13 results on '"Nijsten, Maarten W. N."'
Search Results
2. Cost-effectiveness of procalcitonin testing to guide antibiotic treatment duration in critically ill patients: results from a randomised controlled multicentre trial in the Netherlands
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Kip, Michelle M. A., van Oers, Jos A., Shajiei, Arezoo, Beishuizen, Albertus, Berghuis, A. M. Sofie, Girbes, Armand R., de Jong, Evelien, de Lange, Dylan W., Nijsten, Maarten W. N., IJzerman, Maarten J., Koffijberg, Hendrik, and Kusters, Ron
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- 2018
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3. Effect of high-dose dexamethasone on perioperative lactate levels and glucose control: a randomized controlled trial.
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Ottens, Thomas H., Nijsten, Maarten W. N., Hofland, Jan, Dieleman, Jan M., Hoekstra, Miriam, van Dijk, Diederik, and van der Maaten, Joost M. A. A.
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- 2015
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4. Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery: a prospective observational study.
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Schierenbeck, Fanny, Nijsten, Maarten W. N., Franco-Cereceda, Anders, and Liska, Jan
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- 2014
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5. Implementation and evaluation of a nurse-centered computerized potassium regulation protocol in the intensive care unit - a before and after analysis.
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Hoekstra, Miriam, Vogelzang, Mathijs, Drost, José T., Janse, Marcel, Loef, Bert G., Van der Horst, Iwan C. C., Zijlstra, Felix, and Nijsten, Maarten W. N.
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HYPOKALEMIA ,POTASSIUM deficiency diseases ,POTASSIUM in the body ,PHYSIOLOGICAL effects of potassium ,INTENSIVE care units ,MEDICAL technology - Abstract
Background: Potassium disorders can cause major complications and must be avoided in critically ill patients. Regulation of potassium in the intensive care unit (ICU) requires potassium administration with frequent blood potassium measurements and subsequent adjustments of the amount of potassium administrated. The use of a potassium replacement protocol can improve potassium regulation. For safety and efficiency, computerized protocols appear to be superior over paper protocols. The aim of this study was to evaluate if a computerized potassium regulation protocol in the ICU improved potassium regulation. Methods: In our surgical ICU (12 beds) and cardiothoracic ICU (14 beds) at a tertiary academic center, we implemented a nurse-centered computerized potassium protocol integrated with the pre-existent glucose control program called GRIP (Glucose Regulation in Intensive Care patients). Before implementation of the computerized protocol, potassium replacement was physician-driven. Potassium was delivered continuously either by central venous catheter or by gastric, duodenal or jejunal tube. After every potassium measurement, nurses received a recommendation for the potassium administration rate and the time to the next measurement. In this before-after study we evaluated potassium regulation with GRIP. The attitude of the nursing staff towards potassium regulation with computer support was measured with questionnaires. Results: The patient cohort consisted of 775 patients before and 1435 after the implementation of computerized potassium control. The number of patients with hypokalemia (<3.5 mmol/L) and hyperkalemia (>5.0 mmol/L) were recorded, as well as the time course of potassium levels after ICU admission. The incidence of hypokalemia and hyperkalemia was calculated. Median potassium-levels were similar in both study periods, but the level of potassium control improved: the incidence of hypokalemia decreased from 2.4% to 1.7% (P < 0.001) and hyperkalemia from 7.4% to 4.8% (P < 0.001). Nurses indicated that they considered computerized potassium control an improvement over previous practice. Conclusions: Computerized potassium control, integrated with the nurse-centered GRIP program for glucose regulation, is effective and reduces the prevalence of hypo- and hyperkalemia in the ICU compared with physician-driven potassium regulation. [ABSTRACT FROM AUTHOR]
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- 2010
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6. Trial design: Computer guided normal-low versus normal-high potassium control in critically ill patients: Rationale of the GRIP-COMPASS study.
