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Smit MR, Beenen LF, Valk CM, de Boer MM, Scheerder MJ, Annema JT, Paulus F, Horn J, Vlaar AP, Kooij FO, Hollmann MW, Schultz MJ, Bos LD. Assessment of Lung Reaeration at 2 Levels of Positive End-expiratory Pressure in Patients With Early and Late COVID-19-related Acute Respiratory Distress Syndrome. J Thorac Imaging 2021; 36:286-293. [PMID: 34081643 PMCID: PMC8386391 DOI: 10.1097/rti.0000000000000600] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE Patients with novel coronavirus disease (COVID-19) frequently develop acute respiratory distress syndrome (ARDS) and need invasive ventilation. The potential to reaerate consolidated lung tissue in COVID-19-related ARDS is heavily debated. This study assessed the potential to reaerate lung consolidations in patients with COVID-19-related ARDS under invasive ventilation. MATERIALS AND METHODS This was a retrospective analysis of patients with COVID-19-related ARDS who underwent chest computed tomography (CT) at low positive end-expiratory pressure (PEEP) and after a recruitment maneuver at high PEEP of 20 cm H2O. Lung reaeration, volume, and weight were calculated using both CT scans. CT scans were performed after intubation and start of ventilation (early CT), or after several days of intensive care unit admission (late CT). RESULTS Twenty-eight patients were analyzed. The median percentages of reaerated and nonaerated lung tissue were 19% [interquartile range, IQR: 10 to 33] and 11% [IQR: 4 to 15] for patients with early and late CT scans, respectively (P=0.049). End-expiratory lung volume showed a median increase of 663 mL [IQR: 483 to 865] and 574 mL [IQR: 292 to 670] after recruitment for patients with early and late CT scans, respectively (P=0.43). The median decrease in lung weight attributed to nonaerated lung tissue was 229 g [IQR: 165 to 376] and 171 g [IQR: 81 to 229] after recruitment for patients with early and late CT scans, respectively (P=0.16). CONCLUSIONS The majority of patients with COVID-19-related ARDS undergoing invasive ventilation had substantial reaeration of lung consolidations after recruitment and ventilation at high PEEP. Higher PEEP can be considered in patients with reaerated lung consolidations when accompanied by improvement in compliance and gas exchange.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Fabian O. Kooij
- Anesthesiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | | | - Marcus J. Schultz
- Departments of Intensive Care
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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2
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Sinnige JS, Kooij FO, van Schuppen H, Hollmann MW, Sperna Weiland NH. Protection of healthcare workers during aerosol-generating procedures with local exhaust ventilation. Br J Anaesth 2021; 126:e220-e222. [PMID: 33863475 PMCID: PMC7980185 DOI: 10.1016/j.bja.2021.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jante S Sinnige
- Department of Anaesthesiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Fabian O Kooij
- Department of Anaesthesiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Hans van Schuppen
- Department of Anaesthesiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam UMC, Amsterdam, the Netherlands.
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3
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Veldhuis LI, Hollmann MW, Kooij FO, Ridderikhof ML. A pre-hospital risk score predicts critical illness in non-trauma patients transported by ambulance to a Dutch tertiary referral hospital. Scand J Trauma Resusc Emerg Med 2021; 29:32. [PMID: 33579335 PMCID: PMC7881659 DOI: 10.1186/s13049-021-00843-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Early pre-hospital identification of critically ill patients reduces morbidity and mortality. To identify critically ill non-traumatic and non-cardiac arrest patients, a pre-hospital risk stratification tool was previously developed in the United States. The aim of this study was to investigate the accuracy of this tool in a Dutch Emergency Department. Methods This retrospective study included all patients of 18 years and older transported by ambulance to the Emergency Department of a tertiary referral hospital between January 1st 2017 and December 31st 2017. Documentation of pre-hospital vital parameters had to be available. The tool included a full set of vital parameters, which were categorized by predetermined thresholds. Study outcome was the accuracy of the tool in predicting critical illness, defined as admittance to the Intensive Care Unit for delivery of vital organ support or death within 28 days. Accuracy of the risk stratification tool was measured with the Area Under the Receiver Operating Characteristics (AUROC) curve. Results Nearly 3000 patients were included in the study, of whom 356 patients (12.2%) developed critical illness. We observed moderate discrimination of the pre-hospital risk score with an AUROC of 0.74 (95%-CI 0.71–0.77). Using a threshold of 3 to identify critical illness, we observed a sensitivity of 45.0% (95%-CI 44.8–45.2) and a specificity of 86.0% (95%-CI 85.9–86.0). Conclusion These data show that this pre-hospital risk stratification tool is a moderately effective tool to predict which patients are likely to become critically ill in a Dutch non-trauma and non-cardiac arrest population.
