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Sivapalan P, Kaas-Hansen BS, Meyhoff TS, Hjortrup PB, Kjær MBN, Laake JH, Cronhjort M, Jakob SM, Cecconi M, Nalos M, Ostermann M, Malbrain MLNG, Møller MH, Perner A, Granholm A. Effects of IV fluid restriction according to site-specific intensity of standard fluid treatment-protocol. Acta Anaesthesiol Scand 2024. [PMID: 38576165 DOI: 10.1111/aas.14423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Variation in usual practice in fluid trials assessing lower versus higher volumes may affect overall comparisons. To address this, we will evaluate the effects of heterogeneity in treatment intensity in the Conservative versus Liberal Approach to Fluid Therapy of Septic Shock in Intensive Care trial. This will reflect the effects of differences in site-specific intensities of standard fluid treatment due to local practice preferences while considering participant characteristics. METHODS We will assess the effects of heterogeneity in treatment intensity across one primary (all-cause mortality) and three secondary outcomes (serious adverse events or reactions, days alive without life support and days alive out of hospital) after 90 days. We will classify sites based on the site-specific intensity of standard fluid treatment, defined as the mean differences in observed versus predicted intravenous fluid volumes in the first 24 h in the standard-fluid group while accounting for differences in participant characteristics. Predictions will be made using a machine learning model including 22 baseline predictors using the extreme gradient boosting algorithm. Subsequently, sites will be grouped into fluid treatment intensity subgroups containing at least 100 participants each. Subgroups differences will be assessed using hierarchical Bayesian regression models with weakly informative priors. We will present the full posterior distributions of relative (risk ratios and ratios of means) and absolute differences (risk differences and mean differences) in each subgroup. DISCUSSION This study will provide data on the effects of heterogeneity in treatment intensity while accounting for patient characteristics in critically ill adult patients with septic shock. REGISTRATIONS The European Clinical Trials Database (EudraCT): 2018-000404-42, ClinicalTrials. gov: NCT03668236.
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Affiliation(s)
- Praleene Sivapalan
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Benjamin Skov Kaas-Hansen
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Tine Sylvest Meyhoff
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Lillebælt Hospital, Kolding, Denmark
| | - Peter Buhl Hjortrup
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Cardiothoracic Anaesthesia and Intensive Care, The Heart Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Maj-Brit N Kjær
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Jon Henrik Laake
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Maria Cronhjort
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Stephan M Jakob
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- University of Bern, Bern, Switzerland
| | - Maurizio Cecconi
- Biomedical Sciences Department, Humanitas University, Pieve Emanuele, Italy
- Department of Anaesthesia and Intensive Care, IRCCS-Humanitas Research Hospital, Milan, Italy
| | - Marek Nalos
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Anaesthesiology, Perioperative and Intensive Care Medicine, Masaryk Hospital, J.E. Purkinje University, Usti nad Labem, Czech Republic
| | - Marlies Ostermann
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Intensive Care, Guy's and St Thomas' Hospital, London, UK
| | - Manu L N G Malbrain
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
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Messina A, Chew MS, Poole D, Calabrò L, De Backer D, Donadello K, Hernandez G, Hamzaoui O, Jozwiak M, Lai C, Malbrain MLNG, Mallat J, Myatra SN, Muller L, Ospina-Tascon G, Pinsky MR, Preau S, Saugel B, Teboul JL, Cecconi M, Monnet X. Consistency of data reporting in fluid responsiveness studies in the critically ill setting: the CODEFIRE consensus from the Cardiovascular Dynamic section of the European Society of Intensive Care Medicine. Intensive Care Med 2024; 50:548-560. [PMID: 38483559 DOI: 10.1007/s00134-024-07344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/31/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE To provide consensus recommendations regarding hemodynamic data reporting in studies investigating fluid responsiveness and fluid challenge (FC) use in the intensive care unit (ICU). METHODS The Executive Committee of the European Society of Intensive Care Medicine (ESICM) commissioned and supervised the project. A panel of 18 international experts and a methodologist identified main domains and items from a systematic literature, plus 2 ancillary domains. A three-step Delphi process based on an iterative approach was used to obtain the final consensus. In the Delphi 1 and 2, the items were selected with strong (≥ 80% of votes) or week agreement (70-80% of votes), while the Delphi 3 generated recommended (≥ 90% of votes) or suggested (80-90% of votes) items (RI and SI, respectively). RESULTS We identified 5 main domains initially including 117 items and the consensus finally resulted in 52 recommendations or suggestions: 18 RIs and 2 SIs statements were obtained for the domain "ICU admission", 11 RIs and 1 SI for the domain "mechanical ventilation", 5 RIs for the domain "reason for giving a FC", 8 RIs for the domain pre- and post-FC "hemodynamic data", and 7 RIs for the domain "pre-FC infused drugs". We had no consensus on the use of echocardiography, strong agreement regarding the volume (4 ml/kg) and the reference variable (cardiac output), while weak on administration rate (within 10 min) of FC in this setting. CONCLUSION This consensus found 5 main domains and provided 52 recommendations for data reporting in studies investigating fluid responsiveness in ICU patients.
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Affiliation(s)
- Antonio Messina
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (Milan), Italy.
- Department of Biomedical Sciences, Humanitas University, via Levi Montalcin,i 4, Pieve Emanuele (Milan), Italy.
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Daniele Poole
- Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy
| | - Lorenzo Calabrò
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (Milan), Italy
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Katia Donadello
- Department of Surgery, Dentistry, Gynecology and Paediatrics, University of Verona, Via Dell'artigliere 8, 37129, Verona, Italy
| | - Glenn Hernandez
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Olfa Hamzaoui
- Service de Médecine Intensive Réanimation Polyvalente, Robert Debré Hospital, University Hospitals of Reims, Unité HERVI « Hémostase et Remodelage Vasculaire Post-Ischémie » - EA 3801, University of Reims, Reims, France
| | - Mathieu Jozwiak
- Centre Hospitalier Universitaire L'Archet 1, Service de Médecine Intensive Réanimation, Nice, France
- Equipe 2 CARRES, UR2CA Unité de Recherche Clinique Université Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Christopher Lai
- DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Jihad Mallat
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sheyla Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Laurent Muller
- Department of Anaesthesia, Critical Care and Emergency Medicine, Nîmes University Hospital, Place du Professeur Debré, 30029, Nîmes, France
- Hôpital universitaire Carémeau, University of Montpellier (MUSE), Nîmes, France
| | - Gustavo Ospina-Tascon
- Department of Intensive Care, Fundación Valle del Lili - Universidad ICESI, Cali, Colombia
| | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sebastian Preau
- Intensive Care Unit, Calmette Hospital, University Hospital of Lille, 59000, Lille, France
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jean-Louis Teboul
- DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Maurizio Cecconi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, via Levi Montalcin,i 4, Pieve Emanuele (Milan), Italy
| | - Xavier Monnet
- DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, AP-HP, Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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Meyhoff TS, Granholm A, Hjortrup PB, Sivapalan P, Lange T, Laake JH, Cronhjort M, Jakob SM, Cecconi M, Nalos M, Ostermann M, Malbrain MLNG, Møller MH, Perner A. Albumin use in patients with septic shock-Post-hoc analyses of an international randomised fluid trial. Acta Anaesthesiol Scand 2024; 68:372-384. [PMID: 37975538 DOI: 10.1111/aas.14359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Albumin administration is suggested in patients with sepsis and septic shock who have received large volumes of crystalloids. Given lack of firm evidence, clinical practice variation may exist. To address this, we investigated if patient characteristics or trial site were associated with albumin use in septic shock. METHODS We conducted a post-hoc study of the CLASSIC international, randomised clinical trial of fluid volumes in septic shock. Associations between selected baseline variables and trial site with albumin use during ICU stay were assessed in Cox models considering death, ICU discharge, and loss-to-follow-up as competing events. Baseline variables were first assessed individually, adjusted for treatment allocation (restrictive vs. standard IV fluid), and then adjusted for allocation and the other baseline variables. Site was assessed in a model adjusted for allocation and baseline variables. RESULTS We analysed 1541 of 1554 patients randomised in CLASSIC (99.2%). During ICU stay, 36.3% of patients in the restrictive-fluid group and 52.6% in the standard-fluid group received albumin. Gastrointestinal focus of infection and higher doses of norepinephrine were most strongly associated with albumin use (subgroup with highest quartile of norepinephrine doses, hazard ratio (HR) 2.58, 95% CI 1.89 to 3.53). HRs for associations between site and albumin use ranged from 0.11 (95% CI 0.05 to 0.26) to 1.70 (95% CI 1.06 to 2.74); test for overall effect of site: p < .001. CONCLUSIONS In adults with septic shock, gastrointestinal focus of infection and higher doses of norepinephrine at baseline were associated with albumin use, which also varied substantially between sites.
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Affiliation(s)
- Tine Sylvest Meyhoff
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Peter Buhl Hjortrup
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Cardiothoracic Anaesthesia and Intensive Care, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Praleene Sivapalan
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Theis Lange
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jon Henrik Laake
- Department of Anaesthesiology and Intensive Care Medicine, Rikshospitalet, Oslo University Hospital, Norway
- Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Norway
| | - Maria Cronhjort
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Marek Nalos
- Medical Intensive Care Unit 1, Interni klinika, Fakultni Nemocnice, Plzen, Czech Republic
| | - Marlies Ostermann
- Department of Intensive Care, Guy's and St Thomas' Hospital, London, UK
| | - Manu L N G Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), Jette, Belgium
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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4
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Sivapalan P, Meyhoff TS, Hjortrup PB, Lange T, Kaas-Hansen BS, Kjaer MBN, Laake JH, Cronhjort M, Jakob SM, Cecconi M, Nalos M, Ostermann M, Malbrain MLNG, Møller MH, Perner A, Granholm A. Restrictive versus standard IV fluid therapy in adult ICU patients with septic shock-Bayesian analyses of the CLASSIC trial. Acta Anaesthesiol Scand 2024; 68:236-246. [PMID: 37869991 DOI: 10.1111/aas.14345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The CLASSIC trial assessed the effects of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock. This pre-planned study provides a probabilistic interpretation and evaluates heterogeneity in treatment effects (HTE). METHODS We analysed mortality, serious adverse events (SAEs), serious adverse reactions (SARs) and days alive without life-support within 90 days using Bayesian models with weakly informative priors. HTE on mortality was assessed according to five baseline variables: disease severity, vasopressor dose, lactate levels, creatinine values and IV fluid volumes given before randomisation. RESULTS The absolute difference in mortality was 0.2%-points (95% credible interval: -5.0 to 5.4; 47% posterior probability of benefit [risk difference <0.0%-points]) with restrictive IV fluid. The posterior probabilities of benefits with restrictive IV fluid were 72% for SAEs, 52% for SARs and 61% for days alive without life-support. The posterior probabilities of no clinically important differences (absolute risk difference ≤2%-points) between the groups were 56% for mortality, 49% for SAEs, 90% for SARs and 38% for days alive without life-support. There was 97% probability of HTE for previous IV fluid volumes analysed continuously, that is, potentially relatively lower mortality of restrictive IV fluids with higher previous IV fluids. No substantial evidence of HTE was found in the other analyses. CONCLUSION We could not rule out clinically important effects of restrictive IV fluid therapy on mortality, SAEs or days alive without life-support, but substantial effects on SARs were unlikely. IV fluids given before randomisation might interact with IV fluid strategy.
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Affiliation(s)
- Praleene Sivapalan
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Deptartment of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Tine Sylvest Meyhoff
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Peter Buhl Hjortrup
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Cardiothoracic Anaesthesia and Intensive Care, The Heart Center, Copenhagen University Hospital-Rigshospitalet Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Benjamin Skov Kaas-Hansen
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Maj-Brit N Kjaer
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Deptartment of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Jon Henrik Laake
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Maria Cronhjort
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Clinical sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Maurizio Cecconi
- Biomedical Sciences Department, Humanitas University, Milan, Italy
- Department of Anaesthesia and Intensive Care, IRCCS-Humanitas Research Hospital, Milan, Italy
| | - Marek Nalos
- Department of Intensive Care, University Hospital Pilsen, Pilsen, Czech Republic
| | - Marlies Ostermann
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Intensive Care, Guy's and St Thomas' Hospital, London, UK
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Deptartment of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Deptartment of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Deptartment of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
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Astapenko D, Zrzavecky M, Gorskaja D, Hyspler R, Ticha A, Radochova V, Lehmann C, Malbrain MLNG, Cerny V, Hahn RG. Modulation of the capillary leakage by exogenous albumin in a rat model of endothelial glycocalyx damage. Clin Hemorheol Microcirc 2024; 86:509-517. [PMID: 38073383 DOI: 10.3233/ch-232027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Endothelial glycocalyx (EG) plays a crucial role in maintaining the plasma proteins within the intravascular space. OBJECTIVE We studied whether exogenous albumin protects the EG in an experimental model of EG enzymatic damage in rats. METHODS Rats were divided into three groups of 10 animals that received (1) Evans blue (2) Evans blue + hyaluronidase, or (3) Evans blue + hyaluronidase + 20% human albumin via the tail vein. Spectrophotometric analysis was performed 2 h later to quantify the leakage of Evans blue-labeled albumin into the heart, lungs, brain, kidneys, liver, small intestine, spleen, and skeletal muscle. RESULTS Administration of hyaluronidase numerically increased the capillary leakage of Evans blue in all examined tissues. Co-administration of albumin decreased the leakage of albumin in all tissues except the heart. In the lungs, the ratio between the absorbance and dry organ weight decreased from 5.3 ± 2.4 to 1.7 ± 0.5 (mean ± SD) (P < 0.002), and in the liver, the absorbance decreased from 2.2 ± 0.7 to 1.5 ± 0.4 (P < 0.011). CONCLUSION Exogenous albumin decreased the capillary leakage of albumin which was interpreted as a sign of maintained EG integrity.
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Affiliation(s)
- David Astapenko
- Department of Anesthesiology, Resuscitation, and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
- Faculty of Health Studies, Technical University in Liberec, Liberec, Czech Republic
| | - Marek Zrzavecky
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Diana Gorskaja
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Radomir Hyspler
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Alena Ticha
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Vera Radochova
- Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- Medical Data Management, Medaman, Geel, Belgium
- International Fluid Academy, Lovenjoel, Belgium
| | - Vladimir Cerny
- Department of Anesthesiology, Resuscitation, and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
- Faculty of Health Studies, Technical University in Liberec, Liberec, Czech Republic
- Department of Anesthesiology and Resuscitation, University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovakia
| | - Robert G Hahn
- Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden
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6
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Cleymaet R, D’Hondt M, Scheinok T, Malbrain L, De Laet I, Schoonheydt K, Dits H, Van Regenmortel N, Mekeirele M, Cordemans C, Minini A, Severgnini P, Dabrowski W, Wong A, Malbrain MLNG. Comparison of Bioelectrical Impedance Analysis (BIA)-Derived Parameters in Healthy Volunteers and Critically Ill Patients. Life (Basel) 2023; 14:27. [PMID: 38255643 PMCID: PMC10821189 DOI: 10.3390/life14010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/21/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To compare bioelectrical impedance analysis (BIA)-derived parameters in healthy volunteers and critically ill patients and to assess its prognostic value in an ICU patient cohort. DESIGN Retrospective, observational data analysis. SETTING Single centre, tertiary-level ICU (Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg Hospital). PATIENTS 101 patients and 101 healthy subjects, participants of International Fluid Academy Days. MEASUREMENTS AND MAIN RESULTS Compared to healthy volunteers, both male and female ICU patients had significantly higher values for total body water (TBW), extracellular water (ECW), extracellular fluid (ECF), plasma, and interstitial fluid volumes. The phase angle was significantly lower and the malnutrition index was significantly higher in ICU patients, regardless of gender. Non-survivors in the ICU had significantly higher extracellular water content (ECW, 50.7 ± 5.1 vs. 48.9 ± 4.3%, p = 0.047) and accordingly significantly lower intracellular water (ICW, 49.2 ± 5.1 vs. 51.1 ± 4.3%, p = 0.047). The malnutrition index was also significantly higher in non-survivors compared to survivors (0.94 ± 0.17 vs. 0.87 ± 0.16, p = 0.048), as was the capillary leak index (ECW/ICW). CONCLUSIONS Compared to healthy volunteers, this study observed a higher malnutrition index and TBW in ICU patients with an accumulation of fluids in the extracellular compartment. ICU non-survivors showed similar results, indicating that ICU patients and a fortiori non-survivors are generally overhydrated, with increased TBW and ECW, and more undernourished, as indicated by a higher malnutrition index.
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Affiliation(s)
- Robbert Cleymaet
- Department of Oromaxillofacial and Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Marvin D’Hondt
- Department of Oromaxillofacial and Plastic Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Thomas Scheinok
- Department of Neurology, University Hospital Brussels (UZB), 1090 Jette, Belgium
| | - Luca Malbrain
- University School of Medicine, Katholieke Universiteit Leuven (KUL), 3000 Leuven, Belgium
| | - Inneke De Laet
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, 2000 Antwerp, Belgium
| | - Karen Schoonheydt
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, 2000 Antwerp, Belgium
| | - Hilde Dits
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, 2000 Antwerp, Belgium
| | - Niels Van Regenmortel
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, 2000 Antwerp, Belgium
| | - Michael Mekeirele
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), 1090 Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Jette, Belgium
| | - Colin Cordemans
- Department of Intensive Care, AZ Sint-Maria Hospital, 1500 Halle, Belgium;
| | - Andrea Minini
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), 1090 Jette, Belgium
- School of Anaesthesia and Intensive Care, Dipartimento di Biotecnologie e Scienze della Vita, Insubria University, 21100 Varese, Italy;
| | - Paolo Severgnini
- School of Anaesthesia and Intensive Care, Dipartimento di Biotecnologie e Scienze della Vita, Insubria University, 21100 Varese, Italy;
- Department of Anestesia e Rianimazione Cardiologica, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University Lublin, 20-954 Lublin, Poland
| | - Adrian Wong
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Jette, Belgium
- Department of Intensive Care Medicine and Anaesthesia, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Manu L. N. G. Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University Lublin, 20-954 Lublin, Poland
- International Fluid Academy, 3360 Lovenjoel, Belgium
- Medaman, Medical Data Management, 2440 Geel, Belgium
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7
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Maasdorp SD, Paruk F, de Vasconcellos K, Grion C, Joubert I, Joynt GM, Kalafatis N, Lapinsky SE, Lipman J, Malbrain MLNG, Mrara B, Richards GA, Spruyt MGL, van der Merwe E, Vincent JL, van der Merwe LJ. Core competencies in critical care for general medical practitioners in South Africa: A Delphi study. South Afr J Crit Care 2023; 39:e1261. [PMID: 38357694 PMCID: PMC10866206 DOI: 10.7196/sajcc.2023.v39i3.1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 02/16/2024] Open
Abstract
Background Despite a high burden of disease that requires critical care services, there are a limited number of intensivists in South Africa (SA). Medical practitioners at district and regional public sector hospitals frequently manage critically ill patients in the absence of intensivists, despite these medical practitioners having had minimal exposure to critical care during their undergraduate training. Objectives To identify core competencies in critical care for medical practitioners who provide critical care services at public sector hospitals in SA where intensivists are not available to direct patient management. Methods A preliminary list of core competencies in critical care was compiled. Thereafter, 13 national and international experts were requested to achieve consensus on a final list of core competencies that are required for critical care by medical practitioners, using a modified Delphi process. Results A final list of 153 core competencies in critical care was identified. Conclusion The core competencies identified by this study could assist in developing training programmes for medical practitioners to improve the quality of critical care services provided at district and regional hospitals in SA. Contribution of the study The study provides consensus on a list of core competencies in critical care that non-intensivist medical practitioners managing critically ill patients in healthcare settings in South Africa, especially where intensivists are not readily available, should have. The list can form the core content of training programmes aimed at improving critical care competence of general medical practitioners, and in this way hopefully improve the overall outcomes of critically ill patients in South Africa.
