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Buehler PK, Wendel-Garcia PD, Hofmaenner DA. Eye-tracking as a tool to evaluate defibrillator handling. Resusc Plus 2024; 17:100566. [PMID: 38586863 PMCID: PMC10995637 DOI: 10.1016/j.resplu.2024.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Philipp K. Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Daniel A. Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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2
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Deplazes BC, Hofmaenner DA, Scheier TC, Epprecht J, Mayer M, Schweizer TA, Buehler PK, Frey PM, Brugger SD. Enzymatic debridement with bromelain and development of bacteremia in burn injuries: A retrospective cohort study. Burns 2024; 50:405-412. [PMID: 38182450 DOI: 10.1016/j.burns.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/12/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Debridement is crucial for effective wound management in patients with severe burn injuries, and bromelain, a proteolytic enzyme from pineapple stems, has emerged as a promising alternative for surgery. However, potential links of bromelain use to fever and sepsis have raised some concerns. Given the uncertainty as to whether this was caused by infection or other inflammatory sources, we aimed to investigate if the use of topical bromelain was associated with bacteremia. METHODS This single-centre retrospective cohort study included critically ill adult patients with severe burn injuries hospitalised at the Burn Center of the University Hospital Zurich between January 2017 and December 2021. Data were collected from two in-hospital electronic medical records databases. Our primary outcome, the association between topical bromelain treatment and the development of bacteremia, was investigated using a competing risk regression model, taking into account the competing risk of death. As a secondary outcome, the relationship between bromelain treatment and overall ICU mortality was examined using a Cox proportional hazards model. RESULTS The study included 269 patients with a median age of 50 years and median burnt total body surface area of 19%. A first bacteremia occurred in 61 patients (23%) after a median time of 6 days. Bromelain treatment was given to 83 (31%) of patients, with 22 (27%) of these developing bacteremia. In the fully adjusted competing risk regression model, no evidence for an association between bromelain treatment and bacteremia was found (SHR 0.79, 95%CI 0.42-1.48, p = 0.47). During hospital stay, 40 (15%) of patients died. There was no significant difference in mortality between patients treated with bromelain and those who were not (HR 0.55, 95%CI 0.26-1.20, p = 0.14). Among the five multidrug-resistant (MDR) pathogens identified, three were found in patients with bromelain treatment. CONCLUSION Our study did not confirm an association between topical bromelain and bacteremia in patients with severe burn injuries. This finding can inform evidence-based practices by addressing concerns about potential risks of bromelain use, contributing to the development of more effective and safe burn wound management strategies.
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Affiliation(s)
- Barla C Deplazes
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas C Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jana Epprecht
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michelle Mayer
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tiziano A Schweizer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Department of Intensive Care Medicine, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Pascal M Frey
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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3
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Gebhard CE, Sütsch C, Gebert P, Gysi B, Bengs S, Todorov A, Deforth M, Buehler PK, Meisel A, Schuepbach RA, Zinkernagel AS, Brugger SD, Acevedo C, Patriki D, Wiggli B, Beer JH, Friedl A, Twerenbold R, Kuster GM, Pargger H, Tschudin-Sutter S, Schefold JC, Spinetti T, Henze C, Pasqualini M, Sager DF, Mayrhofer L, Grieder M, Tontsch J, Franzeck FC, Wendel Garcia PD, Hofmaenner DA, Scheier T, Bartussek J, Haider A, Grämer M, Mikail N, Rossi A, Zellweger N, Opić P, Portmann A, von Känel R, Pazhenkottil AP, Messerli M, Buechel RR, Kaufmann PA, Treyer V, Siegemund M, Held U, Regitz-Zagrosek V, Gebhard C. Impact of sex and gender on post-COVID-19 syndrome, Switzerland, 2020. Euro Surveill 2024; 29:2300200. [PMID: 38214079 PMCID: PMC10785203 DOI: 10.2807/1560-7917.es.2024.29.2.2300200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/04/2023] [Indexed: 01/13/2024] Open
Abstract
BackgroundWomen are overrepresented among individuals with post-acute sequelae of SARS-CoV-2 infection (PASC). Biological (sex) as well as sociocultural (gender) differences between women and men might account for this imbalance, yet their impact on PASC is unknown.AimWe assessed the impact of sex and gender on PASC in a Swiss population.MethodOur multicentre prospective cohort study included 2,856 (46% women, mean age 44.2 ± 16.8 years) outpatients and hospitalised patients with PCR-confirmed SARS-CoV-2 infection.ResultsAmong those who remained outpatients during their first infection, women reported persisting symptoms more often than men (40.5% vs 25.5% of men; p < 0.001). This sex difference was absent in hospitalised patients. In a crude analysis, both female biological sex (RR = 1.59; 95% CI: 1.41-1.79; p < 0.001) and a score summarising gendered sociocultural variables (RR = 1.05; 95% CI: 1.03-1.07; p < 0.001) were significantly associated with PASC. Following multivariable adjustment, biological female sex (RR = 0.96; 95% CI: 0.74-1.25; p = 0.763) was outperformed by feminine gender-related factors such as a higher stress level (RR = 1.04; 95% CI: 1.01-1.06; p = 0.003), lower education (RR = 1.16; 95% CI: 1.03-1.30; p = 0.011), being female and living alone (RR = 1.91; 95% CI: 1.29-2.83; p = 0.001) or being male and earning the highest income in the household (RR = 0.76; 95% CI: 0.60-0.97; p = 0.030).ConclusionSpecific sociocultural parameters that differ in prevalence between women and men, or imply a unique risk for women, are predictors of PASC and may explain, at least in part, the higher incidence of PASC in women. Once patients are hospitalised during acute infection, sex differences in PASC are no longer evident.
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Affiliation(s)
- Caroline E Gebhard
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
- These authors contributed equally
| | - Claudia Sütsch
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- These authors contributed equally
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bianca Gysi
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Atanas Todorov
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Manja Deforth
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudio Acevedo
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dimitri Patriki
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Benedikt Wiggli
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Jürg H Beer
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Andrée Friedl
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Department of Cardiology and University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Gabriela M Kuster
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University of Basel, Basel, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thibaud Spinetti
- Department of Intensive Care Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Chiara Henze
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Mina Pasqualini
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Dominik F Sager
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Lilian Mayrhofer
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mirjam Grieder
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Janna Tontsch
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Fabian C Franzeck
- Department of Informatics, University Hospital Basel, Basel, Switzerland
| | - Pedro D Wendel Garcia
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Bartussek
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ahmed Haider
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, and Department of Radiology, Harvard Medical School, Boston, Massachusetts, United States
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Muriel Grämer
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Núria Zellweger
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Petra Opić
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine (GiM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
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Emmenegger M, Emmenegger V, Shambat SM, Scheier TC, Gomez-Mejia A, Chang CC, Wendel-Garcia PD, Buehler PK, Buettner T, Roggenbuck D, Brugger SD, Frauenknecht KBM. Antiphospholipid antibodies are enriched post-acute COVID-19 but do not modulate the thrombotic risk. Clin Immunol 2023; 257:109845. [PMID: 37995947 DOI: 10.1016/j.clim.2023.109845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/29/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND AND OBJECTIVES COVID-19-associated coagulopathy, shown to increase the risk for the occurrence of thromboses and microthromboses, displays phenotypic features of the antiphospholipid syndrome (APS), a prototype antibody-mediated autoimmune disease. Several groups have reported elevated levels of criteria and non-criteria antiphospholipid antibodies (aPL), assumed to cause APS, during acute or post-acute COVID-19. However, disease heterogeneity of COVID-19 is accompanied by heterogeneity in molecular signatures, including aberrant cytokine profiles and an increased occurrence of autoantibodies. Moreover, little is known about the association between autoantibodies and the clinical events. Here, we first aim to characterise the antiphospholipid antibody, anti-SARS-CoV-2 antibody, and the cytokine profiles in a diverse collective of COVID-19 patients (disease severity: asymptomatic to intensive care), using vaccinated individuals and influenza patients as comparisons. We then aim to assess whether the presence of aPL in COVID-19 is associated with an increased incidence of thrombotic events in COVID-19. METHODS AND RESULTS We conducted anti-SARS-CoV-2 IgG and IgA microELISA and IgG, IgA, and IgM antiphospholipid line immunoassay (LIA) against 10 criteria and non-criteria antigens in 155 plasma samples of 124 individuals, and we measured 16 cytokines and chemokines in 112 plasma samples. We additionally employed clinical and demographic parameters to conduct multivariable regression analyses within multiple paradigms. In line with recent results, we find that IgM autoantibodies against annexin V (AnV), β2-glycoprotein I (β2GPI), and prothrombin (PT) are enriched upon infection with SARS-CoV-2. There was no evidence for seroconversion from IgM to IgG or IgA. PT, β2GPI, and AnV IgM as well as cardiolipin (CL) IgG antiphospholipid levels were significantly elevated in the COVID-19 but not in the influenza or control groups. They were associated predominantly with the strength of the anti-SARS-CoV-2 antibody titres and the major correlate for thromboses was SARS-CoV-2 disease severity. CONCLUSION While we have recapitulated previous findings, we conclude that the presence of the aPL, most notably PT, β2GPI, AnV IgM, and CL IgG in COVID-19 are not associated with a higher incidence of thrombotic events.
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Affiliation(s)
- Marc Emmenegger
- Institute of Neuropathology, University of Zurich, 8091 Zurich, Switzerland; Division of Medical Immunology, Department of Laboratory Medicine, University Hospital Basel, 4031 Basel, Switzerland.
| | - Vishalini Emmenegger
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
| | - Srikanth Mairpady Shambat
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas C Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alejandro Gomez-Mejia
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Chun-Chi Chang
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pedro D Wendel-Garcia
- Institute of Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | | | - Dirk Roggenbuck
- GA Generic Assays GmbH, Dahlewitz, Germany; Institute of Biotechnology, Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany; Faculty of Health Sciences Brandenburg, University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katrin B M Frauenknecht
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, Germany; National Center of Pathology (NCP), Laboratoire National de Santé (LNS), Luxembourg Center of Neuropathology (LCNP), 3555 Dudelange, Luxembourg
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5
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Weiss M, Wendel-Garcia PD, Cannizzaro V, Buehler PK, Kleine-Brueggeney M. Effect of central venous pressure on fluid delivery during start-up of syringe infusion pumps for microinfusion. Paediatr Anaesth 2023; 33:837-843. [PMID: 37403751 DOI: 10.1111/pan.14717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Intravenous administration of highly concentrated and potent drugs at low flow rates is common practice, particularly in critically ill children. Drug delivery during infusion start-up can be considerably delayed by intrinsic factors of syringe infusion pump assemblies. The impact of central venous pressures on the course of start-up fluid delivery of such microinfusions remains unknown. METHODS Infusion volumes delivered after activation of the start button in a conventional 50 mL syringe infusion pump assembly equilibrated (representing classical in vitro testing) and not equilibrated (representing real clinical conditions) to central venous pressure levels of 0, 10 and 20 mmHg at a set infusion flow rate of 1 mL/h were measured using a fluidic flow sensor. RESULTS The experimental setup mimicking real life conditions demonstrated considerable differences in fluid delivery during pump start-up depending on central venous pressure. A central venous pressure of 0 mmHg resulted in massive fluid delivery at infusion start-up, while central venous pressure levels of 10 and 20 mmHg resulted in retrograde flows with related mean (95% CI) zero-drug delivery times of 3.22 (2.98-3.46) min and 4.51 (4.33-4.69) min, respectively (p < .0001). CONCLUSION Depending on central venous pressure level, connection and starting a new syringe pump can result in significant antegrade or retrograde fluid volumes. In clinical practice, this can lead to hemodynamic instability and hence requires clinical alertness. Further research and methods to improve start-up performance in syringe infusion pump systems are desirable.
