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Mol F, Scheltinga M, Roumen R, Wille F, Gültuna I, Kallewaard JW, Elzinga L, van de Minkelis J, Nijhuis H, Stronks DL, Huygen FJPM. Comparing the Efficacy of Dorsal Root Ganglion Stimulation With Conventional Medical Management in Patients With Chronic Postsurgical Inguinal Pain: Post Hoc Analyzed Results of the SMASHING Study. Neuromodulation 2023; 26:1788-1794. [PMID: 36456417 DOI: 10.1016/j.neurom.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Approximately 10% of patients who undergo inguinal hernia repair or Pfannenstiel incision develop chronic (> three months) postsurgical inguinal pain (PSIP). If medication or peripheral nerve blocks fail, a neurectomy is the treatment of choice. However, some patients do not respond to this treatment. In such cases, stimulation of the dorsal root ganglion (DRG) appears to significantly reduce chronic PSIP in selected patients. MATERIALS AND METHODS In this multicenter, randomized controlled study, DRG stimulation was compared with conventional medical management (CMM) (noninvasive treatments, such as medication, transcutaneous electric neurostimulation, and rehabilitation therapy) in patients with PSIP that was resistant to a neurectomy. Patients were recruited at a tertiary referral center for groin pain (SolviMáx, Eindhoven, The Netherlands) between March 2015 and November 2016. Suitability for implantation was assessed according to the Dutch Neuromodulation Association guidelines. The sponsor discontinued the study early owing to slow enrollment. Of 78 planned patients, 18 were randomized (DRG and CMM groups each had nine patients). Six patients with CMM (67%) crossed over to DRG stimulation at the six-month mark. RESULTS Fifteen of the 18 patients met the six-month primary end point with a complete data set for a per-protocol analysis. Three patients with DRG stimulation had a negative trial and were lost to follow-up. The average pain reduction was 50% in the DRG stimulation and crossover group (from 6.60 ± 1.24 to 3.28 ± 2.30, p = 0.0029). Conversely, a 13% increase in pain was observed in patients with CMM (from 6.13 ± 2.24 to 6.89 ± 1.24, p = 0.42). Nine patients with DRG stimulation experienced a total of 19 adverse events, such as lead dislocation and pain at the implantation site. CONCLUSIONS DRG stimulation is a promising effective therapy for pain relief in patients with PSIP resistant to conventional treatment modalities; larger studies should confirm this. The frequency of side effects should be a concern in a new study. CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT02349659.
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Affiliation(s)
| | | | - Rudi Roumen
- Maxima Medical Center, Eindhoven, The Netherlands
| | - Frank Wille
- Maxima Medical Center, Eindhoven, The Netherlands
| | | | | | - Lars Elzinga
- Maxima Medical Center, Eindhoven, The Netherlands
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Kallewaard JW, Gültuna I, Hoffmann V, Elzinga L, Munnikes R, Verbrugge L, Minne V, Reiters P, Subbaroyan J, Santos A, Rotte A, Caraway D. 10 kHz Spinal Cord Stimulation for the Treatment of Failed Back Surgery Syndrome with Predominant Leg Pain: Results from a Prospective Study in Patients from the Dutch Healthcare System. Pain Pract 2020; 21:490-500. [PMID: 33274545 PMCID: PMC8247309 DOI: 10.1111/papr.12973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Persistent back/and or leg pain is a common outcome after spinal surgery (otherwise known as failed back surgery syndrome [FBSS]). Studies have shown that spinal cord stimulation (SCS) at 10 kHz provides effective analgesia in FBSS patients with both back and leg pain symptoms and in those with predominant back pain. This study is the first to evaluate the therapy in FBSS patients with predominant leg pain. METHODS The safety and efficacy of 10 kHz SCS was evaluated in an uncontrolled, open-label, prospective study of FBSS patients with predominant leg pain in the Netherlands. Follow-ups were performed at 1, 3, 6, and 12 months post implantation. RESULTS Sixty out of 68 patients (88%) experienced sufficient pain relief during a stimulation trial. Of these, 58 proceeded to permanent implantation of a 10 kHz SCS system. After 12 months of treatment, 80% of patients experienced ≥ 50% reduction in baseline leg pain, and a similar proportion (76%) experienced ≥ 50% reduction in baseline back pain. At least two-thirds of patients were also leg pain and back pain remitters (visual analog scale [VAS] ≤ 2.5 cm). The therapy was also associated with a general improvement in patients' quality of life, as measured by secondary outcomes including disability, perception of health improvement, mental well-being, and satisfaction. A positive impact on opioid consumption was also observed. CONCLUSIONS Consistent with previous findings, 10 kHz SCS for the treatment of FBSS patients with predominant radicular symptoms is safe and effective and is associated with improved quality of life.