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Affiliation(s)
- S D Maasdorp
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - F Paruk
- Department of Critical Care, Faculty of Health Sciences, University of Pretoria, South Africa
| | - K de Vasconcellos
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - C Grion
- Department of Clinical Medical, Hospital Universitári, Universidade Estadual de Londrina, Brazil
| | - I Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - G M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, China
| | - N Kalafatis
- Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - S E Lapinsky
- Department of Critical Care, Faculty of Medicine, University of Toronto, Canada
| | - J Lipman
- Jamieson Trauma Institute, Royal Brisbane and Women’s Hospital, University of Queensland, Brisbane, Australia; and Nimes University Hospital, University of
Montpellier, Nimes, France
| | - M L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Lublin, Poland
| | - B Mrara
- Department of Anaesthesia, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - G A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M G L Spruyt
- Division of Critical Care, Department of Surgery, University of the Free State, Bloemfontein, South Africa
| | - E van der Merwe
- Department of Critical Care, Livingstone Hospital, Gqeberha, South Africa
| | - J L Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Belgium
| | - L J van der Merwe
- Division of Health Sciences Education, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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8
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Aslam TN, Klitgaard TL, Ahlstedt CAO, Andersen FH, Chew MS, Collet MO, Cronhjort M, Estrup S, Fossum OK, Frisvold SK, Gillmann HJ, Granholm A, Gundem TM, Hauss K, Hollenberg J, Huanca Condori ME, Hästbacka J, Johnstad BA, Keus E, Kjaer MBN, Klepstad P, Krag M, Kvåle R, Malbrain MLNG, Meyhoff CS, Morgan M, Møller A, Pfortmueller CA, Poulsen LM, Robertson AC, Schefold JC, Schjørring OL, Siegemund M, Sigurdsson MI, Sjövall F, Strand K, Stueber T, Szczeklik W, Wahlin RR, Wangberg HL, Wian KA, Wichmann S, Hofsø K, Møller MH, Perner A, Rasmussen BS, Laake JH. A survey of preferences for respiratory support in the intensive care unit for patients with acute hypoxaemic respiratory failure. Acta Anaesthesiol Scand 2023; 67:1383-1394. [PMID: 37737652 DOI: 10.1111/aas.14317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND When caring for mechanically ventilated adults with acute hypoxaemic respiratory failure (AHRF), clinicians are faced with an uncertain choice between ventilator modes allowing for spontaneous breaths or ventilation fully controlled by the ventilator. The preferences of clinicians managing such patients, and what motivates their choice of ventilator mode, are largely unknown. To better understand how clinicians' preferences may impact the choice of ventilatory support for patients with AHRF, we issued a survey to an international network of intensive care unit (ICU) researchers. METHODS We distributed an online survey with 32 broadly similar and interlinked questions on how clinicians prioritise spontaneous or controlled ventilation in invasively ventilated patients with AHRF of different severity, and which factors determine their choice. RESULTS The survey was distributed to 1337 recipients in 12 countries. Of these, 415 (31%) completed the survey either fully (52%) or partially (48%). Most respondents were identified as medical specialists (87%) or physicians in training (11%). Modes allowing for spontaneous ventilation were considered preferable in mild AHRF, with controlled ventilation considered as progressively more important in moderate and severe AHRF. Among respondents there was strong support (90%) for a randomised clinical trial comparing spontaneous with controlled ventilation in patients with moderate AHRF. CONCLUSIONS The responses from this international survey suggest that there is clinical equipoise for the preferred ventilator mode in patients with AHRF of moderate severity. We found strong support for a randomised trial comparing modes of ventilation in patients with moderate AHRF.
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Affiliation(s)
- Tayyba N Aslam
- Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Rikshopitalet, Oslo University Hospital, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas L Klitgaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Christian A O Ahlstedt
- Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Finn H Andersen
- Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - Marie O Collet
- Department of Intensive Care 4131, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Cronhjort
- Department of Clinical Science, Danderyds Sjukhus, Karolinska Institutet, Stockholm, Sweden
| | - Stine Estrup
- Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Ole K Fossum
- Anaesthesia and Intensive Care, Akershus University Hospital, Nordbyhagen, Norway
| | - Shirin K Frisvold
- Anesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Hans-Joerg Gillmann
- Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Anders Granholm
- Department of Intensive Care 4131, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine M Gundem
- Anaesthesiology and Intensive Care Medicine, Ullevål, Oslo University Hospital, Oslo, Norway
| | - Kristin Hauss
- Acute- and Emergency Medicine, Sykehuset Telemark, Skien, Norway
| | - Jacob Hollenberg
- Department of Cardiology, Medical Intensive Care Unit, Karolinska Institutet, Stockholm, Sweden
| | | | - Johanna Hästbacka
- Department of Perioperative and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Eric Keus
- Critical Care, University Medical Center Groningen, Groningen, Netherlands
| | - Maj-Brit N Kjaer
- Department of Intensive Care 4131, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Pål Klepstad
- Intensive Care Medicine, St Olavs University Hospital, Trondheim, Norway
| | - Mette Krag
- Department of Anaesthesiology, Holbaek Hospital, Holbaek, Denmark
| | - Reidar Kvåle
- Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Matt Morgan
- Adult Intensive Care, The Royal Perth Hospital, Perth, Western Australia, Australia
| | - Anders Møller
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Carmen A Pfortmueller
- Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lone M Poulsen
- Intensive Care Unit, Zealand University Hospital, Køge, Denmark
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Olav L Schjørring
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Martin I Sigurdsson
- Anaesthesiology and Intensive Care Medicine, Landspital-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Fredrik Sjövall
- Intensive and Perioperative Care, Skane University Hospital, Malmö, Sweden
| | - Kristian Strand
- Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Thomas Stueber
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Rebecka R Wahlin
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | - Karl-Andre Wian
- Anaesthesia and Intensive Care, Vestfold Hospital Trust, Tønsberg, Norway
| | - Sine Wichmann
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Morten H Møller
- Department of Intensive Care 4131, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care 4131, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Bodil S Rasmussen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Jon H Laake
- Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Rikshopitalet, Oslo University Hospital, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Tayebi S, McKinney T, McKinney C, Delvadia D, Levine MA, Spofford ES, Malbrain L, Stiens J, Dabrowski W, Malbrain MLNG. Evaluation of the TraumaGuard Balloon-in-Balloon Catheter Design for Intra-Abdominal Pressure Monitoring: Insights from Pig and Human Cadaver Studies. Sensors (Basel) 2023; 23:8806. [PMID: 37960507 PMCID: PMC10650764 DOI: 10.3390/s23218806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
Introduction: Intra-abdominal pressure (IAP) monitoring is crucial for the detection and prevention of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). In the 1970s, air-filled catheters (AFCs) for urodynamic studies were introduced as a solution to overcome the limitations of water-perfused catheters. Recent studies have shown that for correct IAP measurement with traditional AFC, the bladder needs to be primed with 25 mL of saline solution to allow pressure wave transmission to the transducer outside of the body, which limits continuous IAP monitoring. Methods: In this study, a novel triple balloon, air-filled TraumaGuard (TG) catheter system from Sentinel Medical Technologies (Jacksonville, FL, USA) with a unique balloon-in-balloon design was evaluated in a porcine and cadaver model of IAH via laparoscopy (IAPgold). Results: In total, 27 and 86 paired IAP measurements were performed in two pigs and one human cadaver, respectively. The mean IAPTG was 20.7 ± 10.7 mmHg compared to IAPgold of 20.3 ± 10.3 mmHg in the porcine study. In the cadaver investigation, the mean IAPTG was 15.6 ± 10.8 mmHg compared to IAPgold of 14.4 ± 10.4 mmHg. The correlation, concordance, bias, precision, limits of agreement, and percentage error were all in accordance with the WSACS (Abdominal Compartment Society) recommendations and guidelines for research. Conclusions: These findings support the use of the TG catheter for continuous IAP monitoring, providing early detection of elevated IAP, thus enabling the potential for prevention of IAH and ACS. Confirmation studies with the TraumaGuard system in critically ill patients are warranted to further validate these findings.
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Affiliation(s)
- Salar Tayebi
- Department of Electronics and Informatics, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (S.T.); (J.S.)
| | - Tim McKinney
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA; (T.M.); (D.D.)
| | - Cynthia McKinney
- SGU School of Medicine, Danbury University Hospital, Danbury, CT 06810, USA;
| | - Dipak Delvadia
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA; (T.M.); (D.D.)
| | - Marc-Alan Levine
- Cricket Innovations, Pottstown, PA 19465, USA; (M.-A.L.); (E.S.S.J.)
| | | | - Luca Malbrain
- Faculty of Medicine, Katholieke Universiteit Leuven, 3000 Leuven, Belgium;
| | - Johan Stiens
- Department of Electronics and Informatics, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (S.T.); (J.S.)
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland;
| | - Manu L. N. G. Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland;
- Medical Data Management, Medaman, 2440 Geel, Belgium
- International Fluid Academy, 3360 Lovenjoel, Belgium
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10
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Fishman G, Ram E, Gorfil D, Kassif Y, David R, Hershko T, Malbrain MLNG, Singer P, Sessler DI. Early detection of oliguric events in critically ill patients in the ICU with a novel continuous urine flow measurement device: results of an initial validation study. J Clin Monit Comput 2023; 37:1341-1349. [PMID: 37027058 PMCID: PMC10080177 DOI: 10.1007/s10877-023-00991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/26/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES Urine output is used to evaluate fluid status and is an important marker for acute kidney injury (AKI). Our primary aim was to validate a new automatic urine output monitoring device by comparison to the current practice - the standard urometer. METHODS We conducted a prospective observational study in three ICUs. Urine flow measurements by Serenno Medical Automatic urine output measuring device (Serenno Medical, Yokneam, Israel) were compared to standard urometer readings taken automatically at 5-minutes intervals by a camera, and to hourly urometer readings by the nurses, both over 1 to 7 days. Our primary outcome was the difference between urine flow assessed by the Serenno device and reference camera-derived measurements (Camera). Our secondary outcome was the difference between urine flow assessed by the Serenno device and hourly nursing assessments (Nurse), and detection of oliguria. RESULTS Thirty-seven patients completed the study, with 1,306 h of recording and a median of 25 measurement hours per patient. Bland and Altman analysis comparing the study device to camera measurements demonstrated good agreement, with a bias of -0.4 ml/h and 95% confidence intervals ranging from - 28 to 27ml/h. Concordance was 92%. The correlation between Camera and hourly nursing assessment of urine output was distinctly worse with a bias of 7.2 ml and limits of agreement extending from - 75 to + 107 ml. Severe oliguria (urine output < 0.3 ml/kg/h) lasting 2 h or more was common and observed in 8 (21%) of patients. Among the severe oliguric events lasting more than 3 consecutive hours, 6 (41%) were not detected or documented by the nursing staff. There were no device-related complications. CONCLUSION The Serenno Medical Automatic urine output measuring device required minimal supervision, little ICU nursing staff attention, and is sufficiently accurate and precise. In addition to providing continuous assessments of urine output, it was considerably more accurate than hourly nursing assessments.
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Affiliation(s)
- Guy Fishman
- Department of General Intensive Care, Rabin Medical Center, campus Beilinson, Petah, Tikva, Israel
| | - Eilon Ram
- Department of Cardiac Surgery, Leviev cardiothoracic and vascular center, Sackler School of Medicine, Sheba Medical Center at Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Dan Gorfil
- Cardiothoracic Surgery Department, Rabin Medical Center, campus Beilinson, Petah, Tikva, Israel
| | - Yigal Kassif
- Department of Cardiac Surgery, Leviev cardiothoracic and vascular center, Sackler School of Medicine, Sheba Medical Center at Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Rachel David
- Department of General Intensive Care, Rabin Medical Center, campus Beilinson, Petah, Tikva, Israel
| | - Tzlil Hershko
- Adelson School of Medicine at Ariel University, Samaria, Israel
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego street 8, Lublin, 20-954, Poland
- International Fluid Academy, Dreef 3, Lovenjoel, 3360, Belgium
| | - Pierre Singer
- Department of General Intensive Care, Rabin Medical Center, campus Beilinson, Petah, Tikva, Israel
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Ave L1-407, Cleveland, OH, 44195, USA
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11
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See KC, Tayebi S, Sum CL, Phua J, Stiens J, Wise R, Mukhopadhyay A, Malbrain MLNG. Feasibility analysis of a novel non-invasive ultrasonographic method for the measurement of intra-abdominal pressure in the intensive care unit. J Clin Monit Comput 2023; 37:1351-1359. [PMID: 37133628 DOI: 10.1007/s10877-023-01024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023]
Abstract
Increased intra-abdominal pressure (IAP) is an important vital sign in critically ill patients and has a negative impact on morbidity and mortality. This study aimed to validate a novel non-invasive ultrasonographic approach to IAP measurement against the gold standard intra-bladder pressure (IBP) method. We conducted a prospective observational study in an adult medical ICU of a university hospital. IAP measurements using ultrasonography by two independent operators, with different experience levels (experienced, IAPUS1; inexperienced, IAPUS2), were compared with the gold standard IBP method performed by a third blinded operator. For the ultrasonographic method, decremental external pressure was applied on the anterior abdominal wall using a bottle filled with decreasing volumes of water. Ultrasonography looked at peritoneal rebound upon brisk withdrawal of the external pressure. The loss of peritoneal rebound was identified as the point where IAP was equal to or above the applied external pressure. Twenty-one patients underwent 74 IAP readings (range 2-15 mmHg). The number of readings per patient was 3.5 ± 2.5, and the abdominal wall thickness was 24.6 ± 13.1 mm. Bland and Altman's analysis showed a bias (0.39 and 0.61 mmHg) and precision (1.38 and 1.51 mmHg) for the comparison of IAPUS1 and IAPUS2 and vs. IBP, respectively with small limits of agreement that were in line with the research guidelines of the Abdominal Compartment Society (WSACS). Our novel ultrasound-based IAP method displayed good correlation and agreement between IAP and IBP at levels up to 15 mmHg and is an excellent solution for quick decision-making in critically ill patients.
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Affiliation(s)
- Kay Choong See
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore.
| | - Salar Tayebi
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, BE-1050, Belgium
| | - Chew Lai Sum
- Alexandra Hospital, 378 Alexandra Road, Singapore
| | - Jason Phua
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
- Alexandra Hospital, 378 Alexandra Road, Singapore
| | - Johan Stiens
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, BE-1050, Belgium
| | - Robert Wise
- Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, OX3 7LE, UK
- Discipline of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4000, South Africa
- Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Amartya Mukhopadhyay
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego street 8, Lublin, 20-954, Poland
- Medical Data Management, Medaman, Geel, 2440, Belgium
- International Fluid Academy, Lovenjoel, 3360, Belgium
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12
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Tayebi S, Wise R, Zarghami A, Malbrain L, Khanna AK, Dabrowski W, Stiens J, Malbrain MLNG. In Vitro Validation of a Novel Continuous Intra-Abdominal Pressure Measurement System (TraumaGuard). J Clin Med 2023; 12:6260. [PMID: 37834904 PMCID: PMC10573363 DOI: 10.3390/jcm12196260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Introduction: Intra-abdominal pressure (IAP) has been recognized as an important vital sign in critically ill patients. Due to the high prevalence and incidence of intra-abdominal hypertension in surgical (trauma, burns, cardiac) and medical (sepsis, liver cirrhosis, acute kidney injury) patients, continuous IAP (CIAP) monitoring has been proposed. This research was aimed at validating a new CIAP monitoring device, the TraumaGuard from Sentinel Medical Technologies, against the gold standard (height of a water column) in an in vitro setting and performing a comparative analysis among different CIAP measurement technologies (including two intra-gastric and two intra-bladder measurement devices). A technical and clinical guideline addressing the strengths and weaknesses of each device is provided as well. Methods: Five different CIAP measurement devices (two intra-gastric and three intra-vesical), including the former CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, were validated against the gold standard water column pressure in a bench-top abdominal phantom. The impacts of body temperature and bladder fill volume (for the intra-vesical methods) were evaluated for each system. Subsequently, 48 h of continuous monitoring (n = 2880) on top of intermittent IAP (n = 300) readings were captured for each device. Using Pearson's and Lin's correlations, concordance, and Bland and Altman analyses, the accuracy, precision, percentage error, correlation and concordance coefficients, bias, and limits of agreement were calculated for all the different devices. We also performed error grid analysis on the CIAP measurements to provide an overview of the involved risk level due to wrong IAP measurements and calculated the area under the curve and time above a certain IAP threshold. Lastly, the robustness of each system in tracking the dynamic variations of the raw IAP signal due to respirations and heartbeats was evaluated as well. Results: The TraumaGuard was the only technology able to measure the IAP with an empty artificial bladder. No important temperature dependency was observed for the investigated devices except for the Spiegelberg, which displayed higher IAP values when the temperature was increased, but this could be adjusted through recalibration. All the studied devices showed excellent ability for IAP monitoring, although the intra-vesical IAP measurements seem more reliable. In general, the TraumaGuard, Accuryn, and Serenno showed better accuracy compared to intra-gastric measurement devices. On average, biases of +0.71, +0.93, +0.29, +0.25, and -0.06 mm Hg were observed for the CiMON, Spiegelberg, Serenno, TraumaGuard, and Accuryn, respectively. All of the equipment showed percentage errors smaller than 25%. Regarding the correlation and concordance coefficients, the Serenno and TraumaGuard showed the best results (R2 = 0.98, p = 0.001, concordance coefficient of 99.5%). Error grid analysis based on the Abdominal Compartment Society guidelines showed a very low associated risk level of inappropriate treatment strategies due to erroneous IAP measurements. Regarding the dynamic tracings of the raw IAP signal, all the systems can track respiratory variations and derived parameters; however, the CiMON was slightly superior compared to the other technologies. Conclusions: According to the research guidelines of the Abdominal Compartment Society (WSACS), this in vitro study shows that the TraumaGuard can be used interchangeably with the gold standard for measuring continuous IAP, even in an empty artificial bladder. Confirmation studies with the TraumaGuard in animals and humans are warranted to further validate these findings.