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Affiliation(s)
- Lars I Veldhuis
- Amsterdam UMC, Location AMC, Department of Emergency Medicine, Meibergdreef 9, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Amsterdam UMC, Location AMC, Department of Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Fabian O Kooij
- Amsterdam UMC, Location AMC, Department of Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam UMC, Location VUmc, Lifeliner 1 HEMS, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Milan L Ridderikhof
- Amsterdam UMC, Location AMC, Department of Emergency Medicine, Meibergdreef 9, Amsterdam, The Netherlands.
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van Schuppen H, Boomars R, Kooij FO, den Tex P, Koster RW, Hollmann MW. Optimizing airway management and ventilation during prehospital advanced life support in out-of-hospital cardiac arrest: A narrative review. Best Pract Res Clin Anaesthesiol 2020; 35:67-82. [PMID: 33742579 DOI: 10.1016/j.bpa.2020.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022]
Abstract
Airway management and ventilation are essential components of cardiopulmonary resuscitation to achieve oxygen delivery in order to prevent hypoxic injury and increase the chance of survival. Weighing the relative benefits and downsides, the best approach is a staged strategy; start with a focus on high-quality chest compressions and defibrillation, then optimize mask ventilation while preparing for advanced airway management with a supraglottic airway device. Endotracheal intubation can still be indicated, but has the largest downsides of all advanced airway techniques. Whichever stage of airway management, ventilation and chest compression quality should be closely monitored. Capnography has many advantages and should be used routinely. Optimizing ventilation strategies, harmonizing ventilation with mechanical chest compression devices, and implementation in complex and stressful environments are challenges we need to face through collaborative innovation, research, and implementation.
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Affiliation(s)
- Hans van Schuppen
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands.
| | - René Boomars
- Regional Ambulance Service Utrecht (RAVU), Jan van Eijcklaan 6, Bilthoven, the Netherlands
| | - Fabian O Kooij
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Helicopter Mobile Medical Team (MMT), De Boelelaan 1117, Amsterdam, the Netherlands
| | - Paul den Tex
- University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Rudolph W Koster
- Amsterdam UMC, University of Amsterdam, Amsterdam Resuscitation Studies (ARREST), Meibergdreef 9, Amsterdam, the Netherlands
| | - Markus W Hollmann
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Meibergdreef 9, Amsterdam, the Netherlands
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5
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van Cuilenborg VR, Hermanides J, Bos EME, Hollmann MW, Preckel B, Kooij FO, Terreehorst I. Perioperative approach of allergic patients. Best Pract Res Clin Anaesthesiol 2020; 35:11-25. [PMID: 33742571 DOI: 10.1016/j.bpa.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 12/18/2022]
Abstract
Perioperative allergic reactions are rare, yet important complications of anesthesia. Severe, generalized allergic reactions called anaphylaxis are estimated to have a mortality of 3.5-4.8%. Adequate recognition and handling of a severe perioperative anaphylactic reaction result in better outcomes, including less hypoxic-ischemic encephalopathy and death. The diagnosis of a perioperative allergic reaction can be difficult as the list of possible culprits of a perioperative allergic reaction is extensive. Making an informed guess on the causative agent and avoiding this agent in future anesthesia procedures is undesirable and unsafe. Therefore, to ensure future patient safety, a thorough investigation following a perioperative allergic reaction is mandatory. A collaborate approach by allergists and anesthesiologists is advised. In this article, we discuss the basic approach of the allergic patient and of patients with a suspected allergy to perioperatively administered medication.
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Affiliation(s)
- Vincent R van Cuilenborg
- Dutch Perioperative Allergy Centre, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Jeroen Hermanides
- Dutch Perioperative Allergy Centre, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Elke M E Bos
- Dutch Perioperative Allergy Centre, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Benedikt Preckel
- Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Fabian O Kooij
- Dutch Perioperative Allergy Centre, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Ingrid Terreehorst
- Dutch Perioperative Allergy Centre, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Otorhinolaryngology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, the Netherlands.
