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Mur L, Annon-Eberharter N, Gombos P, Wald M. Effect of additional dead space using end-tidal CO2 measurement on ventilating preterm infants: An experimental study. Technol Health Care 2024; 32:779-785. [PMID: 37483034 PMCID: PMC10977419 DOI: 10.3233/thc-230195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/08/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Dead space is the part of the airway where no gas exchange takes place. Any increase in dead space volume has a proportional effect on the required tidal volume and thus on the risk of ventilation-induced lung injury. Inserts that increase dead space are therefore not used in small preterm infants. This includes end-tidal CO2 measurement. OBJECTIVE The aim of this study was to investigate the effect of the end-tidal CO2 measurement adapter on ventilation. METHODS In an experimental setup, an end-tidal CO2 measurement adapter, three different pneumotachographs (PNT-A, PNT-B, PNT-Neo), and a closed suction adapter were combined in varying set-ups. The time required for CO2 elimination by a CO2-flooded preterm infant test lung was measured. RESULTS PNT-A prolonged CO2 elimination time by 0.9 s (+3.3%), Neo-PNT by 3.2 s (+11.6%) and PNT-B by 9.0 s (+32.7%). The end-tidal CO2 measurement adapter prolonged the elimination time by an additional second without the pneumotachograph (+3.6%) and in combination with PNT-A (+3.1%) and PNT-Neo (+3.1%). In conjunction with PNT-B, the end-tidal CO2 measurement adapter reduced the elimination time by 0.3 seconds (-1%). The use of a closed suction adaptor increased the CO2 elimination time by a further second with PNT-Neo (+3.1%) and by an additional two seconds with no flow sensor (+6.9%), with PNT-A (+6.4%) and with PNT-B (+5.5%). CONCLUSION The flow sensor had the greatest influence on ventilatory effort, while end-tidal CO2 measurement had only a moderate effect. The increased ventilatory effort levied by the CO2 measurement was dependent on the flow sensor selected. The use of closed suctioning more negatively impacted ventilatory effort than did end-tidal CO2 measurement.
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Affiliation(s)
- Linda Mur
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Natalee Annon-Eberharter
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Petra Gombos
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical Private University, Salzburg, Austria
| | - Martin Wald
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical Private University, Salzburg, Austria
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Furthner D, Lukas A, Schneider AM, Mörwald K, Maruszczak K, Gombos P, Gomahr J, Steigleder-Schweiger C, Weghuber D, Pixner T. The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps. Nutrients 2021; 13:nu13103558. [PMID: 34684559 PMCID: PMC8537759 DOI: 10.3390/nu13103558] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (<18 years old) and a mixed age population (paediatric and adult) with T1DM published in the last 10 years was performed. Conclusion: Only a small number of studies with a very low number of participants and high degree of heterogeneity was identified. While all studies concluded that additional bolus insulin for (high) fat and (high) protein is necessary, no consensus on when dietary fat and/or protein should be taken into calculation and no unified algorithm for insulin therapy in this context exists. A prolonged postprandial observation time is necessary to improve individual metabolic control. Further studies focusing on a stratified paediatric population to create a safe and effective algorithm, taking fat and protein into account, are necessary.
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Affiliation(s)
- Dieter Furthner
- Department of Paediatric and Adolescent Medicine, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria; (D.F.); (A.L.); (T.P.)
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
| | - Andreas Lukas
- Department of Paediatric and Adolescent Medicine, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria; (D.F.); (A.L.); (T.P.)
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
| | - Anna Maria Schneider
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Katharina Mörwald
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Katharina Maruszczak
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Petra Gombos
- Department of Paediatric and Adolescent Surgery, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Julian Gomahr
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | | | - Daniel Weghuber
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
- Correspondence: ; Tel.: +43-(0)-5-7255-57518
| | - Thomas Pixner
- Department of Paediatric and Adolescent Medicine, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria; (D.F.); (A.L.); (T.P.)
