1
|
Komninou MA, Egli S, Rossi A, Ernst J, Krauthammer M, Schuepbach RA, Delgado M, Bartussek J. Former smoking, but not active smoking, is associated with delirium in postoperative ICU patients: a matched case-control study. Front Psychiatry 2024; 15:1347071. [PMID: 38559401 PMCID: PMC10979642 DOI: 10.3389/fpsyt.2024.1347071] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Objective To examine the relationship between current and former smoking and the occurrence of delirium in surgical Intensive Care Unit (ICU) patients. Methods We conducted a single center, case-control study involving 244 delirious and 251 non-delirious patients that were admitted to our ICU between 2018 and 2022. Using propensity score analysis, we obtained 115 pairs of delirious and non-delirious patients matched for age and Simplified Acute Physiology Score II (SAPS II). Both groups of patients were further stratified into non-smokers, active smokers and former smokers, and logistic regression was performed to further investigate potential confounders. Results Our study revealed a significant association between former smoking and the incidence of delirium in ICU patients, both in unmatched (adjusted odds ratio (OR): 1.82, 95% confidence interval (CI): 1.17-2.83) and matched cohorts (OR: 3.0, CI: 1.53-5.89). Active smoking did not demonstrate a significant difference in delirium incidence compared to non-smokers (unmatched OR = 0.98, CI: 0.62-1.53, matched OR = 1.05, CI: 0.55-2.0). Logistic regression analysis of the matched group confirmed former smoking as an independent risk factor for delirium, irrespective of other variables like surgical history (p = 0.010). Notably, also respiratory and vascular surgeries were associated with increased odds of delirium (respiratory: OR: 4.13, CI: 1.73-9.83; vascular: OR: 2.18, CI: 1.03-4.59). Medication analysis showed that while Ketamine and Midazolam usage did not significantly correlate with delirium, Morphine use was linked to a decreased likelihood (OR: 0.27, 95% CI: 0.13-0.55). Discussion Nicotine's complex neuropharmacological impact on the brain is still not fully understood, especially its short-term and long-term implications for critically ill patients. Although our retrospective study cannot establish causality, our findings suggest that smoking may induce structural changes in the brain, potentially heightening the risk of postoperative delirium. Intriguingly, this effect seems to be obscured in active smokers, potentially due to the recognized neuroprotective properties of nicotine. Our results motivate future prospective studies, the results of which hold the potential to substantially impact risk assessment procedures for surgeries.
Collapse
Affiliation(s)
- Maria Angeliki Komninou
- Institute of Intensive Care Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland
| | - Simon Egli
- Institute of Intensive Care Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland
| | - Aurelio Rossi
- Institute of Intensive Care Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Center of Clinical Nursing Sciences, University Hospital Zurich, Zurich, Switzerland
| | - Michael Krauthammer
- Department for Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Reto A. Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland
| | - Marcos Delgado
- Institute of Intensive Care Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland
- Department of Anesthesia and Intensive Care Medicine, Tiefenau Hospital, Insel Group. University of Bern, Bern, Switzerland
| | - Jan Bartussek
- Institute of Intensive Care Medicine, University Hospital Zurich & University of Zurich, Zurich, Switzerland
- Department for Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Gebhard CE, Sütsch C, Gebert P, Gysi B, Bengs S, Todorov A, Deforth M, Buehler PK, Meisel A, Schuepbach RA, Zinkernagel AS, Brugger SD, Acevedo C, Patriki D, Wiggli B, Beer JH, Friedl A, Twerenbold R, Kuster GM, Pargger H, Tschudin-Sutter S, Schefold JC, Spinetti T, Henze C, Pasqualini M, Sager DF, Mayrhofer L, Grieder M, Tontsch J, Franzeck FC, Wendel Garcia PD, Hofmaenner DA, Scheier T, Bartussek J, Haider A, Grämer M, Mikail N, Rossi A, Zellweger N, Opić P, Portmann A, von Känel R, Pazhenkottil AP, Messerli M, Buechel RR, Kaufmann PA, Treyer V, Siegemund M, Held U, Regitz-Zagrosek V, Gebhard C. Impact of sex and gender on post-COVID-19 syndrome, Switzerland, 2020. Euro Surveill 2024; 29:2300200. [PMID: 38214079 PMCID: PMC10785203 DOI: 10.2807/1560-7917.es.2024.29.2.2300200] [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: 04/03/2023] [Accepted: 10/04/2023] [Indexed: 01/13/2024] Open