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Affiliation(s)
- Markus Weiss
- Department of Anesthesia, University Children's Hospital, Zurich, Switzerland
| | | | | | - Philipp K Buehler
- Department of Intensive Care, Kantonsspital, Winterthur, Switzerland
| | - Maren Kleine-Brueggeney
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Heuberger D, Wendel-Garcia PD, Sazpinar O, Müller M, Klein H, Kim BS, Andermatt R, Erlebach R, Schuepbach RA, Buehler PK, David S, Hofmaenner DA. The Angiopoietin-2/Angiopoietin-1 ratio increases early in burn patients and predicts mortality. Cytokine 2023; 169:156266. [PMID: 37354645 DOI: 10.1016/j.cyto.2023.156266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Angiopoietin-2 (Angpt-2) is involved in the pathogenesis of the capillary leak syndrome in sepsis and has been shown to be associated with worse outcomes in diverse critical illnesses. It is however unclear whether Angpt-2 plays a similar role in severely burned patients during the early phase characterized by massive capillary leakage. Our aim was to analyze the Angiopoietin-2/Angiopoietin-1 ratio (Angpt-2/Angpt-1 ratio) over the first two days in critically ill burn patients and examine its association with survival and further clinical parameters. METHODS Adult burn patients with a total burn surface area (TBSA) ≥ 20% treated in the burn intensive care unit (ICU) of the University Hospital of Zurich, Switzerland, were included. Serum samples were collected prospectively and serum Angpt-1 and Angpt-2 were measured by enzyme-linked immunosorbent assay (ELISA) over the first two days after burn insult and stratified according to survival status, TBSA and the abbreviated burn severity index (ABSI). Due to hemodilution in the initial resuscitation phase, the Angpt-2/Angpt-1 ratio was normalized to albumin. RESULTS Fifty-six patients were included with a median age of 51.5 years. Overall mortality was 14.3% (8/56 patients). The total amount of infused crystalloids was 12́902 ml (IQR 9́362-16́770 ml) at 24 h and 18́461 ml (IQR 13́024-23́766 ml) at 48 h. The amount of substituted albumin was 20 g (IQR 10-50 g) at 24 h and 50 g (IQR 20-60 g) at 48 h. The albumin-corrected Angpt-2/Angpt-1 ratios increased over the first 48 h after the burn insult (d0: 0.5 pg*l/ml*g [IQR 0.24 - 0.80 pg*l/ml*g]; d1: 0.83 pg*l/ml*g [IQR 0.29 - 1.98 pg*l/ml*g]; d2: 1.76 pg*l/ml*g [IQR 0.70 - 3.23 pg*l/ml*g]; p < 0.001) and were significantly higher in eventual ICU non-survivors (p = 0.005), in patients with a higher TBSA (p = 0.001) and in patients with a higher ABSI (p = 0.001). CONCLUSIONS In analogy to the pathological host response in sepsis, the Angpt-2/Angpt-1 ratio steadily increases in the first two days in critically ill burn patients, suggesting a putative involvement in the pathogenesis of capillary leakage in burns. A higher Angpt-2/Angpt-1 ratio is associated with mortality, total burn surface area and burn scores.
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Affiliation(s)
- Dorothea Heuberger
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Pedro David Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Onur Sazpinar
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Mattia Müller
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Holger Klein
- Plastic and Hand Surgery, Cantonal Hospital Aarau, Tellstrasse 25, CH-5001 Aarau, Switzerland.
| | - Bong-Sung Kim
- Plastic and Hand Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Rea Andermatt
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Rolf Erlebach
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
| | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
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Buehler PK, Wendel-Garcia PD, Hofmaenner DA. Eye-tracking during newborn intubations. Pediatr Res 2023:10.1038/s41390-023-02630-1. [PMID: 37117819 PMCID: PMC10382304 DOI: 10.1038/s41390-023-02630-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
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Sinnberg T, Lichtensteiger C, Ali OH, Pop OT, Jochum AK, Risch L, Brugger SD, Velic A, Bomze D, Kohler P, Vernazza P, Albrich WC, Kahlert CR, Abdou MT, Wyss N, Hofmeister K, Niessner H, Zinner C, Gilardi M, Tzankov A, Röcken M, Dulovic A, Shambat SM, Ruetalo N, Buehler PK, Scheier TC, Jochum W, Kern L, Henz S, Schneider T, Kuster GM, Lampart M, Siegemund M, Bingisser R, Schindler M, Schneiderhan-Marra N, Kalbacher H, McCoy KD, Spengler W, Brutsche MH, Maček B, Twerenbold R, Penninger JM, Matter MS, Flatz L. Pulmonary Surfactant Proteins Are Inhibited by Immunoglobulin A Autoantibodies in Severe COVID-19. Am J Respir Crit Care Med 2023; 207:38-49. [PMID: 35926164 PMCID: PMC9952873 DOI: 10.1164/rccm.202201-0011oc] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rationale: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome with fatal outcomes. Evidence suggests that dysregulated immune responses, including autoimmunity, are key pathogenic factors. Objectives: To assess whether IgA autoantibodies target lung-specific proteins and contribute to disease severity. Methods: We collected 147 blood, 9 lung tissue, and 36 BAL fluid samples from three tertiary hospitals in Switzerland and one in Germany. Severe COVID-19 was defined by the need to administer oxygen. We investigated the presence of IgA autoantibodies and their effects on pulmonary surfactant in COVID-19 using the following methods: immunofluorescence on tissue samples, immunoprecipitations followed by mass spectrometry on BAL fluid samples, enzyme-linked immunosorbent assays on blood samples, and surface tension measurements with medical surfactant. Measurements and Main Results: IgA autoantibodies targeting pulmonary surfactant proteins B and C were elevated in patients with severe COVID-19 but not in patients with influenza or bacterial pneumonia. Notably, pulmonary surfactant failed to reduce surface tension after incubation with either plasma or purified IgA from patients with severe COVID-19. Conclusions: Our data suggest that patients with severe COVID-19 harbor IgA autoantibodies against pulmonary surfactant proteins B and C and that these autoantibodies block the function of lung surfactant, potentially contributing to alveolar collapse and poor oxygenation.
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Affiliation(s)
- Tobias Sinnberg
- Department of Dermatology,,Cluster of Excellence iFIT (EXC 2180) Image Guided and Functionally Instructed Tumor Therapies,,Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | | | - Omar Hasan Ali
- Institute of Immunobiology,,Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada;,Department of Dermatology
| | | | | | - Lorenz Risch
- Center of Laboratory Medicine, Vaduz, Liechtenstein;,Center of Laboratory Medicine, University Institute of Clinical Chemistry, University Hospital Bern, University of Bern, Bern, Switzerland;,Faculty of Medical Sciences, Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - Ana Velic
- Proteome Center Tübingen, Interfaculty Institute for Cell Biology
| | - David Bomze
- Institute of Immunobiology,,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology
| | | | | | - Christian R. Kahlert
- Division of Infectious Diseases and Hospital Epidemiology,,Department of Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | | | | | | | - Heike Niessner
- Department of Dermatology,,Cluster of Excellence iFIT (EXC 2180) Image Guided and Functionally Instructed Tumor Therapies
| | - Carl Zinner
- Pathology, Institute of Medical Genetics and Pathology
| | - Mara Gilardi
- Pathology, Institute of Medical Genetics and Pathology
| | | | - Martin Röcken
- Department of Dermatology,,Cluster of Excellence iFIT (EXC 2180) Image Guided and Functionally Instructed Tumor Therapies
| | | | | | | | - Philipp K. Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | | | | | | | - Gabriela M. Kuster
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)
| | - Maurin Lampart
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)
| | - Martin Siegemund
- Intensive Care Unit, Department of Acute Medicine,,Department of Clinical Research, and
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Hubert Kalbacher
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Kathy D. McCoy
- Snyder Institute for Chronic Disease, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Werner Spengler
- Department of Medical Oncology and Pneumology, University Hospital Tübingen, Tübingen, Germany
| | - Martin H. Brutsche
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Boris Maček
- Proteome Center Tübingen, Interfaculty Institute for Cell Biology
| | - Raphael Twerenbold
- Division of Pneumology, and,University Center of Cardiovascular Science and Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Partner Site Hamburg-Kiel-Lübeck, Hamburg, Germany; and
| | - Josef M. Penninger
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada;,Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna, Austria
| | | | - Lukas Flatz
- Department of Dermatology,,Institute of Immunobiology,,Department of Dermatology, Venereology, and Allergology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;,Department of Dermatology
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9
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Valek R, Wendel-Garcia PD, Schuepbach RA, Buehler PK, Hofmaenner DA. Eye-tracking to observe compliance with hand hygiene in the intensive care unit: a randomized feasibility study. J Hosp Infect 2023; 131:148-155. [PMID: 36243174 DOI: 10.1016/j.jhin.2022.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Healthcare-associated infections are associated with increased patient mortality. Hand hygiene is the most effective method to reduce these infections. Despite simplification of this easy intervention, compliance with hand disinfection remains low. Current assessment of hand hygiene is mainly based on observation by hygiene specialists. The aim of this study was to investigate additional benefits of eye-tracking during the analysis of hand hygiene compliance of healthcare professionals in the intensive care unit. METHODS In a simulated, randomized crossover study conducted at the interdisciplinary intensive care unit at University Hospital Zurich, Switzerland, doctors and nurses underwent eye-tracking and completed two everyday tasks (injection of 10 μg norepinephrine via a central venous line, blood removal from the central line) in two scenarios where the locations of alcoholic dispensers differed ('in-sight' and 'out-of-sight'). The primary outcomes were dwell time, revisits, first fixation duration and average fixation duration on three areas of interest (central venous line, alcohol dispenser, protective glove box) for both scenarios. Compliance with hand hygiene guidelines was analysed. FINDINGS Forty-nine participants (35 nurses, 14 doctors) were included in this study. Eye-tracking provided additional useful information compared with conventional observations. Dwell time, revisits, first fixation duration and average fixation duration did not differ between the two scenarios for all areas of interest. Overall compliance with recommended hand hygiene measures was low in both doctors (mean 20%) and nurses (mean 42.9%). CONCLUSION Compared with conventional observations, eye-tracking offered additional helpful insights and provided an in-depth analysis of gaze patterns during the recording of hand hygiene compliance in the intensive care unit.
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Affiliation(s)
- R Valek
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - P D Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - R A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - P K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - D A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
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10
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Lohmeyer Q, Schiess C, Wendel Garcia PD, Petry H, Strauch E, Dietsche A, Schuepbach RA, Buehler PK, Hofmaenner DA. Effects of tall man lettering on the visual behaviour of critical care nurses while identifying syringe drug labels: a randomised in situ simulation. BMJ Qual Saf 2023; 32:26-33. [PMID: 35260415 PMCID: PMC9811086 DOI: 10.1136/bmjqs-2021-014438] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patients in intensive care units are prone to the occurrence of medication errors. Look-alike, sound-alike drugs with similar drug names can lead to medication errors and therefore endanger patient safety. Capitalisation of distinct text parts in drug names might facilitate differentiation of medication labels. The aim of this study was to test whether the use of such 'tall man' lettering (TML) reduces the error rate and to examine effects on the visual attention of critical care nurses while identifying syringe labels. METHODS This was a prospective, randomised in situ simulation conducted at the University Hospital Zurich, Zurich, Switzerland. Under observation by eye tracking, 30 nurses were given 10 successive tasks involving the presentation of a drug name and its selection from a dedicated set of 10 labelled syringes that included look-alike and sound-alike drug names, half of which had TML-coded labels.Error rate as well as dwell time, fixation count, fixation duration and revisits were analysed using a linear mixed-effects model analysis to compare TML-coded with non-TML-coded labels. RESULTS TML coding of syringe labels led to a significant decrease in the error rate (from 5.3% (8 of 150 in non-TML-coded sets) to 0.7% (1 of 150 in TML-coded sets), p<0.05). Eye tracking further showed that TML affects visual attention, resulting in longer dwell time (p<0.01), more and longer fixations (p<0.05 and p<0.01, respectively) on the drug name as well as more frequent revisits (p<0.01) compared with non-TML-coded labels. Detailed analysis revealed that these effects were stronger for labels using TML in the mid-to-end position of the drug name. CONCLUSIONS TML in drug names changes visual attention while identifying syringe labels and supports critical care nurses in preventing medication errors.
