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Neuwersch-Sommeregger S, Köstenberger M, Sandner-Kiesling A, Fürstner M, Igerc I, Trummer B, Wuntschek J, Pipam W, Stettner H, Likar R, Feigl G. Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion: MRI-Verified Solution Spread. Pain Ther 2024:10.1007/s40122-024-00596-4. [PMID: 38662320 DOI: 10.1007/s40122-024-00596-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Ganglionic local opioid analgesia (GLOA) at the superior cervical ganglion (SCG) is performed for pain control and is known to be an effective procedure. In this study, we evaluated the spread of the injectate in the area of the SCG. Our expectation was that there would be a correlation between the area and volume of the injectate spread and post-procedural outcome measures. METHODS This was a retrospective blinded review of magnetic resonance imaging (MRI) scans. Assessors evaluated the anatomical area of fluid spread, the furthermost spread from midline, any hampered spread and contact of contrast fluid with other structures. The efficacy of GLOA and complications were estimated. RESULTS The main solution spread reached from the C1 to C3 vertebrae. The furthest spread in the lateral and sagittal planes was 21.2 and 15.2 mm, respectively. The furthest craniocaudal spread was 63.5 mm. In 53.3% and 33% of interventions, the solution was found in the parapharyngeal space and in its "medial compartment," respectively. A correlation was found between pain relief and both solution spread and volume of solution spread. No hampered spread was recorded. A negative correlation between pain reduction and number of GLOA was observed. Higher pre-procedural pain intensity was correlated with higher pain reduction. We estimated pain relief in 93% of procedures correctly. No correlation between post-procedural Numerical Rating Scale (NRS) scores and different needle approaches was found. CONCLUSION For the transoral blocking technique, a strict laterodorsal needle direction is recommended to prevent possible block failures. A total volume of 2 ml injected into the parapharyngeal space and its "medial compartment" is recommended. Higher volumes may lead to uncontrolled distribution patterns. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT05257655; date of registration 2022-02-25; patient enrollment date from 2023-01-09 to 2023-08-31.
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Affiliation(s)
- Stefan Neuwersch-Sommeregger
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
- University of Medicine, Graz, Austria
| | - Markus Köstenberger
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria.
- University of Medicine, Graz, Austria.
| | | | - Matthias Fürstner
- Institute of Interventional and Diagnostic Radiology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Isabel Igerc
- Institute of Interventional and Diagnostic Radiology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Brigitte Trummer
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Jessica Wuntschek
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Wolfgang Pipam
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Haro Stettner
- Department of Statistics, Alpen-Adria University Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Rudolf Likar
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
- Sigmund Freud University, Vienna, Austria
| | - Georg Feigl
- Institute of Anatomy and Clinical Morphology, Witten/Herdecke University, Witten, Germany
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Likar R, Köstenberger M. [Developments in anesthesia : Thinking outside the box is worthwhile!]. Anaesthesiologie 2024; 73:221-222. [PMID: 38625540 DOI: 10.1007/s00101-024-01399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Rudolf Likar
- Abteilung für Anästhesiologie, allgemeine Intensivmedizin, Notfallmedizin, interdisziplinäre Schmerztherapie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Landeskrankenanstalten-Betriebsgesellschaft - KABEG, Klagenfurt am Wörthersee, Österreich
| | - Markus Köstenberger
- Abteilung für Anästhesiologie, allgemeine Intensivmedizin, Notfallmedizin, interdisziplinäre Schmerztherapie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Landeskrankenanstalten-Betriebsgesellschaft - KABEG, Klagenfurt am Wörthersee, Österreich.
