überblick über die wichtigsten intensivmedizinischen Publikationen des Jahres 2010 und der ersten Jahreshälfte von 2011 und ordnet diese im Hinblick auf die jeweilige klinische Relevanz ein. In den Jahren 2010 und 2011 sind zahlreiche randomisierte Studien veröffentlicht worden. Schwerpunkte waren die Therapie des Lungenversagens, die Analgosedierung und die Sepsistherapie.
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Affiliation(s)
- J Knapp
- Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
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Reuken PA, Bruns T, Zimmer B, Michael A, Brunkhorst FM, Pletz MW, Stallmach A. Recurrent fever and bacteraemia after endoscopic variceal haemostasis with cyanoacrylate: a case report. Infection 2011; 40:351-3. [PMID: 22002735 DOI: 10.1007/s15010-011-0207-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 09/27/2011] [Indexed: 02/07/2023]
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Reinhart K, Brunkhorst FM, Bone HG, Bardutzky J, Dempfle CE, Forst H, Gastmeier P, Gerlach H, Gründling M, John S, Kern W, Kreymann G, Krüger W, Kujath P, Marggraf G, Martin J, Mayer K, Meier-Hellmann A, Oppert M, Putensen C, Quintel M, Ragaller M, Rossaint R, Seifert H, Spies C, Stüber F, Weiler N, Weimann A, Werdan K, Welte T. [Prevention, diagnosis, treatment, and follow-up care of sepsis. First revision of the S2k Guidelines of the German Sepsis Society (DSG) and the German Interdisciplinary Association for Intensive and Emergency Care Medicine (DIVI)]. Anaesthesist 2010; 59:347-70. [PMID: 20414762 DOI: 10.1007/s00101-010-1719-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- K Reinhart
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Jena der Friedrich-Schiller-Universität Jena, Erlanger Allee 101, 07747 Jena.
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Reinhart K, Brunkhorst FM, Bone HG, Bardutzky J, Dempfle CE, Forst H, Gastmeier P, Gerlach H, Gründling M, John S, Kern W, Kreymann G, Krüger W, Kujath P, Marggraf G, Martin J, Mayer K, Meier-Hellmann A, Oppert M, Putensen C, Quintel M, Ragaller M, Rossaint R, Seifert H, Spies C, Stüber F, Weiler N, Weimann A, Werdan K, Welte T. Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI)). Ger Med Sci 2010; 8:Doc14. [PMID: 20628653 PMCID: PMC2899863 DOI: 10.3205/000103] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Indexed: 12/16/2022]
Abstract
Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1st revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the “German Instrument for Methodological Guideline Appraisal” of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.
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Affiliation(s)
- K Reinhart
- University Hospital Jena, Clinic for Anaesthesiology and Intensive Care Therapy, Jena, Germany
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Brunkhorst FM. [Tight glucose control in intensive care patients--contra]. Dtsch Med Wochenschr 2010; 135:705. [PMID: 20358499 DOI: 10.1055/s-0030-1251922] [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: 10/19/2022]
Affiliation(s)
- F M Brunkhorst
- Klinik für Anästhesiologie und Intensivtherapie, Klinikum der Friedrich-Schiller-Universität Jena.
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Abstract
The high mortality and morbidity of severe sepsis and septic shock had not been reduced during the two recent decades, despite a number of advances in the field of supportive and adjunctive sepsis therapies. The reason might be that important steps towards overcoming of sepsis - early diagnosis, the surgical resection of the infectious focus and an adequate antibiotic treatment - at present are still suboptimal and have to be improved. However, worldwide growing resistances of pathogens against the common antibiotics are detected. In opposite, no major progress in the development of new antibiotics, mainly for the treatment of Gram-negative non-fermenter infections like Pseudomonas aeruginosa, can be predicted for the next years. Therefore, sepsis treatment must be focused on prevention of infection, and on an optimised application of current antibiotic substances. The key factors are a broad, high dose, and early applicated initial treatment, a de-escalation strategy according to the clinical course supported by the application of novel molecular markers, and - with exceptions - a limitation of treatment to 7 to 10 days. A closer cooperation between microbiologists, infection control specialists and clinical infectious disease consultants may be a key factor to overcome the raising problems in the future.