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Affiliation(s)
- Quentin Lohmeyer
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Cornel Schiess
- Department of Nursing and Allied Health Care Professions, University Hospital Zurich, Zurich, Switzerland
| | | | - Heidi Petry
- Department of Nursing and Allied Health Care Professions, University Hospital Zurich, Zurich, Switzerland
| | - Eric Strauch
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Andreas Dietsche
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Reto A. Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp K. Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Daniel A. Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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11
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Wendel-Garcia PD, Moser A, Jeitziner MM, Aguirre-Bermeo H, Arias-Sanchez P, Apolo J, Roche-Campo F, Franch-Llasat D, Kleger GR, Schrag C, Pietsch U, Filipovic M, David S, Stahl K, Bouaoud S, Ouyahia A, Fodor P, Locher P, Siegemund M, Zellweger N, Cereghetti S, Schott P, Gangitano G, Wu MA, Alfaro-Farias M, Vizmanos-Lamotte G, Ksouri H, Gehring N, Rezoagli E, Turrini F, Lozano-Gómez H, Carsetti A, Rodríguez-García R, Yuen B, Weber AB, Castro P, Escos-Orta JO, Dullenkopf A, Martín-Delgado MC, Aslanidis T, Perez MH, Hillgaertner F, Ceruti S, Franchitti Laurent M, Marrel J, Colombo R, Laube M, Fogagnolo A, Studhalter M, Wengenmayer T, Gamberini E, Buerkle C, Buehler PK, Keiser S, Elhadi M, Montomoli J, Guerci P, Fumeaux T, Schuepbach RA, Jakob SM, Que YA, Hilty MP, Hilty MP, Wendel-Garcia P, Schuepbach RA, Montomoli J, Guerci P, Fumeaux T, Bouaoud S, Ouyahia A, Abdoun M, Rais M, Alfaro-Farias M, Vizmanos-Lamotte G, Caballero A, Tschoellitsch T, Meier J, Aguirre-Bermeo H, Arias-Sanchez P, Apolo J, Martinez LA, Tirapé-Castro H, Galal I, Tharwat S, Abdehaleem I, Jurkolow G, Guerci P, Novy E, Losser MR, Wengenmayer T, Zotzmann V, David S, Stahl K, Seeliger B, Welte T, Aslanidis T, Korsos A, Ahmed LA, Hashim HT, Nikandish R, Carsetti A, Casarotta E, Giaccaglia P, Rezoagli E, Giacomini M, Magliocca A, Bolondi G, Potalivo A, Fogagnolo A, Salvi L, Wu MA, Cogliati C, Colombo R, Catena E, Turrini F, Simonini MS, Fabbri S, Montomoli J, Gamberini E, Gangitano G, Bitondo MM, Maciopinto F, de Camillis E, Venturi M, Bocci MG, Antonelli M, Alansari A, Abusalama A, Omar O, Binnawara M, Alameen H, Elhadi M, Alhadi A, Arhaym A, Gommers D, Ince C, Jayyab M, Alsharif M, Rodríguez-García R, Gámez-Zapata J, Taboada-Fraga X, Castro P, Fernandez J, Reverter E, Lander-Azcona A, Escós-Orta J, Martín-Delgado MC, Algaba-Calderon A, Roche-Campo F, Franch-Llasat D, Concha P, Sauras-Colón E, Lozano-Gómez H, Zalba-Etayo B, Montes MP, Michot MP, Klarer A, Ensner R, Schott P, Urech S, Siegemund M, Zellweger N, Gebhard CE, Hollinger A, Merki L, Lambert A, Laube M, Jeitziner MM, Moser A, Que YA, Jakob SM, Wiegand J, Yuen B, Lienhardt-Nobbe B, Westphalen A, Salomon P, Hillgaertner F, Sieber M, Dullenkopf A, Barana G, Ksouri H, Sridharan GO, Cereghetti S, Boroli F, Pugin J, Grazioli S, Bürkle C, Marrel J, Brenni M, Fleisch I, Perez MH, Ramelet AS, Weber AB, Gerecke P, Christ A, Ceruti S, Glotta A, Biggiogero M, Marquardt K, Hübner T, Neff T, Redecker H, Fumeaux T, Moret-Bochatay M, Betello M, zu Bentrup FM, Studhalter M, Stephan M, Gehring N, Selz D, Kleger GR, Schrag C, Pietsch U, Filipovic M, Ristic A, Heise A, Franchitti Laurent M, Laurent JC, Gaspert T, Haberthuer C, Fodor P, Locher P, Garcia PDW, Hilty MP, Schuepbach R, Keiser S, Heuberger D, Bartussek J, Bühler P, Brugger S, Kleinert EM, Fehlbier KJ, Danial A, Almousa M, Abdulbaki Y, Sannah K, Colak E, Marczin N, Al-Ameri S. Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry. Crit Care 2022; 26:199. [PMID: 35787726 PMCID: PMC9254551 DOI: 10.1186/s13054-022-04065-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/10/2022] [Indexed: 12/22/2022] Open
Abstract
Background It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic. Methods Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic. Results Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60–63] years vs 64 [62–66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6–9.0] vs 5.8 [5.3–6.4], p < 0.001) and increased, while more female patients (26 [23–29]% vs 41 [35–48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2–7.2| days vs 9.7 [8.9–10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123–141] mmHg vs 101 [91–113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20–48] mmHg vs 70 [41–100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4–7]% vs 20 [14–29], p < 0.001) and non-invasive mechanical ventilation (14 [11–18]% vs 24 [17–33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76–86]% vs 74 [64–82]%, p < 0.001). The ICU mortality (23 [19–26]% vs 17 [12–25]%, p < 0.001) and length of stay (14 [13–16] days vs 11 [10–13] days, p < 0.001) decreased over 19 months of the pandemic. Conclusion Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04065-2.
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12
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Hofmaenner DA, Buehler PK. The impact of eye-tracking on patient safety in critical care. J Clin Monit Comput 2022; 36:1577-1579. [PMID: 35438366 DOI: 10.1007/s10877-022-00844-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Patient safety has become a high priority in health care. The recognition, prevention and reduction of human errors are crucial for patient care. Diverse approaches to analyze roots of errors exist, however they all bear relevant limitations. In contrast, the technology of eye-tracking offers objective and measurable parameters linked to eye movements, allowing temporal and spatial assessment of visual patterns. Diverse studies in critical care have proved the usefulness of eye-tracking to analyze real-life scenarios. These insights could contribute to increased patient safety.
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Affiliation(s)
- Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
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13
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Deforth M, Gebhard CE, Bengs S, Buehler PK, Schuepbach RA, Zinkernagel AS, Brugger SD, Acevedo CT, Patriki D, Wiggli B, Twerenbold R, Kuster GM, Pargger H, Schefold JC, Spinetti T, Wendel-Garcia PD, Hofmaenner DA, Gysi B, Siegemund M, Heinze G, Regitz-Zagrosek V, Gebhard C, Held U. Development and validation of a prognostic model for the early identification of COVID-19 patients at risk of developing common long COVID symptoms. Diagn Progn Res 2022; 6:22. [PMID: 36384641 PMCID: PMC9668400 DOI: 10.1186/s41512-022-00135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/30/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic demands reliable prognostic models for estimating the risk of long COVID. We developed and validated a prediction model to estimate the probability of known common long COVID symptoms at least 60 days after acute COVID-19. METHODS The prognostic model was built based on data from a multicentre prospective Swiss cohort study. Included were adult patients diagnosed with COVID-19 between February and December 2020 and treated as outpatients, at ward or intensive/intermediate care unit. Perceived long-term health impairments, including reduced exercise tolerance/reduced resilience, shortness of breath and/or tiredness (REST), were assessed after a follow-up time between 60 and 425 days. The data set was split into a derivation and a geographical validation cohort. Predictors were selected out of twelve candidate predictors based on three methods, namely the augmented backward elimination (ABE) method, the adaptive best-subset selection (ABESS) method and model-based recursive partitioning (MBRP) approach. Model performance was assessed with the scaled Brier score, concordance c statistic and calibration plot. The final prognostic model was determined based on best model performance. RESULTS In total, 2799 patients were included in the analysis, of which 1588 patients were in the derivation cohort and 1211 patients in the validation cohort. The REST prevalence was similar between the cohorts with 21.6% (n = 343) in the derivation cohort and 22.1% (n = 268) in the validation cohort. The same predictors were selected with the ABE and ABESS approach. The final prognostic model was based on the ABE and ABESS selected predictors. The corresponding scaled Brier score in the validation cohort was 18.74%, model discrimination was 0.78 (95% CI: 0.75 to 0.81), calibration slope was 0.92 (95% CI: 0.78 to 1.06) and calibration intercept was -0.06 (95% CI: -0.22 to 0.09). CONCLUSION The proposed model was validated to identify COVID-19-infected patients at high risk for REST symptoms. Before implementing the prognostic model in daily clinical practice, the conduct of an impact study is recommended.
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Affiliation(s)
- Manja Deforth
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Caroline E Gebhard
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Claudio T Acevedo
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Dimitri Patriki
- Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - Benedikt Wiggli
- Department of Infectiology and Infection Control, Cantonal Hospital Baden, Baden, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Hamburg-Kiel-Lübeck, Berlin, Germany
| | - Gabriela M Kuster
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, University Hospital Bern, Bern, Switzerland
| | - Thibaud Spinetti
- Department of Intensive Care Medicine, University Hospital Bern, Bern, Switzerland
| | - Pedro D Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Bianca Gysi
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- Department Clinical Research, University of Basel, Basel, Switzerland
| | - Georg Heinze
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria
| | - Vera Regitz-Zagrosek
- University of Zurich, Zurich, Switzerland
- Charité, University Medicine Berlin, Berlin, Germany
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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14
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Zeller FK, Bader PR, Nägeli MC, Buehler PK, Schuepbach RA. Severe Toxic Epidermal Necrolysis and Drug Reaction with Eosinophilia and Systemic Symptoms Overlap Syndrome Treated with Benralizumab: A Case Report. Case Rep Dermatol 2022; 14:203-209. [PMID: 36158858 PMCID: PMC9386431 DOI: 10.1159/000525752] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/19/2022] [Indexed: 11/23/2022] Open
Abstract
TEN/DRESS overlap syndrome can be difficult to diagnose, especially if it is masked by comorbidities in critically ill patients in intensive care units. The existing therapy for the two conditions is also a major challenge for the treating team. A possible alternative, especially for refractory cases, is benralizumab as an IL-5-receptor alpha-chain-specific humanized monoclonal antibody (IgG1k). We are able to show a successful treatment in this case report.
