43 results on '"Nijsten, Maarten W. N."'
Search Results
2. FDG-PET/CT in intensive care patients with bloodstream infection
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Pijl, Jordy P., Londema, Mark, Kwee, Thomas C., Nijsten, Maarten W. N., Slart, Riemer H. J. A., Dierckx, Rudi A. J. O., van der Voort, Peter H. J., Glaudemans, Andor W. J. M., and Pillay, Janesh
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- 2021
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3. Ensemble machine learning prediction and variable importance analysis of 5-year mortality after cardiac valve and CABG operations
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Castela Forte, José, Mungroop, Hubert E., de Geus, Fred, van der Grinten, Maureen L., Bouma, Hjalmar R., Pettilä, Ville, Scheeren, Thomas W. L., Nijsten, Maarten W. N., Mariani, Massimo A., van der Horst, Iwan C. C., Henning, Robert H., Wiering, Marco A., and Epema, Anne H.
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- 2021
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4. Continuous Renal Replacement Therapy During Long-term Normothermic Machine Perfusion of Human Donor Livers for up to 7 D.
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Lascaris, Bianca, Hoffmann, Roland F., Nijsten, Maarten W. N., Porte, Robert J., and de Meijer, Vincent E.
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- 2024
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5. 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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6. Comparison of Machine Learning Models Including Preoperative, Intraoperative, and Postoperative Data and Mortality After Cardiac Surgery
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Castela Forte, José, primary, Yeshmagambetova, Galiya, additional, van der Grinten, Maureen L., additional, Scheeren, Thomas W. L., additional, Nijsten, Maarten W. N., additional, Mariani, Massimo A., additional, Henning, Robert H., additional, and Epema, Anne H., additional
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- 2022
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7. Long-term normothermic machine preservation of human livers: what is needed to succeed?
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Lascaris, Bianca, primary, Thorne, Adam M., additional, Lisman, Ton, additional, Nijsten, Maarten W. N., additional, Porte, Robert J., additional, and de Meijer, Vincent E., additional
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- 2022
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8. IN-HOSPITAL GLYCEMIC CONTROL AFTER LIVER TRANSPLANTATION: CIRCADIAN HYPERGLYCEMIC DERANGEMENTS
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Zeillemaker-Hoekstra, Miriam, Veldscholte, Glenn, Cuperus, Frans J. C., Blokzijl, Hans, Porte, Robert J., Nijsten, Maarten W. N., Vincent E. de Meijer, Groningen Institute for Organ Transplantation (GIOT), Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Microbes in Health and Disease (MHD), and Center for Liver, Digestive and Metabolic Diseases (CLDM)
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- 2021
9. Transplantation of High-risk Donor Livers After Ex Situ Resuscitation and Assessment Using Combined Hypo- and Normothermic Machine Perfusion A Prospective Clinical Trial: A Prospective Clinical Trial
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van Leeuwen, Otto B, de Vries, Yvonne, Fujiyoshi, Masato, Nijsten, Maarten W N, Ubbink, Rinse, Pelgrim, Gert Jan, Werner, Maureen J M, Reyntjens, Koen M E M, van den Berg, Aad P, de Boer, Marieke T, de Kleine, Ruben H J, Lisman, Ton, de Meijer, Vincent E, Porte, Robert J, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Microbes in Health and Disease (MHD), Groningen Institute for Organ Transplantation (GIOT), and Center for Liver, Digestive and Metabolic Diseases (CLDM)
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declined livers ,hypothermic machine perfusion ,CHOLANGIOPATHY ,extended-criteria donor livers ,liver transplantation ,BILIARY COMPLICATIONS ,normothermic machine perfusion ,BILE ,DONATION ,PRESERVATION ,STATIC COLD-STORAGE - Abstract
Objective: The aim of this study was to evaluate sequential hypothermic and normothermic machine perfusion (NMP) as a tool to resuscitate and assess viability of initially declined donor livers to enable safe transplantation. Summary Background Data: Machine perfusion is increasingly used to resuscitate and test the function of donor livers. Although (dual) hypothermic oxygenated machine perfusion ([D]HOPE) resuscitates livers after cold storage, NMP enables assessment of hepatobiliary function. Methods: In a prospective clinical trial, nationwide declined livers were subjected to ex situ NMP (viability assessment phase), preceded by 1-hour DHOPE (resuscitation phase) and 1 hour of controlled oxygenated rewarming (COR), using a perfusion fluid containing an hemoglobin-based oxygen carrier. During the first 2.5 hours of NMP, hepatobiliary viability was assessed, using predefined criteria: perfusate lactate 10mL, and bile pH >7.45. Livers meeting all criteria were accepted for transplantation. Primary endpoint was 3-month graft survival. Results: Sixteen livers underwent DHOPE-COR-NMP. All livers were from donors after circulatory death, with median age of 63 (range 42-82) years and median Eurotransplant donor risk index of 2.82. During NMP, all livers cleared lactate and produced sufficient bile volume, but in 5 livers bile pH remained Conclusions: Sequential DHOPE-COR-NMP enabled resuscitation and safe selection of initially declined high-risk donor livers, thereby increasing the number of transplantable livers by 20%. Trial registration: www.trialregister.nl; NTR5972.