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Neuwersch-Sommeregger S, Köstenberger M, Pipam W, Demschar S, Trummer B, Breschan C, Likar R. Pain in Austrian hospitals: evaluation of 1089 in-patients. Wien Med Wochenschr 2024; 174:69-78. [PMID: 36441358 DOI: 10.1007/s10354-022-00984-5] [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: 02/25/2022] [Accepted: 10/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite the existence of internationally consistent guidelines for the management of pain, efficient regional anesthesia techniques, safe pain medications, and organizational structures, e.g., acute pain services, various studies have shown that pain is still common among both surgical and non-surgical in-patients. OBJECTIVE The primary objective of this study was to evaluate, on a multi-center basis, the point pain prevalence of surgical and non-surgical in-patients. We further analyzed pain intensities, in-hospital pain triggers, pain-related impairments, pain assessments, patient information about pain, and patient satisfaction with pain therapy. This benchmark information should lead to better implementation of pain management strategies and thus improve health care quality. METHODS We surveyed all adult in-patients in three general hospitals in Austria (general hospital Klagenfurt am Wörthersee, general hospital Villach, general hospital Wolfsberg) on the index day with two standardized questionnaires for both surgical and non-surgical patients. RESULTS Overall, a pain prevalence of 40.0%, with no statistically significant difference between surgical and non-surgical patients, was shown. Higher pain prevalence in female patients, high pain prevalence in the age group 18-30 years, and highest pain prevalence in the age group over 90 years old was found. Overall pain intensity was relatively low, but unacceptable maximum pain within the preceding 24 h was shown. Different in-hospital pain triggers like patient's care and mobilization were found. Our survey has shown that pain has an impact on personal hygiene, mobilization, mood, sleep, and appetite. However, patients were very satisfied with their pain therapy. CONCLUSION Medical staff and nurses have to be sensitized to the urgent need to improve pain management strategies.
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Affiliation(s)
- Stefan Neuwersch-Sommeregger
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria.
- Medical University of Graz, Graz, Austria.
| | - Markus Köstenberger
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
- Medical University of Graz, Graz, Austria
| | - Wolfgang Pipam
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Susanne Demschar
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Brigitte Trummer
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Christian Breschan
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
- Medical University of Graz, Graz, Austria
| | - Rudolf Likar
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Clinic Center Klagenfurt, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria
- Paracelsus Medical University, Salzburg, Austria
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Likar R, Aroyo I, Bangert K, Degen B, Dziewas R, Galvan O, Grundschober MT, Köstenberger M, Muhle P, Schefold JC, Zuercher P. Management of swallowing disorders in ICU patients - A multinational expert opinion. J Crit Care 2024; 79:154447. [PMID: 37924574 DOI: 10.1016/j.jcrc.2023.154447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization. PURPOSE To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights. METHODS A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed. RESULTS The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU. CONCLUSIONS Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
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Affiliation(s)
- Rudolf Likar
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria
| | - Ilia Aroyo
- Department of Neurology and Neurointensive Care Medicine, Klinikum Darmstadt, Germany
| | - Katrin Bangert
- Clinic for Intensive Care Medicine, University Hospital Hamburg, Germany
| | - Björn Degen
- Clinic for Intensive Medicine, Dysphagia Centre, Vienna, Austria
| | - Rainer Dziewas
- Department of Neurology and Neurological Rehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Oliver Galvan
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Markus Köstenberger
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria; Department for Anaesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria.
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Likar R, Perruchoud C, Kampusch S, Köstenberger M, Sator S, Stremnitzer C, Wolf A, Neuwersch-Sommeregger S. [Clinical efficacy of auricular vagus nerve stimulation in the treatment of chronic and acute pain : A systematic review]. Schmerz 2023:10.1007/s00482-022-00686-2. [PMID: 36592212 DOI: 10.1007/s00482-022-00686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Current guidelines recommend a personalized, multimodal, and interdisciplinary approach for the treatment of chronic pain. Already in the acute treatment of postoperative pain, it can be useful to minimize risk factors for chronification. Auricular vagus nerve stimulation (aVNS) could be an effective non-drug therapy for the treatment of chronic and acute pain. AIM OF THE WORK The aim of this systematic review is to evaluate the clinical efficacy of aVNS in chronic and acute pain as well as its effect on medication intake. MATERIALS AND METHODS A systematic literature search was carried out on the application of auricular electrical stimulation in chronic and acute pain. Studies were classified according to their level of evidence and evaluated via the Jadad scale as well as their scientific validity, and then analyzed in terms of indication, method, stimulation parameters, duration of treatment, efficacy, and safety. RESULTS Twenty studies on chronic pain indications, ten studies on acute postoperative pain, as well as seven studies on experimental acute pain were identified and analyzed. The search revealed a total of n = 1105 aVNS-treated patients. The best evidence on the efficacy of aVNS is available for the indications chronic low back pain, chronic cervical syndrome, chronic abdominal pain, and chronic migraine as well as acute postoperative pain in oocyte aspiration, laparoscopic nephrectomy, and open colorectal surgery. Additionally a significant reduction in analgesic or opiate intake was evident in most studies. In three randomized controlled trials in chronic pain patients, a sustainable pain reduction over a period of up to 12 months was shown. Overall, aVNS was very well tolerated. CONCLUSION This review indicates that aVNS can be a complementary and effective non-drug treatment for patients with chronic and acute postoperative pain. Future studies in these indications should focus on standardizing and optimizing treatment parameters, inclusion of quality-of-life outcome parameters, and longer follow-up periods to better understand the sustainable therapeutic effect of aVNS.
