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1. Prevalence of malnutrition risk and its association with mortality: nutritionDay Latin America survey results

Author: Suela Sulo, M. Isabel T.D. Correia, Silvia Tarantino, Dolores Rodriguez, Cory Brunton, Michael Hiesmayr, G. Gomez, and I. Sulz
Subjects: Adult, Male, medicine.medical_specialty, Nutrition Education, Population, Nutritional Status, Critical Care and Intensive Care Medicine, Risk Assessment, Eating, Young Adult, Weight loss, Environmental health, Acute care, Outcome Assessment, Health Care, Weight Loss, Prevalence, Humans, Medicine, Hospital Mortality, education, Meals, Aged, Proportional Hazards Models, Inpatients, education.field_of_study, Nutrition and Dietetics, business.industry, Malnutrition, Hazard ratio, Middle Aged, Nutrition Surveys, medicine.disease, Hospitals, Diet, Cross-Sectional Studies, Latin America, Population study, Female, medicine.symptom, business, nutritionDay
Abstract: BACKGROUND & AIMS Across the globe, the prevalence of hospital malnutrition varies greatly depending on the population served and on local socioeconomic conditions. While malnutrition is widely recognized to worsen patient outcomes and add financial burdens to healthcare systems, recent data on hospital malnutrition in Latin America are limited. Our study objectives were: (1) to quantify the prevalence of malnutrition risk in Latin American hospital wards, and (2) to explore associations between nutritional risk status, in-hospital food intake, and health outcomes. METHODS On nutritionDay (nDay), a specific day every year, hospital wards worldwide can participate in a one-day, cross-sectional audit. We analyzed nDay data collected in ten Latin American countries from 2009 to 2015, including demographic and nutrition-related findings for adult patients (≥18 years) from 582 hospital wards/units. Based on patient-reported responses to questions related to the Malnutrition Screening Tool, we determined the prevalence of malnutrition risk (MST score ≥2). We also summarized patient-reported food intake on nDay, and we analyzed staff-collected outcome data at 30 days post-nDay. RESULTS The prevalence of malnutrition risk in the Latin American nDay study population (N = 14,515) was 39.6%. More than 50% of studied patients ate one-half or less of their hospital meal, ate less than normal in the week before nDay, or experienced weight loss in the prior three months. The hospital-mortality hazard ratio was 3.63 (95% CI [2.71, 4.88]; P
Published: 2021
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2. Are traditional screening tools adequate for monitoring the nutrition risk of in‐hospital patients? An analysis of the nutritionDay database

Author: Gustavo Díaz, Olga Lucía Pinzón-Espitia, Romain Fantin, Michael Hiesmayr, Gabriel Gomez, Angélica Pérez, Silvia Tarantino, Charles Bermúdez, Maria Cristina Gonzalez, Diana Cardenas, Claudia Patricia Contreras, Lilia Yadira Cortés, Jose M. Gutierrez, I. Sulz, Cardenas, Diana [https://orcid.org/0000-0002-0709-0307], Cortés, L. Y. [https://orcid.org/0000-0003-2789-3219], Gonzalez, Maria Cristina [https://orcid.org/0000-0002-3901-8182], Fantin, Romain [https://orcid.org/0000-0003-2906-3438], and Sulz, Isabella [https://orcid.org/0000-0003-1807-6292]
Subjects: Adult, Longitudinal study, 030309 nutrition & dietetics, Nutritional Status, Medicine (miscellaneous), Eating, 03 medical and health sciences, 0302 clinical medicine, Food intake, Environmental health, Risk of mortality, Humans, Medicine, Nutrition risk, Malnutrition mortality, 0303 health sciences, Meal, Nutrition and Dietetics, Descriptive statistics, business.industry, Proportional hazards model, Mortality rate, Malnutrition, Hazard ratio, Nutrition screening, Hospitals, Cross-Sectional Studies, 030211 gastroenterology & hepatology, business, nutritionDay
Abstract: Background Monitoring of adequate food intake is not a priority in hospital patients' care. The present study aimed to examine selective data from the nutritionDay survey to determine the impact of food intake during hospitalization on outcomes according to the nutrition risk status. Methods We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross-sectional nutritionDay samples from 2009 to 2015. The impact of food intake on outcomes was assessed by univariate and multivariate Cox models controlling for PANDORA scores. Results A total of 7994 adult patients from Colombia, 7243 patients from 9 Latin American countries, and 155,524 patients worldwid were included. Less than half of the patients worldwide consumed their entire meal on nutritionDay (41%). The number of reduced eaters is larger in the "no nutrition risk group" than in the "nutrition risk group" (30% vs 25%). Reduced eating is associated with higher mortality and delayed discharge in patients, regardless of the nutrition risk status. Patients without nutrition risk at the screening who ate "nothing, but were allowed to eat" had 6 times more risk of mortality (hazard ratio, 6.48; 95% CI, 3.5311.87). Conclusions This is the first large-scale study evaluating the relationship of food intake on clinical outcomes showing an increase of in-hospital mortality rates and a reduction in the probability of being discharged home regardless of the nutrition risk status. Traditional screening tools may not identify a group of patients who will become at risk because of reduced intake while in the hospital.
Published: 2021
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3. The centenary of the Harris–Benedict equations: How to assess energy requirements best? Recommendations from the ESPEN expert group

Author: Eric Fontaine, Marian A. E. de van der Schueren, Alessandro Laviano, Claude Pichard, Pierre Singer, Michael Hiesmayr, Dileep N. Lobo, Moïse Coëffier, Itai Bendavid, Tommy Cederholm, Rocco Barazzoni, Tel Aviv University [Tel Aviv], Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy., Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden, Theme Ageing, Karolinska University Hospital, Stockholm, Sweden., Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de nutrition [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Centre d'Investigation Clinique [CHU Rouen] (CIC Rouen), Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Nutrition and Dietetics, HAN University of Applied Sciences, School of Allied Health, Nijmegen, the Netherlands., Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Division of Cardiac, Thoracic, Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria., Department of Translational and Precision Medicine, Sapienza University, Rome, Italy., Clinical Nutrition, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland., Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv, Bendavid, I., Lobo, D. N., Barazzoni, R., Cederholm, T., Coeffier, M., de van der Schueren, M., Fontaine, E., Hiesmayr, M., Laviano, A., Pichard, C., Singer, P., douville, sabine, Tel Aviv University (TAU), Università degli studi di Trieste = University of Trieste, Uppsala University, Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Charles Nicolle [Rouen], and Normandie Université (NU)-Normandie Université (NU)-CHU Rouen
Subjects: Male, 0301 basic medicine, Critical Illness, Energy (esotericism), Energy requirement, 030209 endocrinology & metabolism, Indirect calorimetry, Energy expenditure, Energy requirements, Nutritional prescriptions, Predictive equations, Critical Care and Intensive Care Medicine, Nutrition Policy, 03 medical and health sciences, Oxygen Consumption, 0302 clinical medicine, Neoplasms, Humans, Medicine, Obesity, Medical prescription, Aged, ddc:616, Estimation, Nutritional prescription, 030109 nutrition & dietetics, Nutrition and Dietetics, Actuarial science, business.industry, Harris–Benedict equation, Body Weight, Nutritional Requirements, Calorimetry, Indirect, Expert group, 3. Good health, Variety (cybernetics), [SDV.AEN] Life Sciences [q-bio]/Food and Nutrition, Surgical Procedures, Operative, Body Constitution, Female, Basal Metabolism, Energy Intake, Energy Metabolism, business, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract: Background & aims: The year 2019 marked the centenary of the publication of the Harris and Benedict equations for estimation of energy expenditure. In October 2019 a Scientific Symposium was organized by the European Society for Clinical Nutrition and Metabolism (ESPEN) in Vienna, Austria, to celebrate this historical landmark, looking at what is currently known about the estimation and measurement of energy expenditure. Methods: Current evidence was discussed during the symposium, including the scientific basis and clinical knowledge, and is summarized here to assist with the estimation and measurement of energy requirements that later translate into energy prescription. Results: In most clinical settings, the majority of predictive equations have low to moderate performance, with the best generally reaching an accuracy of no more than 70%, and often lead to large errors in estimating the true needs of patients. Generally speaking, the addition of body composition measurements did not add to the accuracy of predictive equations. Indirect calorimetry is the most reliable method to measure energy expenditure and guide energy prescription, but carries inherent limitations, greatly restricting its use in real life clinical practice. Conclusions: While the limitations of predictive equations are clear, their use is still the mainstay in clinical practice. It is imperative to recognize specific patient populations for whom a specific equation should be preferred. When available, the use of indirect calorimetry is advised in a variety of clinical settings, aiming to avoid under-as well as overfeeding. (C)2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Published: 2021
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4. Predictors of incident malnutrition—a nutritionDay analysis in 11,923 nursing home residents

Author: Michael Hiesmayr, Karin Schindler, Eva Kiesswetter, Dorothee Volkert, Cornel C. Sieber, I. Sulz, Franz Großhauser, Gabriel Torbahn, Jasmin Weber, Marjolein Visser, Nutrition and Health, APH - Aging & Later Life, APH - Societal Participation & Health, and APH - Health Behaviors & Chronic Diseases
Subjects: 0303 health sciences, medicine.medical_specialty, Meal, Nutrition and Dietetics, 030309 nutrition & dietetics, Meal eaten, business.industry, Medicine (miscellaneous), Nutritional status, Odds ratio, medicine.disease, Gee, 03 medical and health sciences, Malnutrition, 0302 clinical medicine, Internal medicine, medicine, 030212 general & internal medicine, ddc:610, nutritionDay, Nursing homes, business, SDG 2 - Zero Hunger
Abstract: Background/Objectives Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents. Subjects/Methods NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m2) p Results Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56–4.98]), a quarter (2.15 [1.56–2.97]) or half of the meal eaten (1.72 [1.40–2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0–23.0) (1.86 [1.44–2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65–74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00–1.62]) (vs. mobile) predicted incident MN in the final model. Conclusion 10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.
Published: 2022
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5. Ultrasound method of the USVALID study to measure subcutaneous adipose tissue and muscle thickness on the thigh and upper arm: An illustrated step-by-step guide

