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1. Health-related quality of life in older patients surviving ICU treatment for COVID-19: results from an international observational study of patients older than 70 years

Author: Soliman, Ivo, Leaver, Susannah, Flaatten, Hans, Fjølner, Jesper, Wernly, Bernhard, Bruno, Raphael, Artigas, Antonio, Bollen Pinto, Bernardo, Schefold, Joerg, Beil, Michael, Sviri, Sigal, van Heerden, Peter Vernon, Szczeklik, Wojciech, Elhadi, Muhammed, Joannidis, Michael, Oeyen, Sandra, Zafeiridis, Tilemachos, Wollborn, Jakob, Banzo, Maria Jose Arche, Fuest, Kristina, Marsh, Brian, Andersen, Finn, Moreno, Rui, Boumendil, Ariane, Guidet, Bertrand, Jung, Christian, de Lange, Dylan, Eller, Philipp, Mesotten, Dieter, Reper, Pascal, Swinnen, Walter, Brix, Helene, Brushoej, Jens, Villefrance, Maja, Nedergaard, Helene Korvenius, Bjerregaard, Anders Thais, Balleby, Ida Riise, Andersen, Kasper, Hansen, Maria Aagaard, Uhrenholt, Stine, Bundgaard, Helle, Mohamed, Aliae Ar Hussein, Salah, Rehab, Ali, Yasmin Khairy Nasreldin Mohamed, Wassim, Kyrillos, Elgazzar, Yumna, Tharwat, Samar, Azzam, Ahmed, Habib, Ayman Abdelmawgoad, Abosheaishaa, Hazem Maarouf, Azab, Mohammed, Galbois, Arnaud, Charron, Cyril, Guerot, Emmanuel, Besch, Guillaume, Rigaud, Jean-Philippe, Maizel, Julien, Djibré, Michel, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Alexandru, Nica, Marin, Nathalie, Vaissiere, Marie, Plantefeve, Gaëtan, Vanderlinden, Thierry, Jurcisin, Igor, Megarbane, Bruno, Caillard, Anais, Valent, Arnaud, Garnier, Marc, Besset, Sebastien, Oziel, Johanna, Raphaelen, Jean-Herlé, Dauger, Stéphane, Dumas, Guillaume, Goncalves, Bruno, Piton, Gaël, Bruno, Raphael Romano, Kelm, Malte, Wolff, Georg, Barth, Eberhard, Goebel, Ulrich, Kunstein, Anselm, Schuster, Michael, Welte, Martin, Lutz, Matthias, Meybohm, Patrick, Steiner, Stephan, Poerner, Tudor, Haake, Hendrik, Schaller, Stefan, Kindgen-Milles, Detlef, Meyer, Christian, Kurt, Muhammed, Kuhn, Karl Friedrich, Randerath, Winfried, Dindane, Zouhir, Kabitz, Hans-Joachim, Voigt, Ingo, Shala, Gonxhe, Faltlhauser, Andreas, Rovina, Nikoletta, Aidoni, Zoi, Chrisanthopoulou, Evangelia, Papadogoulas, Antonios, Gurjar, Mohan, Mahmoodpoor, Ata, Ahmed, Abdullah Khudhur, Elsaka, Ahmed, Comellini, Vittoria, Rabha, Ahmed, Ahmed, Hazem, Namendys-Silva, Silvio, Ghannam, Abdelilah, Groenendijk, Martijn, Zegers, Marieke, Cornet, Alex, Evers, Mirjam, Haas, Lenneke, Dormans, Tom, Dieperink, Willem, Romundstad, Luis, Sjøbø, Britt, Strietzel, Hans Frank, Olasveengen, Theresa, Hahn, Michael, Czuczwar, Miroslaw, Gawda, Ryszard, Klimkiewicz, Jakub, de Lurdessantos, Maria Campos, Gordinho, André, Santos, Henrique, Assis, Rui, Oliveira, Ana Isabel Pinho, Badawy, Mohamed Raafat, Perez-Torres, David, Gomà, Gemma, Villamayor, Mercedes Ibarz, Mira, Angela Prado, Cubero, Patricia Jimeno, Rivera, Susana Arias, Tomasa, Teresa, Iglesias, David, Vázquez, Eric Mayor, Aldecoa, Cesar, Ferreira, Aida Fernández, Zalba-Etayo, Begoña, Canas-Perez, Isabel, Tamayo-Lomas, Luis, Diaz-Rodriguez, Cristina, Sancho, Susana, Priego, Jesús, Abualqumboz, Enas, Hilles, Momin Majed Yousuf, Saleh, Mahmoud, Ben-Hamouda, Nawfel, Roberti, Andrea, Dullenkopf, Alexander, Fleury, Yvan, Pinto, Bernardo Bollen, Al-Sadawi, Mohammed, Serck, Nicolas, Dewaele, Elisabeth, Kumar, Pritpal, Bundesen, Camilla, Innes, Richard, Gooch, James, Cagova, Lenka, Potter, Elizabeth, Reay, Michael, Davey, Miriam, Humphreys, Sally, Berlemont, Caroline Hauw, Chousterman, Benjamin Glenn, Dépret, François, Ferre, Alexis, Vettoretti, Lucie, Thevenin, Didier, Milovanovic, Milena, Simon, Philipp, Lorenz, Marco, Stoll, Sandra Emily, Dubler, Simon, Mulita, Francesk, Kondili, Eumorifa, Andrianopoulos, Ioannis, Meynaar, Iwan, Cornet, Alexander Daniel, Sjøbøe, Britt, Kluzik, Anna, Zatorski, Paweł, Drygalski, Tomasz, Solek-Pastuszka, Joanna, Onichimowski, Dariusz, Stefaniak, Jan, Stefanska-Wronka, Karina, Zabul, Ewa, Cardoso, Filipe Sousa, Banzo, Maria José Arche, Tomasa-Irriguible, Teresa Maria, Mira, Ángela Prado, Arias-Rivera, Susana, Frutos-Vivar, Fernando, Lopez-Cuenca, Sonia, de Gopegui, Pablo Ruiz, Abidi, Nour, Chau, Ivan, Pugh, Richard, Smuts, Sara, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Bouchard, Mélanie, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), COVIP-study group, Eller, P., Joannidis, M., Mesotten, D., Reper, P., Oeyen, S., Swinnen, W., Brix, H., Brushoej, J., Villefrance, M., Nedergaard, H.K., Bjerregaard, A.T., Balleby, I.R., Andersen, K., Hansen, M.A., Uhrenholt, S., Bundgaard, H., Fjølner, J., Mohamed, AAH, Salah, R., Ali, YKNM, Wassim, K., Elgazzar, Y.A., Tharwat, S., Azzam, A.Y., Habib, A.A., Abosheaishaa, H.M., Azab, M.A., Leaver, S., Galbois, A., Guidet, B., Charron, C., Guerot, E., Besch, G., Rigaud, J.P., Maizel, J., Djibré, M., Burtin, P., Garcon, P., Nseir, S., Valette, X., Alexandru, N., Marin, N., Vaissiere, M., Plantefeve, G., Vanderlinden, T., Jurcisin, I., Megarbane, B., Caillard, A., Valent, A., Garnier, M., Besset, S., Oziel, J., Raphaelen, J.H., Dauger, S., Dumas, G., Goncalves, B., Piton, G., Jung, C., Bruno, R.R., Kelm, M., Wolff, G., Barth, E., Goebel, U., Kunstein, A., Schuster, M., Welte, M., Lutz, M., Meybohm, P., Steiner, S., Poerner, T., Haake, H., Schaller, S., Kindgen-Milles, D., Meyer, C., Kurt, M., Kuhn, K.F., Randerath, W., Wollborn, J., Dindane, Z., Kabitz, H.J., Voigt, I., Shala, G., Faltlhauser, A., Rovina, N., Aidoni, Z., Chrisanthopoulou, E., Papadogoulas, A., Gurjar, M., Mahmoodpoor, A., Ahmed, A.K., Marsh, B., Elsaka, A., Sviri, S., Comellini, V., Rabha, A., Ahmed, H., Namendys-Silva, S.A., Ghannam, A., Groenendijk, M., Zegers, M., de Lange, D., Cornet, A., Evers, M., Haas, L., Dormans, T., Dieperink, W., Romundstad, L., Sjøbø, B., Andersen, F.H., Strietzel, H.F., Olasveengen, T., Hahn, M., Czuczwar, M., Gawda, R., Klimkiewicz, J., de LurdesSantos, M.C., Gordinho, A., Santos, H., Assis, R., Oliveira, AIP, Badawy, M.R., Perez-Torres, D., Gomà, G., Villamayor, M.I., Mira, A.P., Cubero, P.J., Rivera, S.A., Tomasa, T., Iglesias, D., Vázquez, E.M., Aldecoa, C., Ferreira, A.F., Zalba-Etayo, B., Canas-Perez, I., Tamayo-Lomas, L., Diaz-Rodriguez, C., Sancho, S., Priego, J., Abualqumboz, EMY, Hilles, MMY, Saleh, M., Ben-HAmouda, N., Roberti, A., Dullenkopf, A., Fleury, Y., Pinto, B.B., Schefold, J.C., Al-Sadawi, M., Serck, N., Dewaele, E., Kumar, P., Bundesen, C., Innes, R., Gooch, J., Cagova, L., Potter, E., Reay, M., Davey, M., Humphreys, S., Berlemont, C.H., Chousterman, B.G., Dépret, F., Ferre, A., Vettoretti, L., Thevenin, D., Milovanovic, M., Simon, P., Lorenz, M., Stoll, S.E., Dubler, S., Fuest, K., Mulita, F., Kondili, E., Andrianopoulos, I., Meynaar, I., Cornet, A.D., Sjøbøe, B., Kluzik, A., Zatorski, P., Drygalski, T., Szczeklik, W., Solek-Pastuszka, J., Onichimowski, D., Stefaniak, J., Stefanska-Wronka, K., Zabul, E., Cardoso, F.S., Banzo, MJA, Tomasa-Irriguible, T.M., Mira, Á.P., Arias-Rivera, S., Frutos-Vivar, F., Lopez-Cuenca, S., de Gopegui, P.R., Abidi, N., Chau, I., Pugh, R., and Smuts, S.
Subjects: Aging, Activities of Daily Living, Aged, COVID-19, Humans, Intensive Care Units, Prospective Studies, Quality of Life, SARS-CoV-2, Intensive Care Unit (ICU), Older people, Survival, frailty, [SDV]Life Sciences [q-bio], SOCIETY, 610 Medicine & health, General Medicine, INTENSIVE-CARE, humanities, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], [SDV] Life Sciences [q-bio], Medicine and Health Sciences, Geriatrics and Gerontology
Abstract: Background health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. Objective to quantify HRQoL in order to identify areas of interventions. Design prospective observation study. Setting admissions to European ICUs between March 2020 and February 2021. Subjects patients aged 70 years or older admitted with COVID-19 disease. Methods collected determinants include SOFA-score, Clinical Frailty Scale (CFS), number and timing of ICU procedures and limitation of care, Katz Activities of Daily Living (ADL) dependence score. HRQoL was assessed at 3 months after ICU admission with the Euro-QoL-5D-5L questionnaire. An outcome of ≥4 on any of Euro-QoL-5D-5L domains was considered unfavourable. Results in total 3,140 patients from 14 European countries were included in this study. Three months after inclusion, 1,224 patients (39.0%) were alive and the EQ-5D-5L from was obtained. The CFS was associated with an increased odds ratio for an unfavourable HRQoL outcome after 3 months; OR 1.15 (95% confidence interval (CI): 0.71–1.87) for CFS 2 to OR 4.33 (95% CI: 1.57–11.9) for CFS ≧ 7. The Katz ADL was not statistically significantly associated with HRQoL after 3 months. Conclusions in critically ill old intensive care patients suffering from COVID-19, the CFS is associated with the subjectively perceived quality of life. The CFS on admission can be used to inform patients and relatives on the risk of an unfavourable qualitative outcome if such patients survive.
Published: 2022
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2. Additional file 1 of Emergency medical care of patients with psychiatric disorders - challenges and opportunities: Results of a multicenter survey

Author: Schick, Benedikt, Mayer, Benjamin, Jäger, Markus, Jungwirth, Bettina, Barth, Eberhard, Eble, Martin, Sponholz, Christoph, Muth, Claus-Martin, and Schönfeldt-Lecuona, Carlos
Abstract: Supplementary Material 1
Published: 2022
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3. The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19

