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Buschulte K, Kabitz HJ, Hagmeyer L, Hammerl P, Esselmann A, Wiederhold C, Skowasch D, Stolpe C, Joest M, Veitshans S, Höffgen M, Maqhuzu P, Schwarzkopf L, Hellmann A, Pfeifer M, Behr J, Karpavicius R, Günther A, Polke M, Höger P, Somogyi V, Lederer C, Markart P, Kreuter M. Disease trajectories in interstitial lung diseases - data from the EXCITING-ILD registry. Respir Res 2024; 25:113. [PMID: 38448953 PMCID: PMC10919020 DOI: 10.1186/s12931-024-02731-3] [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: 01/02/2024] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Interstitial lung diseases (ILD) comprise a heterogeneous group of mainly chronic lung diseases with different disease trajectories. Progression (PF-ILD) occurs in up to 50% of patients and is associated with increased mortality. METHODS The EXCITING-ILD (Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases) registry was analysed for disease trajectories in different ILD. The course of disease was classified as significant (absolute forced vital capacity FVC decline > 10%) or moderate progression (FVC decline 5-10%), stable disease (FVC decline or increase < 5%) or improvement (FVC increase ≥ 5%) during time in registry. A second definition for PF-ILD included absolute decline in FVC % predicted ≥ 10% within 24 months or ≥ 1 respiratory-related hospitalisation. Risk factors for progression were determined by Cox proportional-hazard models and by logistic regression with forward selection. Kaplan-Meier curves were utilised to estimate survival time and time to progression. RESULTS Within the EXCITING-ILD registry 28.5% of the patients died (n = 171), mainly due to ILD (n = 71, 41.5%). Median survival time from date of diagnosis on was 15.5 years (range 0.1 to 34.4 years). From 601 included patients, progression was detected in 50.6% of the patients (n = 304) with shortest median time to progression in idiopathic NSIP (iNSIP; median 14.6 months) and idiopathic pulmonary fibrosis (IPF; median 18.9 months). Reasons for the determination as PF-ILD were mainly deterioration in lung function (PFT; 57.8%) and respiratory hospitalisations (40.6%). In multivariate analyses reduced baseline FVC together with age were significant predictors for progression (OR = 1.00, p < 0.001). Higher GAP indices were a significant risk factor for a shorter survival time (GAP stage III vs. I HR = 9.06, p < 0.001). A significant shorter survival time was found in IPF compared to sarcoidosis (HR = 0.04, p < 0.001), CTD-ILD (HR = 0.33, p < 0.001), and HP (HR = 0.30, p < 0.001). Patients with at least one reported ILD exacerbation as a reason for hospitalisation had a median survival time of 7.3 years (range 0.1 to 34.4 years) compared to 19.6 years (range 0.3 to 19.6 years) in patients without exacerbations (HR = 0.39, p < 0.001). CONCLUSION Disease progression is common in all ILD and associated with increased mortality. Most important risk factors for progression are impaired baseline forced vital capacity and higher age, as well as acute exacerbations and respiratory hospitalisations for mortality. Early detection of progression remains challenging, further clinical criteria in addition to PFT might be helpful.
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Affiliation(s)
- Katharina Buschulte
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.
| | - Hans-Joachim Kabitz
- Medical Clinic II, Pneumology and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Lars Hagmeyer
- Clinic of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen, Solingen, Germany
| | | | | | | | - Dirk Skowasch
- Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | | | - Marcus Joest
- Outpatient center for pulmonology and allergology, Bonn, Germany
| | | | - Marc Höffgen
- Outpatient center for pulmonology, Rheine, Germany
| | - Phillen Maqhuzu
- Institute of Health Economics and Healthcare Management, Helmholtz Center Munich GmbH, German Research Center for Environmental Health, German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPCM), Neuherberg, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Healthcare Management, Helmholtz Center Munich GmbH, German Research Center for Environmental Health, German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPCM), Neuherberg, Germany
- IFT Institut für Therapieforschung, Center for Mental Health and Addiction Research, Munich, Germany
| | | | - Michael Pfeifer
- Medical Clinic II, University of Regensburg and Klinikum Donaustauf, Donaustauf, Germany
| | - Jürgen Behr
- Department of Medicine V, Comprehensive Pneumology Center, LMU University Hospital, LMU Munich, German Center for Lung Research (DZL), Munich, Germany
| | | | - Andreas Günther
- Medical Clinic II, University Hospital Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Giessen, Germany
- Pulmonary and Critical Care Medicine, Agaplesion Evangelisches Krankenhaus Mittelhessen, Giessen, Germany
| | - Markus Polke
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Philipp Höger
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Vivien Somogyi
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, ZfT, Mainz University Medical Center and of Pulmonary Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| | - Christoph Lederer
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Philipp Markart
- Pulmonary and Critical Care Medicine, Agaplesion Evangelisches Krankenhaus Mittelhessen, Giessen, Germany
- Medical Clinic V (Pneumology), Cardiothoracic Center, University Medicine Marburg, Campus Fulda, Fulda, Germany
| | - Michael Kreuter
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, ZfT, Mainz University Medical Center and of Pulmonary Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany.
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Skowasch D, Bonella F, Buschulte K, Kneidinger N, Korsten P, Kreuter M, Müller-Quernheim J, Pfeifer M, Prasse A, Quadder B, Sander O, Schupp JC, Sitter H, Stachetzki B, Grohé C. [Therapeutic Pathways in Sarcoidosis. A Position Paper of the German Society of Respiratory Medicine (DGP)]. Pneumologie 2024; 78:151-166. [PMID: 38408486 DOI: 10.1055/a-2259-1046] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
The present recommendations on the therapy of sarcoidosis of the German Respiratory Society (DGP) was written in 2023 as a German-language supplement and update of the international guidelines of the European Respiratory Society (ERS) from 2021. It contains 5 PICO questions (Patients, Intervention, Comparison, Outcomes) agreed in the consensus process, which are explained in the background text of the four articles: Confirmation of diagnosis and monitoring of the disease under therapy, general therapy recommendations, therapy of cutaneous sarcoidosis, therapy of cardiac sarcoidosis.
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Affiliation(s)
- Dirk Skowasch
- Medizinische Klinik und Poliklinik II - Sektion Pneumologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland
| | - Katharina Buschulte
- Zentrum für seltene und interstitielle Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg und Deutsches Zentrum für Lungenforschung (DZL) - Heidelberg, Deutschland
| | - Nikolaus Kneidinger
- Lungentransplantation und interstitielle Lungenerkrankungen, Medizinische Klinik und Poliklinik V, München, Deutschland
| | - Peter Korsten
- Klinische Rheumatologie und rheumatologische Intensivmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Michael Kreuter
- Lungenzentrum Mainz, Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz und Klinik für Pneumologie, Zentrum für Thoraxerkrankungen, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Joachim Müller-Quernheim
- Klinik für Pneumologie, Department Innere Medizin, Uniklinik Freiburg, Medizinische Fakultät, Freiburg, Deutschland
| | - Michael Pfeifer
- Innere Medizin, Lungen- und Bronchialheilkunde, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - Antje Prasse
- Lungenfibrose und interstitielle Lungenerkrankungen, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Bernd Quadder
- Deutsche Sarkoidose-Vereinigung, gemeinnütziger e. V. (DSV)
| | - Oliver Sander
- Klinik für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Jonas C Schupp
- Respiratory and Infectious Medicine, Hannover Medical School, Hannover, Germany
| | - Helmut Sitter
- Institut für Chirurgische Forschung, Fachbereich Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| | | | - Christian Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik, Berlin, Deutschland
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Rath A, Kieninger B, Fritsch J, Caplunik-Pratsch A, Blaas S, Ochmann M, Pfeifer M, Hartl J, Holzmann T, Schneider-Brachert W. Whole-genome sequencing reveals two prolonged simultaneous outbreaks involving Pseudomonas aeruginosa high-risk strains ST111 and ST235 with resistance to quaternary ammonium compounds. J Hosp Infect 2024; 145:155-164. [PMID: 38286239 DOI: 10.1016/j.jhin.2024.01.009] [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: 10/23/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE Water-bearing systems are known as frequent Pseudomonas aeruginosa (PA) outbreak sources. However, many older buildings continue to have sanitary facilities in high-risk departments such as the ICU. We present two simultaneous prolonged multi-drug-resistant (MDR) PA outbreaks detected at the ICU of a pulmonology hospital, which were resolved by whole-genome sequencing (WGS). METHODS Outbreak management and investigations were initiated in August 2019 after detecting two patients with nosocomial VIM-2-positive MDR PA. The investigations involved weekly patient screenings for four months and extensive environmental sampling for 15 months. All patient and environmental isolates were collected and analysed by WGS. RESULTS From April to September 2019, we identified 10 patients with nosocomial MDR PA, including five VIM-2-positive strains. VIM-2-positive strains were also detected in nine sink drains, two toilets, and a cleaning bucket. WGS revealed that of 16 VIM-2-positive isolates, 14 were ST111 that carried qacE, or qacEΔ1 genes, whereas 13 isolates clustered (difference of ≤11 alleles by cgMLST). OXA-2 (two toilets), and OXA-2, OXA-74, PER-1 (two patients, three toilets) qacEΔ1-positive ST235 isolates dominated among VIM-2-negative isolates. The remaining seven PA strains were ST17, ST233, ST273, ST309 and ST446. Outbreak containment was achieved by replacing U-bends, and cleaning buckets, and switching from quaternary ammonium compounds (QUATs) to oxygen-releasing disinfectant products. CONCLUSION Comprehension and management of two simultaneous MDR PA outbreaks involving the high-risk strains ST111 and ST235 were facilitated by precise control due to identification of different outbreak sources per strain, and by the in-silico detection of high-level QUATs resistance in all isolates.
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Affiliation(s)
- A Rath
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany.
| | - B Kieninger
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - J Fritsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - A Caplunik-Pratsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - S Blaas
- Donaustauf Hospital, Centre for Pneumology, Donaustauf, Germany
| | - M Ochmann
- Donaustauf Hospital, Centre for Pneumology, Donaustauf, Germany
| | - M Pfeifer
- Donaustauf Hospital, Centre for Pneumology, Donaustauf, Germany; Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany; Hospital of the Merciful Brother Regensburg, Regensburg, Germany
| | - J Hartl
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; Hospital of the Merciful Brother "St. Barbara", Schwandorf, Germany
| | - T Holzmann
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - W Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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Buschulte K, Kabitz HJ, Hagmeyer L, Hammerl P, Esselmann A, Wiederhold C, Skowasch D, Stolpe C, Joest M, Veitshans S, Höffgen M, Maqhuzu P, Schwarzkopf L, Hellmann A, Pfeifer M, Behr J, Karpavicius R, Günther A, Polke M, Höger P, Somogyi V, Lederer C, Markart P, Kreuter M. Hospitalisation patterns in interstitial lung diseases: data from the EXCITING-ILD registry. Respir Res 2024; 25:5. [PMID: 38178212 PMCID: PMC10765927 DOI: 10.1186/s12931-023-02588-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/30/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Interstitial lung diseases (ILD) comprise a heterogeneous group of mainly chronic lung diseases with more than 200 entities and relevant differences in disease course and prognosis. Little data is available on hospitalisation patterns in ILD. METHODS The EXCITING-ILD (Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases) registry was analysed for hospitalisations. Reasons for hospitalisation were classified as all cause, ILD-related and respiratory hospitalisations, and patients were analysed for frequency of hospitalisations, time to first non-elective hospitalisation, mortality and progression-free survival. Additionally, the risk for hospitalisation according to GAP index and ILD subtype was calculated by Cox proportional-hazard models as well as influencing factors on prediction of hospitalisation by logistic regression with forward selection. RESULTS In total, 601 patients were included. 1210 hospitalisations were recorded during the 6 months prior to registry inclusion until the last study visit. 800 (66.1%) were ILD-related, 59.3% of admissions were registered in the first year after inclusion. Mortality was associated with all cause, ILD-related and respiratory-related hospitalisation. Risk factors for hospitalisation were advanced disease (GAP Index stages II and III) and CTD (connective tissue disease)-ILDs. All cause hospitalisations were associated with pulmonary hypertension (OR 2.53, p = 0.005). ILD-related hospitalisations were associated with unclassifiable ILD and concomitant emphysema (OR = 2.133, p = 0.001) as well as with other granulomatous ILDs and a positive smoking status (OR = 3.082, p = 0.005). CONCLUSION Our results represent a crucial contribution in understanding predisposing factors for hospitalisation in ILD and its major impact on mortality. Further studies to characterize the most vulnerable patient group as well as approaches to prevent hospitalisations are warranted.
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Affiliation(s)
- Katharina Buschulte
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany.
| | - Hans-Joachim Kabitz
- Medical Clinic II, Pneumology and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Lars Hagmeyer
- Hospital Bethanien Solingen, Clinic of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Solingen, Germany
| | | | | | | | - Dirk Skowasch
- Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | | | - Marcus Joest
- Outpatient Center for Pulmonology and Allergology, Bonn, Germany
| | | | - Marc Höffgen
- Outpatient Center for Pulmonology, Rheine, Germany
| | - Phillen Maqhuzu
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPCM), Neuherberg, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPCM), Neuherberg, Germany
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany
| | | | - Michael Pfeifer
- Medical Clinic II, University of Regensburg and Klinikum Donaustauf, Donaustauf, Germany
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Centre, German Center for Lung Research (DZL), Munich, Germany
| | | | - Andreas Günther
- Medical Clinic II, University Hospital Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC), German Center for Lung Research (DZL), Giessen, Germany
| | - Markus Polke
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Philipp Höger
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Vivien Somogyi
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, ZfT, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| | - Christoph Lederer
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Philipp Markart
- Medical Clinic II, University Hospital Giessen, Universities of Giessen and Marburg Lung Centre (UGMLC), German Center for Lung Research (DZL), Giessen, Germany
- Medical Clinic V (Pneumology), Cardiothoracic Centre, Campus Fulda, University Medicine Marburg, Fulda, Germany
| | - Michael Kreuter
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, ZfT, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany.
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Baumert M, Linz D, Pfeifer M, Tafelmeier M, Felfeli P, Arzt M, Shahrbabaki SS. Hypoxaemic burden in heart failure patients receiving adaptive servo-ventilation. ESC Heart Fail 2023; 10:3725-3728. [PMID: 37794711 PMCID: PMC10682887 DOI: 10.1002/ehf2.14556] [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: 02/13/2023] [Revised: 08/07/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
AIMS This study aimed to assess the effectiveness of adaptive servo-ventilation (ASV) for lowering hypoxaemic burden components in heart failure with reduced ejection fraction (HFrEF) patients. METHODS AND RESULTS Fifty-six stable HFrEF patients with left ventricular ejection fraction ≤ 40 were randomized to receive either ASV (n = 27; 25 males) or optimal medical management or optimal medical management alone (n = 29; 26 males). Patients underwent overnight polysomnography at baseline and a 12 week follow-up visit. We quantified hypoxaemic as time spent at <90% oxygen saturation (T90) decomposed into desaturation-related components (T90desaturation ) and non-specific drifts (T90non-specific ). In the ASV arm, T90 significantly shortened by nearly 60% from 50.1 ± 95.8 min at baseline to 20.5 ± 33.0 min at follow-up compared with 59.6 ± 88 and 65.4 ± 89.6 min in the control arm (P = 0.009). ASV reduced the apnoea-related component (T90desaturation ) from 37.7 ± 54.5 to 2.1 ± 7.3 min vs. 37.7 ± 54.5 and 40.4 ± 66.4 min in the control arm (P = 0.008). A significant non-specific T90 component of 19.6 ± 31.8 min persisted during ASV. In adjusted multivariable regression, T90desaturation was significantly associated with the ratio of the forced expiratory volume in the first second to the forced vital capacity of the lungs (β = 0.336, 95% confidence interval 0.080 to 0.593; P = 0.011) and T90non-specific with left ventricular ejection fraction (β = -0.345, 95% confidence interval -0.616 to -0.073; P = 0.014). CONCLUSIONS ASV effectively suppresses the sleep apnoea-related component of hypoxaemic burden in HFrEF patients. A significant hypoxaemic burden not directly attributable to sleep apnoea but related to the severity of heart failure remains and may adversely affect cardiovascular long-term outcomes.