Author: Isabel Timmermann, Konstantin Liebau, Anatol Hertwig, Martin Anwar, Maximilian Pesta, A. Fischer, Michael Hiesmayr, Timo Siebenrock, and Ricarda Hahn
Subjects: 0301 basic medicine, Endocrinology, Diabetes and Metabolism, Muscle structures, lcsh:TX341-641, Thigh, Muscle mass, 03 medical and health sciences, 0302 clinical medicine, adipose tissue thickness, Ultrasound method, Medicine, muscle thickness, Reproducibility, body composition, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, ultrasound, Ultrasound, fat mass, Compression (physics), medicine.anatomical_structure, muscle mass, 030211 gastroenterology & hepatology, Subcutaneous adipose tissue, business, lcsh:Nutrition. Foods and food supply, Biomedical engineering
Abstract: Summary Objective So far there is no standardised widely accepted ultrasound method for assessment of both subcutaneous adipose tissue and muscle mass in healthy subjects, patients and ICU patients. The goal is to provide an illustrated step-by-step guide of the ultrasound method developed since 2011, refined and applied during the USVALID study. Methods We use 2 linear probes with a footprint width of 25,6 and 38,4 mm. The subject is lying relaxed with the head of bed elevated to 30°. Foam supports are placed under elbows and knees. Precise anatomical landmarks are palpated to measure the limb lengths. 3 measuring points at 50% of the thigh length and 2 measuring points at 70% of the upper arm length are marked on both sides. A gelpad is used to enable minimal compression. It is verified that the borders of the scan are blurred. Each measuring point is scanned in the short-axis and long-axis plane to more easily determine the subcutaneous adipose tissue and muscle structures especially in the presence of edema. First the quality of the scan is evaluated according to the visibility of the muscle fascia and bone surface. Then subcutaneous adipose tissue and entire muscle thickness are measured at the exact center of the scan drawing the shortest possible line from skin to bone surface. Discussion The illustrated description of the USVALID ultrasound method enables reproducibility by other researchers for external validity. The subject's position, the location of the measuring points, the performance and evaluation of the ultrasound scans are discussed and compared to other published ultrasound methodologies.
Published: 2020

6. A negative impact of recent weight loss on in-hospital mortality is not modified by overweight and obesity

Author: Michael Hiesmayr, Gianluca Gortan Cappellari, Rocco Barazzoni, Karin Schindler, I. Sulz, Stephan C. Bischoff, Barazzoni, Rocco, Sulz, Isabella, Schindler, Karin, Bischoff, Stephan C, Gortan Cappellari, Gianluca, and Hiesmayr, Michael
Subjects: Male, 0301 basic medicine, Weight loss, medicine.medical_specialty, Databases, Factual, 030209 endocrinology & metabolism, Hospitalization, Mortality, Obesity, Overweight, Critical Care and Intensive Care Medicine, Severity of Illness Index, Body Mass Index, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, Hospital Mortality, Risk factor, Aged, Proportional Hazards Models, 030109 nutrition & dietetics, Nutrition and Dietetics, Proportional hazards model, business.industry, Hazard ratio, Middle Aged, Prognosis, medicine.disease, Female, medicine.symptom, nutritionDay, business, Body mass index
Abstract: BACKGROUND: Obesity [Body Mass Index (BMI) > 30 kg/m2] is a risk factor for disease conditions enhancing hospitalization and mortality risks, but higher BMI was paradoxically reported to reduce mortality in several acute and chronic diseases. Unintentional weight loss (WL) is conversely associated with disease development and may worsen patient outcome, but the impact of weight loss and its interaction with obesity in modulating risk of death in hospitalized patients remain undefined. METHODS: We investigated the ESPEN nutritionDay database of non-critically ill hospitalized patients to assess the impact of self-reported 3-month WL (WL1:2.5-6.6%; WL2: 6.6-12.6%, WL3: >12.6%) and its interaction with BMI in modulating 30-day in-hospital mortality. Multivariate Cox regression was used to estimate hazard ratios (HR), with stable weight (WL0) as reference category. RESULTS: In 110835 nDay patients, 30-day mortality increased with increasing WL. Male gender, increasing disease severity index PANDORA score (age, nutrient intake, mobility, fluid status, cancer and main patient group) and not having had surgery also predicted 30-day mortality. HR for 30-day mortality remained significantly higher compared to WL0 for WL2 and WL3 after multiple adjustment. Adjusted HR and its increments through increasing weight loss categories were comparable in lean (BMI30 kg/m2). Impact of gender, PANDORA score and surgery on 30-day mortality were conversely comparable in the three BMI groups. CONCLUSIONS: These results indicate that self-reported WL could represent a relevant prognostic factor in every hospitalized patient. Overweight and obesity per se have no protective impact against WL-associated mortality.
Published: 2020
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7. Very early changes in serum creatinine are associated with 30-day mortality after cardiac surgery

Author: Martin H Bernardi, Andrea Lassnigg, Wilfred Druml, Michael Hiesmayr, Thomas Neugebauer, and Robin Ristl
Subjects: Creatinine, medicine.medical_specialty, business.industry, Hazard ratio, Acute kidney injury, 030208 emergency & critical care medicine, medicine.disease, Intensive care unit, Confidence interval, law.invention, Cardiac surgery, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Anesthesiology and Pain Medicine, chemistry, 030202 anesthesiology, law, Internal medicine, Medicine, business, Balance (ability), Cohort study
Abstract: BACKGROUND Acute kidney injury predicts adverse outcomes after cardiac surgery. OBJECTIVES To determine whether ultra-short-term changes (within 120 min) in serum creatinine (SCrea) levels after cardiac surgery predict clinical outcomes (30-day mortality). DESIGN Observational cohort study. SETTING Austrian tertiary referral centre. PATIENTS A total of 7651 patients scheduled to undergo elective cardiac surgery. MAIN OUTCOME MEASURES We analysed SCrea levels measured pre-operatively (baseline) and within 120 min after surgery. We also adjusted the postoperative SCrea levels for fluid balance. Patients were grouped according to the difference between the pre and postoperative SCrea levels (ΔSCreaAdmICU). We performed univariable and multivariable analyses to determine the association between changes in SCrea levels and 30-day mortality. RESULTS After cardiac surgery, the SCrea level decreased in 5923 patients and increased in 1728 patients. Increased SCrea levels were associated with a 21% increase in 30-day mortality. Even minimal increases in SCrea (0 to
Published: 2020
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8. Corrigendum to 'Patients With Severe Aortic Valve Stenosis and Impaired Platelet Function Benefit From Preoperative Desmopressin Infusion' [Ann Thorac Surg 91 (2011) 1420-1426]

Author: Eva Base, Barbara Steinlechner, Beatrice Birkenberg, Martin Dworschak, Hendrik Jan Ankersmit, Petra Zeidler, Michael Spannagl, Bernd Jilma, Peter Quehenberger, and Michael Hiesmayr
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Von Willebrand factor, Aortic valve replacement, law, Internal medicine, medicine, Cardiopulmonary bypass, Platelet, Desmopressin, Saline, biology, business.industry, PFA-100, medicine.disease, 030228 respiratory system, Aortic valve stenosis, biology.protein, Cardiology, Surgery, Cardiology and Cardiovascular Medicine, business, hormones, hormone substitutes, and hormone antagonists, medicine.drug
Abstract: Background Patients with severe aortic valve stenosis have a markedly reduced platelet function as measured by a prolonged collagen adenosine diphosphate closure time (CADP-CT) determined by the platelet function analyzer PFA-100. We hypothesized that such patients may benefit from desmopressin when they present with prolonged CADP-CT due to the specific action of desmopressin on von Willebrand factor (VWF) and CADP-CT. Methods In this double-blind, randomized placebo controlled trial, 43 patients undergoing aortic valve replacement (due to severe aortic valve stenosis with CADP-CT > 170 seconds) were given desmopressin 0.3 μg/kg or saline intravenously after induction of anesthesia. Measurement of CADP-CT, factor VIII activity, von Willebrand factor antigen, GpIb binding activity, ristocetin cofactor activity, collagen-binding activity, and multimers were performed after induction of anesthesia, one hour after desmopressin infusion, and 24 hours postoperatively. Results In the majority of patients, baseline values of von Willebrand factor related indices were normal, but increased one hour after infusion of desmopressin by 73% to 90% as compared with placebo. Selective loss of high molecular weight multimers was seen only in a minority of patients. The CADP-CT was greater than 170 seconds in 92% of screened patients, and desmopressin shortened CADP-CT by 48% versus baseline and reduced postoperative blood loss by 42% (p Conclusions Prolonged CADP-CT indicates platelet dysfunction in severe aortic valve stenosis, and can guide the use of desmopressin as an effective prohemostatic agent in patients with severe aortic valve stenosis.
Published: 2020
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9. Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