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Affiliation(s)
- F M Brunkhorst
- Paul-Martini-Forschergruppe für klinische Sepsisforschung, Klinik für Anästhesiologie und Intensivtherapie, Klinikum der Friedrich-Schiller-Universität Jena, Erlanger Allee 101, 07743 , Jena, Deutschland.
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Abstract
Severe sepsis and septic shock have an increasing incidence but an unchanged mortality. It has been demonstrated that the time until the start of supportive therapy affects the progress of multiorgan failure and patient outcome. Early goal-directed therapy guided by central venous oxygen saturation is associated with a significant reduction in mortality, as is the use of lung-protective mechanical ventilation and recombinant activated protein C (rhAPC) in eligible patients. The use of starches for volume resuscitation, low-dose dopamine and hydrocortison as well as an intensive insulin protocol for restoration of euglycemia is not recommended. The German Competence Network Sepsis (SepNet) is currently studying further relevant questions.
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Affiliation(s)
- F M Brunkhorst
- Paul-Martini-FG Klinische Sepsisforschung, Klinik für Anästhesiologie und Intensivtherapie, Klinikum der Friedrich-Schiller-Universität Jena, Erlanger Allee 101, 07743, Jena, Deutschland.
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Loebe M, Locziewski S, Brunkhorst FM, Harke C, Hetzer R. Procalcitonin in patients undergoing cardiopulmonary bypass in open heart surgery-first results of the Procalcitonin in Heart Surgery study (ProHearts). Intensive Care Med 2009; 26 Suppl 2:S193-8. [PMID: 18470719 DOI: 10.1007/bf02900737] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate procalcitonin (PCT) levels in patients undergoing cardiopulmonary bypass (CPB) in order to assess the prevalence and prognostic capacity of elevated PCT levels following CPB in open heart surgery. DESIGN prospective observational study in consecutive patients. SETTING Twenty-four-bed ICU, department of thoracic and cardiovascular surgery, university hospital. PATIENTS Seven hundred and twenty two patients, 691 of whom underwent CPB, i.e., 476 had coronary bypass surgery (CABG), 130 valve replacement, 34 combined CABG and valve replacement and 23 thoracic aortic surgery. INTERVENTIONS Standard perfusion techniques were used with cardioplegic arrest and mild hypothermia (28-32 degrees C). With the exception of thoracic aortic procedures, full-flow perfusion was performed. MEASUREMENTS AND RESULTS PCT was measured prior to surgery and daily thereafter until ICU discharge or death. PCT significantly increased at day 1 postoperatively compared to baseline values (0.25+/-1.65 vs 6.49+/-22.0 ng/ml, p<0.005). However, in 55.1% of patients PCT was below 1.0 ng/ml. In 12.8% of CABG patients PCT was increased to >5.0 ng/ml, compared to 39% in valve patients and 35% of patients with aortic surgery. An elevated PCT level >1.0-5.0 ng/ml at day 1 was highly predictive of mortality (P<0.03, vs<1.0 ng/ml), with an additional accuracy when levels >5.0 ng/ml were measured (P<0.002 vs<1.0 ng/ml). CONCLUSIONS These results provide evidence that PCT might serve as an early prognostic marker in patients undergoing CPB in open heart surgery. It may be worth considering immunomodulating approaches in patients presenting elevated PCT levels in the early phase after CPB.
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Affiliation(s)
- M Loebe
- Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany.