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
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Daniel V, Süsal C, Scherer S, Tran H, Gombos P, Trojan K, Sadeghi M, Morath C, Opelz G. Endothelial precursor cell cross-match using Tie-2-enriched spleen cells. Clin Transplant 2017; 31. [PMID: 28925558 DOI: 10.1111/ctr.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-HLA antibodies against human endothelial progenitor cells (EPC) in pre-transplant recipient serum can have a deleterious influence on the graft. EPC enriched from peripheral blood have been commonly used for EPC cross-matching. In the present study, we describe cross-matches using EPC enriched from fresh or frozen-thawed spleen cell preparations, thereby widening the sample source for deceased-donor cross-matching and retrospective studies. METHODS EPC cross-matches were performed retrospectively using spleen cells and the flow cytometric XM-ONE cross-match test kit. RESULTS Healthy controls (n = 28) showed no IgG antibodies against EPC. When sera of 11 random dialysis patients were studied, 2 patients (18%) exhibited IgG EPC antibodies. When pre-transplant sera of 20 kidney graft recipients with good long-term graft outcome (serum creatinine 1.0 ± 0.2 mg/dL measured 2463 ± 324 days post-transplant) were investigated using frozen-thawed and then separated Tie-2-enriched spleen cells of the original transplant donor, 3 patients (15%) had pre-transplant IgG EPC antibodies. When pre-transplant sera of 5 patients with intra-operative graft loss were studied employing the original donor spleen cells, 4 (80%) patients showed IgG EPC antibodies. CONCLUSIONS Cross-matches with spleen cell-derived EPC using the XM-ONE assay are technically possible. Our very preliminary experience suggests clinical relevance.
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Affiliation(s)
- Volker Daniel
- Transplantation-Immunology, Institute of Immunology, University-Hospital Heidelberg, Heidelberg, Germany
| | - Caner Süsal
- Transplantation-Immunology, Institute of Immunology, University-Hospital Heidelberg, Heidelberg, Germany
| | - Sabine Scherer
- Transplantation-Immunology, Institute of Immunology, University-Hospital Heidelberg, Heidelberg, Germany
| | - Hien Tran
- Transplantation-Immunology, Institute of Immunology, University-Hospital Heidelberg, Heidelberg, Germany
| | - Petra Gombos
- Transplantation-Immunology, Institute of Immunology, University-Hospital Heidelberg, Heidelberg, Germany.,Department of Surgery, University-Hospital Heidelberg, Heidelberg, Germany
| | - Karina Trojan
- Transplantation-Immunology, Institute of Immunology, University-Hospital Heidelberg, Heidelberg, Germany
| | - Mahmoud Sadeghi
- Transplantation-Immunology, Institute of Immunology, University-Hospital Heidelberg, Heidelberg, Germany.,Department of Surgery, University-Hospital Heidelberg, Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, Center for Internal Medicine, University-Hospital Heidelberg, Heidelberg, Germany
| | - Gerhard Opelz
- Transplantation-Immunology, Institute of Immunology, University-Hospital Heidelberg, Heidelberg, Germany
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Daniel V, Sadeghi M, Suesal C, Scherer S, Tran H, Gombos P, Trojan K, Morath C, Opelz G. Clinical relevance of preformed IgG and IgM antibodies against donor endothelial progenitor cells in recipients of living donor kidney grafts. Clin Transplant 2015; 30:124-30. [DOI: 10.1111/ctr.12665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 01/30/2023]
Affiliation(s)
- Volker Daniel
- Department of Transplantation-Immunology; University Hospital; Heidelberg Germany
| | - Mahmoud Sadeghi
- Department of Transplantation-Immunology; University Hospital; Heidelberg Germany
| | - Caner Suesal
- Department of Transplantation-Immunology; University Hospital; Heidelberg Germany
| | - Sabine Scherer
- Department of Transplantation-Immunology; University Hospital; Heidelberg Germany
| | - Hien Tran
- Department of Transplantation-Immunology; University Hospital; Heidelberg Germany
| | - Petra Gombos
- Department of Transplantation-Immunology; University Hospital; Heidelberg Germany
| | - Karina Trojan
- Department of Transplantation-Immunology; University Hospital; Heidelberg Germany
| | - Christian Morath
- Department of Nephrology; University Hospital; Heidelberg Germany
| | - Gerhard Opelz
- Department of Transplantation-Immunology; University Hospital; Heidelberg Germany
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Süsal C, Seidl C, Schönemann C, Heinemann FM, Kauke T, Gombos P, Kelsch R, Arns W, Bauerfeind U, Hallensleben M, Hauser IA, Einecke G, Blasczyk R. Determination of unacceptable HLA antigen mismatches in kidney transplant recipients: recommendations of the German Society for Immunogenetics. ACTA ACUST UNITED AC 2015; 86:317-23. [DOI: 10.1111/tan.12682] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Süsal
- Transplantation Immunology, Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - C. Seidl
- Institute for Transfusion Medicine and Immunohaematology; German Red Cross Baden-Württemberg-Hessen; Frankfurt am Main Germany
| | - C. Schönemann
- Center for Transfusion Medicine and Cell Therapy; Charité Campus Virchow Klinikum; Berlin Germany
| | - F. M. Heinemann
- Institute for Transfusion Medicine; University of Essen; Essen Germany
