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Cavaliere F, Allegri M, Apan A, Brazzi L, Carassiti M, Cohen E, DI Marco P, Langeron O, Rossi M, Spieth P, Turnbull D, Weber F. A year in review in Minerva Anestesiologica 2023: anesthesia, analgesia, and perioperative medicine. Minerva Anestesiol 2024; 90:222-234. [PMID: 38535972 DOI: 10.23736/s0375-9393.24.18067-4] [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] [Indexed: 04/04/2024]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Massimo Allegri
- Lemanic Center of Analgesia and Neuromodulation EHC, Morges, Switzerland
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Giresun, Giresun, Türkiye
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University Hospital, Rome, Italy
| | - Edmond Cohen
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierangelo DI Marco
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic, and Geriatric Sciences, Faculty of Medicine, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), University Paris-Est Créteil (UPEC), Paris, France
| | - Marco Rossi
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Dresden, Dresden, Germany
| | - David Turnbull
- Department of Anesthetics and Neuro Critical Care, Royal Hallamshire Hospital, Sheffield, UK
| | - Frank Weber
- Department of Anesthesiology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
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Almeida AB, Schweigert M, Spieth P, Dubecz A, de Abreu MG, Richter T, Kellner P. Outcome of Emergency Pulmonary Lobectomy under ECMO Support in Patients with COVID-19. Thorac Cardiovasc Surg 2023. [PMID: 37399834 DOI: 10.1055/s-0043-1770738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Not much is known about the results of nonelective anatomical lung resections in coronavirus disease 2019 (COVID-19) patients put on extracorporeal membrane oxygenation (ECMO). The aim of this study was to analyze the outcome of lobectomy under ECMO support in patients with acute respiratory failure due to severe COVID-19. METHODS All COVID-19 patients undergoing anatomical lung resection with ECMO support at a German university hospital were included into a prospective database. Study period was April 1, 2020, to April 30, 2021 (first, second, and third waves in Germany). RESULTS A total of nine patients (median age 61 years, interquartile range 10 years) were included. There was virtually no preexisting comorbidity (median Charlson score of comorbidity 0.2). The mean interval between first positive COVID-19 test and surgery was 21.9 days. Clinical symptoms at the time of surgery were sepsis (nine of nine), respiratory failure (nine of nine), acute renal failure (five of nine), pleural empyema (five of nine), lung artery embolism (four of nine), and pneumothorax (two of nine). Mean intensive care unit (ICU) and ECMO days before surgery were 15.4 and 6, respectively. Indications for surgery were bacterial superinfection with lung abscess formation and progressive septic shock (seven of nine) and abscess formation with massive pulmonary hemorrhage into the abscess cavity (two of nine). All patients were under venovenous ECMO with femoral-jugular configuration. Operative procedures were lobectomy (eight) and pneumonectomy (one). Weaning from ECMO was successful in four of nine. In-hospital mortality was five of nine. Mean total ECMO days were 10.3 ± 6.2 and mean total ICU days were 27.7 ± 9.9. Mean length of stay was 28.7 ± 8.8 days. CONCLUSION Emergency surgery under ECMO support seems to open up a perspective for surgical source control in COVID-19 patients with bacterial superinfection and localized pulmonary abscess.
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Affiliation(s)
- Ana Beatriz Almeida
- Department of Surgery, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany
| | - Michael Schweigert
- Department of Surgery, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany
| | - Peter Spieth
- Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Sachsen, Germany
| | - Attila Dubecz
- Department of General and Thoracic Surgery, Klinikum Nuremberg, Nuremberg, Germany
| | - Marcelo Gama de Abreu
- Department of Anesthesiology, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, United States
| | - Torsten Richter
- Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Sachsen, Germany
| | - Patrick Kellner
- Department of Anesthesiology and Intensive Care, University Hospital Schleswig-Holstein Campus Luebeck, Luebeck, Germany
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Cavaliere F, Allegri M, Apan A, Brazzi L, Carassiti M, Cohen E, DI Marco P, Langeron O, Rossi M, Spieth P, Turnbull D, Weber F. A year in review in Minerva Anestesiologica 2022: anesthesia, analgesia, and perioperative medicine. Minerva Anestesiol 2023; 89:239-252. [PMID: 36880326 DOI: 10.23736/s0375-9393.23.17281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Massimo Allegri
- Unit of Pain Therapy of Column and Athlete, Policlinic of Monza, Monza, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Giresun, Giresun, Türkiye
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University, Rome, Italy
| | - Edmond Cohen
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, New York, NY, USA
| | - Pierangelo DI Marco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Faculty of Medicine, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Assistance Publique - Hôpitaux de Paris (APHP), Henri Mondor University Hospital, University Paris-Est Créteil (UPEC), Paris, France
| | - Marco Rossi
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Dresden, Dresden, Germany
| | - David Turnbull
- Department of Anesthetics and Neuro Critical Care, Royal Hallamshire Hospital, Sheffield, UK
| | - Frank Weber
- Department of Anesthesiology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
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Körper S, Grüner B, Zickler D, Wiesmann T, Wuchter P, Blasczyk R, Zacharowski K, Spieth P, Tonn T, Rosenberger P, Paul G, Pilch J, Schwäble J, Bakchoul T, Thiele T, Knörlein J, Dollinger MM, Krebs J, Bentz M, Corman VM, Kilalic D, Schmidtke-Schrezenmeier G, Lepper PM, Ernst L, Wulf H, Ulrich A, Weiss M, Kruse JM, Burkhardt T, Müller R, Klüter H, Schmidt M, Jahrsdörfer B, Lotfi R, Rojewski M, Appl T, Mayer B, Schnecko P, Seifried E, Schrezenmeier H. One-year follow-up of the CAPSID randomized trial for high-dose convalescent plasma in severe COVID-19 patients. J Clin Invest 2022; 132:163657. [PMID: 36326824 PMCID: PMC9753994 DOI: 10.1172/jci163657] [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: 07/19/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUNDResults of many randomized trials on COVID-19 convalescent plasma (CCP) have been reported, but information on long-term outcome after CCP treatment is limited. The objectives of this extended observation of the randomized CAPSID trial are to assess long-term outcome and disease burden in patients initially treated with or without CCP.METHODSOf 105 randomized patients, 50 participated in the extended observation. Quality of life (QoL) was assessed by questionnaires and a structured interview. CCP donors (n = 113) with asymptomatic to moderate COVID-19 were included as a reference group.RESULTSThe median follow-up of patients was 396 days, and the estimated 1-year survival was 78.7% in the CCP group and 60.2% in the control (P = 0.08). The subgroup treated with a higher cumulative amount of neutralizing antibodies showed a better 1-year survival compared with the control group (91.5% versus 60.2%, P = 0.01). Medical events and QoL assessments showed a consistent trend for better results in the CCP group without reaching statistical significance. There was no difference in the increase in neutralizing antibodies after vaccination between the CCP and control groups.CONCLUSIONThe trial demonstrated a trend toward better outcome in the CCP group without reaching statistical significance. A predefined subgroup analysis showed a significantly better outcome (long-term survival, time to discharge from ICU, and time to hospital discharge) among those who received a higher amount of neutralizing antibodies compared with the control group. A substantial long-term disease burden remains after severe COVID-19.Trial registrationEudraCT 2020-001310-38 and ClinicalTrials.gov NCT04433910.FundingBundesministerium für Gesundheit (German Federal Ministry of Health).