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Affiliation(s)
- Salar Tayebi
- Department of Electronics and Informatics, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (S.T.); (A.Z.); (J.S.)
| | - Robert Wise
- Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford OX3 7LE, UK;
- Discipline of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban 4000, South Africa
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Ashkan Zarghami
- Department of Electronics and Informatics, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (S.T.); (A.Z.); (J.S.)
| | - Luca Malbrain
- Faculty of Medicine, Katholieke Universiteit Leuven, 3000 Leuven, Belgium;
| | - Ashish K. Khanna
- Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC 27106, USA;
- Outcomes Research Consortium, Cleveland, OH 44106, USA
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC 27106, USA
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland;
| | - Johan Stiens
- Department of Electronics and Informatics, Vrije Universiteit Brussel, 1050 Brussels, Belgium; (S.T.); (A.Z.); (J.S.)
| | - Manu L. N. G. Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, 20-954 Lublin, Poland;
- Medical Data Management, Medaman, 2440 Geel, Belgium
- International Fluid Academy, 3360 Lovenjoel, Belgium
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13
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Malbrain MLNG, Caironi P, Hahn RG, Llau JV, McDougall M, Patrão L, Ridley E, Timmins A. Multidisciplinary expert panel report on fluid stewardship: perspectives and practice. Ann Intensive Care 2023; 13:89. [PMID: 37747558 PMCID: PMC10519908 DOI: 10.1186/s13613-023-01177-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Although effective and appropriate fluid management is a critical aspect of quality care during hospitalization, the widespread adoption of consistent policies that ensure adequate fluid stewardship has been slow and heterogenous. Despite evidence-based guidelines on fluid management being available, clinical opinions continue to diverge on important aspects of care in this setting, and the consistency of guideline implementation is far from ideal. A multidisciplinary panel of leading practitioners and experts convened to discuss best practices for ongoing staff education, intravenous fluid therapy, new training technologies, and strategies to track the success of institutional fluid stewardship efforts. Fluid leads should be identified in every hospital to ensure consistency in fluid administration and monitoring. In this article, strategies to communicate the importance of effective fluid stewardship for the purposes of education, training, institutional support, and improvement of patient outcomes are reviewed and recommendations are summarized.
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Affiliation(s)
- Manu L N G Malbrain
- First Department Anaesthesiology and Intensive Therapy, Medical University Lublin, Lublin, Poland.
- International Fluid Academy, Lovenjoel, Belgium.
- Medical Data Management, Medaman, Geel, Belgium.
- Medical Management, AZ Oudenaarde Hospital, Oudenaarde, Belgium.
| | - Pietro Caironi
- Department of Anesthesia and Critical Care, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
- Department of Oncology, University of Turin, Turin, Italy
| | - Robert G Hahn
- Anesthesia and Intensive Care, Karolinska Institute, Stockholm, Sweden
| | - Juan V Llau
- Anaesthesiology and Post-Surgical Critical Care, University Hospital Doctor Peset, Valencia, Spain
- Anaesthesiology, Department of Surgery, University of Valencia, Valencia, Spain
| | - Marcia McDougall
- Anaesthetics and Intensive Care, Victoria Hospital, Kirkcaldy, Fife, Scotland
| | - Luís Patrão
- Intensive Care Unit, Centro HospitalarTondela-Viseu, EPE, Viseu, Portugal
- UpHill Health, Lisbon, Portugal
| | - Emily Ridley
- Fluid Management lead, Department of Nursing, Victoria Hospital, Kirkcaldy, Fife, Scotland
| | - Alan Timmins
- Pharmacy Department, Victoria Hospital, Kirkcaldy, Fife, Scotland
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14
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Meyhoff TS, Granholm A, Hjortrup PB, Sivapalan P, Lange T, Laake JH, Cronhjort M, Jakob SM, Cecconi M, Nalos M, Ostermann M, Malbrain MLNG, Møller MH, Perner A. Albumin administration in septic shock-Protocol for post-hoc analyses of data from a multicentre RCT. Acta Anaesthesiol Scand 2023; 67:1128-1136. [PMID: 37246841 DOI: 10.1111/aas.14280] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/30/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Intravenous (IV) albumin is suggested for patients with septic shock who have received large amounts of IV crystalloids; a conditional recommendation based on moderate certainty of evidence. Clinical variation in the administration of IV albumin in septic shock may exist according to patient characteristics and location. METHODS This is a protocol and statistical analysis plan for a post-hoc secondary study of the Conservative versus Liberal Approach to Fluid Therapy of Septic Shock in Intensive Care (CLASSIC) RCT of 1554 adult ICU patients with septic shock. We will assess if specific baseline characteristics or trial site are associated with the administration of IV albumin during ICU stay using Cox models with competing events. All models will be adjusted for the treatment allocation in CLASSIC (restrictive vs. standard IV fluid), and all analyses will consider competing events (death, ICU discharge and loss-to-follow-up). We will present results as hazard ratios with 95% confidence intervals and p-values for the associations of baseline characteristics or site with IV albumin administration. Between-group differences (interactions) will be assessed using p-values from likelihood ratio tests. All results will be considered exploratory only. DISCUSSION This secondary study of the CLASSIC RCT may yield important insight into potential practice variation in the administration of albumin in septic shock.
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Affiliation(s)
- Tine Sylvest Meyhoff
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Peter Buhl Hjortrup
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Cardiothoracic Anaesthesia and Intensive Care, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Praleene Sivapalan
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Theis Lange
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Jon Henrik Laake
- Division of Emergencies and Critical Care, Department of Anaesthesiology and Intensive Care Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Maria Cronhjort
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Stephan M Jakob
- Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Marek Nalos
- Medical Intensive Care Unit, 1. Interni klinika, Fakultni Nemocnice, Plzen, Czech Republic
| | - Marlies Ostermann
- Department of Intensive Care, Guy's and St Thomas' Hospital, London, UK
| | - Manu L N G Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), Jette, Belgium
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
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15
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Wise R, Rodseth R, Párraga-Ros E, Latorre R, López Albors O, Correa-Martín L, M. Sánchez-Margallo F, Eugenia Candanosa-Aranda I, Poelaert J, Castellanos G, L. N. G. Malbrain M. The pathophysiological impact of intra-abdominal hypertension in pigs. PLoS One 2023; 18:e0290451. [PMID: 37639437 PMCID: PMC10461824 DOI: 10.1371/journal.pone.0290451] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/08/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Intra-abdominal hypertension and abdominal compartment syndrome are common with clinically significant consequences. We investigated the pathophysiological effects of raised IAP as part of a more extensive exploratory animal study. The study design included both pneumoperitoneum and mechanical intestinal obstruction models. METHODS Forty-nine female swine were divided into six groups: a control group (Cr; n = 5), three pneumoperitoneum groups with IAPs of 20mmHg (Pn20; n = 10), 30mmHg (Pn30; n = 10), 40mmHg (Pn40; n = 10), and two mechanical intestinal occlusion groups with IAPs of 20mmHg (MIO20; n = 9) and 30mmHg (MIO30; n = 5). RESULTS There were significant changes (p<0.05) noted in all organ systems, most notably systolic blood pressure (SBP) (p<0.001), cardiac index (CI) (p = 0.003), stroke volume index (SVI) (p<0.001), mean pulmonary airway pressure (MPP) (p<0.001), compliance (p<0.001), pO2 (p = 0.003), bicarbonate (p = 0.041), hemoglobin (p = 0.012), lipase (p = 0.041), total bilirubin (p = 0.041), gastric pH (p<0.001), calculated glomerular filtration rate (GFR) (p<0.001), and urine output (p<0.001). SVV increased progressively as the IAP increased with no obvious changes in intravascular volume status. There were no significant differences between the models regarding their impact on cardiovascular, respiratory, renal and gastrointestinal systems. However, significant differences were noted between the two models at 30mmHg, with MIO30 showing worse metabolic and hematological parameters, and Pn30 and Pn40 showing a more rapid rise in creatinine. CONCLUSIONS This study identified and quantified the impact of intra-abdominal hypertension at different pressures on several organ systems and highlighted the significance of even short-lived elevations. Two models of intra-abdominal pressure were used, with a mechanical obstruction model showing more rapid changes in metabolic and haematological changes. These may represent different underlying cellular and vascular pathophysiological processes, but this remains unclear.
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Affiliation(s)
- Robert Wise
- Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Discipline of Anaesthesiology, and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Adult Intensive Care Unit, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Reitze Rodseth
- Discipline of Anaesthesiology, and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ester Párraga-Ros
- Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Murcia, Spain
| | - Rafael Latorre
- Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Murcia, Spain
| | - Octavio López Albors
- Department of Anatomy and Comparative Pathology, Veterinary Faculty, University of Murcia, Murcia, Spain
| | - Laura Correa-Martín
- Laparoscopy Department Jesus Uson Minimally Invasive Surgery Centre, Caceres, Spain
| | | | - Irma Eugenia Candanosa-Aranda
- Highlands Teaching and Research Farm, Faculty of Veterinary Medicine, National Autonomous University of Mexico, Queretaro. Mexico
| | - Jan Poelaert
- Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Gregorio Castellanos
- Department of General Surgery, Virgen de la Arrixaca General University Hospital, Murcia, Spain
| | - Manu L. N. G. Malbrain
- First Department of Anaesthesiology and Intensive Care Medicine, Medical University of Lublin, Lublin, Poland
- Medical Director (CMO), Medical Data Management, Medaman, Geel, Belgium
- International Fluid Academy, Lovenjoel, Belgium
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16
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Coccolini F, Sartelli M, Sawyer R, Rasa K, Viaggi B, Abu-Zidan F, Soreide K, Hardcastle T, Gupta D, Bendinelli C, Ceresoli M, Shelat VG, Broek RT, Baiocchi GL, Moore EE, Sall I, Podda M, Bonavina L, Kryvoruchko IA, Stahel P, Inaba K, Montravers P, Sakakushev B, Sganga G, Ballestracci P, Malbrain MLNG, Vincent JL, Pikoulis M, Beka SG, Doklestic K, Chiarugi M, Falcone M, Bignami E, Reva V, Demetrashvili Z, Di Saverio S, Tolonen M, Navsaria P, Bala M, Balogh Z, Litvin A, Hecker A, Wani I, Fette A, De Simone B, Ivatury R, Picetti E, Khokha V, Tan E, Ball C, Tascini C, Cui Y, Coimbra R, Kelly M, Martino C, Agnoletti V, Boermeester MA, De'Angelis N, Chirica M, Biffl WL, Ansaloni L, Kluger Y, Catena F, Kirkpatrick AW. Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines. World J Emerg Surg 2023; 18:41. [PMID: 37480129 PMCID: PMC10362628 DOI: 10.1186/s13017-023-00509-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/30/2023] [Indexed: 07/23/2023] Open
Abstract
Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy.
| | | | - Robert Sawyer
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | | | - Bruno Viaggi
- ICU Dept., Careggi University Hospital, Florence, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Timothy Hardcastle
- Dept. of Health - KwaZulu-Natal, Surgery, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Deepak Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Cino Bendinelli
- Department of Surgery, John Hunter Hospital, Newcastle, Australia
| | - Marco Ceresoli
- General Surgery Dept., Monza University Hospital, Monza, Italy
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Richard Ten Broek
- Department of Surgery, Radboud University Medical Center, Njmegen, The Netherlands
| | | | | | - Ibrahima Sall
- Département de Chirurgie, Hôpital Principal de Dakar, Hôpital d'Instruction des Armées, Dakar, Senegal
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | | | - Igor A Kryvoruchko
- Department of Surgery No. 2, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Philip Stahel
- Department of Surgery, East Carolina University, Brody School of Medicine, Greenville, NC, USA
| | - Kenji Inaba
- LAC+USC Medical Center, Los Angeles, CA, USA
| | - Philippe Montravers
- Département d'Anesthésie-Réanimation CHU Bichat Claude Bernard, Paris, France
| | - Boris Sakakushev
- Research Institute of Medical, University Plovdiv/University Hospital St. George, Plovdiv, Bulgaria
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Ballestracci
- General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | | | - Manos Pikoulis
- General Surgery, Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | | | - Krstina Doklestic
- Clinic of Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy
| | - Marco Falcone
- Infectious Disease Dept., Pisa University Hospital, Pisa, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Viktor Reva
- Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russia
| | | | - Salomone Di Saverio
- General Surgery Dept, San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy
| | - Matti Tolonen
- Emergency Surgery, Meilahti Tower Hospital, Helsinki, Finland
| | - Pradeep Navsaria
- Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Zsolt Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | | | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | | | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Edward Tan
- Emergency Department, Radboud University Medical Center, Njmegen, The Netherlands
| | - Chad Ball
- Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada
| | - Carlo Tascini
- Infectious Disease Dept., Udine University Hospital, Udine, Italy
| | - Yunfeng Cui
- Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
| | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | | | | | | | - Nicola De'Angelis
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Mircea Chirica
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Walt L Biffl
- Trauma and Emergency Surgery, Scripss Memorial Hospital, La Jolla, CA, USA
| | - Luca Ansaloni
- General Surgery, Pavia University Hospital, Pavia, Italy
| | - Yoram Kluger
- General Surgery, Rambam Medical Centre, Haifa, Israel
| | - Fausto Catena
- General, Emergency and Trauma Surgery Dept, Bufalini Hospital, Cesena, Italy
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
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17
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de Carvalho EB, Battaglini D, Robba C, Malbrain MLNG, Pelosi P, Rocco PRM, Silva PL. Fluid management strategies and their interaction with mechanical ventilation: from experimental studies to clinical practice. Intensive Care Med Exp 2023; 11:44. [PMID: 37474816 PMCID: PMC10359242 DOI: 10.1186/s40635-023-00526-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/31/2023] [Indexed: 07/22/2023] Open
Abstract
Patients on mechanical ventilation may receive intravenous fluids via restrictive or liberal fluid management. A clear and objective differentiation between restrictive and liberal fluid management strategies is lacking in the literature. The liberal approach has been described as involving fluid rates ranging from 1.2 to 12 times higher than the restrictive approach. A restrictive fluid management may lead to hypoperfusion and distal organ damage, and a liberal fluid strategy may result in endothelial shear stress and glycocalyx damage, cardiovascular complications, lung edema, and distal organ dysfunction. The association between fluid and mechanical ventilation strategies and how they interact toward ventilator-induced lung injury (VILI) could potentiate the damage. For instance, the combination of a liberal fluids and pressure-support ventilation, but not pressure control ventilation, may lead to further lung damage in experimental models of acute lung injury. Moreover, under liberal fluid management, the application of high positive end-expiratory pressure (PEEP) or an abrupt decrease in PEEP yielded higher endothelial cell damage in the lungs. Nevertheless, the translational aspects of these findings are scarce. The aim of this narrative review is to provide better understanding of the interaction between different fluid and ventilation strategies and how these interactions may affect lung and distal organs. The weaning phase of mechanical ventilation and the deresuscitation phase are not explored in this review.
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Affiliation(s)
- Eduardo Butturini de Carvalho
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- University of Vassouras, Rio de Janeiro, Brazil
| | | | - Chiara Robba
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Manu L. N. G. Malbrain
- First Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- International Fluid Academy, Lovenjoel, Belgium
| | - Paolo Pelosi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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18
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Kjær MBN, Meyhoff TS, Sivapalan P, Granholm A, Hjortrup PB, Madsen MB, Møller MH, Egerod I, Wetterslev J, Lange T, Cronhjort M, Laake JH, Jakob SM, Nalos M, Ostermann M, Gould D, Cecconi M, Malbrain MLNG, Ahlstedt C, Kiel LB, Bestle MH, Nebrich L, Hildebrandt T, Russell L, Vang M, Rasmussen ML, Sølling C, Brøchner AC, Krag M, Pfortmueller C, Kriz M, Siegemund M, Albano G, Aagaard SR, Bundgaard H, Crone V, Wichmann S, Johnstad B, Martin YK, Seidel P, Mårtensson J, Hollenberg J, Wistrand M, Donati A, Barbara E, Karvunidis T, Hollinger A, Carsetti A, Lumlertgul N, Joelsson-Alm E, Lambiris N, Aslam TN, Friberg FF, Vesterlund GK, Mortensen CB, Vestergaard SR, Caspersen SF, Jensen DB, Borup M, Rasmussen BS, Perner A. Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock. Intensive Care Med 2023; 49:820-830. [PMID: 37330928 PMCID: PMC10354110 DOI: 10.1007/s00134-023-07114-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 03/23/2023] [Accepted: 05/28/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE To assess long-term outcomes of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock included in the European Conservative versus Liberal Approach to Fluid Therapy in Septic Shock in Intensive Care (CLASSIC) trial. METHODS We conducted the pre-planned analyses of mortality, health-related quality of life (HRQoL) using EuroQol (EQ)-5D-5L index values and EQ visual analogue scale (VAS), and cognitive function using Mini Montreal Cognitive Assessment (Mini MoCA) test at 1 year. Deceased patients were assigned numerical zero for HRQoL as a state equal to death and zero for cognitive function outcomes as worst possible score, and we used multiple imputation for missing data on HRQoL and cognitive function. RESULTS Among 1554 randomized patients, we obtained 1-year data on mortality in 97.9% of patients, HRQoL in 91.3%, and cognitive function in 86.3%. One-year mortality was 385/746 (51.3%) in the restrictive-fluid group versus 383/767 (49.9%) in the standard-fluid group, absolute risk difference 1.5%-points [99% confidence interval (CI) - 4.8 to 7.8]. Mean differences were 0.00 (99% CI - 0.06 to 0.05) for EQ-5D-5L index values, - 0.65 for EQ VAS (- 5.40 to 4.08), and - 0.14 for Mini MoCA (- 1.59 to 1.14) for the restrictive-fluid group versus the standard-fluid group. The results for survivors only were similar in both groups. CONCLUSIONS Among adult ICU patients with septic shock, restrictive versus standard IV fluid therapy resulted in similar survival, HRQoL, and cognitive function at 1 year, but clinically important differences could not be ruled out.