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Brunkhorst FM, Wegscheider K, Forycki ZF, Brunkhorst R. Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock. Intensive Care Med 2009; 26 Suppl 2:S148-52. [PMID: 18470710 DOI: 10.1007/bf02900728] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the value of procalcitonin (PCT) in the early diagnosis (and differentiation) of patients with SIRS, sepsis, severe sepsis, and septic shock in comparison to C-reactive protein (CRP), white blood cell and thrombocyte count, and APACHE-II score (AP-II). DESIGN Prospective cohort study including all consecutive patients admitted to the ICU with the suspected diagnosis of infection over a 7-month period. PATIENTS AND METHODS A total of 185 patients were included: 17 patients with SIRS, 61 with sepsis, 68 with severe sepsis, and 39 patients with septic shock. CRP, cell counts, AP-II and PCT were evaluated on the first day after onset of inflammatory symptoms. RESULTS PCT values were highest in patients with septic shock (12.89+/-4.39 ng/ml;P<0.05 vs patients with severe sepsis). Patients with severe sepsis had significantly higher PCT levels than patients with sepsis or SIRS (6.91+/-3.87 ng/ml vs 0.53+/-2.9 ng/ml;P<0.001, and 0.41+/-3.04 ng/ml;P<0.001, respectively). AP-II scores did not differ significantly between sepsis, severe sepsis and SIRS (19.26+/-1.62, 16.09+/-2.06, and 17.42+/-1.72 points, respectively), but was significantly higher in patients with septic shock (29.27+/-1.35,P<0.001 vs patients with severe sepsis). Neither CRP, cell counts, nor the degree of fever showed significant differences between sepsis and severe sepsis, whereas white blood cell count and platelet count differed significantly between severe sepsis and septic shock. CONCLUSIONS In contrast to AP-II, PCT appears to be a useful early marker to discriminate between sepsis and severe sepsis.
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Affiliation(s)
- F M Brunkhorst
- Innere Medizin I, Behring-Krankenhaus, Abt. Internistische Intensivmedizin und Kardiologie, Gimpelsteig 3-5, D-14165 Berlin, Germany.
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Hartog C, Brunkhorst FM, Reinhart K. Old versus New Starches: What do We Know about their Differences? Intensive Care Med 2009. [DOI: 10.1007/978-0-387-92278-2_22] [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: 11/29/2022]
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Hartog C, Brunkhorst FM, Bloos F, Engel C, Bogatsch H, Reinhart K, Sengebusch K, Ragaller M. Fluid therapy in severe sepsis: results from a representative survey of German ICUs. Crit Care 2009. [PMCID: PMC2776188 DOI: 10.1186/cc8071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Affiliation(s)
- F M Brunkhorst
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena.
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Reinhart K, Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Deufel T, Hartog C, Gerlach H, Stüber F, Volk HD, Quintel M, Loeffler M. [Study protocol of the VISEP study. Response of the SepNet study group]. Anaesthesist 2008; 57:723-8. [PMID: 18584135 DOI: 10.1007/s00101-008-1391-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In the commentary by Zander et al. the authors appear concerned about the methods and results of our, at that time, unpublished sepsis trial evaluating hydroxyethyl starch (HES) and insulin therapy. Unfortunately, the authors' concerns are based on false assumptions about the design, conduct and modes of action of the compounds under investigation. For instance, in our study the HES solution was not used for maintenance of daily fluid requirements, so that the assumption of the authors that this colloid was used "exclusively" is wrong. Moreover, the manufacturer of Hemohes, the HES product we used, gives no cut-off value for creatinine, thus the assumption that this cut-off value was "doubled" in our study is also incorrect. Other claims by the authors such as that lactated solutions cause elevated lactate levels, iatrogenic hyperglycemia and increase O(2) consumption are unfounded. There is no randomized controlled trial supporting such a claim - this claim is neither consistent with our study data nor with any credible published sepsis guidelines or with routine practice worldwide. We fully support open scientific debate. Our study methods and results have now been published after a strict peer-reviewing process and this data is now open to critical and constructive reviewing. However, in our opinion this premature action based on wrong assumptions and containing comments by representatives of pharmaceutical companies does not contribute to a serious, unbiased scientific discourse.