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6
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van der Weide L, Popal Z, Terra M, Schwarte LA, Ket JCF, Kooij FO, Exadaktylos AK, Zuidema WP, Giannakopoulos GF. Prehospital ultrasound in the management of trauma patients: Systematic review of the literature. Injury 2019; 50:2167-2175. [PMID: 31627899 DOI: 10.1016/j.injury.2019.09.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Emergency ultrasound methods such as Focused Assessment with Sonography in Trauma (FAST) are a widely used imaging method. This examination can be performed to examine the presence of several life-threatening injuries. Early diagnosis may lead to better outcome, but the effect of timely diagnosis in the prehospital setting is not yet clear. Therefore, the aim is to determine the diagnostic accuracy and the effect of prehospital ultrasound performed in (poly)trauma patients. METHODS A literature search was performed in PubMed, Embase and Cochrane's Library. Articles were included if prehospital ultrasound was performed as a diagnostic intervention in patients with trauma. The main outcome measures included diagnostic accuracy, changes in prehospital diagnosis/treatment, changes in destination hospital and in-hospital response. Case reports and case series were excluded. RESULTS After screening 3343 articles, nine studies met the inclusion criteria. These included three retrospective and six prospective observational studies, with a total number of 2,889 patients. Five studies report at least one change in polytrauma management, ranging from 6% to 48,9% of the cases. The diagnostic accuracy of prehospital ultrasound was adequate in eight (out of nine) articles. High sensitivity and high specificity were found on several endpoints (pneumothorax, free abdominal fluid, haemoperitoneum, both on site and during transport). CONCLUSION Prehospital ultrasound led to a change in polytrauma management in all studies that included this as an outcome measure. The diagnostic accuracy was described in eight studies, high sensitivity and specificity were found. Overall, the studies seem to suggest a positive influence of performing ultrasound. However, additional research with homogenous accuracy endpoints and uniformly trained prehospital care providers is recommended.
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Affiliation(s)
- Laura van der Weide
- Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands.
| | - Zar Popal
- Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands
| | - Maartje Terra
- Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands
| | - Lothar A Schwarte
- Department of Anesthesiology, Amsterdam University Medical Centres, location VUmc, the Netherlands
| | | | - Fabian O Kooij
- Department of Anesthesiology, Amsterdam University Medical Centres, location AMC, the Netherlands
| | | | - Wietse P Zuidema
- Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands
| | - Georgios F Giannakopoulos
- Department of Trauma Surgery, Amsterdam University Medical Centres, location VUmc, De Boelelaan 1117, 1081 HV, the Netherlands
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7
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van Waes OJF, Leemeyer AMR, Kooij FO, Hoogerwerf N, van Vledder MG. Evaluation of out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma; Three years after our first report. Injury 2019; 50:2136-2137. [PMID: 31481153 DOI: 10.1016/j.injury.2019.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/17/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Oscar J F van Waes
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anna-Marie R Leemeyer
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Fabian O Kooij
- Department of Anesthesiology & Lifeliner 1/HEMS, Amsterdam UMC, Amsterdam, the Netherlands
| | - Nico Hoogerwerf
- Department of Anesthesiology & HEMS, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mark G van Vledder
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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8
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Oud FRW, Kooij FO, Burns BJ. Long-term Effectiveness of the Airway Registry at Sydney Helicopter Emergency Medical Service. Air Med J 2019; 38:161-164. [PMID: 31122579 DOI: 10.1016/j.amj.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Prehospital rapid sequence intubation (RSI) is prone to suboptimal documentation. The Greater Sydney Area Helicopter Emergency Medical Service (GSA-HEMS) uses a dedicated Airway Registry (AR) to aid documentation. The AR was only evaluated shortly after its introduction. This first evaluation is followed up to assess the long-term effectiveness of the AR. The secondary objective was to compare the AR with templates in the literature. METHODS A retrospective review of electronic records was undertaken to compare completeness of documentation between an immediate postintroduction and a long-term postintroduction cohort. Differences between the two cohorts were tested for significance. RESULTS There was no significant difference in documentation for Cormack-Lehane laryngoscopy grade at the first intubation attempt (P = .552) and confirmation of end-tidal carbon dioxide (P = .258). A significant improvement in the documentation of laryngoscopy grade for the second attempt (P = 0) was found. The documentation of intubator details remained at 100% (165/165). The variables collected by GSA-HEMS corresponded well to the literature, but some definitions differ (eg, desaturation). CONCLUSION There was no significant change in completeness of documentation for most key intubation variables eight years after the introduction of the AR. GSA-HEMS performs well in registering variables as proposed in the literature; however, variable definitions need to be synchronized.