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Affiliation(s)
- Maj-Brit Nørregaard Kjær
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.
| | - Tine Sylvest Meyhoff
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Praleene Sivapalan
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Peter Buhl Hjortrup
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Cardiothoracic Anaesthesia and Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Martin Bruun Madsen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Cardiothoracic Anaesthesia and Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Jørn Wetterslev
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Theis Lange
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Cronhjort
- Section of Anaesthesia and Intensive Care, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Jon Henrik Laake
- Division of Emergencies and Critical Care, Department of Anaesthesiology and Intensive Care Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stephan M Jakob
- Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Marek Nalos
- Medical Intensive Care Unit, First Department of Internal Medicine, Faculty of Medicine, Teaching Hospital and Biomedical Center in Pilsen, Charles University, Pilsen, Czech Republic
| | - Marlies Ostermann
- Department of Intensive Care, Guy's and St Thomas' Hospital, London, UK
| | - Doug Gould
- Clinical Trial Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy
- Anaesthesia and Intensive Care Medicine IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Manu L N G Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- First Department of Anaesthesiology and Intensive Therapy, Medical University Lublin, Lublin, Poland
| | - Christian Ahlstedt
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Louise Bendix Kiel
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Nebrich
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Thomas Hildebrandt
- Department of Anaesthesia and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Vang
- Department of Anaesthesia and Intensive Care, Randers Hospital, Randers, Denmark
| | | | - Christoffer Sølling
- Department of Anaesthesia and Intensive Care, Viborg Hospital, Viborg, Denmark
| | - Anne Craveiro Brøchner
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Kolding, University Hospital of Southern Denmark, Odense, Denmark
| | - Mette Krag
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Holbæk Hospital, Holbæk, Denmark
| | - Carmen Pfortmueller
- Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Miroslav Kriz
- Medical Intensive Care Unit, First Department of Internal Medicine, Faculty of Medicine, Teaching Hospital and Biomedical Center in Pilsen, Charles University, Pilsen, Czech Republic
| | - Martin Siegemund
- Intensive Care Unit, Basel University Hospital, Basel, Switzerland
| | - Giovanni Albano
- Department of Anaesthesia and Intensive Care, Humanitas Gavazzeni Hospital Bergamo, Bergamo, Italy
| | - Søren Rosborg Aagaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Bundgaard
- Department of Anaesthesia and Intensive Care, Randers Hospital, Randers, Denmark
| | - Vera Crone
- Department of Anaesthesia and Intensive Care, Holbæk Hospital, Holbæk, Denmark
| | - Sine Wichmann
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
| | - Bror Johnstad
- Department of Intensive Care, Hospital Innland Hamar, Hamar, Norway
| | - Yvonne Karin Martin
- Department of Anesthesia and Intensive Care Medicine, Hospital Østfold Kalnes, Grålum, Norway
| | - Philipp Seidel
- Department of Intensive Care Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Johan Mårtensson
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Medical Intensive Care Unit, Center for Resuscitation Science, Karolinska Institutet, Solna, Sweden
| | - Mats Wistrand
- Department of Emergency Medicine, Capio St Görans Hospital, Stockholm, Sweden
- Department of Anaesthesia and Intensive Care, Capio St Görans Hospital, Stockholm, Sweden
| | - Abele Donati
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy
| | - Enrico Barbara
- Anesthesia and Intensive Care Unit, Humanitas Research Hospital, Castellanza, Italy
| | - Thomas Karvunidis
- Medical Intensive Care Unit, First Department of Internal Medicine, Faculty of Medicine, Teaching Hospital and Biomedical Center in Pilsen, Charles University, Pilsen, Czech Republic
| | - Alexa Hollinger
- Intensive Care Unit, Basel University Hospital, Basel, Switzerland
| | - Andrea Carsetti
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Ancona, Italy
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
| | - Nuttha Lumlertgul
- Department of Intensive Care, Guy's and St Thomas' Hospital, London, UK
- Division of Nephrology, Faculty of Medicine, Excellence Centre in Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Eva Joelsson-Alm
- Section of Anaesthesia and Intensive Care, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Nikolas Lambiris
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Tayyba Naz Aslam
- Division of Emergencies and Critical Care, Department of Anaesthesiology and Intensive Care Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Fredrik Femtehjell Friberg
- Department of Intensive Care, Hospital Innland Hamar, Hamar, Norway
- Department of Anesthesia and Intensive Care, Oslo University Hospital Ullevål, Oslo, Norway
| | - Gitte Kingo Vesterlund
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | | | - Stine Rom Vestergaard
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Diana Bertelsen Jensen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
| | - Morten Borup
- Department of Anaesthesia and Intensive Care, Kolding, University Hospital of Southern Denmark, Odense, Denmark
| | - Bodil Steen Rasmussen
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
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Crosignani A, Spina S, Marrazzo F, Cimbanassi S, Malbrain MLNG, Van Regenmortel N, Fumagalli R, Langer T. Correction: Intravenous fluid therapy in patients with severe acute pancreatitis admitted to the intensive care unit: a narrative review. Ann Intensive Care 2023; 13:51. [PMID: 37314539 DOI: 10.1186/s13613-023-01149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Andrea Crosignani
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Spina
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Marrazzo
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Manu L N G Malbrain
- First Department of Anaesthesia and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- International Fluid Academy, Lovenjoel, Belgium
| | - Niels Van Regenmortel
- Department of Intensive Care Medicine, Antwerp University Hospital, Antwerp, Belgium
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Antwerp, Belgium
| | - Roberto Fumagalli
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Thomas Langer
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
- Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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Kirkpatrick AW, Coccolini F, Tolonen M, Minor S, Catena F, Gois E, Doig CJ, Hill MD, Ansaloni L, Chiarugi M, Tartaglia D, Ioannidis O, Sugrue M, Colak E, Hameed SM, Lampela H, Agnoletti V, McKee JL, Garraway N, Sartelli M, Ball CG, Parry NG, Voght K, Julien L, Kroeker J, Roberts DJ, Faris P, Tiruta C, Moore EE, Ammons LA, Anestiadou E, Bendinelli C, Bouliaris K, Carroll R, Ceresoli M, Favi F, Gurrado A, Rezende-Neto J, Isik A, Cremonini C, Strambi S, Koukoulis G, Testini M, Trpcic S, Pasculli A, Picariello E, Abu-Zidan F, Adeyeye A, Augustin G, Alconchel F, Altinel Y, Hernandez Amin LA, Aranda-Narváez JM, Baraket O, Biffl WL, Baiocchi GL, Bonavina L, Brisinda G, Cardinali L, Celotti A, Chaouch M, Chiarello M, Costa G, de'Angelis N, De Manzini N, Delibegovic S, Di Saverio S, De Simone B, Dubuisson V, Fransvea P, Garulli G, Giordano A, Gomes C, Hayati F, Huang J, Ibrahim AF, Huei TJ, Jailani RF, Khan M, Luna AP, Malbrain MLNG, Marwah S, McBeth P, Mihailescu A, Morello A, Mulita F, Murzi V, Mohammad AT, Parmar S, Pak A, Wong MPK, Pantalone D, Podda M, Puccioni C, Rasa K, Ren J, Roscio F, Gonzalez-Sanchez A, Sganga G, Scheiterle M, Slavchev M, Smirnov D, Tosi L, Trivedi A, Vega JAG, Waledziak M, Xenaki S, Winter D, Wu X, Zakaria AD, Zakaria Z. The unrestricted global effort to complete the COOL trial. World J Emerg Surg 2023; 18:33. [PMID: 37170123 PMCID: PMC10173926 DOI: 10.1186/s13017-023-00500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) ( https://clinicaltrials.gov/ct2/show/NCT03163095 ). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. METHODS The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer. DISCUSSION OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of "damage control"; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention. TRIAL REGISTRATION National Institutes of Health ( https://clinicaltrials.gov/ct2/show/NCT03163095 ).
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Affiliation(s)
- Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, EG23T2N 2T9, Canada.
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Matti Tolonen
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Samuel Minor
- Departments of Critical Care Medicine and Surgery, Dalhousie University, Halifax, NS, Canada
| | - Fausto Catena
- Department of Surgery, Bufalini Hospital, Cesena, Italy
| | - Emanuel Gois
- Department of Surgery, Londrina State University, and National COOL Coordinator for Brazil, Londrina, Brazil
| | - Christopher J Doig
- Departments of Critical Care Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael D Hill
- Department of Clinical Neuroscience and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada
| | - Luca Ansaloni
- General Surgery I, San Matteo Hospital Pavia, University of Pavia, Pavia, Italy
| | - Massimo Chiarugi
- Emergency Surgery and Trauma Center, University of Pisa, Pisa, Italy
| | - Dario Tartaglia
- Emergency Surgery and Trauma Center, University of Pisa, Pisa, Italy
| | - Orestis Ioannidis
- 4th Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | | | - Elif Colak
- University of Samsun, Samsun Training and Research Hospital, Samsun, Turkey
| | - S Morad Hameed
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Hanna Lampela
- Department of Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Espoo, Finland
| | | | - Jessica L McKee
- Global Project Manager, COOL Trial and the TeleMentored Ultrasound Supported Medical Interventions Research Group, Calgary, AB, Canada
| | - Naisan Garraway
- Departments of Surgery and Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Global Alliance for Infections in Surgery, Macerata, Italy
| | - Chad G Ball
- Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada
| | - Neil G Parry
- Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kelly Voght
- Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lisa Julien
- Department of Surgery, NSHA-Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Jenna Kroeker
- Departments of Surgery and Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Derek J Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Ernest E Moore
- Ernest E. Moore Shock Trauma Center, University of Colorado, Denver, CO, USA
| | | | - Elissavet Anestiadou
- 4th Department of Surgery, Medical School, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | | | - Konstantinos Bouliaris
- General Surgery Department of Koutlimbaneio, Triantafylleio General Hospital of Larissa, Larissa, Thessaly, Greece
| | | | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Francesco Favi
- Chirurgia Generale E d'Urgenza, Ospedale M. Bufalini - Cesena, AUSL Della Romagna, Cesena, Italy
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Joao Rezende-Neto
- Trauma and Acute Care Surgery, General Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Arda Isik
- General Surgery Department, Istanbul Medeniyet University School of Medicine Istanbul, Istanbul, Turkey
| | - Camilla Cremonini
- Emergency Surgery and Trauma Center, University of Pisa, Pisa, Italy
| | - Silivia Strambi
- Emergency Surgery and Trauma Center, University of Pisa, Pisa, Italy
| | - Georgios Koukoulis
- General Surgery Department of Koutlimbaneio, Triantafylleio General Hospital of Larissa, Larissa, Thessaly, Greece
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Sandy Trpcic
- Trauma and Acute Care Surgery, General Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Alessandro Pasculli
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery "V. Bonomo", University of Bari "A. Moro", Bari, Italy
| | - Erika Picariello
- General Surgery Unit, Ospedale M. Buffalini Di Cesena, Cesena, Italy
| | - Fikri Abu-Zidan
- College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Ademola Adeyeye
- Division of Surgical Oncology, Afe Babalola University Multisystem Hospital, Ado-Ekiti, Nigeria
| | - Goran Augustin
- University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Felipe Alconchel
- Virgen de la Arrixaca University Hospital IMIB-Arrixaca, Ctra. Madrid-Cartagena, S/N, Murcia, Spain
| | - Yuksel Altinel
- Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Luz Adriana Hernandez Amin
- Nurse Master of Nursing, Professor and Coordinator of the teaching-service relationship, Faculty of Health Sciences, University of Sucre, Sincelejo, Colombia
| | - José Manuel Aranda-Narváez
- Trauma and Emergency Surgery Unit. General, Digestive and Transplantation Surgery Department, University Regional Hospital of Málaga, Malaga, Spain
| | | | | | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Bonavina
- Department of Surgery, University of Milan Medical School, Milan, Italy
| | - Giuseppe Brisinda
- Department of Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Luca Cardinali
- Department of Surgery, General Hospital Madonna del Soccorso, San Benedetto del Tronto, Italy
| | - Andrea Celotti
- General Surgery Unit, UO Chirurgia Generale - Ospedale Maggiore Di Cremona, Cremona, Italy
| | - Mohamed Chaouch
- Department of Visceral and Digestive Surgery, Monastir University, Monastir, Tunisia
| | - Maria Chiarello
- Department of Surgery, Azienda Sanitaria Provinciale Di Cosenza, Cosenza, Italy
| | - Gianluca Costa
- Fondazione Policlinico Campus Bio-Medico, University Campus Bio-Medico of Rome, Rome, Italy
| | - Nicola de'Angelis
- Colorectal and Digestive Surgery Unit-DIGEST Department, Beaujon University Hospital AP-HP, University Paris Cité, Clichy, France
| | - Nicolo De Manzini
- Department of General Surgery, Cattinara University Hospital, Trieste, Italy
| | - Samir Delibegovic
- Department of Proctology, Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Salomone Di Saverio
- Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Italy
| | - Belinda De Simone
- Unit of Digestive and Metabolic Minimally Invasive Surgery, Clinique Saint Louis, Poissy, Poissy, Ile de France, France
- Unit of Emergency and General Surgery, Guastalla Hospital, AUSL Reggio Emilia, Guastalla, Italy
| | - Vincent Dubuisson
- Chirurgie Digestive, Service de Chirurgie Vasculaire Et, Générale University Hospital of Bordeaux FR, Bordeaux, France
| | | | | | - Alessio Giordano
- Emergency and General Consultant Surgeon, Nuovo Ospedale "S. Stefano", Azienda ASL Toscana Centro, Prato, Italy
| | - Carlos Gomes
- Surgery Unit, Hospital Universitário Terezinha de Jesus, SUPREMA, Juiz de Fora, Brazil
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Jinjian Huang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | | | | | | | - Mansoor Khan
- General Surgery, University Hospitals, Sussex, UK
| | | | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- International Fluid Academy, Lovenjoel, Belgium
| | - Sanjay Marwah
- Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | | | | | - Alessia Morello
- Department of General Surgery, Madonna del Soccorso Hospital - San Benedetto del Tronto, Italy, Italy
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Rio, Greece
| | - Valentina Murzi
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | | | | | - Ajay Pak
- Department of General Surgery, King George's Medical University, Lucknow, UP, India
| | - Michael Pak-Kai Wong
- School of Medical Sciences & Hospital, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Caterina Puccioni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Kemal Rasa
- Department of General Surgery, Hüseyin Kemal Raşa, Anadolu Medical Center, Kocaeli, Turkey
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Francesco Roscio
- Division of General and Minimally Invasive Surgery, ASST Valle Olona, Busto Arsizio, Italy
| | - Antonio Gonzalez-Sanchez
- Trauma and Emergency Surgery Unit. General, Digestive and Transplantation Surgery Department, University Regional Hospital of Málaga, Malaga, Spain
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Maximilian Scheiterle
- Emergency Surgery Unit and Trauma Team, Careggi University Hospital, Florence, Italy
| | | | - Dmitry Smirnov
- Department of Surgery, South Ural State Medical University, Chelyabinsk City, Russia
| | - Lorenzo Tosi
- Department of General Surgery, University of Bologna, Bologna, Italy
| | | | | | | | - Sofia Xenaki
- Department of General Surgery, University Hospital of Heraklion, Crete, Greece
| | | | - Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Andee Dzulkarnean Zakaria
- Department of Surgery, School of Medical Sciences and Hospital USM, Universiti Sains Malaysia, Georgetown, Malaysia
| | - Zaidi Zakaria
- Department of Surgery, School of Medical Sciences and Hospital USM, Universiti Sains Malaysia, Georgetown, Malaysia
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Dabrowski W, Rola P, Malbrain MLNG. Intra-abdominal pressure monitoring in cardiac surgery: is this the canary in the coalmine for kidney injury? J Clin Monit Comput 2023; 37:351-358. [PMID: 36550345 PMCID: PMC10068659 DOI: 10.1007/s10877-022-00933-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Philippe Rola
- Intensive Care Unit, Santa Cabrini Hospital, CEMTL, Montreal, Canada
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland.
- Medical Data Management, Medaman, Geel, Belgium.
- International Fluid Academy, Lovenjoel, Belgium.
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Pfortmueller CA, Dabrowski W, Malbrain MLNG. Fluid de-resuscitation in critical illness - A journey into uncertain territory. J Crit Care 2023:154249. [PMID: 36870802 DOI: 10.1016/j.jcrc.2022.154249] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 03/06/2023]
Affiliation(s)
- Carmen Andrea Pfortmueller
- Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland; International Fluid Academy, Lovenjoel, Belgium; Medical Data Management, Medaman, Geel, Belgium
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Staelens AS, Heymans A, Christiaens S, Van Regenmortel N, Gyselaers W, Malbrain MLNG. Is it feasible to measure intra-abdominal pressure using a balloon-tipped rectal catheter? Results of a validation study. J Clin Monit Comput 2023; 37:287-296. [PMID: 35907136 PMCID: PMC9852189 DOI: 10.1007/s10877-022-00890-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/22/2022] [Indexed: 01/24/2023]
Abstract
The gold standard to measure intra-abdominal pressure (IAP) is intra-vesical measurement via the urinary bladder. However, this technique is restricted in ambulatory settings because of the risk of iatrogenic urinary tract infections. Rectal IAP measurements (IAPrect) may overcome these limitations, but requires validation. This validation study compares the IAPrect technique against gold standard intra-vesical IAP measurements (IAPves). IAPrect using an air-filled balloon catheter and IAPves using Foley Manometer Low Volume were measured simultaneously in sedated and ventilated patients. Measurements were performed twice in different positions (supine and HOB 45° elevated head of bed) and with an external abdominal pressure belt. Sixteen patients were included. Seven were not eligible for analysis due to unreliable IAPrect values. IAPrect was significantly higher than IAPves for all body positions (p < 0.01) and the correlation between IAPves and IAPrect was poor and not significant in each position (p ≥ 0.25, R2 < 0.6, Lin's CCC < 0.8, bias - 8.1 mmHg and precision of 5.6 mmHg with large limits of agreement between - 19 to 2.9 mmHg, high percentage error 67.3%, and low concordance 86.2%). Repeatability of IAPrect was not reliable (R = 0.539, p = 0.315). For both techniques, measurements with the external abdominal pressure belt were significantly higher compared to those without (p < 0.03). IAPrect has important shortcomings making IAP estimation using a rectal catheter unfeasible because the numbers cannot be trusted nor validated.