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Affiliation(s)
- Felix K. Zeller
- Institut für Intensivmedizin, Universitätsspital Zürich, Zürich, Switzerland
- *Felix K. Zeller,
| | - Patrick R. Bader
- Institut für Intensivmedizin, Universitätsspital Zürich, Zürich, Switzerland
| | - Mirjam C. Nägeli
- Dermatologische Klinik, Universitätsspital Zürich, Zürich, Switzerland
| | - Philipp K. Buehler
- Institut für Intensivmedizin, Universitätsspital Zürich, Zürich, Switzerland
| | - Reto A. Schuepbach
- Institut für Intensivmedizin, Universitätsspital Zürich, Zürich, Switzerland
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15
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Wendel-Garcia PD, Roche-Campo F, Buehler PK. High Positive End-Expiratory Pressure and Lung Recruitment in Moderate to Severe Acute Respiratory Distress Syndrome: Does One Size Really Fit All? Am J Respir Crit Care Med 2022; 205:1260-1262. [PMID: 35297740 PMCID: PMC9873118 DOI: 10.1164/rccm.202202-0281ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
| | - Ferran Roche-Campo
- Intensive Care DepartmentHospital Verge de la Cinta of TortosaTarragona, Spain
| | - Philipp K. Buehler
- Institute of Intensive Care MedicineUniversity Hospital of ZurichZurich, Switzerland
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16
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Hofmaenner DA, Wendel Garcia PD, Blum MR, David S, Schuepbach RA, Buehler PK, Frey PM, Zinkernagel AS, Brugger SD. The importance of intravenous immunoglobulin treatment in critically ill patients with necrotizing soft tissue infection: a retrospective cohort study. BMC Infect Dis 2022; 22:168. [PMID: 35189821 PMCID: PMC8862556 DOI: 10.1186/s12879-022-07135-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Necrotizing soft-tissue infections are infections with high mortality. The use of immunoglobulins within a combination therapy including broad-spectrum antibiotics has been debated. We assessed potential benefits of immunoglobulins and hypothesized that they were associated with a treatment benefit in a high-resource setting. Methods Patients with necrotizing soft-tissue infection hospitalized in the tertiary intensive care unit of the University Hospital of Zurich, Switzerland, between 2008 and 2020 were included retrospectively. The association between immunoglobulin administration and in-hospital survival, intensive care unit length of stay, the incidences of acute renal failure, acute respiratory distress syndrome and septic shock were analyzed. Results After adjustment for confounders, no difference for in-hospital survival (hazard ratio 2.20, 95% confidence interval [CI] 0.24–20.20, p = 0.5), intensive care unit length of stay (subhazard ratio [SHR] 0.90, CI 0.41–1.98, p = 0.8) and the development of acute respiratory distress syndrome (SHR 1.2, CI 0.36–4.03, p = 0.77) was observed in patients with or without immunoglobulin treatment. The Simplified Acute Physiology Score II, the risk of developing acute renal failure (SHR 2.86, CI 1.33–6.15, p = 0.01) and septic shock (SHR 1.86, CI 1.02–3.40, p = 0.04) was higher in patients treated with immunoglobulins, possibly reflecting a higher disease severity beyond measured confounders. Conclusions No clear evidence for a benefit of immunoglobulins in our cohort with consistent antibiotic use was found. Patients receiving immunoglobulins appeared more severely ill. Complementary to high treatment standards and appropriate antibiotics including beta lactams and protein synthesis inhibitors, immunoglobulins should be administered on a case-to-case basis, at least while more evidence from larger randomized controlled trials is missing.
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Affiliation(s)
- Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Pedro David Wendel Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Manuel R Blum
- Department of General Internal Medicine, Bern University Hospital (Inselspital), University of Bern, Bern, Switzerland.,Institute for Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Pascal M Frey
- Department of General Internal Medicine, Bern University Hospital (Inselspital), University of Bern, Bern, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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17
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Schweizer TA, Mairpady Shambat S, Vulin C, Hoeller S, Acevedo C, Huemer M, Gomez‐Mejia A, Chang C, Baum J, Hertegonne S, Hitz E, Scheier TC, Hofmaenner DA, Buehler PK, Moch H, Schuepbach RA, Brugger SD, Zinkernagel AS. Blunted sFasL signalling exacerbates TNF-driven neutrophil necroptosis in critically ill COVID-19 patients. Clin Transl Immunology 2021; 10:e1357. [PMID: 34938538 PMCID: PMC8665925 DOI: 10.1002/cti2.1357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Critically ill coronavirus disease 2019 (COVID-19) patients are characterised by a severely dysregulated cytokine profile and elevated neutrophil counts, impacting disease severity. However, it remains unclear how neutrophils contribute to pathophysiology during COVID-19. Here, we assessed the impact of the dysregulated cytokine profile on the regulated cell death (RCD) programme of neutrophils. METHODS Regulated cell death phenotype of neutrophils isolated from critically ill COVID-19 patients or healthy donors and stimulated with COVID-19 or healthy plasma ex vivo was assessed by flow cytometry, time-lapse microscopy and cytokine multiplex analysis. Immunohistochemistry of COVID-19 patients and control biopsies were performed to assess the in situ neutrophil RCD phenotype. Plasma cytokine levels of COVID-19 patients and healthy donors were measured by multiplex analysis. Clinical parameters were correlated to cytokine levels of COVID-19 patients. RESULTS COVID-19 plasma induced a necroptosis-sensitive neutrophil phenotype, characterised by cell lysis, elevated release of damage-associated molecular patterns (DAMPs), increased receptor-interacting serine/threonine-protein kinase (RIPK) 1 levels and mixed lineage kinase domain-like pseudokinase (MLKL) involvement. The occurrence of neutrophil necroptosis MLKL axis was further confirmed in COVID-19 thrombus and lung biopsies. Necroptosis was induced by the tumor necrosis factor receptor 1 (TNFRI)/TNF-α axis. Moreover, reduction of soluble Fas ligand (sFasL) levels in COVID-19 patients and hence decreased signalling to Fas directly increased RIPK1 levels, exacerbated TNF-driven necroptosis and correlated with disease severity, which was abolished in patients treated with glucocorticoids. CONCLUSION Our results suggest a novel role for sFasL signalling in the TNF-α-induced RCD programme in neutrophils during COVID-19 and a potential therapeutic target to curb inflammation and thus influence disease severity and outcome.
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Affiliation(s)
- Tiziano A Schweizer
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Srikanth Mairpady Shambat
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Clement Vulin
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Sylvia Hoeller
- Department of Pathology and Molecular PathologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Claudio Acevedo
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Markus Huemer
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Alejandro Gomez‐Mejia
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Chun‐Chi Chang
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Jeruscha Baum
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Sanne Hertegonne
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Eva Hitz
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Thomas C Scheier
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Daniel A Hofmaenner
- Institute for Intensive Care MedicineUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Philipp K Buehler
- Institute for Intensive Care MedicineUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Holger Moch
- Department of Pathology and Molecular PathologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Reto A Schuepbach
- Institute for Intensive Care MedicineUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital EpidemiologyUniversity Hospital of ZurichUniversity of ZurichZurichSwitzerland
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18
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Bütikofer S, Lenggenhager D, Wendel Garcia PD, Maggio EM, Haberecker M, Reiner CS, Brüllmann G, Buehler PK, Gubler C, Müllhaupt B, Jüngst C, Morell B. Secondary sclerosing cholangitis as cause of persistent jaundice in patients with severe COVID-19. Liver Int 2021; 41:2404-2417. [PMID: 34018314 PMCID: PMC8242687 DOI: 10.1111/liv.14971] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/16/2021] [Accepted: 05/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS Little is known about cholestasis, including its most severe variant secondary sclerosing cholangitis (SSC), in critically ill patients with coronavirus disease 19 (COVID-19). In this study, we analysed the occurrence of cholestatic liver injury and SSC, including clinical, serological, radiological and histopathological findings. METHODS We conducted a retrospective single-centre analysis of all consecutive patients admitted to the intensive care unit (ICU) as a result of severe COVID-19 at the University Hospital Zurich to describe cholestatic injury in these patients. The findings were compared to a retrospective cohort of patients with severe influenza A. RESULTS A total of 34 patients with severe COVID-19 admitted to the ICU were included. Of these, 14 patients (41%) had no cholestasis (group 0), 11 patients (32%, group 1) developed mild and 9 patients (27%, group 2) severe cholestasis. Patients in group 2 had a more complicated disease course indicated by significantly longer ICU stay (median 51 days, IQR 25-86.5) than the other groups (group 0: median 9.5 days, IQR 3.8-18.3, P = .001; and group 1: median 16 days, IQR 8-30, P < .05 respectively). Four patients in group 2 developed SSC compared to none in the influenza A cohort. The available histopathological findings suggest an ischaemic damage to the perihilar bile ducts. CONCLUSIONS The development of SSC represents an important complication of critically ill COVID-19 patients and needs to be considered in the diagnostic work up in prolonged cholestasis. The occurrence of SSC is of interest in the ongoing pandemic since it is associated with considerable morbidity and mortality.
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Affiliation(s)
- Simon Bütikofer
- Department of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland
| | - Daniela Lenggenhager
- Department of Pathology and Molecular PathologyUniversity Hospital ZurichZurichSwitzerland
| | | | - Ewerton M. Maggio
- Department of Pathology and Molecular PathologyUniversity Hospital ZurichZurichSwitzerland
| | - Martina Haberecker
- Department of Pathology and Molecular PathologyUniversity Hospital ZurichZurichSwitzerland
| | - Cäcilia S. Reiner
- Institute of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
| | - Gregor Brüllmann
- Institute of Intensive CareUniversity Hospital ZurichZurichSwitzerland
| | | | - Christoph Gubler
- Department of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland
| | - Beat Müllhaupt
- Department of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland
| | - Christoph Jüngst
- Department of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland
| | - Bernhard Morell
- Department of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland
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19
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Buehler PK, Herling A, Bienefeld N, Klinzing S, Wegner S, Wendel Garcia PD, Karbach M, Lohmeyer Q, Schaubmayr E, Schuepbach RA, Hofmaenner DA. Differing Visual Behavior Between Inexperienced and Experienced Critical Care Nurses While Using a Closed-Loop Ventilation System-A Prospective Observational Study. Front Med (Lausanne) 2021; 8:681321. [PMID: 34568356 PMCID: PMC8455837 DOI: 10.3389/fmed.2021.681321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Closed-loop ventilation modes are increasingly being used in intensive care units to ensure more automaticity. Little is known about the visual behavior of health professionals using these ventilation modes. The aim of this study was to analyze gaze patterns of intensive care nurses while ventilating a patient in the closed-loop mode with Intellivent adaptive support ventilation® (I-ASV) and to compare inexperienced with experienced nurses. Materials and Methods: Intensive care nurses underwent eye-tracking during daily care of a patient ventilated in the closed-loop ventilation mode. Five specific areas of interest were predefined (ventilator settings, ventilation curves, numeric values, oxygenation Intellivent, ventilation Intellivent). The main independent variable and primary outcome was dwell time. Secondary outcomes were revisits, average fixation time, first fixation and fixation count on areas of interest in a targeted tracking-time of 60 min. Gaze patterns were compared between I-ASV inexperienced (n = 12) and experienced (n = 16) nurses. Results: In total, 28 participants were included. Overall, dwell time was longer for ventilator settings and numeric values compared to the other areas of interest. Similar results could be obtained for the secondary outcomes. Visual fixation of oxygenation Intellivent and ventilation Intellivent was low. However, dwell time, average fixation time and first fixation on oxygenation Intellivent were longer in experienced compared to inexperienced intensive care nurses. Discussion: Gaze patterns of intensive care nurses were mainly focused on numeric values and settings. Areas of interest related to traditional mechanical ventilation retain high significance for intensive care nurses, despite use of closed-loop mode. More visual attention to oxygenation Intellivent and ventilation Intellivent in experienced nurses implies more routine and familiarity with closed-loop modes in this group. The findings imply the need for constant training and education with new tools in critical care, especially for inexperienced professionals.