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Hoekstra, Miriam, Vogelzang, Mathijs, van der Horst, Iwan C. C., Lansink, Annemieke Oude, van der Maaten, Joost M. A. A., Ismael, Farouq, Zijlstra, Felix, and Nijsten, Maarten W. N.
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HIGH-potassium diet ,CATASTROPHIC illness ,INTENSIVE care units ,ARRHYTHMIA ,CARDIAC surgery - Abstract
Background: Potassium depletion is common in hospitalized patients and can cause serious complications such as cardiac arrhythmias. In the intensive care unit (ICU) the majority of patients require potassium suppletion. However, there are no data regarding the optimal control target in critically ill patients. After open-heart surgery, patients have a strongly increased risk of atrial fibrillation or atrial flutter (AFF). In a novel trial design, we examined if in these patients different potassium control-targets within the normal range may have different effects on the incidence of AFF. Methods/Design: The "computer-driven Glucose and potassium Regulation program in Intensive care Patients with COMparison of PotASSium targets within normokalemic range (GRIP-COMPASS) trial" is a single-center prospective trial in which a total of 1200 patients are assigned to either a potassium control-target of 4.0 mmol/L or 4.5 mmol/L in consecutive alternating blocks of 50 patients each. Potassium levels are regulated by the computer-assisted potassium suppletion algorithm called GRIP-II (Glucose and potassium regulation for Intensive care Patients). Primary endpoint is the in-hospital incidence of AFF after cardiac surgery. Secondary endpoints are: in-hospital AFF in medical patients or patients after non-cardiac surgery, actually achieved potassium levels and their variation, electrolyte and glucose levels, potassium and insulin requirements, cumulative fluid balance, (ICU) length of stay, ICU mortality, hospital mortality and 90-day mortality. Discussion: The GRIP-COMPASS trial is the first controlled clinical trial to date that compares potassium targets. Other novel methodological elements of the study are that it is performed in ICU patients where both targets are within the normal range and that a computer-assisted potassium suppletion algorithm is used. Trial registration: NCT 01085071 at ClinicalTrials.gov [ABSTRACT FROM AUTHOR]
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- 2010
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7. Persistent hyperglycemia is an independent predictor of outcome in acute myocardial infarction.
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Van der Horst, Iwan C. C., Nijsten, Maarten W. N., Vogelzang, Mathijs, and Zijlstra, Felix
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MYOCARDIAL infarction , *CORONARY disease , *BLOOD sugar , *HYPERGLYCEMIA , *NECROSIS - Abstract
Background: Elevated blood glucose values are a prognostic factor in myocardial infarction (MI) patients. The unfavourable relation between hyperglycemia and outcome is known for admission glucose and fasting glucose after admission. These predictors are single measurements and thus not indicative of overall hyperglycemia. Increased persistent hyperglycemia may better predict adverse events in MI patients. Methods: In a prospective study of MI patients treated with primary percutaneous coronary intervention (PCI) frequent blood glucose measurements were obtained to investigate the relation between glucose and the occurrence of major adverse cardiac events (MACE) at 30 days follow-up. MACE was defined as death, recurrent infarction, repeat primary coronary intervention, and left ventricular ejection fraction equal to or smaller than 30%. Results: MACE occurred in 89 (21.3%) out 417 patients. In 17 patients (4.1%) it was a fatal event. A mean of 7.4 glucose determinations were available per patient. Mean +/- SD admission glucose was 10.1 +/- 3.7 mmol/L in patients with a MACE versus 9.1 +/- 2.7 mmol/L in event-free patients (P = 0.0024). Mean glucose during the first two days after admission was 9.0 +/- 2.8 mmol/L in patients with MACE compared to 8.1 +/- 2.0 mmol/L in event free patients (P < 0.0001). The area under the receiver operator characteristic curve was 0.64 for persistent hyperglycemia and 0.59 for admission glucose. Persistent hyperglycemia emerged as a significant independent predictor (P < 0.001). Conclusion: Persistent hyperglycemia in MI has a stronger relation with 30-day MACE than elevated glucose at admission. [ABSTRACT FROM AUTHOR]
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- 2007
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8. Boussignac continuous positive airway pressure for themanagement of acute cardiogenic pulmonary edema: prospectivestudy with a retrospective control group.