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Affiliation(s)
- Floris R W Oud
- Greater Sydney Area Helicopter Emergency Medical Service, New South Wales Ambulance, Bankstown Airport, New South Wales, Australia; Department of Anesthesiology, Amsterdam University Medical Centres, location AMC, Amsterdam Zuidoost, The Netherlands(3) Sydney Medical School, Sydney University.
| | - Fabian O Kooij
- Department of Anesthesiology, Amsterdam University Medical Centres, location AMC, Amsterdam Zuidoost, The Netherlands(3) Sydney Medical School, Sydney University
| | - Brian J Burns
- Greater Sydney Area Helicopter Emergency Medical Service, New South Wales Ambulance, Bankstown Airport, New South Wales, Australia; Department of Anesthesiology, Amsterdam University Medical Centres, location AMC, Amsterdam Zuidoost, The Netherlands(3) Sydney Medical School, Sydney University
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9
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van Cuilenborg VR, Hermanides J, Bos EME, Hollmann MW, Kooij FO, Terreehorst I. Awake intravenous provocation with small doses of neuromuscular blocking agent in patients with suspected allergy: experiences from the Dutch Perioperative Allergy Centre. Br J Anaesth 2019; 123:e153-e155. [PMID: 31029406 DOI: 10.1016/j.bja.2019.03.038] [Citation(s) in RCA: 5] [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] [Received: 12/02/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 12/30/2022] Open
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10
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Hulst AH, Polderman JAW, Kooij FO, Vittali D, Lirk P, Hollmann MW, DeVries JH, Preckel B, Hermanides J. Comparison of perioperative glucose regulation in patients with type 1 vs type 2 diabetes mellitus: A retrospective cross-sectional study. Acta Anaesthesiol Scand 2019; 63:314-321. [PMID: 30357807 DOI: 10.1111/aas.13274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/11/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most perioperative diabetes mellitus (DM) guidelines do not distinguish between patients with type 1 (DM1) and type 2 (DM2). We hypothesised that similar treatment of DM1 and DM2 patients leads to differences in their perioperative glucose control. METHODS We performed a retrospective cross-sectional study, of all DM patients undergoing surgery between May 2013 and November 2015 in a Dutch university hospital. We compared DM1 with DM2 patients, treated according to the same perioperative glucose protocol. Our primary outcome was the incidence of hyperglycaemia (glucose ≥10 mmol/L). Secondary outcomes were short-term glycaemic control (glucose before surgery and peak glucose perioperatively), long-term glycaemic control (HbA1c in 90 days before and after surgery) and the incidence of hypoglycaemia (glucose <4 mmol/L). RESULTS We included 2259 patients with DM, 216 (10%) of which had DM1. The calculated incidences in our population were 7 out of 1000 patients with DM1 and 69 out of 1000 patients with DM2. Compared to those with DM2, patients with DM1 were younger, had a lower BMI, a higher glucose concentration before surgery, and a higher perioperative peak glucose concentration (11.0 [8.2-14.7] vs 9.4 [7.7-11.7], P < 0.001). The incidence of the primary endpoint, perioperative hyperglycaemia, was significantly higher in DM1 compared to DM2 patients (63% vs 43%, P < 0.001). Hypoglycaemia occurred more often in the DM1 population (7.1% vs 1.3%, P < 0.001). CONCLUSION Providing similar perioperative treatment to patients with DM1 and DM2 is associated with poorer short-term and long-term glycaemic control in DM1 throughout the perioperative period as well as an increased risk of hypoglycaemia.
