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Hagel S, Brillinger N, Decker S, Deja M, Ertmer C, Fiedler S, Franken P, Heim M, Weigand MA, Zarbock A, Pletz MW. Effect of acyclovir therapy on the outcome of mechanically ventilated patients with lower respiratory tract infection and detection of herpes simplex virus in bronchoalveolar lavage: protocol for a multicentre, randomised controlled trial (HerpMV). BMJ Open 2024; 14:e082512. [PMID: 38670599 PMCID: PMC11057316 DOI: 10.1136/bmjopen-2023-082512] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Herpes simplex virus (HSV) is frequently detected in the respiratory tract of mechanically ventilated patients and is associated with a worse outcome. The aim of this study is to determine whether antiviral therapy in HSV-positive patients improves outcome. METHODS AND ANALYSIS Prospective, multicentre, open-label, randomised, controlled trial in parallel-group design. Adult, mechanically ventilated patients with pneumonia and HSV type 1 detected in bronchoalveolar lavage (≥105 copies/mL) are eligible for participation and will be randomly allocated (1:1) to receive acyclovir (10 mg/kg body weight every 8 hours) for 10 days (or until discharge from the intensive care unit if earlier) or no intervention (control group). The primary outcome is mortality measured at day 30 after randomisation (primary endpoint) and will be analysed with Cox mixed-effects model. Secondary endpoints include ventilator-free and vasopressor-free days up to day 30. A total of 710 patients will be included in the trial. ETHICS AND DISSEMINATION The trial was approved by the responsible ethics committee and by Germany's Federal Institute for Drugs and Medical Devices. The clinical trial application was submitted under the new Clinical Trials Regulation through CTIS (The Clinical Trials Information System). In this process, only one ethics committee, whose name is unknown to the applicant, and Germany's Federal Institute for Drugs and Medical Devices are involved throughout the entire approval process. Results will be published in a journal indexed in MEDLINE and CTIS. With publication, de-identified, individual participant data will be made available to researchers. TRIAL REGISTRATION NUMBER NCT06134492.
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Affiliation(s)
- Stefan Hagel
- Friedrich Schiller University Jena, Jena, Germany
| | - Nicole Brillinger
- Center for Clinical Studies, Universitatsklinikum Jena, Jena, Thüringen, Germany
| | - Sebastian Decker
- Department of Anesthesiology, Heidelberg University, Heidelberg, Germany
| | - Maria Deja
- Department of Anesthesiology and Intensive Care Medicine, University of Schleswig-Holstein, Lübeck, Germany
| | | | | | | | - Markus Heim
- Klinikum rechts der Isar der Technischen Universitat Munchen, Munchen, Germany
| | - Markus A Weigand
- Department of Anaesthesia, UniversitatsKlinikum Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | | | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
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Spies C, Piazena H, Deja M, Wernecke KD, Willemeit T, Luetz A. Modification in ICU Design May Affect Delirium and Circadian Melatonin: A Proof of Concept Pilot Study. Crit Care Med 2024; 52:e182-e192. [PMID: 38112493 PMCID: PMC10930376 DOI: 10.1097/ccm.0000000000006152] [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] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Nonpharmacologic delirium management is recommended by current guidelines, but studies on the impact of ICU design are still limited. The study's primary purpose was to determine if a multicomponent change in room design prevents ICU delirium. Second, the influence of lighting conditions on serum melatonin was assessed. DESIGN Prospective observational cohort pilot study. SETTING The new design concept was established in two two-bed ICU rooms of a university hospital. Besides modifications aimed at stress relief, it includes a new dynamic lighting system. PATIENTS Seventy-four adult critically ill patients on mechanical ventilation with an expected ICU length of stay of at least 48 hours, treated in modified or standard rooms. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The clinical examination included a prospective assessment for depth of sedation, delirium, and pain every 8 hours using validated scores. Blood samples for serum melatonin profiles were collected every 4 hours for a maximum of three 24-hour periods. Seventy-four patients were included in the analysis. Seventy-six percent ( n = 28) of patients in the standard rooms developed delirium compared with 46% of patients ( n = 17) in the modified rooms ( p = 0.017). Patients in standard rooms (vs. modified rooms) had a 2.3-fold higher delirium severity (odds ratio = 2.292; 95% CI, 1.582-3.321; p < 0.0001). Light intensity, calculated using the measure of circadian effective irradiance, significantly influenced the course of serum melatonin ( p < 0.0001). Significant interactions ( p < 0.001) revealed that differences in serum melatonin between patients in standard and modified rooms were not the same over time but varied in specific periods of time. CONCLUSIONS Modifications in ICU room design may influence the incidence and severity of delirium. Dedicated light therapy could potentially influence delirium outcomes by modulating circadian melatonin levels.
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Affiliation(s)
- Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Helmut Piazena
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Maria Deja
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Berlin, Lübeck, Germany
| | - Klaus-Dieter Wernecke
- Institute Department of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Willemeit
- Department of Architectural Research, GRAFT Architects Berlin, Berlin, Germany
| | - Alawi Luetz
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
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Thommes MS, Klasen M, Bickenbach J, Deja M, Engelhard K, Francis R, Gramatté J, Hempel G, Gmeinwieser K, Reedy G, Röder D, Schroeder I, Sopka S. Effects of the "ICU Support" team meeting concept on patient-centered and staff-centered outcomes: study protocol for a randomized controlled multicenter study. Trials 2023; 24:756. [PMID: 38008760 PMCID: PMC10680186 DOI: 10.1186/s13063-023-07754-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 10/26/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Providing optimal care for critically ill patients is an extremely important but also highly demanding task, both emotionally and physically. The "ICU Support" team meeting concept aims to support intensive care unit (ICU) teams by promoting interprofessional communication, peer support, and patient safety by providing a structure for daily team meetings. This protocol describes a study to explore the effectiveness of "ICU Support" for patient- and staff-centered outcomes. METHODS ICU Support will be implemented at nine university hospitals located in Germany, following a two-arm randomized parallel group design with an intervention and a control condition and three data collection periods. In the intervention arm, leading ICU personnel (physicians and nurses) will be trained in ICU Support and implement the ICU Support elements into the daily work routine of their units upon completion of data collection period T0 (baseline). In the control arm, ICU Support will not be implemented until the completion of the data collection period T1 (1 month after study start). Until then, the regular daily schedule of the ICU teams will be maintained. The final data collection period (T2) will take place 4 months after the start of the study. Primary outcomes include the number of intensive care complications per patient during their ICU stay during T1 and the sick-related absence of ICU staff during T1. Secondary outcomes include, among others, the average severity of intensive care complications per patient and employee self-reported data regarding their teamwork and patient safety behaviors. DISCUSSION The need for healthy and well-trained ICU staff is omnipresent; thus, structured and evidence-based interventions aimed at supporting ICU teams and facilitating patient safety are required. This multicenter study aims to explore the effectiveness of ICU Support for patient- and staff-centered outcomes. The insights derived from this study have the potential to significantly improve ICU patient safety, staff communication, and connectedness and decrease sickness-related expenses and social costs associated with high work demands among ICU staff. TRIAL REGISTRATION German Clinical Trials Register DRKS00028642 . Registered on 4 April 2022.
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Affiliation(s)
- Marie S Thommes
- AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany.
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.
| | - Martin Klasen
- AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany
| | - Johannes Bickenbach
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Maria Deja
- Department of Anesthesiology and Intensive Care, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Kristin Engelhard
- Department of Anesthesiology, University Medical Center Mainz, Langenbeck Str. 1, 55131, Mainz, Germany
| | - Roland Francis
- Department of Anesthesiology and Intensive Care Medicine CCM/CVK, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Anesthesiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany
| | - Johannes Gramatté
- Deptartment of Anesthesiology and Intensive Care, Medicine University Hospital Carl Gustav Carus Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Gunther Hempel
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Center, Liebigstr. 20, 04103, Leipzig, Germany
| | - Kerstin Gmeinwieser
- Clinic of Anesthesiology and Surgical Intensive Care Medicine, Department for Clinical Nursing Science and Development, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Gabriel Reedy
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Center for Medical Simulation, Boston, USA
| | - Daniel Röder
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, Würzburg, 97080, Germany
| | - Ines Schroeder
- Department of Anesthesiology, LMU University Hospital, LMU Munich, Marchioninistr. 15, Munich, 81377, Germany
| | - Saša Sopka
- AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany
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Angermair S, Deja M, Thronicke A, Grehn C, Akbari N, Uhrig A, Asgarpur G, Spies C, Treskatsch S, Schwarz C. A prospective phase IIA multicenter double-blinded randomized placebo-controlled clinical trial evaluating the efficacy and safety of inhaled Tobramycin in patients with ventilator-associated pneumonia (iToVAP). Anaesth Crit Care Pain Med 2023; 42:101249. [PMID: 37217019 DOI: 10.1016/j.accpm.2023.101249] [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: 03/11/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Treatment of ventilated pneumonia is often unsuccessful, even when patients are treated according to current guidelines. Therefore, we aimed to investigate the efficacy of the adjunctive inhaled Tobramycin in patients with pneumonia caused by Gram-negative pathogens in addition to the standard systemic treatment. DESIGN Prospective, multicenter, double-blinded, randomized, placebo-controlled clinical trial. SETTING 26 patients in medical and surgical ICUs. PATIENTS Patients with ventilator-associated pneumonia caused by Gram-negative pathogens. MEASUREMENT AND MAIN RESULTS Fourteen patients were assigned to the Tobramycin Inhal group and 12 patients to the control group. The microbiological eradication of the Gram-negative pathogens was significantly higher in the intervention group than in the control group (p < 0.001). The probability of eradication was 100% in the intervention group [95% Confidence Interval: 0.78-1.0] and 25% in the control group [95% CI: 0.09-0.53]. The increased eradication frequency was not associated with increased patient survival. CONCLUSION Inhaled aerosolized Tobramycin demonstrated clinically meaningful efficacy in patients with Gram-negative ventilator-associated pneumonia. The probability of eradication in the intervention group was 100%. However, the successful eradication was not associated with a reduction in systemic anti-infective therapy, a shorter ICU stay, or even a survival benefit. In the presence of multidrug-resistant Gram-negative pathogens that are sensitive only to colistin and/or aminoglycosides, supplemental inhaled therapy with nebulizers suitable for this purpose should be considered in addition to systemic antibiotic therapy.
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Affiliation(s)
- Stefan Angermair
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany.
| | - Maria Deja
- Department of Anesthesiology and Intensive Care Medicine, University of Schleswig-Holstein, Lübeck, Germany
| | - Anja Thronicke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Nilufar Akbari
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Alexander Uhrig
- Department of Infectious Diseases and Respiratory Medicine, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Golschan Asgarpur
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Claudia Spies
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Intensive Care Medicine, Campus Virchow, Berlin, Germany
| | - Sascha Treskatsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Carsten Schwarz
- HMU-Health and Medical University, Klinikum Westbrandenburg Potsdam und Charite - Universitätsmedizin Berlin, Germany
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Kosian P, Hellmund A, Geipel A, Bald R, Geist OM, Böckenhoff P, Jimenez-Cruz J, Deja M, Strizek B, Berg C, Gembruch U. Intrauterine transfusion in 103 fetuses with severe anemia caused by parvovirus infection. A multicenter retrospective study. Arch Gynecol Obstet 2022; 308:117-125. [PMID: 35916962 DOI: 10.1007/s00404-022-06712-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/17/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Evaluating procedure-related complications and perinatal outcomes after intrauterine transfusion (IUT) before or after 20+0 weeks of gestation in fetuses with severe anemia due to intrauterine human parvovirus B19 infection. METHODS A retrospective study investigating fetuses requiring IUT for fetal Parvo B19 infection in two tertiary referral centers between December 2002 and December 2021. Procedure-related complications, intrauterine fetal death (IUFD), and perinatal outcome were correlated to gestational age (GA) at first IUT, the presence of hydrops and fetal blood sampling results. RESULTS A total of 186 IUTs were performed in 103 fetuses. The median GA at first IUT was 19+3 (13+0-31+4) weeks of gestation. IUFD occurred in 16/103 fetuses (15.5%). Overall survival was 84.5% (87/103). Hydrops (p = 0.001), lower mean hemoglobin at first IUT (p = 0.001) and low platelets (p = 0.002) were strongly associated with IUFD. There was no difference observed in fetuses transfused before or after 20+0 weeks of gestation. CONCLUSION IUT is a successful treatment option in fetuses affected by severe anemia due to parvovirus B19 infection in specialized centers. In experienced hands, IUT before 20 weeks is not related to worse perinatal outcome.
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Affiliation(s)
- Philipp Kosian
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.
| | | | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Rainer Bald
- Department of Gynecology and Obstetrics, Klinikum Leverkusen, Leverkusen, Germany
| | - Otilia-Maria Geist
- Department of Gynecology and Obstetrics, Klinikum Leverkusen, Leverkusen, Germany
| | - Paul Böckenhoff
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Jorge Jimenez-Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Maria Deja
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.,Division of Prenatal Medicine and Gynecologic Sonography, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Pickerodt PA, Hofferberth MBT, Busch T, Russ M, Taher M, Boemke W, Weber-Carstens S, Köbrich R, Swenson E, Deja M, Francis RCE. In vitro validation and characterization of pulsed inhaled nitric oxide administration during early inspiration. J Clin Monit Comput 2022; 36:637-648. [PMID: 33735405 PMCID: PMC7970749 DOI: 10.1007/s10877-021-00689-x] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 03/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Admixture of nitric oxide (NO) to the gas inspired with mechanical ventilation can be achieved through continuous, timed, or pulsed injection of NO into the inspiratory limb. The dose and timing of NO injection govern the inspired and intrapulmonary effect site concentrations achieved with different administration modes. Here we test the effectiveness and target reliability of a new mode injecting pulsed NO boluses exclusively during early inspiration. METHODS An in vitro lung model was operated under various ventilator settings. Admixture of NO through injection into the inspiratory limb was timed either (i) selectively during early inspiration ("pulsed delivery"), or as customary, (ii) during inspiratory time or (iii) the entire respiratory cycle. Set NO target concentrations of 5-40 parts per million (ppm) were tested for agreement with the yield NO concentrations measured at various sites in the inspiratory limb, to assess the effectiveness of these NO administration modes. RESULTS Pulsed delivery produced inspiratory NO concentrations comparable with those of customary modes of NO administration. At low (450 ml) and ultra-low (230 ml) tidal volumes, pulsed delivery yielded better agreement of the set target (up to 40 ppm) and inspiratory NO concentrations as compared to customary modes. Pulsed delivery with NO injection close to the artificial lung yielded higher intrapulmonary NO concentrations than with NO injection close to the ventilator. The maximum inspiratory NO concentration observed in the trachea (68 ± 30 ppm) occurred with pulsed delivery at a set target of 40 ppm. CONCLUSION Pulsed early inspiratory phase NO injection is as effective as continuous or non-selective admixture of NO to inspired gas and may confer improved target reliability, especially at low, lung protective tidal volumes.