Abstract
BackgroundWomen are overrepresented among individuals with post-acute sequelae of SARS-CoV-2 infection (PASC). Biological (sex) as well as sociocultural (gender) differences between women and men might account for this imbalance, yet their impact on PASC is unknown.AimWe assessed the impact of sex and gender on PASC in a Swiss population.MethodOur multicentre prospective cohort study included 2,856 (46% women, mean age 44.2 ± 16.8 years) outpatients and hospitalised patients with PCR-confirmed SARS-CoV-2 infection.ResultsAmong those who remained outpatients during their first infection, women reported persisting symptoms more often than men (40.5% vs 25.5% of men; p < 0.001). This sex difference was absent in hospitalised patients. In a crude analysis, both female biological sex (RR = 1.59; 95% CI: 1.41-1.79; p < 0.001) and a score summarising gendered sociocultural variables (RR = 1.05; 95% CI: 1.03-1.07; p < 0.001) were significantly associated with PASC. Following multivariable adjustment, biological female sex (RR = 0.96; 95% CI: 0.74-1.25; p = 0.763) was outperformed by feminine gender-related factors such as a higher stress level (RR = 1.04; 95% CI: 1.01-1.06; p = 0.003), lower education (RR = 1.16; 95% CI: 1.03-1.30; p = 0.011), being female and living alone (RR = 1.91; 95% CI: 1.29-2.83; p = 0.001) or being male and earning the highest income in the household (RR = 0.76; 95% CI: 0.60-0.97; p = 0.030).ConclusionSpecific sociocultural parameters that differ in prevalence between women and men, or imply a unique risk for women, are predictors of PASC and may explain, at least in part, the higher incidence of PASC in women. Once patients are hospitalised during acute infection, sex differences in PASC are no longer evident.
Collapse
Affiliation(s)
- Caroline E Gebhard
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
- These authors contributed equally
| | - Claudia Sütsch
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- These authors contributed equally
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bianca Gysi
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Atanas Todorov
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Manja Deforth
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudio Acevedo
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dimitri Patriki
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Benedikt Wiggli
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Jürg H Beer
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Andrée Friedl
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Department of Cardiology and University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Gabriela M Kuster
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University of Basel, Basel, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thibaud Spinetti
- Department of Intensive Care Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Chiara Henze
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Mina Pasqualini
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Dominik F Sager
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Lilian Mayrhofer
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mirjam Grieder
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Janna Tontsch
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Fabian C Franzeck
- Department of Informatics, University Hospital Basel, Basel, Switzerland
| | - Pedro D Wendel Garcia
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Bartussek
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ahmed Haider
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, and Department of Radiology, Harvard Medical School, Boston, Massachusetts, United States
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Muriel Grämer
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Núria Zellweger
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Petra Opić