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Affiliation(s)
- Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Anique Herling
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Nadine Bienefeld
- Department of Management, Technology, and Economics, Work & Organizational Psychology, ETH Zurich, Zurich, Switzerland
| | - Stephanie Klinzing
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Wegner
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | | | - Michael Karbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Quentin Lohmeyer
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Elisabeth Schaubmayr
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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20
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Maibach MA, Allam A, Hilty MP, Perez Gonzalez NA, Buehler PK, Wendel Garcia PD, Brugger SD, Ganter CC, Krauthammer M, Schuepbach RA, Bartussek J. How to Synchronize Longitudinal Patient Data With the Underlying Disease Progression: A Pilot Study Using the Biomarker CRP for Timing COVID-19. Front Med (Lausanne) 2021; 8:607594. [PMID: 34307391 PMCID: PMC8295502 DOI: 10.3389/fmed.2021.607594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 06/07/2021] [Indexed: 01/29/2023] Open
Abstract
The continued digitalization of medicine has led to an increased availability of longitudinal patient data that allows the investigation of novel and known diseases in unprecedented detail. However, to accurately describe any underlying pathophysiology and allow inter-patient comparisons, individual patient trajectories have to be synchronized based on temporal markers. In this pilot study, we use longitudinal data from critically ill ICU COVID-19 patients to compare the commonly used alignment markers “onset of symptoms,” “hospital admission,” and “ICU admission” with a novel objective method based on the peak value of the inflammatory marker C-reactive protein (CRP). By applying our CRP-based method to align the progression of neutrophils and lymphocytes, we were able to define a pathophysiological window that improved mortality risk stratification in our COVID-19 patient cohort. Our data highlights that proper synchronization of longitudinal patient data is crucial for accurate interpatient comparisons and the definition of relevant subgroups. The use of objective temporal disease markers will facilitate both translational research efforts and multicenter trials.
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Affiliation(s)
- Martina A Maibach
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Ahmed Allam
- Department of Quantitative Biomedicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Matthias P Hilty
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Nicolas A Perez Gonzalez
- Department of Quantitative Biomedicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Pedro D Wendel Garcia
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Christoph C Ganter
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | | | | | - Michael Krauthammer
- Department of Quantitative Biomedicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland
| | - Jan Bartussek
- Institute for Intensive Care Medicine, University and University Hospital Zurich, Zurich, Switzerland.,Department of Quantitative Biomedicine, University and University Hospital Zurich, Zurich, Switzerland
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21
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Wendel Garcia PD, Aguirre-Bermeo H, Buehler PK, Alfaro-Farias M, Yuen B, David S, Tschoellitsch T, Wengenmayer T, Korsos A, Fogagnolo A, Kleger GR, Wu MA, Colombo R, Turrini F, Potalivo A, Rezoagli E, Rodríguez-García R, Castro P, Lander-Azcona A, Martín-Delgado MC, Lozano-Gómez H, Ensner R, Michot MP, Gehring N, Schott P, Siegemund M, Merki L, Wiegand J, Jeitziner MM, Laube M, Salomon P, Hillgaertner F, Dullenkopf A, Ksouri H, Cereghetti S, Grazioli S, Bürkle C, Marrel J, Fleisch I, Perez MH, Baltussen Weber A, Ceruti S, Marquardt K, Hübner T, Redecker H, Studhalter M, Stephan M, Selz D, Pietsch U, Ristic A, Heise A, Meyer Zu Bentrup F, Franchitti Laurent M, Fodor P, Gaspert T, Haberthuer C, Colak E, Heuberger DM, Fumeaux T, Montomoli J, Guerci P, Schuepbach RA, Hilty MP, Roche-Campo F. Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort. Crit Care 2021; 25:175. [PMID: 34034782 PMCID: PMC8146172 DOI: 10.1186/s13054-021-03580-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/15/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. METHODS Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. RESULTS Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). CONCLUSION In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.
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Affiliation(s)
- Pedro D Wendel Garcia
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.,The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland
| | | | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Mario Alfaro-Farias
- Unidad de Cuidados Intensivos, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | - Bernd Yuen
- Interdisziplinaere Intensivstation, Spital Buelach, Buelach, Switzerland
| | - Sascha David
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany
| | - Thomas Tschoellitsch
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria
| | - Tobias Wengenmayer
- Department of Medicine III - Interdisciplinary Medical Intensive Care, Medical Center University of Freiburg, Freiburg, Germany
| | - Anita Korsos
- Departement of Anaethesiology and Intensive Care, University of Szeged, Szeged, Hungary
| | - Alberto Fogagnolo
- Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Gian-Reto Kleger
- Medizinische Intensivstation, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Maddalena A Wu
- Department of Internal Medicine, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy
| | - Riccardo Colombo
- Division of Anesthesia and Intensive Care, ASST Fatebenefratelli Sacco - "Luigi Sacco" Hospital, Milan, Italy
| | - Fabrizio Turrini
- Internal Medicine, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | | | - Emanuele Rezoagli
- Department of Anesthesia and Intensive Care Medicine, Policlinico San Marco, Gruppo Ospedaliero San Donato, Bergamo, Italy
| | - Raquel Rodríguez-García
- Servicio de Medicina intensiva, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | - Herminia Lozano-Gómez
- Unidad de Cuidados Intensivos, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Rolf Ensner
- Klinik für Operative Intensivmedizin, Kantonsspital Aarau, Aarau, Switzerland
| | - Marc P Michot
- Medizinische Intensivstation, Kantonsspital Aarau, Aarau, Switzerland
| | - Nadine Gehring
- Intensivstation, Kantonsspital Schaffhausen, Schaffhausen, Switzerland
| | - Peter Schott
- Institut fuer Anesthaesie und Intensivmedizin, Zuger Kantonsspital AG, Baar, Switzerland
| | - Martin Siegemund
- Department Intensivmedizin, Universitaetsspital Basel, Basel, Switzerland
| | - Lukas Merki
- Intensivmedizin, St. Claraspital, Basel, Switzerland
| | - Jan Wiegand
- Interdisziplinaere Intensivmedizin, Lindenhofspital, Bern, Switzerland
| | - Marie M Jeitziner
- Department of Intensive Care Medicine, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Marcus Laube
- Department Intensive Care Medicine, Spitalzentrum Biel, Biel, Switzerland
| | - Petra Salomon
- Intensivstation, Regionalspital Emmental AG, Burgdorf, Switzerland
| | | | - Alexander Dullenkopf
- Institut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Frauenfeld, Switzerland
| | - Hatem Ksouri
- Soins Intensifs, Hopital cantonal de Fribourg, Fribourg, Switzerland
| | - Sara Cereghetti
- Division of Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Julien Marrel
- Institut für Anaesthesiologie Intensivmedizin & Rettungsmedizin, See-Spital Horgen & Kilchberg, Horgen, Switzerland
| | - Isabelle Fleisch
- Soins Intensifs, Hirslanden Clinique Cecil, Lausanne, Switzerland
| | - Marie-Helene Perez
- Pediatric Intensive Care Unit, University Hospital Lausanne, Lausanne, Switzerland
| | | | - Samuele Ceruti
- Dipartimento Area Critica, Clinica Luganese Moncucco, Lugano, Switzerland
| | - Katharina Marquardt
- Interdisziplinaere Intensivstation, Spital Maennedorf AG, Maennedorf, Switzerland
| | - Tobias Hübner
- Institut fuer Anaesthesie und Intensivmedizin, Spital Thurgau, Muensterlingen, Switzerland
| | - Hermann Redecker
- Intensivmedizin, Schweizer Paraplegikerzentrum Nottwil, Nottwil, Switzerland
| | - Michael Studhalter
- Intensivmedizin & Intermediate Care, Kantonsspital Olten, Olten, Switzerland
| | | | - Daniela Selz
- Anaesthesie Intensivmedizin Schmerzmedizin, Spital Schwyz, Schwyz, Switzerland
| | - Urs Pietsch
- Departement of Anesthesiology and Intensive Care Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Anette Ristic
- Departement for Intensive Care Medicine, Kantonsspital Nidwalden, Stans, Switzerland
| | - Antje Heise
- Intensivstation, Spital Simmental-Thun-Saanenland AG, Thun, Switzerland
| | | | | | - Patricia Fodor
- Interdisziplinaere Intensivstation, Stadtspital Triemli, Zurich, Switzerland
| | - Tomislav Gaspert
- Abteilung für Anaesthesiologie und Intensivmedizin, Hirslanden Klinik Im Park, Zurich, Switzerland
| | - Christoph Haberthuer
- Institut für Anaesthesiologie und Intensivmedizin, Klinik Hirslanden, Zurich, Switzerland
| | - Elif Colak
- General Surgery, Samsun Training and Research Hospital, Samsun, Turkey
| | - Dorothea M Heuberger
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Thierry Fumeaux
- The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.,Soins intensifs, Groupement Hospitalier de l'Ouest Lémanique, Hôpital de Nyon, Nyon, Switzerland
| | - Jonathan Montomoli
- The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.,Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Philippe Guerci
- The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland.,Department of Anesthesiology and Critical Care Medicine, University Hospital of Nancy, Nancy, France
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.,The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland
| | - Matthias P Hilty
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.,The RISC-19-ICU Registry Board, University of Zurich, Zurich, Switzerland
| | - Ferran Roche-Campo
- Servicio de Medicina intensiva, Hospital Verge de la Cinta, Carrer de les Esplanetes 44, 43500, Tortosa, Tarragona, Spain.
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22
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Buehler PK, Hofmaenner DA. Answer: How much surface can we debride with bromelain safely? Burns 2021; 47:1690. [PMID: 34400029 DOI: 10.1016/j.burns.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/18/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Philipp K Buehler
- Institute of Intensive Care, University Hospital Zurich, Zurich, Switzerland.
| | - Daniel A Hofmaenner
- Institute of Intensive Care, University Hospital Zurich, Zurich, Switzerland
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Zander D, Grass B, Weiss M, Buehler PK, Schmitz A. Cuffed endotracheal tubes in neonates and infants of less than 3 kg body weight-A retrospective audit. Paediatr Anaesth 2021; 31:604-610. [PMID: 33615635 DOI: 10.1111/pan.14104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Large prospective clinical studies have shown that modern cuffed pediatric tracheal tubes can be used safely, even in children weighing ≥3 kg. There is a growing interest in their use in children weighing <3 kg so that they, too, can benefit from the potential advantages, particularly the high probability of these tubes fitting into and sealing the pediatric airway at the first intubation attempt. This study aimed to find a cut-off body weight for procedures requiring a cuffed tracheal tube to seal the airway in children weighing <3 kg and to evaluate the frequency and predictive factors for the requirement to place a cuffed instead of an uncuffed tracheal tube. METHODS This study was a retrospective analysis of 269 children weighing 2000-2999 g, primarily intubated by pediatric anesthetists. Frequency of intubation with uncuffed Sheridan tubes versus cuffed Microcuff® Pediatric Endotracheal Tube (PET) 3.0 mm ID was studied. Predictive variables were assessed by means of logistic regression analysis. The ROC curve for weight at intubation time and Youden index was calculated. RESULTS The 149 (55.4%) children were finally intubated with a cuffed tracheal tube. Logistic regression demonstrated that body weight at tracheal intubation and birth weight were the strongest predictors for the appropriateness of cuffed/uncuffed tracheal tubes. The threshold weight at tracheal intubation was 2700 g for a probability >50% of using a cuffed tracheal tube. CONCLUSION Half of the children weighing 2000-2999 g received a Microcuff® PET 3.0 mm ID, especially those with a body weight above 2700 g. Because of the anatomical dimensions in patients with a body weight of 2000-2999 g, cuffed tracheal tubes with smaller outer diameters may be required to better fit their airways.