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Affiliation(s)
- Anneleen S Staelens
- Department Obstetrics and Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium.,Department Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Ann Heymans
- Department Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Sigrid Christiaens
- Department Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Niels Van Regenmortel
- Department of Intensive Care, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerp, Belgium
| | - Wilfried Gyselaers
- Department Obstetrics and Gynaecology, Ziekenhuis Oost Limburg, Genk, Belgium.,Department of Physiology, Hasselt University, Hasselt, Belgium
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Jaczewskiego Street 8, 20-954, Lublin, Poland. .,Medical Data Management, Medaman, 2440, Geel, Belgium. .,International Fluid Academy, Dreef 3, 3360, Lovenjoel, Belgium.
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24
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Affiliation(s)
- Xavier Monnet
- AP-HP, Service de médecine intensive-réanimationHôpital de Bicêtre, DMU 4 CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland.,International Fluid Academy, Lovenjoel, Belgium.,Medical Data Management, Medaman, Geel, Belgium
| | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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25
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Astapenko D, Hyspler R, Ticha A, Tomasova A, Navratil P, Zrzavecky M, Byreddy B, Sedlacek P, Radochova V, Skulec R, Hahn RG, Lehmann C, Malbrain MLNG, Cerny V. Protection of the endothelium and endothelial glycocalyx by hydrogen against ischaemia-reperfusion injury in a porcine model of cardiac arrest. Clin Hemorheol Microcirc 2023; 85:135-146. [PMID: 37694356 DOI: 10.3233/ch-231768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Hydrogen is a potent antioxidant agent that can easily be administered by inhalation. The aim of the study was to evaluate whether hydrogen protects the endothelial glycocalyx layer after successful cardiopulmonary resuscitation (CPR). METHODS Fourteen anesthetized pigs underwent CPR after induced ventricular fibrillation. During CPR and return of spontaneous circulation, 2% hydrogen gas was administered to seven pigs (hydrogen group) and seven constituted a control group. Biochemistry and sublingual microcirculation were assessed at baseline, during CPR, at the 15th, 30th, 60th, 120th minute. RESULTS All seven subjects from the hydrogen group and six subjects in the control group were successfully resuscitated after 6-10 minutes. At baseline, there were no statistically significant differences in examined variables. After the CPR, blood pH, base excess, and lactate showed significantly smaller deterioration in the hydrogen group than in the control group. By contrast, plasma syndecan-1 and the measured variables obtained via sublingual microcirculation did not change after the CPR; and were virtually identical between the two groups. CONCLUSION In pigs, hydrogen gas inhalation during CPR and post-resuscitation care was associated with less pronounced metabolic acidosis compared to controls. However, we could not find evidence of injury to the endothelium or glycocalyx in any studied groups.
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Affiliation(s)
- David Astapenko
- Department of Anesthesiology, Resuscitation, and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, Prague Czech Republic
- Faculty of Health Studies, Technical University in Liberec, Liberec, Czech Republic
| | - Radomir Hyspler
- Faculty of Medicine in Hradec Kralove, Charles University, Prague Czech Republic
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Alena Ticha
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Adela Tomasova
- Faculty of Medicine in Hradec Kralove, Charles University, Prague Czech Republic
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Pavel Navratil
- Faculty of Medicine in Hradec Kralove, Charles University, Prague Czech Republic
- Department of Urology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Marek Zrzavecky
- Faculty of Medicine in Hradec Kralove, Charles University, Prague Czech Republic
| | - Bhavya Byreddy
- Faculty of Medicine in Hradec Kralove, Charles University, Prague Czech Republic
| | - Petr Sedlacek
- Faculty of Medicine in Hradec Kralove, Charles University, Prague Czech Republic
| | - Vera Radochova
- Faculty of Military Health Sciences, University of Defence, Brno, Czech Republic
| | - Roman Skulec
- Department of Anesthesiology, Resuscitation, and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, Prague Czech Republic
- Department of Anesthesiology, Perioperative Medicine, and Intensive Care Medicine, University of J. E. Purkyne in Usti nad Labem, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
- Institute of Postgradual Education in Healthcare, Prague, Czech Republic
- Department of Emergency Medicine, Hospital Bory, Bratislava, Slovak Republic
| | - Robert G Hahn
- Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS, Canada
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- Medical Data Management, Medaman, Pas, Geel, Belgium
- International Fluid Academy, Lovenjoel, Belgium
| | - Vladimir Cerny
- Department of Anesthesiology, Resuscitation, and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
- Faculty of Medicine in Hradec Kralove, Charles University, Prague Czech Republic
- Faculty of Health Studies, Technical University in Liberec, Liberec, Czech Republic
- Department of Anesthesiology, Perioperative Medicine, and Intensive Care Medicine, University of J. E. Purkyne in Usti nad Labem, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
- Institute of Postgradual Education in Healthcare, Prague, Czech Republic
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, Hospital Bory, Bratislava, Slovak Republic
- Department of Anesthesiology and Resuscitation, University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Constantine the Philosopher University in Nitra, Faculty of Social Sciences and Health Care, Nitra, Slovak Republic
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26
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Gavelli F, Shi R, Teboul JL, Azzolina D, Mercado P, Jozwiak M, Chew MS, Huber W, Kirov MY, Kuzkov VV, Lahmer T, Malbrain MLNG, Mallat J, Sakka SG, Tagami T, Pham T, Monnet X. Extravascular lung water levels are associated with mortality: a systematic review and meta-analysis. Crit Care 2022; 26:202. [PMID: 35794612 PMCID: PMC9258010 DOI: 10.1186/s13054-022-04061-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background The prognostic value of extravascular lung water (EVLW) measured by transpulmonary thermodilution (TPTD) in critically ill patients is debated. We performed a systematic review and meta-analysis of studies assessing the effects of TPTD-estimated EVLW on mortality in critically ill patients.
Methods Cohort studies published in English from Embase, MEDLINE, and the Cochrane Database of Systematic Reviews from 1960 to 1 June 2021 were systematically searched. From eligible studies, the values of the odds ratio (OR) of EVLW as a risk factor for mortality, and the value of EVLW in survivors and non-survivors were extracted. Pooled OR were calculated from available studies. Mean differences and standard deviation of the EVLW between survivors and non-survivors were calculated. A random effects model was computed on the weighted mean differences across the two groups to estimate the pooled size effect. Subgroup analyses were performed to explore the possible sources of heterogeneity. Results Of the 18 studies included (1296 patients), OR could be extracted from 11 studies including 905 patients (464 survivors vs. 441 non-survivors), and 17 studies reported EVLW values of survivors and non-survivors, including 1246 patients (680 survivors vs. 566 non-survivors). The pooled OR of EVLW for mortality from eleven studies was 1.69 (95% confidence interval (CI) [1.22; 2.34], p < 0.0015). EVLW was significantly lower in survivors than non-survivors, with a mean difference of −4.97 mL/kg (95% CI [−6.54; −3.41], p < 0.001). The results regarding OR and mean differences were consistent in subgroup analyses. Conclusions The value of EVLW measured by TPTD is associated with mortality in critically ill patients and is significantly higher in non-survivors than in survivors. This finding may also be interpreted as an indirect confirmation of the reliability of TPTD for estimating EVLW at the bedside. Nevertheless, our results should be considered cautiously due to the high risk of bias of many studies included in the meta-analysis and the low rating of certainty of evidence. Trial registration the study protocol was prospectively registered on PROSPERO: CRD42019126985. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04061-6.
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Felix NS, Maia LA, Rocha NN, Rodrigues GC, Medeiros M, da Silva LA, Baldavira CM, Fernezlian SDM, Eher EM, Capelozzi VL, Malbrain MLNG, Pelosi P, Rocco PRM, Silva PL. Biological impact of restrictive and liberal fluid strategies at low and high PEEP levels on lung and distal organs in experimental acute respiratory distress syndrome. Front Physiol 2022; 13:992401. [PMID: 36388107 PMCID: PMC9663484 DOI: 10.3389/fphys.2022.992401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Fluid regimens in acute respiratory distress syndrome (ARDS) are conflicting. The amount of fluid and positive end-expiratory pressure (PEEP) level may interact leading to ventilator-induced lung injury (VILI). We therefore evaluated restrictive and liberal fluid strategies associated with low and high PEEP levels with regard to lung and kidney damage, as well as cardiorespiratory function in endotoxin-induced ARDS. Methods: Thirty male Wistar rats received an intratracheal instillation of Escherichia coli lipopolysaccharide. After 24 h, the animals were anesthetized, protectively ventilated (VT = 6 ml/kg), and randomized to restrictive (5 ml/kg/h) or liberal (40 ml/kg/h) fluid strategies (Ringer lactate). Both groups were then ventilated with PEEP = 3 cmH2O (PEEP3) and PEEP = 9 cmH2O (PEEP9) for 1 h (n = 6/group). Echocardiography, arterial blood gases, and lung mechanics were evaluated throughout the experiments. Histologic analyses were done on the lungs, and molecular biology was assessed in lungs and kidneys using six non-ventilated animals with no fluid therapy. Results: In lungs, the liberal group showed increased transpulmonary plateau pressure compared with the restrictive group (liberal, 23.5 ± 2.9 cmH2O; restrictive, 18.8 ± 2.3 cmH2O, p = 0.046) under PEEP = 9 cmH2O. Gene expression associated with inflammation (interleukin [IL]-6) was higher in the liberal-PEEP9 group than the liberal-PEEP3 group (p = 0.006) and restrictive-PEEP9 (p = 0.012), Regardless of the fluid strategy, lung mechanical power and the heterogeneity index were higher, whereas birefringence for claudin-4 and zonula-ocludens-1 gene expression were lower in the PEEP9 groups. Perivascular edema was higher in liberal groups, regardless of PEEP levels. Markers related to damage to epithelial cells [club cell secreted protein (CC16)] and the extracellular matrix (syndecan) were higher in the liberal-PEEP9 group than the liberal-PEEP3 group (p = 0.010 and p = 0.024, respectively). In kidneys, the expression of IL-6 and neutrophil gelatinase-associated lipocalin was higher in PEEP9 groups, regardless of the fluid strategy. For the liberal strategy, PEEP = 9 cmH2O compared with PEEP = 3 cmH2O reduced the right ventricle systolic volume (37%) and inferior vena cava collapsibility index (45%). Conclusion: The combination of a liberal fluid strategy and high PEEP led to more lung damage. The application of high PEEP, regardless of the fluid strategy, may also be deleterious to kidneys.
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Affiliation(s)
- Nathane S. Felix
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ligia A. Maia
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nazareth N. Rocha
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Physiology and Pharmacology, Biomedical Institute, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Gisele C. Rodrigues
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mayck Medeiros
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leticia A. da Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila M. Baldavira
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Esmeralda M. Eher
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Vera L. Capelozzi
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manu L. N. G. Malbrain
- First Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Patricia R. M. Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro L. Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- *Correspondence: Pedro L. Silva,
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Hawchar F, Tomescu D, Träger K, Joskowiak D, Kogelmann K, Soukup J, Friesecke S, Jacob D, Gummert J, Faltlhauser A, Aucella F, van Tellingen M, Malbrain MLNG, Bogdanski R, Weiss G, Herbrich A, Utzolino S, Nierhaus A, Baumann A, Hartjes A, Henzler D, Grigoryev E, Fritz H, Bach F, Schröder S, Weyland A, Gottschaldt U, Menzel M, Zachariae O, Novak R, Berden J, Haake H, Quintel M, Kloesel S, Kortgen A, Stecher S, Torti P, Nestler F, Nitsch M, Olboeter D, Muck P, Findeisen M, Bitzinger D, Kraßler J, Benad M, Schott M, Schumacher U, Molnar Z, Brunkhorst FM. Hemoadsorption in the critically ill-Final results of the International CytoSorb Registry. PLoS One 2022; 17:e0274315. [PMID: 36282800 PMCID: PMC9595535 DOI: 10.1371/journal.pone.0274315] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/25/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of the current paper is to summarize the results of the International CytoSorb Registry. Data were collected on patients of the intensive care unit. The primary endpoint was actual in-hospital mortality compared to the mortality predicted by APACHE II score. The main secondary endpoints were SOFA scores, inflammatory biomarkers and overall evaluation of the general condition. 1434 patients were enrolled. Indications for hemoadsorption were sepsis/septic shock (N = 936); cardiac surgery perioperatively (N = 172); cardiac surgery postoperatively (N = 67) and "other" reasons (N = 259). APACHE-II-predicted mortality was 62.0±24.8%, whereas observed hospital mortality was 50.1%. Overall SOFA scores did not change but cardiovascular and pulmonary SOFA scores decreased by 0.4 [-0.5;-0.3] and -0.2 [-0.3;-0.2] points, respectively. Serum procalcitonin and C-reactive protein levels showed significant reduction: -15.4 [-19.6;-11.17] ng/mL; -17,52 [-70;44] mg/L, respectively. In the septic cohort PCT and IL-6 also showed significant reduction: -18.2 [-23.6;-12.8] ng/mL; -2.6 [-3.0;-2.2] pg/mL, respectively. Evaluation of the overall effect: minimal improvement (22%), much improvement (22%) and very much improvement (10%), no change observed (30%) and deterioration (4%). There was no significant difference in the primary outcome of mortality, but there were improvements in cardiovascular and pulmonary SOFA scores and a reduction in PCT, CRP and IL-6 levels. Trial registration: ClinicalTrials.gov Identifier: NCT02312024 (retrospectively registered).
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Affiliation(s)
- Fatime Hawchar
- Department of Anesthesiology and Intensive Care, University of Szeged, Szeged, Hungary
- * E-mail:
| | - Dana Tomescu
- Department of Anaesthesia and Critical Care, Fundeni Clinical Institute, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Karl Träger
- Kardioanasthesiologie, Universitätsklinikum Ulm, Ulm, Germany
| | - Dominik Joskowiak
- Universitätsklinikum der LMU München, Herzchirurgische Klinik und Poliklinik, Munich, Germany
| | - Klaus Kogelmann
- Klinik für Anästhesiologie und Intensivmedizin, Hans-Susemihl-Krankenhaus GmbH, Emden, Germany
| | - Jens Soukup
- Klinik für Anästhesiologie, Intensivtherapie und Palliativmedizin, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - Singrun Friesecke
- Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, Greifswald, Germany
| | - David Jacob
- Universitätsklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Jan Gummert
- Herz- und Diabeteszentrum NRW, Klinische Studien Chirurgie, Bad Oeynhausen, Germany
| | | | - Filippo Aucella
- Research Hospital "Casa Sollievo della Sofferenza" Medical Science, Nephrology and Dialysis Unit, San Giovanni, Rotondo, Italy
| | | | - Manu L. N. G. Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- Medical Data Management, Medaman, Geel, Belgium
- International Fluid Academy, Lovenjoel, Belgium
| | - Ralph Bogdanski
- Klinik für Anästhesiologie, AG Hämodynamik, Klinikumrechts der Isar TU München, München, Germany
| | - Günter Weiss
- Krankenhaus Hietzing, Wiener Krankenanstaltenverbund, A, Wien, Austria
| | - Andreas Herbrich
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Region Hannover Nordstadt, Hannover, Germany
| | - Stefan Utzolino
- Universitätsklinikum Freiburg, Abteilung Allgemein- und Viszeralchirurgie, Freiburg, Germany
| | - Axel Nierhaus
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg- Eppendorf, Hamburg, Germany
| | - Andreas Baumann
- Klinik für Anästhesie, Intensiv-, Palliativ- und Schmerzmedizin, Berufsgenossensch Uniklinik Bergmannsheil, Bochum, Germany
| | | | - Dietrich Henzler
- Klinikum Herford, UK Anästhesie, Intensivmedizin, Rettungsmedizin, Schmerztherapie, Herford, Germany
| | - Evgeny Grigoryev
- Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
| | - Harald Fritz
- Krankenhaus Martha Maria Halle Klinik für Anaesthesiologie und Intensivmedizin, Halle, Germany
| | - Friedhelm Bach
- Klinik für Anästhesiologie, Intensiv-, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany
| | - Stefan Schröder
- Krankenhaus Düren gem. GmbH, Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Düren, Germany
| | - Andreas Weyland
- Universitätsklinik für Anästhesiologie/Intensiv-/Notfallmedizin/Schmerztherapie, Klinikum Oldenburg GmbH, Carl von Ossietzky Universität, Oldenburg, Germany
| | | | - Matthias Menzel
- Klinikum Wolfsburg, Klinik für Anästhesie und Intensivmedizin, Wolfsburg, Germany
| | - Olivier Zachariae
- Klinikum Wolfsburg, Klinik für Anästhesie und Intensivmedizin, Wolfsburg, Germany
| | - Radovan Novak
- Klinikum Oberlausitzer Bergland GmbH, Zittau, Germany
| | - Jernej Berden
- University Medical Centre Ljubljana, Dep. Of Internal medicine, ICU, Ljubljana, Slovenia
| | - Hendrik Haake
- Klinik für Kardiologie und Intensivmedizin, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - Michael Quintel
- Zentrum Anästhesiologie, Rettungs-und Intensivmedizin, Universitätsklinikum Göttingen, Göttingen, Germany
| | - Stephan Kloesel
- GPR Klinikum Rüsselsheim, Abteilung Anästhesie, Rüsselsheim, Germany
| | - Andreas Kortgen
- Universitätsklinikum Jena, Klinik für Anästhesiologie und Intensivmedizin, Jena, Germany
| | - Stephanie Stecher
- Medizinische Klinik und Poliklinik II, Klinikum der Universität München, München, Germany
| | - Patricia Torti
- Rianimazione Ospedale U. Parini, S.C. Anestesia e Rianimazione, Aosta, Italy
| | | | - Markus Nitsch
- Klinik für Anästhesie, Intensiv-, Notfallmedizin und Schmerztherapie, Krankenhaus St. Elisabeth und St. Barbara, Halle, Germany
| | - Detlef Olboeter
- Krankenhaus Herzberg, Elbe-Elster-Klinikum GmbH, Herzberg, Germany
| | - Philip Muck
- Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Michael Findeisen
- Klinik für Pneumologie, Gastroenterologie, Internistische Intensiv- und Beatmungsmedizin, Städtisches Klinikum München GmbH, Klinikum Harlaching, Munich, Germany
| | - Diane Bitzinger
- Universitätsklinikum Regensburg, Klinik für Anästhesiologie, Regensburg, Germany
| | - Jens Kraßler
- Fachkrankenhaus Coswig, Klinik für Anästhesiologie und Intensivmedizin, Coswig, Germany
| | - Martin Benad
- Bodden Kliniken Ribnitz Damgarten, Ribnitz Damgarten, Germany
| | | | - Ulrike Schumacher
- Center for Clinical Studies Jena (ZKS), Jena University Hospital, Jena, Germany
| | - Zsolt Molnar
- Doctoral School of Multidisciplinary Medical Sciences, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, School of Medicine, University of Pécs, Pécs, Hungary
- Department of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Frank Martin Brunkhorst
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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Crosignani A, Spina S, Marrazzo F, Cimbanassi S, Malbrain MLNG, Van Regenemortel N, Fumagalli R, Langer T. Intravenous fluid therapy in patients with severe acute pancreatitis admitted to the intensive care unit: a narrative review. Ann Intensive Care 2022; 12:98. [PMID: 36251136 PMCID: PMC9576837 DOI: 10.1186/s13613-022-01072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/11/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with acute pancreatitis (AP) often require ICU admission, especially when signs of multiorgan failure are present, a condition that defines AP as severe. This disease is characterized by a massive pancreatic release of pro-inflammatory cytokines that causes a systemic inflammatory response syndrome and a profound intravascular fluid loss. This leads to a mixed hypovolemic and distributive shock and ultimately to multiorgan failure. Aggressive fluid resuscitation is traditionally considered the mainstay treatment of AP. In fact, all available guidelines underline the importance of fluid therapy, particularly in the first 24–48 h after disease onset. However, there is currently no consensus neither about the type, nor about the optimal fluid rate, total volume, or goal of fluid administration. In general, a starting fluid rate of 5–10 ml/kg/h of Ringer’s lactate solution for the first 24 h has been recommended. Fluid administration should be aggressive in the first hours, and continued only for the appropriate time frame, being usually discontinued, or significantly reduced after the first 24–48 h after admission. Close clinical and hemodynamic monitoring along with the definition of clear resuscitation goals are fundamental. Generally accepted targets are urinary output, reversal of tachycardia and hypotension, and improvement of laboratory markers. However, the usefulness of different endpoints to guide fluid therapy is highly debated. The importance of close monitoring of fluid infusion and balance is acknowledged by most available guidelines to avoid the deleterious effect of fluid overload. Fluid therapy should be carefully tailored in patients with severe AP, as for other conditions frequently managed in the ICU requiring large fluid amounts, such as septic shock and burn injury. A combination of both noninvasive clinical and invasive hemodynamic parameters, and laboratory markers should guide clinicians in the early phase of severe AP to meet organ perfusion requirements with the proper administration of fluids while avoiding fluid overload. In this narrative review the most recent evidence about fluid therapy in severe AP is discussed and an operative algorithm for fluid administration based on an individualized approach is proposed.
