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Unterberg M, Ehrentraut SF, Bracht T, Wolf A, Haberl H, von Busch A, Rump K, Ziehe D, Bazzi M, Thon P, Sitek B, Marcus K, Bayer M, Schork K, Eisenacher M, Ellger B, Oswald D, Wappler F, Defosse J, Henzler D, Köhler T, Zarbock A, Putensen CP, Schewe JC, Frey UH, Anft M, Babel N, Steinmann E, Brüggemann Y, Trilling M, Schlüter A, Nowak H, Adamzik M, Rahmel T, Koos B. Human cytomegalovirus seropositivity is associated with reduced patient survival during sepsis. Crit Care 2023; 27:417. [PMID: 37907989 PMCID: PMC10619294 DOI: 10.1186/s13054-023-04713-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/01/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Sepsis is one of the leading causes of death. Treatment attempts targeting the immune response regularly fail in clinical trials. As HCMV latency can modulate the immune response and changes the immune cell composition, we hypothesized that HCMV serostatus affects mortality in sepsis patients. METHODS We determined the HCMV serostatus (i.e., latency) of 410 prospectively enrolled patients of the multicenter SepsisDataNet.NRW study. Patients were recruited according to the SEPSIS-3 criteria and clinical data were recorded in an observational approach. We quantified 13 cytokines at Days 1, 4, and 8 after enrollment. Proteomics data were analyzed from the plasma samples of 171 patients. RESULTS The 30-day mortality was higher in HCMV-seropositive patients than in seronegative sepsis patients (38% vs. 25%, respectively; p = 0.008; HR, 1.656; 95% CI 1.135-2.417). This effect was observed independent of age (p = 0.010; HR, 1.673; 95% CI 1.131-2.477). The predictive value on the outcome of the increased concentrations of IL-6 was present only in the seropositive cohort (30-day mortality, 63% vs. 24%; HR 3.250; 95% CI 2.075-5.090; p < 0.001) with no significant differences in serum concentrations of IL-6 between the two groups. Procalcitonin and IL-10 exhibited the same behavior and were predictive of the outcome only in HCMV-seropositive patients. CONCLUSION We suggest that the predictive value of inflammation-associated biomarkers should be re-evaluated with regard to the HCMV serostatus. Targeting HCMV latency might open a new approach to selecting suitable patients for individualized treatment in sepsis.
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Affiliation(s)
- M Unterberg
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - S F Ehrentraut
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - T Bracht
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801, Bochum, Germany
| | - A Wolf
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - H Haberl
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - A von Busch
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - K Rump
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - D Ziehe
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - M Bazzi
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - P Thon
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - B Sitek
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801, Bochum, Germany
| | - K Marcus
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801, Bochum, Germany
- Medical Proteome Analysis, Center for Proteindiagnostics (PRODI), Ruhr University Bochum, 44801, Bochum, Germany
| | - M Bayer
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801, Bochum, Germany
| | - K Schork
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801, Bochum, Germany
- Medical Proteome Analysis, Center for Proteindiagnostics (PRODI), Ruhr University Bochum, 44801, Bochum, Germany
| | - M Eisenacher
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801, Bochum, Germany
- Medical Proteome Analysis, Center for Proteindiagnostics (PRODI), Ruhr University Bochum, 44801, Bochum, Germany
| | - B Ellger
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Westfalen, Dortmund, Germany
| | - D Oswald
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Westfalen, Dortmund, Germany
| | - F Wappler
- Department of Anaesthesiology and Operative Intensive Care Medicine, University of Witten/Herdecke, Cologne Merheim Medical School, Cologne, Germany
| | - J Defosse
- Department of Anaesthesiology and Operative Intensive Care Medicine, University of Witten/Herdecke, Cologne Merheim Medical School, Cologne, Germany
| | - D Henzler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr-University Bochum, Klinikum Herford, Herford, Germany
| | - T Köhler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr-University Bochum, Klinikum Herford, Herford, Germany
- Department of Anesthesiology and Intensive Care Medicine, AMEOS-Klinikum Halberstadt, Halberstadt, Germany
| | - A Zarbock
- Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Münster, Germany
| | - C P Putensen
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - J C Schewe
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - U H Frey
- Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany
| | - M Anft
- Center for Translational Medicine, Medical Clinic I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
| | - N Babel
- Center for Translational Medicine, Medical Clinic I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
| | - E Steinmann
- Department of Molecular and Medical Virology, Ruhr University Bochum, 44801, Bochum, Germany
| | - Y Brüggemann
- Department of Molecular and Medical Virology, Ruhr University Bochum, 44801, Bochum, Germany
| | - M Trilling
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - A Schlüter
- Knappschaft Kliniken GmbH, Recklinghausen, Germany
| | - H Nowak
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
- Center for Artficial Intelligence, Medical Informatics and Data Science, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - M Adamzik
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - T Rahmel
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - B Koos
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany.