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Affiliation(s)
- Sixten Körper
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Beate Grüner
- Division of Infectious Diseases, University Hospital and Medical Center Ulm, Ulm, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Wiesmann
- Department of Anesthesiology and Intensive Care Medicine, Phillips-University Marburg, Marburg, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Rainer Blasczyk
- Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University, Germany
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Torsten Tonn
- Transfusion Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden and German Red Cross Blood Donation Service North-East gGmbH, Dresden, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Gregor Paul
- Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Klinikum Stuttgart, Stuttgart, Germany
| | - Jan Pilch
- Institute of Clinical Hemostaseology and Transfusion Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Joachim Schwäble
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg – Hessen, Frankfurt, Germany
| | - Tamam Bakchoul
- Institute of Clinical and Experimental Transfusion Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Thiele
- Institute of Transfusion Medicine, University Hospital Greifswald, Greifswald, Germany
| | - Julian Knörlein
- Clinic of Anesthesiology and Intensive Care Medicine, University Medical Center of Freiburg, Freiburg, Germany
| | | | - Jörg Krebs
- Clinic for Anesthesiology and Surgical Intensive Care Medicine, University of Mannheim, Mannheim, Germany
| | - Martin Bentz
- Department of Internal Medicine III, Hospital of Karlsruhe, Karlsruhe, Germany
| | - Victor M. Corman
- Institute of Virology, Charité - University Medicine Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Dzenan Kilalic
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | | | - Philipp M. Lepper
- Department of Internal Medicine V – Pneumology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Lucas Ernst
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hinnerk Wulf
- Department of Anesthesiology and Intensive Care Medicine, Phillips-University Marburg, Marburg, Germany
| | - Alexandra Ulrich
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Manfred Weiss
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Jan Matthias Kruse
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Burkhardt
- Transfusion Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden and German Red Cross Blood Donation Service North-East gGmbH, Dresden, Germany
| | - Rebecca Müller
- Institute of Transfusion Medicine and Immunology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Harald Klüter
- Institute of Transfusion Medicine and Immunology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Michael Schmidt
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg – Hessen, Frankfurt, Germany
| | - Bernd Jahrsdörfer
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Ramin Lotfi
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Markus Rojewski
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Thomas Appl
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg – Hessen, Frankfurt, Germany
| | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
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5
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Jaschke NP, Funk AM, Jonas S, Riffel RM, Sinha A, Wang A, Pählig S, Hofmann M, Altmann H, Von Bonin S, Koch T, Spieth P, Tausche K, Akgün K, Rauner M, Kronstein-Wiedemann R, Odendahl M, Tonn T, Göbel A, Hofbauer LC, Rachner TD. Circulating Dickkopf1 Parallels Metabolic Adaptations and Predicts Disease Trajectories in Patients With COVID-19. J Clin Endocrinol Metab 2022; 107:3370-3377. [PMID: 36071553 PMCID: PMC9494396 DOI: 10.1210/clinem/dgac514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT AND AIMS Coronavirus disease 19 (COVID-19) trajectories show high interindividual variability, ranging from asymptomatic manifestations to fatal outcomes, the latter of which may be fueled by immunometabolic maladaptation of the host. Reliable identification of patients who are at risk of severe disease remains challenging. We hypothesized that serum concentrations of Dickkopf1 (DKK1) indicate disease outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals. METHODS We recruited hospitalized patients with PCR-confirmed SARS-CoV-2 infection and included 80 individuals for whom blood samples from 2 independent time points were available. DKK1 serum concentrations were measured by ELISA in paired samples. Clinical data were extracted from patient charts and correlated with DKK1 levels. Publicly available datasets were screened for changes in cellular DKK1 expression on SARS-CoV-2 infection. Plasma metabolites were profiled by nuclear magnetic resonance spectroscopy in an unbiased fashion and correlated with DKK1 data. Kaplan-Meier and Cox regression analysis were used to investigate the prognostic value of DKK1 levels in the context of COVID-19. RESULTS We report that serum levels of DKK1 predict disease outcomes in patients with COVID-19. Circulating DKK1 concentrations are characterized by high interindividual variability and change as a function of time during SARS-CoV-2 infection, which is linked to platelet counts. We further find that the metabolic signature associated with SARS-CoV-2 infection resembles fasting metabolism and is mirrored by circulating DKK1 abundance. Patients with low DKK1 levels are twice as likely to die from COVID-19 than those with high levels, and DKK1 predicts mortality independent of markers of inflammation, renal function, and platelet numbers. CONCLUSION Our study suggests a potential clinical use of circulating DKK1 as a predictor of disease outcomes in patients with COVID-19. These results require validation in additional cohorts.
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Affiliation(s)
- Nikolai P Jaschke
- Correspondence to: Nikolai P. Jaschke MD, PhD, , Division of Endocrinology & Metabolic Bone Diseases, Department of Medicine III, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Alexander M Funk
- National Center for Tumor Diseases (NCT/UCC), Technische Universität Dresden, Dresden, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sophie Jonas
- Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Romy M Riffel
- Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Anupam Sinha
- Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andrew Wang
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Sophie Pählig
- Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Maura Hofmann
- Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Heidi Altmann
- Department of Medicine I, Technische Universität Dresden, Dresden, Germany
| | - Simone Von Bonin
- Department of Medicine I, Technische Universität Dresden, Dresden, Germany
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine, Technische Universität Dresden, Dresden, Germany
| | - Peter Spieth
- Department of Anesthesiology and Intensive Care Medicine, Technische Universität Dresden, Dresden, Germany
| | - Kristin Tausche
- Department of Medicine I, Technische Universität Dresden, Dresden, Germany
| | - Katja Akgün
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Martina Rauner
- Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Romy Kronstein-Wiedemann
- Experimental Transfusion Medicine, Technische Universität Dresden, Dresden, Germany
- Institute for Transfusion Medicine Dresden, German Red Cross Blood Donation Service North-East, Dresden, Germany
| | - Marcus Odendahl
- Experimental Transfusion Medicine, Technische Universität Dresden, Dresden, Germany
- Institute for Transfusion Medicine Dresden, German Red Cross Blood Donation Service North-East, Dresden, Germany
| | - Torsten Tonn
- Experimental Transfusion Medicine, Technische Universität Dresden, Dresden, Germany
- Institute for Transfusion Medicine Dresden, German Red Cross Blood Donation Service North-East, Dresden, Germany
- Center for Regenerative Therapies Dresden (CRTD), Dresden, Germany
| | - Andy Göbel
- Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Lorenz C Hofbauer
- Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
| | - Tilman D Rachner
- Department of Medicine III & Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany
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6
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Peters L, Spieth P. [67/m-Fever and altered mentation on postoperative day 3 after PPPD : Preparation course anesthesiological intensive care medicine: case 4]. Anaesthesiologie 2022; 71:18-23. [PMID: 35925181 DOI: 10.1007/s00101-022-01167-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] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Affiliation(s)
- L Peters
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Augsburg, Augsburg, Deutschland.