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Affiliation(s)
- Mathias Baumert
- Discipline of Biomedical Engineering, School of Electrical and Mechanical EngineeringThe University of AdelaideAdelaideSA5005Australia
| | - Dominik Linz
- Department of CardiologyMaastricht University Medical Centre and Cardiovascular Research InstituteMaastrichtThe Netherlands
- Centre for Heart Rhythm DisordersThe University of Adelaide and Royal Adelaide HospitalAdelaideAustralia
- Department of Biomedical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Michael Pfeifer
- Department of PneumologyDonaustauf HospitalDonaustaufGermany
| | - Maria Tafelmeier
- Department of Internal Medicine IIUniversity Hospital RegensburgRegensburgGermany
| | - Philippe Felfeli
- Department of Internal Medicine IIUniversity Hospital RegensburgRegensburgGermany
| | - Michael Arzt
- Department of Internal Medicine IIUniversity Hospital RegensburgRegensburgGermany
| | - Sobhan S. Shahrbabaki
- Discipline of Biomedical Engineering, School of Electrical and Mechanical EngineeringThe University of AdelaideAdelaideSA5005Australia
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Freitag-Wolf S, Schupp JC, Frye BC, Fischer A, Anwar R, Kieszko R, Mihailović-Vučinić V, Milanowski J, Jovanovic D, Zissel G, Bargagli E, Rottoli P, Bumbacea D, Jonkers R, Ho LP, Gaede KI, Dubaniewicz A, Marshall BG, Günther A, Petrek M, Keane MP, Haraldsdottir SO, Bonella F, Grah C, Peroš-Golubičić T, Kadija Z, Pabst S, Grohé C, Strausz J, Safrankova M, Millar A, Homolka J, Wuyts WA, Spencer LG, Pfeifer M, Valeyre D, Poletti V, Wirtz H, Prasse A, Schreiber S, Dempfle A, Müller-Quernheim J. Genetic and geographic influence on phenotypic variation in European sarcoidosis patients. Front Med (Lausanne) 2023; 10:1218106. [PMID: 37621457 PMCID: PMC10446882 DOI: 10.3389/fmed.2023.1218106] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Sarcoidosis is a highly variable disease in terms of organ involvement, type of onset and course. Associations of genetic polymorphisms with sarcoidosis phenotypes have been observed and suggest genetic signatures. Methods After obtaining a positive vote of the competent ethics committee we genotyped 1909 patients of the deeply phenotyped Genetic-Phenotype Relationship in Sarcoidosis (GenPhenReSa) cohort of 31 European centers in 12 countries with 116 potentially disease-relevant single-nucleotide polymorphisms (SNPs). Using a meta-analysis, we investigated the association of relevant phenotypes (acute vs. sub-acute onset, phenotypes of organ involvement, specific organ involvements, and specific symptoms) with genetic markers. Subgroups were built on the basis of geographical, clinical and hospital provision considerations. Results In the meta-analysis of the full cohort, there was no significant genetic association with any considered phenotype after correcting for multiple testing. In the largest sub-cohort (Serbia), we confirmed the known association of acute onset with TNF and reported a new association of acute onset an HLA polymorphism. Multi-locus models with sets of three SNPs in different genes showed strong associations with the acute onset phenotype in Serbia and Lublin (Poland) demonstrating potential region-specific genetic links with clinical features, including recently described phenotypes of organ involvement. Discussion The observed associations between genetic variants and sarcoidosis phenotypes in subgroups suggest that gene-environment-interactions may influence the clinical phenotype. In addition, we show that two different sets of genetic variants are permissive for the same phenotype of acute disease only in two geographic subcohorts pointing to interactions of genetic signatures with different local environmental factors. Our results represent an important step towards understanding the genetic architecture of sarcoidosis.
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Affiliation(s)
- Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany
| | - Jonas C. Schupp
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
- Department of Respiratory Medicine, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), Hannover Medical School (MHH), German Center for Lung Research (DZL), Hannover, Germany
| | - Björn C. Frye
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
| | - Annegret Fischer
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Raihanatul Anwar
- Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany
| | - Robert Kieszko
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | | | - Janusz Milanowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | | | - Gernot Zissel
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplant Unit, University Hospital, Siena, Italy
| | - Paola Rottoli
- Respiratory Diseases and Lung Transplant Unit, University Hospital, Siena, Italy
| | - Dragos Bumbacea
- Department of Cardio-Thoracic Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - René Jonkers
- Pulmonology Department, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Ling-Pei Ho
- Oxford Sarcoidosis Service, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, United Kingdom
| | | | - Anna Dubaniewicz
- Department of Pulmonology, Medical University of Gdansk, Gdansk, Poland
| | - Ben G. Marshall
- Department of Respiratory Medicine, University Hospital, Southampton, United Kingdom
| | - Andreas Günther
- Department of Pneumology and Intensive Care, University Hospital, Giessen, Germany
| | - Martin Petrek
- Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czechia
| | - Michael P. Keane
- Division of Pulmonary and Critical Care Medicine, University College Dublin and St Vincent’s University Hospital, Dublin, Ireland
| | | | - Francesco Bonella
- Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen, Universitätsklinik Essen, Essen, Germany
| | | | | | - Zamir Kadija
- Foundation IRCCS Policlinico San Matteo - Pulmonology Unit, Pavia, Italy
| | - Stefan Pabst
- Department of Pneumology, University Hospital, Bonn, Germany
| | | | | | - Martina Safrankova
- Thomayer Hospital and 1st Faculty of Medicine, Charles University, Praha, Czechia
| | - Ann Millar
- Pulmonary Department, University Hospital, Bristol, United Kingdom
| | - Jiří Homolka
- Prague General Hospital, Charles University, Prague, Czechia
| | - Wim A. Wuyts
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), University Hospital, Leuven, Belgium
| | - Lisa G. Spencer
- Liverpool Interstitial Lung Disease Service, Aintree Chest Centre, Liverpool University Hospitals NHS FT, Liverpool, United Kingdom
| | - Michael Pfeifer
- Department of Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Dominique Valeyre
- Groupe Hospitalier Avicenne-Jean Verdier-René Muret, Service de Pneumologie, Bobigny, France
| | - Venerino Poletti
- Pulmonary Unit, Department of Thoracic Diseases, Azienda USL Romagna, GB Morgagni-L-Pierantoni Hospital, Forlì, Italy
| | - Hubertus Wirtz
- Department of Pneumology, University Hospital Leipzig, Leipzig, Germany
| | - Antje Prasse
- Department of Pneumology, Faculty of Medicine, University Medical Centre, Freiburg, Germany
- Department of Respiratory Medicine, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany
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7
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Meiler S, Poschenrieder F, Mohr A, Strotzer Q, Scharf G, Rennert J, Stroszczynski C, Pfeifer M, Hamer O. CT findings in "Post-Covid": residua from acute pneumonia or "Post-Covid-ILD"? Sarcoidosis Vasc Diffuse Lung Dis 2023; 40:e2023024. [PMID: 37382073 PMCID: PMC10494745 DOI: 10.36141/svdld.v40i2.13983] [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] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
The aim of this study was to evaluate if CT findings in patients with pulmonary Post Covid syndrome represent residua after acute pneumonia or if SARS-CoV 2 induces a true ILD. Consecutive patients with status post acute Covid-19 pneumonia and persisting pulmonary symptoms were enrolled. Inclusion criteria were availability of at least one chest CT performed in the acute phase and at least one chest CT performed at least 80 days after symptom onset. In both acute and chronic phase CTs 14 CT features as well as distribution and extent of opacifications were independently determined by two chest radiologists. Evolution of every single CT lesion over time was registered intraindividually for every patient. Moreover, lung abnormalities were automatically segmented using a pre-trained nnU-Net model and volume as well as density of parenchymal lesions were plotted over the entire course of disease including all available CTs. 29 patients (median age 59 years, IQR 8, 22 men) were enrolled. Follow-up period was 80-242 days (mean 134). 152/157 (97 %) lesions in the chronic phase CTs represented residua of lung pathology in the acute phase. Subjective and objective evaluation of serial CTs showed that CT abnormalities were stable in location and continuously decreasing in extent and density. The results of our study support the hypothesis that CT abnormalities in the chronic phase after Covid-19 pneumonia represent residua in terms of prolonged healing of acute infection. We did not find any evidence for a Post Covid ILD.
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8
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Kreuter M, Behr J, Bonella F, Costabel U, Gerber A, Hamer OW, Heussel CP, Jonigk D, Krause A, Koschel D, Leuschner G, Markart P, Nowak D, Pfeifer M, Prasse A, Wälscher J, Winter H, Kabitz HJ. [Consensus guideline on the interdisciplinary diagnosis of interstitial lung diseases]. Pneumologie 2023; 77:269-302. [PMID: 36977470 DOI: 10.1055/a-2017-8971] [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: 03/30/2023]
Abstract
The evaluation of a patient with interstitial lung disease (ILD) includes assessment of clinical, radiological, and often histopathological data. As there were no specific recommendations to guide the evaluation of patients under the suspicion of an ILD within the German practice landscape, this position statement from an interdisciplinary panel of ILD experts provides guidance related to the diagnostic modalities which should be used in the evaluation of ILD. This includes clinical assessment rheumatological evaluation, radiological examinations, histopathologic sampling and the need for a final discussion in a multidisciplinary team.
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Affiliation(s)
- Michael Kreuter
- Universitäres Lungenzentrum Mainz, Abteilungen für Pneumologie, ZfT, Universitätsmedizin Mainz und Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg und Klinik für Pneumologie, Klinikum Ludwigsburg
- Deutsches Zentrum für Lungenforschung
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München
- Deutsches Zentrum für Lungenforschung
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Alexander Gerber
- Rheumazentrum Halensee, Berlin und Institut für Arbeits- Sozial- und Umweltmedizin, Goetheuniversität Frankfurt am Main
| | - Okka W Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg und Abteilung für Radiologie, Klinik Donaustauf, Donaustauf
| | - Claus Peter Heussel
- Diagnostische und interventionelle Radiologie, Thoraxklinik Heidelberg, Universitätsklinikum Heidelberg
- Deutsches Zentrum für Lungenforschung
| | - Danny Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover und Institut für Pathologie, RWTH Universitätsklinikum Aachen
- Deutsches Zentrum für Lungenforschung
| | - Andreas Krause
- Abteilung für Rheumatologie, klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin
| | - Dirk Koschel
- Abteilung für Innere Medizin und Pneumologie, Fachkrankenhaus Coswig, Lungenzentrum, Coswig und Bereich Pneumologie der Medizinischen Klinik, Carl Gustav Carus Universitätsklinik, Dresden
| | - Gabriela Leuschner
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München
- Deutsches Zentrum für Lungenforschung
| | - Philipp Markart
- Medizinische Klinik V, Campus Fulda, Universitätsmedizin Marburg und Medizinische Klinik und Poliklinik, Universitätsklinikum Gießen
- Deutsches Zentrum für Lungenforschung
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München
| | - Michael Pfeifer
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg
| | - Antje Prasse
- Klinik für Pneumologie und Infektionsmedizin, Medizinische Hochschule Hannover und Abteilung für Fibroseforschung, Fraunhofer ITEM
- Deutsches Zentrum für Lungenforschung
| | - Julia Wälscher
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Hauke Winter
- Abteilung für Thoraxchirurgie, Thoraxklinik, Universität Heidelberg, Heidelberg
- Deutsches Zentrum für Lungenforschung
| | - Hans-Joachim Kabitz
- II. Medizinische Klinik, Pneumologie und Internistische Intensivmedizin, Klinikum Konstanz, GLKN, Konstanz
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9
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Zech N, Scharl L, Seemann M, Pfeifer M, Hansen E. Nocebo Effects of Clinical Communication and Placebo Effects of Positive Suggestions on Respiratory Muscle Strength. Front Psychol 2022; 13:825839. [PMID: 35360592 PMCID: PMC8962828 DOI: 10.3389/fpsyg.2022.825839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction:The effects of specific suggestions are usually studied by measuring parameters that are directly addressed by these suggestions. We recently proposed the use of a uniform, unrelated, and objective measure like maximal muscle strength that allows comparison of suggestions to avoid nocebo effects and thus to improve communication. Since reduced breathing strength might impair respiration and increase the risk of post-operative pulmonary complications, the aim of the present study was to evaluate the effects of the suggestions on respiratory muscle power. Both the identification and neutralization of negative suggestions in the clinical context and stimulating suggestions could improve breathing force, a predictor of physical fitness and convalescence.MethodsIn 50 healthy, adult volunteers, respiratory muscle strength was measured by maximal inspiratory and expiratory pressures, as well as by maximal inspiratory and expiratory flows. Baseline was compared to values after application of eleven suggestions, five out of clinical context, including memory of negative or positive past, risk information for informed consent, and a non-verbal suggestion. Six stimulating suggestions included self-affirmation, empowering words, a heroic mirror image, and an imagination.ResultsAll suggestions showed an impact on respiratory muscle strength, indicating placebo and nocebo effects. No single parameter could represent the breathing force in its complexity, however, trends and different specific aspects of it were measured. The strongest reaction was observed with the recall of a previous negative situation resulting in a reduction in expiratory flow to 96.1% of baseline (p = 0.041). After risk information, a decrease was observed in three of the parameters, with the highest extend in expiratory pressure by 4.4%. This nocebo effect was neutralized by adding positive aspects to the risk information. Every intended strengthening suggestion resulted in statistically significant increases of at least one parameter, with changes of up to 10% (e.g., MEP 110.3%, p = 0.001), indicating placebo effects. Here, expiration was more affected than inspiration. Sex was the only influencing factor reaching statistical significance, with stronger reactions in women.ConclusionRespiratory muscle strength proved to be sensitive to suggestions with clinical context, as well as suggestions intended for stimulation. With this objective measurement, evaluation, and comparison of different suggestions is possible to help avoid nocebo effects. The demonstrated effect of supporting suggestions can be followed up and used in clinical practice.