Author: Nijbroek, Sunny G, Hol, Liselotte, Swart, Pien, Hemmes, Sabrine N T, Serpa Neto, Ary, Binnekade, Jan M, Hedenstierna, Goran, Jaber, Samir, Hiesmayr, Michael, Hollmann, Markus W, Mills, Gary H, Vidal Melo, Marcos F, Putensen, Christian, Schmid, Werner, Severgnini, Paolo, Wrigge, Hermann, Gama de Abreu, Marcelo, Pelosi, Paolo, Schultz, Marcus J, Wolfgang Kroell, Helfried Metzler, Gerd Struber, Thomas Wegscheider, Hans Gombotz, Michael Hiesmayr, Werner Schmid, Bernhard Urbanek, David Kahn, Mona Momeni, Audrey Pospiech, Fernande Lois, Patrice Forget, Irina Grosu, Jan Poelaert, Veerle van Mossevelde, Marie-Claire van Malderen, Dimitri Dylst, Jeroen van Melkebeek, Maud Beran, Stefan de Hert, Luc De Baerdemaeker, Bjorn Heyse, Jurgen Van Limmen, Piet Wyffels, Tom Jacobs, Nathalie Roels, Ann De Bruyne, Stijn van de Velde, Brigitte Leva, Sandrine Damster, Benoit Plichon, Marina Juros-Zovko, Dejana Djonoviċ- Omanoviċ, Selma Pernar, Josip Zunic, Petar Miskovic, Antonio Zilic, Slavica Kvolik, Dubravka Ivic, Darija Azenic-Venzera, Sonja Skiljic, Hrvoje Vinkovic, Ivana Oputric, Kazimir Juricic, Vedran Frkovic, Jasminka Kopic, Ivan Mirkovic, Nenad Karanovic, Mladen Carev, Natasa Dropulic, Jadranka Pavicic Saric, Gorjana Erceg, Matea Bogdanovic Dvorscak, Branka Mazul-Sunko, Anna Marija Pavicic, Tanja Goranovic, Branka Maldini, Tomislav Radocaj, Zeljka Gavranovic, Inga Mladic-Batinica, Mirna Sehovic, Petr Stourac, Hana Harazim, Olga Smekalova, Martina Kosinova, Tomas Kolacek, Kamil Hudacek, Michal Drab, Jan Brujevic, Katerina Vitkova, Katerina Jirmanova, Ivana Volfova, Paula Dzurnakova, Katarina Liskova, Radovan Dudas, Radek Filipsky, Samir el Kafraw, Hisham Hosny Abdelwahab, Tarek Metwally, Ahmed Abdel-Razek, Ahmed Mostafa El-Shaarawy, Hany Yassin, Mohamed Magdy, Mahdy Abdelhady, Mohamed Mahran, Eiko Herodes, Peeter Kivik, Juri Oganjan, Annika Aun, Alar Sormus, Kaili Sarapuu, Merilin Mall, Juri Karjagin, Emmanuel Futier, Antoine Petit, Adeline Gerard, Emmanuel Marret, Marc Solier, Samir Jaber, Albert Prades, Jens Krassler, Simone Merzky, Marcel Gama de Abreu, Christopher Uhlig, Thomas Kiss, Anette Bundy, Thomas Bluth, Andreas Gueldner, Peter Spieth, Martin Scharffenberg, Denny Tran Thiem, Thea Koch, Tanja Treschan, Maximilian Schaefer, Bea Bastin, Johann Geib, Martin Weiss, Peter Kienbaum, Benedikt Pannen, Andre Gottschalk, Mirja Konrad, Diana Westerheide, Ben Schwerdtfeger, Hermann Wrigge, Philipp Simon, Andreas Reske, Christian Nestler, Dimitrios Valsamidis, Konstantinos Stroumpoulis, Georgios Antholopoulos, Antonis Andreou, Dimitris Karapanos, Kassiani Theodoraki, Georgios Gkiokas, Marios-Konstantinos Tasoulis, Tatiana Sidiropoulou, Foteini Zafeiropoulou, Panagiota Florou, Aggeliki Pandazi, Georgia Tsaousi, Christos Nouris, Chryssa Pourzitaki, Dmitri Bystritski, Reuven Pizov, Arieh Eden, Caterina Valeria Pesce, Annamaria Campanile, Antonella Marrella, Salvatore Grasso, Michele De Michele, Francesco Bona, Gianmarco Giacoletto, Elena Sardo, Luigi Giancarlo, Vicari Sottosanti, Maurizio Solca, Carlo Alberto Volta, Savino Spadaro, Marco Verri, Riccardo Ragazzi, Roberto Zoppellari, Gilda Cinnella, Pasquale Raimondo, Daniela La Bella, Lucia Mirabella, Davide D'antini, Paolo Pelosi, Alexandre Molin, Iole Brunetti, Angelo Gratarola, Giulia Pellerano, Rosanna Sileo, Stefano Pezzatto, Luca Montagnani, Laura Pasin, Giovanni Landoni, Alberto Zangrillo, Luigi Beretta, Ambra Licia Di Parma, Valentina Tarzia, Roberto Dossi, Marta Eugenia Sassone, Daniele Sances, Stefano Tredici, Gianluca Spano, Gianluca Castellani, Luigi Delunas, Sopio Peradze, Marco Venturino, Ines Arpino, Sara Sher, Concezione Tommasino, Francesca Rapido, Paola Morelli, Maria Vargas, Giuseppe Servillo, Andrea Cortegiani, Santi Maurizio Raineri, Francesca Montalto, Vincenzo Russotto, Antonino Giarratano, Marco Baciarello, Michela Generali, Giorgia Cerati, Yigal Leykin, Filippo Bressan, Vittoria Bartolini, Lucia Zamidei, Luca Brazzi, Corrado Liperi, Gabriele Sales, Laura Pistidda, Paolo Severgnini, Elisa Brugnoni, Giuseppe Musella, Alessandro Bacuzzi, Dalip Muhardri, Gecaj-Gashi Agreta, Fatos Sada, Adem Bytyqi, Aurika Karbonskiene, Ruta Aukstakalniene, Zivile Teberaite, Erika Salciute, Renatas Tikuisis, Povilas Miliauskas, Sipylaite Jurate, Egle Kontrimaviciute, Gabija Tomkute, John Xuereb, Maureen Bezzina, Francis Joseph Borg, Sabrine Hemmes, Marcus Schultz, Markus Hollmann, Irene Wiersma, Christa Boer, Anne Duvekot, Bas in ‘t Veld, Alice Werger, Paul Dennesen, Charlotte Severijns, Jasper De Jong, Jens Hering, Rienk van Beek, Stefan Ivars, Ib Jammer, Alena Breidablik, Katharina Skirstad Hodt, Frode Fjellanger, Manuel Vico Avalos, Jannicke Mellin-Olsen, Elisabeth Andersson, Amir Shafi-Kabir, Ruby Molina, Stanley Wutai, Erick Morais, Glória Tareco, Daniel Ferreira, Joana Amaral, Maria de Lurdes, Goncalves Castro, Susana Cadilha, Sofia Appleton, Suzana Parente, Mariana Correia, Diogo Martins, Angela Monteirosa, Ana Ricardo, Sara Rodrigues, Lucian Horhota, Ioana Marina Grintescu, Liliana Mirea, Ioana Cristina Grintescu, Dan Corneci, Silvius Negoita, Madalina Dutu, Ioana Popescu Garotescu, Daniela Filipescu, Alexandru Bogdan Prodan, Gabriela Droc, Ruxandra Fota, Mihai Popescu, Dana Tomescu, Ana Maria Petcu, Marian Irinel Tudoroiu, Alida Moise, Catalin-Traian Guran, Iorel Gherghina, Dan Costea, Iulia Cindea, Sanda-Maria Copotoiu, Ruxandra Copotoiu, Victoria Barsan, Zsolt Tolcser, Magda Riciu, Septimiu Gheorghe Moldovan, Mihaly Veres, Alexey Gritsan, Tatyana Kapkan, Galina Gritsan, Oleg Korolkov, Alexander Kulikov, Andrey Lubnin, Alexey Ovezov, Pavel Prokoshev, Alexander Lugovoy, Natalia Anipchenko, Andrey Babayants, Irina Komissarova, Karginova Zalina, Valery Likhvantsev, Sergei Fedorov, Aleksandra Lazukic, Jasmina Pejakovic, Dunja Mihajlovic, Zuzana Kusnierikova, Maria Zelinkova, Katarina Bruncakova, Lenka Polakovicova, Villiam Sobona, Barbka Novak-Supe, Ana Pekle-Golez, Miroljub Jovanov, Branka Strazisar, Jasmina Markovic-Bozi, Vesna Novak-Jankovic, Minca Voje, Andriy Grynyuk, Ivan Kostadinov, Alenka Spindler-Vesel, Victoria Moral, Mari Carmen Unzueta, Carlos Puigbo, Josep Fava, Jaume Canet, Enrique Moret, Mónica Rodriguez Nunez, Mar Sendra, Andrea Brunelli, Frederic Rodenas, Pablo Monedero, Francisco Hidalgo Martinez, Maria Jose Yepes Temino, Antonio Martínez Simon, Ana de Abajo Larriba, Alberto Lisi, Gisela Perez, Raquel Martinez, Manuel Granell, Jose Tatay Vivo, Cristina Saiz Ruiz, Jose Antonio de Andrés Ibañez, Ernesto Pastor, Marina Soro, Carlos Ferrando, Mario Defez, Cesar Aldecoa Alvares-Santullano, Rocio Perez, Jesus Rico, Monir Jawad, Yousif Saeed, Lars Gillberg, Zuleyha Kazak Bengisun, Baturay Kansu Kazbek, Nesil Coskunfirat, Neval Boztug, Suat Sanli, Murat Yilmaz, Necmiye Hadimioglu, Nuzhet Mert Senturk, Emre Camci, Semra Kucukgoncu, Zerrin Sungur, Nukhet Sivrikoz, Serpil Ustalar Ozgen, Fevzi Toraman, Onur Selvi, Ozgur Senturk, Mine Yildiz, Bahar Kuvaki, Ferim Gunenc, Semih Kucukguclu, Şule Ozbilgin, Jale Maral, Seyda Canli, Oguzhan Arun, Ali Saltali, Eyup Aydogan, Fatma Nur Akgun, Ceren Sanlikarip, Fatma Mine Karaman, Andriy Mazur, Sergiy Vorotyntsev, Guy Rousseau, Colin Barrett, Lucia Stancombe, Ben Shelley, Helen Scholes, James Limb, Amir Rafi, Lisa Wayman, Jill Deane, David Rogerson, John Williams, Susan Yates, Elaine Rogers, Mark Pulletz, Sarah Moreton, Stephanie Jones, Suresh Venkatesh, Maudrian Burton, Lucy Brown, Cait Goodall, Matthew Rucklidge, Debbie Fuller, Maria Nadolski, Sandeep Kusre, Michael Lundberg, Lynn Everett, Maka Zuleika, Peter Carvalho, Deborah Clements, Ben Creagh-Brown, Philip Watt, Parizade Raymode, Rupert Pearse, Otto Mohr, Ashok Raj, Thais Creary, Ahmed Chishti, Andrea Bell, Charley Higham, Alistair Cain, Sarah Gibb, Stephen Mowat, Danielle Franklin, Claire West, Gary Minto, Nicholas Boyd, Gary Mills, Emily Calton, Rachel Walker, Felicity Mackenzie, Branwen Ellison, Helen Roberts, Moses Chikungwa, Clare Jackson, Andrew Donovan, Jayne Foot, Elizabeth Homan, Jane Montgomery, David Portch, Pauline Mercer, Janet Palmer, Jonathan Paddle, Anna Fouracres, Amanda Datson, Alyson Andrew, Leanne Welch, Alastair Rose, Sandeep Varma, Karen Simeson, Mrutyunjaya Rambhatla, Jaysimha Susarla, Sudhakar Marri, Krishnan Kodaganallur, Ashok Das, Shivarajan Algarsamy, Julie Colley, Simon Davies, Margaret Szewczyk, Thomas Smith, Ana Fernandez- Bustamante, Elizabeth Luzier, Angela Almagro, Marcos Vidal Melo, Luiz Fernando, Demet Sulemanji, Juraj Sprung, Toby Weingarten, Daryl Kor, Federica Scavonetto, Yeo Tze, Nijbroek, Sunny G, Hol, Liselotte, Swart, Pien, Hemmes, Sabrine N T, Serpa Neto, Ary, Binnekade, Jan M, Hedenstierna, Goran, Jaber, Samir, Hiesmayr, Michael, Hollmann, Markus W, Mills, Gary H, Vidal Melo, Marcos F, Putensen, Christian, Schmid, Werner, Severgnini, Paolo, Wrigge, Hermann, Gama de Abreu, Marcelo, Pelosi, Paolo, Schultz, Marcus J,Wolfgang Kroell, Helfried Metzler, Gerd Struber, Thomas Wegscheider, Hans Gombotz, Michael Hiesmayr, Werner Schmid, Bernhard Urbanek, David Kahn, Mona Momeni, Audrey Pospiech, Fernande Lois, Patrice Forget, Irina Grosu, Jan Poelaert, Veerle van Mossevelde, Marie-Claire van Malderen, Dimitri Dylst, Jeroen van Melkebeek, Maud Beran, Stefan de Hert, Luc De Baerdemaeker, Bjorn Heyse, Jurgen Van Limmen, Piet Wyffels, Tom Jacobs, Nathalie Roels, Ann De Bruyne, Stijn van de Velde, Brigitte Leva, Sandrine Damster, Benoit Plichon, Marina Juros-Zovko, Dejana Djonoviċ- Omanoviċ, Selma Pernar, Josip Zunic, Petar Miskovic, Antonio Zilic, Slavica Kvolik, Dubravka Ivic, Darija Azenic-Venzera, Sonja Skiljic, Hrvoje Vinkovic, Ivana Oputric, Kazimir Juricic, Vedran Frkovic, Jasminka Kopic, Ivan Mirkovic, Nenad Karanovic, Mladen Carev, Natasa Dropulic, Jadranka Pavicic Saric, Gorjana Erceg, Matea Bogdanovic Dvorscak, Branka Mazul-Sunko, Anna Marija Pavicic, Tanja Goranovic, Branka Maldini, Tomislav Radocaj, Zeljka Gavranovic, Inga Mladic-Batinica, Mirna Sehovic, Petr Stourac, Hana Harazim, Olga Smekalova, Martina Kosinova, Tomas Kolacek, Kamil Hudacek, Michal Drab, Jan Brujevic, Katerina Vitkova, Katerina Jirmanova, Ivana Volfova, Paula Dzurnakova, Katarina Liskova, Radovan Dudas, Radek Filipsky, Samir el Kafraw, Hisham Hosny Abdelwahab, Tarek Metwally, Ahmed Abdel-Razek, Ahmed Mostafa El-Shaarawy, Hany Yassin, Mohamed Magdy, Mahdy Abdelhady, Mohamed Mahran, Eiko Herodes, Peeter Kivik, Juri Oganjan, Annika Aun, Alar Sormus, Kaili Sarapuu, Merilin Mall, Juri Karjagin, Emmanuel Futier, Antoine Petit, Adeline Gerard, Emmanuel Marret, Marc Solier, Samir Jaber, Albert Prades, Jens Krassler, Simone Merzky, Marcel Gama de Abreu, Christopher Uhlig, Thomas Kiss, Anette Bundy, Thomas Bluth, Andreas Gueldner, Peter Spieth, Martin Scharffenberg, Denny Tran Thiem, Thea Koch, Tanja Treschan, Maximilian Schaefer, Bea Bastin, Johann Geib, Martin Weiss, Peter Kienbaum, Benedikt Pannen, Andre Gottschalk, Mirja Konrad, Diana Westerheide, Ben Schwerdtfeger, Hermann Wrigge, Philipp Simon, Andreas Reske, Christian Nestler, Dimitrios Valsamidis, Konstantinos Stroumpoulis, Georgios Antholopoulos, Antonis Andreou, Dimitris Karapanos, Kassiani Theodoraki, Georgios Gkiokas, Marios-Konstantinos Tasoulis, Tatiana Sidiropoulou, Foteini Zafeiropoulou, Panagiota Florou, Aggeliki Pandazi, Georgia Tsaousi, Christos Nouris, Chryssa Pourzitaki, Dmitri Bystritski, Reuven Pizov, Arieh Eden, Caterina Valeria Pesce, Annamaria Campanile, Antonella Marrella, Salvatore Grasso, Michele De Michele, Francesco Bona, Gianmarco Giacoletto, Elena Sardo, Luigi Giancarlo, Vicari Sottosanti, Maurizio Solca, Carlo Alberto Volta, Savino Spadaro, Marco Verri, Riccardo Ragazzi, Roberto Zoppellari, Gilda Cinnella, Pasquale Raimondo, Daniela La Bella, Lucia Mirabella, Davide D'antini, Paolo Pelosi, Alexandre Molin, Iole Brunetti, Angelo Gratarola, Giulia Pellerano, Rosanna Sileo, Stefano Pezzatto, Luca Montagnani, Laura Pasin, Giovanni Landoni, Alberto Zangrillo, Luigi Beretta, Ambra Licia Di Parma, Valentina Tarzia, Roberto Dossi, Marta Eugenia Sassone, Daniele Sances, Stefano Tredici, Gianluca Spano, Gianluca Castellani, Luigi Delunas, Sopio Peradze, Marco Venturino, Ines Arpino, Sara Sher, Concezione Tommasino, Francesca Rapido, Paola Morelli, Maria Vargas, Giuseppe Servillo, Andrea Cortegiani, Santi Maurizio Raineri, Francesca Montalto, Vincenzo Russotto, Antonino Giarratano, Marco Baciarello, Michela Generali, Giorgia Cerati, Yigal Leykin, Filippo Bressan, Vittoria Bartolini, Lucia Zamidei, Luca Brazzi, Corrado Liperi, Gabriele Sales, Laura Pistidda, Paolo Severgnini, Elisa Brugnoni, Giuseppe Musella, Alessandro Bacuzzi, Dalip Muhardri, Gecaj-Gashi Agreta, Fatos Sada, Adem Bytyqi, Aurika Karbonskiene, Ruta Aukstakalniene, Zivile Teberaite, Erika Salciute, Renatas Tikuisis, Povilas Miliauskas, Sipylaite Jurate, Egle Kontrimaviciute, Gabija Tomkute, John Xuereb, Maureen Bezzina, Francis Joseph Borg, Sabrine Hemmes, Marcus Schultz, Markus Hollmann, Irene Wiersma, Christa Boer, Anne Duvekot, Bas in ‘t Veld, Alice Werger, Paul Dennesen, Charlotte Severijns, Jasper De Jong, Jens Hering, Rienk van Beek, Stefan Ivars, Ib Jammer, Alena Breidablik, Katharina Skirstad Hodt, Frode Fjellanger, Manuel Vico Avalos, Jannicke Mellin-Olsen, Elisabeth Andersson, Amir Shafi-Kabir, Ruby Molina, Stanley Wutai, Erick Morais, Glória Tareco, Daniel Ferreira, Joana Amaral, Maria de Lurdes, Goncalves Castro, Susana Cadilha, Sofia Appleton, Suzana Parente, Mariana Correia, Diogo Martins, Angela Monteirosa, Ana Ricardo, Sara Rodrigues, Lucian Horhota, Ioana Marina Grintescu, Liliana Mirea, Ioana Cristina Grintescu, Dan Corneci, Silvius Negoita, Madalina Dutu, Ioana Popescu Garotescu, Daniela Filipescu, Alexandru Bogdan Prodan, Gabriela Droc, Ruxandra Fota, Mihai Popescu, Dana Tomescu, Ana Maria Petcu, Marian Irinel Tudoroiu, Alida Moise, Catalin-Traian Guran, Iorel Gherghina, Dan Costea, Iulia Cindea, Sanda-Maria Copotoiu, Ruxandra Copotoiu, Victoria Barsan, Zsolt Tolcser, Magda Riciu, Septimiu Gheorghe Moldovan, Mihaly Veres, Alexey Gritsan, Tatyana Kapkan, Galina Gritsan, Oleg Korolkov, Alexander Kulikov, Andrey Lubnin, Alexey Ovezov, Pavel Prokoshev, Alexander Lugovoy, Natalia Anipchenko, Andrey Babayants, Irina Komissarova, Karginova Zalina, Valery Likhvantsev, Sergei Fedorov, Aleksandra Lazukic, Jasmina Pejakovic, Dunja Mihajlovic, Zuzana Kusnierikova, Maria Zelinkova, Katarina Bruncakova, Lenka Polakovicova, Villiam Sobona, Barbka Novak-Supe, Ana Pekle-Golez, Miroljub Jovanov, Branka Strazisar, Jasmina Markovic-Bozi, Vesna Novak-Jankovic, Minca Voje, Andriy Grynyuk, Ivan Kostadinov, Alenka Spindler-Vesel, Victoria Moral, Mari Carmen Unzueta, Carlos Puigbo, Josep Fava, Jaume Canet, Enrique Moret, Mónica Rodriguez Nunez, Mar Sendra, Andrea Brunelli, Frederic Rodenas, Pablo Monedero, Francisco Hidalgo Martinez, Maria Jose Yepes Temino, Antonio Martínez Simon, Ana de Abajo Larriba, Alberto Lisi, Gisela Perez, Raquel Martinez, Manuel Granell, Jose Tatay Vivo, Cristina Saiz Ruiz, Jose Antonio de Andrés Ibañez, Ernesto Pastor, Marina Soro, Carlos Ferrando, Mario Defez, Cesar Aldecoa Alvares-Santullano, Rocio Perez, Jesus Rico, Monir Jawad, Yousif Saeed, Lars Gillberg, Zuleyha Kazak Bengisun, Baturay Kansu Kazbek, Nesil Coskunfirat, Neval Boztug, Suat Sanli, Murat Yilmaz, Necmiye Hadimioglu, Nuzhet Mert Senturk, Emre Camci, Semra Kucukgoncu, Zerrin Sungur, Nukhet Sivrikoz, Serpil Ustalar Ozgen, Fevzi Toraman, Onur Selvi, Ozgur Senturk, Mine Yildiz, Bahar Kuvaki, Ferim Gunenc, Semih Kucukguclu, Şule Ozbilgin, Jale Maral, Seyda Canli, Oguzhan Arun, Ali Saltali, Eyup Aydogan, Fatma Nur Akgun, Ceren Sanlikarip, Fatma Mine Karaman, Andriy Mazur, Sergiy Vorotyntsev, Guy Rousseau, Colin Barrett, Lucia Stancombe, Ben Shelley, Helen Scholes, James Limb, Amir Rafi, Lisa Wayman, Jill Deane, David Rogerson, John Williams, Susan Yates, Elaine Rogers, Mark Pulletz, Sarah Moreton, Stephanie Jones, Suresh Venkatesh, Maudrian Burton, Lucy Brown, Cait Goodall, Matthew Rucklidge, Debbie Fuller, Maria Nadolski, Sandeep Kusre, Michael Lundberg, Lynn Everett, Maka Zuleika, Peter Carvalho, Deborah Clements, Ben Creagh-Brown, Philip Watt, Parizade Raymode, Rupert Pearse, Otto Mohr, Ashok Raj, Thais Creary, Ahmed Chishti, Andrea Bell, Charley Higham, Alistair Cain, Sarah Gibb, Stephen Mowat, Danielle Franklin, Claire West, Gary Minto, Nicholas Boyd, Gary Mills, Emily Calton, Rachel Walker, Felicity Mackenzie, Branwen Ellison, Helen Roberts, Moses Chikungwa, Clare Jackson, Andrew Donovan, Jayne Foot, Elizabeth Homan, Jane Montgomery, David Portch, Pauline Mercer, Janet Palmer, Jonathan Paddle, Anna Fouracres, Amanda Datson, Alyson Andrew, Leanne Welch, Alastair Rose, Sandeep Varma, Karen Simeson, Mrutyunjaya Rambhatla, Jaysimha Susarla, Sudhakar Marri, Krishnan Kodaganallur, Ashok Das, Shivarajan Algarsamy, Julie Colley, Simon Davies, Margaret Szewczyk, Thomas Smith, Ana Fernandez- Bustamante, Elizabeth Luzier, Angela Almagro, Marcos Vidal Melo, Luiz Fernando, Demet Sulemanji, Juraj Sprung, Toby Weingarten, Daryl Kor, Federica Scavonetto, Yeo Tze, Schultz, Marcus, J, Servillo, G, Vargas, M, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Anesthesiology research group, Supporting clinical sciences, Anesthesiology, Graduate School, AII - Amsterdam institute for Infection and Immunity, Intensive Care Medicine, AII - Inflammatory diseases, ACS - Heart failure & arrhythmias, APH - Quality of Care, ACS - Pulmonary hypertension & thrombosis, APH - Global Health, ACS - Diabetes & metabolism, ACS - Microcirculation, Marcus, J (LAS VEGAS study investigator, the PROVE Network and the Clinical Trial Network of the European Society of, Anaesthesiology), Zangrillo, A, Beretta, L, and Landoni, G
Subjects: Adult, Male, medicine.medical_specialty, Intra operative, health care facilities, manpower, and services, [SDV]Life Sciences [q-bio], Critical Illness, Las Vegas Study, Article, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Internal medicine, Tidal Volume, medicine, Humans, General anaesthesia, Lung, Tidal volume, Female, Respiration, Artificial, Sex Characteristics, Las vegas, business.industry, Respiration, respiratory failure, sex, respiratory system, Sex difference, respiratory tract diseases, Anesthesiology and Pain Medicine, 030228 respiratory system, Relative risk, Artificial, Cohort, Breathing, Observational study, business, intra-operative tidal volume, circulatory and respiratory physiology
Abstract: BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (V(T)). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients. OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference. DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries. MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as V(T) of 8 ml kg(−1) or less predicted bodyweight (PBW). A V(T) was deemed ‘default’ if the set V(T) was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation. RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default V(T) was often set, both in women and men; mode V(T) was 500 ml. Median [IQR] V(T) was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg(−1) PBW, P*** < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P*** < 0.001]. In the mediation analysis, patients’ height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default V(T). CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher V(T) than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV. TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223
Published: 2021
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10. Individualized versus fixed positive end-expiratory pressure for intraoperative mechanical ventilation in obese patients: a secondary analysis