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Affiliation(s)
- Abraham H. Hulst
- Department of Anesthesiology, Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - Jorinde A. W. Polderman
- Department of Anesthesiology, Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - Fabian O. Kooij
- Department of Anesthesiology, Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - Dave Vittali
- Department of Anesthesiology, Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - Philipp Lirk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital; Harvard Medical School; Boston Massachusetts
| | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - J. Hans DeVries
- Department of Endocrinology, Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - Benedikt Preckel
- Department of Anesthesiology, Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam UMC; University of Amsterdam; Amsterdam The Netherlands
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11
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Van Vledder MG, Van Waes OJF, Kooij FO, Peters JH, Van Lieshout EMM, Verhofstad MHJ. Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma. Injury 2017; 48:1865-1869. [PMID: 28442204 DOI: 10.1016/j.injury.2017.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/31/2017] [Accepted: 04/08/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Emergency department thoracotomy is an established procedure for cardiac arrest in patients suffering from penetrating thoracic trauma and yields relatively high survival rates (up to 21%) in patients with cardiac tamponade. To minimize the delay between arrest and thoracotomy, some have advocated thoracotomy on the accident scene. The aim of this study was to determine the proportion of patients with return of spontaneous circulation and subsequent survival after out of hospital thoracotomy in the Netherlands. METHODS A retrospective analysis of data collected on all out of hospital thoracotomies performed in the Netherlands after penetrating trauma between April 1st, 2011 and September 30th, 2016 was performed. Data on patient characteristics, trauma mechanism and outcome were collected and analyzed. Primary outcome measure was return of spontaneous circulation after the intervention. Survival to hospital discharge was the secondary outcome variable. RESULTS Thirty-three prehospital emergency thoracotomies were performed. Ten patients (30%) had gunshot wounds and 23 patients (70%) had stab wounds. Nine patients (27%) had return of spontaneous circulation and were presented to the hospital. Of these, one patient survived until discharge without neurological damage. Five died in the emergency department or operating room and three died in ICU. CONCLUSION Return of spontaneous circulation after out of hospital thoracotomy for cardiac arrest due to penetrating thoracic injury is achievable, but a substantial number of patients die during the in hospital resuscitation phase. However, neurologic intact survival can be achieved.
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Affiliation(s)
- Mark G Van Vledder
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Oscar J F Van Waes
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fabian O Kooij
- Department of Anesthesiology, University of Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Joost H Peters
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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12
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Kooij FO, Klok T, Preckel B, Hollmann MW, Kal JE. The effect of requesting a reason for non-adherence to a guideline in a long running automated reminder system for PONV prophylaxis. Appl Clin Inform 2017; 8:313-321. [PMID: 28352926 DOI: 10.4338/aci-2016-08-ra-0138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/19/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Automated reminders are employed frequently to improve guideline adherence, but limitations of automated reminders are becoming more apparent. We studied the reasons for non-adherence in the setting of automated reminders to test the hypothesis that a separate request for a reason in itself may further improve guideline adherence. METHODS In a previously implemented automated reminder system on prophylaxis for postoperative nausea and vomiting (PONV), we included additional automated reminders requesting a reason for non-adherence. We recorded these reasons in the pre-operative screening clinic, the OR and the PACU. We compared adherence to our PONV guideline in two study groups with a historical control group. RESULTS Guideline adherence on prescribing and administering PONV prophylaxis (dexamethasone and granisetron) all improved compared to the historical control group (89 vs. 82% (p< 0.0001), 96 vs 95% (not significant) and 90 vs 82% (p<0.0001)) while decreasing unwarranted prescription for PONV prophylaxis (10 vs. 13 %). In the pre-operative screening clinic, the main reason for not prescribing PONV prophylaxis was disagreement with the risk estimate by the decision support system. In the OR/PACU, the main reasons for not administering PONV prophylaxis were: 'unintended non-adherence' and 'failure to document'. CONCLUSIONS In this study requesting a reason for non-adherence is associated with improved guideline adherence. The effect seems to depend on the underlying reason for non-adherence. It also illustrates the importance of human factors principles in the design of decision support. Some reasons for non-adherence may not be influenced by automated reminders.
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Affiliation(s)
- Fabian O Kooij
- Fabian O. Kooij, Academic Medical Centre, University of Amsterdam, Department of anaesthesia, PO Box 22660, 1100 DD Amsterdam, Phone: +31 20 566 2533, Fax: +31 20 697 9441,
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13
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Koers L, van Schuppen JL, Viersen VA, Kooij FO, Goslings JC, Hollmann MW. [Resuscitation after trauma: better survival chances thanks to goal-oriented treatment]. Ned Tijdschr Geneeskd 2017; 161:D1174. [PMID: 28466799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
- Recent literature shows increased survival for patients with traumatic cardiac arrest.- An early and aggressive approach to underlying causes and good integrated trauma care are probably responsible for this.- The new resuscitation guideline of the European Resuscitation Council emphasises that treatment of the underlying cause deserves more priority than performing chest compressions.- In addition to a structured approach with interventions focused on the causes of the arrest, standard operating procedures and protocols, regular scenario training and clinical governance are vital to improve survival chances for these patients.