Author: Bruno, Raphael Romano, Wernly, Bernhard, Flaatten, Hans, Fjølner, Jesper, Artigas, Antonio, Baldia, Philipp Heinrich, Binneboessel, Stephan, Bollen Pinto, Bernardo, Schefold, Joerg C., Wolff, Georg, Kelm, Malte, Beil, Michael, Sviri, Sigal, van Heerden, Peter Vernon, Szczeklik, Wojciech, Elhadi, Muhammed, Joannidis, Michael, Oeyen, Sandra, Kondili, Eumorfia, Marsh, Brian, Wollborn, Jakob, Andersen, Finn H., Moreno, Rui, Leaver, Susannah, Boumendil, Ariane, De Lange, Dylan W., Guidet, Bertrand, Jung, Christian, Eller, Philipp, Mesotten, Dieter, Reper, Pascal, Swinnen, Walter, Serck, Nicolas, Dewaele, Elisabeth, Brix, Helene, Brushoej, Jens, Kumar, Pritpal, Nedergaard, Helene Korvenius, Balleby, Ida Riise, Bundesen, Camilla, Hansen, Maria Aagaard, Uhrenholt, Stine, Bundgaard, Helle, Gooch, James, Cagova, Lenka, Potter, Elizabeth, Reay, Michael, Davey, Miriam, Abusayed, Mohammed Abdelshafy, Humphreys, Sally, Galbois, Arnaud, Charron, Cyril, Berlemont, Caroline Hauw, Besch, Guillaume, Rigaud, Jean-Philippe, Maizel, Julien, Djibré, Michel, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Alexandru, Nica, Marin, Nathalie, Vaissiere, Marie, Plantefeve, Gaëtan, Vanderlinden, Thierry, Jurcisin, Igor, Megarbane, Buno, Chousterman, Benjamin Glenn, Dépret, François, Garnier, Marc, Besset, Sebastien, Oziel, Johanna, Ferre, Alexis, Dauger, Stéphane, Dumas, Guillaume, Goncalves, Bruno, Vettoretti, Lucie, Thevenin, Didier, Schaller, Stefan, Kurt, Muhammed, Faltlhauser, Andreas, Meyer, Christian, Milovanovic, Milena, Lutz, Matthias, Shala, Gonxhe, Haake, Hendrik, Randerath, Winfried, Kunstein, Anselm, Meybohm, Patrick, Steiner, Stephan, Barth, Eberhard, Poerner, Tudor, Simon, Philipp, Lorenz, Marco, Dindane, Zouhir, Kuhn, Karl Friedrich, Welte, Martin, Voigt, Ingo, Kabitz, Hans-Joachim, Goebel, Ulrich, Stoll, Sandra Emily, Kindgen-Milles, Detlef, Dubler, Simon, Fuest, Kristina, Schuster, Michael, Papadogoulas, Antonios, Mulita, Francesk, Rovina, Nikoletta, Aidoni, Zoi, Chrisanthopoulou, Evangelia, Andrianopoulos, Ioannis, Groenendijk, Martijn, Evers, Mirjam, van Lelyveld-Haas, Lenneke, Meynaar, Iwan, Cornet, Alexander Daniel, Zegers, Marieke, Dieperink, Willem, Dormans, Tom, Hahn, Michael, Sjøbøe, Britt, Strietzel, Hans Frank, Olasveengen, Theresa, Romundstad, Luis, Kluzik, Anna, Zatorski, Paweł, Drygalski, Tomasz, Klimkiewicz, Jakub, Solek-pastuszka, Joanna, Onichimowski, Dariusz, Czuczwar, Miroslaw, Gawda, Ryszard, Stefaniak, Jan, Stefanska-Wronka, Karina, Zabul, Ewa, Oliveira, Ana Isabel Pinho, Assis, Rui, de Lurdes Campos Santos, Maria, Santos, Henrique, Cardoso, Filipe Sousa, Gordinho, André, Banzo, Maria José Arche, Zalba-Etayo, Begoña, Cubero, Patricia Patricia, Priego, Jesús, Gomà, Gemma, Tomasa-Irriguible, Teresa Maria, Sancho, Susana, Ferreira, Aida Fernández, Vázquez, Eric Mayor, Mira, Ángela Prado, Ibarz, Mercedes, Iglesias, David, Arias-Rivera, Susana, Frutos-Vivar, Fernando, Lopez-Cuenca, Sonia, Aldecoa, Cesar, Perez-Torres, David, Canas-Perez, Isabel, Tamayo-Lomas, Luis, Diaz-Rodriguez, Cristina, de Gopegui, Pablo Ruiz, Ben-Hamouda, Nawfel, Roberti, Andrea, Fleury, Yvan, Abidi, Nour, Chau, Ivan, Dullenkopf, Alexander, Pugh, Richard, Smuts, Sara, COVIP study group, [missing], Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), COVIP study group, Eller, P., Joannidis, M., Mesotten, D., Reper, P., Oeyen, S., Swinnen, W., Serck, N., Dewaele, E., Brix, H., Brushoej, J., Kumar, P., Nedergaard, H.K., Balleby, I.R., Bundesen, C., Hansen, M.A., Uhrenholt, S., Bundgaard, H., Fjølner, J., Gooch, J., Cagova, L., Potter, E., Reay, M., Davey, M., Abusayed, M.A., Humphreys, S., Galbois, A., Guidet, B., Charron, C., Berlemont, C.H., Besch, G., Rigaud, J.P., Maizel, J., Djibré, M., Burtin, P., Garcon, P., Nseir, S., Valette, X., Alexandru, N., Marin, N., Vaissiere, M., Plantefeve, G., Vanderlinden, T., Jurcisin, I., Megarbane, B., Chousterman, B.G., Dépret, F., Garnier, M., Besset, S., Oziel, J., Ferre, A., Dauger, S., Dumas, G., Goncalves, B., Vettoretti, L., Thevenin, D., Schaller, S., Kurt, M., Faltlhauser, A., Meyer, C., Milovanovic, M., Lutz, M., Shala, G., Haake, H., Randerath, W., Kunstein, A., Meybohm, P., Steiner, S., Barth, E., Poerner, T., Simon, P., Lorenz, M., Dindane, Z., Kuhn, K.F., Welte, M., Voigt, I., Kabitz, H.J., Wollborn, J., Goebel, U., Stoll, S.E., Kindgen-Milles, D., Dubler, S., Jung, C., Fuest, K., Schuster, M., Papadogoulas, A., Mulita, F., Rovina, N., Aidoni, Z., Chrisanthopoulou, E., Kondili, E., Andrianopoulos, I., Groenendijk, M., Evers, M., van Lelyveld-Haas, L., Meynaar, I., Cornet, A.D., Zegers, M., Dieperink, W., De Lange, D.W., Dormans, T., Hahn, M., Sjøbøe, B., Strietzel, H.F., Olasveengen, T., Romundstad, L., Andersen, F.H., Kluzik, A., Zatorski, P., Drygalski, T., Szczeklik, W., Klimkiewicz, J., Solek-Pastuszka, J., Onichimowski, D., Czuczwar, M., Gawda, R., Stefaniak, J., Stefanska-Wronka, K., Zabul, E., Oliveira, AIP, Assis, R., de Lurdes Campos Santos, M., Santos, H., Cardoso, F.S., Gordinho, A., Banzo, MJA, Zalba-Etayo, B., Cubero, P.P., Priego, J., Gomà, G., Tomasa-Irriguible, T.M., Sancho, S., Ferreira, A.F., Vázquez, E.M., Mira, Á.P., Ibarz, M., Iglesias, D., Arias-Rivera, S., Frutos-Vivar, F., Lopez-Cuenca, S., Aldecoa, C., Perez-Torres, D., Canas-Perez, I., Tamayo-Lomas, L., Diaz-Rodriguez, C., de Gopegui, P.R., Ben-Hamouda, N., Roberti, A., Fleury, Y., Abidi, N., Schefold, J.C., Chau, I., Dullenkopf, A., Pugh, R., and Smuts, S.
Subjects: IMPACT, MORTALITY, ICU, Medicine and Health Sciences, ILL ELDERLY-PATIENTS, 610 Medicine & health, ddc:610, Critical Care and Intensive Care Medicine, 610 Medizin und Gesundheit, FRAILTY, human activities, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Abstract: Open Access funding enabled and organized by Projekt DEAL. This study was endorsed by the ESICM. Free support for running the electronic database and was granted from the dep. of Epidemiology, University of Aarhus, Denmark. Bruno et al. Annals of Intensive Care (2022) 12:26 Page 10 of 11 The support of the study in France by a grant from Fondation Assistance Publique-Hôpitaux de Paris pour la recherche is greatly appreciated. In Norway, the study was supported by a grant from the Health Region West. In addition, the study was supported by a grant from the European Open Science Cloud (EOSC). EOSCsecretariat.eu has received funding from the European Union’s Horizon Programme call H2020-INFRAEOSC-05-2018-2019, grant agreement number 831644. This work was supported by the Collaborative Research Center SFB 1116 (German Research Foundation, DFG) and by the Forschungskommission of the Medical Faculty of the Heinrich-Heine-University Düsseldorf and No. 2020–21 to RRB for a Clinician Scientist Track. No (industry) sponsorship has been received for this investigator-initiated study. PURPOSE: Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. METHODS: The COVIP study is a prospective international observational study that recruited ICU patients ≥ 70 years admitted with COVID-19 (NCT04321265). Several parameters including ADL (ADL; 0 = disability, 6 = no disability), Clinical Frailty Scale (CFS), SOFA score, intensive care treatment, ICU- and 3-month survival were recorded. A mixed-effects Weibull proportional hazard regression analyses for 3-month mortality adjusted for multiple confounders. RESULTS: This pre-specified analysis included 2359 patients with a documented ADL and CFS. Most patients evidenced independence in their daily living before hospital admission (80% with ADL = 6). Patients with no frailty and no disability showed the lowest, patients with frailty (CFS ≥ 5) and disability (ADL
Published: 2022
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4. Noninvasive ventilation in COVID-19 patients aged ≥ 70 years—a prospective multicentre cohort study

Author: Polok, Kamil, Fronczek, Jakub, Artigas, Antonio, Flaatten, Hans, Guidet, Bertrand, De Lange, Dylan W., Fjølner, Jesper, Leaver, Susannah, Beil, Michael, Sviri, Sigal, Bruno, Raphael Romano, Wernly, Bernhard, Bollen Pinto, Bernardo, Schefold, Joerg C., Studzińska, Dorota, Joannidis, Michael, Oeyen, Sandra, Marsh, Brian, Andersen, Finn H., Moreno, Rui, Cecconi, Maurizio, Jung, Christian, Szczeklik, Wojciech, Eller, Philipp, Mesotten, Dieter, Reper, Pascal, Swinnen, Walter, Brix, Helene, Brushoej, Jens, Villefrance, Maja, Nedergaard, Helene Korvenius, Bjerregaard, Anders Thais, Balleby, Ida Riise, Andersen, Kasper, Hansen, Maria Aagaard, Uhrenholt, Stine, Bundgaard, Helle, Hussein, Aliae A. R. Mohamed, Salah, Rehab, Ali, Yasmin Khairy NasrEldin Mohamed, Wassim, Kyrillos, Elgazzar, Yumna A., Tharwat, Samar, Azzam, Ahmed Y., habib, Ayman abdelmawgoad, Abosheaishaa, Hazem Maarouf, Azab, Mohammed A., Galbois, Arnaud, Charron, Cyril, Guerot, Emmanuel, Besch, Guillaume, Rigaud, Jean-Philippe, Maizel, Julien, Djibré, Michel, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Alexandru, Nica, Marin, Nathalie, Vaissiere, Marie, Plantefeve, Gaëtan, Vanderlinden, Thierry, Jurcisin, Igor, Megarbane, Buno, Caillard, Anais, Valent, Arnaud, Garnier, Marc, Besset, Sebastien, Oziel, Johanna, RAPHALEN, Jean-herlé, Dauger, Stéphane, Dumas, Guillaume, Goncalves, Bruno, Piton, Gaël, Barth, Eberhard, Goebel, Ulrich, Kunstein, Anselm, Schuster, Michael, Welte, Martin, Lutz, Matthias, Meybohm, Patrick, Steiner, Stephan, Poerner, Tudor, Haake, Hendrik, Schaller, Stefan, Kindgen-Milles, Detlef, Meyer, Christian, Kurt, Muhammed, Kuhn, Karl Friedrich, Randerath, Winfried, Wollborn, Jakob, Dindane, Zouhir, Kabitz, Hans-Joachim, Voigt, Ingo, Shala, Gonxhe, Faltlhauser, Andreas, Rovina, Nikoletta, Aidoni, Zoi, Chrisanthopoulou, Evangelia, Papadogoulas, Antonios, Gurjar, Mohan, Mahmoodpoor, Ata, Ahmed, Abdullah khudhur, Elsaka, Ahmed, Comellini, Vittoria, Rabha, Ahmed, Ahmed, Hazem, Namendys-Silva, Silvio A., Ghannam, Abdelilah, Groenendijk, Martijn, Zegers, Marieke, de Lange, Dylan, Cornet, Alex, Evers, Mirjam, Haas, Lenneke, Dormans, Tom, Dieperink, Willem, Romundstad, Luis, Sjøbø, Britt, Strietzel, Hans Frank, Olasveengen, Theresa, Hahn, Michael, Czuczwar, Miroslaw, Gawda, Ryszard, Klimkiewicz, Jakub, de Lurdes Campos Santos, Maria, Gordinho, André, Santos, Henrique, Assis, Rui, Oliveira, Ana Isabel Pinho, Badawy, Mohamed Raafat, Perez-Torres, David, Gomà, Gemma, Villamayor, Mercedes Ibarz, Mira, Angela Prado, Cubero, Patricia Jimeno, Rivera, Susana Arias, Tomasa, Teresa, Iglesias, David, Vázquez, Eric Mayor, Aldecoa, Cesar, Ferreira, Aida Fernández, Zalba-Etayo, Begoña, Canas-Perez, Isabel, Tamayo-Lomas, Luis, Diaz-Rodriguez, Cristina, Sancho, Susana, Priego, Jesús, Abualqumboz, Enas M. Y., Hilles, Momin Majed Yousuf, Saleh, Mahmoud, Ben-HAmouda, Nawfel, Roberti, Andrea, Dullenkopf, Alexander, Fleury, Yvan, Al-Sadawi, Mohammed, COVIP Study Group, [missing], and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
Subjects: Male, Noninvasive Ventilation, Frailty, COVID-19, 610 Medicine & health, Critical Care and Intensive Care Medicine, Noninvasive Ventilation/adverse effects, Respiration, Artificial, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], Cohort Studies, Intensive Care Units, Respiratory Insufficiency/therapy, Elderly, Medicine and Health Sciences, Humans, Intensive care unit, Female, Prospective Studies, 610 Medizin und Gesundheit, Respiratory Insufficiency, Noninvasive ventilation, Pandemics, COVID-19/therapy, Aged
Abstract: Background Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods This is a substudy of COVIP study—an international prospective observational study enrolling patients aged ≥ 70 years with confirmed COVID-19 treated in ICU. We enrolled patients in 156 ICUs across 15 European countries between March 2020 and April 2021.The primary endpoint was 30-day mortality. Results Cohort included 3074 patients, most of whom were male (2197/3074, 71.4%) at the mean age of 75.7 years (SD 4.6). NIV frequency was 25.7% and varied from 1.1 to 62.0% between participating countries. Primary NIV failure, defined as need for endotracheal intubation or death within 30 days since ICU admission, occurred in 470/629 (74.7%) of patients. Factors associated with increased NIV failure risk were higher Sequential Organ Failure Assessment (SOFA) score (OR 3.73, 95% CI 2.36–5.90) and Clinical Frailty Scale (CFS) on admission (OR 1.46, 95% CI 1.06–2.00). Patients initially treated with NIV (n = 630) lived for 1.36 fewer days (95% CI − 2.27 to − 0.46 days) compared to primary IMV group (n = 1876). Conclusions Frequency of NIV use varies across European countries. Higher severity of illness and more severe frailty were associated with a risk of NIV failure among critically ill older adults with COVID-19. Primary IMV was associated with better outcomes than primary NIV. Clinical Trial RegistrationNCT04321265, registered 19 March 2020, https://clinicaltrials.gov.
Published: 2022
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5. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