Author: Simon, Philipp, Girrbach, Felix, Petroff, David, Schliewe, Nadja, Hempel, Gunther, Lange, Mirko, Bluth, Thomas, Gama de Abreu, Marcelo, Beda, Alessandro, Schultz, Marcus J., Pelosi, Paolo, Reske, Andreas W., Wrigge, Hermann, Ilona Bobek, Jaume C Canet, Luc De Baerdemaeker, Cesare Gregoretti, Göran Hedenstierna, Sabrine N T Hemmes, Michael Hiesmayr, Markus Hollmann, Samir Jaber, John Laffey, Marc J Licker, Klaus Markstaller, Idit Matot, Gary Mills, Jan Paul Mulier, Christian Putensen, Rolf Rossaint, Jochen Schmitt, Mert Senturk, Paolo Severgnini, Juraj Sprung, Marcos Francisco Vidal Melo, Ary Serpa Neto, Marcelo Gama de Abreu, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Simon, Philipp, Girrbach, Felix, Petroff, David, Schliewe, Nadja, Hempel, Gunther, Lange, Mirko, Bluth, Thoma, Gama de Abreu, Marcelo, Beda, Alessandro, Schultz, Marcus J., Pelosi, Paolo, Reske, Andreas W., Wrigge, Hermann, Ilona Bobek, Jaume C Canet, Luc De Baerdemaeker, Cesare Gregoretti, Göran Hedenstierna, Sabrine N T Hemmes, Michael Hiesmayr, Markus Hollmann, Samir Jaber, John Laffey, Marc J Licker, Klaus Markstaller, Idit Matot, Gary Mills, Jan Paul Mulier, Christian Putensen, Rolf Rossaint, Jochen Schmitt, Mert Senturk, Paolo Severgnini, Juraj Sprung, Marcos Francisco Vidal Melo, Ary Serpa Neto, Marcelo Gama de Abreu, Intensive Care Medicine, AII - Inflammatory diseases, ACS - Pulmonary hypertension & thrombosis, APH - Quality of Care, ACS - Heart failure & arrhythmias, Anesthesiology, ACS - Diabetes & metabolism, APH - Global Health, and ACS - Microcirculation
Subjects: Pulmonary Atelectasis, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Atelectasis, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Interquartile range, medicine, Tidal Volume, Humans, Obesity, 10. No inequality, PEEP, Positive end-expiratory pressure, Tidal volume, ComputingMilieux_MISCELLANEOUS, 2. Zero hunger, Mechanical ventilation, business.industry, Respiration, Environmental air flow, Oxygenation, respiratory system, medicine.disease, 3. Good health, respiratory tract diseases, Anesthesiology and Pain Medicine, Anesthesia, Artificial, Breathing, business, therapeutics, 030217 neurology & neurosurgery, Respiration, Artificial, circulatory and respiratory physiology
Abstract: Background General anesthesia may cause atelectasis and deterioration in oxygenation in obese patients. The authors hypothesized that individualized positive end-expiratory pressure (PEEP) improves intraoperative oxygenation and ventilation distribution compared to fixed PEEP. Methods This secondary analysis included all obese patients recruited at University Hospital of Leipzig from the multicenter Protective Intraoperative Ventilation with Higher versus Lower Levels of Positive End-Expiratory Pressure in Obese Patients (PROBESE) trial (n = 42) and likewise all obese patients from a local single-center trial (n = 54). Inclusion criteria for both trials were elective laparoscopic abdominal surgery, body mass index greater than or equal to 35 kg/m2, and Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score greater than or equal to 26. Patients were randomized to PEEP of 4 cm H2O (n = 19) or a recruitment maneuver followed by PEEP of 12 cm H2O (n = 21) in the PROBESE study. In the single-center study, they were randomized to PEEP of 5 cm H2O (n = 25) or a recruitment maneuver followed by individualized PEEP (n = 25) determined by electrical impedance tomography. Primary endpoint was Pao2/inspiratory oxygen fraction before extubation and secondary endpoints included intraoperative tidal volume distribution to dependent lung and driving pressure. Results Ninety patients were evaluated in three groups after combining the two lower PEEP groups. Median individualized PEEP was 18 (interquartile range, 16 to 22; range, 10 to 26) cm H2O. Pao2/inspiratory oxygen fraction before extubation was 515 (individual PEEP), 370 (fixed PEEP of 12 cm H2O), and 305 (fixed PEEP of 4 to 5 cm H2O) mmHg (difference to individualized PEEP, 145; 95% CI, 91 to 200; P < 0.001 for fixed PEEP of 12 cm H2O and 210; 95% CI, 164 to 257; P < 0.001 for fixed PEEP of 4 to 5 cm H2O). Intraoperative tidal volume in the dependent lung areas was 43.9% (individualized PEEP), 25.9% (fixed PEEP of 12 cm H2O) and 26.8% (fixed PEEP of 4 to 5 cm H2O) (difference to individualized PEEP: 18.0%; 95% CI, 8.0 to 20.7; P < 0.001 for fixed PEEP of 12 cm H2O and 17.1%; 95% CI, 10.0 to 20.6; P < 0.001 for fixed PEEP of 4 to 5 cm H2O). Mean intraoperative driving pressure was 9.8 cm H2O (individualized PEEP), 14.4 cm H2O (fixed PEEP of 12 cm H2O), and 18.8 cm H2O (fixed PEEP of 4 to 5 cm H2O), P < 0.001. Conclusions This secondary analysis of obese patients undergoing laparoscopic surgery found better oxygenation, lower driving pressures, and redistribution of ventilation toward dependent lung areas measured by electrical impedance tomography using individualized PEEP. The impact on patient outcome remains unclear. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
Published: 2021
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11. Predicting Hospital Length of Stay at Admission Using Global and Country-Specific Competing Risk Analysis of Structural, Patient, and Nutrition-Related Data from nutritionDay 2007–2015