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- 2019
10. Oxygen Transport during Ex Situ Machine Perfusion of Donor Livers Using Red Blood Cells or Artificial Oxygen Carriers
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Bodewes, Silke B., primary, van Leeuwen, Otto B., additional, Thorne, Adam M., additional, Lascaris, Bianca, additional, Ubbink, Rinse, additional, Lisman, Ton, additional, Monbaliu, Diethard, additional, De Meijer, Vincent E., additional, Nijsten, Maarten W. N., additional, and Porte, Robert J., additional
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- 2020
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11. Lactate-Protected Hypoglycemia (LPH)
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Goodwin, Matthew L., primary, Gladden, L. Bruce, additional, and Nijsten, Maarten W. N., additional
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- 2020
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12. Metformin and lactic acidosis during shock: just the tip of the iceberg?
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Posma, Rene A., primary, Absalom, Anthony R., additional, Touw, Daan J., additional, van der Horst, Iwan C. C., additional, and Nijsten, Maarten W. N., additional
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- 2016
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13. Donor Hypernatremia is Not Related with the Duration of Postoperative Mechanical Ventilation, Primary Graft Dysfunction, or Long-Term Outcome Following Lung Transplantation.
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Lansink-Hartgring, Annemieke Oude, Hessels, Lara, de Vries, Adrianus J., van der Bij, Wim, Verschuuren, Erik A. M., Erasmus, Michiel E., and Nijsten, Maarten W. N.
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- 2018
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14. Pretransplant sequential hypo‐ and normothermic machine perfusion of suboptimal livers donated after circulatory death using a hemoglobin‐based oxygen carrier perfusion solution
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Vries, Yvonne, Matton, Alix P. M., Nijsten, Maarten W. N., Werner, Maureen J. M., Berg, Aad P., Boer, Marieke T., Buis, Carlijn I., Fujiyoshi, Masato, Kleine, Ruben H. J., Leeuwen, Otto B., Meyer, Peter, Heuvel, Marius C., Meijer, Vincent E., and Porte, Robert J.
- Abstract
Ex situ dual hypothermic oxygenated machine perfusion (DHOPE) and normothermic machine perfusion (NMP) of donor livers may have a complementary effect when applied sequentially. While DHOPEresuscitates the mitochondria and increases hepatic adenosine triphosphate (ATP) content, NMPenables hepatobiliary viability assessment prior to transplantation. In contrast to DHOPE,NMPrequires a perfusion solution with an oxygen carrier, for which red blood cells (RBC) have been used in most series. RBC, however, have limitations and cannot be used cold. We, therefore, established a protocol of sequential DHOPE, controlled oxygenated rewarming (COR), and NMPusing a new hemoglobin‐based oxygen carrier (HBOC)‐based perfusion fluid (DHOPE‐COR‐NMPtrial, NTR5972). Seven livers from donation after circulatory death (DCD) donors, which were initially declined for transplantation nationwide, underwent DHOPE‐COR‐NMP. Livers were considered transplantable if perfusate pHand lactate normalized, bile production was ≥10 mL and biliary pH> 7.45 within 150 minutes of NMP. Based on these criteria five livers were transplanted. The primary endpoint, 3‐month graft survival, was a 100%. In conclusion, sequential DHOPE‐COR‐NMPusing an HBOC‐based perfusion fluid offers a novel method of liver machine perfusion for combined resuscitation and viability testing of suboptimal livers prior to transplantation. This clinical cohort study indicates that a combination of hypo‐ and normothermic machine perfusion, using a preservation fluid containing an hemoglobin‐based oxygen carrier, is feasible and provides a tool to resuscitate and select initially declined high‐risk donor livers that can be transplanted successfully.