Author: Flaatten, Hans, De Lange, Dylan W., Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Bertolini, Guido, Boumendil, Ariane, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agwald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Zaferidis, Tilemachos, Guidet, Bertrand, Schmutz, René, Wimmer, Franz, Eller, Philipp, Zotter, Klemens, Swinnen, Walter, De Buysscher, Pieter, De Neve, Nikolaas, Abraham, Paul, Fleury, Yvan, Schefold, Joerg C., Biskup, Ewelina, Taliadoros, Ioannis, Piza, Petr, Lauten, Alexander, Sacher, Anna Lena, Brenner, Thorsten, Franz, Marcus, Bloos, Frank, Ebelt, Henning, Schaller, Stefan J., Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobias, Nia, Amir M., Janosi, Rolf Alexander, Meybohm, Patrick, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Dey, Nilanjan, Sølling, Christoffer, Rasmussen, Bodil Steen, Rodriguez, Enver, Rebollo, Sergio, Aguilar, Gerardo, Masdeu, Gaspar, Jaimes, Marián Irazábal, Prado Mira, Ángela, Bodi, Maria A., Barea Mendoza, Jesus A., López-Cuenca, Sonia, Homez Guzman, Marcela, Rico-Feijoo, Jesús, Ibarz, Mercedes, Trenado-Alvarez, Josep, Forceville, Xavier, Besch, Guillaume, Mentec, Herve, Michel, Philippe, Mateu, Philippe, Vettoretti, Lucie, Bourenne, Jeremy, Marin, Nathalie, Guillot, Max, Aissaoui, Naida, Goulenok, Cyril, Thieulot-Rolin, Nathalie, Messika, Jonathan, Lamhaut, Lionel, Charron, Cyril, Dempsey, Ged, Mathew, Shiju J., Raj, Ashok S., Grecu, Irina, Cupitt, Jason, Lawton, Tom, Clark, Richard, Popescu, Monica, Spittle, Nick, Faulkner, Maria, Cowton, Amanda, Elloway, Esme, Williams, Patricia, Reay, Michael, Chukkambotla, Srikanth, Kumar, Ravi, Al-Subaie, Nawaf, Kent, Linda, Tamm, Tiina, Kajtor, Istvan, Burns, Karen, Pugh, Richard, Ostermann, Marlies, Kam, Elisa, Bowyer, Helen, Smith, Neil, Templeton, Maie, Henning, Jeremy, Goffin, Kelly, Kapoor, Ritoo, Laha, Shondipon, Chilton, Phil, Khaliq, Waqas, Crayford, Alison, Coetzee, Samantha, Tait, Moira, Boultoukas, Evangelos, Stoker, Wendy, Gimenez, Marc, Pope, Alan, Camsooksai, Julie, Pogson, David, Quigley, Kate, Ritzema, Jenny, Hormis, Anil, Boulanger, Carole, Balasubramaniam, M., Vamplew, Luke, Burt, Karen, Martin, Daniel, Craig, Jayne, Prowle, John, Doyle, Nanci, Shelton, Jonathon, Scott, Carmen, Donnison, Phil, Shelton, Sarah, Frey, Christian, Ryan, Christine, Spray, Dominic, Barnes, Veronica, Barnes, Kerry, Furneval, Julie, Ridgway, Stephanie, Saha, Rajnish, Clark, Thomas, Wood, James, Bolger, Clare, Bassford, Christopher, Lewandowski, john, Zhao, Xiaobei, Humphreys, Sally, Dowling, Susan, Richardson, Neil, Burtenshaw, Andrew, Stevenson, Carl, Wilcock, Danielle, Aidoni, Zoi, Aloizos, Stavros, Tasioudis, Polychronis, Lampiri, Kleri, Zisopoulou, Vasiliki, Ifigenia, Ravani, Eymorfia, Pagaki, Angela, Anttoniou, Katsoulas, Theodoros A., Kyparissi, Aikaterini, Aikaterini, Kounougeri, Marinakis, George, Tsimpoukas, Fotios, Spyropoulou, Anastasia, Zygoulis, Paris, Hayes, Ivan, Kelly, Yvelynne, Westbrook, Andrew, Fitzpatrick, Gerry, Maheshwari, Darshana, Motherway, Catherine, Gupta, Manish, Gurjar, Mohan, Maji, Ismail M, Negri, Giovanni, Spadaro, Savino, Nattino, Giuseppe, Pedeferri, Matteo, Boscolo, Annalisa, Rossi, Simona, Rossi, Maurizio, Calicchio, Giuseppe, Cubattoli, Lucia, Di Lascio, Gabriella, Barbagallo, Maria, Berruto, Francesco, Codazzi, Daniela, Bottazzi, Andrea, Fumagalli, Paolo, Negro, Giancarlo, Lupi, Giuseppe, Savelli, Flavia, Vulcano, Giuseppe A., Fumagalli, Roberto, Marudi, Andrea, Lefons, Ugo, Lembo, Rita, Babini, Maria, Paggioro, Alessandra, Parrini, Vieri, Zaccaria, Maria, Clementi, Stefano, Gigliuto, Carmelo, Facondini, Francesca, Pastorini, Simonetta, Munaron, Susanna, Calamai, Italo, Bocchi, Anna, Brizio, Elisabetta, Adorni, Adele, Bocci, Maria Grazia, Cortegiani, Andrea, Casalicchio, Tiziana, Mellea, Serena, Graziani, Elia, Barattini, Massimo, van Dijk, I., van Lelyveld-Haas, L. E. M., Ramnarain, D., Jansen, Tim, Nooteboom, Fleur, van der Voort, Peter H. J., Dieperink, Willem, de Waard, Monique C., Bormans, Laura, Hahn, Michael, Kemmerer, Nicolai, Strietzel, Hans Frank, Fehrle, Lutz, Dybwik, Knut, Legernaes, Terje, Klepstad, Pål, Olaussen, Even Braut, Olsen, Knut Inge, Børresen, Ole Marius, Bjørsvik, Geir, Maini, Sameer, Czuczwar, Miroslaw, Krawczyk, Pawel, Ziętkiewicz, Mirosław, Nowak, Łukasz R., Kotfis, Katarzyna, Cwyl, Katarzyna, Gajdosz, Ryszard, Biernawska, Jowita, Grudzień, Paweł, Nasiłowski, Paweł, Popek, Natalia, Cyrankiewicz, Waldemar, Wnuk, Marek, Maciejewski, Dariusz, Studzińska, Dorota, Zukowski, Maciej, Bernas, Szymon, Serwa, Marta, Stefaniak, Jan, Pawel, Maciejewski, Szymkowiak, Malgorzata, Adamik, Barbara, Catorze, Nuno, Castelo Branco, Miguel, Barros, Inês, Barros, Nelson, Krystopchuk, Andriy, Honrado, Teresa, Sousa, Cristina, Munoz, Francisco, Rebelo, Marta, Gomes, Rui, Nunes, Jorge, Dias, Celeste, Fernandes, Ana Margarida, Petrisor, Cristina, Constantin, Bodolea, Belskiy, Vladislav, Boskholov, Boris, Kawati, Rafael, Sivik, Joakim, Nauska, Jessica, Smole, Daniel, Parenmark, Fredric, Lyrén, Johanna, Rockstroh, Katalin, Rydén, Sara, Spångfors, Martin, Strinnholm, Morten, Walther, Sten, De Geer, Lina, Nordlund, Peter, Pålsson, Staffan, Zetterquist, Harald, Nilsson, Annika, Thiringer, Karin, Jungner, Mårten, Bark, Björn, Nordling, Berit, Sköld, Hans, Brorsson, Camilla, Persson, Stefan, Bergström, Anna, Berkius, Johan, Holmström, Johanna, Yapici, Nihan, University of Bergen (UiB), Haukeland University Hospital, University Medical Center [Utrecht], CIBER de Epidemiología y Salud Pública (CIBERESP), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), St George’s University Hospitals, Aarhus University Hospital, Mater Misericordiae University Hospital (The Mater Hospital), NOVA Medical School - Faculdade de Ciências Médicas (NMS), Universidade Nova de Lisboa = NOVA University Lisbon (NOVA), Ghent University Hospital, Karolinska University Hospital [Stockholm], Hôpitaux Universitaires de Genève (HUG), Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Gestionnaire, Hal Sorbonne Université, Flaatten, H, De Lange, D, Morandi, A, Andersen, F, Artigas, A, Bertolini, G, Boumendil, A, Cecconi, M, Christensen, S, Faraldi, L, Fjolner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Ohman, C, Pinto, B, Soliman, I, Szczeklik, W, Valentin, A, Watson, X, Zaferidis, T, Guidet, B, Schmutz, R, Wimmer, F, Eller, P, Zotter, K, Swinnen, W, De Buysscher, P, De Neve, N, Abraham, P, Fleury, Y, Schefold, J, Biskup, E, Taliadoros, I, Piza, P, Lauten, A, Sacher, A, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, S, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, A, Janosi, R, Meybohm, P, Simon, P, Utzolino, S, Rahmel, T, Barth, E, Schuster, M, Dey, N, Solling, C, Rasmussen, B, Rodriguez, E, Rebollo, S, Aguilar, G, Masdeu, G, Jaimes, M, Prado Mira, A, Bodi, M, Barea Mendoza, J, Lopez-Cuenca, S, Homez Guzman, M, Rico-Feijoo, J, Ibarz, M, Trenado-Alvarez, J, Forceville, X, Besch, G, Mentec, H, Michel, P, Mateu, P, Vettoretti, L, Bourenne, J, Marin, N, Guillot, M, Aissaoui, N, Goulenok, C, Thieulot-Rolin, N, Messika, J, Lamhaut, L, Charron, C, Dempsey, G, Mathew, S, Raj, A, Grecu, I, Cupitt, J, Lawton, T, Clark, R, Popescu, M, Spittle, N, Faulkner, M, Cowton, A, Elloway, E, Williams, P, Reay, M, Chukkambotla, S, Kumar, R, Al-Subaie, N, Kent, L, Tamm, T, Kajtor, I, Burns, K, Pugh, R, Ostermann, M, Kam, E, Bowyer, H, Smith, N, Templeton, M, Henning, J, Goffin, K, Kapoor, R, Laha, S, Chilton, P, Khaliq, W, Crayford, A, Coetzee, S, Tait, M, Boultoukas, E, Stoker, W, Gimenez, M, Pope, A, Camsooksai, J, Pogson, D, Quigley, K, Ritzema, J, Hormis, A, Boulanger, C, Balasubramaniam, M, Vamplew, L, Burt, K, Martin, D, Craig, J, Prowle, J, Doyle, N, Shelton, J, Scott, C, Donnison, P, Shelton, S, Frey, C, Ryan, C, Spray, D, Barnes, V, Barnes, K, Furneval, J, Ridgway, S, Saha, R, Clark, T, Wood, J, Bolger, C, Bassford, C, Lewandowski, J, Zhao, X, Humphreys, S, Dowling, S, Richardson, N, Burtenshaw, A, Stevenson, C, Wilcock, D, Aidoni, Z, Aloizos, S, Tasioudis, P, Lampiri, K, Zisopoulou, V, Ifigenia, R, Eymorfia, P, Angela, A, Katsoulas, T, Kyparissi, A, Aikaterini, K, Marinakis, G, Tsimpoukas, F, Spyropoulou, A, Zygoulis, P, Hayes, I, Kelly, Y, Westbrook, A, Fitzpatrick, G, Maheshwari, D, Motherway, C, Gupta, M, Gurjar, M, Maji, I, Negri, G, Spadaro, S, Nattino, G, Pedeferri, M, Boscolo, A, Rossi, S, Rossi, M, Calicchio, G, Cubattoli, L, Di Lascio, G, Barbagallo, M, Berruto, F, Codazzi, D, Bottazzi, A, Fumagalli, P, Negro, G, Lupi, G, Savelli, F, Vulcano, G, Fumagalli, R, Marudi, A, Lefons, U, Lembo, R, Babini, M, Paggioro, A, Parrini, V, Zaccaria, M, Clementi, S, Gigliuto, C, Facondini, F, Pastorini, S, Munaron, S, Calamai, I, Bocchi, A, Brizio, E, Adorni, A, Bocci, M, Cortegiani, A, Casalicchio, T, Mellea, S, Graziani, E, Barattini, M, van Dijk, I, van Lelyveld-Haas, L, Ramnarain, D, Jansen, T, Nooteboom, F, van der Voort, P, Dieperink, W, de Waard, M, Bormans, L, Hahn, M, Kemmerer, N, Strietzel, H, Fehrle, L, Dybwik, K, Legernaes, T, Klepstad, P, Olaussen, E, Olsen, K, Borresen, O, Bjorsvik, G, Maini, S, Czuczwar, M, Krawczyk, P, Zietkiewicz, M, Nowak, L, Kotfis, K, Cwyl, K, Gajdosz, R, Biernawska, J, Grudzien, P, Nasilowski, P, Popek, N, Cyrankiewicz, W, Wnuk, M, Maciejewski, D, Studzinska, D, Zukowski, M, Bernas, S, Serwa, M, Stefaniak, J, Pawel, M, Szymkowiak, M, Adamik, B, Catorze, N, Castelo Branco, M, Barros, I, Barros, N, Krystopchuk, A, Honrado, T, Sousa, C, Munoz, F, Rebelo, M, Gomes, R, Nunes, J, Dias, C, Fernandes, A, Petrisor, C, Constantin, B, Belskiy, V, Boskholov, B, Kawati, R, Sivik, J, Nauska, J, Smole, D, Parenmark, F, Lyren, J, Rockstroh, K, Ryden, S, Spangfors, M, Strinnholm, M, Walther, S, De Geer, L, Nordlund, P, Palsson, S, Zetterquist, H, Nilsson, A, Thiringer, K, Jungner, M, Bark, B, Nordling, B, Skold, H, Brorsson, C, Persson, S, Bergstrom, A, Berkius, J, Holmstrom, J, Yapici, N, Flaatten, Han, De Lange, Dylan W., Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Bertolini, Guido, Boumendil, Ariane, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agwald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andrea, Watson, Ximena, Zaferidis, Tilemacho, Guidet, Bertrand, Schmutz, René, Wimmer, Franz, Eller, Philipp, Zotter, Klemen, Swinnen, Walter, De Buysscher, Pieter, De Neve, Nikolaa, Abraham, Paul, Fleury, Yvan, Schefold, Joerg C., Biskup, Ewelina, Taliadoros, Ioanni, Piza, Petr, Lauten, Alexander, Sacher, Anna Lena, Brenner, Thorsten, Franz, Marcu, Bloos, Frank, Ebelt, Henning, Schaller, Stefan J., Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobia, Nia, Amir M., Janosi, Rolf Alexander, Meybohm, Patrick, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Dey, Nilanjan, Sølling, Christoffer, Rasmussen, Bodil Steen, Rodriguez, Enver, Rebollo, Sergio, Aguilar, Gerardo, Masdeu, Gaspar, Jaimes, Marián Irazábal, Prado Mira, Ángela, Bodi, Maria A., Barea Mendoza, Jesus A., López-Cuenca, Sonia, Homez Guzman, Marcela, Rico-Feijoo, Jesú, Ibarz, Mercede, Trenado-Alvarez, Josep, Forceville, Xavier, Besch, Guillaume, Mentec, Herve, Michel, Philippe, Mateu, Philippe, Vettoretti, Lucie, Bourenne, Jeremy, Marin, Nathalie, Guillot, Max, Aissaoui, Naida, Goulenok, Cyril, Thieulot-Rolin, Nathalie, Messika, Jonathan, Lamhaut, Lionel, Charron, Cyril, Dempsey, Ged, Mathew, Shiju J., Raj, Ashok S., Grecu, Irina, Cupitt, Jason, Lawton, Tom, Clark, Richard, Popescu, Monica, Spittle, Nick, Faulkner, Maria, Cowton, Amanda, Elloway, Esme, Williams, Patricia, Reay, Michael, Chukkambotla, Srikanth, Kumar, Ravi, Al-Subaie, Nawaf, Kent, Linda, Tamm, Tiina, Kajtor, Istvan, Burns, Karen, Pugh, Richard, Ostermann, Marlie, Kam, Elisa, Bowyer, Helen, Smith, Neil, Templeton, Maie, Henning, Jeremy, Goffin, Kelly, Kapoor, Ritoo, Laha, Shondipon, Chilton, Phil, Khaliq, Waqa, Crayford, Alison, Coetzee, Samantha, Tait, Moira, Boultoukas, Evangelo, Stoker, Wendy, Gimenez, Marc, Pope, Alan, Camsooksai, Julie, Pogson, David, Quigley, Kate, Ritzema, Jenny, Hormis, Anil, Boulanger, Carole, Balasubramaniam, M., Vamplew, Luke, Burt, Karen, Martin, Daniel, Craig, Jayne, Prowle, John, Doyle, Nanci, Shelton, Jonathon, Scott, Carmen, Donnison, Phil, Shelton, Sarah, Frey, Christian, Ryan, Christine, Spray, Dominic, Barnes, Veronica, Barnes, Kerry, Furneval, Julie, Ridgway, Stephanie, Saha, Rajnish, Clark, Thoma, Wood, Jame, Bolger, Clare, Bassford, Christopher, Lewandowski, john, Zhao, Xiaobei, Humphreys, Sally, Dowling, Susan, Richardson, Neil, Burtenshaw, Andrew, Stevenson, Carl, Wilcock, Danielle, Aidoni, Zoi, Aloizos, Stavro, Tasioudis, Polychroni, Lampiri, Kleri, Zisopoulou, Vasiliki, Ifigenia, Ravani, Eymorfia, Pagaki, Angela, Anttoniou, Katsoulas, Theodoros A., Kyparissi, Aikaterini, Aikaterini, Kounougeri, Marinakis, George, Tsimpoukas, Fotio, Spyropoulou, Anastasia, Zygoulis, Pari, Hayes, Ivan, Kelly, Yvelynne, Westbrook, Andrew, Fitzpatrick, Gerry, Maheshwari, Darshana, Motherway, Catherine, Gupta, Manish, Gurjar, Mohan, Maji, Ismail M, Negri, Giovanni, Spadaro, Savino, Nattino, Giuseppe, Pedeferri, Matteo, Boscolo, Annalisa, Rossi, Simona, Rossi, Maurizio, Calicchio, Giuseppe, Cubattoli, Lucia, Di Lascio, Gabriella, Barbagallo, Maria, Berruto, Francesco, Codazzi, Daniela, Bottazzi, Andrea, Fumagalli, Paolo, Negro, Giancarlo, Lupi, Giuseppe, Savelli, Flavia, Vulcano, Giuseppe A., Fumagalli, Roberto, Marudi, Andrea, Lefons, Ugo, Lembo, Rita, Babini, Maria, Paggioro, Alessandra, Parrini, Vieri, Zaccaria, Maria, Clementi, Stefano, Gigliuto, Carmelo, Facondini, Francesca, Pastorini, Simonetta, Munaron, Susanna, Calamai, Italo, Bocchi, Anna, Brizio, Elisabetta, Adorni, Adele, Bocci, Maria Grazia, Cortegiani, Andrea, Casalicchio, Tiziana, Mellea, Serena, Graziani, Elia, Barattini, Massimo, van Dijk, I., van Lelyveld-Haas, L.E.M., Ramnarain, D., Jansen, Tim, Nooteboom, Fleur, van der Voort, Peter H.J., Dieperink, Willem, de Waard, Monique C., Bormans, Laura, Hahn, Michael, Kemmerer, Nicolai, Strietzel, Hans Frank, Fehrle, Lutz, Dybwik, Knut, Legernaes, Terje, Klepstad, Pål, Olaussen, Even Braut, Olsen, Knut Inge, Børresen, Ole Mariu, Bjørsvik, Geir, Maini, Sameer, Czuczwar, Miroslaw, Krawczyk, Pawel, Ziętkiewicz, Mirosław, Nowak, Łukasz R., Kotfis, Katarzyna, Cwyl, Katarzyna, Gajdosz, Ryszard, Biernawska, Jowita, Grudzień, Paweł, Nasiłowski, Paweł, Popek, Natalia, Cyrankiewicz, Waldemar, Wnuk, Marek, Maciejewski, Dariusz, Studzińska, Dorota, Zukowski, Maciej, Bernas, Szymon, Serwa, Marta, Stefaniak, Jan, Pawel, Maciejewski, Szymkowiak, Malgorzata, Adamik, Barbara, Catorze, Nuno, Castelo Branco, Miguel, Barros, Inê, Barros, Nelson, Krystopchuk, Andriy, Honrado, Teresa, Sousa, Cristina, Munoz, Francisco, Rebelo, Marta, Gomes, Rui, Nunes, Jorge, Dias, Celeste, Fernandes, Ana Margarida, Petrisor, Cristina, Constantin, Bodolea, Belskiy, Vladislav, Boskholov, Bori, Kawati, Rafael, Sivik, Joakim, Nauska, Jessica, Smole, Daniel, Parenmark, Fredric, Lyrén, Johanna, Rockstroh, Katalin, Rydén, Sara, Spångfors, Martin, Strinnholm, Morten, Walther, Sten, De Geer, Lina, Nordlund, Peter, Pålsson, Staffan, Zetterquist, Harald, Nilsson, Annika, Thiringer, Karin, Jungner, Mårten, Bark, Björn, Nordling, Berit, Sköld, Han, Brorsson, Camilla, Persson, Stefan, Bergström, Anna, Berkius, Johan, Holmström, Johanna, and Yapici, Nihan
Subjects: Male, Time Factors, Outcome Assessment, Frail Elderly/statistics & numerical data, [SDV]Life Sciences [q-bio], HSJ UCI, Passive, Critical Care and Intensive Care Medicine, Frailty/classification/diagnosis/mortality/therapy, Severity of Illness Index, Severity of illne, Elderly, 0302 clinical medicine, Quality of life, Frailty, ICU, Mortality, Octogenarians, Severity of illness, Aged, 80 and over, Critical Illness, Europe, Euthanasia, Passive, Female, Frail Elderly, Geriatric Assessment, Humans, Intensive Care Units, Length of Stay, Outcome Assessment, Health Care, Proportional Hazards Models, Prospective Studies, Quality of Life, Hospital Mortality, 80 and over, 030212 general & internal medicine, Prospective cohort study, education.field_of_study, ddc:617, Mortality rate, [SDV] Life Sciences [q-bio], Length of Stay/statistics & numerical data, Cohort, Intensive Care Units/statistics & numerical data, Critical Illne, SOFA score, Human, medicine.medical_specialty, Time Factor, Intensive Care Unit, Population, INTENSIVE-CARE, Europe/epidemiology, Outcome Assessment (Health Care), 03 medical and health sciences, Octogenarian, Intensive care, Journal Article, medicine, COHORT, Octogenarinans, Intensive care medicine, education, Aged, OLDER, Euthanasia, business.industry, 030208 emergency & critical care medicine, Health Care, Prospective Studie, Critical Illness/mortality, UNIT, Emergency medicine, Proportional Hazards Model, business
Abstract: Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥80years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30days. Results: A total of 5021 patients with a median age of 84years (IQR 81–86years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38–1.73) for frail versus non-frail. Conclusions: Among very old patients (≥80years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group. Trial registration: ClinicalTrials.gov (ID: NCT03134807).
Published: 2017
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6. Management and outcomes in critically ill nonagenarian versus octogenarian patients