Author: Noemi Kiss, Peter Bauer, Christian Schuh, Judit Simon, Silvia Tarantino, Michael Hiesmayr, I. Sulz, Mohamed Mouhieddine, and Georg Heinze
Subjects: Adult, Male, medicine.medical_specialty, Percentile, Time Factors, Adolescent, Nutritional Status, Length of hospitalization, Competing risks, Risk Assessment, Article, Young Adult, Patient Admission, length of stay, Predictive Value of Tests, discharge, Humans, Medicine, dietician, TX341-641, survey, Hospital Mortality, hospital, nutrition screening, Survival analysis, Aged, Proportional Hazards Models, competing risks, Aged, 80 and over, Nutrition and Dietetics, Diagnostic Tests, Routine, business.industry, Proportional hazards model, Nutrition. Foods and food supply, Hazard ratio, Middle Aged, mortality, Confidence interval, Nutrition Assessment, nutrition, Emergency medicine, Female, business, nutritionDay, transfer, Food Science
Abstract: Hospital length of stay (LOS) is an important clinical and economic outcome and knowing its predictors could lead to better planning of resources needed during hospitalization. This analysis sought to identify structure, patient, and nutrition-related predictors of LOS available at the time of admission in the global nutritionDay dataset and to analyze variations by country for countries with n &gt, 750. Data from 2006–2015 (n = 155,524) was utilized for descriptive and multivariable cause-specific Cox proportional hazards competing-risks analyses of total LOS from admission. Time to event analysis on 90,480 complete cases included: discharged (n = 65,509), transferred (n = 11,553), or in-hospital death (n = 3199). The median LOS was 6 days (25th and 75th percentile: 4–12). There is robust evidence that LOS is predicted by patient characteristics such as age, affected organs, and comorbidities in all three outcomes. Having lost weight in the last three months led to a longer time to discharge (Hazard Ratio (HR) 0.89, 99.9% Confidence Interval (CI) 0.85–0.93), shorter time to transfer (HR 1.40, 99.9% CI 1.24–1.57) or death (HR 2.34, 99.9% CI 1.86–2.94). The impact of having a dietician and screening patients at admission varied by country. Despite country variability in outcomes and LOS, the factors that predict LOS at admission are consistent globally.
Published: 2021
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12. Enteral nutrition and dynamics of citrulline and intestinal fatty acid-binding protein in adult ICU patients