| | - P Spieth
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
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7
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Ball L, Serafini SC, Braune A, Güldner A, Bluth T, Spieth P, Huhle R, Scharffenberg M, Wittenstein J, Uhlig C, Robba C, Schultz MJ, Pelosi P, Gama de Abreu M. Changes in lung aeration and respiratory function after open abdominal surgery: a quantitative magnetic resonance imaging study. Acta Anaesthesiol Scand 2022; 66:944-953. [DOI: 10.1111/aas.14111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/13/2022] [Accepted: 06/13/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Lorenzo Ball
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group University of Genoa Genova Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC) Ospedale Policlinico San Martino, IRCCS per l’Oncologia e le Neuroscienze Genova Italy
- Anesthesia and Intensive Care Amsterdam University Medical Centers, location ‘AMC’ Amsterdam The Netherlands
| | - Simon Corrado Serafini
- Department of Surgical Sciences and Integrated Diagnostics (DISC) Ospedale Policlinico San Martino, IRCCS per l’Oncologia e le Neuroscienze Genova Italy
| | - Anja Braune
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group University of Genoa Genova Italy
| | - Andreas Güldner
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group University of Genoa Genova Italy
| | - Thomas Bluth
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group University of Genoa Genova Italy
| | - Peter Spieth
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group University of Genoa Genova Italy
| | - Robert Huhle
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group University of Genoa Genova Italy
| | - Martin Scharffenberg
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group University of Genoa Genova Italy
| | - Jakob Wittenstein
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group University of Genoa Genova Italy
| | - Christopher Uhlig
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group University of Genoa Genova Italy
| | - Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics (DISC) Ospedale Policlinico San Martino, IRCCS per l’Oncologia e le Neuroscienze Genova Italy
- Anesthesia and Intensive Care Amsterdam University Medical Centers, location ‘AMC’ Amsterdam The Netherlands
| | - Marcus J. Schultz
- Department of Intensive Care Cleveland Clinic Cleveland OH United States of America
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC) Ospedale Policlinico San Martino, IRCCS per l’Oncologia e le Neuroscienze Genova Italy
- Anesthesia and Intensive Care Amsterdam University Medical Centers, location ‘AMC’ Amsterdam The Netherlands
| | - Marcelo Gama de Abreu
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group University of Genoa Genova Italy
- Department of Intensive Care and Resuscitation Anesthesiology Institute
- Department of Outcomes Research Anesthesiology Institute
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8
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Sedghi A, Heubner L, Klimova A, Tiebel O, Pietsch J, Mirus M, Barlinn K, Minx TTTT, Beyer-Westendorf J, Puetz V, Spieth P, Siepmann T. Point of Care Assessment of Direct Oral Anticoagulation in Acute Ischemic Stroke: Protocol for a Prospective Observational Diagnostic Accuracy Study. Thromb Haemost 2022; 122:1954-1962. [PMID: 35672013 PMCID: PMC9626030 DOI: 10.1055/a-1869-7853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background
Treatment of ischemic stroke with recombinant tissue plasminogen activator for intravenous thrombolysis (IVT) must be delivered within a narrow time window after symptom onset. This effective hyperacute treatment can be administered after ruling out active anticoagulation with direct oral anticoagulants (DOACs). Whenever this is impractical, e.g., due to aphasia, plasmatic DOAC levels are measured with a consequent delay in the IVT decision-making process ranging from 30 to 60 minutes of time. This study will test the hypothesis that hyperacute point-of-care assessment of clotting time in the patient's whole blood has sufficient diagnostic accuracy to determine immediately whether stroke patients are pretreated with DOAC.
Methods and Design
This will be a prospective single-center diagnostic accuracy study in 1,850 consecutive acute ischemic stroke patients at a tertiary stroke center in Saxony, Germany. Presence of active anticoagulation with DOAC will be determined by point-of-care quantification of clotting time via whole blood viscoelastic testing (ClotPro) using Russell venom viper and ecarin assay compared with high-performance liquid chromatography-tandem mass spectrometry as the reference standard.
Discussion
Viscoelastic point-of-care assessment of clotting time in whole blood might improve swift delivery of time-sensitive hyperacute treatment with IVT in stroke patients.
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Affiliation(s)
- Annahita Sedghi
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Lars Heubner
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Anna Klimova
- National Center for Tumor Diseases Partner Site Dresden, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Oliver Tiebel
- Institute for Clinical Chemistry and Laboratory Medicine, Medizinische Fakultät Carl Gustav Carus, Dresden, Germany
| | - Jörg Pietsch
- Institute of Forensic Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Martin Mirus
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Jan Beyer-Westendorf
- Department of Internal Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
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9
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Cavaliere F, Allegri M, Apan A, Brazzi L, Carassiti M, Cohen E, DI Marco P, Langeron O, Rossi M, Spieth P, Turnbull D, Weber F. A year in review in Minerva Anestesiologica 2021. Anesthesia, analgesia, and perioperative medicine. Minerva Anestesiol 2022; 88:206-216. [PMID: 35315631 DOI: 10.23736/s0375-9393.22.16429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Massimo Allegri
- Unit of Pain Therapy of Column and Athlete, Policlinic of Monza, Monza-Brianza, Italy.,Italian Pain Group, Milan, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Giresun, Giresun, Turkey
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University Hospital, Rome, Italy
| | - Edmond Cohen
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierangelo DI Marco
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic, and Geriatric Sciences, Faculty of Medicine, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), University Paris-Est Créteil (UPEC), Paris, France
| | - Marco Rossi
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Dresden, Dresden, Germany
| | - David Turnbull
- Department of Anesthetics and Neuro Critical Care, Royal Hallamshire Hospital, Sheffield, UK
| | - Frank Weber
- Department of Anesthesiology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
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10
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Körper S, Weiss M, Zickler D, Wiesmann T, Zacharowski K, Corman VM, Grüner B, Ernst L, Spieth P, Lepper PM, Bentz M, Zinn S, Paul G, Kalbhenn J, Dollinger MM, Rosenberger P, Kirschning T, Thiele T, Appl T, Mayer B, Schmidt M, Drosten C, Wulf H, Kruse JM, Jungwirth B, Seifried E, Schrezenmeier H. Results of the CAPSID randomized trial for high-dose convalescent plasma in patients with severe COVID-19. J Clin Invest 2021; 131:e152264. [PMID: 34464358 DOI: 10.1172/jci152264] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/26/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUNDCOVID-19 convalescent plasma (CCP) has been considered a treatment option for COVID-19. This trial assessed the efficacy of a neutralizing antibody containing high-dose CCP in hospitalized adults with COVID-19 requiring respiratory support or intensive care treatment.METHODSPatients (n = 105) were randomized 1:1 to either receive standard treatment and 3 units of CCP or standard treatment alone. Control group patients with progress on day 14 could cross over to the CCP group. The primary outcome was a dichotomous composite outcome of survival and no longer fulfilling criteria for severe COVID-19 on day 21.ResultsThe primary outcome occurred in 43.4% of patients in the CCP group and 32.7% in the control group (P = 0.32). The median time to clinical improvement was 26 days in the CCP group and 66 days in the control group (P = 0.27). The median time to discharge from the hospital was 31 days in the CCP group and 51 days in the control group (P = 0.24). In the subgroup that received a higher cumulative amount of neutralizing antibodies, the primary outcome occurred in 56.0% of the patients (vs. 32.1%), with significantly shorter intervals to clinical improvement (20 vs. 66 days, P < 0.05) and to hospital discharge (21 vs. 51 days, P = 0.03) and better survival (day-60 probability of survival 91.6% vs. 68.1%, P = 0.02) in comparison with the control group.ConclusionCCP added to standard treatment was not associated with a significant improvement in the primary and secondary outcomes. A predefined subgroup analysis showed a significant benefit of CCP among patients who received a larger amount of neutralizing antibodies.Trial registrationClinicalTrials.gov NCT04433910.FundingBundesministerium für Gesundheit (German Federal Ministry of Health): ZMVI1-2520COR802.