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Affiliation(s)
- Rudolf Likar
- Abteilung für Anästhesiologie und Intensivmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt, Österreich.
- Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
| | | | | | - Markus Köstenberger
- Abteilung für Anästhesiologie und Intensivmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt, Österreich
| | - Sabine Sator
- Universitätsklinik für Anästhesie, allgemeine Intensivmedizin und Schmerztherapie, Medizinische Universität Wien, Wien, Österreich
| | | | - Andreas Wolf
- Abteilung für Anästhesie, Krankenhaus St. Vinzenz Zams, Zams, Österreich
| | - Stefan Neuwersch-Sommeregger
- Abteilung für Anästhesiologie und Intensivmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt, Österreich
- Medizinische Universität Graz, Graz, Österreich
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6
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Neuwersch-Sommeregger S, Köstenberger M, Stettner H, Pipam W, Breschan C, Egger M, Kraschl J, Fürstner M, Likar R, Feigl G. Computed Tomography-Guided Coeliac Plexus Neurolysis in Palliative in-Patients with Intra-Abdominal Malignancy: Retrospective Evaluation of Neurolytic Solution Spread as a Predictive Factor. Pain Ther 2022; 11:1229-1243. [PMID: 35953656 PMCID: PMC9633888 DOI: 10.1007/s40122-022-00423-8] [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: 07/05/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Computed tomography (CT)-guided coeliac plexus neurolysis (CPN) is considered effective at controlling pain in patients with intra-abdominal malignancies. The primary objective was to correlate pain outcomes with the spread of neurolytic solution in the coeliac area and to evaluate the predictive value for the spread of injectate for pain outcomes and side effects. METHODS Blinded CT scans were reviewed. The coeliac area was divided into nine quadrants. Assessors evaluated quadrants according to contrast spread, needle tip position, and the contact between the injectate and other organs and plexuses. Efficacy of CPN and complications were estimated. RESULTS In 54.9% there was complete spread of the neurolytic in the coeliac area with no correlation between pain relief and spread of injectate. In 85% the neurolytic had contact with viscera with no correlation with pain relief or complications. There was no correlation between needle tip position and spread of the neurolytic and contact of the neurolytic with viscera. In 71.6% the injectate was found to have spread into "other" plexuses. In 13.3% hampered spread of the injectate was observed. There was no correlation between patterns of injectate spread and pain relief, pain relief and spread of injectate in any particular quadrants, and expected and documented post-procedural pain scores. CONCLUSIONS Based on the spread of contrast medium clinicians can neither correctly anticipate the pain relief or post-procedural NRS, nor the duration of pain relief and complications. It is not essential to have the perfect sickle-shaped spread of the injectate for adequate pain control.
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Affiliation(s)
- Stefan Neuwersch-Sommeregger
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria.,Medical University of Graz, Graz, Austria
| | - Markus Köstenberger
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria. .,Medical University of Graz, Graz, Austria.