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Affiliation(s)
| | - Ismail Gültuna
- Albert Schweitzer Ziekenhuis, Pijnbehandelcentrum, Zwijndrecht, The Netherlands
| | - Vincent Hoffmann
- Amphia Ziekenhuis Breda, Pijnbehandelcentrum, Breda, The Netherlands
| | - Lars Elzinga
- Bravis Ziekenhuis Roosendaal, Pijncentrum, Roosendaal, The Netherlands
| | - Renate Munnikes
- Maasstad Ziekenhuis Rotterdam, Pijnkliniek, Rotterdam, The Netherlands
| | - Lisette Verbrugge
- Maasstad Ziekenhuis Rotterdam, Pijnkliniek, Rotterdam, The Netherlands
| | | | | | | | | | - Anand Rotte
- Nevro Corp., Redwood City, California, U.S.A
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van Gorp EJJAA, Adang EMM, Gültuna I, Hamm-Faber TE, Bürger K, Kallewaard JW, Schapendonk JWCL, Vonhögen L, Bronkhorst E, Teernstra OP, Vissers KCP. Cost-Effectiveness Analysis of Peripheral Nerve Field Stimulation as Add-On Therapy to Spinal Cord Stimulation in the Treatment of Chronic Low Back Pain in Failed Back Surgery Syndrome Patients. Neuromodulation 2019; 23:639-645. [PMID: 31423686 DOI: 10.1111/ner.13032] [Citation(s) in RCA: 2] [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: 03/31/2019] [Revised: 05/30/2019] [Accepted: 06/26/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Presently, there is only limited evidence about the cost-effectiveness of peripheral nerve field stimulation (PNFS) and no evidence to date on the cost-effectiveness of PNFS as an add-on therapy to spinal cord stimulation (SCS). In a multicenter randomized controlled trial, PNFS as add-on therapy to SCS demonstrated clinical effectiveness in treating chronic low back pain in failed back surgery syndrome (FBSS) patients. We report here the cost-effectiveness of PNFS as additional therapy. MATERIALS AND METHODS Cost-effectiveness analysis was performed from a health-care perspective using the general principles of cost-utility analysis, using empirical data from our multicenter randomized controlled trial on the effectiveness of hybrid SCS + PNFS on low back pain in FBSS patients, who were back pain non-responders to initial SCS-therapy, over a time-horizon of three months. Outcome measures were costs and quality-adjusted life-years (QALYs). Cost and QALYs were integrated using the net monetary benefit (NMB). Differences in costs, effects, and NMB were analyzed using multilevel regression. Uncertainty surrounding the NMB was presented by cost-effectiveness acceptability curves. RESULTS A total of 52 patients implanted with both SCS and PNFS, randomly assigned to a group with PNFS either activated or inactive, completed the controlled part of the study. With mean total costs for the SCS + active PNFS group of €1813.86 (SD €109.78) versus €1103.64 (SD €123.43) for the SCS + inactive PNFS group at three months, we found an incremental cost-utility ratio of €25.311 per QALY gained and a probability being cost-effective of more than 80% given a willingness to pay for a QALY of about €40.000. CONCLUSIONS From a Dutch national health-care context, when the willingness to pay threshold is up to 60.000 Euros per QALY, PNFS as an add-on therapy to SCS for the treatment of low back pain in FBSS patients has a high probability of being cost-effective.