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- 2019
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15. Lactate and Cancer: Revisiting the Warburg Effect in an Era of Lactate Shuttling
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Goodwin, Matthew L., primary, Gladden, L. Bruce, additional, Nijsten, Maarten W. N., additional, and Jones, Kevin B., additional
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- 2015
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16. HLA-DR expression on monocytes and systemic inflammation in patients with ruptured abdominal aortic aneurysms
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Haveman, Jan Willem, van den Berg, Aad P., Verhoeven, Eric L. G., Nijsten, Maarten W. N., van den Dungen, Jan J. A. M., The, T. Hauw, and Zwaveling, Jan Harm
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SEPSIS ,SURGERY ,MORTALITY ,SEPTIC SHOCK ,ANTIINFLAMMATORY RESPONSE ,ENDOVASCULAR REPAIR ,CYTOKINE PRODUCTION ,RANDOMIZED CONTROLLED-TRIAL ,ORGAN FAILURE ,TRAUMA - Abstract
Introduction Mortality from ruptured abdominal aortic aneurysms (RAAA) remains high. Severe systemic inflammation, leading to multi-organ failure, often occurs in these patients. In this study we describe the level of HLA-DR expression in a consecutive group of patients following surgery for RAAA and compare results between survivors and non-survivors. A similar comparison is made for IL-6 and IL-10 levels and Sequential Organ Failure Assessment (SOFA) scores. Methods This is a prospective observational study. Patients with RAAA were prospectively analysed. Blood samples were collected on days 1, 3, 5, 7, 10 and 14. The fraction of CD-14 positive monocytes expressing HLA-DR was measured by flow-cytometry. IL-6 and IL-10 levels were measured by ELISA. Results The study included 30 patients with a median age of 70 years, of which 27 (90%) were men. Six patients died from multiple organ failure, all other patients survived. The SOFA scores were significantly higher in non-survivors on days 1 through 14. HLA-DR expression on monocytes was significantly lower on days 3, 5, 7, 10 and 14 in non-survivors. IL-6 and IL-10 levels were significantly higher in non-survivors on day 1 and days 1 and 3, respectively. Conclusion HLA-DR expression on monocytes was decreased, especially in non-survivors. All patients with RAAA displayed a severe inflammatory and anti-inflammatory response with an increased production of IL-6 and IL-10. Poor outcome is associated with high levels of IL-6 and IL-10 and a high SOFA score in the first three days after surgery, while low levels of HLA-DR expression are observed from day three after RAAA repair.
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- 2006
17. Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery: a prospective observational study
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Schierenbeck, Fanny, primary, Nijsten, Maarten W N, additional, Franco-Cereceda, Anders, additional, and Liska, Jan, additional
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- 2014
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18. Survival of Patients after ST-Elevation Myocardial Infarction: External Validation of a Predictive Biomarker Model
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Kampinga, Marthe A, primary, Damman, Peter, primary, van der Horst, Iwan C C, primary, Woudstra, Pier, primary, Kuijt, Wichert J, primary, Nijsten, Maarten W N, primary, Zijlstra, Felix, primary, Tijssen, Jan G P, primary, de Winter, Robbert J, primary, and de Smet, Bart J G L, primary
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- 2012
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19. 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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20. Prognostic Value of Admission Glycosylated Hemoglobin and Glucose in Nondiabetic Patients With ST-Segment-Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention.
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Timmer, Jorik R., Hoekstra, Miriam, Nijsten, Maarten W. N., van der Horst, Iwan C. C., Ottervanger, Jan Paul, Slingerland, Robbert J., Dambrink, Jan-Henk E., Bib, Henk J. G., Zijlstra, Felix, and van't Hof, Arnoud W. J.
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- 2011
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21. Is the Myocardial Blush Grade Scored by the Operator During Primary Percutaneous Coronary Intervention of Prognostic Value in Patients With ST-Elevation Myocardial Infarction in Routine Clinical Practice?