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Neuwirth MM, Marche B, Hoffmann J, Defosse J, Mattner F, Otchwemah R. Measures for Reducing Nosocomial Infections in a Tertiary Care Hospital-an Interventional Study With Before-and-After Comparison. Dtsch Arztebl Int 2023; 120:536-537. [PMID: 37721141 PMCID: PMC10534138 DOI: 10.3238/arztebl.m2023.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Meike M. Neuwirth
- Chair of Hygiene and Environmental Medicine, University of Witten/Herdecke, Institute for Hygiene, Kliniken der Stadt Köln gGmbH, Cologne-Merheim Medical Center, University Hospital of the Witten/Herdecke University, Cologne, Germany
| | - Benedikt Marche
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Kliniken der Stadt Köln gGmbH OPUS Center – Orthopedics, Plastic Surgery, Trauma Surgery, and Sports Traumatology, Cologne-Merheim Medical Center, University Hospital of the Witten/Herdecke University, Cologne, Germany
| | - Jan Hoffmann
- Institute for Hygiene, Kliniken der Stadt Köln gGmbH, Cologne-Merheim Medical Center, University Hospital of the Witten/Herdecke University, Cologne, Germany
| | - Jerome Defosse
- Department of Anesthesiology and Intensive Care Medicine, Kliniken Köln gGmbH, Cologne-Merheim Medical Center, University Hospital of the Witten/Herdecke University, Cologne, Germany
| | - Frauke Mattner
- Chair of Hygiene and Environmental Medicine, University of Witten/Herdecke, Institute for Hygiene, Kliniken der Stadt Köln gGmbH, Cologne-Merheim Medical Center, University Hospital of the Witten/Herdecke University, Cologne, Germany
| | - Robin Otchwemah
- Chair of Hygiene and Environmental Medicine, University of Witten/Herdecke, Institute for Hygiene, Kliniken der Stadt Köln gGmbH, Cologne-Merheim Medical Center, University Hospital of the Witten/Herdecke University, Cologne, Germany
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Tjardes T, Meyer LM, Lotz A, Defosse J, Hensen S, Hirsch P, Salge TO, Imach S, Klasen M, Stead S, Walossek N. [Application of artificial intelligence systems in the emergency room : Do the communication patterns give indications for possible starting points? An observational study]. Unfallchirurgie (Heidelb) 2023:10.1007/s00113-023-01326-9. [PMID: 37273116 DOI: 10.1007/s00113-023-01326-9] [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] [Accepted: 04/06/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND High expectations are currently attached to the application of artificial intelligence (AI) in the resuscitation room treatment of trauma patients with respect to the development of decision support systems. No data are available regarding possible starting points for AI-controlled interventions in resuscitation room treatment. OBJECTIVE Do information request behavior and quality of communication indicate possible starting points for AI applications in the emergency room? MATERIAL AND METHODS A 2‑stage qualitative observational study: 1. Development of an observation sheet based on expert interviews that depicts the following six relevant topics: situational factors (course of accident, environment), vital parameters, treatment-specific Information (treatment carried out). trauma-specific factors (injury patterns), medication, special features of the patient (anamnesis, etc.) 2. Observational study Which topics were inquired about during emergency room treatment? Was the exchange of information complete? RESULTS There were 40 consecutive observations in the emergency room. A total of 130 questions: 57/130 inquiries about medication/treatment-specific Information and vital parameters, 19/28 of which were inquiries about medication. Questions about injury-related parameters 31/130 with 18/31 regarding injury patterns, course of accident (8/31) and type of accident (5/31). Questions about medical or demographic background 42/130. Within this group, pre-existing illnesses (14/42) and demographic background (10/42) were the most frequently asked questions. Incomplete exchange of information was found in all six subject areas. CONCLUSION Questioning behavior and incomplete communication indicate a cognitive overload. Assistance systems that prevent cognitive overload can maintain decision-making abilities and communication skills. Which AI methods can be used requires further research.
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Affiliation(s)
- Thorsten Tjardes
- Klinik für Unfallchirurgie, Orthopädie und Sporttraumatologie Köln Merheim, Lehrstuhl für Unfallchirurgie und Orthopädie der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Köln, Deutschland.
- Klinik für Unfallchirurgie, Orthopädie und Sporttraumatologie Köln Merheim, Kliniken der Stadt Köln gGmbH, Ostmerheimerstr. 200, 51109, Köln, Deutschland.
| | - Lea Mareen Meyer
- Institut für Technologie und Innovationsmanagement (TIM), Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Deutschland
| | - Anna Lotz
- Klinik für Anästhesiologie und operative Intensivmedizin, Lehrstuhl für Anästhesiologie II der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - Jerome Defosse
- Klinik für Anästhesiologie und operative Intensivmedizin, Lehrstuhl für Anästhesiologie II der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - Sandra Hensen
- Institut für Psychologie, Kognitions- und Experimentalpsychologie, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Deutschland
| | - Patricia Hirsch
- Institut für Psychologie, Kognitions- und Experimentalpsychologie, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Deutschland
| | - Torsten Oliver Salge
- Institut für Technologie und Innovationsmanagement (TIM), Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Deutschland
| | - Sebastian Imach
- Klinik für Unfallchirurgie, Orthopädie und Sporttraumatologie Köln Merheim, Lehrstuhl für Unfallchirurgie und Orthopädie der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - Martin Klasen
- AIXTRA Kompetenzzentrum für Training und Patientensicherheit, Aachen, Deutschland
| | - Susan Stead
- Institut für Technologie und Innovationsmanagement (TIM), Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Deutschland
| | - Nina Walossek
- Klinik für Anästhesiologie und operative Intensivmedizin, Lehrstuhl für Anästhesiologie II der Universität Witten/Herdecke, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
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Defosse J, Schieren M, Hartmann B, Egyed E, Koryllos A, Stoelben E, Wappler F, Böhmer A. A New Approach in Airway Management for Tracheal Resection and Anastomosis: A Single-Center Prospective Study. J Cardiothorac Vasc Anesth 2022; 36:3817-3823. [PMID: 35798632 DOI: 10.1053/j.jvca.2022.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/31/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The evaluation of the use of laryngeal mask airways (LMA) as an alternative form of airway management for surgical tracheal reconstruction. DESIGN A prospective case series. SETTING At a single German university hospital. PARTICIPANTS Ten patients. INTERVENTIONS The use of LMA for airway management in surgical reconstruction of the trachea. MEASUREMENTS AND MAIN RESULTS Ten patients with tracheal stenosis of 50% to 90% were enrolled prospectively during the study period. The airway management consisted of the insertion of an LMA. During resection and reconstruction, high-frequency jet ventilation was used. Several arterial blood gas analyses (ABG) were performed before, during, and after the tracheal resection and reconstruction. All values were presented as median and interquartile ranges or as absolute and relative values, and no emergency change to cross-field intubation was necessary. The lowest PaO2 was 93 mmHg in 1 patient after 20 minutes of jet ventilation, whereas PaO2 increased after the induction phase and remained stable in 9 patients. There were no intraoperative complications related to anesthetic management apart from transient hypercarbia during and after jet ventilation. Preoperative and postoperative ABG were comparable. One patient required immediate postoperative ventilatory support. Two patients developed postoperative pneumonia, leading to their admission to the intensive care unit. One patient was operated with a palliative approach due to massive dyspnea and died in the next postoperative course. CONCLUSIONS The use of LMA is an alternative option in airway management for tracheal reconstruction, even in patients with significant tracheal stenosis. Potential advantages compared to tracheal intubation are unimpaired access to the operative field and the lack of stress on the fresh anastomosis.