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Affiliation(s)
- Andrea Crosignani
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Spina
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Marrazzo
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Manu L N G Malbrain
- First Department of Anaesthesia and Intensive Therapy, Medical University of Lublin, Lublin, Poland.,International Fluid Academy, Lovenjoel, Belgium
| | - Niels Van Regenemortel
- Department of Intensive Care Medicine, Antwerp University Hospital, Antwerp, Belgium.,Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Antwerp, Belgium
| | - Roberto Fumagalli
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Thomas Langer
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy. .,Department of Anaesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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Nasa P, Wise R, Elbers PWG, Wong A, Dabrowski W, Regenmortel NV, Monnet X, Myatra SN, Malbrain MLNG. Intravenous fluid therapy in perioperative and critical care setting-Knowledge test and practice: An international cross-sectional survey. J Crit Care 2022; 71:154122. [PMID: 35908420 DOI: 10.1016/j.jcrc.2022.154122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE In the absence of recent international recommendations supported by scientific societies like Anesthesiology or Intensive Care Medicine, healthcare professionals (HCP) knowledge on IV fluid is expected to vary. We undertook a cross-sectional survey, aiming to assess prescription patterns and test the knowledge of HCP for IV fluid use in the operating room (OR) and intensive care unit (ICU). METHODS An online international cross-sectional survey was conducted between October 20, 2019, and November 27, 2021. The survey included multiple-choice questions on demographics, practice patterns and knowledge of IV fluids, and a hemodynamically unstable patient assessment. RESULTS 1045 HCP, from 97 countries responded to the survey. Nearly three-quarters reported the non-existence of internal hospital or ICU-based guidelines on IV fluids. The respondents' mean score on the knowledge assessment questions was 46.4 ± 14.4. The cumulative mean scores were significantly higher among those supervising trainees (p = 0.02), specialists (p < 0.001) and those working in high-income (p < 0.001) countries. Overall performance of respondents on the knowledge testing for IV fluid was unsatisfactory with only 6.5% respondents performed above average. CONCLUSION There is a wide difference in the knowledge and prescription of IV fluids among the HCP surveyed. These findings reflect the urgent need for education on IV fluids.
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Affiliation(s)
| | - Robert Wise
- Vrije Universiteit Brussel, Brussels, Belgium; School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa; Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Paul W G Elbers
- Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Adrian Wong
- King's College Hospital, London, United Kingdom
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland
| | - Niels V Regenmortel
- Intensive Care Unit, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerp, Belgium
| | - Xavier Monnet
- 1AP-HP, Service de Médecine Intensive-réanimation, Hôpital de Bicêtre, DMU 4 CORREVE, Inserm UMR S_999, FHU SEPSIS, CARMAS, Université Paris-Saclay, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Sheila N Myatra
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland.
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Coccolini F, Corradi F, Sartelli M, Coimbra R, Kryvoruchko IA, Leppaniemi A, Doklestic K, Bignami E, Biancofiore G, Bala M, Marco C, Damaskos D, Biffl WL, Fugazzola P, Santonastaso D, Agnoletti V, Sbarbaro C, Nacoti M, Hardcastle TC, Mariani D, De Simone B, Tolonen M, Ball C, Podda M, Di Carlo I, Di Saverio S, Navsaria P, Bonavina L, Abu-Zidan F, Soreide K, Fraga GP, Carvalho VH, Batista SF, Hecker A, Cucchetti A, Ercolani G, Tartaglia D, Galante JM, Wani I, Kurihara H, Tan E, Litvin A, Melotti RM, Sganga G, Zoro T, Isirdi A, De'Angelis N, Weber DG, Hodonou AM, tenBroek R, Parini D, Khan J, Sbrana G, Coniglio C, Giarratano A, Gratarola A, Zaghi C, Romeo O, Kelly M, Forfori F, Chiarugi M, Moore EE, Catena F, Malbrain MLNG. Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines. World J Emerg Surg 2022; 17:50. [PMID: 36131311 PMCID: PMC9494880 DOI: 10.1186/s13017-022-00455-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/16/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. MATERIAL AND METHODS An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. CONCLUSION Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy.
| | | | | | - Raul Coimbra
- Trauma Surgery Department, Riverside University Health System Medical Center, Loma Linda, CA, USA
| | - Igor A Kryvoruchko
- Department of Surgery No2, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Ari Leppaniemi
- General Surgery Department, Helsinki University Hospital, Helsinki, Finland
| | - Krstina Doklestic
- Clinic of Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Elena Bignami
- ICU Department, Parma University Hospital, Parma, Italy
| | | | - Miklosh Bala
- Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Ceresoli Marco
- General Surgery Department, Monza University Hospital, Monza, Italy
| | - Dimitris Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Walt L Biffl
- Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Paola Fugazzola
- General Surgery Department, Pavia University Hospital, Pavia, Italy
| | | | | | | | - Mirco Nacoti
- ICU Department Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Timothy C Hardcastle
- Trauma and Burn Service, Inkosi Albert Luthuli Central Hospital, Mayville, Durban, South Africa
| | - Diego Mariani
- General Surgery Department, Legnano Hospital, Legnano, Milano, Italy
| | - Belinda De Simone
- Emergency and Colorectal Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Matti Tolonen
- Emergency Surgery, HUS Helsinki University Hospital, Meilahti Tower Hospital, Helsinki, Finland
| | - Chad Ball
- Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | | | - Salomone Di Saverio
- General Surgery Department, San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy
| | - Pradeep Navsaria
- Trauma Center, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Luigi Bonavina
- General Surgery Department, San Donato Hospital, Milan, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | - Andreas Hecker
- General Surgery, Giessen University Hospital, Giessen, Germany
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Joseph M Galante
- General Surgery Department, UCLA Davis University Hospital, Los Angeles, CA, USA
| | - Imtiaz Wani
- General Surgery Department, Government Gousiua Hospital, Srinagar, India
| | - Hayato Kurihara
- Emergency and Trauma Surgery Department, Milano University Hospital, Milan, Italy
| | - Edward Tan
- Emergency Department, Nijmegen Hospital, Nijmegen, The Netherlands
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | | | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tamara Zoro
- ICU Department, Pisa University Hospital, Pisa, Italy
| | | | - Nicola De'Angelis
- Service de Chirurgie Digestive Et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Adrien M Hodonou
- Faculty of Medicine of Parakou, University of Parakou, Parakou, Benin
| | - Richard tenBroek
- General Surgery Department, Nijmegen Hospital, Nijmegen, The Netherlands
| | - Dario Parini
- General Surgery Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Jim Khan
- University of Portsmouth, Portsmouth Hospitals University NHS Trust UK, Portsmouth, UK
| | | | | | | | | | - Claudia Zaghi
- General, Emergency and Trauma Surgery Department, Vicenza Hospital, Vicenza, Italy
| | - Oreste Romeo
- Trauma and Surgical Critical Care, East Medical Center Drive, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | | | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | | | - Fausto Catena
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Manu L N G Malbrain
- First Department Anaesthesiology Intensive Therapy, Medical University Lublin, Lublin, Poland.,International Fluid Academy, Lovenjoel, Belgium
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Affiliation(s)
- Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland. .,International Fluid Academy, Lovenjoel, Belgium. .,Medical Data Management, Medaman, Geel, Belgium.
| | - Greg Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
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Khanna AK, Rola P, Malbrain MLNG. Biomarkers for intra-abdominal pressure: another tool in the toolbox? Eur Heart J Acute Cardiovasc Care 2022; 11:461-463. [PMID: 35695764 DOI: 10.1093/ehjacc/zuac073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Ashish K Khanna
- Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Outcomes Research Consortium, Cleveland, OH, USA
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA
| | - Phillipe Rola
- Intensive Care Unit, Santa Cabrini Hospital, CEMTL, Montreal, Canada
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- Medical Data Management, Medaman, Geel, Belgium
- International Fluid Academy, Lovenjoel, Belgium
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34
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Malbrain MLNG, De Keulenaer BL, Khanna AK. Continuous intra-abdominal pressure: is it ready for prime time? Intensive Care Med 2022; 48:1501-1504. [PMID: 35925322 PMCID: PMC9468118 DOI: 10.1007/s00134-022-06780-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/05/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland.
- Medical Data Management, Medaman, Geel, Belgium.
- International Fluid Academy, Lovenjoel, Belgium.
| | - Bart L De Keulenaer
- Intensive Care, Fiona Stanley Hospital, Murdoch, WA, Australia
- School of Surgery, The University of Western Australia, Perth, WA, Australia
- Murdoch Hospital Intensive Care Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Ashish K Khanna
- Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
- Outcomes Research Consortium, Cleveland, OH, USA
- Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA
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Dabrowski W, Siwicka-Gieroba D, Robba C, Bielacz M, Sołek-Pastuszka J, Kotfis K, Bohatyrewicz R, Jaroszyński A, Malbrain MLNG, Badenes R. Potentially Detrimental Effects of Hyperosmolality in Patients Treated for Traumatic Brain Injury. J Clin Med 2021; 10:jcm10184141. [PMID: 34575255 PMCID: PMC8467376 DOI: 10.3390/jcm10184141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023] Open
Abstract
Hyperosmotic therapy is commonly used to treat intracranial hypertension in traumatic brain injury patients. Unfortunately, hyperosmolality also affects other organs. An increase in plasma osmolality may impair kidney, cardiac, and immune function, and increase blood–brain barrier permeability. These effects are related not only to the type of hyperosmotic agents, but also to the level of hyperosmolality. The commonly recommended osmolality of 320 mOsm/kg H2O seems to be the maximum level, although an increase in plasma osmolality above 310 mOsm/kg H2O may already induce cardiac and immune system disorders. The present review focuses on the adverse effects of hyperosmolality on the function of various organs.
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Affiliation(s)
- Wojciech Dabrowski
- Department of Anaesthesiology and Intensive Care, Medical University of Lublin, 20-954 Lublin, Poland;
- Correspondence: (W.D.); (D.S.-G.)
| | - Dorota Siwicka-Gieroba
- Department of Anaesthesiology and Intensive Care, Medical University of Lublin, 20-954 Lublin, Poland;
- Correspondence: (W.D.); (D.S.-G.)
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino, 16100 Genova, Italy;
| | - Magdalena Bielacz
- Institute of Tourism and Recreation, State Vocational College of Szymon Szymonowicz, 22-400 Zamosc, Poland;
| | - Joanna Sołek-Pastuszka
- Department of Anaesthesiology and Intensive Care, Pomeranian Medical University, 71-252 Szczecin, Poland; (J.S.-P.); (R.B.)
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Romuald Bohatyrewicz
- Department of Anaesthesiology and Intensive Care, Pomeranian Medical University, 71-252 Szczecin, Poland; (J.S.-P.); (R.B.)
| | - Andrzej Jaroszyński
- Department of Nephrology, Institute of Medical Science, Jan Kochanowski University of Kielce, 25-736 Kielce, Poland;
| | - Manu L. N. G. Malbrain
- Department of Anaesthesiology and Intensive Care, Medical University of Lublin, 20-954 Lublin, Poland;
- International Fluid Academy, Dreef 3, 3360 Lovenjoel, Belgium
- Medical Department, AZ Jan Palfjin Hospital, Watersportlaan 5, 9000 Gent, Belgium
| | - Rafael Badenes
- Department of Anaesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, 46010 Valencia, Spain;
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Bogaerts E, Ferdinande B, Palmers PJ, Malbrain MLNG, Van Regenmortel N, Wilmer A, Lemmens R, Janssens S, Nijst P, De Deyne C, Verhaert D, Mullens W, Dens J, Dupont M, Ameloot K. The effect of fluid bolus administration on cerebral tissue oxygenation in post-cardiac arrest patients. Resuscitation 2021; 168:1-5. [PMID: 34506875 DOI: 10.1016/j.resuscitation.2021.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 08/07/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Fluid boluses (FB) are often used in post-cardiac arrest (CA) patients with haemodynamic instability. Although FB may improve cardiac output (CO) and mean arterial pressure (MAP), FB may also increase central venous pressure (CVP), reduce arterial PaO2, dilute haemoglobin and cause interstitial oedema. The aim of the present study was to investigate the net effect of FB administration on cerebral tissue oxygenation saturation (SctO2) in post-CA patients. METHODS Pre-planned sub-study of the Neuroprotect post-CA trial (NCT02541591). Patients with anticipated fluid responsiveness based on stroke volume variation (SVV) or passive leg raising test were administered a FB of 500 ml plasma-lyte A (Baxter Healthcare) and underwent pre- and post-FB assessments of stroke volume, CO, MAP, CVP, haemoglobin, PaO2 and SctO2. RESULTS 52 patients (mean age 64 ± 12 years, 75% male) received a total of 115 FB. Although administration of a FB resulted in a significant increase of stroke volume (63 ± 22 vs 67 ± 23 mL, p = 0.001), CO (4,2 ± 1,6 vs 4,4 ± 1,7 L/min, p = 0.001) and MAP (74,8 ± 13,2 vs 79,2 ± 12,9 mmHg, p = 0.004), it did not improve SctO2 (68.54 ± 6.99 vs 68.70 ± 6.80%, p = 0.49). Fluid bolus administration also resulted in a significant increase of CVP (10,0 ± 4,5 vs 10,7 ± 4,9 mmHg, p = 0.02), but did not affect PaO2 (99 ± 31 vs 94 ± 31 mmHg, p = 0.15) or haemoglobin concentrations (12,9 ± 2,1 vs 12,8 ± 2,2 g/dL, p = 0.10). In a multivariate model, FB-induced changes in CO (beta 0,77; p = 0.004) and in CVP (beta -0,23; p = 0.02) but not in MAP (beta 0,02; p = 0.18) predicted post-FB ΔSctO2. CONCLUSIONS Despite improvements in CO and MAP, FB administration did not improve SctO2 in post-cardiac arrest patients.