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine (GiM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| |
Collapse
|
3
|
Wendel-Garcia PD, Moser A, Jeitziner MM, Aguirre-Bermeo H, Arias-Sanchez P, Apolo J, Roche-Campo F, Franch-Llasat D, Kleger GR, Schrag C, Pietsch U, Filipovic M, David S, Stahl K, Bouaoud S, Ouyahia A, Fodor P, Locher P, Siegemund M, Zellweger N, Cereghetti S, Schott P, Gangitano G, Wu MA, Alfaro-Farias M, Vizmanos-Lamotte G, Ksouri H, Gehring N, Rezoagli E, Turrini F, Lozano-Gómez H, Carsetti A, Rodríguez-García R, Yuen B, Weber AB, Castro P, Escos-Orta JO, Dullenkopf A, Martín-Delgado MC, Aslanidis T, Perez MH, Hillgaertner F, Ceruti S, Franchitti Laurent M, Marrel J, Colombo R, Laube M, Fogagnolo A, Studhalter M, Wengenmayer T, Gamberini E, Buerkle C, Buehler PK, Keiser S, Elhadi M, Montomoli J, Guerci P, Fumeaux T, Schuepbach RA, Jakob SM, Que YA, Hilty MP, Hilty MP, Wendel-Garcia P, Schuepbach RA, Montomoli J, Guerci P, Fumeaux T, Bouaoud S, Ouyahia A, Abdoun M, Rais M, Alfaro-Farias M, Vizmanos-Lamotte G, Caballero A, Tschoellitsch T, Meier J, Aguirre-Bermeo H, Arias-Sanchez P, Apolo J, Martinez LA, Tirapé-Castro H, Galal I, Tharwat S, Abdehaleem I, Jurkolow G, Guerci P, Novy E, Losser MR, Wengenmayer T, Zotzmann V, David S, Stahl K, Seeliger B, Welte T, Aslanidis T, Korsos A, Ahmed LA, Hashim HT, Nikandish R, Carsetti A, Casarotta E, Giaccaglia P, Rezoagli E, Giacomini M, Magliocca A, Bolondi G, Potalivo A, Fogagnolo A, Salvi L, Wu MA, Cogliati C, Colombo R, Catena E, Turrini F, Simonini MS, Fabbri S, Montomoli J, Gamberini E, Gangitano G, Bitondo MM, Maciopinto F, de Camillis E, Venturi M, Bocci MG, Antonelli M, Alansari A, Abusalama A, Omar O, Binnawara M, Alameen H, Elhadi M, Alhadi A, Arhaym A, Gommers D, Ince C, Jayyab M, Alsharif M, Rodríguez-García R, Gámez-Zapata J, Taboada-Fraga X, Castro P, Fernandez J, Reverter E, Lander-Azcona A, Escós-Orta J, Martín-Delgado MC, Algaba-Calderon A, Roche-Campo F, Franch-Llasat D, Concha P, Sauras-Colón E, Lozano-Gómez H, Zalba-Etayo B, Montes MP, Michot MP, Klarer A, Ensner R, Schott P, Urech S, Siegemund M, Zellweger N, Gebhard CE, Hollinger A, Merki L, Lambert A, Laube M, Jeitziner MM, Moser A, Que YA, Jakob SM, Wiegand J, Yuen B, Lienhardt-Nobbe B, Westphalen A, Salomon P, Hillgaertner F, Sieber M, Dullenkopf A, Barana G, Ksouri H, Sridharan GO, Cereghetti S, Boroli F, Pugin J, Grazioli S, Bürkle C, Marrel J, Brenni M, Fleisch I, Perez MH, Ramelet AS, Weber AB, Gerecke P, Christ A, Ceruti S, Glotta A, Biggiogero M, Marquardt K, Hübner T, Neff T, Redecker H, Fumeaux T, Moret-Bochatay M, Betello M, zu Bentrup FM, Studhalter M, Stephan M, Gehring N, Selz D, Kleger GR, Schrag C, Pietsch U, Filipovic M, Ristic A, Heise A, Franchitti Laurent M, Laurent JC, Gaspert T, Haberthuer C, Fodor P, Locher P, Garcia PDW, Hilty MP, Schuepbach R, Keiser S, Heuberger D, Bartussek J, Bühler P, Brugger S, Kleinert EM, Fehlbier KJ, Danial A, Almousa M, Abdulbaki Y, Sannah K, Colak E, Marczin N, Al-Ameri S. Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry. Crit Care 2022; 26:199. [PMID: 35787726 PMCID: PMC9254551 DOI: 10.1186/s13054-022-04065-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/10/2022] [Indexed: 12/22/2022] Open
Abstract
Background It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic. Methods Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic. Results Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60–63] years vs 64 [62–66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6–9.0] vs 5.8 [5.3–6.4], p < 0.001) and increased, while more female patients (26 [23–29]% vs 41 [35–48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2–7.2| days vs 9.7 [8.9–10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123–141] mmHg vs 101 [91–113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20–48] mmHg vs 70 [41–100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4–7]% vs 20 [14–29], p < 0.001) and non-invasive mechanical ventilation (14 [11–18]% vs 24 [17–33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76–86]% vs 74 [64–82]%, p < 0.001). The ICU mortality (23 [19–26]% vs 17 [12–25]%, p < 0.001) and length of stay (14 [13–16] days vs 11 [10–13] days, p < 0.001) decreased over 19 months of the pandemic. Conclusion Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04065-2.