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Kampinga, Marthe A., Nijsten, Maarten W. N., Gu, Youlan L., Dijk, W. Arnold, De Smet, Bart J. G. L., van den Heuvel, Ad F. M., Eng-Shiong Tan, and Zijlstra, Felix
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CARDIAC patients ,PROGNOSIS ,THERAPEUTICS ,HEART diseases ,MYOCARDIAL infarction treatment ,HEART disease related mortality - Abstract
The article discusses a study which determined the prognostic value of myocardial blush grade (MBG) during primary percutaneous coronary intervention (PCI) in consecutive patients with ST-elevation myocardial infarction (STEMI). The study included patients with STEMI who underwent primary PCI between January 2004 and July 2008. Study authors concluded that MBG scored by the operator during primary PCI can be used as a prognostic factor for 1-year all cause mortality in patients with STEMI.
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- 2010
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22. 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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23. 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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24. Treatment of humeral shaft fractures related to associated injuries: A retrospective study of 237 patients
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Bleeker, Willem A., primary, Nijsten, Maarten W. N., additional, and Duis, Henk-Jan ten, additional
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- 1991
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25. 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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- 2007
26. 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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27. 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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28. Oxygen Transport during Ex Situ Machine Perfusion of Donor Livers Using Red Blood Cells or Artificial Oxygen Carriers.
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Bodewes, Silke B., van Leeuwen, Otto B., Thorne, Adam M., Lascaris, Bianca, Ubbink, Rinse, Lisman, Ton, Monbaliu, Diethard, De Meijer, Vincent E., Nijsten, Maarten W. N., and Porte, Robert J.
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OXYGEN carriers ,ERYTHROCYTES ,BLOOD substitutes ,ARTIFICIAL cells ,PERFUSION ,OXYGEN - Abstract
Oxygenated ex situ machine perfusion of donor livers is an alternative for static cold preservation that can be performed at temperatures from 0 °C to 37 °C. Organ metabolism depends on oxygen to produce adenosine triphosphate and temperatures below 37 °C reduce the metabolic rate and oxygen requirements. The transport and delivery of oxygen in machine perfusion are key determinants in preserving organ viability and cellular function. Oxygen delivery is more challenging than carbon dioxide removal, and oxygenation of the perfusion fluid is temperature dependent. The maximal oxygen content of water-based solutions is inversely related to the temperature, while cellular oxygen demand correlates positively with temperature. Machine perfusion above 20 °C will therefore require an oxygen carrier to enable sufficient oxygen delivery to the liver. Human red blood cells are the most physiological oxygen carriers. Alternative artificial oxygen transporters are hemoglobin-based oxygen carriers, perfluorocarbons, and an extracellular oxygen carrier derived from a marine invertebrate. We describe the principles of oxygen transport, delivery, and consumption in machine perfusion for donor livers using different oxygen carrier-based perfusion solutions and we discuss the properties, advantages, and disadvantages of these carriers and their use. [ABSTRACT FROM AUTHOR]
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- 2021
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29. Fuel for cancer cells?
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Gladden, L. Bruce, Goodwin, Matthew L., McDonald, James R., and Nijsten, Maarten W. N.
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- 2011
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30. Production of physiological amounts of hemostatic proteins by human donor livers during ex-situ long-term normothermic machine perfusion for up to seven days.
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Lascaris B, Bodewes SB, Adelmeijer J, Nijsten MWN, Porte RJ, de Meijer VE, and Lisman T
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Background: Normothermic machine perfusion (NMP) is used for preservation and assessment of human donor livers prior to transplantation. During NMP, the liver is metabolically active, which allows detailed studies on the physiology of human livers., Objectives: To study the production of hemostatic proteins in human donor livers during NMP for up to 7 days., Methods: In this observational study, nine livers underwent NMP for up to 7 days with a heparinised perfusate based on red blood cells and colloids using a modified Liver Assist device. Perfusate samples were collected before NMP and daily thereafter for measurement of antigen and activity levels of comprehensive panel of hemostatic proteins after heparin neutralization., Results: Within one day, perfusate samples displayed the potential for coagulation activation as evidenced by international normalized ratio and activated partial thromboplastin assays. This was accompanied by detection of substantial quantities of functionally active coagulation proteins and inhibitors, although the specific activity of many proteins was decreased, compared to that in normal plasma. Perfusate levels of hemostatic proteins increased in the first days, reaching a stable level after 3-4 days of perfusion., Conclusion: During long-term NMP of human livers, functionally active hemostatic proteins are released into the perfusate in substantial quantities, but some proteins appear to have decreased functional properties compared to proteins in normal human plasma. We propose that NMP may be used as a platform to test efficacy of drugs that stimulate or inhibit the production of coagulation factors, or to test liver-mediated clearance of prohemostatic protein therapeutics., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2024
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31. Sequential hypothermic and normothermic machine perfusion enables safe transplantation of high-risk donor livers.