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Affiliation(s)
- Philipp A Pickerodt
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Moritz B T Hofferberth
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thilo Busch
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Martin Russ
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Mahdi Taher
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Willehad Boemke
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Erik Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - Maria Deja
- Department of Anesthesiology and Intensive Care Medicine, University of Schleswig-Holstein, Lübeck, Germany
| | - Roland C E Francis
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
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7
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van Duijn PJ, Verbrugghe W, Jorens PG, Spöhr F, Schedler D, Deja M, Rothbart A, Annane D, Lawrence C, Jereb M, Seme K, Šifrer F, Tomič V, Estevez F, Carneiro J, Harbarth S, Bonten MJM. The effects of antibiotic cycling and mixing on acquisition of antibiotic resistant bacteria in the ICU: A post-hoc individual patient analysis of a prospective cluster-randomized crossover study. PLoS One 2022; 17:e0265720. [PMID: 35503768 PMCID: PMC9064081 DOI: 10.1371/journal.pone.0265720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 03/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Repeated rotation of empiric antibiotic treatment strategies is hypothesized to reduce antibiotic resistance. Clinical rotation studies failed to change unit-wide prevalence of antibiotic resistant bacteria (ARB) carriage, including an international cluster-randomized crossover study. Unit-wide effects may differ from individual effects due to “ecological fallacy”. This post-hoc analysis of a cluster-randomized crossover study assesses differences between cycling and mixing rotation strategies in acquisition of carriage with Gram-negative ARB in individual patients. Methods This was a controlled cluster-randomized crossover study in 7 ICUs in 5 European countries. Clinical cultures taken as routine care were used for endpoint assessment. Patients with a first negative culture and at least one culture collected in total were included. Community acquisitions (2 days of admission or less) were excluded. Primary outcome was ICU-acquisition of Enterobacterales species with reduced susceptibility to: third- or fourth generation cephalosporins or piperacillin-tazobactam, and Acinetobacter species and Pseudomonas aeruginosa with reduced susceptibility for piperacillin-tazobactam or carbapenems. Cycling (altering first-line empiric therapy for Gram-negative bacteria, every other 6-weeks), to mixing (changing antibiotic type every empiric antibiotic course). Rotated antibiotics were third- or fourth generation cephalosporins, piperacillin-tazobactam and carbapenems. Results For this analysis 1,613 admissions were eligible (855 and 758 during cycling and mixing, respectively), with 16,437 microbiological cultures obtained. Incidences of acquisition with ARB during ICU-stay were 7.3% (n = 62) and 5.1% (n = 39) during cycling and mixing, respectively (p-value 0.13), after a mean of 17.7 (median 15) and 20.8 (median 13) days. Adjusted odds ratio for acquisition of ARB carriage during mixing was 0.62 (95% CI 0.38 to 1.00). Acquired carriage with ARB were Enterobacterales species (n = 61), Pseudomonas aeruginosa (n = 38) and Acinetobacter species (n = 20), with no statistically significant differences between interventions. Conclusions There was no statistically significant difference in individual patients’ risk of acquiring carriage with Gram-negative ARB during cycling and mixing. These findings substantiate the absence of difference between cycling and mixing on the epidemiology of Gram-negative ARB in ICU. Trial registration This trial is registered with ClinicalTrials.gov, registered 10 January 2011, NCT01293071.
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Affiliation(s)
- Pleun J. van Duijn
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
- * E-mail:
| | - Walter Verbrugghe
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Philippe G. Jorens
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Fabian Spöhr
- Department of Anaesthesiology and Intensive Care, Sana Kliniken Stuttgart, Stuttgart, Germany
| | - Dirk Schedler
- Department of Anaesthesiology and Intensive Care, Sana Kliniken Stuttgart, Stuttgart, Germany
| | - Maria Deja
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Andreas Rothbart
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Djillali Annane
- Department of Intensive Care, Hôpital Raymond Poincaré (APHP), Garches, France
- Laboratory of Infection & Inflammation, School of Medicine Simone Veil, University Versailles Saint Quentin & University Paris Saclay, INSERM, Montigny le Bretonneux, France
- FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis) and RHU RECORDS (Rapid rEcognition of CORticosteroiD resistant or sensitive Sepsis), Garches, France
| | | | - Matjaz Jereb
- Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Seme
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Franc Šifrer
- Department of Intensive Care Medicine, University Hospital Golnik, Golnik, Slovenia
| | - Viktorija Tomič
- Department of Medical Microbiology, University Hospital Golnik, Golnik, Slovenia
| | - Francisco Estevez
- Intensive Care Unit and Emergency Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Jandira Carneiro
- Intensive Care Unit and Emergency Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marc J. M. Bonten
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
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8
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Kowalowka A, Kowalewski M, Wanha W, Kolodziejczak M, Mariani S, Li T, Stefaniak S, Los A, Hudziak D, Gocol R, Suwalski P, Rogowski J, Jemielity M, Wojakowski W, Deja M. Long-term survival benefit of SAVR over TAVR in low-risk elective patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2207] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic valve (AV) stenosis can be treated either by surgical AV replacement (SAVR) or since 2002 by transcatheter aortic valve implantation (TAVI). Due to lower invasiveness, TAVI is a preferred approach in high- and prohibitive risk surgical candidates, yet outcome data is conflicting when lower risk patients are considered and in particular at long-term.
Purpose
Our study evaluates long-term survival in elective low-risk patients after AV replacement with severe AV stenosis.
Methods
We conducted a registry data analyses of patients scheduled for elective isolated AV with AV stenosis between 2015 and 2019 and underwent TAVI or SAVR. Urgent, emergent and salvage procedures were excluded. In TAVI group only transfemoral access was considered. Propensity score matching to determine SAVR controls for TAVI group in 1:3 ratio with caliper 0.2 of standardized deviation (figure 1).
Results
Study group included 2393 elective AVR patients 1765 was in SAVR group and 628 in TAVI group. Median follow-up was 2.72 years ([IQR: 1.32–4.08], max 6.0). Propensity matching with replacement returned 329 TAVI cases and 593 SAVR controls with median age 76 (Interquartile range [IQR:71–73]) and EuroScore II 1.81 [IQR:1.36–2.53]). 30-day mortality was 11/329 (3.32%) vs 18/593 (3.03%) in the TAVI vs SAVR respectively (RR 1.10 [0.52–2.37]; p=0.801). At two years, there was no difference between SAVR and TAVI in terms of mortality (HR 1.23 [0.83–1.83] P=0.309). At 6 years, overall survival analysis favored SAVR which was associated with 30% lower mortality (HR 0.70 [0.496–0.997]; p=0.048, see figure 2).
Conclusions
TAVI as compared to SAVR is equally safe in elective low-risk patients up to 2 years post-op. After that time survival is better in surgically managed patients. Extended observations from randomized trials in low-risk patients are warranted to draw definite conclusions regarding long-term safety of TAVI in this population.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The work was supported by the research non-commercial grant from Medical University of Silesia Figure 1Figure 2
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Affiliation(s)
- A Kowalowka
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiac Surgery, Katowice, Poland
| | - M Kowalewski
- Central Research Hospital the Ministry of The Interior and Administration, Department of Cardiac Surgery, Warsaw, Poland
| | - W Wanha
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - M Kolodziejczak
- Nicolaus Copernicus University, Department of Anaesthesiology and Intensive Care, Bydgoszcz, Poland
| | - S Mariani
- Hannover Medical School, Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - T Li
- Hannover Medical School, Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover, Germany
| | - S Stefaniak
- Poznan University of Medical Sciences, Department of Cardiac Surgery and Transplantology, Poznan, Poland
| | - A Los
- Medical University of Gdansk, Department of Cardiac and Vascular Surgery, Gdansk, Poland
| | - D Hudziak
- 7th Public Hospital of the Silesian Medical University, Katowice, Poland
| | - R Gocol
- 7th Public Hospital of the Silesian Medical University, Katowice, Poland
| | - P Suwalski
- Central Research Hospital the Ministry of The Interior and Administration, Department of Cardiac Surgery, Warsaw, Poland
| | - J Rogowski
- Medical University of Gdansk, Department of Cardiac and Vascular Surgery, Gdansk, Poland
| | - M Jemielity
- Poznan University of Medical Sciences, Department of Cardiac Surgery and Transplantology, Poznan, Poland
| | - W Wojakowski
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiology and Structural Heart Diseases, Katowice, Poland
| | - M Deja
- School of Medicine in Katowice, Medical University of Silesia, Department of Cardiac Surgery, Katowice, Poland
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9
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Koulenti D, Armaganidis A, Arvaniti K, Blot S, Brun-Buisson C, Deja M, De Waele J, Du B, Dulhunty JM, Garcia-Diaz J, Judd M, Paterson DL, Putensen C, Reina R, Rello J, Restrepo MI, Roberts JA, Sjovall F, Timsit JF, Tsiodras S, Zahar JR, Zhang Y, Lipman J. Protocol for an international, multicentre, prospective, observational study of nosocomial pneumonia in intensive care units: the PneumoINSPIRE study. CRIT CARE RESUSC 2021; 23:59-66. [PMID: 38046390 PMCID: PMC10692553 DOI: 10.51893/2021.1.oa5] [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: 11/15/2022]
Abstract
Background: Nosocomial pneumonia in the critical care setting is associated with increased morbidity, significant crude mortality rates and high health care costs. Ventilator-associated pneumonia represents about 80% of nosocomial pneumonia cases in intensive care units (ICUs). Wide variance in incidence of nosocomial pneumonia and diagnostic techniques used has been reported, while successful treatment remains complex and a matter of debate. Objective: To describe the epidemiology, diagnostic strategies and treatment modalities for nosocomial pneumonia in contemporary ICU settings across multiple countries around the world. Design, setting and patients: PneumoINSPIRE is a large, multinational, prospective cohort study of adult ICU patients diagnosed with nosocomial pneumonia. Participating ICUs from at least 20 countries will collect data on 10 or more consecutive ICU patients with nosocomial pneumonia. Site-specific information, including hospital policies on antibiotic therapy, will be recorded along with patient-specific data. Variables that will be explored include: aetiology and antimicrobial resistance patterns, treatment-related parameters (including time to initiation of antibiotic therapy, and empirical antibiotic choice, dose and escalation or de-escalation), pneumonia resolution, ICU and hospital mortality, and risk factors for unfavourable outcomes. The concordance of ventilator-associated pneumonia diagnosis with accepted definitions will also be assessed. Results and conclusions: PneumoINSPIRE will provide valuable information on current diagnostic and management practices relating to ICU nosocomial pneumonia, and identify research priorities in the field. Trial registration:ClinicalTrials.gov identifier NCT02793141.
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Affiliation(s)
- Despoina Koulenti
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Second Critical Care Department, Attikon University Hospital, Medical School, University of Athens, Athens, Greece
| | - Apostolos Armaganidis
- Second Critical Care Department, Attikon University Hospital, Medical School, University of Athens, Athens, Greece
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Stijn Blot
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - Christian Brun-Buisson
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Mixed Research Unit (French Institute for Medical Research [INSERM], Université de Versailles Saint Quentin Medical School and Institut Pasteur), Paris-Saclay University, Montigny-Le-Bretonneux, France
| | - Maria Deja
- Lumbeck Klinik für Anästhesiologie und Intensivmedizin, Sektion Interdisziplinäre Operative Intensivmedizin, Universitatsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Lübeck, Germany
| | - Jan De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Bin Du
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | - Joel M. Dulhunty
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Research and Medical Education, Redcliffe Hospital, Brisbane, QLD, Australia
| | - Julia Garcia-Diaz
- Infectious Diseases Department, Ochsner Clinic Foundation, New Orleans, LA, USA
- Ochsner Clinical School, The University of Queensland, New Orleans, LA, USA
| | - Matthew Judd
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - David L. Paterson
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital,Brisbane, QLD, Australia
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Rosa Reina
- Critical Care Department, Hospital San Martin de la Plata, Buenos Aires, Argentina
| | - Jordi Rello
- Clinical Research/Innovation in Pneumonia and Sepsis Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Efermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Clinical Research Department, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Marcos I. Restrepo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
- Pulmonary and Critical Care Fellowship Program, University of Texas Health Science Center, San Antonio, TX, USA
- Medical Intensive Care Unit, South Texas Veterans Health Care System, Audie L Murphy Division, San Antonio, TX, USA
- INnovation Science in Pulmonary Infections REsearch Network, Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Jason A. Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Fredrik Sjovall
- Department of Intensive Care and Perioperative Medicine, Skane University Hospital, Malmö, Sweden
| | - Jean-Francois Timsit
- Infection, Antimicrobials, Modelling, Evolution Research Centre, French Institute for Medical Research (INSERM), Université de Paris, Paris, France
- Medical and Infectious Diseases Intensive Care Unit (MI2), Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Jean-Ralph Zahar
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, Assistance Publique — Hôpitaux de Paris, Bobigny, France
- Infection, Antimicrobials, Modelling, Evolution Research Centre, Unité Mixte de Recherche 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - Yuchi Zhang
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jeffrey Lipman
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Anesthesiology and Critical Care Department, Centre Hospitalier Universitaire de Nîmes, University of Montpellier, Nîmes, France
| | - On behalf of the Working Group on Pneumonia of the European Society of Intensive Care Medicine
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Second Critical Care Department, Attikon University Hospital, Medical School, University of Athens, Athens, Greece
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
- Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Mixed Research Unit (French Institute for Medical Research [INSERM], Université de Versailles Saint Quentin Medical School and Institut Pasteur), Paris-Saclay University, Montigny-Le-Bretonneux, France
- Lumbeck Klinik für Anästhesiologie und Intensivmedizin, Sektion Interdisziplinäre Operative Intensivmedizin, Universitatsklinikum Schleswig-Holstein, Campus Lübeck, Universität zu Lübeck, Lübeck, Germany
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Research and Medical Education, Redcliffe Hospital, Brisbane, QLD, Australia
- Infectious Diseases Department, Ochsner Clinic Foundation, New Orleans, LA, USA
- Ochsner Clinical School, The University of Queensland, New Orleans, LA, USA
- Infectious Diseases Unit, Royal Brisbane and Women’s Hospital,Brisbane, QLD, Australia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Critical Care Department, Hospital San Martin de la Plata, Buenos Aires, Argentina
- Clinical Research/Innovation in Pneumonia and Sepsis Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Efermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Clinical Research Department, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
- Pulmonary and Critical Care Fellowship Program, University of Texas Health Science Center, San Antonio, TX, USA
- Medical Intensive Care Unit, South Texas Veterans Health Care System, Audie L Murphy Division, San Antonio, TX, USA
- INnovation Science in Pulmonary Infections REsearch Network, Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
- Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Department of Intensive Care and Perioperative Medicine, Skane University Hospital, Malmö, Sweden
- Infection, Antimicrobials, Modelling, Evolution Research Centre, French Institute for Medical Research (INSERM), Université de Paris, Paris, France
- Medical and Infectious Diseases Intensive Care Unit (MI2), Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, Assistance Publique — Hôpitaux de Paris, Bobigny, France
- Infection, Antimicrobials, Modelling, Evolution Research Centre, Unité Mixte de Recherche 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Anesthesiology and Critical Care Department, Centre Hospitalier Universitaire de Nîmes, University of Montpellier, Nîmes, France
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10
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Arnold S, Deja M, Nitschke M, Bohnet S, Wallis S, Humrich JY, Riemekasten G, Steinhoff J, Lamprecht P. Extracorporeal membrane oxygenation in ANCA-associated vasculitis. Autoimmun Rev 2020; 20:102702. [PMID: 33188916 DOI: 10.1016/j.autrev.2020.102702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sabrina Arnold
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Maria Deja
- Department of Anaesthesiology and Intensive Care, University of Lübeck, Lübeck, Germany
| | - Martin Nitschke
- Department of Nephrology, University of Lübeck, Lübeck, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
| | - Sönke Wallis
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
| | - Jens Y Humrich
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | | | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany.
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11
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Bednarek A, Wieczorek J, Elzbieciak M, Deja M, Mizia-Stec K. P1723 Spectacular left ventricle post infarction aneurysm. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1085] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Sixty six-y.o. woman 2 months after anterior wall ST-segment elevation myocardial infraction and PCI LAD + 3DES (TIMI 1) was re-admitted to the clinic because of progressive severe heart failure (NYHA III/IV). In admission NT-proBNP level was 14 000 pg/ml, INR 1,7, bilirubin 4,5mg/dl. The electrocardiogram showed persistent ST elevation on anterior leads. Transthoracic echocardiography (TTE) revealed spectacular finding: aneurysm of left ventricle (LV) involving ½ distal part of interventricular septum, apex, inferior, anterior and lateral wall with LVEF 24%, LVEDV 272ml. Thickness of intraventricular septum (IVS) on aneurysm level was only 2,5-3,5mm. In the middle part of IVS a minimal ventricular septal defect (VSD) was showed. Cardiac magnetic resonance examination confirmed TTE findings. The course of the disease was dynamic. The diameter of VSD was increased during consecutive days of hospitalization with maximum width 6,5mm. The patient was hemodynamical unstable, she needed pressure amines, diuretics and intra-aortic balloon pumping. The patient underwent several Heart Team consultations. She was disqualified from percutaneous VSD closing because of thickness of IVS and spiral shape of VSD. Due to potentially too small LV volume after LV plastic surgery the patient was also disqualified from that procedure. We reported the patient to heart transplantation (HTX). There was no transplant donor. In next days we observed progressive signs of a cardiogenic shock with right ventricle decompensation secondary to widening of VSD. Because of unstable stage and growing decompensation, no possibility of HTX patient had life—saving cardiac surgery of LV with mitral valve and tricuspid valve anuloplasthies. The patient survived operation.
Abstract P1723 Figure.