Author: Liis Starkopf, Sven Erik Ojavee, Stephan M. Jakob, Annika Reintam Blaser, O. Rooijackers, Jan Wernerman, Joel Starkopf, Michael Hiesmayr, Alastair Forbes, and Martin Padar
Subjects: Adult, medicine.medical_specialty, Icu patients, Nutrition and Dietetics, Plasma samples, business.industry, Endocrinology, Diabetes and Metabolism, Reference range, Fatty Acid-Binding Proteins, Enteral administration, Gastroenterology, chemistry.chemical_compound, Intensive Care Units, Parenteral nutrition, Enteral Nutrition, chemistry, Internal medicine, Intestinal Fatty Acid-Binding Protein, Citrulline, medicine, Biomarker (medicine), Humans, Prospective Studies, business
Abstract: Summary Background and aims Plasma citrulline and intestinal fatty acid binding protein (I-FABP) are biomarkers reflecting enterocyte function and intestinal mucosal injury. The aim was to describe daily dynamics of citrulline and I-FABP concentrations in association with enteral nutrition (EN) in adult ICU patients. We hypothesized that success or failure of EN is reflected by differences in citrulline and I-FABP levels at admission, as well as in daily dynamics over the first week. Methods The present study was a planned sub-study of the iSOFA study ( ClinicalTrials.gov Identifier: NCT02613000). With delayed informed consent we included adult (18 years or older) patients admitted for unlimited care to 5 ICUs in Europe. Citrulline and I-FABP were assessed and nutritional data recorded daily during the first week of the patients’ ICU stay. Results The study included 224 patients with 693 plasma samples analyzed for citrulline and 695 for I-FABP. The median ICU stay was 2 (IQR 1–4) days and 35 patients (15.6 %) stayed in the ICU for ≥ 7 days. The majority of patients (184/224; 82.1 %) received EN or oral nutrition (ON) during their ICU stay, in 164 patients (73.2 %) nutrition was started within 48 h of admission (early enteral or oral nutrition, EEN/ON). Median biomarker concentrations on admission were: citrulline 24.5 (IQR 18.1–31.7) μmol/L and I-FABP 2763 (1326–4805) pg/mL. Reference range for citrulline was 17–46 μmol/L and for I-FABP 377–2049 pg/mL. Patients with EEN/ON demonstrated an increase in citrulline concentrations over the first week in ICU unlike those not receiving EEN/ON (P = 0.049 for the mean log-citrulline values over time between groups) as well as higher average citrulline concentrations. Success of EEN/ON (80 % of caloric target achieved by day 4) was associated with citrulline values increasing from day 4, whereas a slight decrease was observed with unsuccessful EEN/ON. However, these dynamics over time were not statistically significantly different (P = 0.654). Patients with EEN/ON unexpectedly had I-FABP values higher than those without (average values for all days P = 0.004). Median I-FABP values on day 3 were higher with successful EEN/ON (646 (IQR 313–1116) vs 278 (IQR 190–701) pg/mL, P = 0.022). Conclusions EEN/ON was associated with higher values and different dynamics of citrulline over the first week in ICU. No clear difference of measured biomarkers was seen when patients were compared according to success of EEN/ON. Our study does not allow suggesting certain thresholds of citrulline nor I-FABP that could be used for bedside decision-making with regard to EN. This study was a planned sub-study of the iSOFA study ( ClinicalTrials.gov Identifier: NCT02613000).
Published: 2021

13. The effects of preoperative moderate to severe anaemia on length of hospital stay:A propensity score-matched analysis in non-cardiac surgery patients

Author: Michael Hiesmayr, Sabrine N T Hemmes, Werner Schmid, A. Serpa Neto, Göran Hedenstierna, M.W. Hollmann, Gary H. Mills, Christian Putensen, Samir Jaber, Jan M. Binnekade, M. Gama de Abreu, Marcus J. Schultz, Marcos F. Vidal Melo, Rupert M Pearse, Hermann Wrigge, Christa Boer, Paolo Severgnini, Cse Bulte, Paolo Pelosi, Anesthesiology, Intensive Care Medicine, ACS - Heart failure & arrhythmias, APH - Quality of Care, ACS - Pulmonary hypertension & thrombosis, APH - Global Health, ACS - Diabetes & metabolism, ACS - Microcirculation, and IOO
Subjects: Adult, medicine.medical_specialty, Anemia, Article, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Humans, Length of Stay, Propensity Score, Prospective Studies, 030202 anesthesiology, Internal medicine, Post-hoc analysis, Medicine, General anaesthesia, Prospective cohort study, Adverse effect, business.industry, 030208 emergency & critical care medicine, medicine.disease, 3. Good health, Anesthesiology and Pain Medicine, Propensity score matching, Cohort, Observational study, business
Abstract: BACKGROUND: Anaemia is frequently recorded during preoperative screening and has been suggested to affect outcomes after surgery negatively. OBJECTIVES: The objectives were to assess the frequency of moderate to severe anaemia and its association with length of hospital stay. DESIGN: Post hoc analysis of the international observational prospective 'Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study. PATIENTS AND SETTING: The current analysis included adult patients requiring general anaesthesia for non-cardiac surgery. Preoperative anaemia was defined as a haemoglobin concentration of 11 g dl-1 or lower, thus including moderate and severe anaemia according to World Health Organisation criteria. MAIN OUTCOME MEASURES: The primary outcome was length of hospital stay. Secondary outcomes included hospital mortality, intra-operative adverse events and postoperative pulmonary complications (PPCs). RESULTS: Haemoglobin concentrations were available for 8264 of 9864 patients. Preoperative moderate to severe anaemia was present in 7.7% of patients. Multivariable analysis showed that preoperative moderate to severe anaemia was associated with an increased length of hospital stay with a mean difference of 1.3 ((95% CI 0.8 to 1.8) days; P
Published: 2021
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14. Early Antibiotic Prophylaxis Prior to Bypass Surgery Improves Tissue Penetration