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Brunkhorst FM, Reinhart K. [Sepsis therapy -- how effective are the therapy strategies?]. Chirurg 2008; 79:877-878. [PMID: 18942197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Affiliation(s)
- F M Brunkhorst
- Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany.
| | - K Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany
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Reinhart K, Brunkhorst FM, Bone HG, Gerlach H, Gründling M, Kreymann G, Kujath P, Marggraf G, Mayer K, Meier-Hellmann A, Peckelsen C, Putensen C, Stüber F, Quintel M, Ragaller M, Rossaint R, Weiler N, Welte T, Werdan K. [Diagnosis and therapy of sepsis]. Clin Res Cardiol 2007; 95:429-54. [PMID: 16868790 DOI: 10.1007/s00392-006-0414-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A recent survey conducted by the publicly funded Competence Network Sepsis (Sep- Net) reveals that severe sepsis and/or septic shock occurs in 75,000 inhabitants (110 out of 100,000) and sepsis in 79,000 inhabitants (116 out of 100,000) in Germany annually. This illness is responsible for approx. 60,000 deaths and ranges as the third most frequent cause of death after acute myocardial infarction. Direct costs for the intensive care of patients with severe sepsis alone amount to approx. 1.77 billion euros, which means that about 30% of the budget in intensive care is used to treat severe sepsis. However, until now German guidelines for the diagnosis and therapy of severe sepsis did not exist. Therefore, the German Sepsis Society initiated the development of guidelines which are based on international recommendations by the International Sepsis Forum (ISF) and the Surviving Sepsis Campaign (SSC) and take into account the structure and organisation of the German health care system. Priority was given to the following guideline topics: a) diagnosis, b) prevention, c) causative therapy, d) supportive therapy, e) adjunctive therapy. The guidelines development process was carefully planned and strictly adhered to according to the requirements of the Working Group of Scientific Medical Societies (AWMF).
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Affiliation(s)
- K Reinhart
- Universitätsklinikum Jena der Friedrich-Schiller-Universität Jena, Klinik für Anästhesiologie und Intensivtherapie, Jena
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Affiliation(s)
- Gernot Marx
- Klinik für Anästhesiologie und Intensivtherapie, Klinikum der Friedrich Schiller Universität Jena.
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Affiliation(s)
- F M Brunkhorst
- Klinik für Anaesthesiologie und Intensivtherapie, Friedrich-Schiller-Universität Jena
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Reinhart K, Brunkhorst FM, Bone HG, Gerlach H, Gründling M, Kreymann G, Kujath P, Marggraf G, Mayer K, Meier-Hellmann A, Peckelsen C, Putensen C, Stüber F, Quintel M, Ragaller M, Rossaint R, Weiler N, Welte T, Werdan K. Diagnose und Therapie der Sepsis. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/s00390-006-0700-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anker SD, John M, Pedersen PU, Raguso C, Cicoira M, Dardai E, Laviano A, Ponikowski P, Schols AMWJ, Becker HF, Böhm M, Brunkhorst FM, Vogelmeier C. ESPEN Guidelines on Enteral Nutrition: Cardiology and Pulmonology. Clin Nutr 2006; 25:311-8. [PMID: 16697084 DOI: 10.1016/j.clnu.2006.01.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 01/20/2006] [Indexed: 10/24/2022]
Abstract
These guidelines are intended to give evidence-based recommendations for the use of enteral nutrition (EN) in patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD). They were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1985. They have been discussed and accepted in a consensus conference. EN by means of oral nutritional supplements (ONS) or tube feeding (TF) enables nutritional intake to be maintained or increased when normal oral intake is inadequate. No data are yet available concerning the effects of EN on cachexia in CHF patients. However, EN is recommended to stop or reverse weight loss on the basis of physiological plausibility. In COPD patients, EN in combination with exercise and anabolic pharmacotherapy has the potential to improve nutritional status and function. Frequent small amounts of ONS are preferred in order to avoid postprandial dyspnoea and satiety as well as to improve compliance.
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Affiliation(s)
- S D Anker
- Division of Applied Cachexia Research, Department of Cardiology, Charité-Universitätsmedizin Berlin, CVK, Berlin, Germany.
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Brunkhorst FM. [Epidemiology, economy and practice -- results of the German study on prevalence by the competence network sepsis (SepNet)]. Anasthesiol Intensivmed Notfallmed Schmerzther 2006; 41:43-4. [PMID: 16440262 DOI: 10.1055/s-2005-921227] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- F M Brunkhorst
- Klinik für Anästhesiologie und Intensivtherapie, Friedrich-Schiller-Universität Jena.