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Affiliation(s)
- Désirée Zander
- Department of Anesthesia, University Children's Hospital, Zurich, Switzerland.,Department of Intensive Care and Neonatology, University Children's Hospital, Zurich, Switzerland
| | - Beate Grass
- Department of Intensive Care and Neonatology, University Children's Hospital, Zurich, Switzerland
| | - Markus Weiss
- Department of Anesthesia, University Children's Hospital, Zurich, Switzerland
| | - Philipp K Buehler
- Department of Anesthesia, University Children's Hospital, Zurich, Switzerland
| | - Achim Schmitz
- Department of Anesthesia, University Children's Hospital, Zurich, Switzerland
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24
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Buehler PK, Zinkernagel AS, Hofmaenner DA, Wendel Garcia PD, Acevedo CT, Gómez-Mejia A, Mairpady Shambat S, Andreoni F, Maibach MA, Bartussek J, Hilty MP, Frey PM, Schuepbach RA, Brugger SD. Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients. Cell Rep Med 2021; 2:100229. [PMID: 33748789 PMCID: PMC7955928 DOI: 10.1016/j.xcrm.2021.100229] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/29/2021] [Accepted: 03/09/2021] [Indexed: 01/02/2023]
Abstract
The impact of secondary bacterial infections (superinfections) in coronavirus disease 2019 (COVID-19) is not well understood. In this prospective, monocentric cohort study, we aim to investigate the impact of superinfections in COVID-19 patients with acute respiratory distress syndrome. Patients are assessed for concomitant microbial infections by longitudinal analysis of tracheobronchial secretions, bronchoalveolar lavages, and blood cultures. In 45 critically ill patients, we identify 19 patients with superinfections (42.2%). Superinfections are detected on day 10 after intensive care admission. The proportion of participants alive and off invasive mechanical ventilation at study day 28 (ventilator-free days [VFDs] at 28 days) is substantially lower in patients with superinfection (subhazard ratio 0.37; 95% confidence interval [CI] 0.15–0.90; p = 0.028). Patients with pulmonary superinfections have a higher incidence of bacteremia, virus reactivations, yeast colonization, and required intensive care treatment for a longer time. Superinfections are frequent and associated with reduced VFDs at 28 days despite a high rate of empirical antibiotic therapy. Secondary bacterial infections (superinfections) are found in 42% of patients Bacterial superinfections occur on day 10 after intensive care admission Bacterial superinfections are associated with longer duration of ventilation Bacterial superinfections are mostly caused by Gram-negative bacteria
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Affiliation(s)
- Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Pedro David Wendel Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Claudio T Acevedo
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Alejandro Gómez-Mejia
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Srikanth Mairpady Shambat
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Federica Andreoni
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Martina A Maibach
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Jan Bartussek
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.,Department of Quantitative Biomedicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Matthias P Hilty
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Pascal M Frey
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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25
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Klein HJ, Buehler PK, Niggemann P, Rittirsch D, Schweizer R, Waldner M, Giovanoli P, Cinelli P, Reding T, Graf R, Plock JA. Expression of Pancreatic Stone Protein is Unaffected by Trauma and Subsequent Surgery in Burn Patients. World J Surg 2021; 44:3000-3009. [PMID: 32451625 DOI: 10.1007/s00268-020-05589-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Altered levels of pro-inflammatory markers secondary to trauma or surgery present a major problem to physicians in being prone to interfere with the clinical identification of infectious events. METHODS Patients admitted to Zurich Burn Center between May 2015 and October 2018 with burns ≥10% total body surface area (TBSA) and without infection. Longitudinal analysis of the time course of PSP and routine inflammatory biomarkers [procalcitonin (PCT), C-reactive protein (CRP) and white blood cells (WBC)] over two days after (a) trauma with initial debridement and (b) subsequent burn surgeries was performed. The influence of TBSA, abbreviated burn severity index (ABSI), age and length of operation was investigated using a linear mixed effect regression model. RESULTS Sixty-six patients (15 female) were included with a mean age of 45.5 ± 18.3 years, median TBSA of 22% (IQR 17) and mean ABSI score 6.8 ± 2.7. PSP was the only biomarker that showed no association with any of the baseline characteristics. Additionally, PSP serum levels did not change over time neither after the burn trauma (p = 0.832) nor after secondary procedures (p = 0.113), while PCT levels increased significantly after the trauma (p < 0.001). Similarly, CRP serum levels were elevated significantly after both trauma and surgery (p < 0.001), whereas WBC values demonstrated a significant decline after the trauma (p < 0.001). CONCLUSION Established biomarkers (WBC, CRP and PCT) demonstrate decisive alterations after tissue destruction caused by burn injuries and subsequent surgical interventions. The robustness of PSP serum levels toward these inflammatory insults is a quality criterion for an upcoming sepsis biomarker.
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Affiliation(s)
- Holger J Klein
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Regenerative and Reconstructive Plastic Surgery Research Laboratory, University of Zurich, Zurich, Switzerland.
| | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Pia Niggemann
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Daniel Rittirsch
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Riccardo Schweizer
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Regenerative and Reconstructive Plastic Surgery Research Laboratory, University of Zurich, Zurich, Switzerland
| | - Matthias Waldner
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Regenerative and Reconstructive Plastic Surgery Research Laboratory, University of Zurich, Zurich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Paolo Cinelli
- Center for Surgical Research, University and University Hospital Zurich, Zurich, Switzerland
| | - Theresia Reding
- Pancreas Research Laboratory, Department of Visceral Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Graf
- Pancreas Research Laboratory, Department of Visceral Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Jan A Plock
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Regenerative and Reconstructive Plastic Surgery Research Laboratory, University of Zurich, Zurich, Switzerland
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Moser B, Kemper M, Dullenkopf A, Dave MH, Buehler PK, Weiss M. Simulated dimensional compatibility of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children. Paediatr Anaesth 2021; 31:167-177. [PMID: 33128267 DOI: 10.1111/pan.14058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/30/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cuffed tracheal tubes have recently been recommended for selective endobronchial intubation to establish single-lung ventilation even in smaller children. This implies that, compared with uncuffed tracheal tubes, the cuffed tracheal tubes selected will be smaller and therefore have a shorter length. We hypothesized that cuffed tracheal tubes might be of insufficient length for selective endobronchial intubation if the tube cuff were fully immersed in the left or right mainstem bronchus. METHODS The distance from the proximal end of the tracheal tube to the upper border of the cuff in cuffed tracheal tubes and to the upper margin of the Murphy eye in uncuffed tracheal tubes, respectively, was assessed in sizes 3.0-7.0 mm internal diameter. The raw data sets of two previously performed studies obtained from 337 children aged from birth to 16 years, including the distances "teeth to tracheal tube tip" and "tracheal tube tip to carina," were used to calculate age-, weight-, and height-related data for the distance from "teeth to carina." Tracheal tube dimensions were compared with age-related distances from "teeth to carina," applying published recommendations for the selection of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children. RESULTS The differences between the length of the age-related tracheal tube and the tracheal tube insertion length required to guarantee full insertion of the tracheal tube cuff or the Murphy eye within the mainstem bronchus ranged from -3.5 to 52.6 mm in cuffed tracheal tubes and from 42.3 to 83.3 mm in uncuffed tracheal tubes. CONCLUSIONS For many age groups of patients requiring selective endobronchial intubation, the lengths of cuffed tracheal tubes, in contrast to those of uncuffed tracheal tubes, were revealed to be critically short for safe taping outside the oral cavity with the cuff placed completely within the right or left mainstem bronchus.
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Affiliation(s)
- Berthold Moser
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Anaesthesia and Intensive Care, Spital Limmattal, Schlieren, Switzerland
| | - Michael Kemper
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Alexander Dullenkopf
- Department of Anaesthesia and Intensive Care, Kantonsspital, Frauenfeld, Switzerland
| | - Mital H Dave
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Markus Weiss
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
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27
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Hofmaenner DA, Wendel Garcia PD, Duvnjak B, Chakrakodi B, Maier JD, Huber M, Huder J, Wolfensberger A, Schreiber PW, Schuepbach RA, Zinkernagel AS, Buehler PK, Brugger SD. Bacterial but no SARS-CoV-2 contamination after terminal disinfection of tertiary care intensive care units treating COVID-19 patients. Antimicrob Resist Infect Control 2021; 10:11. [PMID: 33436105 PMCID: PMC7802978 DOI: 10.1186/s13756-021-00885-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background In intensive care units (ICUs) treating patients with Coronavirus disease 2019 (COVID-19) invasive ventilation poses a high risk for aerosol and droplet formation. Surface contamination of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) or bacteria can result in nosocomial transmission.
Methods Two tertiary care COVID-19 intensive care units treating 53 patients for 870 patient days were sampled after terminal cleaning and preparation for regular use to treat non-COVID-19 patients. Results A total of 176 swabs were sampled of defined locations covering both ICUs. No SARS-CoV-2 ribonucleic acid (RNA) was detected. Gram-negative bacterial contamination was mainly linked to sinks and siphons. Skin flora was isolated from most swabbed areas and Enterococcus faecium was detected on two keyboards. Conclusions After basic cleaning with standard disinfection measures no remaining SARS-CoV-2 RNA was detected. Bacterial contamination was low and mainly localised in sinks and siphons.
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Affiliation(s)
- Daniel A Hofmaenner
- Institute of Intensive Care, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Pedro David Wendel Garcia
- Institute of Intensive Care, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Branko Duvnjak
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Bhavya Chakrakodi
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Julian D Maier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Michael Huber
- Institute of Medical Virology, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Jon Huder
- Institute of Medical Virology, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Aline Wolfensberger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Peter W Schreiber
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Care, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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Hofmaenner DA, Herling A, Klinzing S, Wegner S, Lohmeyer Q, Schuepbach RA, Buehler PK. Use of eye tracking in analyzing distribution of visual attention among critical care nurses in daily professional life: an observational study. J Clin Monit Comput 2020; 35:1511-1518. [PMID: 33296061 PMCID: PMC7724778 DOI: 10.1007/s10877-020-00628-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
Patient safety is a priority in healthcare, yet it is unclear how sources of errors should best be analyzed. Eye tracking is a tool used to monitor gaze patterns in medicine. The aim of this study was to analyze the distribution of visual attention among critical care nurses performing non-simulated, routine patient care on invasively ventilated patients in an ICU. ICU nurses were tracked bedside in daily practice. Eight specific areas of interest were pre-defined (respirator, drug preparation, medication, patient data management system, patient, monitor, communication and equipment/perfusors). Main independent variable and primary outcome was dwell time, secondary outcomes were hit ratio, revisits, fixation count and average fixation time on areas of interest in a targeted tracking-time of 60 min. 28 ICU nurses were analyzed and the average tracking time was 65.5 min. Dwell time was significantly higher for the respirator (12.7% of total dwell time), patient data management system (23.7% of total dwell time) and patient (33.4% of total dwell time) compared to the other areas of interest. A similar distribution was observed for fixation count (respirator 13.3%, patient data management system 25.8% and patient 31.3%). Average fixation time and revisits of the respirator were markedly elevated. Apart from the respirator, average fixation time was highest for the patient data management system, communication and equipment/perfusors. Eye tracking is helpful to analyze the distribution of visual attention of critical care nurses. It demonstrates that the respirator, the patient data management system and the patient form cornerstones in the treatment of critically ill patients. This offers insights into complex work patterns in critical care and the possibility of improving work flows, avoiding human error and maximizing patient safety.