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Affiliation(s)
- Eric-Jan J A A van Gorp
- Albert Schweitzer Hospital, Department of Anesthesiology, Unit of Pain Medicine, Sliedrecht, The Netherlands
| | - Eddy M M Adang
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ismail Gültuna
- Albert Schweitzer Hospital, Department of Anesthesiology, Unit of Pain Medicine, Sliedrecht, The Netherlands
| | - Tanja E Hamm-Faber
- Albert Schweitzer Hospital, Department of Anesthesiology, Unit of Pain Medicine, Sliedrecht, The Netherlands
| | - Katja Bürger
- Rijnland Hospital, Department of Anesthesiology, Leiderdorp, The Netherlands
| | | | | | - Leon Vonhögen
- Sint Maartenskliniek, Department of Anesthesiology, Nijmegen, The Netherlands
| | - Ewald Bronkhorst
- Radboud University Medical Centre, Department of Cariology and Preventive Dentistry, Nijmegen, The Netherlands
| | - Onno P Teernstra
- Atrium Medical Centre, Department of Neurosurgery, Heerlen, The Netherlands.,Maastricht University Medical Centre, Department of Neurosurgery, Maastricht, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain Medicine and Palliative Care, Radboud University Medical Centre, The Netherlands
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Hamm‐Faber TE, Gültuna I, Gorp E, Aukes H. High‐Dose Spinal Cord Stimulation for Treatment of Chronic Low Back Pain and Leg Pain in Patients With FBSS, 12‐Month Results: A Prospective Pilot Study. Neuromodulation 2019; 23:118-125. [DOI: 10.1111/ner.12940] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/11/2019] [Accepted: 01/23/2019] [Indexed: 12/11/2022]
Affiliation(s)
| | - Ismail Gültuna
- Pain Treatment CenterAlbert Schweitzer Hospital Sliedrecht The Netherlands
| | - Eric‐Jan Gorp
- Pain Treatment CenterAlbert Schweitzer Hospital Sliedrecht The Netherlands
| | - Hans Aukes
- Pain Treatment CenterAlbert Schweitzer Hospital Sliedrecht The Netherlands
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Eldabe SS, Taylor RS, Goossens S, Bouche B, Gültuna I, Green C, Tinsley J, Luyet PP, Buchser E. A Randomized Controlled Trial of Subcutaneous Nerve Stimulation for Back Pain Due to Failed Back Surgery Syndrome: The SubQStim Study. Neuromodulation 2018; 22:519-528. [PMID: 29704437 PMCID: PMC6767391 DOI: 10.1111/ner.12784] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/19/2018] [Accepted: 03/09/2018] [Indexed: 11/30/2022]
Abstract
Objectives To compare the effectiveness of peripheral nerve stimulation utilizing a subcutaneous lead implant technique—subcutaneous nerve stimulation (SQS) plus optimized medical management (SQS + OMM arm) vs. optimized medical management alone (OMM arm) in patients with back pain due to failed back surgery syndrome. Patients and Methods Patients were recruited from 21 centers, in Europe, Israel, and Australia. Eligible patients were randomized (1:1) to SQS + OMM or OMM arms. Those in the SQS arm were implanted with a neurostimulator and up to two subcutaneous percutaneous cylindrical leads in the area of pain. Patients were evaluated pre‐randomization and at one, three, six, and nine months post‐randomization. The primary endpoint was the proportion of subjects with a ≥50% reduction in back pain intensity (“responder”) from baseline to nine months. Secondary outcomes included proportion of responders with a ≥50% reduction in back pain intensity at six months and ≥30% reduction at nine months, and the mean change from baseline in back pain intensity at six and nine months between the two arms. Results Due to the slow rate of recruitment, the study was terminated early with 116 subjects randomized. A total of 33.9% (19/56, missing: n = 20 [36%]) of subjects in the SQS + OMM arm and 1.7% (1/60, missing: n = 24 [40%]) in the OMM arm were responders at Month 9 (p < 0.0001). Secondary objectives showed a significant difference in favor of SQS + OMM arm. Conclusion The results indicate that the addition of SQS to OMM is more effective than OMM alone in relieving low back pain at up to nine months.