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Affiliation(s)
- A Bednarek
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - J Wieczorek
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - M Elzbieciak
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - M Deja
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - K Mizia-Stec
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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12
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Denke C, Balzer F, Menk M, Szur S, Brosinsky G, Tafelski S, Wernecke KD, Deja M. Long-term sequelae of acute respiratory distress syndrome caused by severe community-acquired pneumonia: Delirium-associated cognitive impairment and post-traumatic stress disorder. J Int Med Res 2018; 46:2265-2283. [PMID: 29609489 PMCID: PMC6023035 DOI: 10.1177/0300060518762040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective Delirium in critically ill patients is considered a risk factor for various long-term consequences. We evaluated delirium and associated long-term outcomes in patients with acute respiratory distress syndrome with non-H1N1 and H1N1- associated severe community-acquired pneumonia (sCAP) who had been recommended to take antiviral drugs associated with delirious symptoms as adverse effects. Methods Of 64 patients, 42 survivors (H1N1, 15; non-H1N1, 27) were analyzed regarding the relationship between medication and the duration of delirium in the intensive care unit. During follow-up (n = 23), we assessed cognitive abilities, post-traumatic stress disorder (PTSD), physical capacity, and health-related quality of life (HRQoL). Results The incidence of delirium was 88%. There was no difference in the incidence and duration of delirium between patients with H1N1 and non-H1N1 infection. The haloperidol and opioid doses were associated with a longer delirium duration. The delirium duration was correlated with reduced cognitive performance in motor skills, memory function, and learning efficiency. Patients with PTSD (16%) had a significantly longer delirium duration and low mental HRQoL. Conclusions H1N1 infection and corresponding antiviral medication had no impact on delirium. The duration of delirium in these patients was associated with impairments in various outcome parameters, illustrating the burden of sCAP.
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Affiliation(s)
- Claudia Denke
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Balzer
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mario Menk
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Szur
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Georg Brosinsky
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sascha Tafelski
- 1 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Maria Deja
- 3 Department of Anesthesiology and Operative Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,4 Department of Anesthesiology and Intensive Care, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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13
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van Duijn PJ, Verbrugghe W, Jorens PG, Spöhr F, Schedler D, Deja M, Rothbart A, Annane D, Lawrence C, Nguyen Van JC, Misset B, Jereb M, Seme K, Šifrer F, Tomiç V, Estevez F, Carneiro J, Harbarth S, Eijkemans MJC, Bonten M. The effects of antibiotic cycling and mixing on antibiotic resistance in intensive care units: a cluster-randomised crossover trial. Lancet Infect Dis 2018; 18:401-409. [PMID: 29396000 DOI: 10.1016/s1473-3099(18)30056-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/02/2017] [Accepted: 11/23/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Whether antibiotic rotation strategies reduce prevalence of antibiotic-resistant, Gram-negative bacteria in intensive care units (ICUs) has not been accurately established. We aimed to assess whether cycling of antibiotics compared with a mixing strategy (changing antibiotic to an alternative class for each consecutive patient) would reduce the prevalence of antibiotic-resistant, Gram-negative bacteria in European intensive care units (ICUs). METHODS In a cluster-randomised crossover study, we randomly assigned ICUs to use one of three antibiotic groups (third-generation or fourth-generation cephalosporins, piperacillin-tazobactam, and carbapenems) as preferred empirical treatment during 6-week periods (cycling) or to change preference after every consecutively treated patient (mixing). Computer-based randomisation of intervention and rotated antibiotic sequence was done centrally. Cycling or mixing was applied for 9 months; then, following a washout period, the alternative strategy was implemented. We defined antibiotic-resistant, Gram-negative bacteria as Enterobacteriaceae with extended-spectrum β-lactamase production or piperacillin-tazobactam resistance, and Acinetobacter spp and Pseudomonas aeruginosa with piperacillin-tazobactam or carbapenem resistance. Data were collected for all admissions during the study. The primary endpoint was average, unit-wide, monthly point prevalence of antibiotic-resistant, Gram-negative bacteria in respiratory and perineal swabs with adjustment for potential confounders. This trial is registered with ClinicalTrials.gov, number NCT01293071. FINDINGS Eight ICUs (from Belgium, France, Germany, Portugal, and Slovenia) were randomly assigned and patients enrolled from June 27, 2011, to Feb 16, 2014. 4069 patients were admitted during the cycling periods in total and 4707 were admitted during the mixing periods. Of these, 745 patients during cycling and 853 patients during mixing were present during the monthly point-prevalence surveys, and were included in the main analysis. Mean prevalence of the composite primary endpoint was 23% (168/745) during cycling and 22% (184/853) during mixing (p=0·64), yielding an adjusted incidence rate ratio during mixing of 1·039 (95% CI 0·837-1·291; p=0·73). There was no difference in all-cause in-ICU mortality between intervention periods. INTERPRETATION Antibiotic cycling does not reduce the prevalence of carriage of antibiotic-resistant, Gram-negative bacteria in patients admitted to the ICU. FUNDING European Union Seventh Framework Programme.
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Affiliation(s)
- Pleun Joppe van Duijn
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands.
| | - Walter Verbrugghe
- Department of Critical Care Medicine, Antwerp University Hospital, Antwerp, Belgium
| | | | - Fabian Spöhr
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Cologne, Germany
| | - Dirk Schedler
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Cologne, Germany
| | - Maria Deja
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Andreas Rothbart
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin, Berlin, Germany
| | - Djillali Annane
- General Intensive Care Unit, Raymond-Poincaré Hospital, Garches, France
| | | | | | - Benoit Misset
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France
| | - Matjaz Jereb
- Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia
| | - Katja Seme
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Franc Šifrer
- Department of Intensive Care Medicine, Klinika Golnik, Golnik, Slovenia
| | - Viktorija Tomiç
- Department of Medical Microbiology, Klinika Golnik, Golnik, Slovenia
| | - Francisco Estevez
- Intensive Care Unit and Emergency Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Jandira Carneiro
- Intensive Care Unit and Emergency Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Marc Bonten
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
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Dalhoff K, Abele-Horn M, Andreas S, Deja M, Ewig S, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Heußel CP, Höffken G, Kolditz M, Kramme E, Kühl H, Lange C, Mayer K, Nachtigall I, Panning M, Pletz M, Rath PM, Rohde G, Rosseau S, Schaaf B, Schreiter D, Schütte H, Seifert H, Spies C, Welte T. [Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia - Update 2017 - S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology]. Pneumologie 2018; 72:15-63. [PMID: 29341032 DOI: 10.1055/s-0043-121734] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However, infections on general wards are increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.This guideline update was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and treatment of HAP on the basis of quality of evidence and benefit/risk ratio.This guideline has two parts. First an update on epidemiology, spectrum of pathogens and antimicrobials is provided. In the second part recommendations for the management of diagnosis and treatment are given. New recommendations with respect to imaging, diagnosis of nosocomial viral pneumonia and prolonged infusion of antibacterial drugs have been added. The statements to risk factors for infections with MDR pathogens and recommendations for monotherapy vs combination therapy have been actualised. The importance of structured deescalation concepts and limitation of treatment duration is emphasized.
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Affiliation(s)
- K Dalhoff
- Medizinische Klinik III, Pneumologie, Universitätsklinikum Schleswig-Holstein, Lübeck
| | - M Abele-Horn
- Institut für Hygiene und Mikrobiologie der Universität Würzburg, Würzburg
| | - S Andreas
- Lungenfachklinik Immenhausen, Immenhausen
| | - M Deja
- Charité, Universitätsmedizin Berlin, Klinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Berlin
| | - S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Evangelisches Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum, Herne und Bochum
| | - P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - S Gatermann
- Institut für Hygiene und Mikrobiologie, Abteilung für Medizinische Mikrobiologie, Ruhr-Universität Bochum, Bochum
| | - H Gerlach
- Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Berlin
| | - B Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene am Klinikum der Universität München, München
| | - C P Heußel
- Thoraxklinik Heidelberg gGmbH, Abteilung für Diagnostische und Interventionelle Radiologie
| | - G Höffken
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Medizinische Klinik und Poliklinik 1, Fachabteilung für Pneumologie, Dresden
| | - M Kolditz
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Medizinische Klinik und Poliklinik 1, Fachabteilung für Pneumologie, Dresden
| | - E Kramme
- Medizinische Klinik III, Pneumologie, Universitätsklinikum Schleswig-Holstein, Lübeck
| | - H Kühl
- St. Bernhard-Hospital Kamp-Lintfort GmbH, Klinik für Radiologie, Kamp-Lintfort
| | - C Lange
- Medizinische Klinik, Forschungszentrum Borstel, Borstel
| | - K Mayer
- Zentrum für Innere Medizin, Medizinische Klinik II, Pneumologie und Intensivmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen
| | | | - M Panning
- Universitätsklinikum Freiburg, Institut für Medizinische Mikrobiologie und Hygiene, Freiburg
| | - M Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena
| | - P-M Rath
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Essen, Essen
| | - G Rohde
- Klinikum der Johann Wolfgang Goethe-Universität, Pneumologie/Allergologie, Medizinische Klinik 1, Frankfurt am Main
| | - S Rosseau
- Klinik Ernst von Bergmann Bad Belzig gGmbH, Pneumologisches Beatmungszentrum, Bad Belzig
| | - B Schaaf
- Klinikum Dortmund gGmbH, Medizinischen Klinik, Pneumologie und Infektiologie, Dortmund
| | - D Schreiter
- Helios Park-Klinikum Leipzig GmbH und Herzzentrum Leipzig GmbH, Universitätsklinik, Leipzig
| | - H Schütte
- Klinikum Ernst von Bergmann gGmbH, Klinik für Pneumologie, Potsdam
| | - H Seifert
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Klinikum der Universität zu Köln, Köln
| | - C Spies
- Charitè, Universitätsmedizin Berlin, Klinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Berlin
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover
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Gericke B, Raila J, Deja M, Rohn S, Donaubauer B, Nagl B, Haebel S, Schweigert FJ, Kaisers U. Alteration of Transthyretin Microheterogeneity in Serum of Multiple Trauma Patients. Biomark Insights 2017. [DOI: 10.1177/117727190700200014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transthyretin (TTR) which exists in various isoforms, is a valid marker for acute phase response and subclinical malnutrition. The aim of the study was to investigate the relationship between inflammation, oxidative stress and the occurrence of changes in microheterogeneity of TTR. A prospective, observational study at a level-I trauma center of a large urban medical university was performed. Patients were severely injured (n = 18; injury severity score (ISS): 34–66), and were observed within the first 24 hours of admittance and over the following days until day 20 after injury. 20 healthy subjects, matched by age and sex, were used as controls. TTR was enriched by immunoprecipitation. Microheterogeneity of TTR was determined by linear matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS). Four major mass signals were observed for TTR representing native, S-cysteinylated, S-cysteinglycinylated and S-glutathionylated TTR. In the course of their ICU stay, 14 of the 18 patients showed a transient change in microheterogeneity in favour of the S-cysteinglycinylated form of TTR (p < 0.05 vs. controls). The occurrence of this variant was not associated with the severity of trauma or the intensity of the acute-phase response, but was associated with oxidative stress as evidenced by Trolox. Our results demonstrate that changes in microheterogeneity of TTR occur in a substantial number of ICU trauma patients. The diagnostic values of these changes remains to be elucidated. It is speculated that TTR modification may well be the mechanism underlying the morphological manifestation of amyloidose or Alzheimer's diseases in patients surviving multiple trauma.
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Affiliation(s)
- Beate Gericke
- Department of Physiology and Pathophysiology, Institute of Nutritional Science, University of Potsdam
| | - Jens Raila
- Department of Physiology and Pathophysiology, Institute of Nutritional Science, University of Potsdam
| | - Maria Deja
- Department of Anaesthesiology and Intensive Care Medicine, Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin
| | - Sascha Rohn
- Department of Food Analysis, Institute of Food Technology and Food Chemistry, Technical University of Berlin
| | - Bernd Donaubauer
- Department of Anaesthesiology and Intensive Care Medicine, Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin
| | - Britta Nagl
- Department of Physiology and Pathophysiology, Institute of Nutritional Science, University of Potsdam
| | - Sophie Haebel
- Interdisciplinary Center for Mass Spectrometry of Biopolymers, University of Potsdam
| | - Florian J. Schweigert
- Department of Physiology and Pathophysiology, Institute of Nutritional Science, University of Potsdam
| | - Udo Kaisers
- Department of Anaesthesiology and Intensive Care Medicine, Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin
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Tafelski S, Wagner L, Angermair S, Deja M. Therapeutic drug monitoring for colistin therapy in severe multi-resistant Acinetobacter intracerebral abscess: A single case study with high-dose colistin and review of literature. SAGE Open Med Case Rep 2017; 5:2050313X17711630. [PMID: 28680633 PMCID: PMC5480626 DOI: 10.1177/2050313x17711630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 09/09/2016] [Accepted: 05/02/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives: Intracranial infections due to multidrug- resistant (MDR) gram-negative pathogens are associated with increased morbidity and mortality. As therapeutic options are limited and systemic drug penetration into the infection focus is difficult, intraventricular therapy has been described. Methods: We report on a patient with intracranial abscess caused by MDR Acinetobacter baumannii. Results: He was treated with high doses of intravenous and intraventricular colistin resulting in microbiological clearance and clinical cure. Therapy was controlled by therapeutic drug monitoring (TDM) of serum and liquor colistin levels. About 100 cases with intraventricular or intrathecal colistin are reported in literature but data on TDM are sparse. Conclusions: This is one of the first cases providing data on TDM for locally administered high dose colistin therapy for the treatment of intracranial abscess formations. Based on these findings, increasing the intraventricular application interval paralleled with intravenous colistin could possibly be sufficient to achieve appropriate therapeutic drug levels. Further studies are needed to support alternative dosing strategies in similar cases.
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Affiliation(s)
| | - Lukas Wagner
- Charité Virchow Klinikum and Campus Mitte, Berlin, Germany
| | | | - Maria Deja
- Charité Virchow Klinikum and Campus Mitte, Berlin, Germany
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17
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Salm F, Deja M, Gastmeier P, Kola A, Hansen S, Behnke M, Gruhl D, Leistner R. Prolonged outbreak of clonal MDR Pseudomonas aeruginosa on an intensive care unit: contaminated sinks and contamination of ultra-filtrate bags as possible route of transmission? Antimicrob Resist Infect Control 2016; 5:53. [PMID: 27980730 PMCID: PMC5139016 DOI: 10.1186/s13756-016-0157-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 10/13/2016] [Accepted: 11/29/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We report on an outbreak in a surgical, interdisciplinary intensive care unit (ICU) of a tertiary care hospital. We detected a cluster of ICU patients colonized or infected with multidrug-resistant Pseudomonas aeruginosa. We established an outbreak investigation team, performed an exploratory epidemiological analysis and initiated an epidemiology-based intervention. METHODS As part of the outbreak investigation, we performed microbiological examinations of the sinks in the patient rooms and a retrospective case-control study. All patients admitted to the outbreak ICU between January 2012 and February 2014 were included. Cases were patients colonized with the outbreak strain. Controls were patients with a different Pseudomonas aeruginosa strain. Risk factors were evaluated using multivariable conditional logistic regression analysis. Strain typing was performed using the repetitive element-based polymerase chain reaction (rep-PCR) DiversiLab system. RESULTS The outbreak strain was found in the sinks of five (of 16) patient rooms. Altogether 21 cases and 21 (randomly selected) controls were included. In the univariate analysis, there was no significant difference in baseline data of the patients. In the multivariate analysis, stay in a room with a colonized sink (Odds Ratio[OR] 11.2, p = 0.007) and hemofiltration (OR 21.9, p = 0.020) were independently associated with an elevated risk for colonization or infection by the outbreak strain. In a subsequent evaluation of the work procedures associated with hemofiltration, we found that the ultra-filtrate bags had been on average five times per day emptied in the sinks of the patient rooms and were used multiple for the same patient. We exchanged the traps of the contaminated sinks and eliminated work procedures involving sinks in patient rooms by implementation of single use bags, which are emptied outside patient rooms to reduce splash water at the sinks. In the 20 month follow-up period, the outbreak strain was detected only once, which indicated that the outbreak had been ceased (incidence 0.75% vs. 0.04%, p < 0.001) Furthermore, the incidence of Pseudonomas aeruginosa overall was significantly decreased (2.5% vs. 1.5%, p < 0.001). CONCLUSION In ICUs, limiting work processes involving sinks results in reduced multidrug-resistant Pseudomonas aeruginosa rates. ICUs with high rates of Pseudomonas aeruginosa should consider eliminating work processes that involve sinks and potentially splash water in close proximity to patients. TRIAL REGISTRATION All data were surveillance based data which were obtained within the German Law on Protection against Infection ("Infektionsschutzgesetz"). Therefore a trial registration was not required.