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Affiliation(s)
- L Koers
- Academisch Medisch Centrum, Amsterdam
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Affiliation(s)
- Fabian O Kooij
- From the Department of Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands
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Kooij FO, Klok T, Hollmann MW, Kal JE. Decision support increases guideline adherence for prescribing postoperative nausea and vomiting prophylaxis. Anesth Analg 2008; 106:893-8, table of contents. [PMID: 18292437 DOI: 10.1213/ane.0b013e31816194fb] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Guidelines for postoperative nausea and vomiting (PONV) prevention are implemented widely but their effectiveness may be limited by poor adherence. We hypothesized that the use of an electronic decision support (DS) system would significantly improve guideline adherence. METHODS Medical information of all patients undergoing elective surgery in our regional teaching hospital is routinely entered in an anesthesia information management system at the preoperative screening clinic. Our departmental PONV prevention guidelines identifies patients as "high-risk" and thus eligible for PONV prophylaxis based on the presence of at least three of the following risk factors: female gender, history of PONV or motion sickness, nonsmoker status, and anticipated use of postoperative opioids. Using automated reminders, we studied the effect of DS on guidelines adherence using an off-on-off design. In these three study periods, we queried for all consecutive patients visiting the preoperative screening clinic who were eligible for PONV prophylaxis and studied how often it was prescribed correctly. RESULTS Between November 2005 and June 2006, 1340, 2715, and 1035 patients were included in the control, DS and post-DS periods, respectively. As a result of mandatory data entry of risk factors, the percentage of high-risk PONV patients increased from 28% in the control period to 32% and 31% in the DS and post-DS periods, respectively. During the control period, 38% of all high-risk patients were prescribed PONV prophylaxis. This increased to 73% during the DS period and decreased to 37% in the post-DS period. CONCLUSION Electronic DS increases guidelines adherence for the prescription of PONV prophylaxis in high-risk PONV patients.
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Affiliation(s)
- Fabian O Kooij
- Department of Anesthesiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Kooij FO, Kal JE, Hans PC, Bonhomme VL. Blood glucose concentration profile after 10 mg dexamethasone in non-diabetic and type 2 diabetic patients. Br J Anaesth 2006; 97:896-7. [PMID: 17098725 DOI: 10.1093/bja/ael295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Kooij FO, van Alem AP, Koster RW, de Vos R. Training of police officers as first responders with an automated external defibrillator. Resuscitation 2004; 63:33-41. [PMID: 15451584 DOI: 10.1016/j.resuscitation.2004.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2003] [Revised: 03/05/2004] [Accepted: 03/22/2004] [Indexed: 10/26/2022]
Abstract
UNLABELLED A short and effective training programme is an essential prerequisite for the use of automated external defibrillators (AED) by EMS providers and first responders. We evaluated a 3-h AED course based on the ERC requirements. METHODS As part of a study evaluating the effectiveness of AEDs used by first responders (ARREST 4), we trained all police officers in the region of Amsterdam, the Netherlands. By means of a Basic Life Support (BLS) assessment at the beginning of the course and at the end, we evaluated whether BLS can be improved in a 3-h AED course. Through a combined BLS and AED assessment at the end of the course, we evaluated whether AED skills can be acquired sufficiently. BLS skills were measured with the Laerdal SkillMeter in evaluation mode. AED skills were assessed using 13 criteria. By means of logistic regression, we analysed the influence of student characteristics, such as age, gender, previous training, resuscitation experience and motivation for BLS and AED on BLS and AED skills acquisition. RESULTS Between September 1999 and June 2000, 823 police officers were trained (76% male, mean age 36 (S.D. 9) years). BLS improved significantly (P < 0.001) in all criteria, except for hypoventilation (P < 0.001). After training, 89% of the students were able to use an AED safely and effectively. Self-confidence and motivation improved from 12 and 73% to 99 and 94% over the course (P < 0.001). Independent student characteristics influencing the success of the AED course were: previous BLS training, motivation before the course for an AED, and resuscitation experience that dated back for more than 12 months. CONCLUSION The majority of police officers can be trained to use an AED safely and effectively within a 3-h AED course. During this course, they also improve on their BLS skills. Successful completion of the course depends in part on the student characteristics.
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Affiliation(s)
- Fabian O Kooij
- Department of Clinical Epidemiology and Biostatistics, room J2-216, Academical Medical Center, PO Box 22600.1100 DD Amsterdam, The Netherlands.
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