Collapse
|
4
|
Maibach MA, Allam A, Hilty MP, Perez Gonzalez NA, Buehler PK, Wendel Garcia PD, Brugger SD, Ganter CC, Krauthammer M, Schuepbach RA, Bartussek J. How to Synchronize Longitudinal Patient Data With the Underlying Disease Progression: A Pilot Study Using the Biomarker CRP for Timing COVID-19. Front Med (Lausanne) 2021; 8:607594. [PMID: 34307391 PMCID: PMC8295502 DOI: 10.3389/fmed.2021.607594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/28/2020] [Accepted: 06/07/2021] [Indexed: 01/29/2023] Open
Abstract
The continued digitalization of medicine has led to an increased availability of longitudinal patient data that allows the investigation of novel and known diseases in unprecedented detail. However, to accurately describe any underlying pathophysiology and allow inter-patient comparisons, individual patient trajectories have to be synchronized based on temporal markers. In this pilot study, we use longitudinal data from critically ill ICU COVID-19 patients to compare the commonly used alignment markers “onset of symptoms,” “hospital admission,” and “ICU admission” with a novel objective method based on the peak value of the inflammatory marker C-reactive protein (CRP). By applying our CRP-based method to align the progression of neutrophils and lymphocytes, we were able to define a pathophysiological window that improved mortality risk stratification in our COVID-19 patient cohort. Our data highlights that proper synchronization of longitudinal patient data is crucial for accurate interpatient comparisons and the definition of relevant subgroups. The use of objective temporal disease markers will facilitate both translational research efforts and multicenter trials.
Collapse
Affiliation(s)
- Martina A Maibach
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Ahmed Allam
- Department of Quantitative Biomedicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Matthias P Hilty
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Nicolas A Perez Gonzalez
- Department of Quantitative Biomedicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Pedro D Wendel Garcia
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Christoph C Ganter
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | | | | | - Michael Krauthammer
- Department of Quantitative Biomedicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Jan Bartussek
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland.,Department of Quantitative Biomedicine, University and University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
5
|
Wendel Garcia PD, Hofmaenner DA, Brugger SD, Acevedo CT, Bartussek J, Camen G, Bader PR, Bruellmann G, Kattner J, Ganter C, Schuepbach RA, Buehler PK. Closed-Loop Versus Conventional Mechanical Ventilation in COVID-19 ARDS. J Intensive Care Med 2021; 36:1184-1193. [PMID: 34098803 PMCID: PMC8442133 DOI: 10.1177/08850666211024139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 12/15/2022]
Abstract
Background: Lung-protective ventilation is key in bridging patients suffering from
COVID-19 acute respiratory distress syndrome (ARDS) to recovery. However,
resource and personnel limitations during pandemics complicate the
implementation of lung-protective protocols. Automated ventilation modes may
prove decisive in these settings enabling higher degrees of lung-protective
ventilation than conventional modes. Method: Prospective study at a Swiss university hospital. Critically ill,
mechanically ventilated COVID-19 ARDS patients were allocated, by
study-blinded coordinating staff, to either closed-loop or conventional
mechanical ventilation, based on mechanical ventilator availability. Primary
outcome was the overall achieved percentage of lung-protective ventilation
in closed-loop versus conventional mechanical ventilation, assessed
minute-by-minute, during the initial 7 days and overall mechanical
ventilation time. Lung-protective ventilation was defined as the combined
target of tidal volume <8 ml per kg of ideal body weight, dynamic driving
pressure <15 cmH2O, peak pressure <30 cmH2O,
peripheral oxygen saturation ≥88% and dynamic mechanical power <17
J/min. Results: Forty COVID-19 ARDS patients, accounting for 1,048,630 minutes (728 days) of
cumulative mechanical ventilation, allocated to either closed-loop (n = 23)
or conventional ventilation (n = 17), presenting with a median
paO2/ FiO2 ratio of 92 [72-147] mmHg and a static
compliance of 18 [11-25] ml/cmH2O, were mechanically ventilated
for 11 [4-25] days and had a 28-day mortality rate of 20%. During the
initial 7 days of mechanical ventilation, patients in the closed-loop group
were ventilated lung-protectively for 65% of the time versus 38% in the
conventional group (Odds Ratio, 1.79; 95% CI, 1.76-1.82; P
< 0.001) and for 45% versus 33% of overall mechanical ventilation time
(Odds Ratio, 1.22; 95% CI, 1.21-1.23; P < 0.001). Conclusion: Among critically ill, mechanically ventilated COVID-19 ARDS patients during
an early highpoint of the pandemic, mechanical ventilation using a
closed-loop mode was associated with a higher degree of lung-protective
ventilation than was conventional mechanical ventilation.