Author: Bruno, Raphael Romano, Wernly, Bernhard, Kelm, Malte, Boumendil, Ariane, Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Finazzi, Stefano, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Lichtenauer, Michael, Muessig, Johanna M., Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agvald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Leaver, Susannah, Boulanger, Carole, Walther, Sten, Schefold, Joerg C., Joannidis, Michael, Nalapko, Yuriy, Elhadi, Muhammed, Fjølner, Jesper, Zafeiridis, Tilemachos, De Lange, Dylan W., Guidet, Bertrand, Flaatten, Hans, Jung, Christian, Eller, Philipp, Helbok, Raimund, Schmutz, René, Nollet, Joke, de Neve, Nikolaas, Buysscher, Pieter De, Swinnen, Walter, Mikačić, Marijana, Bastiansen, Anders, Husted, Andreas, Dahle, Bård E. S., Cramer, Christine, Sølling, Christoffer, Ørsnes, Dorthe, Thomsen, Jakob Edelberg, Pedersen, Jonas Juul, Enevoldsen, Mathilde Hummelmose, Elkmann, Thomas, Kubisz-Pudelko, Agnieszka, Pope, Alan, Collins, Amy, Raj, Ashok S., Frey, Christian, Hart, Ciaran, Bolger, Clare, Spray, Dominic, Randell, Georgina, Filipe, Helder, Welters, Ingeborg D., Grecu, Irina, Evans, Jane, Cupitt, Jason, Lord, Jenny, Henning, Jeremy, Jones, Joanne, Ball, Jonathan, North, Julie, Salaunkey, Kiran, De Gordoa, Laura Ortiz-Ruiz, Bell, Louise, Balasubramaniam, Madhu, Vizcaychipi, Marcela, Faulkner, Maria, Mupudzi, Mc Donald, Lea-Hagerty, Megan, Reay, Michael, Spivey, Michael, Love, Nicholas, Spittle, Nick Spittle Nick, White, Nigel, Williams, Patricia, Morgan, Patrick, Wakefield, Phillipa, Savine, Rachel, Jacob, Reni, Innes, Richard, Kapoor, Ritoo, Humphreys, Sally, Rose, Steve, Dowling, Susan, Mane, Tarkeshwari, Lawton, Tom, Ogbeide, Vongayi, Khaliq, Waqas, Baird, Yolanda, Romen, Antoine, Galbois, Arnaud, Vinsonneau, Christophe, Charron, Cyril, Thevenin, Didier, Guerot, Emmanuel, Besch, Guillaume, Savary, Guillaume, Mentec, Hervé, Chagnon, Jean-Luc, Rigaud, Jean-Philippe, Quenot, Jean-Pierre, Castanera, Jeremy, Rosman, Jérémy, Maizel, Julien, Tiercelet, Kelly, Vettoretti, Lucie, Hovaere, Maud Mousset, Messika, Messika, Djibré, Michel, Rolin, Nathalie, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Rabe, Christian, Barth, Eberhard, Ebelt, Henning, Fuest, Kristina, Franz, Marcus, Horacek, Michael, Schuster, Michael, Meybohm, Patrick, Allgäuer, Sebastian, Dubler, Simon, Schaller, Stefan J., Schering, Stefan, Steiner, Stephan, Dieck, Thorben, Rahmel, Tim, Graf, Tobias, Koutsikou, Anastasia, Vakalos, Aristeidis, Raitsiou, Bogdan, Flioni, Elli Niki, Neou, Evangelia, Tsimpoukas, Fotios, Papathanakos, Georgios, Marinakis, Giorgos, Koutsodimitropoulos, Ioannis, Aikaterini, Kounougeri, Rovina, Nikoletta, Kourelea, Stylliani, Tasioudis, Polychronis, Zidianakis, Vasiiios, Konstantinia, Vryza, Aidoni, Zoi, Motherway, Catherine, Read, Chris, Martin-Loeches, Ignacio, Cracchiolo, Andrea Neville, Morigi, Aristide, Calamai, Italo, Brusa, Stefania, Elhadi, Ahmed, Tarek, Ahmed, Khaled, Ala, Ahmed, Hazem, Belkhair, Wesal Ali, Cornet, Alexander D., Gommers, Diederik, van Boven, Eva, Haringman, Jasper, Haas, Lenneke, van den Berg, Lettie, Hoiting, Oscar, de Jager, Peter, Gerritsen, Rik T., Dormans, Tom, Dieperink, Willem, Breidablik, Alena Breidablik Alena, Slapgard, Anita, Rime, Anne-Karin, Jannestad, Bente, Sjøbøe, Britt, Rice, Eva, Strietzel, Hans Frank, Jensen, Jan Peter, Langørgen, Jørund, Tøien, Kirsti, Strand, Kristian, Hahn, Michael, Klepstad, Pål, Biernacka, Aleksandra, Kluzik, Anna, Kudlinski, Bartosz, Maciejewski, Dariusz, Studzińska, Dorota, Hymczak, Hubert, Stefaniak, Jan, Solek-Pastuszka, Joanna, Zorska, Joanna, Cwyl, Katarzyna, Krzych, Lukasz J., Zukowski, Maciej, Lipińska-Gediga, Małgorzata, Pietruszko, Marek, Piechota, Mariusz, Serwa, Marta, Czuczwar, Miroslaw, Ziętkiewicz, Mirosław, Kozera, Natalia, Nasiłowski, Paweł, Sendur, Paweł, Zatorski, Paweł, Galkin, Piotr, Gawda, Ryszard, Kościuczuk, Urszula, Cyrankiewicz, Waldemar, Gola, Wojciech, Fernandes Pinto, Alexandre, Fernandes, Ana Margarida, Santos, Ana Rita, Sousa, Cristina, Barros, Inês, Ferreira, Isabel Amorim, Blanco, Jacobo Bacariza, Carvalho, João Teles, Maia, Jose, Candeias, Nuno, Catorze, Nuno, Belskiy, Vladislav, Lores, Africa, Mira, Angela Prado, Cilloniz, Catia, Perez-Torres, David, Maseda, Emilio, Rodriguez, Enver, Prol-Silva, Estefania, Eixarch, Gaspar, Gomà, Gemma, Aguilar, Gerardo, Velasco, Gonzalo Navarro, Jaimes, Marián Irazábal, Villamayor, Mercedes Ibarz, Fernández, Noemí Llamas, Cubero, Patricia Jimeno, López-Cuenca, Sonia, Tomasa, Teresa, Sjöqvist, Anders, Brorsson, Camilla, Schiöler, Fredrik, Westberg, Henrik, Nauska, Jessica, Sivik, Joakim, Berkius, Johan, Thiringer, Karin Kleiven, De Geer, Lina, Boroli, Filippo, Hergafi, Leila, Eckert, Philippe, Yıldız, Ismail, Yovenko, Ihor, Pugh, Richard, and on behalf of the VIP2 study group, [missing]
Subjects: Octogenarians, INTENSIVE-CARE-UNIT, Frailty, PREDICTION, SURGERY, MORTALITY, Nonagenarians, ICU, Medicine and Health Sciences, OLD PATIENTS, SHORT-TERM, Intensive care medicine, Geriatrics and Gerontology, ELDERLY-PATIENTS, Outcome
Abstract: Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (>= 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 +/- 5 vs. 7 +/- 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions.
Published: 2021