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Affiliation(s)
- Florian Salm
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Maria Deja
- Department of Anesthesiology and Intensive Care, Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Axel Kola
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Sonja Hansen
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Michael Behnke
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Désirée Gruhl
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
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18
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Balzer F, Menk M, Ziegler J, Pille C, Wernecke KD, Spies C, Schmidt M, Weber-Carstens S, Deja M. Predictors of survival in critically ill patients with acute respiratory distress syndrome (ARDS): an observational study. BMC Anesthesiol 2016; 16:108. [PMID: 27821065 PMCID: PMC5100178 DOI: 10.1186/s12871-016-0272-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 10/20/2015] [Accepted: 10/14/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Currently there is no ARDS definition or classification system that allows optimal prediction of mortality in ARDS patients. This study aimed to examine the predictive values of the AECC and Berlin definitions, as well as clinical and respiratory parameters obtained at onset of ARDS and in the course of the first seven consecutive days. METHODS The observational study was conducted at a 14-bed intensive care unit specialized on treatment of ARDS. Predictive validity of the AECC and Berlin definitions as well as PaO2/FiO2 and FiO2/PaO2*Pmean (oxygenation index) on mortality of ARDS patients was assessed and statistically compared. RESULTS Four hundred forty two critically-ill patients admitted for ARDS were analysed. Multivariate Cox regression indicated that the oxygenation index was the most accurate parameter for mortality prediction. The third day after ARDS criteria were met at our hospital was found to represent the best compromise between earliness and accuracy of prognosis of mortality regarding the time of assessment. An oxygenation index of 15 or greater was associated with higher mortality, longer length of stay in ICU and hospital and longer duration of mechanical ventilation. In addition, non-survivors had a significantly longer length of stay and duration of mechanical ventilation in referring hospitals before admitted to the national reference centre than survivors. CONCLUSIONS The oxygenation index is suggested to be the most suitable parameter to predict mortality in ARDS, preferably assessed on day 3 after admission to a specialized centre. Patients might benefit when transferred to specialized ICU centres as soon as possible for further treatment.
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Affiliation(s)
- Felix Balzer
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum / Campus Charité Mitte, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - Mario Menk
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum / Campus Charité Mitte, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - Jannis Ziegler
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Christian Pille
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum / Campus Charité Mitte, Augustenburger Platz 1, D-13353, Berlin, Germany
| | | | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum / Campus Charité Mitte, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - Maren Schmidt
- Department of Anaesthesiology and Intensive Care Medicine, Werner Forßmann Krankenhaus, 16225, Eberswalde, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum / Campus Charité Mitte, Augustenburger Platz 1, D-13353, Berlin, Germany.
| | - Maria Deja
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum / Campus Charité Mitte, Augustenburger Platz 1, D-13353, Berlin, Germany. .,Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
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Sakellariou C, Gürntke S, Steinmetz I, Kohler C, Pfeifer Y, Gastmeier P, Schwab F, Kola A, Deja M, Leistner R. Sepsis Caused by Extended-Spectrum Beta-Lactamase (ESBL)-Positive K. pneumoniae and E. coli: Comparison of Severity of Sepsis, Delay of Anti-Infective Therapy and ESBL Genotype. PLoS One 2016; 11:e0158039. [PMID: 27442425 PMCID: PMC4956035 DOI: 10.1371/journal.pone.0158039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/09/2016] [Indexed: 12/22/2022] Open
Abstract
Infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are associated with increased mortality. Outcome differences due to various species of ESBL-E or ESBL genotypes are not well investigated. We conducted a cohort study to assess risk factors for mortality in cases of ESBL-E bacteremia (K. pneumoniae or E. coli) and the risk factors for sepsis with organ failure. All consecutive patients of our institution from 2008 to 2011 with bacteremia due to ESBL-E were included. Basic epidemiological data, underlying comorbidities, origin of bacteremia, severity of sepsis and delay of appropriate anti-infective treatment were collected. Isolates were PCR-screened for the presence of ESBL genes and plasmid-mediated AmpC β-lactamases. Cox proportional hazard regression on mortality and multivariable logistic regression on risk factors for sepsis with organ failure was conducted. 219 cases were included in the analysis: 73.1% due to E. coli, 26.9% due to K. pneumoniae. There was no significant difference in hospital mortality (ESBL-E. coli, 23.8% vs. ESBL-K. pneumoniae 27.1%, p = 0.724). However, the risk of sepsis with organ failure was associated in cases of K. pneumoniae bacteremia (OR 4.5, p<0.001) and patients with liver disease (OR 3.4, p = 0.004) or renal disease (OR 6.8, p<0.001). We found significant differences in clinical presentation of ESBL-E bacteremia due to K. pneumoniae compared to E. coli. As K. pneumoniae cases showed a more serious clinical presentation as E. coli cases and were associated with different risk factors, treatment and prevention strategies should be adjusted accordingly.
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Affiliation(s)
- Christian Sakellariou
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Stephan Gürntke
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Ivo Steinmetz
- Friedrich Loffler Institute of Medical Microbiology, Universitaetsmedizin Greifswald, Martin-Luther-Str.6, 17475, Greifswald, Germany
| | - Christian Kohler
- Friedrich Loffler Institute of Medical Microbiology, Universitaetsmedizin Greifswald, Martin-Luther-Str.6, 17475, Greifswald, Germany
| | - Yvonne Pfeifer
- Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, 38855, Wernigerode, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Axel Kola
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Maria Deja
- Department of Anesthesiology and Intensive Care, Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
- * E-mail:
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20
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Schwarz C, Bernuth HV, Rolinck-Werninghaus C, Röhmel JF, Lau S, Becker M, Deja M, Staab D. Krankheitsentitäten und mikrobiologische Ergebnisse von 423 Patienten mit non-CF Bronchiektasen – Target für neue Diagnostik und Therapien? Pneumologie 2016. [DOI: 10.1055/s-0036-1572250] [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: 10/22/2022]
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Deja M. Lärm- und Lichtauswirkungen auf IST. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563239] [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: 10/23/2022]
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22
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Tafelski S, Nachtigall I, Adam T, Bereswill S, Faust J, Tamarkin A, Trefzer T, Deja M, Idelevich EA, Wernecke KD, Becker K, Spies C. Randomized controlled clinical trial evaluating multiplex polymerase chain reaction for pathogen identification and therapy adaptation in critical care patients with pulmonary or abdominal sepsis. J Int Med Res 2015; 43:364-77. [PMID: 25911587 DOI: 10.1177/0300060514561135] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/29/2014] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To determine whether a multiplex polymerase chain reaction (PCR)-based test could reduce the time required for initial pathogen identification in patients in an intensive care unit (ICU) setting. METHODS This double-blind, parallel-group randomized controlled trial** enrolled adults with suspected pulmonary or abdominal sepsis caused by an unknown pathogen. Both the intervention and control groups underwent the standard blood culture (BC) testing, but additional pathogen identification, based on the results of a LightCycler® SeptiFast PCR test, were provided in the intervention group. RESULTS The study enrolled 37 patients in the control group and 41 in the intervention group. Baseline clinical and demographic characteristics were similar in both groups. The PCR-based test identified a pathogen in 10 out of 41 (24.4%) patients in the intervention group, with a mean duration from sampling to providing the information to the ICU of 15.9 h. In the control group, BC results were available after a significantly longer period (38.1 h). CONCLUSION The LightCycler® SeptiFast PCR test demonstrated a significant reduction in the time required for initial pathogen identification, compared with standard BC.
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Affiliation(s)
- Sascha Tafelski
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Irit Nachtigall
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Thomas Adam
- Institute for Microbiology and Hygiene Berlin, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Stefan Bereswill
- Institute for Microbiology and Hygiene Berlin, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Jana Faust
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Andrey Tamarkin
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Tanja Trefzer
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Maria Deja
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Evgeny A Idelevich
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Klaus-Dieter Wernecke
- Institute of Medical Biometry, Charité-Universitaetsmedizin Berlin, Berlin, Germany SOSTANA GmbH, Berlin, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Tafelski S, Nachtigall I, Troeger U, Deja M, Krannich A, Günzel K, Spies C. Observational clinical study on the effects of different dosing regimens on vancomycin target levels in critically ill patients: Continuous versus intermittent application. J Infect Public Health 2015; 8:355-63. [PMID: 25794497 DOI: 10.1016/j.jiph.2015.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 01/13/2015] [Accepted: 01/23/2015] [Indexed: 12/29/2022] Open
Abstract
Different dosing regimens for vancomycin are in clinical use: intermittent infusion and continuous administration. The intention of using these different dosing regimens is to reduce toxicity, to achieve target levels faster and to avoid treatment failure. The aim of this phase IV study was to compare safety and effectiveness in both administration regimens. The study was conducted in 2010 and 2011 in three postoperative intensive care units (ICUs) in a tertiary care university hospital in Berlin, Germany. Adult patients with vancomycin therapy and therapeutic drug monitoring were included. Out of 675 patients screened, 125 received vancomycin therapy, 39% with intermittent and 61% with continuous administration. Patients with continuous administration achieved target serum levels significantly earlier (median day 3 versus 4, p=0.022) and showed fewer sub-therapeutic serum levels (41% versus 11%, p<0.001). ICU mortality rate, duration of ICU stay and duration of ventilation did not differ between groups. Acute renal failure during the ICU stay occurred in 35% of patients with intermittent infusion versus 26% of patients with continuous application (p=0.324). In conclusion, continuous administration of vancomycin allowed more rapid achievement of targeted drug levels with fewer sub-therapeutic vancomycin levels observed. This might indicate that patients with more severe infections or higher variability in renal function could benefit from this form of administration.
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Affiliation(s)
- S Tafelski
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - I Nachtigall
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Uwe Troeger
- Institute for Clinical Pharmacology, Otto-von-Guericke-Universität, Magdeburg, Germany
| | - Maria Deja
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Alexander Krannich
- Department of Biostatistics, Coordination Center for Clinical Trials, Charité - Universitätsmedizin Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Charité - Universitaetsmedizin Berlin, Campus Benjamin-Franklin, Berlin, Germany
| | - C Spies
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany.
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Nachtigall I, Tafelski S, Deja M, Halle E, Grebe MC, Tamarkin A, Rothbart A, Uhrig A, Meyer E, Musial-Bright L, Wernecke KD, Spies C. Long-term effect of computer-assisted decision support for antibiotic treatment in critically ill patients: a prospective 'before/after' cohort study. BMJ Open 2014; 4:e005370. [PMID: 25534209 PMCID: PMC4275685 DOI: 10.1136/bmjopen-2014-005370] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Antibiotic resistance has risen dramatically over the past years. For individual patients, adequate initial antibiotic therapy is essential for clinical outcome. Computer-assisted decision support systems (CDSSs) are advocated to support implementation of rational anti-infective treatment strategies based on guidelines. The aim of this study was to evaluate long-term effects after implementation of a CDSS. DESIGN This prospective 'before/after' cohort study was conducted over four observation periods within 5 years. One preinterventional period (pre) was compared with three postinterventional periods: directly after intensive implementation efforts (post1), 2 years (post2) and 3 years (post3) after implementation. SETTING Five anaesthesiological-managed intensive care units (ICU) (one cardiosurgical, one neurosurgical, two interdisciplinary and one intermediate care) at a university hospital. PARTICIPANTS Adult patients with an ICU stay of >48 h were included in the analysis. 1316 patients were included in the analysis for a total of 12,965 ICU days. INTERVENTION Implementation of a CDSS. OUTCOME MEASURES The primary end point was percentage of days with guideline adherence during ICU treatment. Secondary end points were antibiotic-free days and all-cause mortality compared for patients with low versus high guideline adherence. MAIN RESULTS Adherence to guidelines increased from 61% prior to implementation to 92% in post1, decreased in post2 to 76% and remained significantly higher compared with baseline in post3, with 71% (p=0.178). Additionally, antibiotic-free days increased over study periods. At all time periods, mortality for patients with low guideline adherence was higher with 12.3% versus 8% (p=0.014) and an adjusted OR of 1.56 (95% CI 1.05 to 2.31). CONCLUSIONS Implementation of computerised regional adapted guidelines for antibiotic therapy is paralleled with improved adherence. Even without further measures, adherence stayed high for a longer period and was paralleled by reduced antibiotic exposure. Improved guideline adherence was associated with reduced ICU mortality. TRIAL REGISTRATION NUMBER ISRCTN54598675.
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Affiliation(s)
- I Nachtigall
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - S Tafelski
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - M Deja
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - E Halle
- Charité-Universitaetsmedizin Berlin, Institute for Microbiology and Hygiene, Berlin, Germany
| | - M C Grebe
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - A Tamarkin
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - A Rothbart
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - A Uhrig
- Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - E Meyer
- Charité Universitaetsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - L Musial-Bright
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - K D Wernecke
- Charité-Universitaetsmedizin Berlin, Institute of Medical Biometrics, and SOSTANA GmbH, Berlin, Germany
| | - C Spies
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Koch S, Wollersheim T, Spies CD, Deja M, Weber-Carstens S. Reply: To PMID 24415656. Muscle Nerve 2014; 51:625-6. [PMID: 25516159 DOI: 10.1002/mus.24535] [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] [Received: 11/18/2014] [Revised: 11/25/2014] [Accepted: 11/29/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Susanne Koch
- Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Kumpf O, Bloos F, Bause H, Brinkmann A, Deja M, Marx G, Kaltwasser A, Dubb R, Muhl E, Greim CA, Weiler N, Chop I, Jonitz G, Schaefer H, Felsenstein M, Liebeskind U, Leffmann C, Jungbluth A, Waydhas C, Pronovost P, Spies C, Braun JP. Voluntary peer review as innovative tool for quality improvement in the intensive care unit--a retrospective descriptive cohort study in German intensive care units. Ger Med Sci 2014; 12:Doc17. [PMID: 25587245 PMCID: PMC4270273 DOI: 10.3205/000202] [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] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/25/2014] [Indexed: 01/06/2023]
Abstract
Introduction: Quality improvement and safety in intensive care are rapidly evolving topics. However, there is no gold standard for assessing quality improvement in intensive care medicine yet. In 2007 a pilot project in German intensive care units (ICUs) started using voluntary peer reviews as an innovative tool for quality assessment and improvement. We describe the method of voluntary peer review and assessed its feasibility by evaluating anonymized peer review reports and analysed the thematic clusters highlighted in these reports. Methods: Retrospective data analysis from 22 anonymous reports of peer reviews. All ICUs – representing over 300 patient beds – had undergone voluntary peer review. Data were retrieved from reports of peers of the review teams and representatives of visited ICUs. Data were analysed with regard to number of topics addressed and results of assessment questionnaires. Reports of strengths, weaknesses, opportunities and threats (SWOT reports) of these ICUs are presented. Results: External assessment of structure, process and outcome indicators revealed high percentages of adherence to predefined quality goals. In the SWOT reports 11 main thematic clusters were identified representative for common ICUs. 58.1% of mentioned topics covered personnel issues, team and communication issues as well as organisation and treatment standards. The most mentioned weaknesses were observed in the issues documentation/reporting, hygiene and ethics. We identified several unique patterns regarding quality in the ICU of which long-term personnel problems und lack of good reporting methods were most interesting Conclusion: Voluntary peer review could be established as a feasible and valuable tool for quality improvement. Peer reports addressed common areas of interest in intensive care medicine in more detail compared to other methods like measurement of quality indicators.