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Affiliation(s)
- Sixten Körper
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
| | - Manfred Weiss
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Wiesmann
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, Marburg, Germany
| | - Kai Zacharowski
- Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Victor M Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Beate Grüner
- Division of Infectious Diseases, University Hospital and Medical Center Ulm, Ulm, Germany
| | - Lucas Ernst
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V - Pneumology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Martin Bentz
- Department of Internal Medicine III, Hospital of Karlsruhe, Karlsruhe, Germany
| | - Sebastian Zinn
- Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Gregor Paul
- Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Klinikum Stuttgart, Stuttgart, Germany
| | - Johannes Kalbhenn
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Kirschning
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University of Heidelberg, University Medical Centre Mannheim, Mannheim, Germany
| | - Thomas Thiele
- Institute of Immunology and Transfusion Medicine, University Hospital Greifswald, Greifswald, Germany
| | - Thomas Appl
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michael Schmidt
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | - Christian Drosten
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Hinnerk Wulf
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, Marburg, Germany
| | - Jan Matthias Kruse
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bettina Jungwirth
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
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11
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Körper S, Weiss M, Zickler D, Wiesmann T, Zacharowski K, Corman VM, Grüner B, Ernst L, Spieth P, Lepper PM, Bentz M, Zinn S, Paul G, Kalbhenn J, Dollinger MM, Rosenberger P, Kirschning T, Thiele T, Appl T, Mayer B, Schmidt M, Drosten C, Wulf H, Kruse JM, Jungwirth B, Seifried E, Schrezenmeier H. Results of the CAPSID randomized trial for high-dose convalescent plasma in patients with severe COVID-19. J Clin Invest 2021. [PMID: 34464358 DOI: 10.1101/2021.05.10.21256192] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/10/2023] Open
Abstract
BACKGROUNDCOVID-19 convalescent plasma (CCP) has been considered a treatment option for COVID-19. This trial assessed the efficacy of a neutralizing antibody containing high-dose CCP in hospitalized adults with COVID-19 requiring respiratory support or intensive care treatment.METHODSPatients (n = 105) were randomized 1:1 to either receive standard treatment and 3 units of CCP or standard treatment alone. Control group patients with progress on day 14 could cross over to the CCP group. The primary outcome was a dichotomous composite outcome of survival and no longer fulfilling criteria for severe COVID-19 on day 21.ResultsThe primary outcome occurred in 43.4% of patients in the CCP group and 32.7% in the control group (P = 0.32). The median time to clinical improvement was 26 days in the CCP group and 66 days in the control group (P = 0.27). The median time to discharge from the hospital was 31 days in the CCP group and 51 days in the control group (P = 0.24). In the subgroup that received a higher cumulative amount of neutralizing antibodies, the primary outcome occurred in 56.0% of the patients (vs. 32.1%), with significantly shorter intervals to clinical improvement (20 vs. 66 days, P < 0.05) and to hospital discharge (21 vs. 51 days, P = 0.03) and better survival (day-60 probability of survival 91.6% vs. 68.1%, P = 0.02) in comparison with the control group.ConclusionCCP added to standard treatment was not associated with a significant improvement in the primary and secondary outcomes. A predefined subgroup analysis showed a significant benefit of CCP among patients who received a larger amount of neutralizing antibodies.Trial registrationClinicalTrials.gov NCT04433910.FundingBundesministerium für Gesundheit (German Federal Ministry of Health): ZMVI1-2520COR802.
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Affiliation(s)
- Sixten Körper
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
| | - Manfred Weiss
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Wiesmann
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, Marburg, Germany
| | - Kai Zacharowski
- Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Victor M Corman
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Beate Grüner
- Division of Infectious Diseases, University Hospital and Medical Center Ulm, Ulm, Germany
| | - Lucas Ernst
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V - Pneumology, Allergology, Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Martin Bentz
- Department of Internal Medicine III, Hospital of Karlsruhe, Karlsruhe, Germany
| | - Sebastian Zinn
- Clinic of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Gregor Paul
- Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Klinikum Stuttgart, Stuttgart, Germany
| | - Johannes Kalbhenn
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Kirschning
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University of Heidelberg, University Medical Centre Mannheim, Mannheim, Germany
| | - Thomas Thiele
- Institute of Immunology and Transfusion Medicine, University Hospital Greifswald, Greifswald, Germany
| | - Thomas Appl
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michael Schmidt
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | - Christian Drosten
- Institute of Virology, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and German Centre for Infection Research, Berlin, Germany
| | - Hinnerk Wulf
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, Marburg, Germany
| | - Jan Matthias Kruse
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, corporate member of Free University Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bettina Jungwirth
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Erhard Seifried
- Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | - Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, and Institute of Transfusion Medicine, and
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12
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von Renesse J, von Bonin S, Held HC, Schneider R, Seifert AM, Seifert L, Spieth P, Weitz J, Welsch T, Meisterfeld R. Energy requirements of long-term ventilated COVID-19 patients with resolved SARS-CoV-2 infection. Clin Nutr ESPEN 2021; 44:211-217. [PMID: 34330468 PMCID: PMC8238638 DOI: 10.1016/j.clnesp.2021.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Abstract
Background & aims Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can rapidly progress into acute respiratory distress syndrome accompanied by multi-organ failure requiring invasive mechanical ventilation and critical care treatment. Nutritional therapy is a fundamental pillar in the management of hospitalized patients. It is broadly acknowledged that overfeeding and underfeeding of intensive care unit (ICU) patients are associated with increased morbidity and mortality. This study aimed to assess the energy demands of long-term ventilated COVID-19 patients using indirect calorimetry and to evaluate the applicability of established predictive equations to estimate their energy expenditure. Methods We performed a retrospective, single-center study in 26 mechanically ventilated COVID-19 patients with resolved SARS-CoV-2 infection in three independent intensive care units. Resting energy expenditure (REE) was evaluated by repetitive indirect calorimetry (IC) measurements. Simultaneously the performance of 12 predictive equations was examined. Patient's clinical data were retrieved from electronic medical charts. Bland-Altman plots were used to assess agreement between measured and calculated REE. Results Mean mREE was 1687 kcal/day and 20.0 kcal relative to actual body weight (ABW) per day (kcal/kg/day). Longitudinal mean mREE did not change significantly over time, although mREE values had a high dispersion (SD of mREE ±487). Obese individuals were found to have significantly increased mREE, but lower energy expenditure relative to their body mass. Calculated REE showed poor agreement with mREE ranging from 33 to 54%. Conclusion Resolution of SARS-CoV-2 infection confirmed by negative PCR leads to stabilization of energy demands at an average 20 kcal/kg in ventilated critically ill patients. Due to high variations in mREE and low agreement with calculated energy expenditure IC remains the gold standard for the guidance of nutritional therapy.
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Affiliation(s)
- Janusz von Renesse
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany
| | - Simone von Bonin
- Department of Medicine I, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany
| | - Hanns-Christoph Held
- University Centre of Surgery Intensive Care Unit, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany
| | - Ralph Schneider
- Department of Medicine I, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany
| | - Adrian M Seifert
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany
| | - Lena Seifert
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany
| | - Thilo Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany
| | - Ronny Meisterfeld
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany; University Centre of Surgery Intensive Care Unit, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany.
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13
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Rodionov RN, Biener A, Spieth P, Achleitner M, Hölig K, Aringer M, Mingrone G, Corman VM, Drosten C, Bornstein SR, Tonn T, Kolditz M. Potential benefit of convalescent plasma transfusions in immunocompromised patients with COVID-19. The Lancet Microbe 2021; 2:e138. [PMID: 33817676 PMCID: PMC8009633 DOI: 10.1016/s2666-5247(21)00030-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Roman N Rodionov
- Medical Clinical III, University Hospital Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Anne Biener
- Medical Clinical III, University Hospital Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Peter Spieth
- Anaesthesiology, University Hospital Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Martin Achleitner
- Medical Clinical III, University Hospital Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Kristina Hölig
- Medical Clinical I, University Hospital Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Martin Aringer
- Medical Clinical III, University Hospital Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Geltrude Mingrone
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | - Victor M Corman
- Charité-Universitätsmedizin Berlin Institute of Virology, Berlin, Germany
| | - Christian Drosten
- Charité-Universitätsmedizin Berlin Institute of Virology, Berlin, Germany
| | - Stefan R Bornstein
- Medical Clinical III, University Hospital Carl Gustav Carus of TU Dresden, Dresden, Germany.,Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | - Torsten Tonn
- Transfusion Medicine, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Institute for Transfusion Medicine, German Red Cross Blood Donation Service North-East, 01307 Dresden, Germany
| | - Martin Kolditz
- Medical Clinical I, University Hospital Carl Gustav Carus of TU Dresden, Dresden, Germany
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14
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Siepmann T, Sedghi A, Simon E, Winzer S, Barlinn J, De With K, Mirow L, Wolz M, Gruenewald T, Schroettner P, von Bonin S, Pallesen LP, Rosengarten B, Schubert J, Lohmann T, Machetanz J, Spieth P, Koch T, Bornstein S, Reichmann H, Puetz V, Barlinn K. Abstract P598: Increased Risk of Acute Stroke in Patients With Severe Course of Covid-19: A Multicenter Study and Meta-Analysis. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Recent studies linked coronavirus disease 2019 (COVID-19) to thromboembolic complications likely mediated by increased blood coagulability and inflammatory endothelial impairment.