7. Additional file 1 of Measurement of the nociceptive flexion reflex threshold in critically ill patients �� a randomized observational pilot study

Author: Schick, Benedikt, Mayer, Benjamin, Walter, Steffen, Gruss, Sascha, Stitz, Ronald, Stitz, Pauline, and Barth, Eberhard
Subjects: Data_FILES
Abstract: Additional file 1.
Published: 2021
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8. The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

Author: Jung, Christian, Flaatten, Hans, Fjølner, Jesper, Bruno, Raphael Romano, Wernly, Bernhard, Artigas, Antonio, Bollen Pinto, Bernardo, Schefold, Joerg, Wolff, Georg, Kelm, Malte, Beil, Michael, Sviri, Sigal, van Heerden, Peter Vernon, Szczeklik, Wojciech, Czuczwar, Miroslaw, Elhadi, Muhammed, Joannidis, Michael, Oeyen, Sandra, Zafeiridis, Tilemachos, Marsh, Brian, Andersen, Finn, Moreno, Rui, Cecconi, Maurizio, Leaver, Susannah, Boumendil, Ariane, de Lange, Dylan, Guidet, Bertrand, Abosheaishaa, Hazem Maarouf, Abualqumboz, Enas, Ahmed, Abdullah Khudhur, Ahmed, Hazem, Aidoni, Zoi, Aldecoa, Cesar, Alexandru, Nica, Ali, Yasmin Khairy Nasreldin Mohamed, Al-Sadawi, Mohammed, Andersen, Kasper, Assis, Rui, Azab, Mohammed, Azzam, Ahmed, Badawy, Mohamed Raafat, Balleby, Ida Riise, Barth, Eberhard, Ben-Hamouda, Nawfel, Besch, Guillaume, Besset, Sebastien, Bjerregaard, Anders Thais, Brix, Helene, Brushoej, Jens, Bundgaard, Helle, Burtin, Philippe, Caillard, Anais, Canas-Perez, Isabel, Charron, Cyril, Chrisanthopoulou, Evangelia, Comellini, Vittoria, Cornet, Alex, Cubero, Patricia Jimeno, Dauger, Stéphane, Diaz-Rodriguez, Cristina, Dieperink, Willem, Dindane, Zouhir, Djibré, Michel, Dormans, Tom, Dullenkopf, Alexander, Dumas, Guillaume, Elgazzar, Yumna, Eller, Philipp, Elsaka, Ahmed, Evers, Mirjam, Faltlhauser, Andreas, Ferreira, Aida Fernández, Fleury, Yvan, Galbois, Arnaud, Garcon, Pierre, Garnier, Marc, Gawda, Ryszard, Ghannam, Abdelilah, Goebel, Ulrich, Gomà, Gemma, Goncalves, Bruno, Gordinho, André, Groenendijk, Martijn, Guerot, Emmanuel, Gurjar, Mohan, Haake, Hendrik, Haas, Lenneke, Habib, Ayman Abdelmawgoad, Hahn, Michael, Hansen, Maria Aagaard, Hilles, Momin Majed Yousuf, Hussein, Aliae, Iglesias, David, Jurcisin, Igor, Kabitz, Hans-Joachim, Kindgen-Milles, Detlef, Klimkiewicz, Jakub, Kuhn, Karl Friedrich, Kunstein, Anselm, Kurt, Muhammed, Lutz, Matthias, Mahmoodpoor, Ata, Maizel, Julien, Marin, Nathalie, Megarbane, Buno, Mesotten, Dieter, Meybohm, Patrick, Meyer, Christian, Mira, Angela Prado, Namendys-Silva, Silvio, Nedergaard, Helene Korvenius, Nseir, Saad, Olasveengen, Theresa, Oliveira, Ana Isabel Pinho, Oziel, Johanna, Papadogoulas, Antonios, Perez-Torres, David, Piton, Gaël, Plantefeve, Gaëtan, Poerner, Tudor, Priego, Jesús, Rabha, Ahmed, Randerath, Winfried, Raphaelen, Jean-Herlé, Reper, Pascal, Rigaud, Jean-Philippe, Rivera, Susana Arias, Roberti, Andrea, Romundstad, Luis, Rovina, Nikoletta, Salah, Rehab, Saleh, Mahmoud, Sancho, Susana, de Lurdes Campos Santos, Maria, Santos, Henrique, Schaller, Stefan, Schuster, Michael, Shala, Gonxhe, Sjøbø, Britt, Steiner, Stephan, Strietzel, Hans Frank, Swinnen, Walter, Tamayo-Lomas, Luis, Tharwat, Samar, Tomasa, Teresa, Uhrenholt, Stine, Vaissiere, Marie, Valent, Arnaud, Valette, Xavier, Vanderlinden, Thierry, Vázquez, Eric Mayor, Villamayor, Mercedes Ibarz, Villefrance, Maja, Voigt, Ingo, Wassim, Kyrillos, Welte, Martin, Wollborn, Jakob, Zalba-Etayo, Begoña, Zegers, Marieke, Mégarbane, Bruno, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and COVIP study group
Subjects: [SDV.TOX] Life Sciences [q-bio]/Toxicology, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.TOX]Life Sciences [q-bio]/Toxicology, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Abstract: Auteurs : COVIP study group; International audience; Background The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients. Methods A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded. Results The study included 1346 patients (28% female) with a median age of 75 years (IQR 72–78, range 70–96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56–62), with 66% (63–69) in fit, 53% (47–61) in vulnerable and 41% (35–47) in frail patients ( p
Published: 2021
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9. Lactate is associated with mortality in very old intensive care patients suffering from COVID-19: results from an international observational study of 2860 patients

Author: Bruno, Raphael Romano, Wernly, Bernhard, Flaatten, Hans, Artigas, Antonio, Bollen Pinto, Bernardo, Binnebössel, Stephan, Baldia, Philipp Heinrich, Kelm, Malte, Beil, Michael, Sigal, Sivri, van Heerden, Peter Vernon, Elhadi, Muhammed, Zafeiridis, Tilemachos, Arche Banzo, Maria José, Moreno, Rui, Boumendil, Ariane, De Lange, Dylan W., Eller, Philipp, Joannidis, Michael, Mesotten, Dieter, Reper, Pascal, Oeyen, Sandra, Swinnen, Walter, Serck, Nicolas, Dewaele, Elisabeth, Chapeta, Edwin, Brix, Helene, Brushoej, Jens, Kumar, Pritpal, Nedergaard, Helene Korvenius, Johnsen, Tim Koch, Bundesen, Camilla, Hansen, Maria Aagaard, Uhrenholt, Stine, Bundgaard, Helle, Fjølner, Jesper, Innes, Richard, Gooch, James, Cagova, Lenka, Potter, Elizabeth, Reay, Michael, Davey, Miriam, Abusayed, Mohammed Abdelshafy, Humphreys, Sally, Collins, Amy, Aujayeb, Avinash, Leaver, Susannah, Khaliq, Waqas, Habib, Ayman Abdelmawgoad, Azab, Mohammed A., Wassim, Kyrillos, Elgazzar, Yumna A., Salah, Rehab, Abosheaishaa, Hazem Maarouf, Hussein Mohamed, Aliae A. R., Azzam, Ahmed Y., Tharwat, Samar, Ali, Yasmin Khairy Nasreldin Mohamed, Elmandouh, Omar, Galal, Islam, Abu-Elfatth, Ahmed, Motawea, Karam, Elbahnasawy, Mohammad, Shehata, Mostafa, Elbahnasawy, Mohamed, Tayeb, Mostafa, Osman, Nermin, Abdel-Elsalam, Wafaa, Hussein, Aliae Mohamed, Aldhalia, Amer, Galbois, Arnaud, Guidet, Bertrand, Charron, Cyril, Berlemont, Caroline Hauw, Besch, Guillaume, Rigaud, Jean-Philippe, Maizel, Julien, Djibré, Michel, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Alexandru, Nica, Marin, Nathalie, Vaissiere, Marie, Plantefeve, Gaëtan, Mentec, Hervé, Vanderlinden, Thierry, Jurcisin, Igor, Megarbane, Buno, Chousterman, Benjamin Glenn, Dépret, François, Garnier, Marc, Besset, Sebastien, Oziel, Johanna, Ferre, Alexis, Dauger, Stéphane, Dumas, Guillaume, Goncalves, Bruno, Vettoretti, Lucie, Thevenin, Didier, Schaller, Stefan, Kurt, Muhammed, Faltlhauser, Andreas, Meyer, Christian, Milovanovic, Milena, Lutz, Matthias, Shala, Gonxhe, Haake, Hendrik, Randerath, Winfried, Kunstein, Anselm, Meybohm, Patrick, Barth, Eberhard, Poerner, Tudor, Simon, Philipp, Lorenz, Marco, Dindane, Zouhir, Kuhn, Karl Friedrich, Welte, Martin, Voigt, Ingo, Kabitz, Hans-Joachim, Wollborn, Jakob, Goebel, Ulrich, Stoll, Sandra Emily, Kindgen-Milles, Detlef, Dubler, Simon, Jung, Christian, Fuest, Kristina, Schuster, Michael, Steiner, Stephan, Papadogoulas, Antonios, Mulita, Francesk, Rovina, Nikoletta, Aidoni, Zoi, Chrisanthopoulou, Evangelia, Kondili, Eumorfia, Andrianopoulos, Ioannis, Gurjar, Mohan, Mahmoodpoor, Ata, Hussein, Rand, Al-Juaifari, Maytham Aqeel, Karantenachy, Abdullah Khudhur Ahmed, Sviri, Sigal, Elsaka, Ahmed, Marsh, Brian, Comellini, Vittoria, Al-Ali, Farah, Almani, Sari, Khamees, Almu' Atasim, Al-Shami, Khayry, El Din, Ibrahim Salah, Abubaker, Taha, Ahmed, Hazem, Rabha, Ahmed, Emhamed, Marwa, Abdeewi, Saedah, Abusalama, Abdurraouf, Alhadi, Abdulmueti, Huwaysh, Mohammed, Alghati, Esraa Abdalqader, Ghannam, Abdelilah, Namendys-Sylva, Silvio A., Groenendijk, Martijn, Evers, Mirjam, Van Lelyveld-Haas, Lenneke, Meynaar, Iwan, Cornet, Alexander Daniel, Zegers, Marieke, Dieperink, Willem, De Lange, Dylan, Dormans, Tom, Hahn, Michael, Sjøbøe, Britt, Strietzel, Hans Frank, Olasveengen, Theresa, Romundstad, Luis, Andersen, Finn H., Massoud, John George Grace, Khan, Aamir Ghafoor, Al-Qasrawi, Shahd, Amro, Sarah, Kluzik, Anna, Zatorski, Pawel, Drygalski, Tomasz, Szczeklik, Wojciech, Klimkiewicz, Jakub, Solek-Pastuszka, Joanna, Onichimowski, Dariusz, Czuczwar, Miroslaw, Gawda, Ryszard, Stefaniak, Jan, Stefanska-Wronka, Karina, Zabul, Ewa, Oliveira, Ana Isabel Pinho, Assis, Rui, De Lurdes Campos Santos, Maria, Santos, Henrique, Cardoso, Filipe Sousa, Gordinho, André, Grintescu, Ioana Marina, Tomescu, Dana, Badawy, Mohamed Raafat, José Arche Banzo, M., Zalba-Etayo, Begoña, Cubero, Patricia Jimeno, Priego, Jesús, Gomà, Gemma, Tomasa-Irriguible, Teresa Maria, Sancho, Susana, Ferreira, Aida Fernández, Vázquez, Eric Mayor, Mira, Ángela Prado, Ibarz, Mercedes, Iglesias, David, Arias-Rivera, Susana, Frutos-Vivar, Fernando, Lopez-Cuenca, Sonia, Aldecoa, Cesar, Perez-Torres, David, Canas-Perez, Isabel, Tamayo-Lomas, Luis, Diaz-Rodriguez, Cristina, De Gopegui, Pablo Ruiz, Saleh, Mahmoud, Hilles, Momin Majed Yousuf, Abualqumboz, Enas M. Y., Ben-Hamouda, Nawfel, Roberti, Andrea, Fleury, Yvan, Abidi, Nour, Schefold, Joerg C., Chau, Ivan, Dullenkopf, Alexander, Chaaban, Mohammad Karam, Shebani, Mohammed Mouaz, Hmaideh, Ahmad, Shaher, Aymen, Sahin, Ayca Sultan, Saracoglu, Kemal Tolga, Al-Sadawi, Mohammed, Pugh, Richard, Smuts, Sara, and Al-Saban, Rafat Ameen Mohammed
Subjects: Research, Intensive / Critical Care Medicine, Emergency Medicine, Anesthesiology, ddc
Published: 2020

10. Animal-Free human whole blood sepsis model to study changes in innate immunity

Author: Messerer, David Alexander Christian, Vidoni, Laura, Erber, Maike, Stratmann, Alexander Elias Paul, Bauer, Jonas Martin, Braun, Christian Karl, Hug, Stefan, Adler, Anna, Nilsson Ekdahl, Kristina, Nilsson, Bo, Barth, Eberhard, Radermacher, Peter, and Huber-Lang, Markus
Subjects: Inflammation, Lipopolysaccharides, neutrophil dysfunction, Blood physiological phenomena, blood physiology, Neutrophils, Entzündung, Immunology, Immunology in the medical area, Shock, Septic, neutrophil granulocytes, Phagocytosis, principles of the 3Rs, Immunologi inom det medicinska området, Sepsis, Immunologi, ex vivo whole blood model, Immunology and Allergy, ddc:610, oxidative burst, Neutrophiler Granulozyt, DDC 610 / Medicine & health, Receptor, Anaphylatoxin C5a, lipopolysaccharide (LPS), Granulocytes
Abstract: Studying innate immunity in humans is crucial for understanding its role in the pathophysiology of systemic inflammation, particularly in the complex setting of sepsis. Therefore, we standardized a step-by-step process from the venipuncture to the transfer in a human model system, while closely monitoring the inflammatory response for up to three hours. We designed an animal-free, human whole blood sepsis model using a commercially available, simple to use, tubing system. First, we analyzed routine clinical parameters, including cell count and blood gas analysis. Second, we demonstrated that extracellular activation markers (e.g., CD11b and CD62l) as well as intracellular metabolic (intracellular pH) and functional (generation of radical oxygen species) features remained stable after incubation in the whole blood model. Third, we mimicked systemic inflammation during early sepsis by exposure of whole blood to pathogen-associated molecular patterns. Stimulation with lipopolysaccharide revealed the capability of the model system to evoke a sepsis-like inflammatory phenotype of innate immunity. In summary, the presented model serves as a convenient, economic, and reliable platform to study innate immunity in human whole blood, which may yield clinically important insights., publishedVersion
Published: 2020