Author: Joerg-Michael Hiesmayr, Maximilian Edlinger-Stanger, Wilfried Wisser, Alexandra Maier-Salamon, Shiva Shabanian, Rainer Thell, Guenther Laufer, Alfred Kocher, Doris Hutschala, Walter Jaeger, Martin Andreas, and Markus Zeitlinger
Subjects: Male, 0301 basic medicine, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Microdialysis, Time Factors, 030106 microbiology, Cefazolin, Microbial Sensitivity Tests, 030204 cardiovascular system & hematology, Drug Administration Schedule, 03 medical and health sciences, 0302 clinical medicine, Humans, Surgical Wound Infection, Medicine, Tissue Distribution, Coronary Artery Bypass, Antibiotic prophylaxis, Aged, Aged, 80 and over, business.industry, Area under the curve, Perioperative, Antibiotic Prophylaxis, Middle Aged, Anti-Bacterial Agents, Surgery, Treatment Outcome, medicine.anatomical_structure, Bypass surgery, Austria, Female, Cardiology and Cardiovascular Medicine, business, Artery, medicine.drug, Subcutaneous tissue
Abstract: Background We previously identified preparation of the internal mammary artery as a risk factor significantly impairing antibiotic tissue penetration into the presternal subcutaneous tissue. We, therefore, adapted our dosing schema regarding preoperative timing to overcome this risk factor. Methods Eight patients who underwent coronary artery bypass grafting with a left internal mammary artery and vein grafts were included in this clinical trial. Cefazolin (4 g) was administered twice (3 hours and 1 hour) prior to skin incision and once during skin closure (2 g). Antibiotic concentrations were measured with subcutaneous microdialysis probes on both sternal sides. Results were directly compared with the previously published patient cohort receiving the standard schema (4 g cefazolin prior to skin incision and 2 g during closure). Results All patients (7 male, 1 female, 69 ± 7 years, 26.3 ± 3.9 kg/m2) survived the perioperative period. Mean area under the curve on the right and left sternal side was 117.0 ± 92.5 μg/mL and 114.5 ± 83.2 μg/mL, respectively (p = 0.95). This was well above the previously measured mean peak tissue concentrations without early preoperative antibiotic administration on the side of mammary artery harvesting (52.4 ± 48.5 μg/mL vs. 13.1 ± 5.8 μg/mL; p = 0.039). The %fT > minimal inhibitory concentration (MIC) for Staphylococcus epidermidis and Staphylococcus aureus during the first 10 hours in presternal tissue was ≥ 70% but did not differ compared with standard schema. Conclusions Early, additional preoperative administration of cefazolin was able to significantly increase peak tissue concentrations during surgery compared with the standard protocol. No difference, however, could be achieved in the percentage of time during which the concentration exceeded the MIC.
Published: 2019
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15. Hemoadsorption does not Have Influence on Hemolysis During Cardiopulmonary Bypass

Author: Harald Rinoesl, Martin H Bernardi, Dominik Wiedemann, Michael Hiesmayr, Robin Ristl, and Ulrike Weber
Subjects: Male, medicine.medical_treatment, Biomedical Engineering, Biophysics, Bioengineering, 030204 cardiovascular system & hematology, Hemolysis, law.invention, Biomaterials, Hemoglobins, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Randomized controlled trial, law, Lactate dehydrogenase, Post-hoc analysis, Hemofiltration, medicine, Cardiopulmonary bypass, Humans, Aged, Aged, 80 and over, Cardiopulmonary Bypass, Haptoglobins, biology, business.industry, Haptoglobin, General Medicine, Middle Aged, medicine.disease, 030228 respiratory system, chemistry, Anesthesia, biology.protein, Female, Bilirubin levels, business
Abstract: Cardiopulmonary bypass (CPB) induces hemolysis, which manifests as plasma free hemoglobin. We investigated in a post hoc analysis of a single-center, blinded, controlled study whether the use of a novel hemoadsorption device (CytoSorb, CytoSorbents Europe GmbH, Berlin, Germany) affects hemolysis during CPB. A total of 35 patients undergoing elective CPB surgery with an expected CPB duration of more than 120 min were included in the analysis. The hemoadsorption device was used in 17 patients (intervention group) and not used in 18 patients (control group). The primary outcome was differences of postoperative free hemoglobin and haptoglobin levels. As secondary outcomes, we investigated differences in postoperative lactate dehydrogenase and bilirubin levels. Postoperative free hemoglobin levels were not significantly different between the groups. However, there were statistically significant differences between the treatment and control groups in the median levels of haptoglobin (58.4 vs. 17.9 mg/dL, respectively; P < 0.01) and lactate dehydrogenase (353.0 vs. 432.0 U/L, respectively; P < 0.05) on postoperative day 1. Thus, in this study, we did not find an effect on hemolysis in patients treated with hemoadsorption, though lower haptoglobin level and higher secondary hemolysis markers on postoperative day 1 in patients not treated with the hemoadsorber may be an indication of some moderate effect of the device. Studies with larger samples are needed to clarify the significance of the small differences detected in this study.
Published: 2019
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16. ESPEN guideline on clinical nutrition in the intensive care unit

Author: Waleed Alhazzani, Michael P Casaer, Michael Hiesmayr, Wojciech Szczeklik, Claude Pichard, J.C. Montejo, Philip C. Calder, Simon Oczkowski, Mette M. Berger, Arthur R. H. van Zanten, Jean-Charles Preiser, Pierre Singer, Stephan C. Bischoff, Annika Reintam Blaser, and Konstantin Mayer
Subjects: 0301 basic medicine, Parenteral Nutrition, medicine.medical_specialty, ESPEN, Critical Care, Critical Illness, Nutritional Status, 030209 endocrinology & metabolism, Clinical nutrition, Guidelines, Critical Care and Intensive Care Medicine, Enteral administration, law.invention, 03 medical and health sciences, Enteral Nutrition, 0302 clinical medicine, Parenteral, law, Intensive care, Humans, Medicine, Medical nutrition therapy, Intensive care medicine, Enteral, Societies, Medical, Nutrition, ddc:616, 030109 nutrition & dietetics, Nutrition and Dietetics, Nutritional Support, business.industry, Guideline, Dysphagia, Intensive care unit, Europe, Intensive Care Units, medicine.symptom, business, Abdominal surgery
Abstract: Following the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to start and how to progress in the administration of adequate provision of nutrients is also described. The best determination of amount and nature of carbohydrates, fat and protein are suggested. Special attention is given to glutamine and omega-3 fatty acids. Particular conditions frequently observed in intensive care such as patients with dysphagia, frail patients, multiple trauma patients, abdominal surgery, sepsis, and obesity are discussed to guide the practitioner toward the best evidence based therapy. Monitoring of this nutritional therapy is discussed in a separate document.
Published: 2019
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17. Prevalence of Malnutrition Risk and the Impact of Nutrition Risk on Hospital Outcomes: Results From nutritionDay in the U.S

Author: I. Sulz, S. Moick, Kris M. Mogensen, Ainsley Malone, Alessandro Laviano, Abby C. Sauer, Gail Gewirtz, Michael Hiesmayr, and Scott Goates
Subjects: Male, Food intake, 030309 nutrition & dietetics, Prevalence, Nutritional Status, Medicine (miscellaneous), Eating, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Environmental health, Humans, Mass Screening, Medicine, Hospital Mortality, Meals, Aged, 0303 health sciences, Meal, Nutrition and Dietetics, business.industry, Malnutrition, Hazard ratio, Feeding Behavior, Middle Aged, Nutrition Surveys, medicine.disease, Hospitals, United States, Nutrition risk, Hospitalization, Cross-Sectional Studies, Hospital outcomes, Female, 030211 gastroenterology & hepatology, Self Report, Energy Intake, nutritionDay, business
Abstract: BACKGROUND Malnutrition risk estimates vary greatly, and no robust data on the association between food intake and outcomes exist for hospitals in the United States (U.S.). This study aimed to determine the prevalence of malnutrition risk and to evaluate the impact of food intake on mortality using the nutritionDay in the U.S. dataset. METHODS This study analyzed data from 2009 to 2015 for all adult patients from participating hospitals. Prevalence of malnutrition risk was determined by mapping self-reported nutritionDay survey questions to the Malnutrition Screening Tool (MST). Fine and Gray competing-risk analysis with clustering was used to evaluate the impact of nutrition risk and food intake on patients' 30-day in-hospital mortality, while controlling for age, mobility, and other disease-related factors. RESULTS Analysis included data from 9959 adult patients from 601 wards. The overall prevalence of malnutrition risk (MST score ≥2) was 32.7%. On nutritionDay, 32.1% of patients ate a quarter of their meal or less. Hospital mortality hazard ratio was 3.24 (95% CI: [1.73, 6.07]; P-value < 0.001) for patients eating a quarter compared with those who ate all their meal and increased to 5.99 (95% CI: [3.03, 11.84]; P-value < 0.0001) for patients eating nothing despite being allowed to eat. CONCLUSION This study provides the most robust estimate of malnutrition risk in U.S. hospitalized patients to date, finding that approximately 1 in 3 are at risk. Additionally, patients who have diminished meal intake experience increased mortality risk. These results highlight the ongoing issue of malnutrition in the hospital setting.
Published: 2019
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18. Reply to: very early creatinine changes and 30-day mortality after cardiac surgery

Author: Robin Ristl, Michael Hiesmayr, Andrea Lassnigg, and Martin H Bernardi
Subjects: Creatinine, medicine.medical_specialty, business.industry, Acute Kidney Injury, Cardiac surgery, chemistry.chemical_compound, Anesthesiology and Pain Medicine, Text mining, chemistry, 30 day mortality, Internal medicine, medicine, Cardiology, Humans, Cardiac Surgical Procedures, business
Published: 2021

19. Timing of parenteral nutrition in ICU patients: A transatlantic controversy

Author: Silvia Tarantino, Mohamed Mouhieddine, Johannes Geilen, Michael Hiesmayr, Christian Schuh, B. Mora, A. Fischer, Pierre Singer, I. Sulz, and Cecilia Veraar
Subjects: medicine.medical_specialty, Parenteral Nutrition, Nutrition and Dietetics, business.industry, Endocrinology, Diabetes and Metabolism, Critical Illness, Audit, law.invention, Route of administration, Intensive Care Units, Parenteral nutrition, Cross-Sectional Studies, Enteral Nutrition, Randomized controlled trial, law, Intensive care, Emergency medicine, Medicine, Humans, Medical nutrition therapy, Medical prescription, business, nutritionDay
Abstract: Summary Background and aims European and North American guidelines on Parenteral Nutrition (PN) and large Randomized Controlled Trials give divergent advices on nutritional therapeutic strategies for critically ill patients. We therefore investigated differences in therapeutic strategies of clinicians between European and Non-European Intensive Care Units (ICU) regarding start day of PN, preferred route of administration and prescription of total energy targets over the years. Methods In this study 16,032 patients from 1389 different ICUs were included. Data collection was performed in 28 different European and Non-European ICUs from 2007 to 2018 via nutritionDay, a worldwide-standardized one-day multinational cross-sectional audit. Results In this analysis an abrupt delay in PN start days was observed in 2011 (7.64 days (4.31; 19.97); p = 0.001) and 2012 (6.41 days (3.1; 9.72); p = 0.001), which was significantly reversed within the following years until 2018. In European, compared to Non-European countries PN prescription was increased (27% versus 13%). Patients from North-America received significantly less kcal per day compared to Europe (−4.3 kcal kg−1 (−6.9; −1.6); p = 0.001). Conclusions Our study provides further evidence on transatlantic discrepancies in nutritional therapy of ICU patients. Regular audits, such as nutritionDay are substantial for self-reflection of clinical daily practice of intensivists. It is time for worldwide consensus in nutritional therapy by developing worldwide guidelines and supporting standardization in nutrition care of critically ill patients.
Published: 2021