| | - Haro Stettner
- Department of Statistics, Alpen-Adria University Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Wofgang Pipam
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Christian Breschan
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria.,Medical University of Graz, Graz, Austria
| | - Markus Egger
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Jakob Kraschl
- Department of Neurosurgery, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Matthias Fürstner
- Institute of Interventional and Diagnostic Radiology, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Rudolf Likar
- Centre for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria.,Sigmund Freud University Vienna, Vienna, Austria
| | - Georg Feigl
- Institute for Anatomy and Clinical Morphology, Witten/Herdecke University, Witten, Germany
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Sallmon H, Kramer P, Avian A, Gamillscheg A, Cvirn G, Schweintzger S, Kurath-Koller S, Cantinotti M, Berger F, Köstenberger M. Right Ventricular Wall Tension in the Assessment of Pediatric Pulmonary Arterial Hypertension. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- H. Sallmon
- Deutsches Herzzentrum Berlin (DHZB), Berlin, Deutschland
| | - P. Kramer
- Deutsches Herzzentrum Berlin (DHZB), Berlin, Deutschland
| | - A. Avian
- Medical University of Graz, Graz, Austria
| | | | - G. Cvirn
- Medical University of Graz, Graz, Austria
| | | | | | - M. Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - F. Berger
- Deutsches Herzzentrum Berlin (DHZB), Berlin, Deutschland
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Hansmann G, Hasan H, Diekmann F, Köstenberger M, Chouvarine P. Validation of the New EPPVDN Pediatric Pulmonary Hypertension Risk Score by Cardiac Magnetic Resonance Imaging and Speckle Tracking Echocardiography. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- G. Hansmann
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - H. Hasan
- Pädiatrische kardiologie und intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - F. Diekmann
- Pädiatrische kardiologie und intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - M. Köstenberger
- Pädiatrische kárdiologie, Medizinische Universität Graz, Graz, Austria
| | - P. Chouvarine
- Pediatric Cardiology and Critical Care, Medizinische Hochschule Hannover, Hannover, Deutschland
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Köstenberger M, Hasibeder W, Dankl D, Eisenburger P, Germann R, Grander W, Hörmann C, Joannidis M, Markstaller K, Müller-Muttonen SO, Neuwersch-Sommeregger S, Pfausler B, Schindler O, Schittek G, Schaden E, Staudinger T, Ullrich R, Urban M, Valentin A, Likar R. Update SARS-CoV-2 Behandlungsempfehlungen für die Intensivmedizin. Anästhesie Nachr 2022. [PMCID: PMC8856728 DOI: 10.1007/s44179-022-00019-9] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Markus Köstenberger
- Klagenfurt, Österreich
- Abteilung für Anästhesiologie und Intensivmedizin, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Österreich
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Neuwersch-Sommeregger S, Köstenberger M, Stettner H, Pipam W, Breschan C, Feigl G, Likar R, Egger M. CT-Guided Coeliac Plexus Neurolysis in Patients with Intra-Abdominal Malignancy: A Retrospective Evaluation of 52 Palliative In-Patients. Pain Ther 2021; 10:1593-1603. [PMID: 34546553 PMCID: PMC8586091 DOI: 10.1007/s40122-021-00317-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Prevalence rates of chronic abdominal pain (CAP) and breakthrough cancer pain (BTcP) are high in patients with intra-abdominal malignancies. As part of a multimodal approach, CT-guided coeliac plexus blockade (CPB) and CT-guided coeliac plexus neurolysis (CPN) are commonly used pain management strategies. The aim of this study was to evaluate pain outcomes among patients with intra-abdominal malignancies who underwent CPB and/or CPN. METHODS Patients with intra-abdominal malignancies who underwent CPB and/or CPN for pain control at the general hospital Klagenfurt am Wörthersee from 2010 to 2019 were enrolled. RESULTS A total of 84 procedures (24 CPB and 60 CPN) were performed on 52 patients; 62% of these patients had pancreatic cancer. CPN led to significant pain reduction and decreased BTcP intensity. Patients receiving repeated CPN showed higher individual pain reduction. Higher pre-procedural pain intensity was correlated with higher pain reduction. No difference in pain reduction in patients receiving a diagnostic CPB prior to CPN compared to patients without a diagnostic CPB was found. Higher pain reduction after CPN led to longer-lasting pain relief. The time frame from diagnosis to CPN was 472 (± 416) days. Patients experienced a mean duration of pain prior to CPN of 330 (± 53) days. The time frame from diagnosis to CPN was shorter in patients with pancreatic cancer compared to other intra-abdominal malignancies. In 58% of patients pain medication was stable or was reduced after CPN; 16% of patients complained about pain during the procedure; no major complications occurred. There was no correlation between median survival after CPN and pain outcomes. CONCLUSIONS In patients with intra-abdominal malignancy-related CAP, CPN is a safe and effective procedure which can provide long-lasting significant relief of background pain and BTcP. As part of a multimodal approach, CPN should be considered as an earlier option for pain management in these patients.
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Affiliation(s)
- Stefan Neuwersch-Sommeregger
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria.