Objective:
We aimed to assess the risk of acute stroke in patients with COVID-19 related to clinical severity of the disease.
Methods:
We conducted an observational multicenter cohort study in four participating hospitals in Saxony, Germany to characterize consecutive patients with laboratory-confirmed COVID-19 who experienced acute stroke during hospitalization. Furthermore, we performed a systematic review using PubMed/MEDLINE, EMBASE, Cochrane Library and bibliographies of identified articles following PRISMA guidelines including data from observational studies of acute stroke in COVID-19 patients. Data was extracted by two independent reviewers and pooled with multicenter data to calculate risk ratios (RR) and 95% confidence intervals (95%CIs) for acute stroke related to COVID-19 severity using random effects model. Between-study heterogeneity was assessed using Cochran’s Q and I
2
-statistics. PROSPERO identifier
:
CRD42020187194.
Results:
Of 165 patients hospitalized for COVID-19 (49.1% males, median age 67 [57-79], 72.1% severe or critical) included in the multicenter study, overall stroke rate was 4.2% (95%CI: 1.9-8.7). Systematic literature search identified two observational studies involving 576 patients that were eligible for meta-analysis. Among 741 pooled COVID-19 patients overall stroke rate was 2.9% (95%CI: 1.9-4.5). Risk of acute stroke was increased for patients with severe compared to non-severe COVID-19 (RR 4.12, 95%CI 1.7-10.25; p=0.002) with no evidence of heterogeneity (I
2
=0%, p=0.82).
Conclusions:
Synthesized analysis of data from our multicenter study and previously published cohorts demonstrate that severity of COVID-19 is associated with an increased risk of acute stroke, underscoring the necessity of neurological monitoring in patients infected with SARS-CoV-2.
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Affiliation(s)
- Timo Siepmann
- Neurology, Univ Hosp Carl Gustav Carus, Dresden, Germany
| | | | - Erik Simon
- Neurology, Univ Hosp Carl Gustav Carus, Dresden, Germany
| | - Simon Winzer
- Neurology, Univ Hosp Carl Gustav Carus, Dresden, Germany
| | | | - Katja De With
- Infectious Diseases, Univ Hosp Carl Gustav Carus, Dresden, Germany
| | - Lutz Mirow
- General and Visceral Surgery, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Martin Wolz
- Neurology, Elblandklinikum Meißen, Meißen, Germany
| | - Thomas Gruenewald
- Infectious Diseases / Tropical Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | | | - Simone von Bonin
- Internal Medicine, Univ Hosp Carl Gustav Carus, Dresden, Germany
| | | | | | - Joerg Schubert
- Hematology and Oncology, Elblandklinikum Riesa, Riesa, Germany
| | - Tobias Lohmann
- Internal Medicine, Städtisches Klinikum Dresden, Dresden, Germany
| | | | - Peter Spieth
- Anaesthesiology and Intensive Care Medicine, Univ Hosp Carl Gustav Carus, Dresden, Germany
| | - Thea Koch
- Anaesthesiology and Intensive Care Medicine, Univ Hosp Carl Gustav Carus, Dresden, Germany
| | - Stefan Bornstein
- Internal Medicine III, Univ Hosp Carl Gustav Carus, Dresden, Germany
| | | | - Volker Puetz
- Neurology, Univ Hosp Carl Gustav Carus, Dresden, Germany
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15
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Siepmann T, Sedghi A, Barlinn J, de With K, Mirow L, Wolz M, Gruenewald T, Helbig S, Schroettner P, Winzer S, von Bonin S, Moustafa H, Pallesen LP, Rosengarten B, Schubert J, Gueldner A, Spieth P, Koch T, Bornstein S, Reichmann H, Puetz V, Barlinn K. Association of history of cerebrovascular disease with severity of COVID-19. J Neurol 2021; 268:773-784. [PMID: 32761508 PMCID: PMC7407424 DOI: 10.1007/s00415-020-10121-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine whether a history of cerebrovascular disease (CVD) increases risk of severe coronavirus disease 2019 (COVID-19). METHODS In a retrospective multicenter study, we retrieved individual data from in-patients treated March 1 to April 15, 2020 from COVID-19 registries of three hospitals in Saxony, Germany. We also performed a systematic review and meta-analysis following PRISMA recommendations using PubMed, EMBASE, Cochrane Library databases and bibliographies of identified papers (last search on April 11, 2020) and pooled data with those deriving from our multicenter study. Of 3762 records identified, 11 eligible observational studies of laboratory-confirmed COVID-19 patients were included in quantitative data synthesis. Risk ratios (RR) of severe COVID-19 according to history of CVD were pooled using DerSimonian and Laird random effects model. Between-study heterogeneity was assessed using Cochran's Q and I2-statistics. Severity of COVID-19 according to definitions applied in included studies was the main outcome. Sensitivity analyses were conducted for clusters of studies with equal definitions of severity. RESULTS Pooled analysis included data from 1906 laboratory-confirmed COVID-19 patients (43.9% females, median age ranging from 39 to 76 years). Patients with previous CVD had higher risk of severe COVID-19 than those without [RR 2.07, 95% confidence interval (CI) 1.52-2.81; p < 0.0001]. This association was also observed in clusters of studies that defined severe manifestation of the disease by clinical parameters (RR 1.44, 95% CI 1.22-1.71; p < 0.0001), necessity of intensive care (RR 2.79, 95% CI 1.83-4.24; p < 0.0001) and in-hospital death (RR 2.18, 95% CI 1.75-2.7; p < 0.0001). CONCLUSION A history of CVD might constitute an important risk factor of unfavorable clinical course of COVID-19 suggesting a need of tailored infection prevention and clinical management strategies for this population at risk.