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Affiliation(s)
- Sam S Eldabe
- Department of Pain and Anaesthesia, The James Cook Hospital, Middlesbrough, UK
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | | | | | - Ismail Gültuna
- Albert Schweitzer Ziekenhuis, Sliedrecht, The Netherlands
| | - Colin Green
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Kriek N, Schreurs MW, Groeneweg JG, Dik WA, Tjiang GC, Gültuna I, Stronks DL, Huygen FJ. Spinal Cord Stimulation in Patients With Complex Regional Pain Syndrome: A Possible Target for Immunomodulation? Neuromodulation 2017; 21:77-86. [DOI: 10.1111/ner.12704] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/10/2017] [Accepted: 07/25/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Nadia Kriek
- Center for Pain Medicine; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Marco W.J. Schreurs
- Department of Immunology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - J. George Groeneweg
- Center for Pain Medicine; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Wim A. Dik
- Department of Immunology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Gilbert C.H. Tjiang
- Department of Anaesthesiology, Pain Management and Intensive Care; Amphia Hospital; Oosterhout The Netherlands
| | - Ismail Gültuna
- Pain Treatment Center; Albert Schweitzer Hospital; Sliedrecht The Netherlands
| | - Dirk L. Stronks
- Center for Pain Medicine; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Frank J.P.M. Huygen
- Center for Pain Medicine; Erasmus University Medical Center; Rotterdam The Netherlands
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van Gorp EJJ, Teernstra OP, Gültuna I, Hamm-Faber T, Bürger K, Schapendonk R, Willem Kallewaard J, Spincemaille G, Vonhögen LH, Hendriks JC, Vissers KC. Subcutaneous Stimulation as ADD-ON Therapy to Spinal Cord Stimulation Is Effective in Treating Low Back Pain in Patients With Failed Back Surgery Syndrome: A Multicenter Randomized Controlled Trial. Neuromodulation 2016; 19:171-8. [DOI: 10.1111/ner.12385] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/10/2015] [Accepted: 10/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Eric-Jan J.A.A. van Gorp
- Department of Anesthesiology and Pain Medicine Albert Schweitzer ziekenhuis Sliedrecht; The Netherlands
| | | | - Ismail Gültuna
- Department of Anesthesiology and Pain Medicine Albert Schweitzer ziekenhuis Sliedrecht; The Netherlands
| | - Tanja Hamm-Faber
- Department of Anesthesiology and Pain Medicine Albert Schweitzer ziekenhuis Sliedrecht; The Netherlands
| | - Katja Bürger
- Department of Anesthesiology and Pain Medicine Rijnland Ziekenhuis Leiderdorp; The Netherlands
| | - Ronald Schapendonk
- Department of Anesthesiology and Pain Medicine Diakonessenhuis Zeist/Utrecht; The Netherlands
| | - Jan Willem Kallewaard
- Department of Anesthesiology and Pain Medicine Rijnstate Ziekenhuis Arnhem; The Netherlands
| | - Geert Spincemaille
- Department of Neurosurgery, University Medical Center Maastricht, Maastricht; The Netherlands, retired
| | - Leon H. Vonhögen
- Department of Anesthesiology and Pain Medicine Sint Maartenskliniek Nijmegen; The Netherlands
| | - Jan C.M. Hendriks
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Centre; The Netherlands
| | - Kris C.P. Vissers
- Department of Anesthesiology, Pain- and Palliative Medicine Radboud University Medical Centre; The Netherlands
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Hamm-Faber TE, Aukes H, van Gorp EJ, Gültuna I. Subcutaneous Stimulation as an Additional Therapy to Spinal Cord Stimulation for the Treatment of Low Back Pain and Leg Pain in Failed Back Surgery Syndrome: Four-Year Follow-Up. Neuromodulation 2015; 18:618-22; discussion 622. [DOI: 10.1111/ner.12309] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/27/2015] [Accepted: 03/24/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Tanja E. Hamm-Faber
- Pain Treatment Center; Albert Schweitzer Hospital; Sliedrecht The Netherlands
| | - Hans Aukes
- Pain Treatment Center; Albert Schweitzer Hospital; Sliedrecht The Netherlands
| | - Eric-Jan van Gorp
- Pain Treatment Center; Albert Schweitzer Hospital; Sliedrecht The Netherlands
| | - Ismail Gültuna
- Pain Treatment Center; Albert Schweitzer Hospital; Sliedrecht The Netherlands
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Slegers AS, Gültuna I, Aukes JA, van Gorp EJJAA, Blommers FMN, Niehof SP, Bosman J. Coaching Reduced the Radiation Dose of Pain Physicians by Half during Interventional Procedures. Pain Pract 2014; 15:400-6. [DOI: 10.1111/papr.12251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/09/2014] [Accepted: 09/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. S. Slegers
- Department of Medical Physics; Albert Schweitzer Hospital; Dordrecht the Netherlands
| | - I. Gültuna
- Department of Anesthesiology; Albert Schweitzer Hospital; Dordrecht the Netherlands
| | - J. A. Aukes
- Department of Anesthesiology; Albert Schweitzer Hospital; Dordrecht the Netherlands