11. Additional file 1: of Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs: a multicentre prospective cohort study

Author: Muessig, Johanna, Nia, Amir, Masyuk, Maryna, Lauten, Alexander, Sacher, Anne, Brenner, Thorsten, Franz, Marcus, Bloos, Frank, Ebelt, Henning, Schaller, Stefan, Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobias, JĂĄnosi, Rolf, Meybohm, Patrick, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Kelm, Malte, and Jung, Christian
Abstract: Ethics Committees. (DOCX 111 kb)
Published: 2018
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12. Delirium Accompanied by Cholinergic Deficiency and Organ Failure in a 73-Year-Old Critically Ill Patient: Physostigmine as a Therapeutic Option

Author: Zujalovic, Benedikt and Barth, Eberhard
Subjects: Article Subject
Abstract: Delirium is a common problem in ICU patients, resulting in prolonged ICU stay and increased mortality. A cholinergic deficiency in the central nervous system is supposed to be a relevant pathophysiologic process in delirium. Acetylcholine is a major transmitter of the parasympathetic nervous system influencing several organs (e.g., heart and kidneys) and the inflammatory response too. This perception might explain that delirium is not an individual symptom, but rather a part of a symptom complex with various disorders of the whole organism. The cholinergic deficiency could not be quantified up to now. Using the possibility of bedside determination of the acetylcholinesterase activity (AChE activity), we assumed to objectify the cholinergic homeostasis within minutes. As reported here, the postoperative delirium was accompanied by a massive hemodynamic and renal deterioration of unclear genesis. We identified the altered AChE activity as a plausible pathophysiological mechanism. The pharmacological intervention with the indirect parasympathomimetic physostigmine led to a quick and lasting improvement of the patient’s cognitive, hemodynamic, and renal status. In summary, severe delirium is not always an attendant phenomenon of critical illness. It might be causal for multiple organ deterioration if it is based on cholinergic deficiency and has to be treated at his pathophysiological roots whenever possible.
Published: 2015
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13. Strahlenbelastung für das OP-Team im Hybridoperationssaal des Universitätsklinikums Ulm

Author: Cintean, Raffael, Dehner, Christoph, and Barth, Eberhard
Subjects: Radiographic image enhancement, Bildgebendes Verfahren, Intraoperative care, Radiation exposure, Intraoperative Phase, Strahlenbelastung, Hybrid-OP, ddc:610, Imaging, Three-dimensional, DDC 610 / Medicine & health, Image Processing, Computer-assisted, Intraoperative Strahlentherapie
Abstract: Hybrid-Operationss��le werden heutzutage interdisziplin��r bei verschiedensten Eingriffen genutzt. In der Unfallchirurgie bieten die Hybrid-OP die M��glichkeit, komplexe Regionen wie die Wirbels��ule oder die Beckenegion mit minimalinvasiven Eingriffen unter intraoperativer Navigation zu versorgen. W��hrend die Vorteile der dreidimensionalen Darstellung und die dadurch entstandene M��glichkeit zur minimalinvasiven Operationstechnik im klinischen Umfeld klar erscheinen, bleibt die vermeintlich h��here Strahlenbelastung von Personal sowie Patient ein Hauptproblem. Diese Studie dient zur Darstellung der Streustrahlung w��hrend 3D-Scans im Hybrid-OP an der Universit��tsklinik Ulm unter labor��hnlichen Voraussetzungen sowie im realen klinischen Umfeld. Zun��chst wurden RaySafeTM i2 Dosimeter zur Messung der Streustrahlung w��hrend 3D-Scans an verschiedenen anatomischen am Leichenpr��parat sowie verschiedenen Abst��nden und H��hen innerhalb des Hybrid-OP in einem 320�� Radius im Abstand von jeweils 45�� platziert. Alle 3D-Scans wurden mit einem bodengebunden roboterassistierten Flat-panel C-Arm (Artis Zeego, Siemens, Deutschland) durchgef��hrt. Die 3D-Scans wurden mit den bereits integrierten Standard- sowie einem strahlenreduziertem Bodycare-Modus durchgef��hrt. Zum Vergleich wurden mit selbigem Dosimeter Messungen von Streustrahlung an Operateur und Operationstechnischer/Operationstechnischem Assistentin/Assistenten w��hrend 109 Becken- und Wirbels��uleneingriffen im Hybrid-OP durchgef��hrt und die Operationsmethoden sowie anatomischen Regionen unter dem Gesichtspunkt der vom Operationspersonal absorbierten Strahlung verglichen. Insgesamt konnte die h��chste Strahlung bei 3D-Scans der Beckenregion des K��rperspenders bei 135�� auf ca. einem Meter (m) H��he gemessen werden. Ebenso wurde bei Messungen der Strahlung w��hrend der 3D-Scans der zervikothorakalen Wirbels��ule sowie der thorakolumbalen Wirbels��ule die h��chste Strahlung bei 135�� und 1 m H��he und einer Entfernung von 0,8 m gemessen. Eine deutliche Strahlenreduktion zwischen 66% und 70% wurde durch die Nutzung des Bodycare-Modus erreicht. Die Streustrahlung zeigte sich noch um ein vielfaches niedriger hinter einer Strahlenschutzwand. W��hrend den klinischen Messungen zeigte sich die h��chste Strahlung bei Eingriffen an der thorakalen Wirbels��ule. Signifikant h��her war die Strahlung bei Positionierung des Operateurs innerhalb des C-Armes. Bei navigierten Operationen wurde eine signifikant niedrigere Streustrahlung im Vergleich zu nicht-navigierten Operationen gemessen. Keine Signifikanz wies hingegen die minimalinvasive im Vergleich zur offenen Operationstechnik auf. Die Strahlenbelastung ist w��hrend 3D-Scans im Hybrid-OP weiterhin ein sensibles Thema und gewinnt durch den technischen Fortschritt an Relevanz. Insbesondere bei Scans der Beckenregion sowie operativen Versorgung der thorakalen Wirbels��ule sollte das OP-Personal weitestm��glichen Abstand zur Strahlenquelle halten. Falls vorhanden, sollte eine Strahlenschutzwand genutzt werden. Bestenfalls sollte das Personal w��hrend der Scans den Operationssaal verlassen und die T��ren zum Operationssaal geschlossen halten. Ein integriertes Strahlenschutzprogramm zur Reduktion der Streustrahlung sollte wann immer m��glich genutzt werden. Unter Beachtung einfacher, h��ufig bereits etablierter Regeln l��sst sich die Strahlenbelastung des OP-Personals im klinischen Alltag signifikant reduzieren.
Published: 2022

14. Analyse der 13C-Acetatatemgastestergebnisse zur individuellen Charakterisierung der Magenentleerung bei Intensivpatienten

Author: Bernhard, Lukas, Barth, Eberhard, and Huber-Lang, Markus
Subjects: Parenterale Ern��hrung, Marginalization and Regularization approach, Gastrointestinal motility, Intensivmedizin, Atemgastest, Atemgasanalyse, Sondenern��hrung, Acetatatemgastest, Parenteral nutrition, Enterale Ern��hrung, Gastrointestinale Motilit��tsst��rung, Enterale Ernährung, Critical care, Breath tests, Sondenernährung, MRA, 13C-Acetat, Parenterale Ernährung, Gastrointestinale Motilitätsstörung, ddc:610, Enteral nutrition, DDC 610 / Medicine & health
Abstract: Dem Gastrointestinaltrakt (GI-Trakt) kommt in der Intensivmedizin eine au��erordentliche Bedeutung zu. Bei einer kritischen Erkrankung wird der GI-Trakt durch das fehlgeleitete Zusammenspiel von Epithel, GALT (gut associated lymphoid tissue), Mikrobiom und darmeigenem Nervensystem zum ��motor of critical illness��. In Folge bakterieller Translokation und Freisetzung toxischer Mediatoren kann ein Multiorganversagen resultieren. Um diesem Circulus vitiosus vorzubeugen, empfehlen intensivmedizinische Leitlinien die fr��he Einleitung einer enteralen Ern��hrung. Allerdings liegt bei bis zu 50% aller Intensivpatienten eine Nahrungsintoleranz vor, sodass die Einleitung der enteralen Ern��hrung zum richtigen Zeitpunkt und in richtiger Dosierung erfolgen muss. Hierzu muss der Funktionszustand des GI-Traktes, sprich die Absorptionsf��higkeit und die gastrointestinale Motilit��t, richtig beurteilt werden. Noch existiert kein validiertes Diagnostiktool zur Messung der GI-Funktion beim Intensivpatienten. Die klinische Beurteilung erfolgt mehr intuitiv als objektiv. Da sich Motilit��tsst��rungen in einer zeitverz��gerten Magenentleerung wiederspiegeln, kann mittels nicht-invasivem, nicht-radioaktiv-markiertem Acetat-Atemgastest der Funktionszustand des GI-Traktes beurteilt werden. Bisherige Auswerteverfahren wie der GEC (gastric emptying coefficient) -Ansatz oder der BEX (��-exponential approach) ziehen f��r die Beurteilung der GI-Funktion die Magenentleerungsgeschwindigkeit heran. Physiologische Stoffwechselprozesse im K��rper werden nicht oder nur stark vereinfacht ber��cksichtigt, sodass nur einphasige Magenentleerungsmuster abgebildet werden. In vorliegender Dissertation wurde untersucht, ob die Magenentleerungsgeschwindigkeit allein ausreicht, um den Funktionszustand des GI-Traktes zu beurteilen. Es wurde untersucht, ob die bisherigen Limitationen in der Interpretation des 13C-Atemgastests mithilfe eines neuen Auswerteverfahrens, dem MRA (marginalization and regularization approach) ��berwunden werden k��nnen. Zudem wurde evaluiert, wie h��ufig und pr��zise Magenentleerungsst��rungen unter Ber��cksichtigung der Tracerkinetik und -metabolisierung detektiert werden k��nnen. Ferner wurden Zusammenh��nge zwischen den Testergebnissen und der GI-Funktion des Patienten aufgezeigt. In vorliegender Studie wurde an 29 beatmeten Intensivpatienten der Acetat-Atemgastest durchgef��hrt. Die Messung der Acetatabsorption wurde mittels Isotopen-markiertem 13C-Acetat durchgef��hrt. Die Atemgasdaten wurden mit dem MRA ausgewertet. Die Magenentleerungsgeschwindigkeit f��r die Intensivpatienten zeigte sich bei der Auswertung durch den MRA im Vergleich zum BEX um 215 % erh��ht (Zeitpunkt bei dem 50% des Tracers absorbiert sind t50 1,70 h �� 1,0 h vs. 0,79 h �� 0,46 h; p
Published: 2022

15. Darstellung der Kurz- und Langzeitergebnisse bei prophylaktischer Netzanwendung zum Zeitpunkt der primären Stomaanlage

Author: Fortunova, Aglika, Berger, Dieter, and Barth, Eberhard
Subjects: Netz, Hernia, Therapy, Anus diseases, Anus praeternaturalis, Hernie, ddc:610, Surgical mesh, DDC 610 / Medicine & health
Abstract: Die parastomale Hernie (PSH) ist eine der häufigsten Komplikationen nach einer Stomaanlage. Um dieser Komplikation vorzubeugen, wurde erstmals im Jahr 1977 der Einsatz eines Netzes in den Bauchraum beschrieben, der als Stütze die Belastung des Gewebes verringern und so einer parastomalen Hernie vorbeugen sollte. Im Rahmen der vorliegenden Untersuchung sollte anhand von Daten von 270 Patienten aus drei Zeiträumen nach der Stomaanlage (bis 30 Tage postoperativ, 30 Tage bis ein Jahr, mehr als ein Jahr) bestimmt werden, ob der Einsatz eines Netzes die Auftretenswahrscheinlichkeit einer parastomalen Hernierung reduziert und ob dieser Einsatz mit einer erhöhten Komplikationsrate einhergeht. Die Untersuchung fußt auf zwei Studien. In Rahmen einer prospektiven Analyse wurden im Follow-up-Zeitraum die Daten von 165 Patienten erhoben, die mithilfe eines Netzes operiert wurden. Retrospektiv erfolgte die Auswertung von Daten von 105 Patienten, die ohne den Einsatz eines Netzes operiert wurden. Neben demografischen Angaben wurden vorrangig klinische Charakteristika ausgewertet, die für Komplikationen im Allgemeinen und das Auftreten einer PSH im Besonderen relevant erschienen. Bezüglich der Auswertung der Faktoren Alter, Geschlecht, Größe, Gewicht und Body- Mass-Index ergaben sich keine statistischen Unterschiede in den Ausgangsbedingungen zwischen den Gruppen. Lediglich bezüglich des PSH-Risikofaktors einer Radio- oder Chemotherapie waren in der Netzgruppe signifikant mehr Patienten diesem Risiko ausgesetzt. Zusammenfassend kann gesagt werden, dass der Einsatz eines Netzes mit einer signifikanten Reduktion des PSH-Risikos einhergeht. Gleichzeitig ist die Komplikationsrate in der netzfrei operierten Patientengruppe signifikant höher. Der Einsatz eines Netzes zur Prävention einer parastomalen Hernie ist ein sicherer und effektiver Weg, um diese zu vermeiden. Jedoch sollten bei dieser Schlussfolgerung die Ergebnisse von Studien berücksichtigt werden, die diesen Zusammenhang derzeit noch vergleichend untersuchen.
Published: 2018
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16. Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