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Dieperink, Willem, Jaarsma, Tiny, Van der Horst, Iwan C. C., Nieuwland, Wybe, Vermeulen, Karin M., Rosman, Hanka, Aarts, Leon P. H. J., Zijlstra, Felix, and Nijsten, Maarten W. N .
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PULMONARY edema ,CARDIOVASCULAR diseases ,LUNG diseases ,RESPIRATION ,CARDIOVASCULAR services in hospitals ,INTENSIVE care units ,CARDIAC research - Abstract
Background: Continuous positive airway pressure (CPAP) treatment for acute cardiogenic pulmonary edema can have important benefits in acute cardiac care. However, coronary care units are usually not equipped and their personnel not adequately trained for applying CPAP with mechanical ventilators. Therefore we investigated in the coronary care unit setting the feasibility and outcome of the simple Boussignac mask-CPAP (BCPAP) system that does not need a mechanical ventilator. Methods: BCPAP was introduced in a coronary care unit where staff had no CPAP experience. All consecutive patients transported to our hospital with acute cardiogenic pulmonary edema, a respiratory rate > 25 breaths/min and a peripheral arterial oxygen saturation of < 95% while receiving oxygen, were included in a prospective BCPAP group that was compared with a historical control group that received conventional treatment with oxygen alone. Results: During the 2-year prospective BCPAP study period 108 patients were admitted with acute cardiogenic pulmonary edema. Eighty-four of these patients (78%) were treated at the coronary care unit of which 66 (61%) were treated with BCPAP. During the control period 66 patients were admitted over a 1-year period of whom 31 (47%) needed respiratory support in the intensive care unit. BCPAP treatment was associated with a reduced hospital length of stay and fewer transfers to the intensive care unit for intubation and mechanical ventilation. Overall estimated savings of approximately € 3,800 per patient were achieved with the BCPAP strategy compared to conventional treatment. Conclusion: At the coronary care unit, BCPAP was feasible, medically effective, and cost-effective in the treatment of acute cardiogenic pulmonary edema. Endpoints included mortality, coronary care unit and hospital length of stay, need of ventilatory support, and cost (savings). [ABSTRACT FROM AUTHOR]
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- 2007
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9. The impact of glucose-insulin-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction [ISRCTN56720616].
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van der Horst, Iwan C. C., Ottervanger, Jan Paul, van 't Hof, Arnoud W. J., Reiffers, Stoffer, Miedema, Kor, Hoorntje, Jan C. A., Dambrink, Jan-Henk E., Gosselink, A. T. Marcel, Nijsten, Maarten W. N., Suryapranata, Harry, de Boer, Menko-Jan, and Zijlstra, Felix
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MYOCARDIAL infarction treatment ,INFUSION therapy ,GLUCOSE ,INSULIN ,POTASSIUM ,LEFT heart ventricle - Abstract
Background: Favorable clinical outcomes have been observed with glucose-insulin-potassium infusion (GIK) in acute myocardial infarction (MI). The mechanisms of this beneficial effect have not been delineated clearly. GIK has metabolic, anti-inflammatory and profibrinolytic effects and it may preserve the ischemic myocardium. We sought to assess the effect of GIK infusion on infarct size and left ventricular function, as part of a randomized controlled trial. Methods: Patients (n = 940) treated for acute MI by primary percutaneous coronary intervention (PCI) were randomized to GIK infusion or no infusion. Endpoints were the creatinine kinase MB-fraction (CK-MB) and left ventricular ejection fraction (LVEF). CK-MB levels were determined 0, 2, 4, 6, 24, 48, 72 and 96 hours after admission and the LVEF was measured before discharge. Results: There were no differences between the two groups in the time course or magnitude of CK-MB release: the peak CK-MB level was 249 ± 228 U/L in the GIK group and 240 ± 200 U/L in the control group (NS). The mean LVEF was 43.7 ± 11.0 % in the GIK group and 42.4 ± 11.7% in the control group (P = 0.12). A LVEF ≤ 30% was observed in 18% in the controls and in 12% of the GIK group (P = 0.01). Conclusion: Treatment with GIK has no effect on myocardial function as determined by LVEF and by the pattern or magnitude of enzyme release. However, left ventricular function was preserved in GIK treated patients. [ABSTRACT FROM AUTHOR]
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- 2005
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10. Metformin and lactic acidosis during shock: just the tip of the iceberg?