| | | | - F. M. N. Blommers
- Department of Radiology; Albert Schweitzer Hospital; Dordrecht the Netherlands
| | - S. P. Niehof
- Department of Medical Physics; Maasstad Hospital; Rotterdam the Netherlands
| | - J. Bosman
- Department of Medical Physics; Albert Schweitzer Hospital; Dordrecht the Netherlands
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Halim W, Wullems JA, Lim T, Aukes HA, van der Weegen W, Vissers KC, Gültuna I, Chua NHL. The Long-term Efficacy and Safety of Percutaneous Cervical Nucleoplasty in Patients with a Contained Herniated Disk. Pain Pract 2012; 13:364-71. [DOI: 10.1111/papr.12003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 09/04/2012] [Indexed: 01/22/2023]
Affiliation(s)
- Willy Halim
- Department of Anesthesia and Pain Management; St. Anna Hospital; Geldrop; The Netherlands
| | - Jorgen A. Wullems
- Department of Orthopedic Surgery; St. Anna Hospital; Geldrop; The Netherlands
| | - Toine Lim
- Department of Anesthesia and Pain Management; St. Anna Hospital; Geldrop; The Netherlands
| | - Hans A. Aukes
- Department of Anesthesia and Pain Management; Albert Schweitzer Hospital; Sliedrecht; The Netherlands
| | | | - Kris C. Vissers
- Department of Anesthesiology, Pain Therapy and Palliative Care; UMC St. Radboud; Nijmegen; The Netherlands
| | - Ismail Gültuna
- Department of Anesthesia and Pain Management; Albert Schweitzer Hospital; Sliedrecht; The Netherlands
| | - Nicholas H. L. Chua
- Department of Anesthesia, Surgical Intensive Care and Pain Management; Tan Tock Seng Hospital; Singapore; Singapore
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Hamm-Faber TE, Aukes HA, de Loos F, Gültuna I. Subcutaneous Stimulation as an Additional Therapy to Spinal Cord Stimulation for the Treatment of Lower Limb Pain and/or Back Pain: A Feasibility Study. Neuromodulation 2011; 15:108-16; discussion 116-7. [DOI: 10.1111/j.1525-1403.2011.00393.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
There are few reports on anaesthesia for patients with Eisenmenger's syndrome requiring non-cardiac surgery and none of the use of xenon. We describe the use of xenon with a closed-circuit system in a patient with Eisenmenger's syndrome having a laparoscopic cholecystectomy.
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Affiliation(s)
- J Hofland
- Department of Anaesthesiology, Erasmus Medical Centre Rotterdam, The Netherlands
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14
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Unal N, Kanhai JK, Buijk SL, Pompe JC, Holland WP, Gültuna I, Ince C, Saygin B, Bruining HA. A novel method of evaluation of three heat-moisture exchangers in six different ventilator settings. Intensive Care Med 1998; 24:138-46. [PMID: 9539071 DOI: 10.1007/s001340050535] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [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: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to assess and compare the humidification, heating, and resistance properties of three commercially available heat-moisture exchangers (HMEs). To mimic clinical conditions, a previously validated, new, realistic experimental set-up and measurement protocol was used. DESIGN Prospective, comparative experimental study. SETTING Surgical Intensive Care Unit, University Hospital of Rotterdam. MATERIALS An experimental set-up consisting of a patient model, measurement systems, and ventilator and three different HME types. INTERVENTIONS The air flow, pressure in the ventilation circuit, pressure difference over the HME, and partial water vapour pressure and temperature at each side of the HMEs were measured. Measurements were repeated every 30 min during the first 2 h and every hour up to 24 h for each HME at six different ventilator settings. The mean inspiratory and maximum expiratory resistance, flow-weighted mean absolute humidity and temperature outputs, and humidification and heating efficiencies of HMEs were calculated. MEASUREMENTS AND RESULTS The Dar Hygroster had the highest humidity output, temperature output, humidification efficiency, and heating efficiency values throughout the study (32.8 +/- 21. mg/l, 32.2 +/- 0.8 degrees C, 86.3 +/- 2.3%, and 0.9 +/- 0.01%, respectively) in comparison to the Humid-Vent Filter (25.3 +/- 3.2 mg/l, 31.9 +/- 0.8 degrees C, 72.2 +/- 5.3%, 0.9 +/- 0.02%, respectively) and the Pall Ultipor BB100 breathing circuit filter (23.4 +/- 3 mg/l, 28.3 +/- 0.7 degrees C, 68.8 +/- 5.9%, 0.8 +/- 0.02%, respectively). The inspiratory and expiratory resistance of the HMEs remained below clinically acceptable maximum values (2.60 +/- 0.04 and 2.45 +/- 0.05 cmH2O/l per s, respectively). CONCLUSION The Dar Hygroster filter was found to have the highest humidity and temperature output of all three HMEs, the Humid-Vent filter had a satisfactory humidity output only at low tidal volume flow rate and minute volume settings, whereas the Pall Ultipore BB 100 never achieved a sufficient humidity and temperature output.