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Affiliation(s)
- Nina Zech
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
- *Correspondence: Nina Zech,
| | - Leoni Scharl
- Department of Pediatrics, RoMed Klinikum Rosenheim, Rosenheim, Germany
| | - Milena Seemann
- Department of Anaesthesiology, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
| | - Michael Pfeifer
- Department of Internal Medicine II (Cardiology and Pulmonology), University Hospital Regensburg, Regensburg, Germany
| | - Ernil Hansen
- Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany
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10
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Vaduganathan M, Sattar N, Xu J, Butler J, Mahaffey KW, Neal B, Shaw W, Rosenthal N, Pfeifer M, Hansen MK, Januzzi JL. BEHIND THE SCREEN: A RETROSPECTIVE COMPARATIVE ANALYSIS OF CONGESTIVE HEART FAILURE EXACERBATION ADMISSIONS, FOLLOW UP AND MANAGEMENT DURING THE COVID19 PANDEMIC AND PRE PANDEMIC. J Am Coll Cardiol 2022. [PMID: 35115099 PMCID: PMC8972403 DOI: 10.1016/s0735-1097(22)01423-1] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/mvaduganathan
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Jialin Xu
- Janssen Research and Development, LLC, Spring House, Pennsylvania, USA
| | - Javed Butler
- University of Mississippi, Jackson, Missouri, USA. https://twitter.com/JavedButler1
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. https://twitter.com/TheMahaf
| | - Bruce Neal
- Department of Renal and Metabolic, The George Institute for Global Health, UNSW Sydney, Sydney, Australia; The Charles Perkins Centre, University of Sydney, Sydney, Australia; Imperial College London, London, United Kingdom
| | - Wayne Shaw
- Janssen Research and Development, LLC, Raritan, New Jersey, USA
| | | | - Michael Pfeifer
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Michael K Hansen
- Janssen Research and Development, LLC, Spring House, Pennsylvania, USA
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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11
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Hartmann B, Tittel SR, Femerling M, Pfeifer M, Meyhöfer S, Lange K, Milek S, Stemler L, Best F, Holl RW. COVID-19 Lockdown Periods in 2020: Good Maintenance of Metabolic Control in Adults with Type 1 and Type 2 Diabetes. Exp Clin Endocrinol Diabetes 2022; 130:621-626. [PMID: 35181878 DOI: 10.1055/a-1743-2537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/04/2022]
Abstract
During the COVID-19 pandemic, there were increased concerns about glycemic control in patients with diabetes. Therefore, we aimed to assess changes in diabetes management during the COVID-19 lockdown for patients with type 1 or type 2 diabetes mellitus (T1DM, T2DM) in Germany. We included data from 24,623 patients (age>18 years) with T1DM (N=6,975) or T2DM (N=17,648) with documented data in 2019 and 2020 from the multicenter Diabetes-Prospective Follow-up registry (DPV). We conducted a groupwise comparison of identical patients in 2019 and 2020 for different time periods of pandemia. Pairwise differences of continuous parameters of treatment modalities and metabolic outcome between 2019 and 2020 were adjusted for seasonality, age, and diabetes duration. We presented these outcomes as adjusted medians with 95% confidence intervals. Rates were compared using negative-binomial models, dichotomous outcomes were compared using logistic models. Models were additionally adjusted for age and diabetes duration. These outcomes were presented as least-square means with 95% confidence intervals, p-values of<.05 were considered significant.In participants with T1DM, CGI (combined glucose indicator) increased only by 0.11-0.12% in all time periods of 2020 compared to 2019 (all p<0.001) while BMI decreased slightly by -(0.09-0.10) kg/m² (p<0.0001). In participants with T2DM, HbA1c increased by 0.12%, while BMI decreased slightly by -(0.05-0.06) kg/m² (p<0.0001).During the COVID-19 lockdown period, patients with T1DM and T2DM experienced only clinically insignificant changes in glucose control or body weight. Despite lockdown restrictions, patients were able to maintain metabolic control.
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Affiliation(s)
- B Hartmann
- Heilig-Geist Hospital, Department of Gastroenterology and Diabetology, Bensheim, Germany
| | - S R Tittel
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | | | - M Pfeifer
- Klinik Tettnang GmbH, Tettnang, Germany
| | - S Meyhöfer
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany.,University of Lübeck, Institute for Endocrinology and Diabetes, Lübeck, Germany.,Department of Internal Medicine 1, Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
| | - K Lange
- Hanover Medical School, Department of Medical Psychology, Hanover, Germany
| | - S Milek
- Diabetes-Schwerpunkt und Schulungspraxis, Hohenmölsen, Germany
| | - L Stemler
- Diabetologikum DDG Ludwigshafen, Ludwigshafen, Germany
| | - F Best
- Specialized diabetes practice, Essen, Germany
| | - R W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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12
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Koczulla AR, Ankermann T, Behrends U, Berlit P, Böing S, Brinkmann F, Franke C, Glöckl R, Gogoll C, Hummel T, Kronsbein J, Maibaum T, Peters EMJ, Pfeifer M, Platz T, Pletz M, Pongratz G, Powitz F, Rabe KF, Scheibenbogen C, Stallmach A, Stegbauer M, Wagner HO, Waller C, Wirtz H, Zeiher A, Zwick R. [S1 Guideline "Post-COVID/Long-COVID"]. Chirurg 2022. [PMID: 35041036 DOI: 10.1007/s00104-021-01543-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A R Koczulla
- LL-Sekretariat Anja Flender, Schön Klinik Berchtesgadener Land, Malterhöh 1, 83471, Schönau am Königssee, Deutschland.
| | - T Ankermann
- Gesellschaft für Pädiatrische Pneumologie (DGPP), Berlin, Deutschland
| | - U Behrends
- Chronisches Fatigue Centrum, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - P Berlit
- Deutsche Gesellschaft f. Neurologie (DGN), Berlin, Deutschland
| | - S Böing
- Berufsverband der Pneumologen (BdP), Heidenheim, Deutschland
| | - F Brinkmann
- Gesellschaft für Pädiatrische Pneumologie (DGPP), Berlin, Deutschland
| | - C Franke
- Berufsverband der Pneumologen (BdP), Heidenheim, Deutschland
| | - R Glöckl
- Deutsche Gesellschaft f. Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - C Gogoll
- Deutsche Gesellschaft f. Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - T Hummel
- Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V., Bonn, Deutschland
| | - J Kronsbein
- Deutsche gesetzliche Unfallversicherung (DGUV), Berlin, Deutschland
| | - T Maibaum
- Deutsche Gesellschaft f. Neurologie (DGN), Berlin, Deutschland
| | - E M J Peters
- Deutsche Gesellschaft f. Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM), Stuttgart, Deutschland
| | - M Pfeifer
- Deutsche Gesellschaft f. Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - T Platz
- Deutsche Gesellschaft für Neurorehabilitation (DGNR), Rheinbach, Deutschland
| | - M Pletz
- Sektion Infektiologie, Paul Ehrlich Gesellschaft für Chemotherapie e.V. (PEG), Köln, Deutschland
| | - G Pongratz
- Deutsche Schmerzgesellschaft der Deutschen Migräne und Kopfschmerzgesellschaft, Königstein im Taunus, Deutschland.,Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - F Powitz
- Berufsverband der Pneumologen (BdP), Heidenheim, Deutschland
| | - K F Rabe
- Deutsche Gesellschaft f. Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | | | - A Stallmach
- Deutsche Gesellschaft f. Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS), Berlin, Deutschland.,Deutsche Gesellschaft f. Infektiologie (DGI), Berlin, Deutschland
| | - M Stegbauer
- Deutsche gesetzliche Unfallversicherung (DGUV), Berlin, Deutschland
| | - H O Wagner
- Deutsche Gesellschaft f. Allgemeinmedizin und Familienmedizin (DEGAM), Berlin, Deutschland
| | - C Waller
- Deutsches Kollegium für Psychosomatische Medizin (DKPM), Berlin, Deutschland
| | - H Wirtz
- Deutsche Gesellschaft f. Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - A Zeiher
- Deutsche Gesellschaft f. Kardiologie - Herz- und Kreislaufforschung (DGK), Düsseldorf, Deutschland
| | - R Zwick
- Österreichische Gesellschaft für Pneumologie (ÖGP), Wien, Österreich
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13
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Karagiannidis C, Hentschker C, Westhoff M, Weber-Carstens S, Janssens U, Kluge S, Pfeifer M, Spies C, Welte T, Rossaint R, Mostert C, Windisch W. Observational study of changes in utilization and outcomes in mechanical ventilation in COVID-19. PLoS One 2022; 17:e0262315. [PMID: 35030205 PMCID: PMC8759661 DOI: 10.1371/journal.pone.0262315] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 07/23/2021] [Accepted: 12/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background The role of non-invasive ventilation (NIV) in severe COVID-19 remains a matter of debate. Therefore, the utilization and outcome of NIV in COVID-19 in an unbiased cohort was determined. Aim The aim was to provide a detailed account of hospitalized COVID-19 patients requiring non-invasive ventilation during their hospital stay. Furthermore, differences of patients treated with NIV between the first and second wave are explored. Methods Confirmed COVID-19 cases of claims data of the Local Health Care Funds with non-invasive and/or invasive mechanical ventilation (MV) in the spring and autumn pandemic period in 2020 were comparable analysed. Results Nationwide cohort of 17.023 cases (median/IQR age 71/61–80 years, 64% male) 7235 (42.5%) patients primarily received IMV without NIV, 4469 (26.3%) patients received NIV without subsequent intubation, and 3472 (20.4%) patients had NIV failure (NIV-F), defined by subsequent endotracheal intubation. The proportion of patients who received invasive MV decreased from 75% to 37% during the second period. Accordingly, the proportion of patients with NIV exclusively increased from 9% to 30%, and those failing NIV increased from 9% to 23%. Median length of hospital stay decreased from 26 to 21 days, and duration of MV decreased from 11.9 to 7.3 days. The NIV failure rate decreased from 49% to 43%. Overall mortality increased from 51% versus 54%. Mortality was 44% with NIV-only, 54% with IMV and 66% with NIV-F with mortality rates steadily increasing from 62% in early NIV-F (day 1) to 72% in late NIV-F (>4 days). Conclusions Utilization of NIV rapidly increased during the autumn period, which was associated with a reduced duration of MV, but not with overall mortality. High NIV-F rates are associated with increased mortality, particularly in late NIV-F.
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Affiliation(s)
- Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Center, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
- * E-mail: ,
| | | | - Michael Westhoff
- Department of Pneumology, Sleep and Critical Care Medicine, Lungenklinik Hemer, Hemer, Germany
- University Witten/Herdecke, Witten, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St.-Antonius Hospital, Eschweiler, Germany
| | - Stefan Kluge
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Pfeifer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital Aachen, RWTH Aachen, Aachen, Germany
| | - Carina Mostert
- Research Institute of the Local Health Care Funds, Berlin, Germany
| | - Wolfram Windisch
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Center, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
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14
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Feng KY, Li J, Ianus J, de Zeeuw D, Fulcher GR, Pfeifer M, Matthews DR, Jardine MJ, Perkovic V, Neal B, Mahaffey KW. Reasons for hospitalizations in patients with type 2 diabetes in the CANVAS programme: A secondary analysis. Diabetes Obes Metab 2021; 23:2707-2715. [PMID: 34402161 DOI: 10.1111/dom.14525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 01/22/2023]
Abstract
AIM To determine the reasons for hospitalizations in the CANagliflozin cardioVascular Assessment Study (CANVAS) programme and the effects of the sodium-glucose co-transporter-2 inhibitor canagliflozin on hospitalization. MATERIALS AND METHODS A secondary analysis was performed on the CANVAS programme that included 10 142 participants with type 2 diabetes randomized to canagliflozin or placebo. The primary outcome was the rate of total (first plus all recurrent) all-cause hospitalizations (ACH). Secondary outcomes were total hospitalizations categorized by the Medical Dictionary for Regulatory Activities hierarchy at the system organ class level, reported by investigators at each centre. Outcomes were assessed using negative binomial models. RESULTS Of the 7115 hospitalizations reported, the most common reasons were cardiac disorders (23.7%), infections and infestations (15.0%), and nervous system disorders (9.0%). The rate of total ACH was lower in the canagliflozin group (n = 5795) compared with the placebo group (n = 4347): 197.9 versus 215.8 participants per 1000 patient-years, respectively (rate ratio [RR] 0.92; 95% confidence interval [CI] 0.86, 0.98). Canagliflozin reduced the rate of total hospitalizations because of cardiac disorders (RR 0.81; 95% CI 0.75, 0.88). There was no significant difference between the canagliflozin and placebo groups in the rates of total hospitalizations because of infections and infestations (RR 0.96; 95% CI 0.86, 1.02) or nervous system disorders (RR 0.96; 95% CI 0.88, 1.05). CONCLUSIONS In the CANVAS programme, the most common reasons for hospitalization were cardiac disorders, infections and infestations, and nervous system disorders. Canagliflozin, compared with placebo, reduced the rate of total ACH.
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Affiliation(s)
- Kent Y Feng
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, California, USA
| | - JingWei Li
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Juliana Ianus
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Dick de Zeeuw
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Greg R Fulcher
- Medicine, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Michael Pfeifer
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - David R Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism and Harris Manchester College, University of Oxford, Oxford, UK
| | - Meg J Jardine
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Vlado Perkovic
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Bruce Neal
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, California, USA
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15
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Kluge S, Janssens U, Welte T, Weber-Carstens S, Schälte G, Salzberger B, Gastmeier P, Langer F, Welper M, Westhoff M, Pfeifer M, Hoffmann F, Böttiger BW, Marx G, Karagiannidis C. Recommendations for treatment of critically ill patients with COVID-19 : Version 3 S1 guideline. Anaesthesist 2021; 70:19-29. [PMID: 33245382 PMCID: PMC7694585 DOI: 10.1007/s00101-020-00879-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Since December 2019 a novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) has rapidly spread around the world resulting in an acute respiratory illness pandemic. The immense challenges for clinicians and hospitals as well as the strain on many healthcare systems has been unprecedented.The majority of patients present with mild symptoms of coronavirus disease 2019 (COVID-19); however, 5-8% become critically ill and require intensive care treatment. Acute hypoxemic respiratory failure with severe dyspnea and an increased respiratory rate (>30/min) usually leads to intensive care unit (ICU) admission. At this point bilateral pulmonary infiltrates are typically seen. Patients often develop a severe acute respiratory distress syndrome (ARDS).So far, remdesivir and dexamethasone have shown clinical effectiveness in severe COVID-19 in hospitalized patients. The main goal of supportive treatment is to ascertain adequate oxygenation. Invasive mechanical ventilation and repeated prone positioning are key elements in treating severely hypoxemic COVID-19 patients.Strict adherence to basic infection control measures (including hand hygiene) and correct use of personal protection equipment (PPE) are essential in the care of patients. Procedures that lead to formation of aerosols should be carried out with utmost precaution and preparation.
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Affiliation(s)
- S Kluge
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Germany.
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany.
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Germany.
- ARDS Netzwerk Deutschland, Berlin, Germany.
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - U Janssens
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Germany
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- ARDS Netzwerk Deutschland, Berlin, Germany
| | - T Welte
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Germany
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Germany
- ARDS Netzwerk Deutschland, Berlin, Germany
| | - S Weber-Carstens
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Germany
- ARDS Netzwerk Deutschland, Berlin, Germany
| | - G Schälte
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Germany
| | - B Salzberger
- Deutsche Gesellschaft für Infektiologie (DGI), Munich, Germany
| | - P Gastmeier
- Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Münster, Germany
| | - F Langer
- Gesellschaft für Thrombose und Hämostaseforschung (GTH), Cologne, Germany
| | - M Welper
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Germany
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Germany
| | - M Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Germany
| | - F Hoffmann
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Berlin, Germany
| | - B W Böttiger
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- Deutscher Rat für Wiederbelebung (German Resuscitation Council, GRC), Ulm, Germany
| | - G Marx
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Germany
- ARDS Netzwerk Deutschland, Berlin, Germany
| | - C Karagiannidis
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Germany
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Germany
- ARDS Netzwerk Deutschland, Berlin, Germany
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16
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Gehlen M, Schmidt N, Pfeifer M, Balasingam S, Schwarz-Eywill M, Maier A, Werner M, Siggelkow H. Osteoporosis Caused by Systemic Mastocytosis: Prevalence in a Cohort of 8392 Patients with Osteoporosis. Calcif Tissue Int 2021; 109:685-695. [PMID: 34223956 DOI: 10.1007/s00223-021-00887-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
Indolent systemic mastocytosis (ISM) is a group of heterogenous diseases characterized by abnormal accumulation of mast cells in at least one organ. ISM can be a cause of osteoporosis. The aim of this study is to determine the prevalence, and the prognosis of ISM in a cohort of patients with osteoporosis. In this monocentric and retrospective study, patients with osteoporosis who did not receive a bone biopsy (cohort 1) and patients that subsequently received a diagnostic bone biopsy for differential diagnosis (cohort 2) are compared with patients who are diagnosed with ISM (cohort 3). A total of 8392 patients are diagnosed with osteoporosis. Out of these patients 1374 underwent a diagnostic bone biopsy resulting in 43 patients with ISM. These figures indicate that ISM is diagnosed in 0.5% of patients with osteoporosis and in 3.1% (men 5.8%) of patients who underwent bone biopsies. Patients with ISM sustained significantly more vertebral fractures in comparison to patients in cohort 2 (4.4 ± 3.6 versus 2.4 ± 2.5 vertebral fractures, p < 0.001) and women were significantly younger compared to cohort 2 (57.3 ± 12 versus 63.6 ± 12 years, p < 0.05). Only 33% showed an involvement of the skin (urticaria pigmentosa). ISM is a rare cause of osteoporosis (0.5%). However, in a subgroup of rather young male patients with osteoporosis the prevalence is more than 5%. Thus, ISM should be considered in premenopausal women and men presenting with vertebral fractures even if urticaria pigmentosa is not present.