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Affiliation(s)
- Jerome Defosse
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany.
| | - Mark Schieren
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Burkhard Hartmann
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Enikö Egyed
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Aris Koryllos
- Witten/Herdecke University, Medical Center Cologne-Merheim, Lung Clinic, Thoracic Surgery, Cologne, Germany
| | - Erich Stoelben
- Witten/Herdecke University, Medical Center Cologne-Merheim, Lung Clinic, Thoracic Surgery, Cologne, Germany
| | - Frank Wappler
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Andreas Böhmer
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
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Defosse J, Kleinschmidt J, Schmutz A, Torsten L, Staat M, Gatzweiler KH, Wappler F, Schieren M. Dental strain on maxillary incisors during tracheal intubation with double-lumen tubes and different laryngoscopy techniques - a blinded manikin study. J Cardiothorac Vasc Anesth 2022; 36:3021-3027. [DOI: 10.1053/j.jvca.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 11/11/2022]
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Abstract
PURPOSE OF REVIEW The aim of this review is to provide an overview of current anesthetic management of tracheal and carinal resection and reconstruction. RECENT FINDINGS In addition to the traditional anesthetic approach using conventional tracheal intubation after induction of general anesthesia and cross-field intubation or jet-ventilation once the airway has been surgically opened, there is a trend toward less invasive anesthetic procedures. Regional anesthetic techniques and approaches focusing on the maintenance of spontaneous respiration have emerged. Especially for cervical tracheal stenosis, laryngeal mask airways appear to be an advantageous alternative to tracheal intubation.Extracorporeal support can ensure adequate gas exchange and/or perfusion during complex resections and reconstructions without interference of airway devices with the operative field. It also serves as an effective rescue technique in case other approaches fail. SUMMARY The spectrum of available anesthetic techniques for major airway surgery is immense. To find the safest approach for the individual patient, comprehensive interdisciplinary planning is essential. The location and anatomic consistency of the stenosis, comorbidities, the functional status of respiratory system, as well as the planned reconstructive technique need to be considered. Until more data is available, however, a reliable evidence-based comparison of different approaches is not possible.
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Affiliation(s)
- Mark Schieren
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
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Defosse J, Schieren M, Loop T, von Dossow V, Wappler F, de Abreu MG, Gerbershagen MU. Current practice of thoracic anaesthesia in Europe - a survey by the European Society of Anaesthesiology Part I - airway management and regional anaesthesia techniques. BMC Anesthesiol 2021; 21:266. [PMID: 34719390 PMCID: PMC8558093 DOI: 10.1186/s12871-021-01480-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background The scientific working group for “Anaesthesia in thoracic surgery” of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) has performed an online survey to assess the current standards of care and structural properties of anaesthesia workstations in thoracic surgery. Methods All members of the European Society of Anaesthesiology (ESA) were invited to participate in the study. Results Thoracic anaesthesia was most commonly performed by specialists/board-certified anaesthetists and/or senior/attending physicians. Across Europe, the double lumen tube (DLT) was most commonly chosen as the primary device for lung separation (461/ 97.3%). Bronchial blockers were chosen less frequently (9/ 1.9%). Throughout Europe, bronchoscopy was not consistently used to confirm correct double lumen tube positioning. Respondents from Eastern Europe (32/ 57.1%) frequently stated that there were not enough bronchoscopes available for every intrathoracic operation. A specific algorithm for difficult airway management in thoracic anaesthesia was available to only 18.6% (n = 88) of the respondents. Thoracic epidural analgesia (TEA) is the most commonly used form of regional analgesia for thoracic surgery in Europe. Ultrasonography was widely available 93,8% (n = 412) throughout Europe and was predominantly used for central line placement and lung diagnostics. Conclusions While certain „gold standards “are widely met, there are also aspects of care requiring substantial improvement in thoracic anaesthesia throughout Europe. Our data suggest that algorithms and standard operating procedures for difficult airway management in thoracic anaesthesia need to be established. A European recommendation for the basic requirements of an anaesthesia workstation for thoracic anaesthesia is expedient and desirable, to improve structural quality and patient safety. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01480-w.
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Affiliation(s)
- Jerome Defosse
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical centre Cologne-Merheim, Cologne, Germany.
| | - Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical centre Cologne-Merheim, Cologne, Germany
| | - Torsten Loop
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vera von Dossow
- Institute of Anesthesiology, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Frank Wappler
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical centre Cologne-Merheim, Cologne, Germany
| | - Marcelo Gama de Abreu
- Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany.,Department of Intensive Care and Resuscitation, Cleveland Clinic, Anesthesiology Institute, Ohio, USA.,Department of Outcomes Research, Cleveland Clinic, Anesthesiology Institute, Ohio, USA
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Galetin T, Merres J, Schieren M, Marks B, Haffke Y, Defosse J, Wappler F, Koryllos A, Stoelben E. Most patient conditions do not a priori debilitate the sensitivity of thoracic ultrasound in thoracic surgery-a prospective comparative study. J Cardiothorac Surg 2021; 16:75. [PMID: 33849605 PMCID: PMC8045207 DOI: 10.1186/s13019-021-01454-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/31/2021] [Indexed: 11/30/2022] Open
Abstract
Background The few existing studies on the accuracy of lung ultrasound in the detection of a postoperative pneumothorax after thoracic surgery differ in the sonographic technique and the inclusion criteria. Several conditions are considered unfavourable in the sonographic examination of the lung. We aim to test these conditions for their impact on the diagnostic accuracy of lung ultrasound. Methods We compared lung ultrasound and chest roentgenograms for the detection of a pneumothorax after lung-resecting surgery in two prospective trials (register ID DRKS00014557 and DRKS00020216). The ultrasound examiners and radiologists were blinded towards the corresponding findings. We performed posthoc subgroup analyses to determine the influence of various patient or surgery related conditions on the sensitivity and specificity of ultrasound in the detection of pneumothorax. Results We performed 340 examinations in 208 patients. The covariates were age, gender, body mass index, smoking status, severity of chronic obstructive pulmonary disease, previous ipsilateral operation or irradiation, thoracotomy, postoperative skin emphysema, indwelling chest tube and X-ray in supine position. In univariate analysis, an indwelling chest-tube was associated with a higher sensitivity (58%, p = 0.04), and a postoperative subcutaneous emphysema with a lower specificity (73% vs. 88%, p = 0.02). None of the other subgroups differed in sensitivity or specificity from the total population . Conclusions Most of the patient- or surgery related conditions usually considered unfavourable for lung ultrasound did not impair the sensitivity or specificity of lung ultrasound. Further studies should not excluce patients with these conditions, but test the accuracy under routine conditions. Trial registration DRKS, DRKS00014557, registered 06/09/2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014557 and DRKS00020216, registered 03/12/2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020216 Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01454-6.
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Affiliation(s)
- Thomas Galetin
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| | - Julika Merres
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Benjamin Marks
- Department of Radiology, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Yves Haffke
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Jerome Defosse
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Frank Wappler
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Aris Koryllos
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Erich Stoelben
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
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Limper U, Defosse J, Schildgen O, Wappler F. Perioperative risk evaluation in patients scheduled for elective surgery in close relation to their SARS-CoV-2 vaccination. Br J Anaesth 2021; 126:e225-e226. [PMID: 33863474 PMCID: PMC7980143 DOI: 10.1016/j.bja.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ulrich Limper
- Department of Anesthesiology and Critical Care Medicine, Merheim Medical Center, Hospitals of Cologne, Witten/Herdecke University, Cologne, Germany.
| | - Jerome Defosse
- Department of Anesthesiology and Critical Care Medicine, Merheim Medical Center, Hospitals of Cologne, Witten/Herdecke University, Cologne, Germany
| | - Oliver Schildgen
- Institute of Pathology, Merheim Medical Center, Hospitals of Cologne, Witten/Herdecke University, Cologne, Germany
| | - Frank Wappler
- Department of Anesthesiology and Critical Care Medicine, Merheim Medical Center, Hospitals of Cologne, Witten/Herdecke University, Cologne, Germany
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Joppich R, Wappler F, Defosse J. Patients' satisfaction with anesthesia in enzymatic debridement from a surgical perspective: Schiefer et al. Burns 46 (2020). Burns 2020; 47:738-739. [PMID: 33288332 DOI: 10.1016/j.burns.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
Affiliation(s)
- R Joppich
- Department of Anesthesiology and Operative Intensive Care Medicine, University of Witten/Herdecke, Cologne Merheim Medical School, Cologne, Germany.
| | - F Wappler
- Department of Anesthesiology and Operative Intensive Care Medicine, University of Witten/Herdecke, Cologne Merheim Medical School, Cologne, Germany
| | - J Defosse
- Department of Anesthesiology and Operative Intensive Care Medicine, University of Witten/Herdecke, Cologne Merheim Medical School, Cologne, Germany
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Koryllos A, Lopez-Pastorini A, Galetin T, Defosse J, Strassmann S, Karagiannidis C, Stoelben E. Use of Extracorporeal Membrane Oxygenation for Major Cardiopulmonary Resections. Thorac Cardiovasc Surg 2020; 69:231-239. [PMID: 32268398 DOI: 10.1055/s-0040-1708486] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In thoracic surgery, utilization of extracorporeal membrane oxygenation (ECMO) is mainly established for patients undergoing lung transplantation. The aim of our study was to summarize our single-center experience with intraoperative use of veno-venous- or veno-arterial-ECMO in patients undergoing complex lung surgery involving the main carina, or the left atrium or the descending aorta. METHODS A total of 24 patients underwent combined complex lung, carinal, aortal, or left atrial resections. In cases of carinal resection, percutaneous veno-venous, jugular-femoral cannulation was considered suitable. For combined resection of lung and descending aorta, a percutaneous femoral veno-arterial cannulation was used. In cases of extended left atrial resection, a percutaneous jugular-femoral veno-venous-arterial cannulation was favored. RESULTS Procedures were divided into three groups: carinal resections and reconstruction (n = 8), resections of the descending aorta and left lung (n = 7), resections of lung and left atrium (n = 9). No intraoperative complications occurred. Overall 30-day mortality was 25%. A complete resection was achieved in 18 patients. Median survival was 12 months. One- and 5-year survival were 48.1 and 22.7%, respectively. CONCLUSION The present study shows that intraoperative use of ECMO for extended carinal, aortic, or atrial resections is feasible with minimal intraoperative complications allowing surgeons increased operating-field safety. Perioperative mortality is high, but this is rather an attribute of local extended disease and patient comorbidities.