Collapse
Affiliation(s)
| | | | - Silvio D Brugger
- Division of Infectious Diseases, 27243University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Claudio T Acevedo
- Division of Infectious Diseases, 27243University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Bartussek
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Giovanni Camen
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Patrick Raphael Bader
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Gregor Bruellmann
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Johannes Kattner
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Christoph Ganter
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Reto Andreas Schuepbach
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| | - Philipp Karl Buehler
- Institute of Intensive Care Medicine, 27243University Hospital of Zurich, Zurich, Switzerland
| |
Collapse
|
6
|
Buehler PK, Zinkernagel AS, Hofmaenner DA, Wendel Garcia PD, Acevedo CT, Gómez-Mejia A, Mairpady Shambat S, Andreoni F, Maibach MA, Bartussek J, Hilty MP, Frey PM, Schuepbach RA, Brugger SD. Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients. Cell Rep Med 2021; 2:100229. [PMID: 33748789 PMCID: PMC7955928 DOI: 10.1016/j.xcrm.2021.100229] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/29/2021] [Accepted: 03/09/2021] [Indexed: 01/02/2023]
Abstract
The impact of secondary bacterial infections (superinfections) in coronavirus disease 2019 (COVID-19) is not well understood. In this prospective, monocentric cohort study, we aim to investigate the impact of superinfections in COVID-19 patients with acute respiratory distress syndrome. Patients are assessed for concomitant microbial infections by longitudinal analysis of tracheobronchial secretions, bronchoalveolar lavages, and blood cultures. In 45 critically ill patients, we identify 19 patients with superinfections (42.2%). Superinfections are detected on day 10 after intensive care admission. The proportion of participants alive and off invasive mechanical ventilation at study day 28 (ventilator-free days [VFDs] at 28 days) is substantially lower in patients with superinfection (subhazard ratio 0.37; 95% confidence interval [CI] 0.15–0.90; p = 0.028). Patients with pulmonary superinfections have a higher incidence of bacteremia, virus reactivations, yeast colonization, and required intensive care treatment for a longer time. Superinfections are frequent and associated with reduced VFDs at 28 days despite a high rate of empirical antibiotic therapy. Secondary bacterial infections (superinfections) are found in 42% of patients Bacterial superinfections occur on day 10 after intensive care admission Bacterial superinfections are associated with longer duration of ventilation Bacterial superinfections are mostly caused by Gram-negative bacteria
Collapse
Affiliation(s)
- Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Pedro David Wendel Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Claudio T Acevedo
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Alejandro Gómez-Mejia
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Srikanth Mairpady Shambat
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Federica Andreoni
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Martina A Maibach
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Jan Bartussek
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.,Department of Quantitative Biomedicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Matthias P Hilty
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Pascal M Frey
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| |
Collapse
|
7
|
Bartussek J, Lehmann FO. Sensory processing by motoneurons: a numerical model for low-level flight control in flies. J R Soc Interface 2019; 15:rsif.2018.0408. [PMID: 30158188 PMCID: PMC6127168 DOI: 10.1098/rsif.2018.0408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/04/2018] [Accepted: 07/30/2018] [Indexed: 01/07/2023] Open
Abstract
Rhythmic locomotor behaviour in animals requires exact timing of muscle activation within the locomotor cycle. In rapidly oscillating motor systems, conventional control strategies may be affected by neural delays, making these strategies inappropriate for precise timing control. In flies, wing control thus requires sensory processing within the peripheral nervous system, circumventing the central brain. The underlying mechanism, with which flies integrate graded depolarization of visual interneurons and spiking proprioceptive feedback for precise muscle activation, is under debate. Based on physiological parameters, we developed a numerical model of spike initiation in flight muscles of a blowfly. The simulated Hodgkin–Huxley neuron reproduces multiple experimental findings and explains on the cellular level how vision might control wing kinematics. Sensory processing by single motoneurons appears to be sufficient for control of muscle power during flight in flies and potentially other flying insects, reducing computational load on the central brain during body posture reflexes and manoeuvring flight.