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Affiliation(s)
- Oliver Kumpf
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Bloos
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Hanswerner Bause
- Quality Committee of the State Chamber of Physicians, Hamburg, Germany
| | - Alexander Brinkmann
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Heidenheim, Heidenheim, Germany
| | - Maria Deja
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine, Universitätsklinikum RWTH Aachen, Aachen, Germany
| | | | - Rolf Dubb
- Kreiskliniken Reutlingen GmbH, Reutlingen, Germany
| | - Elke Muhl
- Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Clemens-A Greim
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Fulda, Fulda, Germany
| | - Norbert Weiler
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ines Chop
- German Medical Association, Berlin, Germany
| | - Günther Jonitz
- German Medical Association, Berlin, Germany ; State Chamber of Physicians Berlin, Berlin, Germany
| | | | | | | | - Carsten Leffmann
- State Chamber of Physicians Schleswig-Holstein, Bad Segeberg, Germany
| | | | | | - Peter Pronovost
- The Johns Hopkins University School of Medicine, Departments of Anesthesiology/Critical Care Medicine and Surgery, Baltimore, Maryland, United States
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan-Peter Braun
- Department of Anaesthesiology and Intensive Care Medicine, Helios Klinikum Hildesheim, Hildesheim, Germany
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Koch S, Wollersheim T, Bierbrauer J, Haas K, Mörgeli R, Deja M, Spies CD, Spuler S, Krebs M, Weber-Carstens S. Long-term recovery In critical illness myopathy is complete, contrary to polyneuropathy. Muscle Nerve 2014; 50:431-6. [PMID: 24415656 DOI: 10.1002/mus.24175] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 12/10/2013] [Accepted: 01/08/2014] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Muscle weakness in critically ill patients after discharge varies. It is not known whether the electrophysiological distinction between critical illness myopathy (CIM) and critical illness polyneuropathy (CIP) during the early part of a patient's stay in the intensive care unit (ICU) predicts long-term prognosis. METHODS This was a prospective cohort study of mechanically ventilated ICU patients undergoing conventional nerve conduction studies and direct muscle stimulation in addition to neurological examination during their ICU stay and 1 year after ICU discharge. RESULTS Twenty-six patients (7 ICU controls, 8 CIM patients, and 11 CIM/CIP patients) were evaluated 1 year after discharge from the ICU. Eighty-eight percent (n = 7) of CIM patients recovered within 1 year compared with 55% (n = 6) of CIM/CIP patients. Thirty-six percent (n = 4) of CIM/CIP patients still needed assistance during their daily routine (P = 0.005). CONCLUSIONS Early electrophysiological testing predicts long-term outcome in ICU survivors. CIM has a significantly better prognosis than CIM/CIP.
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Affiliation(s)
- Susanne Koch
- Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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28
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Töpfer L, Menk M, Weber-Carstens S, Spies C, Wernecke KD, Uhrig A, Lojewski C, Jörres A, Deja M. Influenza A (H1N1) vs non-H1N1 ARDS: analysis of clinical course. J Crit Care 2013; 29:340-6. [PMID: 24508203 DOI: 10.1016/j.jcrc.2013.12.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 08/07/2013] [Revised: 12/17/2013] [Accepted: 12/21/2013] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of the study is to compare H1N1-induced acute respiratory distress syndrome (ARDS) with ARDS due to other causes of severe community-acquired pneumonia focusing on pulmonary function. MATERIALS AND METHODS This is a retrospective data analysis of adult ARDS patients between January 2009 and December 2010 in an ARDS referral center. Patient characteristics, severity of illness scores, modalities, and duration of extracorporeal lung support were evaluated as well as intensive care unit stay and survival. Parameters of mechanical ventilation and pulmonary function were analyzed on day of admission and over the consecutive 10 days using a nonparametric analysis of longitudinal data in a 2-factorial design. In a logistic regression analysis, risk factors for extracorporeal lung support were investigated. RESULTS Twenty-one patients with H1N1-ARDS and 41 with non-H1N1-ARDS were identified. Gas exchange was more severely impaired in patients with H1N1-ARDS over course of time. Extracorporeal membrane oxygenation was more frequently needed in H1N1-ARDS. Despite significantly prolonged weaning off extracorporeal lung support and intensive care unit stay in H1N1 patients, the proportion of survivors did not differ significantly. Only Sepsis-Related Organ Failure Assessment score could be identified as an independent predictor of extracorporeal lung support. CONCLUSIONS Clinical course of H1N1-ARDS is substantially different from non-H1N1-ARDS. Affected patients may require extensive therapy including extracorporeal lung support in ARDS referral centers.
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Affiliation(s)
- Lars Töpfer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Mario Menk
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | | | - Alexander Uhrig
- Department of Infectious Diseases and Pulmonary Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, D-10117 Berlin, Germany
| | - Christian Lojewski
- Department of General, Visceral, and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Achim Jörres
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Maria Deja
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany.
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Caiani E, Pellegrini A, Carminati M, Lang R, Auricchio A, Vaida P, Obase K, Sakakura T, Komeda M, Okura H, Yoshida K, Zeppellini R, Noni M, Rigo T, Erente G, Carasi M, Costa A, Ramondo B, Thorell L, Akesson-Lindow T, Shahgaldi K, Germanakis I, Fotaki A, Peppes S, Sifakis S, Parthenakis F, Makrigiannakis A, Richter U, Sveric K, Forkmann M, Wunderlich C, Strasser R, Djikic D, Potpara T, Polovina M, Marcetic Z, Peric V, Ostenfeld E, Werther-Evaldsson A, Engblom H, Ingvarsson A, Roijer A, Meurling C, Holm J, Radegran G, Carlsson M, Tabuchi H, Yamanaka T, Katahira Y, Tanaka M, Kurokawa T, Nakajima H, Ohtsuki S, Saijo Y, Yambe T, D'alto M, Romeo E, Argiento P, D'andrea A, Vanderpool R, Correra A, Sarubbi B, Calabro' R, Russo M, Naeije R, Saha SK, Warsame TA, Caelian AG, Malicse M, Kiotsekoglou A, Omran AS, Sharif D, Sharif-Rasslan A, Shahla C, Khalil A, Rosenschein U, Erturk M, Oner E, Kalkan A, Pusuroglu H, Ozyilmaz S, Akgul O, Aksu H, Akturk F, Celik O, Uslu N, Bandera F, Pellegrino M, Generati G, Donghi V, Alfonzetti E, Guazzi M, Rangel I, Goncalves A, Sousa C, Correia A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Lee S, Kim W, Yun H, Jung L, Kim E, Ko J, Enescu O, Florescu M, Rimbas R, Cinteza M, Vinereanu D, Kosmala W, Rojek A, Cielecka-Prynda M, Laczmanski L, Mysiak A, Przewlocka-Kosmala M, Liu D, Hu K, Niemann M, Herrmann S, Cikes M, Gaudron P, Knop S, Ertl G, Bijnens B, Weidemann F, Saravi M, Tamadoni A, Jalalian R, Hojati M, Ramezani S, Yildiz A, Inci U, Bilik M, Yuksel M, Oyumlu M, Kayan F, Ozaydogdu N, Aydin M, Akil M, Tekbas E, Shang Q, Zhang Q, Fang F, Wang S, Li R, Lee AP, Yu C, Mornos C, Ionac A, Cozma D, Popescu I, Ionescu G, Dan R, Petrescu L, Sawant A, Srivatsa S, Adhikari P, Mills P, Srivatsa S, Boshchenko A, Vrublevsky A, Karpov R, Trifunovic D, Stankovic S, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Banovic M, Tesic M, Petrovic M, Dragovic M, Ostojic M, Zencirci E, Esen Zencirci A, Degirmencioglu A, Karakus G, Ekmekci A, Erdem A, Ozden K, Erer H, Akyol A, Eren M, Zamfir D, Tautu O, Onciul S, Marinescu C, Onut R, Comanescu I, Oprescu N, Iancovici S, Dorobantu M, Melao F, Pereira M, Ribeiro V, Oliveira S, Araujo C, Subirana I, Marrugat J, Dias P, Azevedo A, Grillo MT, Piamonti B, Abate E, Porto A, Dell'angela L, Gatti G, Poletti A, Pappalardo A, Sinagra G, Pinto-Teixeira P, Galrinho A, Branco L, Fiarresga A, Sousa L, Cacela D, Portugal G, Rio P, Abreu J, Ferreira R, Fadel B, Abdullah N, Al-Admawi M, Pergola V, Bech-Hanssen O, Di Salvo G, Tigen MK, Pala S, Karaahmet T, Dundar C, Bulut M, Izgi A, Esen AM, Kirma C, Boerlage-Van Dijk K, Yamawaki M, Wiegerinck E, Meregalli P, Bindraban N, Vis M, Koch K, Piek J, Bouma B, Baan J, Mizia M, Sikora-Puz A, Gieszczyk-Strozik K, Lasota B, Chmiel A, Chudek J, Jasinski M, Deja M, Mizia-Stec K, Silva Fazendas Adame PR, Caldeira D, Stuart B, Almeida S, Cruz I, Ferreira A, Lopes L, Joao I, Cotrim C, Pereira H, Unger P, Dedobbeleer C, Stoupel E, Preumont N, Argacha J, Berkenboom G, Van Camp G, Malev E, Reeva S, Vasina L, Pshepiy A, Korshunova A, Timofeev E, Zemtsovsky E, Jorgensen PG, Jensen J, Fritz-Hansen T, Biering-Sorensen T, Jons C, Olsen N, Henri C, Magne J, Dulgheru R, Laaraibi S, Voilliot D, Kou S, Pierard L, Lancellotti P, Tayyareci Y, Dworakowski R, Kogoj P, Reiken J, Kenny C, Maccarthy P, Wendler O, Monaghan M, Song J, Ha T, Jung Y, Seo M, Choi S, Kim Y, Sun B, Kim D, Kang D, Song J, Le Tourneau T, Topilsky Y, Inamo J, Mahoney D, Suri R, Schaff H, Enriquez-Sarano M, Bonaque Gonzalez J, Sanchez Espino A, Merchan Ortega G, Bolivar Herrera N, Ikuta I, Macancela Quinonez J, Munoz Troyano S, Ferrer Lopez R, Gomez Recio M, Dreyfus J, Cimadevilla C, Brochet E, Himbert D, Iung B, Vahanian A, Messika-Zeitoun D, Izumo M, Takeuchi M, Seo Y, Yamashita E, Suzuki K, Ishizu T, Sato K, Aonuma K, Otsuji Y, Akashi Y, Muraru D, Addetia K, Veronesi F, Corsi C, Mor-Avi V, Yamat M, Weinert L, Lang R, Badano L, Minamisawa M, Koyama J, Kozuka A, Motoki H, Izawa A, Tomita T, Miyashita Y, Ikeda U, Florescu C, Niemann M, Liu D, Hu K, Herrmann S, Gaudron P, Scholz F, Stoerk S, Ertl G, Weidemann F, Marchel M, Serafin A, Kochanowski J, Piatkowski R, Madej-Pilarczyk A, Filipiak K, Hausmanowa-Petrusewicz I, Opolski G, Meimoun P, M'barek D, Clerc J, Neikova A, Elmkies F, Tzvetkov B, Luycx-Bore A, Cardoso C, Zemir H, Mansencal N, Arslan M, El Mahmoud R, Pilliere R, Dubourg O, Ikonomidis I, Lambadiari V, Pavlidis G, Koukoulis C, Kousathana F, Varoudi M, Tritakis V, Triantafyllidi H, Dimitriadis G, Lekakis I, Kovacs A, Kosztin A, Solymossy K, Celeng C, Apor A, Faludi M, Berta K, Szeplaki G, Foldes G, Merkely B, Kimura K, Daimon M, Nakajima T, Motoyoshi Y, Komori T, Nakao T, Kawata T, Uno K, Takenaka K, Komuro I, Gabric ID, Vazdar L, Pintaric H, Planinc D, Vinter O, Trbusic M, Bulj N, Nobre Menezes M, Silva Marques J, Magalhaes R, Carvalho V, Costa P, Brito D, Almeida A, Nunes-Diogo A, Davidsen ES, Bergerot C, Ernande L, Barthelet M, Thivolet S, Decker-Bellaton A, Altman M, Thibault H, Moulin P, Derumeaux G, Huttin O, Voilliot D, Frikha Z, Aliot E, Venner C, Juilliere Y, Selton-Suty C, Yamada T, Ooshima M, Hayashi H, Okabe S, Johno H, Murata H, Charalampopoulos A, Tzoulaki I, Howard L, Davies R, Gin-Sing W, Grapsa J, Wilkins M, Gibbs J, Castillo J, Bandeira A, Albuquerque E, Silveira C, Pyankov V, Chuyasova Y, Lichodziejewska B, Goliszek S, Kurnicka K, Dzikowska Diduch O, Kostrubiec M, Krupa M, Grudzka K, Ciurzynski M, Palczewski P, Pruszczyk P, Arana X, Oria G, Onaindia J, Rodriguez I, Velasco S, Cacicedo A, Palomar S, Subinas A, Zumalde J, Laraudogoitia E, Saeed S, Kokorina M, Fromm A, Oeygarden H, Waje-Andreassen U, Gerdts E, Gomez E, Vallejo N, Pedro-Botet L, Mateu L, Nunyez R, Llobera L, Bayes A, Sabria M, Antonini-Canterin F, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Antonini-Canterin F, Pudil R, Praus R, Vasatova M, Vojacek J, Palicka V, Hulek P, Pradel S, Mohty D, Damy T, Echahidi N, Lavergne D, Virot P, Aboyans V, Jaccard A, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Antonini-Canterin F, Doulaptsis C, Symons R, Matos A, Florian A, Masci P, Dymarkowski S, Janssens S, Bogaert J, Lestuzzi C, Moreo A, Celik S, Lafaras C, Dequanter D, Tomkowski W, De Biasio M, Cervesato E, Massa L, Imazio M, Watanabe N, Kijima Y, Akagi T, Toh N, Oe H, Nakagawa K, Tanabe Y, Ikeda M, Okada K, Ito H, Milanesi O, Biffanti R, Varotto E, Cerutti A, Reffo E, Castaldi B, Maschietto N, Vida V, Padalino M, Stellin G, Bejiqi R, Retkoceri R, Bejiqi H, Retkoceri A, Surdulli S, Massoure P, Cautela J, Roche N, Chenilleau M, Gil J, Fourcade L, Akhundova A, Cincin A, Sunbul M, Sari I, Tigen M, Basaran Y, Suermeci G, Butz T, Schilling I, Sasko B, Liebeton J, Van Bracht M, Tzikas S, Prull M, Wennemann R, Trappe H, Attenhofer Jost CH, Pfyffer M, Scharf C, Seifert B, Faeh-Gunz A, Naegeli B, Candinas R, Medeiros-Domingo A, Wierzbowska-Drabik K, Roszczyk N, Sobczak M, Plewka M, Krecki R, Kasprzak J, Ikonomidis I, Varoudi M, Papadavid E, Theodoropoulos K, Papadakis I, Pavlidis G, Triantafyllidi H, Anastasiou - Nana M, Rigopoulos D, Lekakis J, Tereshina O, Surkova E, Vachev A, Merchan Ortega G, Bonaque Gonzalez J, Sanchez Espino A, Bolivar Herrera N, Bravo Bustos D, Ikuta I, Aguado Martin M, Navarro Garcia F, Ruiz Lopez F, Gomez Recio M, Merchan Ortega G, Bonaque Gonzalez J, Bravo Bustos D, Sanchez Espino A, Bolivar Herrera N, Bonaque Gonzalez J, Navarro Garcia F, Aguado Martin M, Ruiz Lopez M, Gomez Recio M, Eguchi H, Maruo T, Endo K, Nakamura K, Yokota K, Fuku Y, Yamamoto H, Komiya T, Kadota K, Mitsudo K, Nagy AI, Manouras A, Gunyeli E, Shahgaldi K, Winter R, Hoffmann R, Barletta G, Von Bardeleben S, Kasprzak J, Greis C, Vanoverschelde J, Becher H, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Gaudron P, Knop S, Ertl G, Bijnens B, Weidemann F, Di Salvo G, Al Bulbul Z, Issa Z, Khan A, Faiz A, Rahmatullah S, Fadel B, Siblini G, Al Fayyadh M, Menting ME, Van Den Bosch A, Mcghie J, Cuypers J, Witsenburg M, Van Dalen B, Geleijnse M, Roos-Hesselink J, Olsen F, Jorgensen P, Mogelvang R, Jensen J, Fritz-Hansen T, Bech J, Biering-Sorensen T, Agoston G, Pap R, Saghy L, Forster T, Varga A, Scandura S, Capodanno D, Dipasqua F, Mangiafico S, Caggegi AM, Grasso C, Pistritto AM, Imme' S, Ministeri M, Tamburino C, Cameli M, Lisi M, D'ascenzi F, Cameli P, Losito M, Sparla S, Lunghetti S, Favilli R, Fineschi M, Mondillo S, Ojaghihaghighi Z, Javani B, Haghjoo M, Moladoust H, Shahrzad S, Ghadrdoust B, Altman M, Aussoleil A, Bergerot C, Bonnefoy-Cudraz E, Derumeaux GA, Thibault H, Shkolnik E, Vasyuk Y, Nesvetov V, Shkolnik L, Varlan G, Gronkova N, Kinova E, Borizanova A, Goudev A, Saracoglu E, Ural D, Sahin T, Al N, Cakmak H, Akbulut T, Akay K, Ural E, Mushtaq S, Andreini D, Pontone G, Bertella E, Conte E, Baggiano A, Annoni A, Formenti A, Fiorentini C, Pepi M, Cosgrove C, Carr L, Chao C, Dahiya A, Prasad S, Younger J, Biering-Sorensen T, Christensen L, Krieger D, Mogelvang R, Jensen J, Hojberg S, Host N, Karlsen F, Christensen H, Medressova A, Abikeyeva L, Dzhetybayeva S, Andossova S, Kuatbayev Y, Bekbossynova M, Bekbossynov S, Pya Y, Farsalinos K, Tsiapras D, Kyrzopoulos S, Spyrou A, Stefopoulos C, Romagna G, Tsimopoulou K, Tsakalou M, Voudris V, Cacicedo A, Velasco Del Castillo S, Anton Ladislao A, Aguirre Larracoechea U, Onaindia Gandarias J, Romero Pereiro A, Arana Achaga X, Zugazabeitia Irazabal G, Laraudogoitia Zaldumbide E, Lekuona Goya I, Varela A, Kotsovilis S, Salagianni M, Andreakos V, Davos C, Merchan Ortega G, Bonaque Gonzalez J, Sanchez Espino A, Bolivar Herrera N, Macancela Quinones J, Ikuta I, Ferrer Lopez R, Munoz Troyano S, Bravo Bustos D, Gomez Recio M. Poster session Friday 13 December - PM: 13/12/2013, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dalhoff K, Ewig S, Abele-Horn M, Andreas S, Bauer TT, von Baum H, Deja M, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Höffken G, Kern W, Kramme E, Lange C, Lorenz J, Mayer K, Nachtigall I, Pletz M, Rohde G, Rosseau S, Schaaf B, Schaumann R, Schreiter D, Schütte H, Seifert H, Sitter H, Spies C, Welte T. Adult patients with nosocomial pneumonia: epidemiology, diagnosis, and treatment. Dtsch Arztebl Int 2013; 110:634-40. [PMID: 24133545 DOI: 10.3238/arztebl.2013.0634] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/13/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Nosocomial pneumonia is among the most common types of infection in hospitalized patients. The increasing prevalence of multi-drug resistant organisms (MDROs) in recent years points to the need for an up-to-date clinical guideline. METHODS An interdisciplinary S3 guideline was created on the basis of a systematic literature review in the PubMed and Cochrane Library databases, with assessment and grading of the evidence according to the GRADE system. RESULTS 9097 abstracts and 808 articles were screened in full text, and 22 recommendations were issued. It is recommended that any antimicrobial treatment should be preceded by a microbiological diagnostic evaluation with cultures of blood and respiratory samples. The diagnosis of nosocomial pneumonia should be suspected in any patient with a new or worsened pulmonary infiltrate who meets any two of the following three criteria: leucocyte count above 10,000 or below 4000/µL, temperature above 38.3°C, and/or the presence of purulent respiratory secretions. The initially calculated antimicrobial treatment should be begun without delay; it should be oriented to the locally prevailing resistance pattern, and its intensity should be a function of the risk of infection with MDROs. The initial treatment should be combination therapy if there is a high risk of MDRO infection and/or if the patient is in septic shock. In the new guideline, emphasis is laid on a strict de-escalation concept. In particular, antimicrobial treatment usually should not be continued for longer than eight days. CONCLUSION The new guideline's recommendations are intended to encourage rational use of antibiotics, so that antimicrobial treatment will be highly effective while the unnecessary selection of multi-drug-resistant organisms will be avoided.