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Affiliation(s)
- Martin Gehlen
- Clinic "DER FÜRSTENHOF", Department of Rheumatology, Osteology and Orthopaedics, Am Hylligen Born 7, 31812, Bad Pyrmont, Germany.
| | - Niels Schmidt
- Clinic "DER FÜRSTENHOF", Department of Rheumatology, Osteology and Orthopaedics, Am Hylligen Born 7, 31812, Bad Pyrmont, Germany
| | - Michael Pfeifer
- Clinic "DER FÜRSTENHOF", Department of Rheumatology, Osteology and Orthopaedics, Am Hylligen Born 7, 31812, Bad Pyrmont, Germany
| | - Subathira Balasingam
- Clinic "DER FÜRSTENHOF", Department of Rheumatology, Osteology and Orthopaedics, Am Hylligen Born 7, 31812, Bad Pyrmont, Germany
| | - Michael Schwarz-Eywill
- Clinic "DER FÜRSTENHOF", Department of Rheumatology, Osteology and Orthopaedics, Am Hylligen Born 7, 31812, Bad Pyrmont, Germany
| | - Anna Maier
- Department of Rheumatology, Sankt Josef-Stift Sendenhorst, West Gate 7, 48324, Sendenhorst, Germany
| | - Mathias Werner
- Department of Pathology, Vivantes Klinikum Friedrichshain, Landsberger Allee 49, 10249, Berlin, Germany
| | - Heide Siggelkow
- Clinic of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
- MVZ Endokrinologikum Goettingen, Von-Siebold-Str. 3, 37075, Goettingen, Germany
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17
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Avellanet M, Boada-Pladellorens A, Pages E, Dorca A, Sabria B, Pfeifer M, Gea E. A Comparative Study of a Novel Postural Garment Versus Exercise for Women with Nonspecific Cervical Pain: A Randomized Cross-over Trial. Spine (Phila Pa 1976) 2021; 46:1517-1524. [PMID: 34292213 PMCID: PMC8553007 DOI: 10.1097/brs.0000000000004123] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/24/2021] [Accepted: 03/08/2021] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized cross-over study. OBJECTIVE The aim of this study was to compare exercise, the criterion standard, to the postural garment PosturePlusForce in the management of nonspecific cervical pain in women. We also analyzed both interventions with regards to baseline posture, use of pharmacological pain relievers, compliance, and comfort. SUMMARY OF BACKGROUND DATA The prevalence of neck pain has increased during the last decade, preferentially affecting women. Those suffering from this condition may manifest a decrease in quality of life and inability to work. Consistent recommendations highlight the importance of exercise and posture for neck pain improvement. METHODS A total of 32 female health care professionals with cervical pain (≥3 on the visual analogue scale) entered the trial. Participants were allocated to either performing exercises or wearing the postural garment. The cross-over between interventions was separated by a 3-month washout period. Primary outcomes included pain intensity and posture. Secondary outcomes comprised cervical pain-related disability, psychological factors, physical activity, global perceived effect of treatment, and garment comfort. Treatment compliance, medication use, and adverse events were also recorded. RESULTS Both interventions showed a significant improvement in pain in subjects with an adherence >60%. However, in participants with dorsal hyperkyphosis (>45°), the garment demonstrated a greater reduction in pain than exercise (P = 0.019). Additionally, those wearing the garment needed fewer pain relievers than those performing exercises (P = 0.007). Compliance was >50% for both interventions and comfort was contingent on season. CONCLUSION In our study, PosturePlusForce showed, at least, a similar effect on pain to exercise, although those with dorsal hyperkyphosis exhibited a greater reduction in pain and related variables with the garment. Pain relievers were less required by those wearing PosturePlusForce than by those performing the exercises.Level of Evidence: 1.
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Affiliation(s)
- Merce Avellanet
- Rehabilitation Department, Hospital Nostra Sra. de Meritxell, Andorra, Research Group on Health Sciences and Health Services, University of Andorra, Andorra
| | - Anna Boada-Pladellorens
- Rehabilitation Department, Hospital Nostra Sra. de Meritxell, Andorra, Research Group on Health Sciences and Health Services, University of Andorra, Andorra
| | - Esther Pages
- Rehabilitation Department, Hospital Nostra Sra. de Meritxell, Andorra, Research Group on Health Sciences and Health Services, University of Andorra, Andorra
| | | | | | | | - Elvira Gea
- Head of Pharmacy Department, Hospital Nostra Sra de Meritxell, Andorra
- Research Group on Health Sciences and Health Services, University of Andorra, Andorra
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18
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Koczulla AR, Ankermann T, Behrends U, Berlit P, Böing S, Brinkmann F, Franke C, Glöckl R, Gogoll C, Hummel T, Kronsbein J, Maibaum T, Peters EMJ, Pfeifer M, Platz T, Pletz M, Pongratz G, Powitz F, Rabe KF, Scheibenbogen C, Stallmach A, Stegbauer M, Wagner HO, Waller C, Wirtz H, Zeiher A, Zwick RH. [S1 Guideline Post-COVID/Long-COVID]. Pneumologie 2021; 75:869-900. [PMID: 34474488 DOI: 10.1055/a-1551-9734] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The German Society of Pneumology initiated the AWMFS1 guideline Post-COVID/Long-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendation describes current post-COVID/long-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an expilcit practical claim and will be continuously developed and adapted by the author team based on the current increase in knowledge.
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Affiliation(s)
| | | | - Uta Behrends
- Klinikum rechts der Isar der Technischen Universität München, Chronisches Fatigue Centrum
| | | | | | | | | | - Rainer Glöckl
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)
| | - Christian Gogoll
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)
| | - Thomas Hummel
- Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V
| | | | - Thomas Maibaum
- Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)
| | - Eva M J Peters
- Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM)
| | - Michael Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)
| | - Thomas Platz
- Deutsche Gesellschaft für Neurorehabilitation (DGNR) und Redaktionskomitee S2k-LL SARS-CoV-2, COVID-19 und (Früh-) Rehabilitation
| | - Matthias Pletz
- Paul Ehrlich Gesellschaft für Chemotherapie e. V. (PEG)/Sektion Infektiologie
| | - Georg Pongratz
- Deutsche Schmerzgesellschaft, Deutsche Migräne- und Kopfschmerzgesellschaft und Deutsche Gesellschaft für Rheumatologie
| | | | - Klaus F Rabe
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)
| | | | - Andreas Stallmach
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS), Deutsche Gesellschaft für Infektiologie (DGI)
| | | | - Hans Otto Wagner
- Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)
| | | | - Hubert Wirtz
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)
| | - Andreas Zeiher
- Deutsche Gesellschaft für Kardiologie- Herz- und Kreislaufforschung (DGK)
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19
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Kahnert K, Lutter JI, Welte T, Alter P, Behr J, Herth F, Kauczor HU, Söhler S, Pfeifer M, Watz H, Vogelmeier CF, Bals R, Jörres RA, Trudzinski FC. Impact of the COVID-19 pandemic on the behaviour and health status of patients with COPD: results from the German COPD cohort COSYCONET. ERJ Open Res 2021; 7:00242-2021. [PMID: 34430659 PMCID: PMC8287574 DOI: 10.1183/23120541.00242-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Infection control measures for coronavirus disease 2019 (COVID-19) might have affected management and clinical state of patients with COPD. We analysed to which extent this common notion is fact-based. Methods: Patients of the COSYCONET cohort were contacted with three recurring surveys (COVID1, 2 and 3 at 0, 3 and 6 months, respectively). The questionnaires comprised behaviour, clinical and functional state, and medical treatment. The responses to the questionnaires were compared amongst themselves and with pre-COVID information from the last visit of COSYCONET. Results: Overall, 594 patients were contacted and 375 patients (58% males, forced expiratory volume in 1 s (FEV1) 61±22% predicted) provided valid data in COVID1 and COVID2. Five patients reported infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most patients – except for patients with higher education – reported compliance with recommended protective measures, whereby compliance to hygiene, contact and access to physicians slightly improved between COVID1 and COVID2. Also, patients obtained more information from physicians than from public media. In the majority of cases, the personal physician could not be substituted by remote consultation. Over time, symptoms slightly increased and self-assessed physical capacity decreased. Results of COVID3 were similar. Women and patients with more exacerbations and dyspnoea avoided medical consultations, whereas Global Initiative for Chronic Obstructive Lung Disease (GOLD) D patients were more amenable to tele-consultation. Conclusion: In well-characterised COPD patients, we observed on average slight deteriorations of clinical state during the period of COVID-19 restrictions, with high and partially increasing adherence to protective measures. The data suggest that in particular, women and GOLD D patients should be actively contacted by physicians to identify deteriorations. During the period of #COVID19 restrictions, slight deteriorations of clinical state with increasing adherence to protective measures were observed. In particular, women and GOLD D patients are at risk of deterioration.https://bit.ly/2S7fhEo
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Affiliation(s)
- Kathrin Kahnert
- Dept of Medicine V, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Johanna I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, CPC-M, DZL, Munich, Germany
| | - Tobias Welte
- Dept of Pneumology, Hannover Medical School, Hannover, Germany
| | - Peter Alter
- Dept of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), DZL, Marburg, Germany
| | - Jürgen Behr
- Dept of Medicine V, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Felix Herth
- Dept of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), DZL, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, DZL, Heidelberg, Germany
| | - Sandra Söhler
- Dept of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), DZL, Marburg, Germany
| | - Michael Pfeifer
- Dept of Respiratory Medicine, Donaustauf Hospital, Regensburg, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), DZL, Grosshansdorf, Germany
| | - Claus F Vogelmeier
- Dept of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), DZL, Marburg, Germany
| | - Robert Bals
- Dept of Internal Medicine V - Pulmonology, Allergology, Critical Care Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, LMU, LMU University Hospital, CPC-M, DZL, Munich, Germany
| | - Franziska C Trudzinski
- Dept of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), DZL, Heidelberg, Germany
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20
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21
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Abstract
Fragestellung: Einstellung von Pflegekräften zur SARS-CoV-2-Impfung und einer etwaigen Impfpflicht. Methode: Im Rahmen einer strukturierten anonymen wissenschaftlichen Erhebung zwischen 29. Januar und 26. April 2021 wurden Fragebögen an 72 Leiter von Orthopädie- und Unfallchirurgie-Abteilungen verschickt. Die Ärzte wurden gebeten, das Einverständnis von Klinikverwaltung, Pflegedienstleitung und Betriebsrat einzuholen und die Fragebögen an das Pflegepersonal zu verteilen und wieder einzusammeln. Die statistische Auswertung erfolgte deskriptiv. Ergebnisse: Es wurden 355 Antworten aus 5 Kliniken ausgewertet. In 65 der 72 Kliniken lehnten Verwaltung, Pflegedienstleitung oder Betriebsrat die Teilnahme ab, in 2 Kliniken waren die ärztlichen Leiter nicht interessiert. 50,7% der Pflegekräfte waren bereits geimpft oder hatten einen festen Impftermin, 14,9% waren noch unentschlossen und 34,4% lehnten eine Impfung ab. Gegen eine Impfpflicht sprach sich die Mehrheit der Pflegekräfte aus (47,6%), weniger als ein Viertel befürwortete sie (23,4%). Schlussfolgerung: Die Impfbereitschaft war in dieser Umfrage ausgesprochen gering. Hauptgrund für Impfverweigerung ist Angst vor Nebenwirkungen, Aufklärung sollte daher in erster Linie auf dieses Thema fokussieren. Schlüsselwörter: SARS-CoV-2, Corona, COVID-19, Impfbereitschaft, Impfpflicht, Pflegekräfte, Nebenwirkungen, Impfskepsis Eingereicht am 13.6.2021 - Revision akzeptiert am 21.6.2021
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Affiliation(s)
| | | | - Martin Lucke
- Artemed-Gruppe/Dr. Rinecker, Chirurgisches Klinikum München Süd GmbH & Co. KG, München, Germany
| | - Georg Täger
- Klinikverbund Kempten-Oberallgäu, Kempten, Germany
| | | | - Michael A Scherer
- Abteilung für Unfallchirurgie und Orthopädie, HELIOS Amper-Klinikum Dachau, Krankenhausstr. 15, 85221, Dachau, Germany.
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22
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Malin JJ, Spinner CD, Janssens U, Welte T, Weber-Carstens S, Schälte G, Gastmeier P, Langer F, Wepler M, Westhoff M, Pfeifer M, Rabe KF, Hoffmann F, Böttiger BW, Weinmann-Menke J, Kersten A, Berlit P, Krawczyk M, Nehls W, Fichtner F, Laudi S, Stegemann M, Skoetz N, Nothacker M, Marx G, Karagiannidis C, Kluge S. Correction to: Key summary of German national treatment guidance for hospitalized COVID‑19 patients : Key pharmacologic recommendations from a national German living guideline using an Evidence to Decision Framework (last updated 17.05.2021). Infection 2021; 50:107-108. [PMID: 34414563 PMCID: PMC8375461 DOI: 10.1007/s15010-021-01665-y] [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] [Indexed: 11/03/2022]
Affiliation(s)
- Jakob J Malin
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.
| | - Christoph D Spinner
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, University Hospital Rechts Der Isar, Munich, Germany
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St Antonius Hospital, Eschweiler, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gereon Schälte
- Department of Anaesthesiology, Medical Faculty Aachen, Rhenish Westphalian Technical University (RWTH), Aachen, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | - Florian Langer
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Wepler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm, Germany
| | - Michael Westhoff
- Department of Pneumology, Intensive Care and Sleep Medicine, Hemer Lung Clinic Centre of Pneumology and Thoracic Surgery, 58675, Hemer, Germany
| | - Michael Pfeifer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany
| | - Florian Hoffmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Weinmann-Menke
- Division of Nephrology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander Kersten
- Department of Cardiology, Angiology and Intensive Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Peter Berlit
- Germany German Society of Neurology, Berlin, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Wiebke Nehls
- Department of Palliative Care and Geriatric Medicine, Helios Clinic Emil Von Behring, Berlin, Germany
| | - Falk Fichtner
- Department of Anesthesiology and Intensive Care, University Hospital of Leipzig, Leipzig, Germany
| | - Sven Laudi
- Department of Anesthesiology and Intensive Care, University Hospital of Leipzig, Leipzig, Germany
| | - Miriam Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Skoetz
- Evidence-Based Oncology, Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies (AWMF), Universität Marburg, Marburg, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken Der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
| | - Stefan Kluge
- Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Malin JJ, Spinner CD, Janssens U, Welte T, Weber-Carstens S, Schälte G, Gastmeier P, Langer F, Wepler M, Westhoff M, Pfeifer M, Rabe KF, Hoffmann F, Böttiger BW, Weinmann-Menke J, Kersten A, Berlit P, Krawczyk M, Nehls W, Fichtner F, Laudi S, Stegemann M, Skoetz N, Nothacker M, Marx G, Karagiannidis C, Kluge S. Key summary of German national treatment guidance for hospitalized COVID-19 patients Key pharmacologic recommendations from a national German living guideline using an Evidence to Decision Framework (last updated 17.05.2021). Infection 2021; 50:93-106. [PMID: 34228347 PMCID: PMC8259552 DOI: 10.1007/s15010-021-01645-2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/19/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE This executive summary of a national living guideline aims to provide rapid evidence based recommendations on the role of drug interventions in the treatment of hospitalized patients with COVID-19. METHODS The guideline makes use of a systematic assessment and decision process using an evidence to decision framework (GRADE) as recommended standard WHO (2021). Recommendations are consented by an interdisciplinary panel. Evidence analysis and interpretation is supported by the CEOsys project providing extensive literature searches and living (meta-) analyses. For this executive summary, selected key recommendations on drug therapy are presented including the quality of the evidence and rationale for the level of recommendation. RESULTS The guideline contains 11 key recommendations for COVID-19 drug therapy, eight of which are based on systematic review and/or meta-analysis, while three recommendations represent consensus expert opinion. Based on current evidence, the panel makes strong recommendations for corticosteroids (WHO scale 5-9) and prophylactic anticoagulation (all hospitalized patients with COVID-19) as standard of care. Intensified anticoagulation may be considered for patients with additional risk factors for venous thromboembolisms (VTE) and a low bleeding risk. The IL-6 antagonist tocilizumab may be added in case of high supplemental oxygen requirement and progressive disease (WHO scale 5-6). Treatment with nMABs may be considered for selected inpatients with an early SARS-CoV-2 infection that are not hospitalized for COVID-19. Convalescent plasma, azithromycin, ivermectin or vitamin D3 should not be used in COVID-19 routine care. CONCLUSION For COVID-19 drug therapy, there are several options that are sufficiently supported by evidence. The living guidance will be updated as new evidence emerges.