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Affiliation(s)
- Aris Koryllos
- Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Thomas Galetin
- Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Jerome Defosse
- Department of Anaesthesiology and Intensive Care Medicine, Kliniken der Stadt Köln gGmbH, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Stephan Strassmann
- ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Christian Karagiannidis
- ARDS and ECMO Centre, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, Kliniken der Stadt Köln gGmbH, Lung Clinic, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany
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Schieren M, Wappler F, Wafaisade A, Lefering R, Sakka SG, Kaufmann J, Heiroth HJ, Defosse J, Böhmer AB. Impact of blunt chest trauma on outcome after traumatic brain injury- a matched-pair analysis of the TraumaRegister DGU®. Scand J Trauma Resusc Emerg Med 2020; 28:21. [PMID: 32164757 PMCID: PMC7069167 DOI: 10.1186/s13049-020-0708-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/05/2020] [Indexed: 12/02/2022] Open
Abstract
Background Traumatic brain injury (TBI) is associated with high rates of long-term disability and mortality. Our aim was to investigate the effects of thoracic trauma on the in-hospital course and outcome of patients with TBI. Methods We performed a matched pair analysis of the multicenter trauma database TraumaRegisterDGU® (TR-DGU) in the 5-year period from 2012 to 2016. We included adult patients (≥18 years of age) with moderate to severe TBI (abbreviated injury scale (AIS)= 3–5). Patients with isolated TBI (group 1) were compared to patients with TBI and varying degrees of additional blunt thoracic trauma (AISThorax= 2–5) (group 2). Matching criteria were gender, age, severity of TBI, initial GCS and presence/absence of shock. The χ2-test was used for comparing categorical variables and the Mann-Whitney-U-test was chosen for continuous parameters. Statistical significance was defined by a p-value < 0.05. Results A total of 5414 matched pairs (10,828 patients) were included. The presence of additional thoracic injuries in patients with TBI was associated with a longer duration of mechanical ventilation and a prolonged ICU and hospital length of stay. Additional thoracic trauma was also associated with higher mortality rates. These effects were most pronounced in thoracic AIS subgroups 4 and 5. Additional thoracic trauma, regardless of its severity (AISThorax ≥2) was associated with significantly decreased rates of good neurologic recovery (GOS = 5) after TBI. Conclusions Chest trauma in general, regardless of its initial severity (AISThorax= 2–5), is associated with decreased chance of good neurologic recovery after TBI. Affected patients should be considered “at risk” and vigilance for the maintenance of optimal neuro-protective measures should be high.
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Affiliation(s)
- Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str, 200, 51109, Cologne, Germany.
| | - Frank Wappler
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str, 200, 51109, Cologne, Germany
| | - Arasch Wafaisade
- Department of Traumatology and Orthopedic Surgery, University Witten/Herdecke, Medical Center Cologne-Merheim, Cologne, Germany
| | - Rolf Lefering
- IFOM - Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany
| | - Samir G Sakka
- Department of Intensive Care Medicine, University of Mainz, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany
| | - Jost Kaufmann
- Department of Pediatric Anaesthesiology, University Witten/Herdecke, Children Hospital Amsterdamer Straße, Cologne, Germany
| | - Hi-Jae Heiroth
- Department of Neurosurgery, University Witten/Herdecke, Medical Center Cologne-Merheim, Cologne, Germany
| | - Jerome Defosse
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str, 200, 51109, Cologne, Germany
| | - Andreas B Böhmer
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str, 200, 51109, Cologne, Germany
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Schieren M, Wappler F, Klodt D, Sakka SG, Lefering R, Jäcker V, Defosse J. Continuous lateral rotational therapy in thoracic trauma--A matched pair analysis. Injury 2020; 51:51-58. [PMID: 31757469 DOI: 10.1016/j.injury.2019.11.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Given the lack of reliable evidence on the utility of continuous lateral rotational therapy (CLRT) in chest trauma, we performed a single-centre retrospective matched-pair analysis of patients treated either with CLRT or non-continuous manual turning after blunt thoracic trauma. METHODS We included adult patients that were admitted to our level 1 trauma centre from 2010-2014 and presented with severe thoracic injuries (AISThorax ≥3) within 24 h after the injury and required at least 72 h of mechanical ventilation. Patients were either treated with manual turning every 2-4 h or CLRT. To ensure comparable injury severity and a similar risk for posttraumatic respiratory complications, we matched for thoracic injury severity, age, additional injuries (head, abdomen, extremities) and need for massive transfusion. RESULTS A total of 22 pairs (n = 44 patients) were successfully matched and analysed. The use of CLRT did not have a statistically significant impact on respiratory function, gas exchange, duration of mechanical ventilation, ICU or hospital length of stay, or overall patient outcomes (e.g. pneumonia, sepsis, ARDS, mortality). During active rotation the level of sedation was lower compared to manual turning (Richmond Agitation Sedation Scale; manual turning: -3.6; CLRT: -4.0; p = 0.01). Patient agitation was noticed more frequently in the CLRT group (manual turning: n = 2 (9%); CLRT: n = 9 (41%); p = 0.02). DISCUSSION In this well-matched sample, the use of CLRT did not seem to translate into relevant clinical benefits in patients with thoracic trauma in the setting of modern ICU care with the widespread implementation of lung protective ventilation. However, statistical power and generalisability were limited by the small sample size and single centre design. A large RCT is required to provide conclusive results.
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Affiliation(s)
- Mark Schieren
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str, 200, Cologne, Germany.
| | - Frank Wappler
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str, 200, Cologne, Germany.
| | - Daniel Klodt
- Krankenhaus der Augustinerinnen, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Cologne, Gemany.
| | - Samir G Sakka
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str, 200, Cologne, Germany.
| | - Rolf Lefering
- IFOM - Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany.
| | - Vera Jäcker
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Traumatology and Orthopaedic Surgery, Cologne, Germany.
| | - Jerome Defosse
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Ostmerheimer Str, 200, Cologne, Germany.