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Affiliation(s)
- Klaus Dalhoff
- Department of Pulmonology, University Medical Center Schleswig-Holstein, Campus Lübeck
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Braun JP, Kumpf O, Deja M, Brinkmann A, Marx G, Bloos F, Kaltwasser A, Dubb R, Muhl E, Greim C, Bause H, Weiler N, Chop I, Waydhas C, Spies C. The German quality indicators in intensive care medicine 2013--second edition. Ger Med Sci 2013; 11:Doc09. [PMID: 23904823 PMCID: PMC3728642 DOI: 10.3205/000177] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Indexed: 12/26/2022]
Abstract
Quality indicators are key elements of quality management. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI) from the year 2010 were recently evaluated when their validity time expired after two years. Overall one indicator was replaced and further three were in part changed. The former indicator I “elevation of head of bed” was replaced by the indicator “Daily multi-professional ward rounds with the documentation of daily therapy goals” and added to the indicator IV “Weaning and other measures to prevent ventilator associated pneumonias (short: Weaning/VAP Bundle)” (VAP = ventilator-associated pneumonia) which aims at the reduction of VAP incidence. The indicator VIII “Documentation of structured relative-/next-of-kin communication” was refined. The indicator X “Direction of the ICU by a specially trained certified intensivist with no other clinical duties in a department” was also updated according to recent study results. These updated quality indicators are part of the Peer Review in intensive care medicine. The next update of the quality indicators is due in 2016.
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Affiliation(s)
- Jan-Peter Braun
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany.
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Martin-Loeches I, Deja M, Koulenti D, Dimopoulos G, Marsh B, Torres A, Niederman MS, Rello J. Potentially resistant microorganisms in intubated patients with hospital-acquired pneumonia: the interaction of ecology, shock and risk factors. Intensive Care Med 2013; 39:672-81. [PMID: 23358539 DOI: 10.1007/s00134-012-2808-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 10/22/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE As per 2005 American Thoracic Society and Infectious Disease Society of America (ATS/IDSA) guidelines for managing hospital-acquired pneumonia, patients with early-onset pneumonia and without risk factors do not need to be treated for potentially resistant microorganisms (PRM). METHODS This was a secondary analysis of a prospective, observational, cohort, multicentre study conducted in 27 ICUs from nine European countries. RESULTS From a total of 689 patients with nosocomial pneumonia who required mechanical ventilation, 485 patients with confirmed etiology and antibiotic susceptibility were further analysed. Of these patients, 152 (31.3 %) were allocated to group 1 with early-onset pneumonia and no risk factors for PRM acquisition, and 333 (68.7 %) were classified into group 2 with early-onset pneumonia with risk factors for PRM or late-onset pneumonia. Group 2 patients were older and had more chronic renal failure and more severe illness (SAPS II score, 44.6 ± 16.5 vs. 47.4 ± 17.8, p = 0.04) than group 1 patients. Trauma patients were more frequent and surgical patients less frequent in group 1 than in group 2 (p < 0.01). In group 1, 77 patients (50.7 %) had PRM in spite of the absence of classic risk factors recognised by the current guidelines. A logistic regression analysis identified that presence of severe sepsis/septic shock (OR = 3.7, 95 % CI 1.5-8.9) and pneumonia developed in centres with greater than 25 % prevalence of PRM (OR = 11.3, 95 % CI 2.1-59.3) were independently associated with PRM in group 1 patients. CONCLUSIONS In patients admitted to ICUs with a prevalence of PRM greater than 25 % or with severe sepsis/septic shock, empiric therapy for group 1 nosocomial pneumonia requiring mechanical ventilation should also include agents likely to be effective for PRM pathogens.
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MESH Headings
- Cross Infection/microbiology
- Cross Infection/therapy
- Drug Resistance, Multiple, Bacterial
- Europe
- Female
- Humans
- Intensive Care Units
- Male
- Middle Aged
- Multicenter Studies as Topic
- Pneumonia, Bacterial/complications
- Pneumonia, Bacterial/microbiology
- Pneumonia, Bacterial/therapy
- Pneumonia, Ventilator-Associated/complications
- Pneumonia, Ventilator-Associated/microbiology
- Pneumonia, Ventilator-Associated/therapy
- Practice Guidelines as Topic
- Prospective Studies
- Respiration, Artificial/adverse effects
- Respiration, Artificial/statistics & numerical data
- Risk Factors
- Severity of Illness Index
- Shock/etiology
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Dalhoff K, Abele-Horn M, Andreas S, Bauer T, von Baum H, Deja M, Ewig S, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Höffken G, Kern WV, Kramme E, Lange C, Lorenz J, Mayer K, Nachtigall I, Pletz M, Rohde G, Rosseau S, Schaaf B, Schaumann R, Schreiter D, Schütte H, Seifert H, Sitter H, Spies C, Welte T. [Epidemiology, diagnosis and treatment of adult patients with nosocomial pneumonia. S-3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy]. Pneumologie 2012; 66:707-65. [PMID: 23225407 DOI: 10.1055/s-0032-1325924] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However infections on general wards are also increasing. A central issue are infections with multi drug resistant (MDR) pathogens which are difficult to treat particularly in the empirical setting potentially leading to inappropriate use of antimicrobial therapy. This guideline was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and therapy of HAP on the basis of quality of evidence and benefit/risk ratio. The guideline has two parts. First an update on epidemiology, spectrum of pathogens and antiinfectives is provided. In the second part recommendations for the management of diagnosis and treatment are given. Proper microbiologic work up is emphasized for knowledge of the local patterns of microbiology and drug susceptibility. Moreover this is the optimal basis for deescalation in the individual patient. The intensity of antimicrobial therapy is guided by the risk of infections with MDR. Structured deescalation concepts and strict limitation of treatment duration should lead to reduced selection pressure.
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Affiliation(s)
- K Dalhoff
- Medizinische Klinik III, Pneumologie und Infektiologie, Universitätsklinikum Schleswig-Holstein, Lübeck.
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Hugues T, Lacroix-Hugues V, Yaici K, Gibelin P, Cabrita I, Pires S, Nunes A, Sousa C, Cortez-Dias N, Pinto F, Hrynkiewicz-Szymanska A, Braksator W, Szymanski F, Chmielewski M, Dluzniewski M, Alonso Fernandez P, Andres Lahuerta A, Miro Palau V, Buendia Fuentes F, Igual Munoz B, Osa Saez A, Quesada Carmona A, Tejada Ponce D, Munoz B, Salvador Sanz A, Imamura S, Hirata KH, Kubo T, Orii M, Tanimono T, Takemoto K, Ino Y, Yamaguchi T, Imanishi T, Akasaka T, Kinoshita T, Asai T, Suzuki T, Krestjyaninov M, Ruzov V, Imamura S, Hirata KH, Kubo T, Orii M, Tanimoto T, Yamano T, Ino Y, Yamaguchi T, Imanishi T, Akasaka T, Junca Puig G, Sistach EF, Delgado Ramis L, Lopez Ayerbe J, Vallejo Camazon N, Gual Capllonch F, Teis Soley A, Camara Rosell M, Ruyra Baliarda X, Bayes-Genis A, Alonso fernandez P, Igual Munoz B, Andres Lahuerta A, Maceira Gonzalez A, Hernandez C, Bel Minguez A, Miro Palau V, Munoz Igual B, Montero Argudo A, Salvador Sanz A, Antit S, fennira S, Zairi I, Kamoun S, Kraiem S, Matsuyama A, Hirata KH, Kubo T, Orii M, Takemoto K, Tanimoto T, Yamano T, Ino Y, Imanishi T, Akasaka T, Van De Heyning C, Magne J, Pierard L, Davin L, Bruyere P, De Maeyer C, Paelinck B, Vrints C, Lancellotti P, Wang J, fang F, Liu M, Liang Y, Yu C, Lam Y, Kenny C, Monaghan M, Ercan S, Kervancioglu S, Davutoglu V, Cakici M, Ozkur A, Oylumlu M, Sari I, Sikora-Puz A, Mizia M, Gieszczyk-Strozik K, Matyjaszczyk-Zbieg K, Haberka M, Mizia-Stec K, Gasior Z, Wos S, Deja M, Jasinski M, Enescu O, florescu M, Mihalcea D, Rimbas R, Cinteza M, Vinereanu D. Club 35 Poster Session Wednesday 5 December * Right ventricular systolic function. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kleber C, Becker C, van Scherpenzeel KM, Weidemann H, Deja M, Haas NP. [Coincidence of traumatic tracheal rupture accompanied by ARDS. Illustrated by the example of a 17-year-old patient with multiple injuries]. Unfallchirurg 2012; 115:546-51. [PMID: 21584704 DOI: 10.1007/s00113-011-1995-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Treatment and diagnosis of a traumatic tracheal rupture is a challenge. Due to the rarity of such injuries and the subtle and delayed clinical presentation it is difficult to diagnose. We present for the first time the successful management of a 17-year-old multiply injured patient with coincidental tracheal rupture and ARDS (acute respiratory distress syndrome) after a fall. Besides the case report and pathogenesis the essential diagnostic and therapeutic measures are mentioned and discussed. The circumstances surrounding the accident have to be balanced with the severity of the trauma to also exclude rare injuries with certainty. Finally level 1 trauma centers specialized in ARDS provide the best clinical setting for successful treatment of these life-threatening injuries.
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Affiliation(s)
- C Kleber
- Klinik für Unfall- und Wiederherstellungschirurgie, Operative Intensiv- und Notfallmedizin, Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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Deja M, Menk M, Heidenhain C, Spies CD, Heymann A, Weidemann H, Branscheid D, Weber-Carstens S. Strategies for diagnosis and treatment of iatrogenic tracheal ruptures. Minerva Anestesiol 2011; 77:1155-1166. [PMID: 21602752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Management of tracheal ruptures in critically ill patients is challenging. Conservative treatment has been described, but in mechanically ventilated patients with distal tracheal ruptures surgical repair might be inevitable. Strategies for diagnosis and treatment of tracheal ruptures and handling of mechanical ventilation remain to be clarified. Our aim was to comprise a structured diagnostic and treatment protocol for patients suspicious of tracheal injury, including detailed principles of mechanical ventilation and specific indications for conservative or surgical treatment. METHODS Patients with tracheal ruptures were compared in accordance to the need of mechanical ventilation and to indication for surgical repair. In patients suffering from tracheal ruptures affecting the whole tracheal wall and with protrusion of mediastinal structures into the lumen surgery was indicated. We compared ventilatory, hemodynamic and clinical parameters between the different patient groups. We report our structured approach in diagnostics and treatment of tracheal ruptures and place special emphasis on respiratory management. RESULTS Seventeen patients with tracheal rupture were identified. In 8 patients surgical repair was performed 1.8±1.5 days after diagnosis. Previous to surgery, ventilation parameters improved significantly: plateau pressure decreased, percentage of assisted spontaneous breathing increased and compliance improved. Conservative treatment was successful in long-term ventilated patients (13.7±8 days) even when suffering from distal lesions. CONCLUSION Invasiveness of mechanical ventilation and obstruction of tracheal lumen might indicate conservative or surgical treatment strategies in long-term ventilated patients suffering from iatrogenic tracheal rupture. Indications for surgical repair remain to be further clarified.
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Affiliation(s)
- M Deja
- Department of Anesthesiology and Intensive Care Medicine, Charité, Berlin Medical University, Campus Virchow-Klinikum, Campus Charité Mitte, Berlin, Germany.
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Deja M, Trefzer T, Geffers C. [Prevention of ventilator-associated pneumonia: what's evidence-based treatment?]. Anasthesiol Intensivmed Notfallmed Schmerzther 2011; 46:560-7. [PMID: 21894587 DOI: 10.1055/s-0031-1286606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Patients who suffer from a ventilator-associated pneumonia (VAP) are ventilated longer, stay longer in the ICU and in hospital and therefore lead to higher costs. Despite the therapeutic potential of the VAP nowadays there is about 10% additional mortality observed. Although the clinical VAP diagnosis is limited (sensitivity/specificity) rapid diagnosis promotes treatment (calculated antibiotic therapy) and improves the survival rate. And in the course the review of the VAP diagnosis of unnecessary antibiotics reduces the resistance development in that area and also the selection pressure.
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Russ M, Deja M, Ott S, Bedarf J, Keckel T, Hiebl B, Wagner JJ, Unger JK. Experimental High-Volume Hemofiltration With Predilutional Tris-Hydroxymethylaminomethane for Correction of Low Tidal Volume Ventilation-Induced Acidosis. Artif Organs 2011; 35:E108-18. [DOI: 10.1111/j.1525-1594.2011.01204.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grieser C, Pérez Fernández C, Steffen IG, Goldmann A, Kastrup M, Engert U, Deja M, Lojewski C, Hamm B, Denecke T. „Acute Respiratory Distress Syndrom“ bei Schweinegrippenpneumonie - prognostische Wertigkeit der Computertomographie. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279248] [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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Tafelski S, Nachtigall I, Deja M, Tamarkin A, Trefzer T, Halle E, Wernecke KD, Spies C. Computer-assisted decision support for changing practice in severe sepsis and septic shock. J Int Med Res 2011; 38:1605-16. [PMID: 21309474 DOI: 10.1177/147323001003800505] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Computer-assisted decision support systems (CDSS) are designed to improve infection management. The aim of this prospective, clinical pre- and post-intervention study was to investigate the influence of CDSS on infection management of severe sepsis and septic shock in intensive care units (ICUs). Data were collected for a total of 180 days during two study periods in 2006 and 2007. Of the 186 patients with severe sepsis or septic shock, 62 were stratified into a low adherence to infection management standards group (LAG) and 124 were stratified into a high adherence group (HAG). ICU mortality was significantly increased in LAG versus HAG patients (Kaplan-Meier analysis). Following CDSS implementation, adherence to standards increased significantly by 35%, paralleled with improved diagnostics, more antibiotic-free days and a shortened time until antibiotics were administered. In conclusion, adherence to infection standards is beneficial for patients with severe sepsis or septic shock and CDSS is a useful tool to aid adherence.