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Affiliation(s)
- Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Annahita Sedghi
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Katja de With
- Division of Infectious Diseases, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lutz Mirow
- Department of General and Visceral Surgery, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Martin Wolz
- Department of Neurology, Elblandklinikum Meißen, Meißen, Germany
| | - Thomas Gruenewald
- Department of Infectious Diseases/Tropical Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Sina Helbig
- Division of Infectious Diseases, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Percy Schroettner
- Department of Virology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Simon Winzer
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Simone von Bonin
- Department of Virology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Haidar Moustafa
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | | | - Joerg Schubert
- Department of Hematology and Oncology, Elblandklinikum Riesa, Riesa, Germany
| | - Andreas Gueldner
- Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter Spieth
- Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thea Koch
- Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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16
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Cavaliere F, Allegri M, Apan A, Calderini E, Carassiti M, Cohen E, Coluzzi F, DI Marco P, Langeron O, Rossi M, Spieth P, Turnbull D. A year in review in Minerva Anestesiologica 2020. Anesthesia, analgesia, and perioperative medicine. Minerva Anestesiol 2021; 87:253-265. [PMID: 33599441 DOI: 10.23736/s0375-9393.21.15570-1] [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: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome Italy -
| | - Massimo Allegri
- Unit of Pain Therapy of Column and Athlete, Policlinic of Monza, Monza, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Giresun, Giresun, Turkey
| | - Edoardo Calderini
- Unit of Women-Child Anesthesia and Intensive Care, Maggiore Polyclinic Hospital, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University Hospital, Rome, Italy
| | - Edmond Cohen
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Polo Pontino, Latina, Italy.,Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, Rome, Italy
| | - Pierangelo DI Marco
- Department of Internal Anesthesiologic and Cardiovascular Clinical Studies, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), University Paris-Est Créteil (UPEC), Paris, France
| | - Marco Rossi
- Institute of Anesthesia and Intensive Care, Sacred Heart Catholic University, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Dresden, Germany
| | - David Turnbull
- Department of Anaesthetics and Neuro Critical Care, Royal Hallamshire Hospital, Sheffield, UK
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17
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Cavaliere F, Allegri M, Apan A, Calderini E, Carassiti M, Cohen E, Coluzzi F, Di Marco P, Langeron O, Rossi M, Spieth P, Turnbull D. A year in review in Minerva Anestesiologica 2019. Anesthesia, analgesia, and perioperative medicine. Minerva Anestesiol 2021; 86:225-239. [PMID: 32118384 DOI: 10.23736/s0375-9393.20.14424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Department of Cardiovascular and Thoracic Sciences, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Massimo Allegri
- Unità Operativa Terapia del Dolore della Colonna e dello Sportivo, Policlinic of Monza, Monza, Italy.,Italian Pain Group, Milan, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Giresun, Giresun, Turkey
| | - Edoardo Calderini
- Unit of Women-Child Anesthesia and Intensive Care, Maggiore Polyclinic Hospital, Ca' Granda IRCCS and Foundation, Milan, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University Hospital, Rome, Italy
| | - Edmond Cohen
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Flaminia Coluzzi
- Unit of Anesthesia, Department of Medical and Surgical Sciences and Biotechnologies, Intensive Care and Pain Medicine, Sapienza University, Rome, Italy
| | - Pierangelo Di Marco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri Mondor University Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Marco Rossi
- Institute of Anesthesia and Intensive Care, Sacred Heart Catholic University, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Dresden, Dresden, Germany
| | - David Turnbull
- Department of Anaesthetics and Neuro Critical Care, Royal Hallamshire Hospital, Sheffield, UK
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18
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Siepmann T, Sedghi A, Simon E, Winzer S, Barlinn J, de With K, Mirow L, Wolz M, Gruenewald T, Schroettner P, von Bonin S, Pallesen LP, Rosengarten B, Schubert J, Lohmann T, Machetanz J, Spieth P, Koch T, Bornstein S, Reichmann H, Puetz V, Barlinn K. Increased risk of acute stroke among patients with severe COVID-19: a multicenter study and meta-analysis. Eur J Neurol 2021; 28:238-247. [PMID: 32920964 DOI: 10.1111/ene.14535] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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: 06/01/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Recent observations linked coronavirus disease 2019 (COVID-19) to thromboembolic complications possibly mediated by increased blood coagulability and inflammatory endothelial impairment. We aimed to define the risk of acute stroke in patients with severe and non-severe COVID-19. METHODS We performed an observational, multicenter cohort study in four participating hospitals in Saxony, Germany to characterize consecutive patients with laboratory-confirmed COVID-19 who experienced acute stroke during hospitalization. Furthermore, we conducted a systematic review using PubMed/MEDLINE, Embase, Cochrane Library and bibliographies of identified papers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines including data from observational studies of acute stroke in COVID-19 patients. Data were extracted by two independent reviewers and pooled with multicenter data to calculate risk ratios (RRs) and 95% confidence intervals (95% CIs) for acute stroke related to COVID-19 severity using a random-effects model. Between-study heterogeneity was assessed using Cochran's Q and I2 statistics. International Prospective Register of Systematic Reviews registration number: CRD42020187194. RESULTS Of 165 patients hospitalized for COVID-19 (49.1% males, median age = 67 years [57-79 years], 72.1% severe or critical) included in the multicenter study, overall stroke rate was 4.2% (95% CI: 1.9-8.7). Systematic literature search identified two observational studies involving 576 patients that were eligible for meta-analysis. Amongst 741 pooled COVID-19 patients, overall stroke rate was 2.9% (95% CI: 1.9-4.5). Risk of acute stroke was increased for patients with severe compared to non-severe COVID-19 (RR = 4.18, 95% CI: 1.7-10.25; P = 0.002) with no evidence of heterogeneity (I2 = 0%, P = 0.82). CONCLUSIONS Synthesized analysis of data from our multicenter study and previously published cohorts indicates that severity of COVID-19 is associated with an increased risk of acute stroke.
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Affiliation(s)
- T Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - A Sedghi
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - E Simon
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - S Winzer
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - J Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - K de With
- Division of Infectious Diseases, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - L Mirow
- Department of General and Visceral Surgery, Klinikum Chemnitz gGmbH, Chemnitz
| | - M Wolz
- Department of Neurology, Elblandklinikum Meissen, Meissen
| | - T Gruenewald
- Department of Infectious Diseases/Tropical Medicine, Klinikum Chemnitz gGmbH, Chemnitz
| | - P Schroettner
- Department of Virology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - S von Bonin
- Department of Internal Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - L-P Pallesen
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - B Rosengarten
- Department of Neurology, Klinikum Chemnitz gGmbH, Chemnitz
| | - J Schubert
- Department of Hematology and Oncology, Elblandklinikum Riesa, Riesa
| | - T Lohmann
- Department of Internal Medicine, Städtisches Klinikum Dresden, Dresden
| | - J Machetanz
- Department of Neurology, Städtisches Klinikum Dresden, Dresden
| | - P Spieth
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - T Koch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - S Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - H Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - V Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - K Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden
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19
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Abstract
Neurological outcome and quality of live are of uttermost interest in survivors of cardiac arrest. Assuming acceptable rates of return of spontaneous circulation, the long-term effects on neurological function and quality of live after cardiopulmonary resuscitation remain unsatisfactory. Extracorporeal cardiopulmonary resuscitation (eCPR) can reduce low-flow times and therefore provide adequate cerebral tissue perfusion and oxygenation. This may improve favorable outcomes after cardiac arrest. Due to the risk of procedure related complications and ethical issues, this technique should be only performed in selected patients by specially trained and experienced teams. In this review we aimed at providing an insight into the sparse evidence in this field and discussing ethical issues associated with the use of eCPR.