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Schieren M, Kleinschmidt J, Schmutz A, Loop T, Staat M, Gatzweiler KH, Wappler F, Defosse J. Comparison of forces acting on maxillary incisors during tracheal intubation with different laryngoscopy techniques: a blinded manikin study. Anaesthesia 2019; 74:1563-1571. [PMID: 31448404 DOI: 10.1111/anae.14815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 12/01/2022]
Abstract
Dental trauma is a common complication of tracheal intubation. As existing evidence is insufficient to validly assess the impact of different laryngoscopy techniques on the incidence of dental trauma, the force exerted onto dental structures during tracheal intubation was investigated. An intubation manikin was equipped with hidden force sensors in all maxillary incisors. Dental force was measured while 104 anaesthetists performed a series of tracheal intubations using direct laryngoscopy with a Macintosh blade, and videolaryngoscopy with a C-MAC® , or the hyperangulated GlideScope® or KingVision® laryngoscopes in both normal and difficult airway conditions. A total of 624 tracheal intubations were analysed. The median (IQR [range]) peak force of direct laryngoscopy in normal airways was 21.1 (14.0-32.8 [2.3-127.6]) N and 29.3 (17.7-44.8 [3.3-97.2]) N in difficult airways. In normal airways, these were lower with the GlideScope and KingVision hyperangulated laryngoscopes, with a reduction of 4.6 N (p = 0.006) and 10.9 N (p < 0.001) compared with direct laryngoscopy, respectively. In difficult airways, these were lower with the GlideScope and KingVision hyperangulated laryngoscopes, with a reduction of 9.8 N (p < 0.001) and 17.6 N (p < 0.001) compared with direct laryngoscopy, respectively. The use of the C-MAC did not have an impact on the median peak force. Although sex of anaesthetists did not affect peak force, more experienced anaesthetists generated a higher peak force than less experienced providers. We conclude that hyperangulated videolaryngoscopy was associated with a significantly decreased force exerted on maxillary incisors and might reduce the risk for dental injury in clinical settings.
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Affiliation(s)
- M Schieren
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - J Kleinschmidt
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - A Schmutz
- Department of Anaesthesiology and Intensive Care Medicine, Medical Centre, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - T Loop
- Department of Anaesthesiology and Intensive Care Medicine, Medical Centre, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - M Staat
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Biomechanics Laboratory, Julich, Germany
| | - K-H Gatzweiler
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Biomechanics Laboratory, Julich, Germany
| | - F Wappler
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - J Defosse
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
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Schroeder-Finckh A, Lopez-Pastorini A, Galetin T, Defosse J, Stoelben E, Koryllos A. Anterior Chest Wall Reconstruction Using Polypropylene Mesh: A Retrospective Study. Thorac Cardiovasc Surg 2019; 68:341-351. [DOI: 10.1055/s-0039-1694033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background Anterior chest wall resection for oncological purposes is usually combined with a form of reconstruction. Most surgeons are convinced that ventrally located defects more than 4 to 5 cm require adequate reconstruction to minimize the risk of lung herniation and respiratory distress through paradox motion. We describe our in-house results of ventral chest wall reconstruction using polypropylene mesh without the use of metallic or biological implants regardless of the extent of chest wall resection.
Methods Patient selection involved ventral chest wall resection and reconstruction by polypropylene mesh for all indications such as primary tumors, metastasis, or infiltration by lung cancer from January 2008 to December 2016. Primary end point was the difference between both sides. Secondary end points were postoperative complications such as infection, surgical revision, and pulmonary complications.
Results Forty-five cases of isolated anterior reconstruction could be identified. In 34 cases, postoperative computed tomography scan of the thorax was available. Fifteen males and 19 females with a median age of 70.5 years were operated. The evaluation of maximum hemithorax diameter between operated and nonoperated sides was documented in centimeters, and the difference was documented in percentage. The mean percentage difference was 11.1% (minimum: 0.3, maximum: 44.4). In one case, wound infection with positive culture could not be treated conservatively and required operative revision and removal of the polypropylene mesh.
Conclusion Polypropylene mesh, though not rigid, can safely be used for anterior chest wall reconstruction.
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Affiliation(s)
| | - Alberto Lopez-Pastorini
- Lung Clinic, Hospital Cologne-Merheim, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
| | - Thomas Galetin
- Lung Clinic, Hospital Cologne-Merheim, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
| | - Jerome Defosse
- Clinic for Anaesthesiology and Operative Intensive Medicine, Hospital Cologne-Merheim, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
| | - Erich Stoelben
- Lung Clinic, Hospital Cologne-Merheim, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
| | - Aris Koryllos
- Lung Clinic, Hospital Cologne-Merheim, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
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Schieren M, Böhmer AB, Lefering R, Paffrath T, Wappler F, Defosse J. Impact of body mass index on outcomes after thoracic trauma-A matched-triplet analysis of the TraumaRegister DGU ®. Injury 2019; 50:96-100. [PMID: 30297280 DOI: 10.1016/j.injury.2018.09.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 06/12/2018] [Revised: 09/11/2018] [Accepted: 09/27/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Chest trauma and obesity are both associated with increased risks for respiratory complications (e.g. hypoxia, hypercarbia, pneumonia), which are frequent causes of posttraumatic morbidity and mortality. However, as there is only limited and inconsistent evidence, the aim of our study was to analyse the effect of body mass index (BMI) on patient outcomes after thoracic trauma. PATIENTS AND METHODS We screened 50.519 patients entered in TraumaRegister DGU®, between 2004-2009, when the BMI was part of the standardized dataset. After matching for injury patterns and severity of trauma we performed a matched tripled analysis with regard to the BMI (group 1: <25.0 kg/m2; group 2: 25.0-29.9 kg/m2; group 3: >30.0 kg/m2). Data are shown as percentages and mean values with standard deviation. RESULTS The matching process yielded a cohort of 828 patients with serious blunt thoracic trauma, evenly distributed over the 3 BMI groups (276 triplets). BMI did not have an impact on the need for prehospital or emergency department interventions. There was a trend towards more liberal use of whole-body-CT scanning with increasing BMI (group 1: 68.8%; group 2: 73.2%; group 3: 75.0%). Additional abdominal injuries were more common in normal weight patients (Group 1: 28.3%; Group 2: 14.9%; Group 3: 17.8%). Obesity (BMI > 30.0 kg/m2) had a significant impact on the duration of mechanical ventilation (in days; group 1: 6.5 (9.4); group 2: 6.4 (8.9); group 3: 9.1 (14.4); p = 0.002), ICU days (in days; group 1: 11.5 (11.5); group 2: 10.9 (9.6); group 3: 14.1 (16.7); p = 0.005) and hospital length of stay (in days; group 1: 27.8 (19.3); group 2: 27.4 (19.2); group 3: 32.2 (25.9); p = 0.009). There were no significant differences regarding overall mortality (group 1: 3.6%; group 2: 1.8%; group 3: 4.0%; p = 0.26). CONCLUSIONS Obesity has a negative impact on outcomes after blunt chest trauma, as it is associated with prolonged duration of mechanical ventilation, ICU and hospital length of stay. Mortality did not seem to be affected, yet, further research is required to confirm these results in a larger cohort.