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Affiliation(s)
- N Unal
- Department of Anesthesiology and Reanimation, Medical Faculty, University of Ankara, Turkey
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15
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Gültuna I, Huygen PE, Ince C, Strijdhorst H, Bogaard JM, Bruining HA. Clinical evaluation of diminished early expiratory flow (DEEF) ventilation in mechanically ventilated COPD patients. Intensive Care Med 1996; 22:539-45. [PMID: 8814468 DOI: 10.1007/bf01708093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 02/02/2023]
Abstract
OBJECTIVE To evaluate the cardiopulmonary effects, especially the end-expiratory lung volume (EEV) and ventilation inhomogeneity during diminished early expiratory flow ventilation (DEEF), which resembles pursed-lips breathing, with the conventional intermittent positive pressure ventilation (IPPV) in postoperative mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). DESIGN A prospective study measuring cardiopulmonary parameters during IPPV, DEEF, and positive end-expiratory pressure (PEEP) as a control mode. In the PEEP mode, PEEP values were chosen such that the mean airway pressure during a breath cycle was equal to that during the DEEF mode, which was higher than the conventional IPPV mode. SETTING Surgical intensive care unit of a university hospital. PATIENTS 20 postoperative mechanically ventilated COPD patients who were optimally pretreated and had normal blood oxygenation. INTERVENTIONS Measurements were started in the IPPV (IPPV1) mode, continued in a randomized order with DEEF or PEEP, and completed with a second IPPV (IPPV2) mode, with 1 h equilibration time in each mode before each measurement. MEASUREMENTS AND RESULTS A multi-breath indicator gas wash-out test was used to calculate the EEV and ventilation inhomogeneity. There was a 9% increase (p < 0.05) in the mean EEV during both the DEEF and PEEP mode compared to IPPV. No significant changes in the ventilation inhomogeneity and deadspace fractions or the hemodynamic parameters were found during the different ventilatory modes. CONCLUSIONS There was no improvement in pulmonary and hemodynamic parameters during the DEEF mode in comparison to the IPPV mode. The small increase in EEV during DEEF was probably caused by the slightly higher mean expiratory pressures as in the PEEP mode. However, this had no effect on the hemodynamic parameters. As we could not observe any improvement with the DEEF ventilation in our optimally pretreated postoperative COPD patients, we do not advise applying this therapy in this group of patients, since this mode of ventilation may cause barotrauma if not monitored adequately.