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Affiliation(s)
- S Tafelski
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Koch S, Spuler S, Deja M, Bierbrauer J, Dimroth A, Behse F, Spies CD, Wernecke KD, Weber-Carstens S. Critical illness myopathy is frequent: accompanying neuropathy protracts ICU discharge. J Neurol Neurosurg Psychiatry 2011; 82:287-93. [PMID: 20802220 DOI: 10.1136/jnnp.2009.192997] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Neuromuscular dysfunction in critically ill patients is attributed to either critical illness myopathy (CIM) or critical illness polyneuropathy (CIP) or a combination of both. However, it is unknown whether differential diagnosis has an impact on prognosis. This study investigates whether there is an association between the early differentiation of CIM versus CIP and clinical prognosis. METHODS The authors included mechanically ventilated patients who featured a Simplified Acute Physiology Score II (SAPS-II) ≥ 20 on three consecutive days within the first week after intensive care unit (ICU) admission. Fifty-three critically ill patients were enrolled and examined by conventional nerve-conduction studies and direct muscle stimulation (184 examinations in total). The first examination was conducted within the first week after admission to the ICU. RESULTS In this cohort of critically ill patients, CIM was more frequent (68%) than CIP (38%). Electrophysiological signs of CIM preceded electrophysiological signs of CIP (median at day 7 in CIM patients vs day 10 in CIP patients, p<0.001). Most patients with CIP featured concomitant CIM. At discharge from ICU, 25% of patients with isolated CIM showed electrophysiological signs of recovery and significantly lower degrees of weakness. Recovery could not be observed in patients with combined CIM/CIP, even though the ICU length of stay was significantly longer (mean 35 days in CIM/CIP vs mean 19 days in CIM, p<0.001). CONCLUSION Prognoses of patients differ depending on electrophysiological findings during early critical illness: early electrophysiological differentiation of ICU acquired neuromuscular disorder enhances the evaluation of clinical prognosis during critical illness.
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Affiliation(s)
- Susanne Koch
- Department of Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Mitte, Augustenburger Platz 1, Berlin D-13353, Germany.
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Foehre B, von Heymann C, Deja M, Lange LF, Krampe H, Wernecke KD, Spies C. Central area for induction of anesthesia and job satisfaction. Acta Anaesthesiol Belg 2011; 62:15-21. [PMID: 21612141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A central area for induction of anesthesia (CAIA) is supposed to optimize processes of preoperative patient preparation for anesthesia. The purpose of this study was to assess whether the separation of the anesthesia process into anesthesia induction and anesthesia maintenance is associated with residents' job satisfaction. The central area for induction of anesthesia model (CAIA model) was prospectively compared to the conventional model of anesthesia being induced, maintained and ended by the same anesthetist. Quality of senior staff supervision for each day as well as workday satisfaction was additionally graded by a Likert-scale. More than 80% of residents considered their workday as satisfying or very satisfying, regardless of the model applied. Furthermore, work day satisfaction was significantly associated with the quality of supervision provided by the teaching staff. It was concluded that time and attention provided by the teaching staff rather than the anesthesia organisational model were the major determinants of workday satisfaction.
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Affiliation(s)
- B Foehre
- Klinik for Anisthesiologie m.S. operative Intensivmedizin, Campus Virchow-Klinikum und Campus Charit6 Mitte, Berlin
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Blot SI, Serra ML, Koulenti D, Lisboa T, Deja M, Myrianthefs P, Manno E, Diaz E, Topeli A, Martin-Loeches I, Rello J. Patient to nurse ratio and risk of ventilator-associated pneumonia in critically ill patients. Am J Crit Care 2011; 20:e1-9. [PMID: 21196562 DOI: 10.4037/ajcc2011555] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [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: 11/01/2022]
Abstract
OBJECTIVE To determine how the patient to nurse ratio affects risk for ventilator-associated pneumonia. METHODS Data from an earlier study in 27 intensive care units in 9 European countries were examined in a secondary analysis. The initial cohort included 2585 consecutive patients who had mechanical ventilation (1) after admission for treatment of pneumonia or (2) for more than 48 hours irrespective of the diagnosis at admission. In units with variable staffing levels, the highest patient to nurse ratio in a 24-hour period was considered. Patients from 6 units that did not provide data on nurse staffing levels were excluded from the analysis. RESULTS Ventilator-associated pneumonia developed in 393 of the 1658 patients (23.7%) in the secondary cohort. In units with patient to nurse ratios of 1 to 1, 2 to 1, 2.5 to 1, and 3 to 1, rates were 9.3%, 25.7%, 18.7%, and 24.2%, respectively (P = .003). Rates were significantly lower (P = .002) in units with a ratio of 1 to 1 (9.3%) than in units with a ratio of more than 1 patient to 1 nurse (24.4%). After adjustments for confounding covariates, ratios of more than 1 patient to 1 nurse were no longer associated with increased risk for ventilator-associated pneumonia. CONCLUSIONS A patient to nurse ratio of 1 to 1 appears to be associated with a lower risk for ventilator-associated pneumonia, but after adjustments for confounding covariates, the difference is not significant.
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Affiliation(s)
- Stijn I Blot
- Ghent University Hospital, Ghent University, Belgium.
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Rello J, Ulldemolins M, Lisboa T, Koulenti D, Mañez R, Martin-Loeches I, De Waele JJ, Putensen C, Guven M, Deja M, Diaz E. Determinants of prescription and choice of empirical therapy for hospital-acquired and ventilator-associated pneumonia. Eur Respir J 2010; 37:1332-9. [PMID: 20847075 DOI: 10.1183/09031936.00093010] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objectives of this study were to assess the determinants of empirical antibiotic choice, prescription patterns and outcomes in patients with hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) in Europe. We performed a prospective, observational cohort study in 27 intensive care units (ICUs) from nine European countries. 100 consecutive patients on mechanical ventilation for HAP, on mechanical ventilation>48 h or with VAP were enrolled per ICU. Admission category, sickness severity and Acinetobacter spp. prevalence>10% in pneumonia episodes determined antibiotic empirical choice. Trauma patients were more often prescribed non-anti-Pseudomonas cephalosporins (OR 2.68, 95% CI 1.50-4.78). Surgical patients received less aminoglycosides (OR 0.26, 95% CI 0.14-0.49). A significant correlation (p<0.01) was found between Simplified Acute Physiology Score II score and carbapenem prescription. Basal Acinetobacter spp. prevalence>10% dramatically increased the prescription of carbapenems (OR 3.5, 95% CI 2.0-6.1) and colistin (OR 115.7, 95% CI 6.9-1,930.9). Appropriate empirical antibiotics decreased ICU length of stay by 6 days (26.3±19.8 days versus 32.8±29.4 days; p=0.04). The antibiotics that were prescribed most were carbapenems, piperacillin/tazobactam and quinolones. Median (interquartile range) duration of antibiotic therapy was 9 (6-12) days. Anti-methicillin-resistant Staphylococcus aureus agents were prescribed in 38.4% of VAP episodes. Admission category, sickness severity and basal Acinetobacter prevalence>10% in pneumonia episodes were the major determinants of antibiotic choice at the bedside. Across Europe, carbapenems were the antibiotic most prescribed for HAP/VAP.
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Affiliation(s)
- J Rello
- Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
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Niethard M, Deja M, Rogalski M. [Correction of angular deformity of the knee in growing children by temporary hemiepiphyseodesis using the eight-plate]. Z Orthop Unfall 2010; 148:215-21. [PMID: 20135618 DOI: 10.1055/s-0029-1240732] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM Angular deformities of the lower extremity are considered as prearthrotic factors. Osteotomy is regarded as a way of corrective treatment. But this intervention is considered as complex and requires a special after-treatment. During childhood and with remaining growth, guided growth offers an elegant solution for this problem. Resulting in a temporary hemiepiphyseodesis, the eight-Plate offers an alternative technique besides the Blount staples and the definitive epiphyseodesis. We evaluated the effect of this device on the correction of angular deformities in children with different diagnoses and at different ages. METHOD Since 04/2006 22 patients with angular deformities of the lower extremities due to different diagnoses were treated at our department with the eight-Plate (42 eight-Plates). In this study we evaluated the outcome of 13 patients (26 eight-Plates) until the completed angular correction and removal of the eight-Plate. A special treatment after plate removal was not applied. RESULTS All patients improved their mechanical leg axis. The average age at implantation was 9.4 years (2.3-13.7 years). The average time until plate removal was 10.7 months (6-34 months). No hardware failures, extrusions, growth arrests, wound infections or other complications were observed. Two patients did not achieve the desired axis correction because of insufficient remaining growth potential. An additional surgical intervention was realised. The average correction of the study group regarding the mechanical axis deviation (MAD) was 22 mm (6-43 mm) and 10.6 degrees (5-27 degrees) regarding the angular correction of the mechanical lateral distal femoral angle (mLDFW). The mechanical medial proximal tibial angle (mMPTW) changed by 8.0 degrees (3-15 degrees). CONCLUSION In our opinion the eight-Plate seems to be a safe and reliable device for guided growth of angular deformities around the knee. The technique is easy to learn and the complication rate low compared to the staple technique. A special after-treatment is not needed and there is only minor operative trauma. At present there are only few data on long-term follow-up after plate removal until skeletal maturity. The definition of the ideal point in time for plate removal is still open.
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Affiliation(s)
- M Niethard
- Klinik für Orthopädie, Abt Kinderorthopädie, HELIOS Klinikum Berlin Buch, Berlin.
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Schuchardt M, Toelle M, Huang T, Wiedon A, Van Der Giet M, Mill C, George S, Jeremy J, Santulli G, Illario M, Cipolletta E, Sorriento D, Del Giudice C, Anastasio A, Trimarco B, Iaccarino G, Jobs A, Wagner C, Kurtz A, De Wit C, Koller A, Suvorava T, Weber M, Dao V, Kojda G, Tsaousi A, Lyon C, Williams H, George S, Barth N, Loot A, Fleming I, Keul P, Lucke S, Graeler M, Heusch G, Levkau B, Biessen E, De Jager S, Bermudez-Pulgarin B, Bot I, Abia R, Van Berkel T, Renger A, Noack C, Zafiriou M, Dietz R, Bergmann M, Zelarayan L, Hammond J, Hamelet J, Van Assche T, Belge C, Vanderper A, Langin D, Herijgers P, Balligand J, Perrot A, Neubert M, Dietz R, Posch M, Oezcelik C, Posch M, Waldmuller S, Perrot A, Berger F, Scheffold T, Bouvagnet P, Ozcelik C, Lebreiro A, Martins E, Lourenco P, Cruz C, Martins M, Bettencourt P, Maciel M, Abreu-Lima C, Pilichou K, Bauce B, Rampazzo A, Carturan E, Corrado D, Thiene G, Basso C, Piccini I, Fortmueller L, Kuhlmann M, Schaefers M, Carmeliet P, Kirchhof P, Fabritz L, Sanchez J, Rodriguez-Sinovas A, Agullo E, Garcia-Dorado D, Lymperopoulos A, Rengo G, Gao E, Zincarelli C, Koch W, Fontes-Sousa A, Silva S, Gomes M, Ferreira P, Leite-Moreira A, Capuano V, Ferron L, Ruchon Y, Ben Mohamed F, Renaud JF, Morgan P, Falcao-Pires I, Goncalves N, Gavina C, Pinho S, Moura C, Amorim M, Pinho P, Leite-Moreira A, Christ T, Molenaar P, Diez A, Ravens U, Kaumann A, Kletsiou E, Giannakopoulou M, Bozas E, Iliodromitis E, Anastasiou-Nana M, Papathanassoglou E, Chottova Dvorakova M, Mistrova E, Perez N, Slavikova J, Hynie S, Sida P, Klenerova V, Massaro M, Scoditti E, Carluccio M, Storelli C, Distante A, De Caterina R, Cingolani H, Zakrzewicz A, Hoffmann C, Hohberg M, Chlench S, Maroski J, Drab M, Siegel G, Pries A, Farrell K, Holt C, Zahradnikova A, Schrot G, Ibatov A, Wilck N, Fechner M, Arias A, Meiners S, Baumann G, Stangl V, Stangl K, Ludwig A, Polakova E, Christ A, Eijgelaar W, Daemen M, Li X, Penfold M, Schall T, Weber C, Schober A, Hintenberger R, Kaun C, Zahradnik I, Pfaffenberger S, Maurer G, Huber K, Wojta J, Demyanets S, Titov V, Nazari-Jahantigh M, Weber C, Schober A, Chin-Dusting J, Zahradnikova A, Vaisman B, Khong S, Remaley A, Andrews K, Hoeper A, Khalid A, Fuglested B, Aasum E, Larsen T, Titov V, Fluschnik N, Carluccio M, Scoditti E, Massaro M, Storelli C, Distante A, De Caterina R, Diebold I, Petry A, Djordjevic T, Belaiba R, Sossalla S, Fratz S, Hess J, Kietzmann T, Goerlach A, O'shea K, Chess D, Khairallah R, Walsh K, Stanley W, Falcao-Pires I, Ort K, Goncalves N, Van Der Velden J, Moreira-Goncalves D, Paulus W, Niessen H, Perlini S, Leite-Moreira A, Azibani F, Tournoux F, Fazal L, Neef S, Polidano E, Merval R, Chatziantoniou C, Samuel J, Delcayre C, Azibani F, Tournoux F, Fazal L, Polidano E, Merval R, Hasenfuss G, Chatziantoniou C, Samuel J, Delcayre C, Mgandela P, Brooksbank R, Maswanganyi T, Woodiwiss A, Norton G, Makaula S, Sartiani L, Maier L, Bucciantini M, Spinelli V, Coppini R, Russo E, Mugelli A, Cerbai E, Stefani M, Sukumaran V, Watanabe K, Ma M, Weinert S, Thandavarayan R, Azrozal W, Sari F, Shimazaki H, Kobayashi Y, Roleder T, Golba K, Deja M, Malinowski M, Wos S, Poitz D, Stieger P, Grebe M, Tillmanns H, Preissner K, Sedding D, Ercan E, Guven A, Asgun F, Ickin M, Ercan F, Herold J, Kaplan A, Yavuz