- Medical University of Graz, Graz, Austria.
| | - Markus Köstenberger
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
- Medical University of Graz, Graz, Austria
| | - Haro Stettner
- Department of Statistics, Alpen-Adria University Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Wofgang Pipam
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Christian Breschan
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
- Medical University of Graz, Graz, Austria
| | - Georg Feigl
- Institute for Anatomy and Clinical Morphology, Witten/Herdecke University, Witten, Germany
| | - Rudolf Likar
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Markus Egger
- Center for Interdisciplinary Pain Therapy, Oncology and Palliative Care, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020, Klagenfurt am Wörthersee, Austria
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Schittek GA, Köstenberger M, Allerberger F, Schaden E. Web-based survey of the importance and effectiveness of personal protective equipment during the COVID-19 pandemic. Intensive Crit Care Nurs 2020; 63:102996. [PMID: 33342653 PMCID: PMC7713545 DOI: 10.1016/j.iccn.2020.102996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Gregor A Schittek
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, University Hospital of Graz, Austria.
| | | | - Franz Allerberger
- Division of Public Health at the Austrian Agency for Health and Food Safety, Spargelfeldstraße 191, 1220 Vienna, Austria
| | - Eva Schaden
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria; Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, Bauteil 86, 2. Stock, 1090 Vienna, Austria
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Köstenberger M, Hasibeder W, Dankl D, Germann R, Hörmann C, Joannidis M, Markstaller K, Müller-Muttonen SO, Neuwersch-Sommeregger S, Schaden E, Staudinger T, Ullrich R, Valentin A, Likar R. SARS-CoV-2: recommendations for treatment in intensive care medicine. Wien Klin Wochenschr 2020; 132:664-670. [PMID: 32948888 PMCID: PMC7500247 DOI: 10.1007/s00508-020-01734-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) progresses mildly in most of the cases; however, about 5% of the patients develop a severe acute respiratory distress syndrome (ARDS). Of all COVID-19 patients 3% need intensive care treatment, which becomes a great challenge for anesthesiology and intensive care medicine, medically, hygienically and for technical safety requirements. For these reasons, only experienced medical and nursing staff in the smallest grouping possible should be assigned. For these team members, a consistent use of personal protective equipment (PPE) is essential. Due to the immense medical challenges, the following treatment guidelines were developed by the ÖGARI (Österreichische Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin), FASIM (Federation of Austrian Societies of Intensive Care Medicine) and ÖGIAIN (Österreichische Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin). The recommendations given in this article are to be understood as short snapshots of the moment; all basic guidelines are works in progress and will be regularly updated as evidence levels, new study results and additional experience are gathered.
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Affiliation(s)
- Markus Köstenberger
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria.
| | - Walter Hasibeder
- Department of Anaesthesiology and Critical Care Medicine, Hospital Zams, Zams, Austria
| | - Daniel Dankl
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Reinhard Germann
- Department of Anaesthesiology and Critical Care Medicine, Hospital Feldkirch, Feldkirch, Austria
| | - Christoph Hörmann
- Department of Anaesthesiology an Critical Care Medicine, University Hospital St. Pölten, St. Pölten, Austria
| | - Michael Joannidis
- University Hospital Innsbruck, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Markstaller
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Stefan Neuwersch-Sommeregger
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Eva Schaden
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- Department of Internal and Critical Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Roman Ullrich
- Department of Internal and Critical Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Valentin
- Department of Internal and Critical Care Medicine, Hospital Schwarzach, Schwarzach, Austria
| | - Rudolf Likar
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
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Köstenberger M, Diegelmann S, Terlutter R, Bidmon S, Neuwersch S, Likar R. Advance directives in Austrian intensive care units: An analysis of prevalence and barriers. Resusc Plus 2020; 3:100014. [PMID: 34223298 PMCID: PMC8244481 DOI: 10.1016/j.resplu.2020.100014] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/20/2020] [Accepted: 06/16/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the prevalence of advance directives, healthcare proxies, and legal representatives in Austrian intensive care units (ICUs), and to explore barriers faced by adults engaged in the contemplation and documentation phase of the advance care planning process. Methods Two studies were conducted: (1) A 4-week multicenter study covering seven Austrian ICUs. A retrospective chart review of 475 patients who presented to the ICUs between 1 January 2019 and 31 January 2019 was conducted. (2) An interview and focus group study with 12 semi-structured expert interviews and three focus groups with 21 adults was performed to gain insights into potential barriers faced by Austrian adults planning medical decisions in advance. Results Of the 475 ICU patients, 3 (0.6%) had an advance directive, 4 (0.8%) had a healthcare proxy, and 7 (1.5%) had a legal guardian. Despite the low prevalence rates, patients and relatives reacted positively to the question of whether they had an advance directive. Patients older than 55 years and patients with children reacted significantly more positively than younger patients and patients without children. The interviews and focus groups revealed important barriers that prevent adults in Austria from considering planning in advance for potentially critical health states. Conclusion The studies show low prevalence rates of healthcare documents in Austrian ICUs. However, when patients were asked about an advance directive, reactions indicated positive attitudes. The gap between positive attitudes and actual document completion can be explained by multiple barriers that exist for adults in Austria when it comes to planning for potential future incapacity.