| | - T. Kauke
- Laboratory for Immunogenetics and General, Visceral, Transplantation, Vascular and Thoracic Surgery; Campus Grosshadern Ludwig-Maximilians-University; Munich Germany
| | - P. Gombos
- Transplantation Immunology, Institute of Immunology; University of Heidelberg; Heidelberg Germany
| | - R. Kelsch
- Institute of Transfusion Medicine and Transplantation Immunology; University Clinics of Münster; Münster Germany
| | - W. Arns
- Transplantation Programs; Clinics of City Cologne; Cologne Germany
| | - U. Bauerfeind
- Institute for Transfusion Medicine; Clinics of City Cologne; Cologne Germany
| | - M. Hallensleben
- Institute for Transfusion Medicine; Hannover Medical School; Hannover Germany
| | - I. A. Hauser
- Medical Clinic III; JW Goethe University; Frankfurt am Main Germany
| | - G. Einecke
- Internal Medicine Center, Clinic for Kidney and Hypertension Diseases; Hannover Medical School; Hannover Germany
| | - R. Blasczyk
- Institute for Transfusion Medicine; Hannover Medical School; Hannover Germany
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Gombos P, Opelz G, Scherer S, Morath C, Zeier M, Schemmer P, Süsal C. Influence of test technique on sensitization status of patients on the kidney transplant waiting list. Am J Transplant 2013; 13:2075-82. [PMID: 23841891 DOI: 10.1111/ajt.12332] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [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: 11/07/2012] [Revised: 04/05/2013] [Accepted: 04/08/2013] [Indexed: 01/25/2023]
Abstract
The exquisitely sensitive single antigen bead (SAB) technique was shown to detect human leukocyte antigen (HLA) antibodies in sera of healthy male blood donors. Such false reactions can have an impact on critical decisions, especially with respect to the determination of unacceptable HLA-antigen mismatches in patients awaiting a kidney transplant. We tested pretransplant sera of 534 patients on the kidney waiting list using complement-dependent cytotoxicity (CDC), enzyme-linked immunosorbent assay (ELISA) and SAB in parallel. Evidence of HLA antibodies was obtained in 5% of patients using CDC, 14% using ELISA, and 81% using SAB. Among patients without history of an immunizing event, 77% showed evidence of HLA antibodies in SAB. In contrast 98% of these patients were negative in ELISA and CDC. In patients without an immunizing event, SAB-detected antibodies reacted not always weakly but with mean fluorescence intensity (MFI) values as high as 14 440. High-MFI-value antibodies were found in some of these patients with HLA specificities that are rather common in general population, consideration of which would lead to unjustified exclusion of potential kidney donors. False SAB reactions can be unveiled by testing with additional antibody assays. Denial of donor kidneys to recipients based on HLA-antibody specificities detected exclusively in the SAB assay is not advisable.
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Affiliation(s)
- P Gombos
- Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany
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Opelz G, Döhler B, Ruhenstroth A, Cinca S, Unterrainer C, Stricker L, Scherer S, Gombos P, Süsal C, Daniel V, Tran H. The collaborative transplant study registry. Transplant Rev (Orlando) 2013; 27:43-5. [DOI: 10.1016/j.trre.2013.01.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/22/2013] [Indexed: 11/24/2022]
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Gombos P, Langer RM, Korbely R, Varga M, Kaposi A, Dinya E, Müller V. Smoking following renal transplantation in Hungary and its possible deleterious effect on renal graft function. Transplant Proc 2011; 42:2357-9. [PMID: 20692480 DOI: 10.1016/j.transproceed.2010.05.143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Smoking is a known risk factor for kidney damage and also influences graft function following renal transplantation. Because smoking habits following kidney transplantation are not systematically evaluated, we analyzed them in a single center in Hungary. The survey was conducted among 402 randomly selected kidney graft recipients. We assessed smoking-related questions as well as clinical kidney disease and transplantation data. Posttransplantation renal function was analyzed based on serum creatinine values at 1 month and at 3 years after transplantation. In our study 25% (n = 102) of patients continued to smoke after transplantation. Smokers who received grafts displayed a significantly younger age compared with nonsmokers (40.1 +/- 13.4 vs 47.1 +/- 12.7 years; P < .001) independent of underlying kidney disease. Posttransplantation kidney function in smokers did not differ at 1 month after engraftment, but was significantly impaired at 3 years as assessed based on serum creatinine levels: 138.9 +/- 42.4 versus 128.4 +/- 48.5 micromol/L (P < .05). Decrease of renal function correlated with smoking intensity defined in pack-years (r(2) = 0.102; P < .05). Smoking is common following kidney transplantation in Hungary and might represent a risk factor for kidney damage following renal transplantation. Therefore, effective tobacco-dependence treatment is necessary in this patient population.
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Affiliation(s)
- P Gombos
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
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