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van Leeuwen OB, Bodewes SB, Lantinga VA, Haring MPD, Thorne AM, Brüggenwirth IMA, van den Berg AP, de Boer MT, de Jong IEM, de Kleine RHJ, Lascaris B, Nijsten MWN, Reyntjens KMEM, de Meijer VE, and Porte RJ
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- Hemoglobins, Humans, Liver, Living Donors, Organ Preservation methods, Oxygen, Perfusion methods, Prospective Studies, Liver Transplantation methods
- Abstract
Ex situ normothermic machine perfusion (NMP) is increasingly used for viability assessment of high-risk donor livers, whereas dual hypothermic oxygenated machine perfusion (DHOPE) reduces ischemia-reperfusion injury. We aimed to resuscitate and test the viability of initially-discarded, high-risk donor livers using sequential DHOPE and NMP with two different oxygen carriers: an artificial hemoglobin-based oxygen carrier (HBOC) or red blood cells (RBC). In a prospective observational cohort study of 54 livers that underwent DHOPE-NMP, the first 18 procedures were performed with a HBOC-based perfusion solution and the subsequent 36 procedures were performed with an RBC-based perfusion solution for the NMP phase. All but one livers were derived from extended criteria donation after circulatory death donors, with a median donor risk index of 2.84 (IQR 2.52-3.11). After functional assessment during NMP, 34 livers (63% utilization), met the viability criteria and were transplanted. One-year graft and patient survival were 94% and 100%, respectively. Post-transplant cholangiopathy occurred in 1 patient (3%). There were no significant differences in utilization rate and post-transplant outcomes between the HBOC and RBC group. Ex situ machine perfusion using sequential DHOPE-NMP for resuscitation and viability assessment of high-risk donor livers results in excellent transplant outcomes, irrespective of the oxygen carrier used., (© 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.)
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- 2022
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32. Long-term normothermic machine preservation of human livers: what is needed to succeed?
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Lascaris B, Thorne AM, Lisman T, Nijsten MWN, Porte RJ, and de Meijer VE
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- Homeostasis physiology, Humans, Organ Preservation Solutions, Perfusion, Liver metabolism, Liver Transplantation methods, Organ Preservation methods, Time Factors
- Abstract
Although short-term machine perfusion (≤24 h) allows for resuscitation and viability assessment of high-risk donor livers, the donor organ shortage might be further remedied by long-term perfusion machines. Extended preservation of injured donor livers may allow reconditioning, repairing, and regeneration. This review summarizes the necessary requirements and challenges for long-term liver machine preservation, which requires integrating multiple core physiological functions to mimic the physiological environment inside the body. A pump simulates the heart in the perfusion system, including automatically controlled adjustment of flow and pressure settings. Oxygenation and ventilation are required to account for the absence of the lungs combined with continuous blood gas analysis. To avoid pressure necrosis and achieve heterogenic tissue perfusion during preservation, diaphragm movement should be simulated. An artificial kidney is required to remove waste products and control the perfusion solution's composition. The perfusate requires an oxygen carrier, but will also be challenged by coagulation and activation of the immune system. The role of the pancreas can be mimicked through closed-loop control of glucose concentrations by automatic injection of insulin or glucagon. Nutrients and bile salts, generally transported from the intestine to the liver, have to be supplemented when preserving livers long term. Especially for long-term perfusion, the container should allow maintenance of sterility. In summary, the main challenge to develop a long-term perfusion machine is to maintain the liver's homeostasis in a sterile, carefully controlled environment. Long-term machine preservation of human livers may allow organ regeneration and repair, thereby ultimately solving the shortage of donor livers.
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- 2022
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33. Pretransplant sequential hypo- and normothermic machine perfusion of suboptimal livers donated after circulatory death using a hemoglobin-based oxygen carrier perfusion solution.