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Affiliation(s)
- Markus Köstenberger
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria.,Medical University of Graz, Austria
| | - Svenja Diegelmann
- Department of Marketing and International Management, Alpen-Adria-Universität Klagenfurt, Universitätsstraße 65-67, 9020, Klagenfurt am Wörthersee, Austria
| | - Ralf Terlutter
- Department of Marketing and International Management, Alpen-Adria-Universität Klagenfurt, Universitätsstraße 65-67, 9020, Klagenfurt am Wörthersee, Austria
| | - Sonja Bidmon
- Department of Marketing and International Management, Alpen-Adria-Universität Klagenfurt, Universitätsstraße 65-67, 9020, Klagenfurt am Wörthersee, Austria
| | - Stefan Neuwersch
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
| | - Rudolf Likar
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Austria
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Köstenberger M, Reiterer F, Meinel K, Avian A, Sallmon H, Kurath-Koller S, Grangl G, Burmas A, Schweintzger S, Hansmann G. Extremely Low Gestational Age Newborns (ELGANs) have a Substantial Risk for Chronic Pulmonary Hypertension at 3 and 12 Months of Corrected Gestational Age. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Neuwersch-Sommeregger S, Köstenberger M, Pipam W, Breschan C, Stettner H, Demschar S, Trummer B, Likar R. [Electrical muscle stimulation in combination with heat for patients with chronic, nonspecific low back pain : A randomized, double-blind, stratified, placebo-controlled clinical trial]. Schmerz 2019; 34:65-73. [PMID: 31784906 DOI: 10.1007/s00482-019-00431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic non-specific low back pain (LBP) causes more disability than any other medical condition worldwide. Electrical muscle stimulation in combination with heat (EMS/H) for management of LBP has yet not been properly studied. Our hypothesis was that EMS/H provides better pain relief and improves subjective and objective data compared to standard treatment. METHODS Between 2015 and 2017, we conducted a 6 week randomized, double-blind, stratified, placebo controlled clinical trial, comparing two different forms of EMS/H with placebo treatment with a follow-up 12 weeks after randomization. Patients >18 years with LBP for >6 months and a pain intensity of numerical rating scale (NRS) ≥4/10 were enrolled. RESULTS A total of 100 patients were recruited. Patients were representative of a LBP population with moderate to severe pain (NRS 5.7/10). After 18 treatments, we found a statistically significant pain reduction, which was also observed at the 12 week follow-up. CONCLUSION EMS/H is an effective and safe method for managing LBP. A clinically relevant and persisting pain reduction, a stable decrease in self-perceived disability, an improvement in both mood and affective characterization as well as sensory characterization of pain, muscle strength and endurance may have a significant impact on the management of LBP.
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Affiliation(s)
- Stefan Neuwersch-Sommeregger
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich.
- Medizinische Universität Graz, Graz, Österreich.
| | - Markus Köstenberger
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
- Medizinische Universität Graz, Graz, Österreich
| | - Wolfgang Pipam
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - Christian Breschan
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - Haro Stettner
- Institut für Statistik, Alpen-Adria-Universität Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Österreich
| | - Susanne Demschar
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - Brigitte Trummer
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - Rudolf Likar
- Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
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Oratsch C, Pipam W, Köstenberger M, Apich G, Likar R. [Treatment for chronic back pain? : Active multimodal, interdisciplinary pain therapy vs. physiotherapy-physical therapy for chronic back pain]. Schmerz 2019; 33:337-346. [PMID: 31098706 DOI: 10.1007/s00482-019-0379-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In industrialized countries, chronic back pain is referred to as the "number one common disease". OBJECTIVES Are there any indications of different outcomes of chronic back pain patients when treated with a multimodal, interdisciplinary pain therapy (MMSTh) compared to physiotherapy-physical therapy? MATERIALS AND METHODS Entrance and final examination by means of survey, questionnaires and physical tests in the intervention and control group, evaluation and comparison of the results. RESULTS The intervention group showed very significant improvements in all tests. In contrast, the control group achieved only partial improvements in physical parameters and quality of life. This resulted in clear group differences in favor of the MMSTh. In terms of patient satisfaction, the control group showed a better result than the intervention group. CONCLUSIONS Treatment with MMSTh is superior to standard physiotherapy-physical. Due to the extensive, proven positive effect on many pain-causing and pain-preserving factors, multimodal pain centers should be used more frequently in chronic back pain patients.