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Brunkhorst F, Engel C, Reinhart K, Bone H, Brunkhorst R, Burchardi H, Eckhardt K, Forst H, Gerlach H, Grond S, Gründling M, Huhle G, Oppert M, Olthoff D, Quintel M, Ragaller M, Rossaint R, Seeger W, Stüber F, Weiler N, Welte T, Loeffler M. Crit Care 2005; 9:P196. [DOI: 10.1186/cc3259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Brunkhorst FM, Wagner F, Reinhart K. Therapie der Sepsis—was ist
gesichert? Z Herz-, Thorax-, Gefäßchir 2003. [DOI: 10.1007/s00398-003-0411-3] [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: 10/26/2022]
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Abstract
Early diagnosis of the different severities of septic inflammation is important for early implementation of specific therapies. Sepsis and severe sepsis are accompanied by clinical and laboratory signs of systemic inflammation. However, patients suffering from non-infectious inflammation may present with similiar signs and symptoms making it difficult to diagnose infection based on clinical findings alone. Bacteriological evidence of sepsis, though definitive and specific, may not be obtainable, is time-consuming and even may not occur concurrently with clinical signs of sepsis. It is therefore important to identify markers, which, by enabling an early diagnosis of sepsis and organ dysfunction, would allow early specific therapeutic interventions. Wheras C-reactive Protein is a more sensitive parameter for the diagnosis of non-systemic infections, Procalcitonin seems to be a useful parameter to improve the diagnosis and monitoring of therapy in patients with severe sepsis and septic shock.
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Affiliation(s)
- F M Brunkhorst
- Klinik für Anästhesiologie und Intensivtherapie, Klinikum der Friedrich Schiller Universität Jena, Germany
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Reinhart K, Brunkhorst FM. [Sepsis]. Zentralbl Chir 2002; 127:161-3. [PMID: 11935476 DOI: 10.1055/s-2002-24257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Brunkhorst FM, Al-Nawas B, Krummenauer F, Forycki ZF, Shah PM. Procalcitonin, C-reactive protein and APACHE II score for risk evaluation in patients with severe pneumonia. Clin Microbiol Infect 2002; 8:93-100. [PMID: 11952722 DOI: 10.1046/j.1469-0691.2002.00349.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Procalcitonin (PCT) is a peptide that is found elevated in patients with sepsis and severe infections. In healthy persons PCT serum levels are below 0.1 ng/mL. The aim of this study was to investigate the value of serum PCT determination for risk evaluation in patients with pneumonia. METHODS We focused on the correlation of PCT with the clinical status of the patient and prognosis of the disease. In a prospective study, in a nonsurgical intensive care unit the following parameters were assessed regularly in 93 patients with documented pneumonia: C-reactive protein (CRP), white blood cell count (WBC), body temperature, PCT and Acute Physiology and Chronic Health Evaluation (APACHE) II score. RESULTS At the onset of infection 50% of the patients had elevated PCT levels above 2 ng/mL. The model of multivariate analysis of all tested parameters on days 0-5 stratified for clinical outcome (change in clinical classification or death) showed local significance for APACHE II score only. None of the other parameters in this model serves as an isolated indicator for change of clinical status or death. An intra-individual change of body temperature or CRP was never significantly associated with a change in the clinical status of the patient. CONCLUSION Change in PCT on admission and at the end of the observation period significantly indicated a clinical change.