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Affiliation(s)
- Jakob J Malin
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.
| | - Christoph D Spinner
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, University Hospital Rechts Der Isar, Munich, Germany
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St Antonius Hospital, Eschweiler, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gereon Schälte
- Department of Anaesthesiology, Medical Faculty Aachen, Rhenish Westphalian Technical University (RWTH), Aachen, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | - Florian Langer
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Wepler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm, Germany
| | - Michael Westhoff
- Department of Pneumology, Intensive Care and Sleep Medicine, Hemer Lung Clinic Centre of Pneumology and Thoracic Surgery, 58675, Hemer, Germany
| | - Michael Pfeifer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.,Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany
| | - Florian Hoffmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Weinmann-Menke
- Division of Nephrology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander Kersten
- Department of Cardiology, Angiology and Intensive Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Peter Berlit
- Germany German Society of Neurology, Berlin, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Wiebke Nehls
- Department of Palliative Care and Geriatric Medicine, Helios Clinic Emil Von Behring, Berlin, Germany
| | - Falk Fichtner
- Department of Anesthesiology and Intensive Care, University Hospital of Leipzig, Leipzig, Germany
| | - Sven Laudi
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Miriam Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Skoetz
- Evidence-Based Oncology, Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies (AWMF), Universität Marburg, Marburg, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken Der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
| | - Stefan Kluge
- Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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24
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Poschenrieder F, Meiler S, Lubnow M, Zeman F, Rennert J, Scharf G, Schaible J, Stroszczynski C, Pfeifer M, Hamer OW. Severe COVID-19 pneumonia: Perfusion analysis in correlation with pulmonary embolism and vessel enlargement using dual-energy CT data. PLoS One 2021; 16:e0252478. [PMID: 34101734 PMCID: PMC8186798 DOI: 10.1371/journal.pone.0252478] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Gas exchange in COVID-19 pneumonia is impaired and vessel obstruction has been suspected to cause ventilation-perfusion mismatch. Dual-energy CT (DECT) can depict pulmonary perfusion by regional assessment of iodine uptake. OBJECTIVE The purpose of this study was the analysis of pulmonary perfusion using dual-energy CT in a cohort of 27 consecutive patients with severe COVID-19 pneumonia. METHOD We retrospectively analyzed pulmonary perfusion with DECT in 27 consecutive patients (mean age 57 years, range 21-73; 19 men and 8 women) with severe COVID-19 pneumonia. Iodine uptake (IU) in regions-of-interest placed into normally aerated lung, ground-glass opacifications (GGO) and consolidations was measured using a dedicated postprocessing software. Vessel enlargement (VE) within opacifications and presence of pulmonary embolism (PE) was assessed by subjective analysis. Linear mixed models were used for statistical analyses. RESULTS Compared to normally aerated lung 106/151 (70.2%) opacifications without upstream PE demonstrated an increased IU, 9/151 (6.0%) an equal IU and 36/151 (23.8%) a decreased IU. The estimated mean iodine uptake (EMIU) in opacifications without upstream PE (GGO 1.77 mg/mL; 95%-CI: 1.52-2.02; p = 0.011, consolidations 1.82 mg/mL; 95%-CI: 1.56-2.08, p = 0.006) was significantly higher compared to normal lung (1.22 mg/mL; 95%-CI: 0.95-1.49). In case of upstream PE, EMIU of opacifications (combined GGO and consolidations) was significantly decreased compared to normal lung (0.52 mg/mL; 95%-CI: -0.07-1.12; p = 0.043). The presence of VE in opacifications correlated significantly with iodine uptake (p<0.001). CONCLUSIONS DECT revealed the opacifications in a subset of patients with severe COVID-19 pneumonia to be perfused non-uniformly with some being hypo- and others being hyperperfused. Mean iodine uptake in opacifications (both ground-glass and consolidation) was higher compared to normally aerated lung except for areas with upstream pulmonary embolism. Vessel enlargement correlated with iodine uptake: In summary, in a cohort of 27 consecutive patients with severe COVID-19 pneumonia, dual-energy CT demonstrated a wide range of iodine uptake in pulmonary ground-glass opacifications and consolidations as a surrogate marker for hypo- and hyperperfusion compared to normally aerated lung. Applying DECT to determine which pathophysiology is predominant might help to tailor therapy to the individual patient´s needs.
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Affiliation(s)
| | - Stefanie Meiler
- Department of Radiology, Regensburg University Medical Center, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, Regensburg University Medical Center, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, Regensburg University Medical Center, Regensburg, Germany
| | - Janine Rennert
- Department of Radiology, Regensburg University Medical Center, Regensburg, Germany
| | - Gregor Scharf
- Department of Radiology, Regensburg University Medical Center, Regensburg, Germany
| | - Jan Schaible
- Department of Radiology, Regensburg University Medical Center, Regensburg, Germany
| | | | - Michael Pfeifer
- Department of Internal Medicine II, Regensburg University Medical Center, Regensburg, Germany
- Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Okka W. Hamer
- Department of Radiology, Regensburg University Medical Center, Regensburg, Germany
- Department of Radiology, Donaustauf Hospital, Donaustauf, Germany
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25
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Idzko M, Lommatzsch M, Taube C, Eber E, Lamprecht B, Horak F, Pohl W, Rabe KF, Virchow JC, Hamelmann E, Pfeifer M, Bauer T, Buhl R. [Treatment of COVID-19 with Inhaled Glucocorticoids - Statement of the German Respiratory Society (DGP), the Austrian Society of Pneumology (ÖGP) and the German Society of Allergology and Clinical Immunology (DGAKI)]. Pneumologie 2021; 75:418-420. [PMID: 34000741 DOI: 10.1055/a-1488-5373] [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: 12/15/2022]
Affiliation(s)
- Marco Idzko
- Universitätsklinikum AKH Wien, Medizinische Universität Wien
| | | | | | | | | | | | - Wolfgang Pohl
- Karl-Landsteiner-Institut für klinische und experimentelle Pneumologie, Wien
| | - Klaus F Rabe
- LungenClinic Grosshansdorf und Medizinische Klinik Universität Kiel, Deutsches Zentrum für Lungenforschung (DZL)
| | | | | | | | - Torsten Bauer
- Lungenklinik Heckeshorn, Helios-Klinikum Emil von Behring, Berlin
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26
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Dellweg D, Lepper PM, Nowak D, Köhnlein T, Olgemöller U, Pfeifer M. [Statement of the German Society for Pulmonology and Respiratory Medicine Regarding the Regulation to Use FFP and Surgical Masks in the General Population]. Pneumologie 2021; 75:181-186. [PMID: 33598902 DOI: 10.1055/a-1375-6717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
On January 19, 2021, a new regulation on the mask requirement was issued in an initiative by the federal and state governments. This regulation obliges citizens to wear medical masks on public transport and in shops. In its statement, the German Society for Pneumology and Respiratory Medicine (DGP) describes the technical background of the various medical masks and explains their functionality using the associated standards. The DGP comes to the conclusion that FFP masks of the EN 149 standard were designed for the self-protection of the wearer and ensure this if the mask is worn properly and closes tightly to the face. Incorrect use must be avoided at all costs. Surgical masks in accordance with the EN 14683 standard were designed to protect against bacteria-carrying aerosols and, due to their design, have a rather low self-protection component. Community masks are not yet subject to any official standard. Community masks with electrostatic properties and high filtration performance could represent a reusable alternative in the future. Depending on the severity of their illness, patients with heart and/or lung diseases require a stress test with a mask to minimize medical risks.
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Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - P M Lepper
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München
| | - T Köhnlein
- Pneumologisches Facharztzentrum Teuchern, Teuchern
| | - U Olgemöller
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg.,Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf.,Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
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27
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Gehlen M, Schwarz-Eywill M, Hinz C, Pfeifer M, Siebers-Renelt U, Ratanski M, Maier A. [Rehabilitation of orphan diseases in adulthood: osteogenesis imperfecta]. Z Rheumatol 2021; 80:29-42. [PMID: 33259008 DOI: 10.1007/s00393-020-00927-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Osteogenesis imperfecta (brittle bone disease) is an orphan disease caused by a genetic mutation in collagen metabolism. Bone fractures are the most common symptoms; however, the clinical manifestation can vary widely. Additional features can include blue sclera, dwarfism, bone deformities, muscular weakness, scoliosis, hearing loss and hypermobility of joints. Most patients show a reduction of skeletal function. This leads to an increased risk of being unable to continue their former work and to participate in social life. A comprehensive treatment includes drug therapy, surgery and rehabilitation. This article gives an overview of the current status of rehabilitation in adult patients with osteogenesis imperfecta.
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Affiliation(s)
- M Gehlen
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland.
| | - M Schwarz-Eywill
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - C Hinz
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - M Pfeifer
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - U Siebers-Renelt
- Institut für Humangenetik, Universitätsklinikum Münster, Münster, Deutschland
| | - M Ratanski
- St. Josef Stift, Abteilung für Rheumatologie, Nordwestdeutsches Rheumazentrum, Sendenhorst, Deutschland
| | - A Maier
- St. Josef Stift, Abteilung für Rheumatologie, Nordwestdeutsches Rheumazentrum, Sendenhorst, Deutschland
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28
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Abstract
The logistical and infectious peculiarities and requirements challenge the intensive care treatment teams aiming at a successful liberation of patients from long-term mechanical ventilation. Especially in the pandemic, it is therefore important to use all potentials for weaning and decannulation, respectively, in patients with prolonged weaning.Weaning centers represent units of intensive medical care with a particular specialization in prolonged weaning. They are an integral part of a continuous care concept for these patients. A systematic weaning concept in the pandemic includes structural, personnel, equipment, infectiological and hygienic issues. In addition to the S2k guideline "Prolonged weaning" this position paper hightlights a new classification in prolonged weaning and organizational structures required in the future for the challenging pandemic situation. Category A patients with high weaning potential require a structured respiratory weaning in specialized weaning units, so as to get the greatest possible chance to realize successful weaning. Patients in category B with low or currently nonexistent weaning potential should receive a weaning attempt after an intermediate phase of further stabilization in an out-of-hospital ventilator unit. Category C patients with no weaning potential require a permanent out-of-hospital care, alternatively finishing mechanical ventilation with palliative support.Finally, under perspective in the position paper the following conceivable networks and registers in the future are presented: 1. locally organized regional networks of certified weaning centers, 2. a central, nationwide register of weaning capacities accordingly the already existing DIVI register and 3. registration of patients in difficult or prolonged weaning.
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Affiliation(s)
- M Westhoff
- Klinik für Pneumologie, Schlaf- und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer
- Universität Witten-Herdecke, Witten
| | - J Geiseler
- Medizinische Klinik IV: Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Klinikum Vest GmbH, Paracelsus-Klinik, Marl
| | - B Schönhofer
- Pneumologische Praxis und pneumologischer Konsildienst im Klinikum Agnes Karll Laatzen, Klinikum Region Hannover, Laatzen, Germany
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
- Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
| | - D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg
| | - M Bachmann
- Klinik für Intensiv- und Beatmungsmedizin, Asklepios-Klinik Harburg, Hamburg
| | - W Randerath
- Institut für Pneumologie an der Universität zu Köln, Köln
- Klinik für Pneumologie, Krankenhaus Bethanien, Solingen
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29
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Mohr A, Dannerbeck L, Lange TJ, Pfeifer M, Blaas S, Salzberger B, Hitzenbichler F, Koch M. Cardiopulmonary exercise pattern in patients with persistent dyspnoea after recovery from COVID-19. Multidiscip Respir Med 2021; 16:732. [PMID: 33623700 PMCID: PMC7893311 DOI: 10.4081/mrm.2021.732] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/29/2021] [Indexed: 12/31/2022] Open
Abstract
Cause and mechanisms of persistent dyspnoea after recovery from COVID-19 are not well described. The objective is to describe causal factors for persistent dyspnoea in patients after COVID-19. We examined patients reporting dyspnoea after recovery from COVID-19 by cardiopulmonary exercise testing. After exclusion of patients with pre-existing lung diseases, ten patients (mean age 50±13.1 years) were retrospectively analysed between May 14th and September 15th, 2020. On chest computed tomography, five patients showed residual ground glass opacities, and one patient showed streaky residua. A slight reduction of the mean diffusion capacity of the lung for carbon monoxide was noted in the cohort. Mean peak oxygen uptake was reduced with 1512±232 ml/min (72.7% predicted), while mean peak work rate was preserved with 131±29 W (92.4% predicted). Mean alveolar-arterial oxygen gradient (AaDO2) at peak exercise was 25.6±11.8 mmHg. Mean value of lactate post exercise was 5.6±1.8 mmol/l. A gap between peak work rate in (92.4% predicted) to peak oxygen uptake (72.3% pred.) was detected in our study cohort. Mean value of lactate post exercise was high in our study population and even higher (n.s.) compared to the subgroup of patients with reduced peak oxygen uptake and other obvious reason for limitation. Both observations support the hypothesis of anaerobic metabolism. The main reason for dyspnoea may therefore be muscular.