Collapse
Affiliation(s)
- Jan Bartussek
- Institute of Biological Sciences, Department of Animal Physiology, University of Rostock, 18059 Rostock, Germany
| | - Fritz-Olaf Lehmann
- Institute of Biological Sciences, Department of Animal Physiology, University of Rostock, 18059 Rostock, Germany
| |
Collapse
|
8
|
Lehmann FO, Bartussek J. Neural control and precision of flight muscle activation in Drosophila. J Comp Physiol A Neuroethol Sens Neural Behav Physiol 2017; 203:1-14. [PMID: 27942807 PMCID: PMC5263198 DOI: 10.1007/s00359-016-1133-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 01/20/2023]
Abstract
Precision of motor commands is highly relevant in a large context of various locomotor behaviors, including stabilization of body posture, heading control and directed escape responses. While posture stability and heading control in walking and swimming animals benefit from high friction via ground reaction forces and elevated viscosity of water, respectively, flying animals have to cope with comparatively little aerodynamic friction on body and wings. Although low frictional damping in flight is the key to the extraordinary aerial performance and agility of flying birds, bats and insects, it challenges these animals with extraordinary demands on sensory integration and motor precision. Our review focuses on the dynamic precision with which Drosophila activates its flight muscular system during maneuvering flight, considering relevant studies on neural and muscular mechanisms of thoracic propulsion. In particular, we tackle the precision with which flies adjust power output of asynchronous power muscles and synchronous flight control muscles by monitoring muscle calcium and spike timing within the stroke cycle. A substantial proportion of the review is engaged in the significance of visual and proprioceptive feedback loops for wing motion control including sensory integration at the cellular level. We highlight that sensory feedback is the basis for precise heading control and body stability in flies.
Collapse
Affiliation(s)
- Fritz-Olaf Lehmann
- Department of Animal Physiology, University of Rostock, Albert-Einstein-Str. 3, 18059, Rostock, Germany.
| | - Jan Bartussek
- Department of Animal Physiology, University of Rostock, Albert-Einstein-Str. 3, 18059, Rostock, Germany
| |
Collapse
|
9
|
Bartussek J, Lehmann FO. Proprioceptive feedback determines visuomotor gain in Drosophila. R Soc Open Sci 2016; 3:150562. [PMID: 26909184 PMCID: PMC4736939 DOI: 10.1098/rsos.150562] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/04/2015] [Indexed: 05/11/2023]
Abstract
Multisensory integration is a prerequisite for effective locomotor control in most animals. Especially, the impressive aerial performance of insects relies on rapid and precise integration of multiple sensory modalities that provide feedback on different time scales. In flies, continuous visual signalling from the compound eyes is fused with phasic proprioceptive feedback to ensure precise neural activation of wing steering muscles (WSM) within narrow temporal phase bands of the stroke cycle. This phase-locked activation relies on mechanoreceptors distributed over wings and gyroscopic halteres. Here we investigate visual steering performance of tethered flying fruit flies with reduced haltere and wing feedback signalling. Using a flight simulator, we evaluated visual object fixation behaviour, optomotor altitude control and saccadic escape reflexes. The behavioural assays show an antagonistic effect of wing and haltere signalling on visuomotor gain during flight. Compared with controls, suppression of haltere feedback attenuates while suppression of wing feedback enhances the animal's wing steering range. Our results suggest that the generation of motor commands owing to visual perception is dynamically controlled by proprioception. We outline a potential physiological mechanism based on the biomechanical properties of WSM and sensory integration processes at the level of motoneurons. Collectively, the findings contribute to our general understanding how moving animals integrate sensory information with dynamically changing temporal structure.
Collapse
|
10
|
Chakraborty S, Bartussek J, Fry SN, Zapotocky M. Correction: independently controlled wing stroke patterns in the fruit fly Drosophila melanogaster. PLoS One 2015; 10:e0124475. [PMID: 25875378 PMCID: PMC4395434 DOI: 10.1371/journal.pone.0124475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0116813.].