Author: Guidet B., Flaatten H., Boumendil A., Morandi A., Andersen F. H., Artigas A., Bertolini G., Cecconi M., Christensen S., Faraldi L., Fjolner J., Jung C., Marsh B., Moreno R., Oeyen S., Ohman C. A., Pinto B. B., Soliman I. W., Szczeklik W., Valentin A., Watson X., Zafeiridis T., De Lange D. W., Schmutz R., Wimmer F., Eller P., Zotter K., De Buysscher P., De Neve N., Swinnen W., Abraham P., Hergafi L., Schefold J. C., Biskup E., Taliadoros I., Piza P., Lauten A., Sacher A. L., Brenner T., Franz M., Bloos F., Ebelt H., Schaller S. J., Fuest K., Rabe C., Dieck T., Steiner S., Graf T., Nia A. M., Janosi R. A., Simon P., Utzolino S., Rahmel T., Barth E., Schuster M., Dey N., Solling C., Rasmussen B. S., Rodriguez E., Rebollo S., Aguilar G., Masdeu G., Jaimes M. I., Mira A. P., Bodi M. A., Barea Mendoza J. A., Lopez-Cuenca S., Guzman M. H., Rico-Feijoo J., Ibarz M., Alvarez J. T., Forceville X., Besch G., Mentec H., Michel P., Mateu P., Vettoretti L., Bourenne J., Marin N., Guillot M., Aissaoui N., Goulenok C., Thieulot-Rolin N., Messika J., Lamhaut L., Charron C., Dempsey G., Mathew S. J., Raj A. S., Grecu I., Cupitt J., Lawton T., Clark R., Popescu M., Spittle N., Faulkner M., Cowton A., Elloway E., Williams P., Reay M., Chukkambotla S., Kumar R., Al-Subaie N., Kent L., Tamm T., Kajtor I., Burns K., Pugh R., Ostermann M., Kam E., Bowyer H., Smith N., Templeton M., Henning J., Goffin K., Kapoor R., Laha S., Chilton P., Khaliq W., Crayford A., Coetzee S., Tait M., Stoker W., Gimenez M., Pope A., Camsooksai J., Pogson D., Quigley K., Ritzema J., Hormis A., Boulanger C., Balasubramaniam M., Vamplew L., Burt K., Martin D., Craig J., Prowle J., Doyle N., Shelton J., Scott C., Donnison P., Shelton S., Frey C., Ryan C., Spray D., Barnes V., Barnes K., Ridgway S., Saha R., Clark T., Wood J., Bolger C., Bassford C., Lewandowski J., Zhao X., Humphreys S., Dowling S., Richardson N., Burtenshaw A., Stevenson C., Wilcock D., Aidoni Z., Aloizos S., Tasioudis P., Lampiri K., Zisopoulou V., Ravani I., Pagaki E., Antoniou A., Katsoulas T. A., Kounougeri A., Marinakis G., Tsimpoukas F., Spyropoulou A., Zygoulis P., Kyparissi A., Hayes I., Kelly Y., Westbrook A., Fitzpatrick G., Maheshwari D., Motherway C., Gupta M., Gurjar M., Maji I. M., Negri G., Spadaro S., Nattino G., Pedeferri M., Boscolo A., Rossi S., Calicchio G., Cubattoli L., Di Lascio G., Barbagallo M., Berruto F., Codazzi D., Bottazzi A., Fumagalli P., Negro G., Lupi G., Savelli F., Vulcano G. A., Fumagalli R., Marudi A., Lefons U., Lembo R., Babini M., Paggioro A., Parrini V., Zaccaria M., Clementi S., Gigliuto C., Facondini F., Pastorini S., Munaron S., Calamai I., Bocchi A., Adorni A., Bocci M. G., Cortegiani A., Casalicchio T., Mellea S., Graziani E., Barattini M., Brizio E., Rossi M., van Dijk I., van Lelyveld-Haas L. E. M., Ramnarain D., Jansen T., Nooteboom F., van der Voort P. H., de Lange D., Dieperink W., de Waard M. C., de Smet A. G. E., Bormans L., Dormans T., Hahn M., Kemmerer N., Strietzel H. F., Dybwik K., Legernaes T., Klepstad P., Olaussen E. B., Olsen K. I., Brresen O. M., Bjorsvik G., Maini S., Fehrle L., Czuczwar M., Krawczyk P., Zietkiewicz M., Nowak L. R., Kotfis K., Cwyl K., Gajdosz R., Biernawska J., Bohatyrewicz R., Gawda R., Grudzien P., Nasilowski P., Popek N., Cyrankiewicz W., Wawrzyniak K., Wnuk M., Maciejewski D., Studzinska D., Zukowski M., Bernas S., Piechota M., Nowak I., Fronczek J., Serwa M., Machala W., Stefaniak J., Wujtewicz M., Maciejewski P., Szymkowiak M., Adamik B., Catorze N., Branco M. C., Barros I., Barros N., Krystopchuk A., Honrado T., Sousa C., Munoz F., Rebelo M., Gomes R., Nunes J., Dias C., Fernandes A. M., Petrisor C., Constantin B., Belskiy V., Boskholov B., Kawati R., Sivik J., Nauska J., Smole D., Parenmark F., Lyren J., Rockstroh K., Ryden S., Spangfors M., Strinnholm M., Walther S., De Geer L., Nordlund P., Palsson S., Zetterquist H., Nilsson A., Thiringer K., Jungner M., Bark B., Nordling B., Skold H., Brorsson C., Persson S., Bergstrom A., Berkius J., Holmstrom J., Nalapko Y., Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Bergen (UiB), Haukeland University Hospital, Norwegian University of Science and Technology [Trondheim] (NTNU), Norwegian University of Science and Technology (NTNU), Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Universitat Autònoma de Barcelona (UAB), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), St George's, University of London, Aarhus University Hospital, Ghent University Hospital, Karolinska University Hospital [Stockholm], Hôpitaux Universitaires de Genève (HUG), University Medical Center [Utrecht], Utrecht University [Utrecht], Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Guidet, B, Flaatten, H, Boumendil, A, Morandi, A, Andersen, F, Artigas, A, Bertolini, G, Cecconi, M, Christensen, S, Faraldi, L, Fjolner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Ohman, C, Pinto, B, Soliman, I, Szczeklik, W, Valentin, A, Watson, X, Zafeiridis, T, De Lange, D, Schmutz, R, Wimmer, F, Eller, P, Zotter, K, De Buysscher, P, De Neve, N, Swinnen, W, Abraham, P, Hergafi, L, Schefold, J, Biskup, E, Taliadoros, I, Piza, P, Lauten, A, Sacher, A, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, S, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, A, Janosi, R, Simon, P, Utzolino, S, Rahmel, T, Barth, E, Schuster, M, Dey, N, Solling, C, Rasmussen, B, Rodriguez, E, Rebollo, S, Aguilar, G, Masdeu, G, Jaimes, M, Mira, A, Bodi, M, Barea Mendoza, J, Lopez-Cuenca, S, Guzman, M, Rico-Feijoo, J, Ibarz, M, Alvarez, J, Forceville, X, Besch, G, Mentec, H, Michel, P, Mateu, P, Vettoretti, L, Bourenne, J, Marin, N, Guillot, M, Aissaoui, N, Goulenok, C, Thieulot-Rolin, N, Messika, J, Lamhaut, L, Charron, C, Dempsey, G, Mathew, S, Raj, A, Grecu, I, Cupitt, J, Lawton, T, Clark, R, Popescu, M, Spittle, N, Faulkner, M, Cowton, A, Elloway, E, Williams, P, Reay, M, Chukkambotla, S, Kumar, R, Al-Subaie, N, Kent, L, Tamm, T, Kajtor, I, Burns, K, Pugh, R, Ostermann, M, Kam, E, Bowyer, H, Smith, N, Templeton, M, Henning, J, Goffin, K, Kapoor, R, Laha, S, Chilton, P, Khaliq, W, Crayford, A, Coetzee, S, Tait, M, Stoker, W, Gimenez, M, Pope, A, Camsooksai, J, Pogson, D, Quigley, K, Ritzema, J, Hormis, A, Boulanger, C, Balasubramaniam, M, Vamplew, L, Burt, K, Martin, D, Craig, J, Prowle, J, Doyle, N, Shelton, J, Scott, C, Donnison, P, Shelton, S, Frey, C, Ryan, C, Spray, D, Barnes, V, Barnes, K, Ridgway, S, Saha, R, Clark, T, Wood, J, Bolger, C, Bassford, C, Lewandowski, J, Zhao, X, Humphreys, S, Dowling, S, Richardson, N, Burtenshaw, A, Stevenson, C, Wilcock, D, Aidoni, Z, Aloizos, S, Tasioudis, P, Lampiri, K, Zisopoulou, V, Ravani, I, Pagaki, E, Antoniou, A, Katsoulas, T, Kounougeri, A, Marinakis, G, Tsimpoukas, F, Spyropoulou, A, Zygoulis, P, Kyparissi, A, Hayes, I, Kelly, Y, Westbrook, A, Fitzpatrick, G, Maheshwari, D, Motherway, C, Gupta, M, Gurjar, M, Maji, I, Negri, G, Spadaro, S, Nattino, G, Pedeferri, M, Boscolo, A, Rossi, S, Calicchio, G, Cubattoli, L, Di Lascio, G, Barbagallo, M, Berruto, F, Codazzi, D, Bottazzi, A, Fumagalli, P, Negro, G, Lupi, G, Savelli, F, Vulcano, G, Fumagalli, R, Marudi, A, Lefons, U, Lembo, R, Babini, M, Paggioro, A, Parrini, V, Zaccaria, M, Clementi, S, Gigliuto, C, Facondini, F, Pastorini, S, Munaron, S, Calamai, I, Bocchi, A, Adorni, A, Bocci, M, Cortegiani, A, Casalicchio, T, Mellea, S, Graziani, E, Barattini, M, Brizio, E, Rossi, M, van Dijk, I, van Lelyveld-Haas, L, Ramnarain, D, Jansen, T, Nooteboom, F, van der Voort, P, de Lange, D, Dieperink, W, de Waard, M, de Smet, A, Bormans, L, Dormans, T, Hahn, M, Kemmerer, N, Strietzel, H, Dybwik, K, Legernaes, T, Klepstad, P, Olaussen, E, Olsen, K, Brresen, O, Bjorsvik, G, Maini, S, Fehrle, L, Czuczwar, M, Krawczyk, P, Zietkiewicz, M, Nowak, L, Kotfis, K, Cwyl, K, Gajdosz, R, Biernawska, J, Bohatyrewicz, R, Gawda, R, Grudzien, P, Nasilowski, P, Popek, N, Cyrankiewicz, W, Wawrzyniak, K, Wnuk, M, Maciejewski, D, Studzinska, D, Zukowski, M, Bernas, S, Piechota, M, Nowak, I, Fronczek, J, Serwa, M, Machala, W, Stefaniak, J, Wujtewicz, M, Maciejewski, P, Szymkowiak, M, Adamik, B, Catorze, N, Branco, M, Barros, I, Barros, N, Krystopchuk, A, Honrado, T, Sousa, C, Munoz, F, Rebelo, M, Gomes, R, Nunes, J, Dias, C, Fernandes, A, Petrisor, C, Constantin, B, Belskiy, V, Boskholov, B, Kawati, R, Sivik, J, Nauska, J, Smole, D, Parenmark, F, Lyren, J, Rockstroh, K, Ryden, S, Spangfors, M, Strinnholm, M, Walther, S, De Geer, L, Nordlund, P, Palsson, S, Zetterquist, H, Nilsson, A, Thiringer, K, Jungner, M, Bark, B, Nordling, B, Skold, H, Brorsson, C, Persson, S, Bergstrom, A, Berkius, J, Holmstrom, J, Nalapko, Y, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Guidet, Bertrand, Flaatten, Han, Boumendil, Ariane, Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Bertolini, Guido, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agwald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andrea, Watson, Ximena, Zafeiridis, Tilemacho, de Lange, Dylan W., Schmutz, René, Wimmer, Franz, Eller, Philipp, Zotter, Klemen, de Buysscher, Pieter, de Neve, Nikolaa, Swinnen, Walter, Abraham, Paul, Hergafi, Leila, Schefold, Joerg C., Biskup, Ewelina, Taliadoros, Ioanni, Piza, Petr, Lauten, Alexander, Sacher, Anna Lena, Brenner, Thorsten, Franz, Marcu, Bloos, Frank, Ebelt, Henning, Schaller, Stefan J, Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobia, Nia, Amir M, Janosi, Rolf Alexander, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Dey, Nilanjan, Sølling, Christoffer, Rasmussen, Bodil Steen, Rodriguez, Enver, Rebollo, Sergio, Aguilar, Gerardo, Masdeu, Gaspar, Jaimes, Marián Irazábal, Mira, Ángela Prado, Bodi, Maria A., Barea Mendoza, Jesus A., López-Cuenca, Sonia, Guzman, Marcela Homez, Rico-Feijoo, Jesú, Ibarz, Mercede, Alvarez, Josep Trenado, Forceville, Xavier, Besch, Guillaume, Mentec, Herve, Michel, Philippe, Mateu, Philippe, Vettoretti, Lucie, Bourenne, Jeremy, MARIN, Nathalie, Guillot, Max, Aissaoui, Naida, Goulenok, Cyril, Thieulot-Rolin, Nathalie, Messika, Jonathan, Lamhaut, Lionel, Charron, Cyril, Dempsey, Ged, Mathew, Shiju J, Raj, Ashok S, Grecu, Irina, Cupitt, Jason, Lawton, Tom, Clark, Richard, Popescu, Monica, Spittle, Nick, Faulkner, Maria, Cowton, Amanda, Elloway, Esme, Williams, Patricia, Reay, Michael, Chukkambotla, Srikanth, Kumar, Ravi, Al-Subaie, Nawaf, Kent, Linda, Tamm, Tiina, Kajtor, Istvan, Burns, Karen, Pugh, Richard, Ostermann, Marlie, Kam, Elisa, Bowyer, Helen, Smith, Neil, Templeton, Maie, Henning, Jeremy, Goffin, Kelly, Kapoor, Ritoo, Laha, Shondipon, Chilton, Phil, Khaliq, Waqa, Crayford, Alison, Coetzee, Samantha, Tait, Moira, Stoker, Wendy, Gimenez, Marc, Pope, Alan, Camsooksai, Julie, Pogson, David, Quigley, Kate, Ritzema, Jenny, Hormis, Anil, Boulanger, Carole, Balasubramaniam, M., Vamplew, Luke, Burt, Karen, Martin, Daniel, Craig, Jayne, Prowle, John, Doyle, Nanci, Shelton, Jonathon, Scott, Carmen, Donnison, Phil, Shelton, Sarah, Frey, Christian, Ryan, Christine, Spray, Dominic, Barnes, Veronica, Barnes, Kerry, Ridgway, Stephanie, Saha, Rajnish, Clark, Thoma, Wood, Jame, Bolger, Clare, Bassford, Christopher, Lewandowski, John, Zhao, Xiaobei, Humphreys, Sally, Dowling, Susan, Richardson, Neil, Burtenshaw, Andrew, Stevenson, Carl, Wilcock, Danielle, Aidoni, Zoi, Aloizos, Stavro, Tasioudis, Polychroni, Lampiri, Kleri, Zisopoulou, Vasiliki, Ravani, Ifigenia, Pagaki, Eumorfia, Antoniou, Angela, Katsoulas, Theodoros A., Kounougeri, Aikaterini, Marinakis, George, Tsimpoukas, Fotio, Spyropoulou, Anastasia, Zygoulis, Pari, Kyparissi, Aikaterini, Hayes, Ivan, Kelly, Yvelynne, Westbrook, Andrew, Fitzpatrick, Gerry, Maheshwari, Darshana, Motherway, Catherine, Gupta, Manish, Gurjar, Mohan, Maji, Ismail M, Negri, Giovanni, Spadaro, Savino, Nattino, Giuseppe, Pedeferri, Matteo, Boscolo, Annalisa, Rossi, Simona, Calicchio, Giuseppe, Cubattoli, Lucia, Di Lascio, Gabriella, Barbagallo, Maria, Berruto, Francesco, Codazzi, Daniela, Bottazzi, Andrea, Fumagalli, Paolo, Negro, Giancarlo, Lupi, Giuseppe, Savelli, Flavia, Vulcano, Giuseppe A., Fumagalli, Roberto, Marudi, Andrea, Lefons, Ugo, Lembo, Rita, Babini, Maria, Paggioro, Alessandra, Parrini, Vieri, Zaccaria, Maria, Clementi, Stefano, Gigliuto, Carmelo, Facondini, Francesca, Pastorini, Simonetta, Munaron, Susanna, Calamai, Italo, Bocchi, Anna, Adorni, Adele, Bocci, Maria Grazia, Cortegiani, Andrea, Casalicchio, Tiziana, Mellea, Serena, Graziani, Elia, Barattini, Massimo, Brizio, Elisabetta, Rossi, Maurizio, van Dijk, I., van Lelyveld-Haas, L.E.M., Ramnarain, D., Jansen, Tim, Nooteboom, Fleur, van der Voort, Peter HJ, de Lange, Dylan, Dieperink, Willem, de Waard, Monique C., de Smet, Annemarie G. E., Bormans, Laura, Dormans, Tom, Hahn, Michael, Kemmerer, Nicolai, Strietzel, Hans Frank, Dybwik, Knut, Legernaes, Terje, Klepstad, Pål, Olaussen, Even Braut, Olsen, Knut Inge, Brresen, Ole Mariu, Bjorsvik, Geir, Maini, Sameer, Fehrle, Lutz, Czuczwar, Miroslaw, Krawczyk, Pawel, Ziętkiewicz, Mirosław, Nowak, Łukasz R., Kotfis, Katarzyna, Cwyl, Katarzyna, Gajdosz, Ryszard, Biernawska, Jowita, Bohatyrewicz, Romuald, Gawda, Ryszard, Grudzień, Paweł, Nasiłowski, Paweł, Popek, Natalia, Cyrankiewicz, Waldemar, Wawrzyniak, Katarzyna, Wnuk, Marek, Maciejewski, Dariusz, Studzińska, Dorota, Żukowski, Maciej, Bernas, Szymon, Piechota, Mariusz, Nowak, Ilona, Fronczek, Jakub, Serwa, Marta, Machała, Waldemar, Stefaniak, Jan, Wujtewicz, Maria, Maciejewski, Paweł, Szymkowiak, Małgorzata, Adamik, Barbara, Catorze, Nuno, Branco, Miguel Castelo, Barros, Inê, Barros, Nelson, Krystopchuk, Andriy, Honrado, Teresa, Sousa, Cristina, Munoz, Francisco, Rebelo, Marta, Gomes, Rui, Nunes, Jorge, Dias, Celeste, Fernandes, Ana Margarida, Petrisor, Cristina, Constantin, Bodolea, Belskiy, Vladislav, Boskholov, Bori, Kawati, Rafael, Sivik, Joakim, Nauska, Jessica, Smole, Daniel, Parenmark, Fredric, Lyrén, Johanna, Rockstroh, Katalin, Rydén, Sara, Spångfors, Martin, Strinnholm, Morten, Walther, Sten, de Geer, Lina, Nordlund, Peter, Pålsson, Staffan, Zetterquist, Harald, Nilsson, Annika, Thiringer, Karin, Jungner, Mårten, Bark, Björn, Nordling, Berit, Sköld, Han, Brorsson, Camilla, Persson, Stefan, Bergström, Anna, Berkius, Johan, Holmström, Johanna, Nalapko, Yuiry, and Critical Care
Subjects: Male, medicine.medical_treatment, HSJ UCI, Critical Care and Intensive Care Medicine, law.invention, Life sustaining treatment, 0302 clinical medicine, Elderly, law, 80 and over, Medicine, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Aged, 80 and over, education.field_of_study, Withholding Treatment, ddc:617, [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Withholding, Intensive care unit, 3. Good health, Europe, aged, Intensive Care Units, Withdrawal, SOFA score, Human, medicine.medical_specialty, ethical aspects, Population, Intensive Care Unit, Decision Making, Ethics, Intensive care, life-sustaining therapy, NO, 03 medical and health sciences, Anesthesiology, Humans, Ethic, education, Mechanical ventilation, business.industry, 030208 emergency & critical care medicine, critical care, Life Support Care, Prospective Studie, Emergency medicine, business
Abstract: PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries. CONCLUSIONS: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NTC03134807). info:eu-repo/semantics/publishedVersion
Published: 2018
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17. Prospektiv randomisierte Studie zur Nachbehandlung von Beugesehnennähten in Zone II an der Hand - Vergleich von klassischer Physiotherapie und Nachbehandlung mit einem Exoskelett