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Affiliation(s)
- I Gültuna
- Department of Surgery, University Hospital of Rotterdam, The Netherlands
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16
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Unal N, Pompe JC, Holland WP, Gültuna I, Huygen PE, Jabaaij K, Ince C, Saygin B, Bruining HA. An experimental set-up to test heat-moisture exchangers. Intensive Care Med 1995; 21:142-8. [PMID: 7775695 DOI: 10.1007/bf01726537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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: 01/27/2023]
Abstract
OBJECTIVES The purpose of this study was to build an experimental set-up to assess continuously the humidification, heating and resistance properties of heat-moisture exchangers (HMEs) under clinical conditions. DESIGN The experimental set-up consists of a patient model, measurement systems and a ventilator. SETTING Surgical ICU, University Hospital of Rotterdam. MATERIALS A clinically used HME. MEASUREMENTS AND RESULTS The air flow, pressure in the ventilation circuit, pressure difference over the HME, and partial water vapour pressure and temperature at each side of the HME were measured. The resistance, absolute humidity, humidification efficiency and temperature difference at the patient side of the HME were calculated. Measurements were performed during 24 h. The temperature output, humidity output and lung mechanics of the patient model were similar to values found in mechanically ventilated patients. The measurement system was in agreement with the ISO draft standard and was capable of measuring dynamic variation of water and heat exchange over the range of a clinically used ventilator setting. CONCLUSION The experimental set-up described is reliable for evaluating HMEs and can also be used for future clinical evaluation of HMEs. The main advantages of this set-up over those described previously are: (i) measurements of dynamic variations of water and heat exchange; (ii) on-line measurements of expiratory, as well as inspiratory resistance.
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Affiliation(s)
- N Unal
- Department of Surgery, University Hospital Rotterdam, The Netherlands
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Kesecioglu J, Ince C, Pompe JC, Gültuna I, Erdmann W, Bruining HA. Effect of ketanserine on oxygenation and ventilation inhomogeneity in pigs with ARDS. Adv Exp Med Biol 1994; 361:443-7. [PMID: 7597968 DOI: 10.1007/978-1-4615-1875-4_78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J Kesecioglu
- Department of Anesthesiology, University Hospital Dijkzigt, Rotterdam, The Netherlands
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Huygen PE, Gültuna I, Ince C, Zwart A, Bogaard JM, Feenstra BW, Bruining HA. A new ventilation inhomogeneity index from multiple breath indicator gas washout tests in mechanically ventilated patients. Crit Care Med 1993; 21:1149-58. [PMID: 8339579 DOI: 10.1097/00003246-199308000-00013] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES a) To determine the validity of a new method to analyze indicator gas washout tests on mechanically ventilated patients. This method takes into account the difference between the end-expiratory gas fraction and the mean gas fraction in the lung and provides the end-expiratory lung volume and a new index of ventilation inhomogeneity called volumes regression index. b) To determine the validity of this index as a predictor of chronic obstructive pulmonary disease. c) To compare this index with the moment ratio index and Becklake index. DESIGN Prospective study of diagnostic test. Criterium standards: Closed-circuit indicator gas dilution technique and Tiffeneau index. SETTING Surgical intensive care unit of a university hospital. PATIENTS A total of 38 mechanically ventilated postoperative patients, divided into two groups: the obstructive group (n = 21) and the nonobstructive group (n = 17), based on their preoperative lung function. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS a) The mean coefficient of variation of all lung volume measurements in a group of nine healthy volunteers was 5%, and the difference between this technique and the closed-circuit helium dilution measurements was -2 +/- 5%. In patients, the mean coefficient of variation of the lung volume measurements was 3.5%. The volumes regression index was measured as 0.02 +/- 0.04 in a dummy lung, 0.37 +/- 0.08 in the healthy volunteers, 0.64 +/- 0.23 in the nonobstructive patients, and 1.1 +/- 0.3 in the obstructive patients. The volumes regression index provided a better correlation (r2 = .46) with preoperatively determined Tiffeneau index than the Becklake index (r2 = .11) or the moment ratio index (r2 = .18). CONCLUSION The proposed technique provides a means for accurate measurement of the end-expiratory lung volume and the amount of ventilation inhomogeneity in mechanically ventilated intensive care unit patients.