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de Vries Y, Matton APM, Nijsten MWN, Werner MJM, van den Berg AP, de Boer MT, Buis CI, Fujiyoshi M, de Kleine RHJ, van Leeuwen OB, Meyer P, van den Heuvel MC, de Meijer VE, and Porte RJ
- Subjects
- Adult, Cold Ischemia, Humans, Middle Aged, Solutions, Warm Ischemia, Hemoglobins metabolism, Liver Transplantation methods, Oxygen metabolism, Perfusion, Shock
- Abstract
Ex situ dual hypothermic oxygenated machine perfusion (DHOPE) and normothermic machine perfusion (NMP) of donor livers may have a complementary effect when applied sequentially. While DHOPE resuscitates the mitochondria and increases hepatic adenosine triphosphate (ATP) content, NMP enables hepatobiliary viability assessment prior to transplantation. In contrast to DHOPE, NMP requires a perfusion solution with an oxygen carrier, for which red blood cells (RBC) have been used in most series. RBC, however, have limitations and cannot be used cold. We, therefore, established a protocol of sequential DHOPE, controlled oxygenated rewarming (COR), and NMP using a new hemoglobin-based oxygen carrier (HBOC)-based perfusion fluid (DHOPE-COR-NMP trial, NTR5972). Seven livers from donation after circulatory death (DCD) donors, which were initially declined for transplantation nationwide, underwent DHOPE-COR-NMP. Livers were considered transplantable if perfusate pH and lactate normalized, bile production was ≥10 mL and biliary pH > 7.45 within 150 minutes of NMP. Based on these criteria five livers were transplanted. The primary endpoint, 3-month graft survival, was a 100%. In conclusion, sequential DHOPE-COR-NMP using an HBOC-based perfusion fluid offers a novel method of liver machine perfusion for combined resuscitation and viability testing of suboptimal livers prior to transplantation., (© 2018 The Authors American Journal of Transplantation published by Wiley Periodicals, Inc. on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Published
- 2019
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34. Donor Hypernatremia is Not Related with the Duration of Postoperative Mechanical Ventilation, Primary Graft Dysfunction, or Long-Term Outcome Following Lung Transplantation.
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Oude Lansink-Hartgring A, Hessels L, de Vries AJ, van der Bij W, Verschuuren EAM, Erasmus ME, and Nijsten MWN
- Subjects
- Adult, Female, Graft Survival, Humans, Male, Middle Aged, Postoperative Period, Primary Graft Dysfunction mortality, Prognosis, Retrospective Studies, Treatment Outcome, Donor Selection, Hypernatremia complications, Lung Transplantation mortality, Primary Graft Dysfunction etiology
- Abstract
BACKGROUND Donor hypernatremia has been associated with reduced graft and recipient survival after heart, liver, kidney, and pancreas transplantation. However, it is unknown what effect donor hypernatremia has on graft and recipient outcomes after lung transplantation. The aim of this study was to investigate the relation of donor hypernatremia with the duration of postoperative mechanical ventilation, the incidence of severe primary graft dysfunction, and survival following lung transplantation. MATERIAL AND METHODS We analyzed all consecutive lung transplantations performed in adult patients at our center between 1995 and 2016. During the study period, donor hypernatremia was not considered a reason to reject lungs for transplantation. Donors were classified into 3 groups: normonatremia (sodium <145 mmol/L), moderate hypernatremia (sodium 145-154 mmol/L), or severe hypernatremia (sodium ≥155 mmol/L). Short-term outcome was defined by the duration of mechanical ventilation and incidence of primary graft dysfunction; long-term outcome was defined by 10-year mortality. RESULTS Donor hypernatremia was recorded in 275 (58%) of the 474 donors. There were no differences in baseline characteristics between the 3 study groups. The duration of mechanical ventilation was similar for all groups (8±25, 7±17, and 9±15 days respectively, P=0.204). Severe primary graft dysfunction was not different between the 3 groups (29%, 26%, 28%, P=0.724). Donor hypernatremia was not associated with (graft) survival, or after correction for potential confounders. CONCLUSIONS Donor hypernatremia was not associated with a worse outcome in lung transplant recipients. Thus, in contrast to solid organ transplantation, donor hypernatremia is not a contraindication for lung transplantation.
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- 2018
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35. Acute Kidney Injury Classification Underestimates Long-Term Mortality After Cardiac Valve Operations.