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Posma, Rene A., Absalom, Anthony R., Touw, Daan J., van der Horst, Iwan C. C., and Nijsten, Maarten W. N.
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- 2016
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11. Boussignac continuous positive airway pressure for the management of acute cardiogenic pulmonary edema: prospective study with a retrospective control group.
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Dieperink W, Jaarsma T, van der Horst IC, Nieuwland W, Vermeulen KM, Rosman H, Aarts LP, Zijlstra F, and Nijsten MW
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- Aged, Algorithms, Case-Control Studies, Continuous Positive Airway Pressure economics, Coronary Care Units, Feasibility Studies, Female, Heart Rate, Humans, Intubation, Intratracheal statistics & numerical data, Length of Stay statistics & numerical data, Male, Oxygen blood, Patient Transfer statistics & numerical data, Prospective Studies, Retrospective Studies, Continuous Positive Airway Pressure methods, Outcome Assessment, Health Care, Pulmonary Edema therapy
- Abstract
Background: Continuous positive airway pressure (CPAP) treatment for acute cardiogenic pulmonary edema can have important benefits in acute cardiac care. However, coronary care units are usually not equipped and their personnel not adequately trained for applying CPAP with mechanical ventilators. Therefore we investigated in the coronary care unit setting the feasibility and outcome of the simple Boussignac mask-CPAP (BCPAP) system that does not need a mechanical ventilator., Methods: BCPAP was introduced in a coronary care unit where staff had no CPAP experience. All consecutive patients transported to our hospital with acute cardiogenic pulmonary edema, a respiratory rate > 25 breaths/min and a peripheral arterial oxygen saturation of < 95% while receiving oxygen, were included in a prospective BCPAP group that was compared with a historical control group that received conventional treatment with oxygen alone., Results: During the 2-year prospective BCPAP study period 108 patients were admitted with acute cardiogenic pulmonary edema. Eighty-four of these patients (78%) were treated at the coronary care unit of which 66 (61%) were treated with BCPAP. During the control period 66 patients were admitted over a 1-year period of whom 31 (47%) needed respiratory support in the intensive care unit. BCPAP treatment was associated with a reduced hospital length of stay and fewer transfers to the intensive care unit for intubation and mechanical ventilation. Overall estimated savings of approximately euro 3,800 per patient were achieved with the BCPAP strategy compared to conventional treatment., Conclusion: At the coronary care unit, BCPAP was feasible, medically effective, and cost-effective in the treatment of acute cardiogenic pulmonary edema. Endpoints included mortality, coronary care unit and hospital length of stay, need of ventilatory support, and cost (savings).