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Affiliation(s)
- P E Huygen
- Department of Surgery, University Hospital Rotterdam, The Netherlands
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Mondèjar EF, Mata GV, Ferròn F, Navarrete P, Ruiz JMT, Lestavel P, Tronchon L, Chambrin MC, Mangalaboyi J, Rime A, Chopin C, Valta P, Campodonico R, Corbeil C, Chassè M, Châtillon A, Braidy J, Matar N, Milic-Emili J, Lòpez-Messa J, Penas L, Valverde A, Dambrosio M, Roupie E, Carneiro A, Anglade MC, Vasile N, Brochard L, Lemaire F, Rubio J, Carrasco MS, Mateo I, Sierra R, Escolar A, Cozar J, Bastin K, Knapen R, Moraine JJ, Melot C, Sergysels R, Kahn RJ, Pelosi P, Cereda M, Foti G, D’Andrea L, Manetti B, Lissoni A, Pesenti A, Gallego JMA, Rubi JAG, Sànchez CP, Moreno AM, Lherm T, Boiteau R, Valente E, Beaussier M, Chamieh F, Tenaillon A, Righini ER, Alvisi R, Ragazzi R, Volta CA, Capuzzo M, Gritti G, Sydow M, Burchardi H, Zinserling J, Crozier TA, Guttmann J, Eberhard L, Bertschmann W, Fabry B, Wolff G, Rubini A, DelMonte DD, Catena V, Attar I, Rattazzi G, Alati GL, Diaz MA, Mata GV, Navarro PN, Lòpez FG, Morales AM, Isenegger J, Picazo L, Sanchez A, Hernandez B, Pons A, Conti G, Di Chiara L, De Blasi RA, Dell’Utri D, Cogliati A, Pelaia P, Ferretti A, Bernasconi F, Banfi G, Pesenti A, Putensen C, Putensen-Himmer G, Leon M, Huygen PEM, Gültuna I, Zwart A, Ince C, Bruining HA, Pompe JC, Kesecioĝlu J, Rabbat A, Laaban JP, Orvoen-Frija E, Achkar A, Rochemaure J, Frigo V, Solca M, Melloni G, Gerbsa C, Ornaghi A, Mancini S, Cavagnoli R, Fasano W, Santos C, Roca J, Torres A, Cardùs J, Barberà JA, Felez MA, Rodriguez-Roisin R, Oviedo-Moreira R, Beydon L, Nakos G, Precates A, Mathas C, Bassilakis N, Chagianagnostou K, Massoura L, Labropoulos S, Devroey M, Vansnick P, Mèlot C, Naeije R, Nagy V, Kiiski R, Kaitainen S, Karppi R, Takala J, Kesecioglu J, Erdmann W, Marin J, Arnau A, Tejeda M, Olivares D, Servera E, Boix JH, Alvarez F, Peydro F, Mira JP, Belghith M, Renaud B, Deland E, Brunet F, Brusset A, Lanore JJ, Hamy I, Termignon JL, Soubrane O, Pochard F, Dhainaut JF, Sidhu PS, Cockburn JF, Nicholson DA, Kennedy A, Dawson P, Servera FE. Acute/Chronic respiratory failure III. Intensive Care Med 1992. [DOI: 10.1007/bf03216369] [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: 10/18/2022]
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Gültuna I, Huygen PE, Jabaaij C, Holland WP, Ince C, Bruining HA. A simple device to inject indicator gas for wash-out tests during mechanical ventilation. Intensive Care Med 1992; 18:304-8. [PMID: 1527263 DOI: 10.1007/bf01706480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 12/27/2022]
Abstract
OBJECTIVE To evaluate a simple device which injects a constant fraction of indicator gas to the inspiratory mixture for performing multi-breath wash-out tests during controlled ventilation. DESIGN the technique in which the indicator gas is injected at the mouth of the patient (post-mix) is compared with the technique where the indicator gas is administered in the bellows of the ventilator (pre-mix). SETTING Surgical Intensive Care Unit of a University Hospital. PATIENTS 10 post-operative mechanically ventilated patients. INTERVENTIONS None. MEASUREMENTS AND RESULTS 3 wash-out tests with the post-mix and 3 wash-out tests with the pre-mix method were performed within an hour on every patient. The calculated mean end expiratory lung volume (EEV) was 1.91 +/- 0.871 with the post-mix technique and 1.89 +/- 0.881 with the pre-mix technique. There was a good agreement with a mean difference of -1.9 +/- 6.5% in the calculated EEV values by the two different techniques. CONCLUSION The described injector is an affordable device, is easy to assemble and can be incorporated in most electronically regulated ventilators to perform multi-breath indicator gas wash-out tests for pulmonary monitoring at the bed side of ICU patients.
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Affiliation(s)
- I Gültuna
- Department of Surgery, University Hospital of Rotterdam, The Netherlands
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