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Affiliation(s)
- Christopher Lotz
- Department of Anesthesia and Critical Care, University of Würzburg, Würzburg, Germany
| | - Ralf M Muellenbach
- Department of Anesthesia and Critical Care, Städtisches Klinikum Kassel, Kassel, Germany
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Dresden, Dresden, Germany -
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20
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Güldner A, Spieth P. [52-year-old female with community-acquired pneumonia, acute respiratory distress syndrome : Preparation for the medical specialist examination: Part 25]. Anaesthesist 2020; 68:194-198. [PMID: 30989295 DOI: 10.1007/s00101-019-0580-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Güldner
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - P Spieth
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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21
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Cavaliere F, Allegri M, Apan A, Calderini E, Carassiti M, Coluzzi F, Di Marco P, Langeron O, Rossi M, Spieth P. A year in review in Minerva Anestesiologica 2018. Minerva Anestesiol 2020; 85:206-220. [PMID: 30773000 DOI: 10.23736/s0375-9393.19.13597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy -
| | - Massimo Allegri
- Unità Operativa Terapia del Dolore della Colonna e dello Sportivo, Policlinic of Monza, Monza, Italy.,Italian Pain Group, Milan, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Edoardo Calderini
- Unit of Women-Child Anesthesia and Intensive Care, IRCCS Cà Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, University Hospital School of Medicine Campus Bio-Medico of Rome, Rome, Italy
| | - Flaminia Coluzzi
- Unit of Anesthesia, Department of Medical and Surgical Sciences and Biotechnologies, Intensive Care and Pain Medicine, Sapienza University, Rome, Italy
| | - Pierangelo Di Marco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesiology and Intensive Care, Pitié-Salpètrière Hospital, Sorbonne University Paris, Paris, France
| | - Marco Rossi
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Dresden, Germany
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22
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Cavaliere F, Allegri M, Apan A, Calderini E, Carassiti M, Coluzzi F, DI Marco P, Langeron O, Rossi M, Spieth P. A year in review in Minerva Anestesiologica 2017. Minerva Anestesiol 2019; 84:269-282. [PMID: 29493180 DOI: 10.23736/s0375-9393.18.12714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy -
| | - Massimo Allegri
- Department of Medicine and Surgery, SIMPAR Group, University of Parma, Parma, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Edoardo Calderini
- Unit of Women-Child Anesthesia and Intensive Care, IRCCS Cà Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, University Hospital School of Medicine Campus Bio-Medico of Rome, Rome, Italy
| | - Flaminia Coluzzi
- Unit of Anesthesia, Department of Medical and Surgical Sciences and Biotechnologies, Intensive Care and Pain Medicine Sapienza University, Rome, Italy
| | - Pierangelo DI Marco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesiology and Intensive Care, Pitié-Salpètrière Hospital, Sorbonne University Paris, Paris, France
| | - Marco Rossi
- Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Dresden, Germany
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23
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Chiumello D, Sferrazza Papa GF, Artigas A, Bouhemad B, Grgic A, Heunks L, Markstaller K, Pellegrino GM, Pisani L, Rigau D, Schultz MJ, Sotgiu G, Spieth P, Zompatori M, Navalesi P. ERS statement on chest imaging in acute respiratory failure. Eur Respir J 2019; 54:13993003.00435-2019. [PMID: 31248958 DOI: 10.1183/13993003.00435-2019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/16/2019] [Indexed: 12/17/2022]
Abstract
Chest imaging in patients with acute respiratory failure plays an important role in diagnosing, monitoring and assessing the underlying disease. The available modalities range from plain chest X-ray to computed tomography, lung ultrasound, electrical impedance tomography and positron emission tomography. Surprisingly, there are presently no clear-cut recommendations for critical care physicians regarding indications for and limitations of these different techniques.The purpose of the present European Respiratory Society (ERS) statement is to provide physicians with a comprehensive clinical review of chest imaging techniques for the assessment of patients with acute respiratory failure, based on the scientific evidence as identified by systematic searches. For each of these imaging techniques, the panel evaluated the following items: possible indications, technical aspects, qualitative and quantitative analysis of lung morphology and the potential interplay with mechanical ventilation. A systematic search of the literature was performed from inception to September 2018. A first search provided 1833 references. After evaluating the full text and discussion among the committee, 135 references were used to prepare the current statement.These chest imaging techniques allow a better assessment and understanding of the pathogenesis and pathophysiology of patients with acute respiratory failure, but have different indications and can provide additional information to each other.
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Affiliation(s)
- Davide Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze della Salute, Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy
| | | | - Antonio Artigas
- Corporacion Sanitaria, Universitaria Parc Tauli, CIBER de Enfermedades Respiratorias Autonomous University of Barcelona, Sabadell, Spain.,Intensive Care Dept, University Hospitals Sagrado Corazon - General de Cataluna, Quiron Salud, Barcelona-Sant Cugat del Valles, Spain
| | - Belaid Bouhemad
- Service d'Anesthésie - Réanimation, Université Bourgogne - Franche Comtè, lncumr 866L, Dijon, France
| | - Aleksandar Grgic
- Dept of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Leo Heunks
- Dept of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Klaus Markstaller
- Dept of Anesthesia, General Intensive Care Medicine and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | - Giulia M Pellegrino
- Dipartimento di Scienze della Salute, Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milan, Italy.,Casa di Cura del Policlinico, Dipartimento di Scienze Neuroriabilitative, Milan, Italy
| | - Lara Pisani
- Respiratory and Critical Care Unit, Alma Mater Studiorum, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | | | - Marcus J Schultz
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Peter Spieth
- Dept of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany
| | | | - Paolo Navalesi
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, University of Magna Graecia, Catanzaro, Italy
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24
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Abstract
Transfusions of blood and blood products are live-saving, but complications may be fatal. Transfusion related lung injury (TRALI) is rare and pathophysiology not yet entirely understood. Diagnosis is difficult due to the usually life-threatening circumstances associated with transfusions and underlying diseases. In this mini-review article, we introduce two cases of TRALI to discuss the problems and controversies associated with different definitions, epidemiology, pathophysiology, blood products, diagnosis, and treatment. Future directions in the field are highlighted.
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Affiliation(s)
- Maria Theresa Voelker
- Department of Anesthesiology and Critical Care Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Dresden, Germany
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25
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Cavaliere F, Albaiceta GM, Biancofiore G, Bignami E, DE Robertis E, Giannini A, Grasso S, Scolletta S, Spieth P, Taccone FS, Terragni P. A year in review in Minerva Anestesiologica 2016. Critical Care. Experimental and clinical studies. Minerva Anestesiol 2019; 83:108-120. [PMID: 28106352 DOI: 10.23736/s0375-9393.17.11904-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, Sacro Cuore Catholic University, "A. Gemelli" Policlinic, Rome, Italy -
| | - Guillermo M Albaiceta
- Department of Functional Biology, Physiology Area, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Gianni Biancofiore
- Anestesia and Critical Care for Organ Transplantation, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Elena Bignami
- Cardiovascular Anesthesia and Intensive Care Cardiac Surgery, Vita-Salute University, San Raffaele Hospital, Milan, Italy
| | - Edoardo DE Robertis
- Anaesthesia and Intensive Care Neurosciences, Reproductive Sciences and Odontostomatology, University of Napoli Federico II, Naples, Italy
| | - Alberto Giannini
- Pediatric Intensive Care Unit Fondazione IRCCS Ca' Granda, Maggiore Policlinico Hospital, Milan, Italy
| | - Salvatore Grasso
- Department of Emergency and Organ Transplantation (DETO), Section of Anesthesiology and Intensive Care, Aldo Moro University, Bari, Italy
| | - Sabino Scolletta
- Department of Medical Biotechnology, Anesthesia and Intensive Care, University of Siena, Siena, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Dresden, Germany
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Pierpaolo Terragni
- AOU Sassari, Unit of Anesthesia and Intensive Care, Department of Medical, Surgical and Microsurgical Sciences, Università di Sassari, Sassari, Italy
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Joshi J, Spieth P, Patel A. Cell cultures and endophytes from Indian plants as sources for antimicrobials. CHEM-ING-TECH 2018. [DOI: 10.1002/cite.201855332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J. Joshi
- FH Bielefeld University of Applied Sciences; Department of Engineering and Mathematics; Interaktion 1 33619 Bielefeld Germany
| | - P. Spieth
- FH Bielefeld University of Applied Sciences; Department of Engineering and Mathematics; Interaktion 1 33619 Bielefeld Germany
| | - A. Patel
- FH Bielefeld University of Applied Sciences; Department of Engineering and Mathematics; Interaktion 1 33619 Bielefeld Germany
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Ball L, Braune A, Spieth P, Herzog M, Chandrapatham K, Hietschold V, Schultz MJ, Patroniti N, Pelosi P, Gama de Abreu M. Magnetic Resonance Imaging for Quantitative Assessment of Lung Aeration: A Pilot Translational Study. Front Physiol 2018; 9:1120. [PMID: 30150943 PMCID: PMC6099446 DOI: 10.3389/fphys.2018.01120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/25/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Computed tomography is the gold standard for lung aeration assessment, but exposure to ionizing radiation limits its application. We assessed the ability of magnetic resonance imaging (MRI) to detect changes in lung aeration in ex vivo isolated swine lung and the potential of translation of the findings to human MRI scans. Methods: We performed MRI scans in 11 isolated non-injured and injured swine lungs, as well as 6 patients both pre- and post-operatively. Images were obtained using a 1.5 T MRI scanner, with T1 – weighted volumetric interpolated breath-hold examination (VIBE) and T2 – weighted half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences. We scanned swine lungs, with reference samples of water and muscle, at different airway pressure levels: 0, 40, 10, 2 cmH2O. We investigated the relations between MRI signal intensity and both lung density and gas content fraction. We analyzed patients’ images according to the findings of the ex vivo model. Results: In the ex vivo samples, the lung T1 – VIBE signal intensity normalized to water or muscle reference signal correlated with lung density (r2 = 0.98). Thresholds for poorly and non-aerated lung tissue, expressed as MRI intensity attenuation factor compared to the deflated lung, were estimated as 0.70 [95% CI: 0.65–0.74] and 0.28 [95% CI: 0.27–0.30], respectively. In patients, dorsal versus ventral regions had a higher MRI signal intensity both pre- and post-operatively (p = 0.031). Comparing post- versus pre-operative scans, lung volume decreased (p = 0.028), while the following increased: MRI signal intensity in ventral (p = 0.043) and dorsal (p < 0.0001) regions, and percentages of non-aerated (p = 0.028) and poorly aerated tissue volumes (p = 0.028). Conclusion: Magnetic resonance imaging signal intensity is a function of lung density, decreasing linearly with increasing gas content. Lung MRI might be useful for estimating lung aeration. Compared to CT, this technique is radiation-free but requires a longer acquisition time and has a lower spatial resolution.