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Affiliation(s)
- Arno Mohr
- Center for Pneumology, Donaustauf Hospital, Donaustauf
| | | | - Tobias J Lange
- Department of Internal Medicine 2, University Medical Center, Regensburg
| | - Michael Pfeifer
- Center for Pneumology, Donaustauf Hospital, Donaustauf.,Department of Internal Medicine 2, University Medical Center, Regensburg
| | - Stefan Blaas
- Center for Pneumology, Donaustauf Hospital, Donaustauf
| | - Bernd Salzberger
- Department of Infection Control and Infectious Diseases, University Medical Center Regensburg, Germany
| | - Florian Hitzenbichler
- Department of Infection Control and Infectious Diseases, University Medical Center Regensburg, Germany
| | - Myriam Koch
- Department of Internal Medicine 2, University Medical Center, Regensburg
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30
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Kluge S, Janssens U, Welte T, Weber-Carstens S, Schälte G, Spinner CD, Malin JJ, Gastmeier P, Langer F, Wepler M, Westhoff M, Pfeifer M, Rabe KF, Hoffmann F, Böttiger BW, Weinmann-Menke J, Kersten A, Berlit P, Haase R, Marx G, Karagiannidis C. [S2k Guideline - Recommendations for Inpatient Therapy of Patients with COVID-19]. Pneumologie 2021; 75:88-112. [PMID: 33450783 DOI: 10.1055/a-1334-1925] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since December 2019, the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus-2) has been spreading rapidly in the sense of a global pandemic. This poses significant challenges for clinicians and hospitals and is placing unprecedented strain on the healthcare systems of many countries. The majority of patients with Coronavirus Disease 2019 (COVID-19) present with only mild symptoms such as cough and fever. However, about 6 % require hospitalization. Early clarification of whether inpatient and, if necessary, intensive care treatment is medically appropriate and desired by the patient is of particular importance in the pandemic. Acute hypoxemic respiratory insufficiency with dyspnea and high respiratory rate (> 30/min) usually leads to admission to the intensive care unit. Often, bilateral pulmonary infiltrates/consolidations or even pulmonary emboli are already found on imaging. As the disease progresses, some of these patients develop acute respiratory distress syndrome (ARDS). Mortality reduction of available drug therapy in severe COVID-19 disease has only been demonstrated for dexamethasone in randomized controlled trials. The main goal of supportive therapy is to ensure adequate oxygenation. In this regard, invasive ventilation and repeated prone positioning are important elements in the treatment of severely hypoxemic COVID-19 patients. Strict adherence to basic hygiene, including hand hygiene, and the correct wearing of adequate personal protective equipment are essential when handling patients. Medically necessary actions on patients that could result in aerosol formation should be performed with extreme care and preparation.
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Affiliation(s)
- S Kluge
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin.,ARDS Netzwerk Deutschland, Berlin
| | - U Janssens
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,ARDS Netzwerk Deutschland, Berlin
| | - T Welte
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin.,ARDS Netzwerk Deutschland, Berlin
| | - S Weber-Carstens
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg.,ARDS Netzwerk Deutschland, Berlin
| | - G Schälte
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg
| | - C D Spinner
- Deutsche Gesellschaft für Infektiologie (DGI), Berlin
| | - J J Malin
- Deutsche Gesellschaft für Infektiologie (DGI), Berlin
| | - P Gastmeier
- Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Münster
| | - F Langer
- Gesellschaft für Thrombose und Hämostaseforschung (GTH), Köln
| | - M Wepler
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
| | - M Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
| | - K F Rabe
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
| | - F Hoffmann
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Berlin
| | - B W Böttiger
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutscher Rat für Wiederbelebung (German Resuscitation Council; GRC), Ulm
| | | | - A Kersten
- Deutsche Gesellschaft für Kardiologie (DGK)
| | - P Berlit
- Deutsche Gesellschaft für Neurologie (DGN)
| | - R Haase
- Patientenvertretung (individueller Betroffener)
| | - G Marx
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg.,ARDS Netzwerk Deutschland, Berlin
| | - C Karagiannidis
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin.,ARDS Netzwerk Deutschland, Berlin
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31
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Kluge S, Janssens U, D. Spinner C, Pfeifer M, Marx G, Karagiannidis C. Clinical Practice Guideline: Recommendations on Inpatient Treatment of Patients with COVID-19. Dtsch Arztebl Int 2021; 118:arztebl.m2021.0110. [PMID: 33531113 PMCID: PMC8119662 DOI: 10.3238/arztebl.m2021.0110] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Since identification of the first cases in December 2019, COVID-19, caused by the novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2) has spread across the world, giving rise to a global pandemic. METHODS A literature search was carried out in PubMed, using search terms defined by the authors. Questions important for the management of patients with COVID-19 were identified and discussed, and recommendations or statements on these topics were formulated in a structured consensus process. RESULTS Determination of the indication for the admission of COVID-19 patients to the hospital should involve consideration of age, comorbidities, respiratory rate, and oxygen saturation. Every patient admitted without a recent PCR test should be tested immediately. It is recommended that any COVID-19 patient with hypoxemia (SpO2 <90%) despite being given oxygen, dyspnea, or a high respiratory rate be admitted to intensive care. In the case of hypoxemic respiratory insufficiency, an attempt at treatment with high-flow oxygen or non-invasive ventilation is suggested, while patients with severe hypoxemia/high respiratory rate should undergo intubation and invasive ventilation. In the presence of additional risk factors (such as obesity, known thrombophilia, intensive care treatment, or elevated D-dimers), intensified prophylaxis against thromboembolism may be indicated. Treatment with dexamethasone decreases the mortality among patients with severe or critical COVID-19. The important personal protection measures are attention to hygiene and the correct wearing of personal protective equipment. CONCLUSION The principal treatment measures are maintenance of adequate oxygenation, pharmacological prevention of thrombosis, and, in severe cases, administration of dexamethasone.
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Affiliation(s)
- Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf
| | - Uwe Janssens
- Department of Internal Medicine, St.-Antonius-Hospital Eschweiler
| | - Christoph D. Spinner
- University hospital rechts der Isar, Department of Internal Medicine II, Technical University of Munich, School of Medicine, München
| | - Michael Pfeifer
- Department of Internal Medicine II, University Medical Center Regensburg
| | - Gernot Marx
- Clinic for Surgical Intensive Medicine and Intermediate Caree, University Medical Center RWTH Aachen
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32
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Januzzi JL, Butler J, Sattar N, Xu J, Shaw W, Rosenthal N, Pfeifer M, Mahaffey KW, Neal B, Hansen MK. Insulin-Like Growth Factor Binding Protein 7 Predicts Renal and Cardiovascular Outcomes in the Canagliflozin Cardiovascular Assessment Study. Diabetes Care 2021; 44:210-216. [PMID: 33158949 DOI: 10.2337/dc20-1889] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/02/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze the association between concentrations of plasma insulin-like growth factor binding protein 7 (IGFBP7) with renal and cardiac outcomes among participants with type 2 diabetes and high cardiovascular risk. RESEARCH DESIGN AND METHODS Associations between IGFBP7 levels and clinical outcomes were assessed among participants in the Canagliflozin Cardiovascular Assessment Study (CANVAS) with type 2 diabetes and high cardiovascular risk. RESULTS Among CANVAS participants, 3,577 and 2,898 had IGFBP7 measured at baseline and 1 year, respectively. Per log-unit higher concentration, baseline IGFBP7 was significantly associated with the composite renal end point of sustained 40% reduction in estimated glomerular filtration rate, need for renal replacement therapy, or renal death (hazard ratio [HR] 3.51; P < 0.001) and the composite renal end point plus cardiovascular death (HR 4.90; P < 0.001). Other outcomes, including development or progression of albuminuria, were also predicted by baseline IGFBP7. Most outcomes were improved by canagliflozin regardless of baseline IGFBP7; however, those with baseline concentrations ≥96.5 ng/mL appeared to benefit more from canagliflozin relative to the first progression of albuminuria compared with those with lower baseline IGFBP7 (HR 0.64 vs. 0.95; P interaction = 0.003). Canagliflozin did not lower IGFBP7 concentrations by 1 year; however, at 1 year, higher IGFBP7 concentrations more strongly predicted the composite renal end point (HR 15.7; P < 0.001). Patients with rising IGFBP7 between baseline and 1 year had the highest number of composite renal events. CONCLUSIONS Plasma IGFBP7 concentrations predicted renal and cardiac events among participants with type 2 diabetes and high cardiovascular risk. More data are needed regarding circulating IGFBP7 and progression of diabetic kidney disease and its complications.
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Affiliation(s)
- James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, MA
| | | | | | - Jialin Xu
- Janssen Research & Development, LLC, Spring House, PA
| | - Wayne Shaw
- Janssen Research & Development, LLC, Raritan, NJ
| | | | | | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bruce Neal
- The George Institute for Global Health and Charles Perkins Centre, University of Sydney, Sydney, Australia.,Imperial College London, London, U.K
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33
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Pankow W, Andreas S, Rupp A, Pfeifer M. [Smoking Cessation with E-Cigarettes? - Ad Hoc Statement of the German Respiratory Society (DGP)]. Pneumologie 2020; 75:31-32. [PMID: 33285598 DOI: 10.1055/a-1323-6045] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The German Respiratory Society (DGP) turns against the e-cigarette as a means for harm reduction because of potential health risk and dangers to young people. The aerosol of e-cigarettes contains toxic ingredients that have been shown to be damaging to the lungs, the cardiovascular system and the immune system and are potentially carcinogenic. Studies on e-cigarettes as a means of smoking cessation are not very convincing, in order to favor e-cigarettes over nicotine replacement therapy, which have been tried and tested for many years, or other drugs that reduce the desire to smoke.
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Affiliation(s)
- W Pankow
- Vertreter der DGP im Aktionsbündnis Nichtrauchen e. V., Berlin
| | - S Andreas
- Vertreter der Deutschen Lungenstiftung e. V., Lungenfachklinik Immenhausen
| | - A Rupp
- Sprecher der Arbeitsgruppe Tabakprävention und -entwöhnung e. V., Pneumologische Praxis im Zentrum, Stuttgart
| | - M Pfeifer
- Präsident der DGP, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg
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34
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Loddenkemper R, Konietzko N, Seehausen V, Bauer T, Pfeifer M. [125 Years German Central Committee for the Fight against Tuberculosis (DZK)]. Pneumologie 2020; 74:719-741. [PMID: 33202436 DOI: 10.1055/a-1234-7581] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The German Central Committee for the Fight against Tuberculosis (DZK) celebrates this year its 125th birthday. On this occasion, the DZK as one of the oldest TB organizations worldwide is looking back on the development during its history and records the results in a comprehensive book, summarized in this article. In the book, the various political changes with their impact on the DZK are mirrored, starting with the German Empire, the Weimar Republic, the so-called "Third Reich", the two German states separated after the Second World War and the current FRG. Tuberculosis (TB) was the dominant widespread disease in the 19th century, today it is the leading infectious disease worldwide. As a consequence of migration, this affects also Germany. After meanwhile - in particular in 2015/16 - risen numbers of new cases (especially of those not born in Germany, which in 2019 accounted for 72 % of all cases), the impact of drug-resistant tuberculosis (in 2019, 11.4 % of all new cases had some resistance (384 cases), including 87 cases of MDR-TB, and of these 8 cases of XDR-TB and 27 cases of pre-XDR-TB), as well as the high proportion (81,5 %) - in 2019 - of open and thus very infectious pulmonary TB among new TB cases in Germany, impressively show that TB continues to be a health problem that should not be underestimated and that is increasingly concentrated in risk groups (socially disadvantaged persons, people from high-prevalence countries, homeless people, drug addicts, alcoholics, HIV-infected persons). The DZK therefore continues to play an important role in TB control as a link between the national and international organizations responsible for combating TB.
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Affiliation(s)
- R Loddenkemper
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | - N Konietzko
- vormals Ruhrlandklinik, Universitätsmedizin Essen, Essen
| | - V Seehausen
- Institut für Geschichte der Medizin und Ethik in der Medizin, Charité - Universitätsmedizin Berlin
| | - T Bauer
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin.,Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin
| | - M Pfeifer
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin.,Klinik Donaustauf, Universitätsklinikum Regensburg, Regensburg
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Abstract
The prognosis of patients with the coronavirus disease 2019 (COVID-19) is determined by the severity of lower respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The majority of patients demonstrate mild symptoms only. However, development of pneumonia is associated with the risk of severe respiratory insufficiency. Reverse transcriptase polymerase chain reaction (RT-PCR) of specimens from the upper and/or lower respiratory tract is the gold standard for the diagnosis of COVID-19. Radiology and especially high-resolution computed tomography (HRCT) are important for diagnosis and follow-up. This narrative review provides an overview of clinical signs and the complex and unique pathophysiology of COVID-19 pneumonia. Radiological features are addressed. Therapy is mainly supportive with the most important task being management of respiratory insufficiency. Recently, promising data were presented regarding effectiveness of antiviral and anti-inflammatory drugs.
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Affiliation(s)
- M. Pfeifer
- Klinik II für Innere Medizin, Pneumologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Deutschland
- Klinikum Donaustauf, Donaustauf, Deutschland
- Klinikum Barmherzige Brüder, Regensburg, Deutschland
| | - O. W. Hamer
- Klinikum Donaustauf, Donaustauf, Deutschland
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
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36
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Fisser C, Wiest C, Hamer OW, Müller T, Lubnow M, Pfeifer M, Lerzer C, Dvorak I. Die Diagnose liegt auf der Hand. Pneumologie 2020; 74:780-786. [DOI: 10.1055/a-1177-4209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungEine seltene Form der Dermatomyositis ist die klinische amyopathische Dermatomyositis (CADM). Charakterisiert ist sie durch das Fehlen einer bzw. durch eine nur sehr gering ausgeprägte Muskelbeteiligung. Dementsprechend sind die Kreatinkinase-Werte meist im Normalbereich. Typische Hautmanifestationen sind Gottron-Papeln und Mechanikerhände. Bei Nachweis eines MDa5 (Melanoma-differentiation-associated gene 5 intracellular pathogen sensor)-Antikörpers ist die CADM häufig mit einer rasch progredienten und schweren Verlaufsform einer interstitiellen Lungenerkrankung assoziiert. In der Lungenfunktion lässt sich eine Restriktion und eine Hypoxämie unterschiedlichen Ausmaßes nachweisen. Die HRCT-Bildgebung ist nicht spezifisch. Es lassen sich u. a. Milchglas, Retikulationen und Konsolidierungen beobachten. In der bronchioloalveolären Lavage zeigen sich gelegentlich vermehrt Lymphozyten. Histologisch ähnelt das Bild einer nicht-spezifischen interstitiellen Pneumonie oder einer organisierenden Pneumonie. Die Therapie richtet sich nach der Schwere der Ausprägung der klinischen Manifestation. Im Allgemeinen ist eine ausgeprägte immunsuppressive Therapie notwendig. Meist müssen verschiedene Immunsuppressiva kombiniert werden. Ein neuer Therapieansatz stellt die Verwendung des Januskinase-Inhibitors Tofacitinib dar. Zur Therapiekontrolle können der Ferritinspiegel und der MDa5-Antikörper-Titer verwendet werden. Es besteht eine hohe Mortalität von bis zu 84 %.
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Affiliation(s)
- C. Fisser
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
| | - C. Wiest
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
| | - O. W. Hamer
- Institut für Röntgendiagnostik, Universitätsklinik Regensburg, Regensburg
- Abteilung für Radiologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
| | - T. Müller
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
| | - M. Lubnow
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
| | - M. Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
- Abteilung für Pneumologie, Krankenhaus der Barmherzigen Brüder Regensburg, Regensburg
| | - C. Lerzer
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
| | - I. Dvorak
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
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37
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Mohr A, Plentz A, Sieroslawski A, Pezenburg F, Pfeifer M, Salzberger B, Hitzenbichler F. Use of Pneumococcal and influenza vaccine in patients with COPD, asthma bronchiale and interstitial lung diseases in south east Germany. Respir Med 2020; 174:106207. [PMID: 33152552 DOI: 10.1016/j.rmed.2020.106207] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/16/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of this study was to analyse use of and adherence to influenza and pneumococcal vaccination in high-risk patients with chronic pulmonary disease. METHODS The study was initiated at the Centre of Pneumology in Donaustauf, Germany. All patients with asthma bronchiale (AB), chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) that were treated in a pneumological Non-ICU ward, in the sleep laboratory or in the outpatient's clinic between October 1st, 2019 and March 26th, 2020 and provided informed consent were included. Vaccination certificates and a vaccination-centred questionnaire were analysed in relation to vaccination status, risk factors, patient characteristics. RESULTS 133 patients with COPD, 68 patients with AB and 104 patients with ILD were included. PCV13/PPSV23 vaccination only (no sequential vaccination) was performed in less than 10%/33% of all patients. Sequential vaccination of PCV13 and PPSV23 was performed in 12.8% of COPD, 7.4% of AB patients and 13.5% of ILD patients. Influenza vaccination was performed in less than 30% of all patients. Vaccinations were mainly performed by general practitioners (GPs) and rarely by specialists of pulmonary care (<6%). 67% of all patients were seen by a specialist in pulmonary care in the last 36 months, but in less than 15% the vaccination status was evaluated. DISCUSSION Use of and adherence for PPSV23 and influenza vaccinations is low in patients with COPD, AB and ILD in south east Germany.