O, Bagla S, Yang Y, Ma Y, Liu F, Li X, Huang Y, Kuka J, Vilskersts R, Schmeisser A, Vavers E, Liepins E, Dambrova M, Mariero L, Rutkovskiy A, Stenslokken K, Vaage J, Duerr G, Suchan G, Heuft T, Strasser J, Klaas T, Zimmer A, Welz A, Fleischmann B, Dewald O, Voelkl J, Haubner B, Kremser C, Mayr A, Klug G, Braun-Dullaeus R, Reiner M, Pachinger O, Metzler B, Pisarenko O, Shulzhenko V, Pelogeykina Y, Khatri D, Studneva I, Barnucz E, Loganathan S, Nazari-Jahantigh M, Hirschberg K, Korkmaz S, Merkely B, Karck M, Szabo G, Bencsik P, Gorbe A, Kocsis G, Csonka C, Csont T, Weber C, Shamloo M, Woodburn K, Ferdinandy P, Szucs G, Kupai K, Csonka C, Csont C, Ferdinandy P, Kocsisne Fodor G, Bencsik P, Schober A, Fekete V, Varga Z, Monostori P, Turi S, Ferdinandy P, Csont T, Leuner A, Eichhorn B, Ravens U, Morawietz H, Babes E, Babes V, Popescu M, Ardelean A, Rus M, Bustea C, Gwozdz P, Csanyi G, Luzak B, Gajda M, Mateuszuk L, Chmura-Skirlinska A, Watala C, Chlopicki S, Kierzkowska I, Sulicka J, Kwater A, Strach M, Surdacki A, Siedlar M, Grodzicki T, Olieslagers S, Pardali L, Tchaikovski V, Ten Dijke P, Waltenberger J, Renner M, Redwan B, Winter M, Panzenboeck A, Jakowitsch J, Sadushi-Kolici R, Bonderman D, Lang I, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Oliviero C, Bellandi F, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Casprini P, Bellandi F, Toso A, Tanini L, Pizzetti T, Leoncini M, Maioli M, Tedeschi D, Amato M, Bellandi F, Molins B, Pena E, Badimon L, Ferreiro Gutierrez J, Ueno M, Alissa R, Dharmashankar K, Capodanno D, Desai B, Bass T, Angiolillo D, Chabielska E, Gromotowicz A, Szemraj J, Stankiewicz A, Zakrzeska A, Mohammed S, Molla F, Soldo A, Russo I, Germano G, Balconi G, Staszewsky L, Latini R, Lynch F, Austin C, Prendergast B, Keenan D, Malik R, Izzard A, Heagerty A, Czikora A, Lizanecz E, Rutkai I, Boczan J, Porszasz R, Papp Z, Edes I, Toth A, Colantuoni A, Vagnani S, Lapi D, Maroz-Vadalazhskaya N, Koslov I, Shumavetz V, Glibovskaya T, Ostrovskiy Y, Koutsiaris A, Tachmitzi S, Kotoula M, Giannoukas A, Tsironi E, Rutkai I, Czikora A, Darago A, Orosz P, Megyesi Z, Edes I, Papp Z, Toth A, Eichhorn B, Schudeja S, Matschke K, Deussen A, Ravens U, Castro M, Cena J, Walsh M, Schulz R, Poddar K, Rha S, Ramasamy S, Park J, Choi C, Seo H, Park C, Oh D, Lebreiro A, Martins E, Almeida J, Pimenta S, Bernardes J, Machado J, Abreu-Lima C, Sabatasso S, Laissue J, Hlushchuk R, Brauer-Krisch E, Bravin A, Blattmann H, Michaud K, Djonov V, Hirschberg K, Tarcea V, Pali S, Korkmaz S, Loganathan S, Merkely B, Karck M, Szabo G, Pagliani L, Faggin E, Rattazzi M, Puato M, Presta M, Grego F, Deriu G, Pauletto P, Kaiser R, Albrecht K, Schgoer W, Theurl M, Beer A, Wiedemann D, Steger C, Bonaros N, Kirchmair R, Kharlamov A, Cabaravdic M, Breuss J, Uhrin P, Binder B, Fiordaliso F, Balconi G, Mohammed S, Maggioni M, Biondi A, Masson S, Cervo L, Latini R, Francke A, Herold J, Soenke W, Strasser R, Braun-Dullaeus R, Hecht N, Vajkoczy P, Woitzik J, Hackbusch D, Gatzke N, Duelsner A, Tsuprykov O, Slavic S, Buschmann I, Kappert K, Massaro M, Scoditti E, Carluccio M, Storelli C, Distante A, De Caterina R, Barandi L, Harmati G, Simko J, Horvath B, Szentandrassy N, Banyasz T, Magyar J, Nanasi P, Kaya A, Uzunhasan I, Yildiz A, Yigit Z, Turkoglu C, Doisne N, Zannad N, Hivert B, Cosnay P, Maupoil V, Findlay I, Virag L, Kristof A, Koncz I, Szel T, Jost N, Biliczki P, Papp J, Varro A, Bukowska A, Skopp K, Hammwoehner M, Huth C, Bode-Boeger S, Goette A, Workman A, Dempster J, Marshall G, Rankin A, Revnic C, Ginghina C, Revnic F, Yakushev S, Petrushanko I, Makhro A, Segato Komniski M, Mitkevich V, Makarov A, Gassmann M, Bogdanova A, Rutkovskiy A, Mariero L, Stenslokken K, Valen G, Vaage J, Dizayee S, Kaestner S, Kuck F, Piekorz R, Hein P, Matthes J, Nurnberg B, Herzig S, Hertel F, Switalski A, Bender K, Kienitz MC, Pott L, Fornai L, Angelini A, Erika Amstalden Van Hove E, Fedrigo M, Thiene G, Heeren R, Kruse M, Pongs O, Lehmann H, Martens-Lobenhoffer J, Hammwoehner M, Roehl F, Bukowska A, Bode-Boeger S, Goette A, Radicke S, Cotella C, Sblattero D, Schaefer M, Ravens U, Wettwer E, Santoro C, Seyler C, Kulzer M, Zitron E, Scholz E, Welke F, Thomas D, Karle C, Schmidt K, Radicke S, Dobrev D, Ravens U, Wettwer E, Houshmand N, Menesi D, Ravens U, Wettwer E, Cotella D, Papp J, Varro A, Szuts V, Szuts V, Houshmand N, Puskas L, Jost N, Virag L, Kiss I, Deak F, Varro A, Tereshchenko S, Gladyshev M, Kalachova G, Syshchik N, Gogolashvili N, Dedok E, Evert L, Wenzel J, Brandenburger M, Bogdan R, Richardt D, Reppel M, Hescheler J, Dendorfer A, Terlau H, Wiegerinck R, Galvez-Monton C, Jorge E, Martinez R, Ricart E, Cinca J, Bagavananthem Andavan G, Lemmens Gruber R, Brack K, Coote J, Ng G, Daimi H, Haj Khelil A, Neji A, Ben Hamda K, Maaoui S, Aranega A, Chibani J, Franco Jaime D, Tanko AS, Brack K, Coote J, Ng G, Doisne N, Hivert B, Cosnay P, Findlay I, Maupoil V, Daniel JM, Bielenberg W, Stieger P, Tillmanns H, Sedding D, Fortini C, Toffoletto B, Fucili A, Beltrami A, Fiorelli V, Francolini G, Ferrari R, Beltrami C, Castellani C, Ravara B, Tavano R, Thiene G, Vettor R, De Coppi P, Papini E, Angelini A, Molla F, Soldo A, Biondi A, Staszewsky L, Russo I, Gunetti M, Fagioli F, Latini R, Suffredini S, Sartiani L, Stillitano F, Mugelli A, Cerbai E, Krausgrill B, Halbach M, Soemantri S, Schenk K, Lange N, Hescheler J, Saric T, Muller-Ehmsen J, Kavanagh D, Zhao Y, Yemm A, Kalia N, Wright E, Farrell K, Wallrapp C, Geigle P, Lewis A, Stratford P, Malik N, Holt C, Krausgrill B, Raths M, Halbach M, Schenk K, Hescheler J, Muller-Ehmsen J, Zagallo M, Luni C, Serena E, Cimetta E, Zatti S, Giobbe G, Elvassore N, Serena E, Cimetta E, Zaglia T, Zatti S, Zambon A, Gordon K, Elvassore N, Mioulane M, Foldes G, Ali N, Harding S, Gorbe A, Szunyog A, Varga Z, Pirity M, Rungaruniert S, Dinnyes A, Csont T, Ferdinandy P, Foldes G, Mioulane M, Iqbal A, Schneider MD, Ali N, Harding S, Babes E, Babes V, Khodjaeva E, Ibadov R, Khalikulov K, Mansurov A, Astvatsatryan A, Senan M, Astvatsatryan A, Senan M, Nemeth A, Lenkey Z, Ajtay Z, Cziraki A, Sulyok E, Horvath I, Lobenhoffer J, Bode-Boger S, Li J, He Y, Yang X, Wang F, Xu H, Li X, Zhao X, Lin Y, Juszynski M, Ciszek B, Jablonska A, Stachurska E, Ratajska A, Atkinson A, Inada S, Li J, Sleiman R, Zhang H, Boyett M, Dobrzynski H, Fedorenko O, Hao G, Atkinson A, Yanni J, Buckley D, Anderson R, Boyett M, Dobrzynski H, Ma Y, Ma X, Hu Y, Yang Y, Huang D, Liu F, Huang Y, Liu C, Jedrzejczyk T, Balwicki L, Wierucki L, Zdrojewski T, Makhro A, Agarkova I, Vogel J, Gassmann M, Bogdanova A, Korybalska K, Pyda M, Witowski J, Ibatov A, Sozmen N, Seymen A, Tuncay E, Turan B, Huang Y, Ma Y, Yang Y, Liu F, Chen B, Li X, Houston-Feenstra L, Chiong JR, Jutzy K, Furundzija V, Kaufmann J, Kappert K, Meyborg H, Fleck E, Stawowy P, Ksiezycka-Majczynska E, Lubiszewska B, Kruk M, Kurjata P, Ruzyllo W, Ibatov A, Driesen R, Coenen T, Fagard R, Sipido K, Petrov V, Aksentijevic D, Lygate C, Makinen K, Sebag-Montefiore L, Medway D, Schneider J, Neubauer S, Gasser R, Holzwart E, Rainer P, Von Lewinski D, Maechler H, Gasser S, Roessl U, Pieske B, Krueger J, Kintscher U, Kappert K, Podramagi T, Paju K, Piirsoo A, Roosimaa M, Kadaja L, Orlova E, Ruusalepp A, Seppet E, Auquier J, Ginion A, Hue L, Horman S, Beauloye C, Vanoverschelde J, Bertrand L, Fekete V, Zvara A, Pipis J, Konya C, Csonka C, Puskas L, Csont T, Ferdinandy P, Gasser S, Rainer P, Holzwart E, Roessl U, Kraigher-Krainer E, Von Lewinksi D, Pieske B, Gasser R, Gonzalez-Loyola A, Barba I, Rodriguez-Sinovas A, Fernandez-Sanz C, Agullo E, Ruiz-Meana M, Garcia-Dorado D, Forteza M, Bodi Peris V, Monleon D, Mainar L, Morales J, Moratal D, Trapero I, Chorro F, Leszek P, Sochanowicz B, Szperl M, Kolsut P, Piotrowski W, Rywik T, Danko B, Kruszewski M, Stanley W, Khairallah R, Khanna N, O'shea K, Kristian T, Hecker P, Des Rosiers R, Fiskum G, Fernandez-Alfonso M, Guzman-Ruiz R, Somoza B, Gil-Ortega M, Attane C, Castan-Laurell I, Valet P, Ruiz-Gayo M, Maroz-Vadalazhskaya N, Denissevich T, Shumavetz V, Ostrovskiy Y, Schrepper A, Schwarzer M, Amorim P, Schoepe M, Mohr F, Doenst T, Chiellini G, Ghelardoni S, Saba A, Marchini M, Frascarelli S, Raffaelli A, Scanlan T, Zucchi R, Van Den Akker N, Molin D, Kolk F, Jeukens F, Olde Engberink R, Waltenberger J, Post M, Van Den Akker N, Molin D, Verbruggen S, Schulten H, Post M, Waltenberger J, Rochais F, Kelly R, Aberg M, Johnell M, Wickstrom M, Siegbahn A, Dimitrakis P, Groppalli V, Ott D, Seifriz F, Suter T, Zuppinger C, Kashcheyeu Y, Mueller R, Wiesen M, Saric T, Gruendemann D, Hescheler J, Herzig S, Falcao-Pires I, Fontes-Sousa A, Lopes-Conceicao L, Bras-Silva C, Leite-Moreira A, Bukauskas F, Palacios-Prado N, Norheim F, Raastad T, Thiede B, Drevon C, Haugen F, Lindner D, Westermann D, Zietsch C, Schultheiss HP, Tschoepe C, Horn M, Graham H, Hall M, Richards M, Clarke J, Dibb K, Trafford A, Cheng CF, Lin H, Eigeldiger-Berthou S, Buntschu P, Frobert A, Flueck M, Tevaearai H, Kadner A, Mikhailov A, Torrado M, Centeno A, Lopez E, Lourido L, Castro Beiras A, Popov T, Srdanovic I, Petrovic M, Canji T, Kovacevic M, Jovelic A, Sladojevic M, Panic G, Kararigas G, Fliegner D, Regitz-Zagrosek V, De La Rosa Sanchez A, Dominguez J, Sedmera D, Franco D, Aranega A, Medunjanin S, Burgbacher F, Schmeisser A, Strasser R, Braun-Dullaeus R, Li X, Ma Y, Yang Y, Liu F, Han W, Chen B, Zhang J, Gao X, Bayliss C, Song W, Stuckey D, Dyer E, Leung MC, Monserrat L, Marston S, Sorriento D, Santulli G, Fusco A, Trimarco B, Iaccarino G, Revnic C, Ginghina C, Revnic F, Paillard M, Liang J, Strub G, Gomez L, Hait N, Allegood J, Lesnefsky E, Spiegel S, Zuchi C, Coiro S, 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Sunday, 18 July 2010. Cardiovasc Res 2010. [DOI: 10.1093/cvr/cvq176] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Weber-Carstens S, Deja M, Koch S, Spranger J, Bubser F, Wernecke KD, Spies CD, Spuler S, Keh D. Risk factors in critical illness myopathy during the early course of critical illness: a prospective observational study. Crit Care 2010; 14:R119. [PMID: 20565863 PMCID: PMC2911767 DOI: 10.1186/cc9074] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 04/20/2010] [Accepted: 06/18/2010] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Non-excitable muscle membrane indicates critical illness myopathy (CIM) during early critical illness. We investigated predisposing risk factors for non-excitable muscle membrane at onset of critical illness. METHODS We performed sequential measurements of muscle membrane excitability after direct muscle stimulation (dmCMAP) in 40 intensive care unit (ICU) patients selected upon a simplified acute physiology (SAPS-II) score >OR= 20 on 3 successive days within 1 week after ICU admission. We then investigated predisposing risk factors, including the insulin-like growth factor (IGF)-system, inflammatory, metabolic and hemodynamic parameters, as well as suspected medical treatment prior to first occurrence of abnormal dmCMAP. Nonparametric analysis of two-factorial longitudinal data and multivariate analysis were used for statistical analysis. RESULTS 22 patients showed abnormal muscle membrane excitability during direct muscle stimulation within 7 (5 to 9.25) days after ICU admission. Significant risk factors for the development of impaired muscle membrane excitability in univariate analysis included inflammation, disease severity, catecholamine and sedation requirements, as well as IGF binding protein-1 (IGFBP-I), but did not include either adjunctive hydrocortisone treatment in septic shock, nor administration of neuromuscular blocking agents or aminoglycosides. In multivariate Cox regression analysis, interleukin-6 remained the significant risk factor for the development of impaired muscle membrane excitability (HR 1.006, 95%-CI (1.002 to 1.011), P = 0.002). CONCLUSIONS Systemic inflammation during early critical illness was found to be the main risk factor for development of CIM during early critical illness. Inflammation-induced impairment of growth-factor mediated insulin sensitivity may be involved in the development of CIM.
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Affiliation(s)
- Steffen Weber-Carstens
- Clinic of Anesthesiology and Intensive Care Medicine, Charité University Medicine, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Deja M, Ahlers O, Macguill M, Wust P, Hildebrandt B, Riess H, Kerner T. Changes in hepatic blood flow during whole body hyperthermia. Int J Hyperthermia 2010; 26:95-100. [PMID: 20146563 DOI: 10.3109/02656730903250574] [Citation(s) in RCA: 17] [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: 02/06/2023] Open
Abstract
PURPOSE Changes in blood flow distribution are important for heat dispersion and for supportive therapeutic strategies such as simultaneous whole body hyperthermia (WBH) and administration of chemotherapy. The aim of this clinical study was to determine changes in hepatic blood flow during WBH for the treatment of metastatic cancer. MATERIALS AND METHODS This observational clinical study was part of a phase I/II feasibility study of WBH. WBH was induced using a radiant heat device. Hepatic blood flow was estimated using indocyanine green clearance measurements. The plasma disappearance rate of indocyanine green (PDR-ICG) was recorded in percent/min. We used an invasive thermo-dye-dilution technique to estimate hepatic blood flow, cardiac output, and volume status. Mean arterial blood pressure was also measured invasively. To determine the effects of hyperthermia the measurements were performed at defined temperature points. RESULTS In 10 of 22 treatments the PDR-ICG fell below normal values during hyperthermia, which represented a significant fall in hepatic blood flow. Cardiac output, volume status, and mean arterial blood pressure did not differ between patients whose liver blood flow was reduced and those whose liver blood flow remained unchanged. CONCLUSIONS We observed distinct reductions in hepatic blood flow during WBH, which suggested a significant redistribution of blood flow away from the core during WBH. This was not mirrored by global circulatory parameters.
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Affiliation(s)
- Maria Deja
- Department of Anaesthesiology and Intensive Care Medicine, Charite-Universitätsmedizin Berlin, Germany.
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