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Affiliation(s)
- Lorenzo Ball
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Surgical Sciences and Integrated Diagnostics, Università degli Studi di Genova, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy.,Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anja Braune
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter Spieth
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Moritz Herzog
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Karthikka Chandrapatham
- Department of Surgical Sciences and Integrated Diagnostics, Università degli Studi di Genova, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy
| | - Volker Hietschold
- Department of Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marcus J Schultz
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nicolò Patroniti
- Department of Surgical Sciences and Integrated Diagnostics, Università degli Studi di Genova, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, Università degli Studi di Genova, Genoa, Italy.,Ospedale Policlinico San Martino, Genoa, Italy
| | - Marcelo Gama de Abreu
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Chiumello D, Allegri M, Cavaliere F, De Cosmo G, Iohom G, Langeron O, Apan A, Spieth P, Capogna G. A year in review in Minerva Anestesiologica 2014. Minerva Anestesiol 2015; 81:238-249. [PMID: 25650560] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- D Chiumello
- Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del dolore, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italia
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29
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Chiumello D, Allegri M, Cavaliere F, De Cosmo G, Iohom G, Langeron O, Apan A, Spieth P, Capogna G. A year in review in Minerva Anestesiologica 2014. Minerva Anestesiol 2015:R02Y9999N00A150013. [PMID: 25612236] [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: 06/04/2023]
Affiliation(s)
- D Chiumello
- Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del dolore,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italia
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Haase J, Hammermüller S, Beilicke A, Spieth P, Buchloh D, Haska S, Noreikat K, Muders T, Reske A, Wrigge H. 0896. Temporal changes in tidal recruitment compared to histologic outcome in experimental acute respiratory distress syndrome. Intensive Care Med Exp 2014. [PMCID: PMC4796188 DOI: 10.1186/2197-425x-2-s1-o22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Patel A, Spieth P, Bednarz H, Niehaus K, Lohse R. Können Endophyten eines tropischen Baumes Bioinsektizide produzieren? CHEM-ING-TECH 2014. [DOI: 10.1002/cite.201450062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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32
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Chiumello D, Allegri M, Cavaliere F, De Cosmo G, Iohom G, Langeron O, Apan A, Spieth P, Capogna G. A year in review in Minerva Anestesiologica 2013. Minerva Anestesiol 2014; 80:266-280. [PMID: 24500141] [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] [Indexed: 06/03/2023]
Abstract
BACKGROUND We organized a training program for oral fiber optic intubation (FOI) under conscious sedation. The efficacy of the program was evaluated by comparing the performances of experts and novices. METHODS The training procedure was divided into two sessions: a theoretical session on difficult airways, the fiber optic bronchoscope (FOB), remifentanil, topical anesthesia and patient interactions; and a session involving simulations of the FOI technique on dummies. For in vivo FOI, we enrolled patients requiring orotracheal intubation for elective surgery. Electrocardiograms, mean arterial pressure was railroaded over the fiberscope, and tracheal intubati6 and 7) FOIs, respectively, joined the study. To reach ±23 bpm, P=0.02), and RR was decreased (from 16±3 to 12±4 bpm, P<0.05). No differences were recorded between the experts and less-experienced anesthesiologists. The average duration of FOI was 3.3±2.0 min for experts and 4.2±2.4 min for novices (P=0.03). Procedures were successful in both groups, with patients in each group being equally satisfied with the procedures. CONCLUSION This study highlights the importance of a structured FOI training program, demonstrating that it is possible to learn to perform FOI proficiently by practicing on dummies.
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Affiliation(s)
- D Chiumello
- Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del dolore, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italia -
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Fanelli V, Spieth P, Zhang H. Forced oscillation technique: an alternative tool to define the optimal PEEP? Intensive Care Med 2011; 37:1235-7. [PMID: 21455749 DOI: 10.1007/s00134-011-2215-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
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34
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Carvalho A, Spieth P, Pelosi P, Neykova B, Heller A, Koch T, de Abreu MG. Pressure support ventilation improves oxygenation by redistribution of pulmonary blood flow in experimental lung injury. Crit Care 2008. [PMCID: PMC4088651 DOI: 10.1186/cc6501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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35
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de Abreu MG, Quelhas AD, Spieth P, Bräuer G, Knels L, Kasper M, Pino AV, Bleyl JU, Hübler M, Bozza F, Salluh J, Kuhlisch E, Giannella-Neto A, Koch T. Comparative effects of vaporized perfluorohexane and partial liquid ventilation in oleic acid-induced lung injury. Anesthesiology 2006; 104:278-89. [PMID: 16436847 DOI: 10.1097/00000542-200602000-00013] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND It is currently not known whether vaporized perfluorohexane is superior to partial liquid ventilation (PLV) for therapy of acute lung injury. In this study, the authors compared the effects of both therapies in oleic acid-induced lung injury. METHODS Lung injury was induced in 30 anesthetized and mechanically ventilated pigs by means of central venous infusion of oleic acid. Animals were assigned to one of the following groups: (1) control or gas ventilation (GV), (2) 2.5% perfluorohexane vapor, (3) 5% perfluorohexane vapor, (4) 10% perfluorohexane vapor, or (5) PLV with perfluorooctane (30 ml/kg). Two hours after randomization, lungs were recruited and positive end-expiratory pressure was adjusted to obtain minimal elastance. Ventilation was continued during 4 additional hours, when animals were killed for lung histologic examination. RESULTS Gas exchange and elastance were comparable among vaporized perfluorohexane, PLV, and GV before the open lung approach was used and improved in a similar fashion in all groups after positive end-expiratory pressure was adjusted to optimal elastance (P < 0.05). A similar behavior was observed in functional residual capacity (FRC) in animals treated with vaporized perfluorohexane and GV. Lung resistance improved after recruitment (P < 0.05), but values were higher in the 10% perfluorohexane and PLV groups as compared with GV (P < 0.05). Interestingly, positive end-expiratory pressure values required to obtain minimal elastance were lower with 5% perfluorohexane than with PLV and GV (P < 0.05). In addition, diffuse alveolar damage was significantly lower in the 5% and 10% perfluorohexane vapor groups as compared with PLV and GV (P < 0.05). CONCLUSIONS Although the use of 5% vaporized perfluorohexane permitted the authors to reduce pressures needed to stabilize the lungs and was associated with better histologic findings than were PLV and GV, none of these perfluorocarbon therapies improved gas exchange or lung mechanics as compared with GV.
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Affiliation(s)
- Marcelo Gama de Abreu
- Clinic of Anesthesiology and Intensive Care Medicine, University Clinic Carl Gustav Carus, Technical University Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
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