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Bouma HR, Mungroop HE, de Geus AF, Huisman DD, Nijsten MWN, Mariani MA, Scheeren TWL, Burgerhof JGM, Henning RH, and Epema AH
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- Acute Kidney Injury classification, Aged, Cardiopulmonary Bypass methods, Cohort Studies, Coronary Artery Bypass methods, Female, Heart Valve Prosthesis Implantation methods, Humans, Kidney Function Tests, Male, Middle Aged, Predictive Value of Tests, Proportional Hazards Models, Prospective Studies, Registries, Risk Assessment, Survival Analysis, Survivors, Time Factors, Acute Kidney Injury etiology, Acute Kidney Injury mortality, Cardiopulmonary Bypass adverse effects, Cause of Death, Coronary Artery Bypass adverse effects, Heart Valve Prosthesis Implantation adverse effects
- Abstract
Background: Perioperative acute kidney injury (AKI) is an important predictor of long-term all-cause mortality after coronary artery bypass (CABG). However, the effect of AKI on long-term mortality after cardiac valve operations is hitherto undocumented., Methods: Perioperative renal injury and long-term all-cause mortality after valve operations were studied in a prospective cohort of patients undergoing solitary valve operations (n = 2,806) or valve operations combined with CABG (n = 1,260) with up to 18 years of follow-up. Postoperative serum creatinine increase was classified according to AKI staging 0 to 3. Patients undergoing solitary CABG (n = 4,938) with cardiopulmonary bypass served as reference., Results: In both valve and valve+CABG operations, postoperative renal injury of AKI stage 1 or higher was progressively associated with an increase in long-term mortality (hazard ratio [HR], 2.27, p < 0.05 for valve; HR, 1.65, p < 0.05 for valve+CABG; HR, 1.56, p < 0.05 for CABG). Notably, the mortality risk increased already substantially at serum creatinine increases of 10% to 25%-that is, far below the threshold for AKI stage 1 after valve operations (HR, 1.39, p < 0.05), but not after valve operations combined with CABG or CABG only., Conclusions: An increase in serum creatinine by more than 10% during the first week after valve operation is associated with an increased risk for long-term mortality after cardiac valve operation. Thus, AKI classification clearly underestimates long-term mortality risk in patients undergoing valve operations., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2018
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36. Computer-assisted myocardial blush quantification after percutaneous coronary angioplasty for acute myocardial infarction: a substudy from the TAPAS trial.
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Vogelzang M, Vlaar PJ, Svilaas T, Amo D, Nijsten MW, and Zijlstra F
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- Aged, Coronary Angiography, Coronary Circulation, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Myocardial Infarction diagnostic imaging, Myocardial Infarction physiopathology, Observer Variation, Prognosis, Software Design, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Myocardial Infarction therapy, Radiographic Image Interpretation, Computer-Assisted methods
- Abstract
Aims: Myocardial reperfusion after acute myocardial infarction can be angiographically assessed by the myocardial blush grade (MBG) or TIMI Perfusion Grade. These scores are based on subjective human judgement and lead to a score of four categories. A more operator-independent way of scoring myocardial perfusion may facilitate research in this area., Methods and Results: We designed the 'Quantitative Blush Evaluator' (QuBE), a computer program which calculates a score for myocardial perfusion. This program will be freely available as open source software. The inter-observer concordance was 97.7%. We calculated values on prospectively collected angiograms in patients with acute ST-elevation myocardial infarction from the TAPAS trial. Quantitative blush evaluator values could be assessed on 790 out of 980 collected angiograms (81%). The QuBE score correlated significantly with MBG as determined by a core lab. The QuBE score predicted complete ST-elevation resolution, low enzyme levels, and 1 year survival (all P < 0.001). Quantitative blush evaluator value was an independent predictor of mortality at 1 year [OR 0.40 (0.17-0.90), P = 0.02]., Conclusion: The QuBE program provides a practical, freely available computer-assisted assessment of myocardial perfusion. The QuBE score provides a useful surrogate endpoint in trials of therapies aimed at improving myocardial reperfusion.
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- 2009
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37. Health technology assessment review: Computerized glucose regulation in the intensive care unit--how to create artificial control.