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Affiliation(s)
- Arno Mohr
- Center for Pneumology, Donaustauf Hospital, Ludwigstr. 68, 93093, Donaustauf, Germany.
| | - Annelie Plentz
- Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Anna Sieroslawski
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Fabian Pezenburg
- Center for Pneumology, Donaustauf Hospital, Ludwigstr. 68, 93093, Donaustauf, Germany
| | - Michael Pfeifer
- Center for Pneumology, Donaustauf Hospital, Ludwigstr. 68, 93093, Donaustauf, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Florian Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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38
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Kluge S, Janssens U, Welte T, Weber-Carstens S, Schälte G, Salzberger B, Gastmeier P, Langer F, Wepler M, Westhoff M, Pfeifer M, Hoffmann F, Böttiger BW, Marx G, Karagiannidis C. [German recommendations for treatment of critically ill patients with COVID-19-version 3]. Pneumologe (Berl) 2020; 17:406-425. [PMID: 33110402 PMCID: PMC7581953 DOI: 10.1007/s10405-020-00359-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Seit Dezember 2019 verbreitet sich das neuartige Coronavirus SARS-CoV‑2 (Severe Acute Respiratory Syndrome – Corona Virus-2) rasch im Sinne einer weltweiten Pandemie. Dies stellt Kliniker und Krankenhäuser vor große Herausforderungen und belastet die Gesundheitssysteme vieler Länder in einem nie dagewesenen Ausmaß. Die Mehrheit der Patienten zeigt lediglich milde Symptome der sogenannten Coronavirus Disease 2019 (COVID-19). Dennoch benötigen etwa 5–8 % eine intensivmedizinische Behandlung. Die akute hypoxämische respiratorische Insuffizienz mit Dyspnoe und hoher Atemfrequenz (>30/Min) führt in der Regel zur Aufnahme auf die Intensivstation. Oft finden sich dann bereits bilaterale pulmonale Infiltrate/Konsolidierungen oder auch Lungenembolien in der Bildgebung. Im weiteren Verlauf entwickeln viele Patienten ein Acute Respiratory Distress Syndrome (ARDS). Eine klinische Wirksamkeit einer medikamentösen Therapie bei schwerer COVID-Erkrankung (hospitalisierte Patienten) ist bisher für Remdesivir und Dexamethason nachgewiesen. Das Hauptziel der supportiven Therapie ist es eine ausreichende Oxygenierung sicherzustellen. Die invasive Beatmung und wiederholte Bauchlagerung sind dabei wichtige Elemente in der Behandlung von schwer hypoxämischen COVID-19 Patienten. Die strikte Einhaltung der Basishygiene, einschließlich der Händehygiene, sowie das korrekte Tragen von adäquater persönlicher Schutzausrüstung sind im Umgang mit den Patienten unabdingbar. Prozeduren, die zur Aerosolbildung führen könnten, sollten falls nötig, mit äußerster Sorgfalt und Vorbereitung durchgeführt werden.
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Affiliation(s)
- S. Kluge
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Deutschland
| | - U. Janssens
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - T. Welte
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - S. Weber-Carstens
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - G. Schälte
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B. Salzberger
- Deutsche Gesellschaft für Infektiologie (DGI), München, Deutschland
| | - P. Gastmeier
- Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Münster, Deutschland
| | - F. Langer
- Gesellschaft für Thrombose und Hämostaseforschung (GTH), Köln, Deutschland
| | - M. Wepler
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - M. Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - M. Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - F. Hoffmann
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Berlin, Deutschland
| | - B. W. Böttiger
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutscher Rat für Wiederbelebung (German Resuscitation Council; GRC), Ulm, Deutschland
| | - G. Marx
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - C. Karagiannidis
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
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39
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Kluge S, Janssens U, Welte T, Weber-Carstens S, Schälte G, Salzberger B, Gastmeier P, Langer F, Wepler M, Westhoff M, Pfeifer M, Hoffmann F, Böttiger BW, Marx G, Karagiannidis C. [German recommendations for treatment of critically ill patients with COVID-19-version 3 : S1-guideline]. Anaesthesist 2020; 69:653-664. [PMID: 32833080 PMCID: PMC7444177 DOI: 10.1007/s00101-020-00833-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Seit Dezember 2019 verbreitet sich das neuartige Coronavirus SARS-CoV‑2 (Severe Acute Respiratory Syndrome – Corona Virus-2) rasch im Sinne einer weltweiten Pandemie. Dies stellt Kliniker und Krankenhäuser vor große Herausforderungen und belastet die Gesundheitssysteme vieler Länder in einem nie dagewesenen Ausmaß. Die Mehrheit der Patienten zeigt lediglich milde Symptome der sogenannten Coronavirus Disease 2019 (COVID-19). Dennoch benötigen etwa 5–8 % eine intensivmedizinische Behandlung. Die akute hypoxämische respiratorische Insuffizienz mit Dyspnoe und hoher Atemfrequenz (>30/Min) führt in der Regel zur Aufnahme auf die Intensivstation. Oft finden sich dann bereits bilaterale pulmonale Infiltrate/Konsolidierungen oder auch Lungenembolien in der Bildgebung. Im weiteren Verlauf entwickeln viele Patienten ein Acute Respiratory Distress Syndrome (ARDS). Eine klinische Wirksamkeit einer medikamentösen Therapie bei schwerer COVID-Erkrankung (hospitalisierte Patienten) ist bisher für Remdesivir und Dexamethason nachgewiesen. Das Hauptziel der supportiven Therapie ist es eine ausreichende Oxygenierung sicherzustellen. Die invasive Beatmung und wiederholte Bauchlagerung sind dabei wichtige Elemente in der Behandlung von schwer hypoxämischen COVID-19 Patienten. Die strikte Einhaltung der Basishygiene, einschließlich der Händehygiene, sowie das korrekte Tragen von adäquater persönlicher Schutzausrüstung sind im Umgang mit den Patienten unabdingbar. Prozeduren, die zur Aerosolbildung führen könnten, sollten falls nötig, mit äußerster Sorgfalt und Vorbereitung durchgeführt werden.
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Affiliation(s)
- S Kluge
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland.
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland.
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland.
- ARDS Netzwerk Deutschland, Berlin, Deutschland.
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - U Janssens
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - T Welte
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - S Weber-Carstens
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - G Schälte
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B Salzberger
- Deutsche Gesellschaft für Infektiologie (DGI), München, Deutschland
| | - P Gastmeier
- Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Münster, Deutschland
| | - F Langer
- Gesellschaft für Thrombose und Hämostaseforschung (GTH), Köln, Deutschland
| | - M Wepler
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - M Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - F Hoffmann
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Berlin, Deutschland
| | - B W Böttiger
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutscher Rat für Wiederbelebung (German Resuscitation Council; GRC), Ulm, Deutschland
| | - G Marx
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - C Karagiannidis
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
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40
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Windisch W, Dellweg D, Geiseler J, Westhoff M, Pfeifer M, Suchi S, Schönhofer B. Prolonged Weaning from Mechanical Ventilation. Dtsch Arztebl Int 2020; 117:197-204. [PMID: 32343653 DOI: 10.3238/arztebl.2020.0197] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 05/31/2019] [Accepted: 12/17/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND To accommodate the increasing number of patients requiring prolonged weaning from mechanical ventilation, specialized weaning centers have been established for patients in whom weaning on the intensive care unit (ICU) was unsuccessful. METHODS This study aimed to determine both the outcome of treatment and the factors associated with prolonged weaning in patients who were transferred from the ICU to specialized weaning centers in Germany during the period 2011 to 2015, based on a nationwide registry covering all specialized weaning centers currently going through the process of accreditation by the German Respiratory Society. RESULTS Of 11 424 patients, 7346 (64.3%) were successfully weaned, of whom 2236 were switched to long-term non-invasive ventilation; 1658 (14.5%) died in the weaning unit; and 2420 (21.2%) could not be weaned. The duration of weaning decreased significantly from 22 to 18 days between 2011 and 2015 (p <0.0001). Multivariate analysis revealed that the factor most strongly associated with in-hospital mortality was advanced age (odds ratio [OR] 11.07, 95% confidence interval [6.51; 18.82], p <0.0001). The need to continue with invasive ventilation was most strongly associated with the duration mechanical ventilation prior to transfer from the ICU (OR 4.73 [3.25; 6.89]), followed by a low body mass index (OR 0.38 [0.26; 0.58]), pre-existing neuromuscular disorders (OR 2.98 [1.88; 4.73]), and advanced age (OR 2.96 [1.87; 4.69]) (each p <0.0001). CONCLUSION Weaning duration has decreased over time, but prolonged weaning is still unsuccessful in one third of patients.Overall, the results warrant the establishment of specialized weaning centers. Variables associated with death and weaningfailure can be integrated into ICU decision-making processes.
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Affiliation(s)
- Wolfram Windisch
- Department of Respiratory Medicine, Cologne Merheim Hospital, Witten/Herdecke University; Kloster Grafschaft Hospital GmbH, Academic Teaching Hospital of Marburg University, Schmallenberg-Grafschaft; Vest Hospital, Department of Internal Medicine IV: Respiratory, Ventilation, and Sleep Medicine, Academic Teaching Hospital of Bochum University, Marl; Department of Respiratory Medicine, Hemer Lung Hospital, Witten/Herdecke University; Department of Respiratory Medicine, Donaustauf Hospital, Regensburg University; Data-quest GmbH -Statistics and Data Management, Göttingen; Department of Respiratory, Intensive Care, and Sleep Medicine, Siloah Hospital, Hanover
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Abstract
Coronavirus disease 2019 (COVID-19) continues to pose a major global threat. Although a wide range of organ manifestations have now been described, the respiratory system remains in the forefront in terms of the course of infection. Severe pneumonia can develop and is generally prognostically relevant. The following article discusses currently known features of these pulmonary manifestations from a pathophysiological, symptomatological, and radiological perspective. With regard to pathophysiology, the complex nature of the acute pulmonary disease involving severe injury to the alveolar epithelium and pulmonary vascular endothelium resulting in severe respiratory failure in a proportion of patients is discussed. The differences from "classic" acute respiratory distress syndrome and the major effects these have on the treatment of COVID-19 are elucidated. Following a brief description of PCR-based pathogen identification and information on typical laboratory findings, imaging of COVID-19 pneumonia is described in greater details (typical findings, differential diagnoses, grading of the likelihood of COVID-19 pneumonia). This is followed by a description of symptoms, which develop in three phases. With regard to treatment, supportive and intensive care approaches are discussed, including O2 administration and (non-)invasive ventilation. The article concludes with a summary of the insights gained into pharmacological therapies: thrombosis prevention on the one hand, and specific antiviral and immunomodulatory therapies (remdesivir, tocilizumab, anakinra, dexamethasone) on the other.
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Affiliation(s)
- M Pfeifer
- Pneumologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
- Klinikum Donaustauf, Donaustauf, Deutschland.
- Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland.
| | - O W Hamer
- Klinikum Donaustauf, Donaustauf, Deutschland
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
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42
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Karagiannidis C, Mostert C, Hentschker C, Voshaar T, Malzahn J, Schillinger G, Klauber J, Janssens U, Marx G, Weber-Carstens S, Kluge S, Pfeifer M, Grabenhenrich L, Welte T, Busse R. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med 2020; 8:853-862. [PMID: 32735842 PMCID: PMC7386882 DOI: 10.1016/s2213-2600(20)30316-7] [Citation(s) in RCA: 519] [Impact Index Per Article: 129.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 02/09/2023]
Abstract
Background Nationwide, unbiased, and unselected data of hospitalised patients with COVID-19 are scarce. Our aim was to provide a detailed account of case characteristics, resource use, and outcomes of hospitalised patients with COVID-19 in Germany, where the health-care system has not been overwhelmed by the pandemic. METHODS In this observational study, adult patients with a confirmed COVID-19 diagnosis, who were admitted to hospital in Germany between Feb 26 and April 19, 2020, and for whom a complete hospital course was available (ie, the patient was discharged or died in hospital) were included in the study cohort. Claims data from the German Local Health Care Funds were analysed. The data set included detailed information on patient characteristics, duration of hospital stay, type and duration of ventilation, and survival status. Patients with adjacent completed hospital stays were grouped into one case. Patients were grouped according to whether or not they had received any form of mechanical ventilation. To account for comorbidities, we used the Charlson comorbidity index. FINDINGS Of 10 021 hospitalised patients being treated in 920 different hospitals, 1727 (17%) received mechanical ventilation (of whom 422 [24%] were aged 18-59 years, 382 [22%] were aged 60-69 years, 535 [31%] were aged 70-79 years, and 388 [23%] were aged ≥80 years). The median age was 72 years (IQR 57-82). Men and women were equally represented in the non-ventilated group, whereas twice as many men than women were in the ventilated group. The likelihood of being ventilated was 12% for women (580 of 4822) and 22% for men (1147 of 5199). The most common comorbidities were hypertension (5575 [56%] of 10 021), diabetes (2791 [28%]), cardiac arrhythmia (2699 [27%]), renal failure (2287 [23%]), heart failure (1963 [20%]), and chronic pulmonary disease (1358 [14%]). Dialysis was required in 599 (6%) of all patients and in 469 (27%) of 1727 ventilated patients. The Charlson comorbidity index was 0 for 3237 (39%) of 8294 patients without ventilation, but only 374 (22%) of 1727 ventilated patients. The mean duration of ventilation was 13·5 days (SD 12·1). In-hospital mortality was 22% overall (2229 of 10 021), with wide variation between patients without ventilation (1323 [16%] of 8294) and with ventilation (906 [53%] of 1727; 65 [45%] of 145 for non-invasive ventilation only, 70 [50%] of 141 for non-invasive ventilation failure, and 696 [53%] of 1318 for invasive mechanical ventilation). In-hospital mortality in ventilated patients requiring dialysis was 73% (342 of 469). In-hospital mortality for patients with ventilation by age ranged from 28% (117 of 422) in patients aged 18-59 years to 72% (280 of 388) in patients aged 80 years or older. INTERPRETATION In the German health-care system, in which hospital capacities have not been overwhelmed by the COVID-19 pandemic, mortality has been high for patients receiving mechanical ventilation, particularly for patients aged 80 years or older and those requiring dialysis, and has been considerably lower for patients younger than 60 years. FUNDING None.