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Affiliation(s)
- Mark Schieren
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany.
| | - Andreas B Böhmer
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany.
| | - Rolf Lefering
- IFOM - Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany.
| | - Thomas Paffrath
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Traumatology and Orthopaedic Surgery, Cologne, Germany.
| | - Frank Wappler
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany.
| | - Jerome Defosse
- University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany.
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Schieren M, Böhmer A, Golbeck W, Defosse J, Wappler F, Marcus HE. [Anesthesia problem cards-indispensable yet problematic : Nationwide survey on experiences from clinical practice]. Anaesthesist 2018; 67:264-269. [PMID: 29352365 DOI: 10.1007/s00101-018-0407-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/19/2017] [Accepted: 12/23/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anesthetic procedures may lead to severe and potentially life-threatening complications (e. g. difficult airway, allergic reactions, malignant hyperthermia). Most complications can be avoided in future anesthetic procedures with adequate preparation (e. g. awake intubation, trigger-free anesthesia). In Germany, anesthesia problem cards were introduced two decades ago to identify patients at risk and to increase patient safety by creating a standardized documentation system for anesthesia-related complications. The purpose of our study was to evaluate the utility and problems of anesthesia problem cards in clinical practice. MATERIAL AND METHODS All registered members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Professional Association of German Anesthesiologists (BDA) (n = 19,042) were invited to participate in an online survey on patient safety. A subsection of the survey focused specifically on anesthesia problem cards and their utility in clinical practice (e. g. field of application, issuing procedures, benefits and problems). RESULTS The survey subsection on anesthesia problem cards was completed by 1783 participants. Most agreed that anesthesia problem cards are a useful tool to increase patient safety (n = 1502; 84.2%) and that they are routinely issued after the occurrence of anesthesia-related complications (n = 1664, 93.4%). One of the major problems noted was that patients frequently forget to bring their anesthesia problem cards when presenting for the preanesthetic assessment. This was observed by 1457 participants (81.7%). Furthermore, the information provided on anesthesia problem cards may be inadequately phrased (n = 874; 49.0%) or illegible (n = 833; 46.7%). In addition, the space for individual comments or problem solutions is insufficient (n = 811; 45.5%). Replacements for lost anesthesia problem cards with identical informational content can be issued in only 41.9% (n = 747) of the participants' departments. CONCLUSION Anesthesia problem cards are considered a useful tool to increase patient safety and are frequently issued in clinical practice; however, in the document's current form its full potential for risk minimization cannot be exploited. Structural changes are required to increase documentation quality and reproducibility. Concerning its informational content, the spectrum of included complications and their individual solutions need to be expanded to meet the requirements of modern anesthetic practice.
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Affiliation(s)
- M Schieren
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Kliniken Köln, Ostmerheimer Str. 200, 51109, Köln, Deutschland.
| | - A Böhmer
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Kliniken Köln, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - W Golbeck
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Kliniken Köln, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - J Defosse
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Kliniken Köln, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - F Wappler
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Kliniken Köln, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - H E Marcus
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke, Kliniken Köln, Ostmerheimer Str. 200, 51109, Köln, Deutschland
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Schieren M, Böhmer A, Dusse F, Koryllos A, Wappler F, Defosse J. New Approaches to Airway Management in Tracheal Resections-A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth 2017; 31:1351-1358. [PMID: 28800992 DOI: 10.1053/j.jvca.2017.03.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 11/28/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Although endotracheal intubation, surgical crossfield intubation, and jet ventilation are standard techniques for airway management in tracheal resections, there are also reports of new approaches, ranging from regional anesthesia to extracorporeal support. The objective was to outline the entire spectrum of new airway techniques. DESIGN The literature databases PubMed/Medline and the Cochrane Library were searched systematically for prospective and retrospective trials as well as case reports on tracheal resections. SETTING No restrictions applied to hospital types or settings. PARTICIPANTS Adult patients undergoing surgical resections of noncongenital tracheal stenoses with end-to-end anastomoses. INTERVENTIONS Airway management techniques were divided into conventional and new approaches and analyzed regarding their potential risks and benefits. MEASUREMENTS AND MAIN RESULTS A total of 59 publications (n = 797 patients) were included. The majority of publications (71.2%) describe conventional airway techniques. Endotracheal tube placement after induction of general anesthesia and surgical crossfield intubation after incision of the trachea were used most frequently without major complications. A total of 7 new approaches were identified, including 4 different regional anesthetic techniques (25 cases), supraglottic airways (4 cases), and new forms of extracorporeal support (25 cases). Overall failure rates of new techniques were low (1.8%). Details on patient selection and procedural specifics are provided. CONCLUSIONS New approaches have several theoretical benefits, yet further research is required to establish criteria for patient selection and evaluate procedural safety. Given the low level of evidence, it currently is impossible to compare methods of airway management regarding outcome-related risks and benefits.