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- 2007
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- View/download PDF
12. The impact of a reduced dose of dexamethasone on glucose control after coronary artery bypass surgery.
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Vogelzang M, Hoekstra M, Drost JT, Janse M, van der Horst IC, Boonstra PW, Zijlstra F, Loef BG, and Nijsten MW
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- Aged, Anti-Inflammatory Agents therapeutic use, Dexamethasone therapeutic use, Dose-Response Relationship, Drug, Female, Humans, Hyperglycemia metabolism, Hyperglycemia prevention & control, Hypoglycemic Agents therapeutic use, Inflammation drug therapy, Insulin therapeutic use, Male, Middle Aged, Multivariate Analysis, Postoperative Period, Anti-Inflammatory Agents adverse effects, Blood Glucose metabolism, Coronary Artery Bypass, Dexamethasone adverse effects, Hyperglycemia chemically induced, Postoperative Complications
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Background: Intensive insulin therapy to maintain normoglycemia after cardiac surgery reduces morbidity and mortality. We investigated the magnitude and duration of hyperglycemia caused by dexamethasone administered after cardiopulmonary bypass., Methods: A single-center before-after cohort study was performed. All consecutive patients undergoing coronary artery bypass grafting with cardiopulmonary bypass during a 6-month period were included. Insulin administration was guided by a sliding scale protocol. Halfway the observation period, the dexamethasone protocol was changed. The single dose (1D) group received a pre-operative dose of dexamethasone of 1 mg/kg. The double dose group (2D) received an additional dose of 0.5 mg/kg of dexamethasone post-operatively at ICU admission., Results: We included 116 patients in the 1D group and 158 patients in the 2D group. There were no significant baseline differences between the groups. Median Euroscore was 5. In univariable analysis, the glucose level was different between groups 1D and 2D at 4, 6, 9, 12 and 24 hours after ICU admission (all p < 0.001). Insulin infusion was higher in the 1D group. Corrected for insulin dose in multivariable linear analysis, the difference in glucose between the 1D and 2D groups was 1.5 mmol/L (95% confidence interval 1.0-2.0, p < 0.001) 12 hours after ICU admission., Conclusion: Dexamethasone exerts a hyperglycemic effect in cardiac surgery patients. Patients receiving high-dose corticosteroid therapy should be monitored and treated more intensively for hyperglycemic episodes.
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- 2007
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13. Design and implementation of GRIP: a computerized glucose control system at a surgical intensive care unit.
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Vogelzang M, Zijlstra F, and Nijsten MW
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- Aged, Algorithms, Attitude of Health Personnel, Autoanalysis, Blood Glucose drug effects, Clinical Protocols, Critical Care methods, Drug Administration Schedule, Female, Humans, Hypoglycemia nursing, Insulin Infusion Systems, Male, Middle Aged, Netherlands, Nursing Staff, Hospital psychology, Postoperative Care standards, Programming Languages, Blood Glucose analysis, Decision Support Systems, Clinical, Hypoglycemia prevention & control, Insulin administration & dosage, Intensive Care Units, Point-of-Care Systems, Postoperative Care nursing
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Background: Tight glucose control by intensive insulin therapy has become a key part of critical care and is an important field of study in acute coronary care. A balance has to be found between frequency of measurements and the risk of hypoglycemia. Current nurse-driven protocols are paper-based and, therefore, rely on simple rules. For safety and efficiency a computer decision support system that employs complex logic may be superior to paper protocols., Methods: We designed and implemented GRIP, a stand-alone Java computer program. Our implementation of GRIP will be released as free software. Blood glucose values measured by a point-of-care analyzer were automatically retrieved from the central laboratory database. Additional clinical information was asked from the nurse and the program subsequently advised a new insulin pump rate and glucose sampling interval., Results: Implementation of the computer program was uneventful and successful. GRIP treated 179 patients for a total of 957 patient-days. Severe hypoglycemia (< 2.2 mmol/L) only occurred once due to human error. With a median (IQR) of 4.9 (4.2-6.2) glucose measurements per day the median percentage of time in which glucose fell in the target range was 78%. Nurses rated the program as easy to work with and as an improvement over the preceding paper protocol. They reported no increase in time spent on glucose control., Conclusion: A computer driven protocol is a safe and effective means of glucose control at a surgical ICU. Future improvements in the recommendation algorithm may further improve safety and efficiency.
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- 2005
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