Author: Gulkin, David, Gülke, Joachim, and Barth, Eberhard
Subjects: Zone II, Exoskeleton device, Physical therapy modalities, Hand injuries, Therapy, Ektoskelett, Handchirurgie, Hand, Exoskelett, Physiotherapie, Beugesehne, Nachbehandlung, Physikalische Therapie, ddc:610, Tendon injuries, Rehabilitation, DDC 610 / Medicine & health
Abstract: Beugesehnenverletzungen in Zone II der Hand zählen weiterhin zu den kompliziertesten Verletzungen der Finger, die ein hohes Maß an funktionellen Einschränkungen nach sich ziehen können. Heutzutage verfügen Operateure und Physiotherapeuten über das Wissen und die Instrumente um zufriedenstellende Ergebnisse zu ermöglichen. Diese Arbeit untersuchte den postoperativen Therapieverlauf über 17 Wochen und verglich den Goldstandard der Physiotherapie mit einem neu konzipierten Nachbehandlungsprogramm, das um den Einsatz einer passiven Bewegungsschiene entworfen wurde. Die Patienten wurden nach operativer Versorgung am Universitätsklinikum Ulm mit Hilfe der Block-Randomisierung in die Nachbehandlungsgruppen eingeteilt. Es wurden sowohl objektiv messbare Größen, wie Bewegungsumfang und Kraft, als auch subjektive Größen, wie Lebensqualität und Bewältigung des Alltags erfasst. Beide Gruppen konnten signifikante Verbesserungen über alle Größen während des Untersuchungszeitraums erzielen. Hierbei zeigten sich keine signifikanten Unterschiede zwischen den Nachbehandlungsgruppen. Ein weiterer Fokus lag auf der möglichst raschen beruflichen Wiedereingliederung und dem damit verbundenen volkswirtschaftlichen Faktor. Die Interventionsgruppe erreichte deutlich früher ein zufriedenstellendes Ergebnis und konnte dementsprechend zügiger wieder aus der Arbeitsunfähigkeit entlassen werden, ohne dabei einer größeren Gefahr von Rerupturen ausgesetzt zu sein. Schlussendlich lässt sich sagen, dass die Anwendung einer passiven Bewegungsschiene in der Nachbehandlung von Beugesehnenverletzungen in Zone II der Hand eine gute Ergänzung zur ambulanten Physiotherapie darstellen kann.
Published: 2017

18. Spektrum neurologischer Erkrankungen mit isolierter Laktaterhöhung im Liquor cerebrospinalis bei zunächst unklarer Diagnose

Author: Hanschke, Nina, Süßmuth, Sigurd, and Barth, Eberhard
Subjects: Laktate, Spinal puncture, Lactic acid, Blood, Epilepsie, Laktaterhöhung, Blut-Liquor-Schranke, Unklare Diagnose, Liquor cerebrospinalis, Cerebral fluid, ddc:610, Lactates, Cerebropsinal fluid, DDC 610 / Medicine & health, Cerebrovascular circulation
Abstract: Das Liquorlaktat ist in der Liquordiagnostik ein wichtiger Parameter des Notfall- und Grundprogramms. Es kann Hinweise auf Krankheitsursachen liefern und zur Erhärtung einer Diagnose beitragen. Der ursprüngliche Ausgangspunkt dieser Arbeit war die Frage, welche Erkrankungen bei einer isolierten Laktaterhöhung im Liquor, bei der die klinische Krankheitsursache zunächst unklar ist, letzten Endes zu finden sind. Des weiteren sollte geklärt werden, ob das Liquorlaktat bei zunächst unklarem klinischen Krankheitsbild zur Diagnose oder zum pathophysiologischen Verständnis beitragen kann, und wie es sich in den Zusammenhang von Erkrankungen einordnen lässt. Die Analyse der Datenbank des Liquorlabors der Universitäts- und Rehabilitationskliniken Ulm (RKU) ergab aus einem Gesamtprobenumfang von 6597 Liquores 67 Patienten mit einer isolierten Laktaterhöhung mit zunächst unklarer Diagnose. Die entsprechenden Patienten hatten bei ätiologisch unklarer neurologischer Symptomatik eine diagnostische Lumbalpunktion erhalten. Bei allen war eine Erhöhung des Laktats (Spannweite 2,2-6,9 mmol/l) ohne Zeichen einer akuten oder chronischen Entzündung, einer Blutung oder eines Tumors aufgefallen. Da bei 12 dieser Patienten eine zusätzliche Schrankenstörung vorlag, wurden sie gesondert ausgewertet. Aufgrund der häufig abschließend gestellten Diagnose eines epileptischen Ereignisses wurden 12 Epilepsiepatienten mit isolierter Laktaterhöhung im Liquor (Spannweite 2,2-3,2 mmol/l) und 11 mit zusätzlicher Schrankendysfunktion (Spannweite 2,2-5,5 mmol/l) ergänzend betrachtet. Die Liquorbefunde wurden retrospektiv hinsichtlich der initialen Verdachtsdiagnosen, den damit zusammenhängenden Leitsymptomen, häufigen Begleiterkrankungen und der Hauptdiagnose bei Entlassung bewertet. Die Laktatwerte lagen im Median bei Patienten mit einer isolierten Laktaterhöhung bei 3,0 mmol/l bei unklarer Diagnose und bei 2,7 mmol/l bei schon vorher bekannten Anfällen. Lag eine zusätzliche Schrankenstörung vor, fanden sich 3,7 mmol/l bei unklarer Diagnose und von 2,8 mmol/l bei Anfallspatienten. Es zeigte sich also immer eine deutliche Erhöhung des Liquorlaktats, aber nur in Einzelfällen ergaben sich sehr hohe Werte bis zu 6,9 mmol/l. Das mit Abstand häufigste Leitsymptom war eine Bewusstseinsstörung (bei unklarer Diagnose und isolierter Laktaterhöhung 58%, bei zusätzlicher Schrankenstörung 67%; bei Anfällen jeweils fast 100%). Die häufigste Verdachtsdiagnose bei Patienten mit unklarer Diagnose und isolierter Laktaterhöhung war mit fast 60% ein Schlaganfall, und in mehr als einem Drittel der Fälle vermutete man ein entzündliches Geschehen. Der Verdacht auf einen epileptischen Anfall wurde nur selten gestellt. Bei Patienten mit zusätzlicher Schrankenstörung war die Verteilung ähnlich. Die Begleiterkrankungen der betrachteten Patienten waren sehr vielfältig. Oft fanden sich eine arterielle Hypertonie, subkortikale vaskuläre Enzephalopathie, Diabetes mellitus Typ 2 oder eine Alkoholabhängigkeit. Die häufigste Diagnose, die im Zusammenhang mit einer isolierten Laktaterhöhung im Liquor bei Entlassung gestellt wurde, war in einem Drittel der Fälle ein epileptisches Ereignis (komplex-fokal: 2,2-5,7 mmol/l [n=8]; generalisiert: 2,8-4,9 mmol/l [n=6]; Status epilepticus: 2,9-3,7 mmol/l [n=4]). Bei zusätzlicher Schrankenstörung war die häufigste Diagnose mit einem Viertel eine zerebrale Ischämie (2,9-6,0 mmol/l [n=3]), mit jeweils einem Fall wurden ein fokaler und ein generalisierter epileptischer Anfall diagnostiziert (komplex-fokal: 3,7 mmol/l [n=1]; generalisiert: 3,0 mmol/l [n=1]). Ist die Krankheitsursache bei einer isolierten Laktaterhöhung zunächst klinisch unklar, sollte also auch an einen epileptischen Anfall gedacht werden. Das Vorliegen einer Bewusstseinsstörung macht die Diagnose wahrscheinlicher. Ein Mechanismus, der zur Erhöhung des Laktatwertes beitragen könnte, wird im Rahmen der Astrozyten-Neuronen-Laktat-Shuttle-Hypothese beschrieben, der die Vorstellung zugrunde liegt, dass das von Astrozyten gebildete Laktat von Neuronen oxidativ weiter verstoffwechselt werden kann. Außerdem entsteht eine Laktaterhöhung im Rahmen der anaeroben Glykolyse bei Hypoxie und bei neuroexzitativen Vorgängen. Auch die neuroprotektive sowie möglicherweise anfallslimitierende Funktion des Laktats ist in Betracht zu ziehen. Zukünftige Aufgaben wären es, genau zu analysieren, in welchem Zusammenhang der Zeitpunkt der Lumbalpunktion und die Höhe des Laktatwertes bei verschiedenen Erkrankungen stehen, welche Rolle eine Schrankenfunktionsstörung dabei spielt und welchen positiven Einfluss das Laktat bei epileptischen Ereignissen und zerebralen Ischämien hat.
Published: 2017
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18 results on '"Barth, Eberhard"'

1. Health-related quality of life in older patients surviving ICU treatment for COVID-19: results from an international observational study of patients older than 70 years

2. Additional file 1 of Emergency medical care of patients with psychiatric disorders - challenges and opportunities: Results of a multicenter survey

3. The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19

4. Noninvasive ventilation in COVID-19 patients aged ≥ 70 years—a prospective multicentre cohort study

5. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

6. Management and outcomes in critically ill nonagenarian versus octogenarian patients

7. Additional file 1 of Measurement of the nociceptive flexion reflex threshold in critically ill patients �� a randomized observational pilot study

8. The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

9. Lactate is associated with mortality in very old intensive care patients suffering from COVID-19: results from an international observational study of 2860 patients

10. Animal-Free human whole blood sepsis model to study changes in innate immunity

11. Additional file 1: of Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs: a multicentre prospective cohort study

12. Delirium Accompanied by Cholinergic Deficiency and Organ Failure in a 73-Year-Old Critically Ill Patient: Physostigmine as a Therapeutic Option

13. Strahlenbelastung für das OP-Team im Hybridoperationssaal des Universitätsklinikums Ulm

14. Analyse der 13C-Acetatatemgastestergebnisse zur individuellen Charakterisierung der Magenentleerung bei Intensivpatienten

15. Darstellung der Kurz- und Langzeitergebnisse bei prophylaktischer Netzanwendung zum Zeitpunkt der primären Stomaanlage

16. Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

17. Prospektiv randomisierte Studie zur Nachbehandlung von Beugesehnennähten in Zone II an der Hand - Vergleich von klassischer Physiotherapie und Nachbehandlung mit einem Exoskelett

18. Spektrum neurologischer Erkrankungen mit isolierter Laktaterhöhung im Liquor cerebrospinalis bei zunächst unklarer Diagnose

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