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Affiliation(s)
- C Oratsch
- Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich.
| | - W Pipam
- Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - M Köstenberger
- Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - G Apich
- Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
| | - R Likar
- Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, 9020, Klagenfurt am Wörthersee, Österreich
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Likar R, Pipam W, Neuwersch S, Köstenberger M, Pinter G, Gatternig C, Marksteiner J. [Pain measurement in cognitively impaired patients with the Doloshort scale]. Schmerz 2017; 29:440-4. [PMID: 26024644 DOI: 10.1007/s00482-015-0006-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Until recently the measurement of pain in cognitively impaired patients represented a neglected field in the diagnostics and treatment of pain. Investigations indicate a prevalence of pain in nursing home residents of between 45 % and 80 %. MATERIAL AND METHODS This study investigated the reliability of the German translation of the Doloshort scale and compared it with the visual analog scale (VS). The aim of this study was to determine the practical applicability of this scale in the clinical routine and to calculate the intrarater reliability (retest) and interrater reliability. RESULTS The interrater and intrarater reliability of the Doloshort scale was between 0.949 and 0.970. There was a highly significant correlation between the values of the Doloshort scale and the VAS. CONCLUSION The Doloshort scale is a well suited measurement instrument for the evaluation of pain in cognitively impaired patients. Because of the short form only simple instructions are necessary and it has a high acceptance with users.
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Affiliation(s)
- R Likar
- Abteilung für Anästhesie und Allgemeine Intensivmedizin, Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Österreich,
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Rödl S, Marschitz I, Mache CJ, Köstenberger M, Madler G, Rehak T, Zobel G. Erste klinische Erfahrungen hinsichtlich der Nierenersatztherapie mit dem Prismaflex HF 20 Set bei vier Säuglingen und Kleinkindern. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rödl S, Marschitz I, Rehak T, Mache CJ, Köstenberger M, Madler G, Zobel G. Hemodiafiltration bei Säuglingen mit terminalem Nierenversagen und Komplikationen der Peritonealdialyse. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Heinzl B, Köstenberger M, Boysen A, Nagel B, Beitzke A, Gamillscheg A. Chest pain in a 15-year-old girl (Case Presentation). Acta Paediatr 2009; 98:1549; discussion 1696-8. [PMID: 19843020 DOI: 10.1111/j.1651-2227.2009.01414.x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- B Heinzl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria.
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Abstract
UNLABELLED In neonates, despite poor platelet function in various in vitro tests, closure times (CTs) in PFA-100 measurements are shorter than in adults. Neonates have a higher polymeric von Willebrand factor (vWF). They also have a higher haematocrit and higher white blood cell count than adults. which may interfere with the evaluation of platelet and vWF function by means of the PFA-100 in neonates. To assess the role of different blood constituents on neonatal CTs, red blood cell, platelet and white blood cell counts in cord blood were modified. These modifications did not provide any evidence that the difference in number between adult and neonatal blood cells was responsible for shorter neonatal CTs. In further experiments, platelets and/or vWF were inhibited by means of abciximab and anti-vWF antibody, and mixing experiments with neonatal platelet-rich and platelet-poor plasma were performed. The results showed that short cord blood PFA-100 CTs were caused by a constituent of neonatal platelet-poor plasma, probably the neonatal high multimeric vWF. CONCLUSION This study demonstrates that CTs in neonates are dependent on the same components, platelets and vWF, as in adults, making it likely that the PFA-100 can be used in neonates in the same way as in adults to investigate platelet and vWF function.
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Affiliation(s)
- B Roschitz
- Department of Pediatrics, Karl-Franzens University of Graz, Austria
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