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Affiliation(s)
- Mark Schieren
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany.
| | - Andreas Böhmer
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Frank Wappler
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Jerome Defosse
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
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Arends S, Defosse J, Diaz C, Wappler F, Sakka SG. Successful treatment of severe Clostridium difficile infection by administration of crushed fidaxomicin via a nasogastric tube in a critically ill patient. Int J Infect Dis 2016; 55:27-28. [PMID: 28027991 DOI: 10.1016/j.ijid.2016.12.020] [Citation(s) in RCA: 2] [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: 06/12/2016] [Revised: 12/07/2016] [Accepted: 12/16/2016] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To report the successful use of crushed fidaxomicin via a nasogastric tube for treatment of a severe Clostridium difficile infection in a critically ill patient. DATA SOURCES Clinical observation of a patient, images of abdominal computed tomography, antimicrobial therapy and course of infection parameters. DATA EXTRACTION Relevant information contained in the medical observation of the patient and selection of image and laboratory parameters performed in the patient. DATA SYNTHESIS We report a case of a 79-year old patient who developed septic shock with an increasing need for norepinephrine and acute renal failure due to a severe Clostridium difficile infection. Antimicrobial therapy with vancomycin via a nasogastric tube and metronidazole i.v. did not lead to improvement, infection parameters further increased, and the clinical condition became increasingly impaired. After 10 days, antimicrobial therapy was changed to fidaxomicin, crushed and administered via nasogastric tube. Within 24hours, infection parameters decreased. Further diarrhoea ceased and stool samples were negative for Clostridium difficile antigen. CONCLUSIONS Our case confirms that administration of fidaxomicin via a nasogastric tube was safe and effective in this patient. Further studies are needed to evaluate the efficacy of this strategy in critically ill patients systematically.
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Affiliation(s)
- Sven Arends
- Department of Anaesthesiology and Operative Intensive Care Medicine, Witten/Herdecke University, Cologne Merheim Medical Centre, Germany.
| | - Jerome Defosse
- Department of Anaesthesiology and Operative Intensive Care Medicine, Witten/Herdecke University, Cologne Merheim Medical Centre, Germany.
| | - Cori Diaz
- MVZ synlab Leverkusen GmbH, Leverkusen, Germany.
| | - Frank Wappler
- Department of Anaesthesiology and Operative Intensive Care Medicine, Witten/Herdecke University, Cologne Merheim Medical Centre, Germany.
| | - Samir G Sakka
- Department of Anaesthesiology and Operative Intensive Care Medicine, Witten/Herdecke University, Cologne Merheim Medical Centre, Germany.
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Defosse J, Schieren M, Böhmer A, von Dossow V, Loop T, Wappler F, Gerbershagen MU. Deutschlandweite Umfrage zur Thoraxanästhesie. Anaesthesist 2016; 65:449-57. [DOI: 10.1007/s00101-016-0175-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
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Igressa A, Defosse J, Disqué C, Wappler F, Sakka S. Usefulness of broad-range PCR plus sequencing for the diagnosis of bacteremia due to a lung abscess. Int J Infect Dis 2014; 25:168-9. [DOI: 10.1016/j.ijid.2014.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/03/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022] Open
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Böhmer A, Defosse J, Geldner G, Mertens E, Zwissler B, Wappler F. Präoperative Risikoevaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen. Anaesthesist 2014; 63:198-208. [DOI: 10.1007/s00101-014-2288-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/19/2013] [Accepted: 12/30/2013] [Indexed: 12/18/2022]
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Otchwemah R, Defosse J, Wappler F, Sakka SG. Percutaneous dilatation tracheostomy in the critically ill: use of ultrasound to detect an aberrant course of the brachiocephalic trunk. J Cardiothorac Vasc Anesth 2012; 26:e72-3. [PMID: 22818498 DOI: 10.1053/j.jvca.2012.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Indexed: 11/11/2022]
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Seibel A, Zimmerschied B, Grensemann J, Defosse J, Sakka SG. Measurement of indocyanine green plasma disappearance rate during running renal replacement therapy. Anaesth Intensive Care 2012; 40:733-735. [PMID: 22813520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Hohn A, Defosse J, Berger HJ, Knüttgen D, Wappler F. Kasuistik interaktiv: Thoraxschmerzen und Hemiparese – Ein paradoxer Notfall? Anasthesiol Intensivmed Notfallmed Schmerzther 2011; 46:486-90. [DOI: 10.1055/s-0031-1284467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wrigge H, Zinserling J, Neumann P, Defosse J, Magnusson A, Putensen C, Hedenstierna G. Spontaneous breathing improves lung aeration in oleic acid-induced lung injury. Anesthesiology 2003; 99:376-84. [PMID: 12883410 DOI: 10.1097/00000542-200308000-00019] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Experimental and clinical studies have shown reduction in intrapulmonary shunt with improved oxygenation by spontaneous breathing with airway pressure release ventilation (APRV) in acute lung injury. The mechanisms of these findings are not clear. The authors hypothesized that spontaneous breathing results in better aeration of lung tissue and that improvement in oxygenation can be explained by these changes. This hypothesis was studied in a porcine model of oleic acid-induced lung injury. METHODS Two hours after induction of lung injury, 24 pigs were randomly assigned to APRV with or without spontaneous breathing at a positive end-expiratory pressure of 5 cm H(2)O. Hemodynamics, spirometry, and end-expiratory lung volume by nitrogen washout were measured at baseline, after 2 h of lung injury, and after 2 and 4 h of mechanical ventilation in the specific mode. Finally, spiral computed tomography of the chest was performed at end-expiratory lung volume in 22 pigs. RESULTS Arterial carbon dioxide tension and mean and end-inspiratory airway pressures were comparable between settings. Four hours of APRV with spontaneous breathing resulted in improved oxygenation compared with APRV without spontaneous breathing (arterial oxygen tension, 144 +/- 65 vs. 91 +/- 50 mmHg, P < 0.01 for interaction time x mode), higher end-expiratory lung volume (786 +/- 320 vs. 384 +/- 148 ml, P < 0.001), and better aeration. End-expiratory lung volume and venous admixture were both correlated with the amount of lung reaeration (r(2) = 0.62 and r(2) = 0.61, respectively). CONCLUSIONS The results support the hypothesis that spontaneous breathing during APRV improves oxygenation mainly by recruitment of nonaerated lung and improved aeration of the lungs.
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Affiliation(s)
- Hermann Wrigge
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Germany.
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