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Hoekstra M, Vogelzang M, Verbitskiy E, and Nijsten MW
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- Blood Glucose drug effects, Glycemic Index, Humans, Hyperglycemia prevention & control, Hypoglycemia prevention & control, Quality of Health Care, Blood Glucose metabolism, Decision Support Systems, Clinical, Intensive Care Units, Therapy, Computer-Assisted organization & administration
- Abstract
Current care guidelines recommend glucose control (GC) in critically ill patients. To achieve GC, many ICUs have implemented a (nurse-based) protocol on paper. However, such protocols are often complex, time-consuming, and can cause iatrogenic hypoglycemia. Computerized glucose regulation protocols may improve patient safety, efficiency, and nurse compliance. Such computerized clinical decision support systems (Cuss) use more complex logic to provide an insulin infusion rate based on previous blood glucose levels and other parameters. A computerized CDSS for glucose control has the potential to reduce overall workload, reduce the chance of human cognitive failure, and improve glucose control. Several computer-assisted glucose regulation programs have been published recently. In order of increasing complexity, the three main types of algorithms used are computerized flowcharts, Proportional-Integral-Derivative (PID), and Model Predictive Control (MPC). PID is essentially a closed-loop feedback system, whereas MPC models the behavior of glucose and insulin in ICU patients. Although the best approach has not yet been determined, it should be noted that PID controllers are generally thought to be more robust than MPC systems. The computerized Cuss that are most likely to emerge are those that are fully a part of the routine workflow, use patient-specific characteristics and apply variable sampling intervals.
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- 2009
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38. 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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39. 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
- Abstract
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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40. Persistent hyperglycemia is an independent predictor of outcome in acute myocardial infarction.
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van der Horst IC, Nijsten MW, Vogelzang M, and Zijlstra F
- Subjects
- Aged, Blood Glucose analysis, Blood Glucose metabolism, Death, Sudden, Cardiac etiology, Disease Progression, Female, Humans, Male, Middle Aged, Myocardial Infarction complications, Predictive Value of Tests, Prospective Studies, Risk Factors, Treatment Outcome, Hyperglycemia blood, Myocardial Infarction blood, Myocardial Infarction therapy
- 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.
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- 2007
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41. A wise nurse can manage a paper protocol but prefers intelligent technology.
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Vogelzang M, Zijlstra F, and Nijsten MW
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- Disease Management, Glycemic Index physiology, Humans, Therapy, Computer-Assisted standards, Nurses standards, Therapy, Computer-Assisted methods
- Published
- 2007
- Full Text
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42. 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
- Abstract
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.
- Published
- 2005
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43. Hyperglycaemic index as a tool to assess glucose control: a retrospective study.
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Vogelzang M, van der Horst IC, and Nijsten MW
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- APACHE, Adolescent, Adult, Aged, Aged, 80 and over, Biomarkers blood, Female, Hospitals, Teaching, Humans, Hyperglycemia blood, Hyperglycemia physiopathology, Intensive Care Units, Male, Middle Aged, Netherlands, Patient Admission, Prognosis, Reference Values, Retrospective Studies, Survival Analysis, Blood Glucose analysis, Critical Care standards, Critical Illness mortality, Hyperglycemia diagnosis, Outcome Assessment, Health Care
- Abstract
Introduction: Critically ill patients may benefit from strict glucose control. An objective measure of hyperglycaemia for assessing glucose control in acutely ill patients should reflect the magnitude and duration of hyperglycaemia, should be independent of the number of measurements, and should not be falsely lowered by hypoglycaemic values. The time average of glucose values above the normal range meets these requirements., Methods: A retrospective, single-centre study was performed at a 12-bed surgical intensive care unit. From 1990 through 2001 all patients over 15 years, staying at least 4 days, were included. Admission type, sex, age, Acute Physiology and Chronic Health Evaluation II score and outcome were recorded. The hyperglycaemic index (HGI) was defined as the area under the curve above the upper limit of normal (glucose level 6.0 mmol/l) divided by the total length of stay. HGI, admission glucose, mean morning glucose, mean glucose and maximal glucose were calculated for each patient. The relations between these measures and 30-day mortality were determined., Results: In 1779 patients with a median stay in the intensive care unit of 10 days, the 30-day mortality was 17%. A total of 65,528 glucose values were analyzed. Median HGI was 0.9 mmol/l (interquartile range 0.3-2.1 mmol/l) in survivors versus 1.8 mmol/l (interquartile range 0.7-3.4 mmol/l) in nonsurvivors (P < 0.001). The area under the receiver operator characteristic curve was 0.64 for HGI, as compared with 0.61 and 0.62 for mean morning glucose and mean glucose. HGI was the only significant glucose measure in binary logistic regression., Conclusion: HGI exhibited a better relation with outcome than other glucose indices. HGI is a useful measure of glucose control in critically ill patients.
- Published
- 2004
- Full Text
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