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Affiliation(s)
- F M Brunkhorst
- Klinik für Anästesiologie und Intensivtherapie, Friedrich-Schiller-Universität Jena, Bachstr 18, D-07740 Jena, Germany
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Meisner M, Brunkhorst FM, Reith HB, Schmidt J, Lestin HG, Reinhart K. Clinical experiences with a new semi-quantitative solid phase immunoassay for rapid measurement of procalcitonin. Clin Chem Lab Med 2000; 38:989-95. [PMID: 11140634 DOI: 10.1515/cclm.2000.147] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A self-developing solid-phase immunoassay (B.R.A.H.M.S. PCT-Q, B.R.A.H.M.S.-Diagnostica GmbH, Hennigsdorf, Germany) has recently become available for the semi-quantitative and rapid measurement of procalcitonin (PCT). In this study we examined the validity of this assay at daily clinical routine conditions at five different hospitals in a prospective study. After development of the assay (200 microl plasma, 30 minutes incubation), PCT levels were categorized into four groups (< 0.5 microg/l; > or = 0.5-< 2 microg/l; > or = 2-< 10 microg/l; > or = 10 microg/l) according to the provided reference scale. Samples from patients with suspected elevation of PCT of different etiology (n=237) were read by various analyzers and compared with the results of the Lumitest PCT (B.R.A.H.M.S.-Diagnostica GmbH, Hennigsdorf, Germany). A total of 74.7% of measurements were categorized according to the results of the LumitestPCT, 24.5% were read within the next lower or higher category. Using a +/- 10% range at the reference concentrations (20% at 0.5 microg/l), 82.7% of samples were correctly categorized and 16.4% within the next categories. Using a cut-off value of 2.0 microg/l, 92.0% (94.1% for +/- 10%) of the results were correctly categorized. The semi-quantitative solid phase immunoassay allows a rapid, simple and semi-quantitative measurement of plasma PCT. The validity of the test results and its ease of use are sufficient to support acute diagnostic decisions. However, for the follow-up of PCT concentrations and routine daily measurements, the quantitative luminometric assay should be preferred, when available.
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Affiliation(s)
- M Meisner
- Department of Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller-Universität Jena, Germany.
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Brunkhorst FM, Clark AL, Forycki ZF, Anker SD. Pyrexia, procalcitonin, immune activation and survival in cardiogenic shock: the potential importance of bacterial translocation. Int J Cardiol 1999; 72:3-10. [PMID: 10636626 DOI: 10.1016/s0167-5273(99)00118-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS Exposure to bacterial endotoxin, perhaps due to bowel congestion or ischaemia and altered gut permeability, may result in immune activation that is characteristic for patients with severe heart failure. It is known that blood procalcitonin rises in response to bacterial endotoxin exposure. METHODS We measured procalcitonin in a group of 29 patients with acute cardiogenic shock and no sign of infection (all without bacteraemia) and 26 with septic shock. Blood was analysed for procalcitonin, interleukin-6, tumour necrosis factor-alpha (TNF-alpha), c-reactive protein (CRP) and neopterin. Patients were managed conventionally in an intensive care unit with no further experimental procedures. RESULTS Three cardiogenic (10%) and seven septic shock patients (27%) survived. Most patients with acute heart failure surviving 12 h or more (18 of 20) developed a pyrexia (738.0 degrees C) of unknown origin in the absence of positive cultures, with a rise in procalcitonin (1.4+/-0.8 to 48.0+/-16.2 ng/ml, P<0.001), CRP (76.5+/-16.4 to 154.7+/-22.9 mg/l, P<0.001) and neopterin (20.7+/-3.5 to 41.2+/-6.7 nmol/l, P<0.001). Patients with septic shock had higher initial levels of cytokines, and higher peak levels. Those with heart failure surviving (n=3) and those dying in the first 12 h (n=9) had no rise in cytokine levels. The patients with high procalcitonin had a higher temperature (38.9+/-0.3 vs. 37.3+/-0.23 degrees C, P<0.05), TNF-alpha (43.95+/-9.64 vs. 16.43+/-4.33 pg/ml; P<0.005) and CRP (146.1+/-18.4 vs. 68.2+/-39.6 mg/ml, P<0.005). Peak procalcitonin levels correlated with peak temperature (r=0.74, P<0.001). CONCLUSION Cardiogenic shock causes a pyrexia of unknown origin in patients surviving for 12 h and that is associated with a rise in procalcitonin levels. This lends support to the hypothesis that patients with cardiogenic shock may be being exposed to bacterial endotoxin at a time when bowel wall congestion and or ischaemia is likely to be present.
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Affiliation(s)
- F M Brunkhorst
- Krankenhaus Zehlendorf, Department of Internal Medicine, Berlin, Germany.
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