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Affiliation(s)
- Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany.
| | - Carina Mostert
- Research Institute of the Local Health Care Funds, Berlin, Germany
| | | | - Thomas Voshaar
- Department of Pneumology and Allergy, Immunology and Sleep Medicine, Lung Cancer Center, Bethanien Hospital, Moers, Germany
| | - Jürgen Malzahn
- Federal Association of the Local Health Care Funds, Berlin, Germany
| | | | - Jürgen Klauber
- Research Institute of the Local Health Care Funds, Berlin, Germany
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St Antonius Hospital, Eschweiler, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Kluge
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Pfeifer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany; Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Linus Grabenhenrich
- Department for Infectious Disease Epidemiology, Robert Koch Institut, Berlin, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
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43
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Kolditz M, Dellweg D, Geerdes-Fenge H, Lepper PM, Schaberg T, Ewig S, Pfeifer M, Bauer T. [Treatment with Dexamethasone in Patients with COVID-19 - A Position Paper of the German Respiratory Society (DGP)]. Pneumologie 2020; 74:493-495. [PMID: 32674177 PMCID: PMC7516361 DOI: 10.1055/a-1216-5739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- M Kolditz
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Innere Medizin I, Dresden
| | - D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - H Geerdes-Fenge
- Universitätsmedizin Rostock, Zentrum für Innere Medizin, Abteilung für Infektionskrankheiten und Tropenmedizin, Rostock
| | - P M Lepper
- Universitätsklinikum des Saarlandes, Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Homburg/Saar
| | | | - S Ewig
- Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Krankenanstalt Bochum, Bochum
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg.,Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf.,Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
| | - T Bauer
- Helios Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin
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44
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Dellweg D, Pfeifer M. Stellungnahme zum Leserbrief „Die maskierte Gesellschaft“ von Prof. Santiago Ewig, Prof. Sören Gatermann und Prof. Sebastian Lemmen. Pneumologie 2020; 74:409-411. [PMID: 32583379 PMCID: PMC7416200 DOI: 10.1055/a-1199-4557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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45
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Pfeifer M, Ewig S, Voshaar T, Randerath WJ, Bauer T, Geiseler J, Dellweg D, Westhoff M, Windisch W, Schönhofer B, Kluge S, Lepper PM. Position Paper for the State-of-the-Art Application of Respiratory Support in Patients with COVID-19. Respiration 2020; 99:521-542. [PMID: 32564028 PMCID: PMC7360514 DOI: 10.1159/000509104] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 01/25/2023] Open
Abstract
Against the background of the pandemic caused by infection with the SARS-CoV-2 virus, the German Respiratory Society has appointed experts to develop therapy strategies for COVID-19 patients with acute respiratory failure (ARF). Here we present key position statements including observations about the pathophysiology of (ARF). In terms of the pathophysiology of pulmonary infection with SARS-CoV-2, COVID-19 can be divided into 3 phases. Pulmonary damage in advanced COVID-19 often differs from the known changes in acute respiratory distress syndrome (ARDS). Two types (type L and type H) are differentiated, corresponding to early- and late-stage lung damage. This differentiation should be taken into consideration in the respiratory support of ARF. The assessment of the extent of ARF should be based on arterial or capillary blood gas analysis under room air conditions, and it needs to include the calculation of oxygen supply (measured from the variables of oxygen saturation, hemoglobin level, the corrected values of Hüfner's factor, and cardiac output). Aerosols can cause transmission of infectious, virus-laden particles. Open systems or vented systems can increase the release of respirable particles. Procedures in which the invasive ventilation system must be opened and endotracheal intubation carried out are associated with an increased risk of infection. Personal protective equipment (PPE) should have top priority because fear of contagion should not be a primary reason for intubation. Based on the current knowledge, inhalation therapy, nasal high-flow therapy (NHF), continuous positive airway pressure (CPAP), or noninvasive ventilation (NIV) can be performed without an increased risk of infection to staff if PPE is provided. A significant proportion of patients with ARF present with relevant hypoxemia, which often cannot be fully corrected, even with a high inspired oxygen fraction (FiO2) under NHF. In this situation, the oxygen therapy can be escalated to CPAP or NIV when the criteria for endotracheal intubation are not met. In ARF, NIV should be carried out in an intensive care unit or a comparable setting by experienced staff. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring and readiness for intubation are to be ensured at all times. If the ARF progresses under CPAP/NIV, intubation should be implemented without delay in patients who do not have a "do not intubate" order.
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Affiliation(s)
- Michael Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg, Germany
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf, Germany
- Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg, Germany
| | - Santiago Ewig
- Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Krankenanstalt Bochum, Bochum, Germany
| | - Thomas Voshaar
- Schwerpunkt Pneumologie, Allergologie, Klinische Immunologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien, Moers, Germany
| | - Winfried Johannes Randerath
- Institut für Pneumologie an der Universität zu Köln, Cologne, Germany
- Klinik für Pneumologie, Krankenhaus Bethanien, Solingen, Germany
| | - Torsten Bauer
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring GmbH, Berlin, Germany,
| | - Jens Geiseler
- Medizinische Klinik IV: Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Klinikum Vest GmbH, Paracelsus-Klinik, Marl, Germany
| | - Dominic Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg, Germany
| | - Michael Westhoff
- Klinik für Pneumologie, Lungenklinik Hemer, Hemer, Germany
- Universität Witten-Herdecke, Witten, Germany
| | - Wolfram Windisch
- Universität Witten-Herdecke, Witten, Germany
- Klinik für Pneumologie, Klinikum Köln-Merheim, Kliniken der Stadt Köln, Lehrstuhl für Pneumologie der Universität Witten-Herdecke, Cologne, Germany
| | - Bernd Schönhofer
- Pneumologische Praxis und pneumologischer Konsildienst im Klinikum Agnes Karll Laatzen, Klinikum Region Hannover, Laatzen, Germany
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp M Lepper
- Innere Medizin V: Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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46
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Fisser C, Götz K, Hetzenecker A, Debl K, Zeman F, Hamer OW, Poschenrieder F, Fellner C, Stadler S, Maier LS, Pfeifer M, Buchner S, Arzt M. Obstructive sleep apnoea but not central sleep apnoea is associated with left ventricular remodelling after acute myocardial infarction. Clin Res Cardiol 2020; 110:971-982. [PMID: 32519084 PMCID: PMC8238704 DOI: 10.1007/s00392-020-01684-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/02/2020] [Indexed: 12/02/2022]
Abstract
Obejctive Obstructive sleep apnoea (OSA) increases left ventricular transmural pressure more than central sleep apnoea (CSA) owing to negative intrathoracic pressure swings. We tested the hypothesis that the severity of OSA, and not CSA, is therefore associated with spheric cardiac remodelling after acute myocardial infarction. Methods This sub-analysis of a prospective observational study included 24 patients with acute myocardial infarction who underwent primary percutaneous coronary intervention. Spheric remodelling, calculated according to the sphericity index, was assessed by cardiac magnetic resonance imaging at baseline and 12 weeks after acute myocardial infarction. OSA and CSA [apnoea-hypopnoea index (AHI) ≥ 5/hour] were diagnosed by polysomnography.
Results Within 12 weeks after acute myocardial infarction, patients with OSA exhibited a significant increase in systolic sphericity index compared to patients without sleep-disordered breathing (no SDB) and patients with CSA (OSA vs. CSA vs. no SDB: 0.05 ± 0.04 vs. 0.01 ± 0.04 vs. − 0.03 ± 0.03, p = 0.002). In contrast to CSA, the severity of OSA was associated with an increase in systolic sphericity index after accounting for TIMI-flow before percutaneous coronary intervention, infarct size, pain-to-balloon-time and systolic blood pressure [OSA: B (95% CI) 0.443 (0.021; 0.816), p = 0.040; CSA: 0.193 (− 0.134; 0.300), p = 0.385]. Conclusion In contrast to CSA and no SDB, OSA is associated with spheric cardiac remodelling within the first 12 weeks after acute myocardial infarction. Data suggest that OSA-related negative intrathoracic pressure swings may contribute to this remodelling after acute myocardial infaction. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01684-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christoph Fisser
- Department of Internal Medicine II, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Kristina Götz
- Department of Internal Medicine II, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | | | - Kurt Debl
- Department of Internal Medicine II, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Okka W Hamer
- Department of Radiology, University Medical Centre Regensburg, Regensburg, Germany
| | | | - Claudia Fellner
- Department of Radiology, University Medical Centre Regensburg, Regensburg, Germany
| | - Stefan Stadler
- Department of Internal Medicine II, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Michael Pfeifer
- Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Stefan Buchner
- Department of Internal Medicine II, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Internal Medicine, Cham Hospital, Cham, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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47
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Budweiser S, Tratz F, Gfüllner F, Pfeifer M. Long-term outcome with focus on pulmonary hypertension in Obesity Hypoventilation Syndrome. Clin Respir J 2020; 14:940-947. [PMID: 32506595 DOI: 10.1111/crj.13225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pulmonary Hypertension (PH) is a frequent comorbidity in Obesity Hypoventilation Syndrome (OHS). OBJECTIVE We investigated long-term outcome of OHS with a particular emphasis on PH. METHODS In a prospective design, 64 patients with OHS and established noninvasive positive pressure ventilation (NPPV), were assessed by serum biomarkers, right heart catheterization, blood gases analysis, lung function, Epworth-Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), World Health Organization-functional class (WHO-FC) and health-related quality of life (HRQL) via the Severe Respiratory Insufficiency (SRI) questionnaire. After a planned follow-up of 5 years patients were reassessed regarding vital status, WHO-FC, ESS, SRI, PSQI, body mass index (BMI) and NPPV use. Prognostic markers were explored using univariate and multivariate Cox regression analyses. RESULTS At the 5-year follow-up, BMI tended to decrease (P = 0.05), while WHO-FC, ESS and PSQI remained unchanged. HRQL deteriorated in terms of SRI summary score and most subdomains (P < .05 each). NPPV adherence still was high (89%), while daily NPPV use increased from 6.7 (5.1; 8.0) h/d to 8.2 (7.4; 9.0) h/d (P < .05). After a 5-year follow-up, mortality was 25.8%. In univariate regression analyses only age > 69.5 years (HR = 4.145, 95%-CI = 1.180-14.565, P = 0.016), NT-proBNP > 1256 pg/mL (HR = 5.162, 95%-CI = 1.136-23.467, P = 0.018), diffusion capacity for carbon monoxide (DLCO, %pred) (HR = 0.341, 95%-CI = 0.114-1.019, P = 0.043) and higher oxygen use during daytime (HR = 5.236, 95%-CI = 1.489-18.406, P = 0.004) predicted mortality. No independent factor predicting mortality was detected in multivariate analysis. CONCLUSION Despite a high long-term NPPV use HRQL worsened. Age, oxygen use at baseline, DLCO (%pred) and NT-proBNP, as a surrogate parameter for PH, were related to long-term survival.
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Affiliation(s)
- Stephan Budweiser
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre, Rosenheim, Germany
| | - Florian Tratz
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Centre, Rosenheim, Germany
| | | | - Michael Pfeifer
- Centre for Pneumology, Donaustauf Hospital, Donaustauf, Germany
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48
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Dellweg D, Lepper PM, Nowak D, Köhnlein T, Olgemöller U, Pfeifer M. [Position Paper of the German Respiratory Society (DGP) on the Impact of Community Masks on Self-Protection and Protection of Others in Regard to Aerogen Transmitted Diseases]. Pneumologie 2020. [PMID: 32455450 DOI: 10.1055/a-1184-7263] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - P M Lepper
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München
| | | | - U Olgemöller
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg.,Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf.,Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
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Pfeifer M, Ewig S, Voshaar T, Randerath W, Bauer T, Geiseler J, Dellweg D, Westhoff M, Windisch W, Schönhofer B, Kluge S, Lepper PM. [Position Paper for the State of the Art Application of Respiratory Support in Patients with COVID-19 - German Respiratory Society]. Pneumologie 2020; 74:337-357. [PMID: 32323287 PMCID: PMC7378547 DOI: 10.1055/a-1157-9976] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Against the background of the pandemic caused by infection with the SARS-CoV-2, the German Society for Pneumology and Respiratory Medicine (DGP e.V.), in cooperation with other associations, has designated a team of experts in order to answer the currently pressing questions about therapy strategies in dealing with COVID-19 patients suffering from acute respiratory insufficiency (ARI).The position paper is based on the current knowledge that is evolving daily. Many of the published and cited studies require further review, also because many of them did not undergo standard review processes.Therefore, this position paper is also subject to a continuous review process and will be further developed in cooperation with the other professional societies.This position paper is structured into the following five topics:1. Pathophysiology of acute respiratory insufficiency in patients without immunity infected with SARS-CoV-22. Temporal course and prognosis of acute respiratory insufficiency during the course of the disease3. Oxygen insufflation, high-flow oxygen, non-invasive ventilation and invasive ventilation with special consideration of infectious aerosol formation4. Non-invasive ventilation in ARI5. Supply continuum for the treatment of ARIKey points have been highlighted as core statements and significant observations. Regarding the pathophysiological aspects of acute respiratory insufficiency (ARI), the pulmonary infection with SARS-CoV-2 COVID-19 runs through three phases: early infection, pulmonary manifestation and severe hyperinflammatory phase.There are differences between advanced COVID-19-induced lung damage and those changes seen in Acute Respiratory Distress Syndromes (ARDS) as defined by the Berlin criteria. In a pathophysiologically plausible - but currently not yet histopathologically substantiated - model, two types (L-type and H-type) are distinguished, which correspond to an early and late phase. This distinction can be taken into consideration in the differential instrumentation in the therapy of ARI.The assessment of the extent of ARI should be carried out by an arterial or capillary blood gas analysis under room air conditions and must include the calculation of the oxygen supply (measured from the variables of oxygen saturation, the Hb value, the corrected values of the Hüfner number and the cardiac output). In principle, aerosols can cause transmission of infectious viral particles. Open systems or leakage systems (so-called vented masks) can prevent the release of respirable particles. Procedures in which the invasive ventilation system must be opened, and endotracheal intubation must be carried out are associated with an increased risk of infection.The protection of personnel with personal protective equipment should have very high priority because fear of contagion must not be a primary reason for intubation. If the specifications for protective equipment (eye protection, FFP2 or FFP-3 mask, gown) are adhered to, inhalation therapy, nasal high-flow (NHF) therapy, CPAP therapy or NIV can be carried out according to the current state of knowledge without increased risk of infection to the staff. A significant proportion of patients with respiratory failure presents with relevant hypoxemia, often also caused by a high inspiratory oxygen fraction (FiO2) including NHF, and this hypoxemia cannot be not completely corrected. In this situation, CPAP/NIV therapy can be administered under use of a mouth and nose mask or a respiratory helmet as therapy escalation, as long as the criteria for endotracheal intubation are not fulfilled.In acute hypoxemic respiratory insufficiency, NIV should be performed in an intensive care unit or in a comparable unit by personnel with appropriate expertise. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring with readiness to carry out intubation must be ensured at all times. If CPAP/NIV leads to further progression of ARI, intubation and subsequent invasive ventilation should be carried out without delay if no DNI order is in place.In the case of patients in whom invasive ventilation, after exhausting all guideline-based measures, is not sufficient, extracorporeal membrane oxygenation procedure (ECMO) should be considered to ensure sufficient oxygen supply and to remove CO2.
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Affiliation(s)
- M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf
- Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
| | - S Ewig
- Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Krankenanstalt Bochum, Bochum
| | - T Voshaar
- Schwerpunkt Pneumologie, Allergologie, Klinische Immunologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien, Moers
| | - W Randerath
- Institut für Pneumologie an der Universität zu Köln, Köln
- Klinik für Pneumologie, Krankenhaus Bethanien, Solingen
| | - T Bauer
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring GmbH, Berlin
| | - J Geiseler
- Medizinische Klinik IV: Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Klinikum Vest GmbH, Paracelsus-Klinik, Marl
| | - D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - M Westhoff
- Klinik für Pneumologie, Lungenklinik Hemer, Hemer
- Universität Witten-Herdecke, Witten
| | - W Windisch
- Universität Witten-Herdecke, Witten
- Klinik für Pneumologie, Klinikum Köln-Merheim, Kliniken der Stadt Köln, Lehrstuhl für Pneumologie der Universität Witten-Herdecke, Köln
| | - B Schönhofer
- Pneumologische Praxis und pneumologischer Konsildienst im Klinikum Agnes Karll Laatzen, Klinikum Region Hannover, Laatzen
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - P M Lepper
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
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Dellweg D, Lepper PM, Nowak D, Köhnlein T, Olgemöller U, Pfeifer M. [Position Paper of the German Respiratory Society (DGP) on the Impact of Community Masks on Self-Protection and Protection of Others in Regard to Aerogen Transmitted Diseases]. Pneumologie 2020; 74:331-336. [PMID: 32434252 PMCID: PMC7362397 DOI: 10.1055/a-1175-8578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - P M Lepper
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München
| | | | - U Olgemöller
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
- Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
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