Collapse
|
11
|
|
12
|
Bartussek J, Mutlu AK, Zapotocky M, Fry SN. Limit-cycle-based control of the myogenic wingbeat rhythm in the fruit fly Drosophila. J R Soc Interface 2013; 10:20121013. [PMID: 23282849 DOI: 10.1098/rsif.2012.1013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In many animals, rhythmic motor activity is governed by neural limit cycle oscillations under the control of sensory feedback. In the fruit fly Drosophila melanogaster, the wingbeat rhythm is generated myogenically by stretch-activated muscles and hence independently from direct neural input. In this study, we explored if generation and cycle-by-cycle control of Drosophila's wingbeat are functionally separated, or if the steering muscles instead couple into the myogenic rhythm as a weak forcing of a limit cycle oscillator. We behaviourally tested tethered flying flies for characteristic properties of limit cycle oscillators. To this end, we mechanically stimulated the fly's 'gyroscopic' organs, the halteres, and determined the phase relationship between the wing motion and stimulus. The flies synchronized with the stimulus for specific ranges of stimulus amplitude and frequency, revealing the characteristic Arnol'd tongues of a forced limit cycle oscillator. Rapid periodic modulation of the wingbeat frequency prior to locking demonstrates the involvement of the fast steering muscles in the observed control of the wingbeat frequency. We propose that the mechanical forcing of a myogenic limit cycle oscillator permits flies to avoid the comparatively slow control based on a neural central pattern generator.
Collapse
Affiliation(s)
- Jan Bartussek
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
| | | | | | | |
Collapse
|
13
|
Herzog J, Hamel W, Wenzelburger R, Pötter M, Pinsker MO, Bartussek J, Morsnowski A, Steigerwald F, Deuschl G, Volkmann J. Kinematic analysis of thalamic versus subthalamic neurostimulation in postural and intention tremor. ACTA ACUST UNITED AC 2007; 130:1608-25. [PMID: 17439979 DOI: 10.1093/brain/awm077] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [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: 11/13/2022]
Abstract
Deep brain stimulation of the thalamus (thalamic DBS) is an established therapy for medically intractable essential tremor and tremor caused by multiple sclerosis. In both disorders, motor disability results from complex interaction between kinetic tremor and accompanying ataxia with voluntary movements. In clinical studies, the efficacy of thalamic DBS has been thoroughly assessed. However, the optimal anatomical target structure for neurostimulation is still debated and has never been analysed in conjunction with objective measurements of the different aspects of motor impairment. In 10 essential tremor and 11 multiple sclerosis patients, we analysed the effect of thalamic DBS through each contact of the quadripolar electrode on the contralateral tremor rating scale, accelerometry and kinematic measures of reach-to-grasp-movements. These measures were correlated with the anatomical position of the stimulating electrode in stereotactic space and in relation to nuclear boundaries derived from intraoperative microrecording. We found a significant impact of the stereotactic z-coordinate of stimulation contacts on the TRS, accelerometry total power and spatial deviation in the deceleration and target period of reach-to-grasp-movements. Most effective contacts clustered within the subthalamic area (STA) covering the posterior Zona incerta and prelemniscal radiation. Stimulation within this region led to a mean reduction of the lateralized tremor rating scale by 15.8 points which was significantly superior to stimulation within the thalamus (P < 0.05, student's t-test). STA stimulation resulted in reduction of the accelerometry total power by 99%, whereas stimulation at the ventral thalamic border (68%) or within the thalamus proper (2.5%) was significantly less effective (P < 0.01). Concomitantly, STA stimulation led to a significantly higher increase of tremor frequency and decrease in EMG synchronization compared to stimulation within the thalamus proper (P < 0.001). In reach-to-grasp movements, STA stimulation reduced the spatial variability of the movement path in the deceleration period by 28.9% and in the target period by 58.4%, whereas stimulation within the thalamus was again significantly less effective (P < 0.05), with a reduction in the deceleration period between 6.5 and 21.8% and in the target period between 1.2 and 11.3%. An analysis of the nuclear boundaries from intraoperative microrecording confirmed the anatomical impression that most effective electrodes were located within the STA. Our data demonstrate a profound effect of deep brain stimulation of the thalamic region on tremor and ataxia in essential tremor and tremor caused by multiple sclerosis. The better efficacy of stimulation within the STA compared to thalamus proper favours the concept of a modulation of cerebello-thalamic projections underlying the improvement of these symptoms.
Collapse
Affiliation(s)
- Jan Herzog
- Department of Neurology, Christian Albrechts University Kiel, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|