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Affiliation(s)
- E Bogaerts
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
| | - B Ferdinande
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - P J Palmers
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - M L N G Malbrain
- Medical Department, Medical Direction, AZ Jan Palfijn Hospital, Watersportlaan 5, B-9000 Gent, Belgium; First Department of Anaesthesia and Intensive Therapy, Medical University of Lublin, Aleje Raclawickie 1, 20-059 Lublin, Poland; International Fluid Academy, Dreef 3, B-3360 Lovenjoel, Belgium
| | - N Van Regenmortel
- Department of Intensive Care Medicine, Ziekenhuisnetwerk Antwerpen, Campus Stuivenberg, Antwerp, Belgium
| | - A Wilmer
- Medical Intensive Care Unit, University Hospital Leuven, Leuven, Belgium
| | - R Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - S Janssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - P Nijst
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - C De Deyne
- Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium; Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - D Verhaert
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - W Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - J Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - M Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
| | - K Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium; Department of Intensive Care Medicine, Ziekenhuisnetwerk Antwerpen, Campus Stuivenberg, Antwerp, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium
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Kanjo A, Molnar Z, Zádori N, Gede N, Erőss B, Szakó L, Kiss T, Márton Z, Malbrain MLNG, Szuldrzynski K, Szrama J, Kusza K, Kogelmann K, Hegyi P. Dosing of Extracorporeal Cytokine Removal In Septic Shock (DECRISS): protocol of a prospective, randomised, adaptive, multicentre clinical trial. BMJ Open 2021; 11:e050464. [PMID: 34446497 PMCID: PMC8395301 DOI: 10.1136/bmjopen-2021-050464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Sepsis and septic shock have mortality rates between 20% and 50%. In sepsis, the immune response becomes dysregulated, which leads to an imbalance between proinflammatory and anti-inflammatory mediators. When standard therapeutic measures fail to improve patients' condition, additional therapeutic alternatives are applied to reduce morbidity and mortality. One of the most recent alternatives is extracorporeal cytokine adsorption with a device called CytoSorb. This study aims to compare the efficacy of standard medical therapy and continuous extracorporeal cytokine removal with CytoSorb therapy in patients with early refractory septic shock. Furthermore, we compare the dosing of CytoSorb adsorber device changed every 12 or 24 hours. METHODS AND ANALYSIS It is a prospective, randomised, controlled, open-label, international, multicentre, phase III study. Patients fulfilling the inclusion criteria will be randomly assigned to receive standard medical therapy (group A) or-in addition to standard treatment-CytoSorb therapy. CytoSorb treatment will be continuous and last for at least 24 hours, CytoSorb adsorber device will be changed every 12 (group B) or 24 hours (group C). Our primary outcome is shock reversal (no further need or a reduced (≤10% of the maximum dose) vasopressor requirement for 3 hours) and time to shock reversal (number of hours elapsed from the start of the treatment to shock reversal).Based on sample size calculation, 135 patients (1:1:1) will need to be enrolled in the study. A predefined interim analysis will be performed after reaching 50% of the planned sample size, therefore, the corrected level of significance (p value) will be 0.0294. ETHICS AND DISSEMINATION Ethics approval was obtained from the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (OGYÉI/65049/2020). Results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04742764; Pre-results.
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Affiliation(s)
- Anna Kanjo
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Heim Pál National Paediatric Institute, Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Molnar
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
- Chair and Department of Anaesthesiology and Intensive Therapy and Pain Treatment, Poznan University for Medical Sciences, Poznan, Poland
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Anaesthesiology and Intensive Care, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Lajos Szakó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Tamás Kiss
- Department of Anaesthesiology and Intensive Care, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Márton
- 1st Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Manu L N G Malbrain
- International Fluid Academy, Lovenjoel, Belgium
- Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Medical Department, CMO, AZ Jan Palfijn Hospital, Ghent, Belgium
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Konstanty Szuldrzynski
- Department of Anaesthesiology and Intensive Care, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
- Chair of Anatomy, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Szrama
- Chair and Department of Anaesthesiology and Intensive Therapy and Pain Treatment, Poznan University for Medical Sciences, Poznan, Poland
| | - Krzysztof Kusza
- Chair and Department of Anaesthesiology and Intensive Therapy and Pain Treatment, Poznan University for Medical Sciences, Poznan, Poland
| | - Klaus Kogelmann
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Emden, Emden, Germany
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Astapenko D, Ticha A, Hyspler R, Tomasova A, Navratil P, Maly O, Parizkova RC, Cizkova D, Huey SC, Lehmann C, Malbrain MLNG, Cerny V. A porcine model of endothelial glycocalyx damage by enzymatic digestion: A pilot study. Clin Hemorheol Microcirc 2021; 78:325-338. [PMID: 33843666 DOI: 10.3233/ch-211133] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND The endothelial glycocalyx (EG) plays a vital role in the physiology and pathophysiology of human microcirculation. Having relevant EG damage model would be important tool for testing new interventions aiming at EG protection and recovery. We describe the first in vivo EG damage model in pig. OBJECTIVE To investigate the course of animal EG damage induced by specific enzymes. MATERIAL AND METHODS Four anesthetized piglets received enzymes: 1g hyaluronidase and 25 IU heparanase I intravenously. Blood and urine samples were collected at baseline and 20/40/60/80/100/120 min for detecting markers of endothelial and EG function. Sublingual microcirculation and EG thickness were assessed by Side-stream Dark Field (SDF) imaging and Perfused Boundary Region (PBR) respectively. EG of the mesentery artery was visualized in fluorescent microscopy. RESULTS Biochemical marker of EG damage syndecan-1 showed temporary increase with return to baseline and was reflected by PBR values. Albumin levels suggested brief period of capillary leakage (decrease in the serum, increase in the urine) with a trend to normalization. Urine glycosaminoglycans peaked at 120 minutes. Microcirculatory perfusion parameter showed significant alteration. Diffusion parameters were altered with no statistical significance. CONCLUSION EG damage induced by specific enzymes was reflected by temporary changes of biochemical makers together with alteration of microcirculation and changes in fluorescent microscopy of EG layer. Our results support to further validate presented model of EG damage on a larger number of animals.
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Affiliation(s)
- David Astapenko
- Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Alena Ticha
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Radomir Hyspler
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic.,Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Adela Tomasova
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Pavel Navratil
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic.,Department of Urology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Ondrej Maly
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic.,Department of Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Faculty of Military Health Sciences, University of Defense Brno, Brno, Czech Republic
| | - Renata Cerna Parizkova
- Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Dana Cizkova
- Department of Histology and Embryology, Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Shin Chua Huey
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Christian Lehmann
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Manu L N G Malbrain
- Faculty of Engineering, Dept. of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,International Fluid Academy, Lovenjoel, Belgium
| | - Vladimir Cerny
- Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic.,Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic.,Centrum for Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.,Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Van Regenmortel N, Moers L, Langer T, Roelant E, De Weerdt T, Caironi P, Malbrain MLNG, Elbers P, Van den Wyngaert T, Jorens PG. Fluid-induced harm in the hospital: look beyond volume and start considering sodium. From physiology towards recommendations for daily practice in hospitalized adults. Ann Intensive Care 2021; 11:79. [PMID: 33999276 PMCID: PMC8128950 DOI: 10.1186/s13613-021-00851-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/03/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Iatrogenic fluid overload is a potential side effect of intravenous fluid therapy in the hospital. Little attention has been paid to sodium administration as a separate cause of harm. With this narrative review, we aim to substantiate the hypothesis that a considerable amount of fluid-induced harm is caused not only by fluid volume, but also by the sodium that is administered to hospitalized patients. METHODS We show how a regular dietary sodium intake is easily surpassed by the substantial amounts of sodium that are administered during typical hospital stays. The most significant sodium burdens are caused by isotonic maintenance fluid therapy and by fluid creep, defined as the large volume unintentionally administered to patients in the form of dissolved medication. In a section on physiology, we elaborate on the limited renal handling of an acute sodium load. We demonstrate how the subsequent retention of water is an energy-demanding, catabolic process and how free water is needed to excrete large burdens of sodium. We quantify the effect size of sodium-induced fluid retention and discuss its potential clinical impact. Finally, we propose preventive measures, discuss the benefits and risks of low-sodium maintenance fluid therapy, and explore options for reducing the amount of sodium caused by fluid creep. CONCLUSION The sodium burdens caused by isotonic maintenance fluids and fluid creep are responsible for an additional and avoidable derailment of fluid balance, with presumed clinical consequences. Moreover, the handling of sodium overload is characterized by increased catabolism. Easy and effective measures for reducing sodium load and fluid retention include choosing a hypotonic rather than isotonic maintenance fluid strategy (or avoiding these fluids when enough free water is provided through other sources) and dissolving as many medications as possible in glucose 5%.
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Affiliation(s)
- Niels Van Regenmortel
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, B-2650, Antwerp, Belgium. .,Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Lange Beeldekensstraat 267, B-2060, Antwerp, Belgium.
| | - Lynn Moers
- Department of Pharmacy, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Lange Beeldekensstraat 267, B-2060, Antwerp, Belgium
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Anaesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Ella Roelant
- StatUa, Center for Statistics, University of Antwerp, Prinsstraat 13, B-2000, Antwerp, Belgium.,Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650, Edegem, Belgium
| | - Tim De Weerdt
- Department of Nephrology, Kliniek Sint-Jan, Kruidtuinlaan 32, B-1000, Brussels, Belgium
| | - Pietro Caironi
- Department of Anesthesia and Critical Care, AOU S. Luigi Gonzaga, Department of Oncology, University of Turin, Turin, Italy
| | - Manu L N G Malbrain
- Faculty of Engineering, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium
| | - Paul Elbers
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, B-2650, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, B-2610, Antwerp, Belgium
| | - Philippe G Jorens
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, B-2650, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, B-2610, Antwerp, Belgium
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40
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Regli A, Reintam Blaser A, De Keulenaer B, Starkopf J, Kimball E, Malbrain MLNG, Van Heerden PV, Davis WA, Palermo A, Dabrowski W, Siwicka-Gieroba D, Barud M, Grigoras I, Ristescu AI, Blejusca A, Tamme K, Maddison L, Kirsimägi Ü, Litvin A, Kazlova A, Filatau A, Pracca F, Sosa G, Santos MD, Kirov M, Smetkin A, Ilyina Y, Gilsdorf D, Ordoñez CA, Caicedo Y, Greiffenstein P, Morgan MM, Bodnar Z, Tidrenczel E, Oliveira G, Albuquerque A, Pereira BM. Intra-abdominal hypertension and hypoxic respiratory failure together predict adverse outcome - A sub-analysis of a prospective cohort. J Crit Care 2021; 64:165-172. [PMID: 33906106 DOI: 10.1016/j.jcrc.2021.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess whether the combination of intra-abdominal hypertension (IAH, intra-abdominal pressure ≥ 12 mmHg) and hypoxic respiratory failure (HRF, PaO2/FiO2 ratio < 300 mmHg) in patients receiving invasive ventilation is an independent risk factor for 90- and 28-day mortality as well as ICU- and ventilation-free days. METHODS Mechanically ventilated patients who had blood gas analyses performed and intra-abdominal pressure measured, were included from a prospective cohort. Subgroups were defined by the absence (Group 1) or the presence of either IAH (Group 2) or HRF (Group 3) or both (Group 4). Mixed-effects regression analysis was performed. RESULTS Ninety-day mortality increased from 16% (Group 1, n = 50) to 30% (Group 2, n = 20) and 27% (Group 3, n = 100) to 49% (Group 4, n = 142), log-rank test p < 0.001. The combination of IAH and HRF was associated with increased 90- and 28-day mortality as well as with fewer ICU- and ventilation-free days. The association with 90-day mortality was no longer present after adjustment for independent variables. However, the association with 28-day mortality, ICU- and ventilation-free days persisted after adjusting for independent variables. CONCLUSIONS In our sub-analysis, the combination of IAH and HRF was not independently associated with 90-day mortality but independently increased the odds of 28-day mortality, and reduced the number of ICU- and ventilation-free days.
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Affiliation(s)
- Adrian Regli
- Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia; Medical School, The Notre Dame University, Fremantle, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia.
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Bart De Keulenaer
- Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia; School of Surgery, The University of Western Australia, Perth, WA, Australia
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Edward Kimball
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Manu L N G Malbrain
- Faculty of Engineering, Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussels, Belgium; International Fluid Academy, Lovenjoel, Belgium
| | | | - Wendy A Davis
- Medical School, The University of Western Australia, Perth, WA, Australia
| | | | - Annamaria Palermo
- Department of Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Dorota Siwicka-Gieroba
- First Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Malgorzata Barud
- First Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Ioana Grigoras
- Grigore T. Popa, University of Medicine and Pharmacy, Iasi, Romania; Regional Institute of Oncology, Iasi, Romania
| | - Anca Irina Ristescu
- Grigore T. Popa, University of Medicine and Pharmacy, Iasi, Romania; Regional Institute of Oncology, Iasi, Romania
| | | | - Kadri Tamme
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Liivi Maddison
- Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Ülle Kirsimägi
- Department of Surgery, Tartu University Hospital, Tartu, Estonia
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | - Anastasiya Kazlova
- Department of Intensive Care Medicine, Regional Clinical Hospital, Gomel, Belarus
| | - Aliaksandr Filatau
- Department of Intensive Care Medicine, Regional Clinical Hospital, Gomel, Belarus
| | - Francisco Pracca
- Department of Intensive Care Unit, Clinics University Hospital, UDELAR, Montevideo, Uruguay
| | - Gustavo Sosa
- Department of Intensive Care Unit, Clinics University Hospital, UDELAR, Montevideo, Uruguay
| | - Maicol Dos Santos
- Department of Intensive Care Unit, Clinics University Hospital, UDELAR, Montevideo, Uruguay
| | - Mikhail Kirov
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia
| | - Alexey Smetkin
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia
| | - Yana Ilyina
- Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russia
| | - Daniel Gilsdorf
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Carlos A Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili - Universidad del Valle, Cali, Colombia
| | - Yaset Caicedo
- Centro de Investigaciones Clínicas (CIC), Fundacion Valle del Lili, Cali, Colombia
| | | | - Margaret M Morgan
- Louisiana State University Health Sciences Center, New Orleans, United States; UC Health Memorial Hospital Central, Colorado Springs, California, United States
| | - Zsolt Bodnar
- University Hospital of Torrevieja, Torrevieja, Spain; Letterkenny University Hospital, Letterkenny, Ireland
| | - Edit Tidrenczel
- University Hospital of Torrevieja, Torrevieja, Spain; Killybegs Family Health Centre, Killybegs, Ireland
| | - Gina Oliveira
- Polyvalent Intensive Care Unit, Hospitalar Center Tondela-Viseu, Tondela-Viseu, Portugal
| | - Ana Albuquerque
- Polyvalent Intensive Care Unit, Hospitalar Center Tondela-Viseu, Tondela-Viseu, Portugal
| | - Bruno M Pereira
- Postgraduate and Research Division, Masters Program in Health Applied Sciences, Vassouras University, Vassouras, RJ, Brazil; Grupo Surgical, Campinas, SP, Brazil; Terzius Institute of Education, Campinas, SP, Brazil
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41
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Dabrowski W, Siwicka-Gieroba D, Robba C, Badenes R, Malbrain MLNG. The prone position must accommodate changes in IAP in traumatic brain injury patients. Crit Care 2021; 25:132. [PMID: 33827641 PMCID: PMC8024931 DOI: 10.1186/s13054-021-03506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Wojciech Dabrowski
- Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-954, Lublin, Poland.
| | - Dorota Siwicka-Gieroba
- Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-954, Lublin, Poland
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino, Genoa, Italy
| | - Rafael Badenes
- Department of Anesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, Valencia, Spain
| | - Manu L N G Malbrain
- Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-954, Lublin, Poland.,Department of Electronics and Informatics (ETRO), Faculty of Engineering, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,International Fluid Academy, Lovenjoel, Belgium
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the utilization and most recent developments with regard to the use of ultrasound when imaging the abdomen and gastrointestinal tract. RECENT FINDINGS Although the use of ultrasound to assess the anatomy of the various abdominal organs is well established within radiology and critical care, its use as part of functional and physiological assessment is still evolving. Recent developments have extended the use of ultrasound beyond standard B-mode/2D imaging techniques to incorporate more functional and haemodynamic assessment. These include the use of contrast-enhanced ultrasound (CEUS), elastography, and colour Doppler techniques. SUMMARY Whilst Doppler techniques are reasonably well established within critical care ultrasound (CCUS), especially in echocardiography, CEUS and elastography are less well known. CEUS utilizes a purely intravascular contrast agent whilst elastography measures the degree of deformation or stiffness in various organs. Whilst their use individually may be limited; they may play a role in a multiparametric assessment. Mirroring the overall trends in critical care ultrasound development, abdominal ultrasound assessment is best integrated in a holistic approach and adapted to the individual patient.
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Affiliation(s)
| | | | - Manu L N G Malbrain
- Faculty of Engineering, Department of Electronics and Informatics, VUB, Brussels, Belgium
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Nasa P, Azoulay E, Khanna AK, Jain R, Gupta S, Javeri Y, Juneja D, Rangappa P, Sundararajan K, Alhazzani W, Antonelli M, Arabi YM, Bakker J, Brochard LJ, Deane AM, Du B, Einav S, Esteban A, Gajic O, Galvagno SM, Guérin C, Jaber S, Khilnani GC, Koh Y, Lascarrou JB, Machado FR, Malbrain MLNG, Mancebo J, McCurdy MT, McGrath BA, Mehta S, Mekontso-Dessap A, Mer M, Nurok M, Park PK, Pelosi P, Peter JV, Phua J, Pilcher DV, Piquilloud L, Schellongowski P, Schultz MJ, Shankar-Hari M, Singh S, Sorbello M, Tiruvoipati R, Udy AA, Welte T, Myatra SN. Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method. Crit Care 2021; 25:106. [PMID: 33726819 PMCID: PMC7962430 DOI: 10.1186/s13054-021-03491-y] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. METHODS Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p < 0·05 was considered as unstable). RESULTS Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. CONCLUSION Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. TRIAL REGISTRATION The study was registered with Clinical trials.gov Identifier: NCT04534569.
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Affiliation(s)
- Prashant Nasa
- Critical Care Medicine, NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Elie Azoulay
- Saint-Louis teaching hospital - APHP - and University of Paris, Paris, France
| | - Ashish K Khanna
- Wake Forest University School of Medicine, Winston-Salem, NC and Outcomes Research Consortium , Cleveland, USA
| | - Ravi Jain
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Sachin Gupta
- Narayana Super Speciality Hospital, Gurugram, India
| | - Yash Javeri
- Regency Super Speciality Hospital, Lucknow, India
| | | | | | | | | | | | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Jan Bakker
- New York University School of Medicine and Columbia University College of Physicians & Surgeons, New York, USA
- Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Laurent J Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, and University of Toronto, Toronto, Canada
| | - Adam M Deane
- Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
| | - Bin Du
- Peking Union Medical College Hospital, Peking, China
| | - Sharon Einav
- The Shaare Zedek Medical Center, Jerusalem, Israel
| | - Andrés Esteban
- Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | | | | | - Claude Guérin
- University de Lyon, Lyon, France
- Institut Mondor de Recherches Biomédicales, Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, and Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, Créteil, France
| | - Samir Jaber
- Montpellier University Hospital, Montpellier, France
- Hôpital Saint-Éloi, CHU de Montpellier, Phy Med Exp, Université de Montpellier, Montpellier, France
| | | | - Younsuck Koh
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | - Manu L N G Malbrain
- International Fluid Academy, Lovenjoel, Belgium
- Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | | | - Brendan A McGrath
- Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Academic Health Sciences Centre, Manchester, UK
| | - Sangeeta Mehta
- Sinai Health and the University of Toronto, Toronto, Canada
| | - Armand Mekontso-Dessap
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Medicine Intensive Réanimation, and Univ Paris Est Créteil, CARMAS, Créteil, France
| | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael Nurok
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, USA
| | | | - Paolo Pelosi
- San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences , Genoa, Italy
- Department of Surgical Sciences and Integrated Sciences, University of Genoa , Genoa, Italy
| | | | - Jason Phua
- Alexandra Hospital and National University Hospital, Singapore, Singapore
| | | | - Lise Piquilloud
- Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | | | - Marcus J Schultz
- Amsterdam University Medical Center, Amsterdam, The Netherlands
- Mahidol University, Bangkok, Thailand
- University of Oxford, Oxford, UK
| | - Manu Shankar-Hari
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Suveer Singh
- Royal Brompton Hospital and Chelsea and Westminster Hospital, Imperial College, London, UK
| | | | | | | | - Tobias Welte
- Department of Respiratory Medicine, German Centre of Lung Research, Hannover, Germany
| | - Sheila N Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India.