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Affiliation(s)
- Daniel A Hofmaenner
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland.
| | - Anique Herling
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Stephanie Klinzing
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Stephan Wegner
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Quentin Lohmeyer
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
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29
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Hofmaenner DA, Klinzing S, Brandi G, Hess S, Lohmeyer Q, Enthofer K, Schuepbach RA, Buehler PK. The doctor's point of view: eye-tracking as an investigative tool in the extubation process in intensive care units. A pilot study. Minerva Anestesiol 2020; 86:1180-1189. [DOI: 10.23736/s0375-9393.20.14468-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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30
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Brandi G, Drewniak D, Buehler PK, Budilivschi A, Steiger P, Krones T. Indications and contraindications for extracorporeal life support for severe heart or lung failure: a systematic review. Minerva Anestesiol 2020; 87:199-209. [PMID: 32755087 DOI: 10.23736/s0375-9393.20.14513-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The effectiveness of extracorporeal life support (ECLS) in critically ill patients remains unclear despite a substantial increase in its use. This study critically assesses existing ECLS guidelines, consensus statements, and position papers to systematically review them for agreements and differences regarding indications and contraindications for ECLS. EVIDENCE ACQUISITION The aims of this review were to identify available indications and contraindications for ECLS and to evaluate the quality of the evidence on which they are based. Documents containing recommendations regarding indications and/or contraindications for ECLS in adults (aged 18+) were identified through Medline, EMBASE, and CENTRAL searches. Additional documents were identified from guideline-specific databases and the internet websites of professional societies. Based on the Appraisal of Guidelines for Research and Evaluation (AGREE II), four independent reviewers assessed the rigor of development and quality of the documents. EVIDENCE SYNTHESIS Eleven documents met the inclusion criteria. Three documents received an average score of ≥50% in all domains. However, the Editorial independence domain only scored <50% in most of the documents. Overall, 13 cardiac and 13 pulmonary ECLS indications, and 23 cardiac and 14 pulmonary contraindications were identified. Indications and contraindications for ECLS use are variable across the documents included and leave considerable room for interpretation. CONCLUSIONS The documents included for review show considerable variability, with little consensus on indications and contraindications. This lack of consensus may reflect a lack of clarity regarding ECLS utility. Additionally, it may reveal the necessity for individualized, patient-dependent criteria supported by the best evidence available.
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Affiliation(s)
- Giovanna Brandi
- Institute of Intensive Medicine, Zurich University Hospital, University of Zurich, Zurich, Switzerland -
| | - Daniel Drewniak
- Institute of Biomedical Ethics and History of Medicine, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Medicine, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Ana Budilivschi
- Institute of Biomedical Ethics and History of Medicine, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Peter Steiger
- Institute of Intensive Medicine, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Tanja Krones
- Clinical Ethics Unit, Institute of Biomedical Ethics and History of Medicine, Zurich University Hospital, University of Zurich, Zurich, Switzerland
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31
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Peduzzi N, Batliner M, Grass B, Buehler PK, Schmid Daners M, Meboldt M, Weiss M. Flow irregularities from syringe infusion pumps caused by syringe stiction. Paediatr Anaesth 2020; 30:885-891. [PMID: 32443169 DOI: 10.1111/pan.13926] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The current study aimed to evaluate the extent of the slide-stick phenomenon in differently designed infusion syringes at various infusion rates and filling positions. METHODS Fluid delivery from three 50-mL infusion syringe brands (BD; Codan; Fresenius) was investigated using a flow sensor at flow rates of 0.5, 1.0, or 5.0 mL h-1 , with the syringes filled with either 10, 30, or 50 mL of distilled water. Two identical models (A/B) of the same infusion pump model were used. The effect of flow rate variations on the plasma concentration of a continuous epinephrine infusion in a 3 kg neonate receiving a continuous infusion of 0.1 μg kg min-1 epinephrine was studied using a pharmacokinetic simulation model. RESULTS Considerable variations in calculated plasma epinephrine concentration were detected between flow rates of 5 and 0.5 or 1 mL h-1 for all syringe types and filling volumes. The median deviation of plasma concentration for the 5 mL h-1 flow rate varied depending on assembly from 1.3% (Codan) to 1.8% (Fresenius). This was more pronounced for lower flow rates, where at 1 mL h-1 the deviation varied from 3.3% (BD) to 4.8% (Fresenius) and at 0.5 mL h-1 from 4.9% (BD) to 5.4% (Fresenius). Differences between filling volumes (within syringe type and flow rate) did not appear to have relevant influence on variations in calculated plasma epinephrine concentration. CONCLUSION Infusion set rate rather than syringe brand or filling volume was a major predictor for syringe stiction-related amount of variation in the calculated plasma epinephrine concentration.
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Affiliation(s)
- Neris Peduzzi
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Batliner
- Product Development Group Zurich, ETH Zurich, Zurich, Switzerland
| | - Beate Grass
- Department of Intensive Care and Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Mirko Meboldt
- Product Development Group Zurich, ETH Zurich, Zurich, Switzerland
| | - Markus Weiss
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland
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Klein HJ, Rittirsch D, Buehler PK, Schweizer R, Giovanoli P, Cinelli P, Plock JA, Reding T, Graf R. Response of routine inflammatory biomarkers and novel Pancreatic Stone Protein to inhalation injury and its interference with sepsis detection in severely burned patients. Burns 2020; 47:338-348. [PMID: 33272743 DOI: 10.1016/j.burns.2020.04.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Inhalation of thermal and chemical products of combustion evokes an immune response measurable at a systemic level. Inhalation injury related kinetics of currently available inflammatory biomarkers and novel Pancreatic Stone Protein (PSP) as well as their interference with septic events has not been addressed to literature yet. METHODS Analysis of the influence of inhalation injury and ARDS on biomarker kinetics (PSP, procalcitonin (PCT), C-reactive Protein (CRP), white blood cells (WBC)) in 90 patients admitted to Zurich Burn Center between May 2015 and October 2018 with burns ≥15% total body surface area (TBSA) over 14 days. RESULTS Twenty-five (27%) of 90 included patients presented with inhalation injury (median age 52 years [IQR 27], median TBSA 31.5% [IQR 21], mean ABSI-Score 7±3). At admission, only WBC demonstrated significantly higher values in the inhalation injury group (p=0.011). Acute respiratory distress syndrome (ARDS) was present in 32% without association to the severity of inhalation injury (p=0.11). WBC, CRP and PCT failed to delineate inhalation injury related inflammation from septic progression at most time points. PSP was the strongest marker to identify septic patients both by its higher values and steeper increase over time (p<0.001). CONCLUSION Inhalation injury leads to an inflammatory response at a systemic level with alterations of biomarkers. While routine inflammatory markers demonstrated strong interferences between inhalation injury with its associated ARDS and evolving sepsis, PSP reliably identified septic patients in a setting of inflammatory turbulences secondary to inhalation injury.
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Affiliation(s)
- Holger J Klein
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Zurich, Switzerland; Regenerative and Reconstructive Plastic Surgery Research Laboratory, University of Zurich, Zurich, Switzerland.
| | - Daniel Rittirsch
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Riccardo Schweizer
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Zurich, Switzerland; Regenerative and Reconstructive Plastic Surgery Research Laboratory, University of Zurich, Zurich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Zurich, Switzerland
| | - Paolo Cinelli
- Center for Surgical Research, University and University Hospital Zurich, Zurich, Switzerland
| | - Jan A Plock
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Zurich, Switzerland; Regenerative and Reconstructive Plastic Surgery Research Laboratory, University of Zurich, Zurich, Switzerland
| | - Theresia Reding
- Pancreas Research Laboratory, Department of Visceral Surgery & Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Graf
- Pancreas Research Laboratory, Department of Visceral Surgery & Transplantation, University Hospital Zurich, Zurich, Switzerland
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Kemper ME, Buehler PK, Schmitz A, Gysin C, Nicolai T, Weiss M. Classical versus controlled rapid sequence induction and intubation in children with bleeding tonsils (a retrospective audit). Acta Anaesthesiol Scand 2020; 64:41-47. [PMID: 31508809 DOI: 10.1111/aas.13473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/14/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine whether bag-mask ventilation between induction of anaesthesia and tracheal intubation in children with post-tonsillectomy bleeding reduces the incidence of hypoxaemia and difficult direct laryngoscopy without increasing perioperative respiratory complications. METHODS Medical records, anaesthesia protocols and vital sign data were analysed from February 2005 to March 2017 for patients undergoing anaesthesia for surgical revision of bleeding tonsils. Type of rapid sequence induction and intubation (RSII; classical, ie, apnoeic, vs controlled, ie, with gentle bag-mask ventilation) was noted. Primary outcomes were incidence of moderate and severe hypoxaemia, grade of direct laryngoscopic views as well as occurrence of noted tracheal intubation difficulties. Haemodynamic alterations during RSII and perioperative adverse events such as noted gastric regurgitation, pulmonary aspiration and perioperative pulmonary morbidity were also recorded. RESULTS A classical RSII was performed for 22 surgical revisions in 22 children and a controlled RSII was used for 88 surgical revisions in 81 children. Patients undergoing controlled RSII had less incidence of severe hypoxaemia (1 vs 3; P = .025), better direct laryngoscopic views (P = .048) and less hypertension (5 vs 9; P < .001) than those patients managed by classical RSII. No tracheal intubation difficulties occurred. There was no significant perioperative pulmonary morbidity reported in either group. CONCLUSIONS Controlled RSII had advantages over classical RSII in children with post-tonsillectomy bleeding and may become a strategic option in these patients to avoid hypoxaemia, difficult laryngoscopy and hypertension during induction of anaesthesia and tracheal intubation. Bag-mask ventilation in patients with bleeding tonsils did not lead to pulmonary morbidity.
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Affiliation(s)
- Melanie E. Kemper
- Department of Anaesthesia University Children's Hospital Zurich Switzerland
- Department of Pediatric Intensive Care Dr. von Hauner Children's Hospital Ludwig-Maximilians-University Munich Germany
| | - Philipp K. Buehler
- Department of Anaesthesia University Children's Hospital Zurich Switzerland
| | - Achim Schmitz
- Department of Anaesthesia University Children's Hospital Zurich Switzerland
| | - Claudine Gysin
- Department of Otorhinolaryngology University Children's Hospital Zurich Switzerland
| | - Thomas Nicolai
- Department of Pediatric Intensive Care Dr. von Hauner Children's Hospital Ludwig-Maximilians-University Munich Germany
| | - Markus Weiss
- Department of Anaesthesia University Children's Hospital Zurich Switzerland
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Baeckert M, Batliner M, Grass B, Buehler PK, Daners MS, Meboldt M, Weiss M. Performance of modern syringe infusion pump assemblies at low infusion rates in the perioperative setting. Br J Anaesth 2019; 124:173-182. [PMID: 31864721 DOI: 10.1016/j.bja.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/16/2019] [Accepted: 10/08/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Syringe infusion pumps are used for the precise continuous administration of intravenous drugs. Their compliance and mechanical deficiencies have been found to cause considerable start-up delays, flow irregularities during vertical displacement, as well extensive delays of occlusion alarms at low infusion rates. The aim of this study was to evaluate the performance of several modern syringe infusion pumps at low infusion rates and the impact on drug concentration. METHODS Seven currently marketed syringe infusion pump assemblies were assessed in an in vitro study during start-up, vertical displacement manoeuvres, and infusion line occlusion at a set flow rate of 1 ml h-1. The measured data were used as input for a pharmacokinetic simulation modelling plasma concentration during a standard neonatal continuous epinephrine infusion. RESULTS The mean time from starting the infusion pump to steady-state flow varied from 89 to 1622 s. The zero-drug delivery time after lowering the pump ranged from 145 to 335 s. In all assemblies tested, occlusion alarm delays and measured flow irregularities during vertical displacement manoeuvres resulted in relevant deviations in plasma epinephrine concentration (>25%) as calculated by the pharmacokinetic simulation model. CONCLUSION Problems with the performance of syringe infusion pump assemblies can have considerable impact on plasma drug concentration when highly concentrated short-acting cardiovascular drugs are administered at low flow rates. The problems, which affected all assemblies tested, are mainly related to the functional principle of syringe infusion pumps and will only partially be solved by incremental improvements of existing equipment.
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Affiliation(s)
- Martina Baeckert
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Batliner
- Product Development Group Zurich, ETH Zurich, Zurich, Switzerland
| | - Beate Grass
- Department of Paediatric Intensive Care and Neonatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Mirko Meboldt
- Product Development Group Zurich, ETH Zurich, Zurich, Switzerland
| | - Markus Weiss
- Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland.