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Nasa P, Azoulay E, Khanna AK, Jain R, Gupta S, Javeri Y, Juneja D, Rangappa P, Sundararajan K, Alhazzani W, Antonelli M, Arabi YM, Bakker J, Brochard LJ, Deane AM, Du B, Einav S, Esteban A, Gajic O, Galvagno SM, Guérin C, Jaber S, Khilnani GC, Koh Y, Lascarrou JB, Machado FR, Malbrain MLNG, Mancebo J, McCurdy MT, McGrath BA, Mehta S, Mekontso-Dessap A, Mer M, Nurok M, Park PK, Pelosi P, Peter JV, Phua J, Pilcher DV, Piquilloud L, Schellongowski P, Schultz MJ, Shankar-Hari M, Singh S, Sorbello M, Tiruvoipati R, Udy AA, Welte T, Myatra SN. Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method. Crit Care 2021. [PMID: 33726819 DOI: 10.1186/s13054-021-03491-y.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. METHODS Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p < 0·05 was considered as unstable). RESULTS Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. CONCLUSION Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. TRIAL REGISTRATION The study was registered with Clinical trials.gov Identifier: NCT04534569.
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Affiliation(s)
- Prashant Nasa
- Critical Care Medicine, NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Elie Azoulay
- Saint-Louis teaching hospital - APHP - and University of Paris, Paris, France
| | - Ashish K Khanna
- Wake Forest University School of Medicine, Winston-Salem, NC and Outcomes Research Consortium , Cleveland, USA
| | - Ravi Jain
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Sachin Gupta
- Narayana Super Speciality Hospital, Gurugram, India
| | - Yash Javeri
- Regency Super Speciality Hospital, Lucknow, India
| | | | | | | | | | | | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Jan Bakker
- New York University School of Medicine and Columbia University College of Physicians & Surgeons, New York, USA.,Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Laurent J Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, and University of Toronto, Toronto, Canada
| | - Adam M Deane
- Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia
| | - Bin Du
- Peking Union Medical College Hospital, Peking, China
| | - Sharon Einav
- The Shaare Zedek Medical Center, Jerusalem, Israel
| | - Andrés Esteban
- Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | | | | | - Claude Guérin
- University de Lyon, Lyon, France.,Institut Mondor de Recherches Biomédicales, Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, and Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, Créteil, France
| | - Samir Jaber
- Montpellier University Hospital, Montpellier, France.,Hôpital Saint-Éloi, CHU de Montpellier, Phy Med Exp, Université de Montpellier, Montpellier, France
| | | | - Younsuck Koh
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | - Manu L N G Malbrain
- International Fluid Academy, Lovenjoel, Belgium.,Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | | | - Brendan A McGrath
- Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Academic Health Sciences Centre, Manchester, UK
| | - Sangeeta Mehta
- Sinai Health and the University of Toronto, Toronto, Canada
| | - Armand Mekontso-Dessap
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Medicine Intensive Réanimation, and Univ Paris Est Créteil, CARMAS, Créteil, France
| | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael Nurok
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, USA
| | | | - Paolo Pelosi
- San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences , Genoa, Italy.,Department of Surgical Sciences and Integrated Sciences, University of Genoa , Genoa, Italy
| | | | - Jason Phua
- Alexandra Hospital and National University Hospital, Singapore, Singapore
| | | | - Lise Piquilloud
- Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | | | - Marcus J Schultz
- Amsterdam University Medical Center, Amsterdam, The Netherlands.,Mahidol University, Bangkok, Thailand.,University of Oxford, Oxford, UK
| | - Manu Shankar-Hari
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Suveer Singh
- Royal Brompton Hospital and Chelsea and Westminster Hospital, Imperial College, London, UK
| | | | | | | | - Tobias Welte
- Department of Respiratory Medicine, German Centre of Lung Research, Hannover, Germany
| | - Sheila N Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India.
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45
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Tayebi S, Gutierrez A, Mohout I, Smets E, Wise R, Stiens J, Malbrain MLNG. A concise overview of non-invasive intra-abdominal pressure measurement techniques: from bench to bedside. J Clin Monit Comput 2021; 35:51-70. [PMID: 32700152 PMCID: PMC7889558 DOI: 10.1007/s10877-020-00561-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 02/29/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
This review presents an overview of previously reported non-invasive intra-abdominal pressure (IAP) measurement techniques. Each section covers the basic physical principles and methodology of the various measurement techniques, the experimental results, and the advantages and disadvantages of each method. The most promising non-invasive methods for IAP measurement are microwave reflectometry and ultrasound assessment, in combination with an applied external force.
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Affiliation(s)
- Salar Tayebi
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Adrian Gutierrez
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Ikram Mohout
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Evelien Smets
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Robert Wise
- Adult Intensive Care, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, England
- Discipline of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Johan Stiens
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Manu L. N. G. Malbrain
- Intensive Care Unit, ICU Director, University Hospital Brussel (UZB), Laarbeeklaan 101, 1090 Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Jette, Belgium
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46
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Moretti M, Van Laethem J, Minini A, Pierard D, Malbrain MLNG. Ventilator-associated bacterial pneumonia in coronavirus 2019 disease, a retrospective monocentric cohort study. J Infect Chemother 2021; 27:826-833. [PMID: 33583739 PMCID: PMC7826005 DOI: 10.1016/j.jiac.2021.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 01/08/2023]
Abstract
Introduction Severe coronavirus 2019 disease (CoViD-19) may lead to respiratory failure and mechanical ventilation. Therefore, ventilator associated pneumonia (VAP) may complicate the course of the disease. The aim of the current article was to investigate possible predictive factors for bacterial VAP on a retrospective manner, in a cohort of mechanically ventilated CoViD-19 patients. Additionally, determinant factors of lethality were analyzed. Methods Medical records of patients hospitalized in the intensive care units (ICU) at the university hospital UZ Brussel during the epidemic were reviewed. VAP was defined following the National Healthcare Safety Network 2017 criteria. Univariate and multivariate logistic regressions analyses were performed. Results Among the 39 patients included in the study, 54% were diagnosed with bacterial VAP. Case fatality rate was 44%, but 59% of the deceased patients had a do-not-resuscitate status. Multivariate logistic regression for prediction of VAP showed significant differences in duration of ICU hospitalization and in minimal lung compliance. Additional analyses were performed on CoViD-19 patients who were affected by bacterial respiratory superinfection. The responsible pathogens correspond to the commonly found bacteria in VAP. However, 71% of the isolated germs were multi-drug resistant and bacteraemia was reported in 38%. Multivariate analyses for prediction of lethality found significant difference in SOFA score. Conclusions Mechanically ventilated CoViD-19 patients might frequently develop VAP. Longer ICU hospitalization was associated with pulmonary superinfection in the current cohort. Moreover, decreased minimal lung compliance was correlated to VAP and higher SOFA score at VAP diagnosis was associated with lethality.
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Affiliation(s)
- Marco Moretti
- Department of Internal Medicine and Infectious Diseases, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| | - Johan Van Laethem
- Department of Internal Medicine and Infectious Diseases, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Andrea Minini
- Faculty of Medicine and Pharmacy, University of Insubria, Como, Italy; Department of Intensive Care, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Denis Pierard
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Manu L N G Malbrain
- Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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47
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Mazzinari G, Diaz-Cambronero O, Serpa Neto A, Martínez AC, Rovira L, Argente Navarro MP, Malbrain MLNG, Pelosi P, Gama de Abreu M, Hollmann MW, Schultz MJ. Modeling intra-abdominal volume and respiratory driving pressure during pneumoperitoneum insufflation-a patient-level data meta-analysis. J Appl Physiol (1985) 2020; 130:721-728. [PMID: 33357006 DOI: 10.1152/japplphysiol.00814.2020] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
During pneumoperitoneum, intra-abdominal pressure (IAP) is usually kept at 12-14 mmHg. There is no clinical benefit in IAP increments if they do not increase intra-abdominal volume IAV. We aimed to estimate IAV (ΔIAV) and respiratory driving pressure changes (ΔPRS) in relation to changes in IAP (ΔIAP). We carried out a patient-level meta-analysis of 204 adult patients with available data on IAV and ΔPRS during pneumoperitoneum from three trials assessing the effect of IAP on postoperative recovery and airway pressure during laparoscopic surgery under general anesthesia. The primary endpoint was ΔIAV, and the secondary endpoint was ΔPRS. The endpoints' response to ΔIAP was modeled using mixed multivariable Bayesian regression to estimate which mathematical function best fitted it. IAP values on the pressure-volume (PV) curve where the endpoint rate of change according to IAP decreased were identified. Abdomino-thoracic transmission (ATT) rate, that is, the rate ΔPRS change to ΔIAP was also estimated. The best-fitting function was sigmoid logistic and linear for IAV and ΔPRS response, respectively. Increments in IAV reached a plateau at 6.0 [95%CI 5.9-6.2] L. ΔIAV for each ΔIAP decreased at IAP ranging from 9.8 [95%CI 9.7-9.9] to 12.2 [12.0-12.3] mmHg. ATT rate was 0.65 [95%CI 0.62-0.68]. One mmHg of IAP raised ΔPRS 0.88 cmH2O. During pneumoperitoneum, IAP has a nonlinear relationship with IAV and a linear one with ΔPRS. IAP should be set below the point where IAV gains diminish.NEW & NOTEWORTHY We found that intra-abdominal volume changes related to intra-abdominal pressure increase reached a plateau with diminishing gains in commonly used pneumoperitoneum pressure ranges. We also found a linear relationship between intra-abdominal pressure and respiratory driving pressure, a known marker of postoperative pulmonary complications.
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Affiliation(s)
- Guido Mazzinari
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain.,Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Oscar Diaz-Cambronero
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain.,Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain.,Spanish Clinical Research Network (SCReN), SCReN-IIS La Fe, Madrid, Spain
| | - Ary Serpa Neto
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Center, location "AMC." Amsterdam, The Netherlands.,Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Pulmonary Division, Cardio-Pulmonary Department, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Antonio Cañada Martínez
- Data Science, Biostatistics and Bioinformatics Unit, Instituto de Investigacion Sanitaria la Fe, Valencia, Spain
| | - Lucas Rovira
- Department of Anaesthesiology, Consorcio Hospital General Universitario, Valencia, Spain
| | - María Pilar Argente Navarro
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain.,Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Manu L N G Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), Brussels, Belgium.,Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,International Fluid Academy, Lovenjoel, Belgium
| | - Paolo Pelosi
- San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Marcelo Gama de Abreu
- Department of Anesthesiology and Intensive Care Therapy, Pulmonary Engineering Group, Technische Universität Dresden, Dresden, Germany.,Outcomes Research Consortium, Cleveland, Ohio
| | - Markus W Hollmann
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Center, location "AMC." Amsterdam, The Netherlands.,Department of Anaesthesiology, Amsterdam University Medical Center, location "AMC," Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Center, location "AMC." Amsterdam, The Netherlands.,Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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48
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Kirkpatrick AW, Hamilton DR, McKee JL, MacDonald B, Pelosi P, Ball CG, Roberts D, McBeth PB, Cocolini F, Ansaloni L, Peireira B, Sugrue M, Campbell MR, Kimball EJ, Malbrain MLNG, Roberts D. Do we have the guts to go? The abdominal compartment, intra-abdominal hypertension, the human microbiome and exploration class space missions. Can J Surg 2020. [PMID: 33278908 DOI: 10.1503/cjs.019219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Humans are destined to explore space, yet critical illness and injury may be catastrophically limiting for extraterrestrial travel. Humans are superorganisms living in symbiosis with their microbiomes, whose genetic diversity dwarfs that of humans. Symbiosis is critical and imbalances are associated with disease, occurring within hours of serious illness and injury. There are many characteristics of space flight that negatively influence the microbiome, especially deep space itself, with its increased radiation and absence of gravity. Prolonged weightlessness causes many physiologic changes that are detrimental; some resemble aging and will adversely affect the ability to tolerate critical illness or injury and subsequent treatment. Critical illness-induced intra-abdominal hypertension (IAH) may induce malperfusion of both the viscera and microbiome, with potentially catastrophic effects. Evidence from animal models confirms profound IAH effects on the gut, namely ischemia and disruption of barrier function, mechanistically linking IAH to resultant organ dysfunction. Therefore, a pathologic dysbiome, space-induced immune dysfunction and a diminished cardiorespiratory reserve with exacerbated susceptibility to IAH, imply that a space-deconditioned astronaut will be vulnerable to IAH-induced gut malperfusion. This sets the stage for severe gut ischemia and massive biomediator generation in an astronaut with reduced cardiorespiratory/immunological capacity. Fortunately, experiments in weightless analogue environments suggest that IAH may be ameliorated by conformational abdominal wall changes and a resetting of thoracoabdominal mechanics. Thus, review of the interactions of physiologic changes with prolonged weightlessness and IAH is required to identify appropriate questions for planning exploration class space surgical care.
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Affiliation(s)
- Andrew W Kirkpatrick
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Douglas R Hamilton
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Jessica L McKee
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Braedon MacDonald
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Paolo Pelosi
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Chad G Ball
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Derek Roberts
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Paul B McBeth
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Federico Cocolini
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Luca Ansaloni
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Bruno Peireira
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Michael Sugrue
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Mark R Campbell
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Edward J Kimball
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Manu L N G Malbrain
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Derek Roberts
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
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Kirkpatrick AW, Hamilton DR, McKee JL, MacDonald B, Pelosi P, Ball CG, Roberts D, McBeth PB, Cocolini F, Ansaloni L, Peireira B, Sugrue M, Campbell MR, Kimball EJ, Malbrain MLNG, Roberts D. Do we have the guts to go? The abdominal compartment, intra-abdominal hypertension, the human microbiome and exploration class space missions. Can J Surg 2020; 63:E581-E593. [PMID: 33278908 PMCID: PMC7747844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 11/11/2023] Open
Abstract
Humans are destined to explore space, yet critical illness and injury may be catastrophically limiting for extraterrestrial travel. Humans are superorganisms living in symbiosis with their microbiomes, whose genetic diversity dwarfs that of humans. Symbiosis is critical and imbalances are associated with disease, occurring within hours of serious illness and injury. There are many characteristics of space flight that negatively influence the microbiome, especially deep space itself, with its increased radiation and absence of gravity. Prolonged weightlessness causes many physiologic changes that are detrimental; some resemble aging and will adversely affect the ability to tolerate critical illness or injury and subsequent treatment. Critical illness-induced intra-abdominal hypertension (IAH) may induce malperfusion of both the viscera and microbiome, with potentially catastrophic effects. Evidence from animal models confirms profound IAH effects on the gut, namely ischemia and disruption of barrier function, mechanistically linking IAH to resultant organ dysfunction. Therefore, a pathologic dysbiome, space-induced immune dysfunction and a diminished cardiorespiratory reserve with exacerbated susceptibility to IAH, imply that a space-deconditioned astronaut will be vulnerable to IAH-induced gut malperfusion. This sets the stage for severe gut ischemia and massive biomediator generation in an astronaut with reduced cardiorespiratory/immunological capacity. Fortunately, experiments in weightless analogue environments suggest that IAH may be ameliorated by conformational abdominal wall changes and a resetting of thoracoabdominal mechanics. Thus, review of the interactions of physiologic changes with prolonged weightlessness and IAH is required to identify appropriate questions for planning exploration class space surgical care.
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Affiliation(s)
- Andrew W Kirkpatrick
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Douglas R Hamilton
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Jessica L McKee
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Braedon MacDonald
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Paolo Pelosi
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Chad G Ball
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Derek Roberts
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Paul B McBeth
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Federico Cocolini
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Luca Ansaloni
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Bruno Peireira
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Michael Sugrue
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Mark R Campbell
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Edward J Kimball
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Manu L N G Malbrain
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
| | - Derek Roberts
- From the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Departments of Medicine and Engineering, University of Calgary, Calgary, Alta. (Kirkpatrick, Hamilton, McKee); the Departments of Critical Care Medicine and Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alta. (MacDonald); the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy (Pelosi); Regional Trauma Services; Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (Ball); the Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Roberts); the Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group Collaborators; Regional Trauma Services; Foothills Medical Centre; Departments of Engineering, Surgery and Critical Care Medicine, University of Calgary, Calgary, Alta. (McBeth); the Departments of Trauma and Emergency Surgery, Pisa University Hospital, Pisa, Italy (Cocolini); the Departments of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy (Ansaloni); the Division of Trauma Surgery, University of Campinas, Campinas, São Paulo, Brazil (Peireira); the Department of Surgery, Letterkenny University Hospital, Letterkenny, Donegal, Ireland (Sugrue); the Paris Regional Medical Centre, Paris, Texas, United States (Campbell); the Departments of Surgery and Critical Care, Network Development and Telehealth, University of Utah, Salt Lake City, US (Kimball); the Faculties of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Malbrain)
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Gyselaers W, Lozada MJ, Pacheco LD, Tayebi S, Malbrain MLNG. Intra-abdominal pressure as an ignored parameter in the pathophysiology of preeclampsia. Acta Obstet Gynecol Scand 2020; 99:963-965. [PMID: 32683680 DOI: 10.1111/aogs.13898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Wilfried Gyselaers
- Department of Physiology, Hasselt University, Hasselt, Belgium.,Department of Obstetrics and Gynecology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - M James Lozada
- Division of Obstetric Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Luis D Pacheco
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA.,Division of Critical Care Medicine, Department of Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Salar Tayebi
- Department of Biomedical Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | - Manu L N G Malbrain
- Intensive Care Unit, University Hospital Brussels, Jette, Belgium.,Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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