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Bastian K, Buehler PK, Slizyte D, Rüst CA, Toft K, Studer W, Lecheler L, Aguirre J, Siegemund M, Hollinger A. A preoperative single dose of methadone for moderate-to-severely painful surgery reduces postoperative morphine consumption. Minerva Anestesiol 2019; 85:1053-1061. [DOI: 10.23736/s0375-9393.19.13136-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schmid K, Buehler PK, Schmitz A, Both CP, Weiss M. Frequency distribution of modified Cormack-Lehane views-A retrospective audit of tracheal intubation in children with normal airways. Acta Anaesthesiol Scand 2019; 63:1001-1008. [PMID: 31162669 DOI: 10.1111/aas.13387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/17/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Paediatric patients with an unanticipated poor grade of laryngoscopic view during tracheal intubation represent a challenging situation potentially associated with increased morbidity and mortality. The aim of this study was to investigate the frequency of modified Cormack-Lehane (MCL) views and to elucidate variables for poor views in a large collective of children without anticipated airway difficulties. METHODS The departmental anaesthesia patient database was searched for patients who had undergone general anaesthesia with tracheal intubation between January 2007 and March 2017. Inclusion criteria were age from birth to 17.99 years, general anaesthesia with tracheal intubation using direct laryngoscopy, no history, symptoms or signs of a difficult airway and the best obtained MCL view documented in the database. Patient- and anaesthesia-related variables associated with a poor view (MCL IIb, III and IV) were elucidated using a logistic regression model. RESULTS In all, 22 965 patients were included; of these, 17 593 were observed only once. The prevalence of the first observed MCL views I, IIa, IIb, III and IV was 90.6%, 8.5%, 0.86%, 0.05% and 0%, respectively. The logistic regression model indicates that age and gender are the most important variables associated with MCL views IIb and III in the model. The probability for MCL views IIb/III decreases across the first 5-7 years before increasing again. CONCLUSIONS The incidence of a poor grade of laryngoscopic view was found to be very low in children with a normal airway. They mainly occurred in infants and adolescent patients and were more common in male patients.
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Affiliation(s)
- Kathrin Schmid
- Department of Anaesthesia and Children's Research Centre University Children's Hospital Zurich Switzerland
| | - Philipp K. Buehler
- Department of Anaesthesia and Children's Research Centre University Children's Hospital Zurich Switzerland
| | - Achim Schmitz
- Department of Anaesthesia and Children's Research Centre University Children's Hospital Zurich Switzerland
| | - Christian P. Both
- Department of Anaesthesia and Children's Research Centre University Children's Hospital Zurich Switzerland
| | - Markus Weiss
- Department of Anaesthesia and Children's Research Centre University Children's Hospital Zurich Switzerland
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Buehler PK, Bleiler D, Tegtmeier I, Heitzmann D, Both C, Georgieff M, Lesage F, Warth R, Thomas J. Abnormal respiration under hyperoxia in TASK-1/3 potassium channel double knockout mice. Respir Physiol Neurobiol 2017; 244:17-25. [PMID: 28673876 DOI: 10.1016/j.resp.2017.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/23/2017] [Accepted: 06/24/2017] [Indexed: 01/29/2023]
Abstract
Despite intensive research, the exact function of TASK potassium channels in central and peripheral chemoreception is still under debate. In this study, we investigated the respiration of unrestrained TASK-3 (TASK-3-/-) and TASK-1/TASK-3 double knockout (TASK-1/3-/-) adult male mice in vivo using a plethysmographic device. Ventilation parameters of TASK-3-/- mice were normal under control condition (21% O2) and upon hypoxia and hypercapnia they displayed the physiological increase of ventilation. TASK-1/3-/- mice showed increased ventilation under control conditions. This increase of ventilation was caused by increased tidal volumes (VT), a phenomenon similarly observed in TASK-1-/- mice. Under acute hypoxia, TASK-1/3-/- mice displayed the physiological increase of the minute volume. Interestingly, this increase was not related to an increase of the respiratory frequency (fR), as observed in wild-type mice, but was caused by a strong increase of VT. This particular respiratory phenotype is reminiscent of the respiratory phenotype of carotid body-denervated rodents in the compensated state. Acute hypercapnia (5% CO2) stimulated ventilation in TASK-1/3-/- and wild-type mice to a similar extent; however, at higher CO2 concentrations (>5% CO2) the stimulation of ventilation was more pronounced in TASK-1/3-/- mice. At hyperoxia (100% O2), TASK-1-/-, TASK-3-/- and wild-type mice showed the physiological small decrease of ventilation. In sharp contrast, TASK-1/3-/- mice exhibited an abnormal increase of ventilation under hyperoxia. In summary, these measurements showed a grossly normal respiration of TASK-3-/- mice and a respiratory phenotype of TASK-1/3-/- mice that was characterized by a markedly enhanced tidal volume, similar to the one observed in TASK-1-/- mice. The abnormal hyperoxia response, exclusively found in TASK-1/3-/- double mutant mice, indicates that both TASK-1 and TASK-3 are essential for the hyperoxia-induced hypoventilation. The peculiar respiratory phenotype of TASK-1/3 knockout mice is reminiscent of the respiration of animals with long-term carotid body dysfunction. Taken together, TASK-1 and TASK-3 appear to serve specific and distinct roles in the complex processes underlying chemoreception and respiratory control.
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Affiliation(s)
- Philipp K Buehler
- University Children's Hospital, Steinwiesstr. 75, CH-8032 Zürich, Switzerland
| | - Doris Bleiler
- Institute of Physiology, University of Regensburg, D-93053 Regensburg, Germany; Department of Anaesthesia, University Hospital Regensburg, 93042 Regensburg, Germany
| | - Ines Tegtmeier
- Institute of Physiology, University of Regensburg, D-93053 Regensburg, Germany
| | - Dirk Heitzmann
- Institute of Physiology, University of Regensburg, D-93053 Regensburg, Germany; University Medical Centre Mannheim, V. Medical Clinic, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Christian Both
- University Children's Hospital, Steinwiesstr. 75, CH-8032 Zürich, Switzerland
| | - Michael Georgieff
- Institute of Anesthesiology, University of Ulm, D-89081 Ulm, Germany
| | - Florian Lesage
- Université Côte d'Azur, Inserm, CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, LabEx ICST, 660 Route des Lucioles, 06560, Valbonne, France
| | - Richard Warth
- Institute of Physiology, University of Regensburg, D-93053 Regensburg, Germany
| | - Jörg Thomas
- University Children's Hospital, Steinwiesstr. 75, CH-8032 Zürich, Switzerland.
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Schmitz A, Schmidt AR, Buehler PK, Schraner T, Frühauf M, Weiss M, Klaghofer R, Kellenberger CJ. Gastric ultrasound as a preoperative bedside test for residual gastric contents volume in children. Paediatr Anaesth 2016; 26:1157-1164. [PMID: 27543559 DOI: 10.1111/pan.12993] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Emergency situations and conditions with impaired gastric emptying enhance the risk of perioperative pulmonary aspiration due to increased residual gastric contents volume (GCV). Gastric ultrasonographic (US) measurement of the gastric antral cross-sectional area (CSA) has been proposed to estimate preanesthetic GCV. However, only few healthy children and fasted pediatric patients have been investigated so far, predicting GCV with considerable imprecision. This study aimed to compare GCV assessed by US in different patient positions for measuring CSA, using magnetic resonance imaging (MRI) as reference, and to evaluate its potential as diagnostic test. METHODS Healthy volunteer children were examined in a crossover design on 2 days. After baseline examination, they received a light breakfast, followed by 7 ml·kg-1 clear fluid after 2 or 4 h. Gastric emptying was examined with MRI over 4 or 6 h, respectively. US was performed immediately after MRI in right lateral decubital (RLD) and supine with upper body elevated (SUBE) positions. Correlation coefficients (Pearson R; 95%CI) between CSA and body weight corrected GCV (GCVw ) as determined by MRI volumetry were calculated. Data are presented as median (range). RESULTS Eighteen children aged 9.8 (6.8-12.2) years had 72 US examinations completed. CSA was 401 (101-1311) mm2 and 271 (118-582) mm2 , and R between CSA and GCVw was 0.76 (0.76-1) and 0.57 (0.41-0.88) for the RLD and SUBE positions, respectively. The corresponding GCVw was 2.1 (0.1-13.8) ml·kg-1 . A linear regression model from RLD was similar to one previously derived. Bland-Altman analysis and ROC plots are presented. CONCLUSION CSA correlated with GCVw in healthy children over a wide range of gastric filling, with the RLD position clearly superior to the SUBE position, confirming a previously derived formula. Although direct calculation of GCVw is imprecise, this technique has the potential to become a diagnostic risk assessment test.
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Affiliation(s)
- Achim Schmitz
- Department of Anesthesiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Alexander R Schmidt
- Department of Anesthesiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Philipp K Buehler
- Department of Anesthesiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Thomas Schraner
- Children's Research Center, University Children's Hospital, Zurich, Switzerland.,Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
| | - Melanie Frühauf
- Department of Anesthesiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Markus Weiss
- Department of Anesthesiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Richard Klaghofer
- Division of Psychiatry and Psychotherapy, University Hospital, Zurich, Switzerland
| | - Christian J Kellenberger
- Children's Research Center, University Children's Hospital, Zurich, Switzerland.,Department of Diagnostic Imaging, University Children's Hospital, Zurich, Switzerland
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Abstract
Prolactin secretion in women undergoing augmentation and reduction mammaplasties was studied by determining serum prolactin concentrations preoperatively, intraoperatively, and for one year postoperatively. Thyrotropin-releasing hormone tests for prolactin secretion were performed in a small subgroup of these patients. The subjects were 7 women undergoing reduction mammaplasty, 13 women undergoing augmentation mammaplasty, and 14 normal control women. Short-term (up to three days postoperatively) but not long-term changes in prolactin secretion were identified. Persistent hyperprolactinemia does not appear to be a common complication of plastic breast operations.
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Affiliation(s)
- M R Soules
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle
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Abstract
This technique produces patient cooperation during the phase of local anesthetic injection by judicious use of intravenous ketamine. The addition of diazepam and a narcotic drug to low-dose ketamine may account for a low incidence of hallucinations and psychic sensations. The use of a dilute solution of lidocaine and a very low concentration of epinephrine allows large areas to be anesthetized. The ultralow concentration of epinephrine provides effective vasoconstriction. The result is good patient acceptance, a stable blood pressure and heart rate, and a low incidence of complications classically associated with local anesthetic toxicity.
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Abstract
Patient selection for prophylactic mastectomy should be based on an individual assessment of risk factors. These should be correlated with the patient's age, the difficulty of clinical examination, and, in the case of a previous breast cancer, its prognosis. Only then can the patient and her surgeon make an intelligent decision regarding management.
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Abstract
Though commercially available 11.2% mafenide acetate cream (Sulfamylon) has been shown to be very effective in preventing burn wound sepsis, it has several serious drawbacks. Five percent mafenide acetate solution dressings are also effective and do not have the disadvantages of the cream. This preparation, however, is not available for general usage. For these reasons, we have devised a laminated dressing using the 11.2% cream and saline, which delivers an aqueous solution of mafenide acetate to the wound. The dressing has proved both effective and acceptable to patients, and is particularly valuable following the application of split-thickness skin grafts to burns and other chronic open wounds. The technique is described.
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Abstract
Two cases of spontaneous rupture of colicartery aneurysms are presented, one involving the left colic artery and the other the right colic artery, and the literature on abdominal apoplexy and visceral arterial aneurysms is reviewed. In view of the potential for life-threatening hemorrhage, it is urged that, whenever feasible, visceral arterial aneurysms be resected prophylactically when discovered by angiography or at celiotomy.
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