20. Association between outcome and nutrition care in critically ill covid-19 patients: a nutritionday 2020 analysis

Author: I. Sulz, Stéphane M. Schneider, C. Cuerda-Compes, Pierre Singer, Rocco Barazzoni, Silvia Tarantino, Alessandro Laviano, and Michael Hiesmayr
Subjects: 2019-20 coronavirus outbreak, medicine.medical_specialty, Nutrition and Dietetics, Coronavirus disease 2019 (COVID-19), Critically ill, business.industry, Endocrinology, Diabetes and Metabolism, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Article, Nutrition care, Medicine, business, nutritionDay, Intensive care medicine
Published: 2021

21. Hospital Malnutrition, Nutritional Risk Factors, and Elements of Nutritional Care in Europe: Comparison of Polish Results with All European Countries Participating in the nDay Survey

Author: Michael Hiesmayr, Dorota Szostak-Węgierek, I. Sulz, Silvia Tarantino, and Joanna Ostrowska
Subjects: 0301 basic medicine, Male, Appetite, Nutritional Status, lcsh:TX341-641, Clinical nutrition, malnutrition, Enteral administration, Article, Body Mass Index, 03 medical and health sciences, Eating, 0302 clinical medicine, Risk Factors, Environmental health, Weight Loss, Medicine, Humans, Mass Screening, 030212 general & internal medicine, Medical prescription, Reference group, Aged, Aged, 80 and over, Medical Audit, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Nutritional Support, nutrition risk factors, Middle Aged, medicine.disease, Hospitals, Europe, Hospitalization, nutritional care, Malnutrition, Parenteral nutrition, Cross-Sectional Studies, Female, Poland, nutritionDay, business, Body mass index, lcsh:Nutrition. Foods and food supply, Food Science
Abstract: NutritionDay (nDay) is a project established by the Medical University of Vienna and the European Society for Clinical Nutrition and Metabolism (ESPEN) to audit the nutritional status of hospitalized patients and nursing home residents. This study aimed to evaluate nDay data describing the prevalence of hospital malnutrition, nutritional risk factors, and elements of the nutritional care process implemented in hospital wards in 25 European countries and to compare the data derived from Poland with the data collected in all the European countries participating in the study. In total, 10,863 patients (European reference group: 10,863 participants including Poland: 498 participants) were involved in the study. The prevalence of malnutrition was identified on the basis of the ESPEN diagnostic criteria established in 2015, while the prevalence of nutritional risk factors was assessed by analyzing the following parameters: body mass index (BMI), score of Malnutrition Screening Tool (MST), recent weight loss, insufficient food intake, decreased appetite, increased number of drugs intake, reduced mobility, and poor self-reported health status. Malnutrition prevalence was 12.9% in patients from the European reference group and 9.4% in patients from Polish hospital wards (p &lt, 0.05). However, the prevalence of some nutritional risk factors, i.e., recent weight loss, history of decreased food intake, and low actual food intake, were approximately four times more prevalent than diagnosed malnutrition (referring to approximately 40–50% of all participants). In comparison to the European reference group, the significant differences observed in Polish hospital wards concerned mainly dietitian’s involvement in the process of treating malnutrition (16% vs. 57.2%, p &lt, 0.001), supply of special diets (8% vs. 16.1%, 0.0001), provision of oral nutritional support (ONS) (3.8% vs. 12.2%, prescription of enteral/parenteral nutrition therapy to hospitalized patients (8.2% vs. 11.7%, as well as recording patient weight performed at hospital admission (100% vs. 72.9%, 0.0001), weekly (20% vs. 41.4%, 0.05), and occasionally (0% vs. 9.2%). These results indicate that the prevalence of malnutrition and malnutrition risk factors in hospitalized patients in Poland was slightly lower than in the European reference group. However, some elements of the nutritional care process in Polish hospitals were found insufficient and demand more attention.
Published: 2021
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22. Protocol for a prospective cohort study on the use of clinical nutrition and assessment of long-term clinical and functional outcomes in critically ill adult patients

Author: M. Matejovic, O. Huet, L. Krzych, C. Vaquerizo, A. Csomos, K. Dams, Michael Hiesmayr, H. Kuechenhoff, Inga Tjäder, Wolfgang H. Hartl, Zudin Puthucheary, R. Tetamo, Gunnar Elke, Olav Rooyackers, and Servicio de Medicina Intensiva. Hospital Universitario de Fuenlabrada
Subjects: 0301 basic medicine, Adult, medicine.medical_specialty, Clinical nutrition, Multivariate analysis, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Critical Illness, Aftercare, 030209 endocrinology & metabolism, 03 medical and health sciences, 0302 clinical medicine, Parenteral, Intensive care, medicine, Humans, Prospective Studies, Prospective cohort study, Enteral, Retrospective Studies, Mechanical ventilation, Protocol (science), 030109 nutrition & dietetics, Nutrition and Dietetics, Data collection, business.industry, Functional status, Patient Discharge, Emergency medicine, ICU, Human medicine, business
Abstract: Background and aims: Limited data are available on the impact of clinical nutrition over the course of critical illness and post-discharge outcomes. The present study aims to characterize the use of nutrition support in patients admitted to European intensive care units (ICUs), and its impact on clinical outcomes. Here we present the procedures of data collection and evaluation. Methods: Around 100 medical, surgical, or trauma ICUs in 11 countries (Austria, Belgium, Czech Republic, Germany, France, Hungary, Italy, Poland, Spain, Sweden, United Kingdom) participate in the study. In defined months between November 2019 and April 2020, approximately 1250 patients are enrolled if staying in ICU for at least five consecutive days. Data from ICU day 1-4 are collected retrospectively, followed by a prospective observation period from day 5-90 after ICU admission. Data collection includes patient characteristics, nutrition parameters, complications, ICU and hospital length of stay, discharge status, and functional outcomes. For data analysis, the target is 1000 patients with complete data. Statistical analyses will be descriptive, with multivariate analyses adjusted for potential confounders to explore associations between nutritional balance and change in functional status, time-to-weaning from invasive mechanical ventilation, time to first clinical complication, and overall 15, 30 and 90-day survival. Ethics and dissemination: This non-interventional study was reviewed and approved by the ethics committee of the Medical University Vienna, Vienna, Austria (approval number 1678/2019), and the respective ethical committees from participating sites at country and/or local level, as required. Results will be shared with investigators on a country level, and a publication and results presentation at the 2021 ESPEN Congress is planned. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism.
Published: 2021

23. How reliably can ultrasound help determine muscle and adipose tissue thickness in clinical settings? An assessment of intra- and inter-examiner reliability in the USVALID study

Author: I. Sulz, Isabel Timmermann, Anatol Hertwig, Martin Posch, Ricarda Hahn, Maximilian Pesta, Martin Anwar, Michael Hiesmayr, Timo Siebenrock, Jonas Brugger, Konstantin Liebau, and A. Fischer
Subjects: Upper Arms, Nutrition and Dietetics, business.industry, Ultrasound, Medicine (miscellaneous), Adipose tissue, Reproducibility of Results, Measuring point, Clinical settings, Thigh, medicine.anatomical_structure, Adipose Tissue, medicine, Arm, Humans, business, Muscle, Skeletal, Reliability (statistics), Biomedical engineering, Ultrasonography
Abstract: Background/objectives Ultrasound is used to measure muscle and adipose tissue thickness at the bedside. This study was aimed at determining the intra- and inter-examiner reliability for marking points to measure adipose tissue and muscle thickness and assessing it in terms of the performance and evaluation of the corresponding ultrasound scans. Subjects/methods Intra- and inter-examiner reliability was tested in 120 patients. Limb lengths were measured to mark three and two measuring points on both the thighs and upper arms, respectively. Ultrasound scans were performed at each measuring point to evaluate muscle and adipose tissue thickness. Results Regarding the marking of the measuring points, intra- and inter-examiner reliability were high to very high, with correlation coefficients ranging from 0.74 to 0.96. In the performance and evaluation of adipose tissue thickness, all measuring points showed a high to very high reliability, with correlation coefficients ranging from 0.70 to 0.97. In the performance and evaluation of muscle thickness, the ventral measuring point on the thigh and the anterior measuring point on the upper arm showed the best reliability, with high to very high correlation coefficients ranging from 0.77 to 0.93. Conclusions In terms of intra- and inter-examiner reliability, the ventral measuring point on the thigh and the anterior measuring point on the upper arm can be strongly recommended for ultrasound measurements of muscle and adipose tissue thickness.
Published: 2020

24. Intraoperative Driving Pressure and Postoperative Pulmonary Complications After Abdominal Surgery – A Posthoc Propensity Score–Weighted Cohort Analysis of the LAS VEGAS Study Comparing Open to Closed Surgery

Author: Samir Jaber, Guido Mazzinari, Gary H. Mills, Marcus J. Schultz, Werner Schmid, Hermann Wrigge, Christian Putensen, Rupert M Pearse, Marcelo Gama de Abreu, Göran Hedenstierna, Markus W. Hollmann, Oscar Diaz-Cambronero, Michael Hiesmayr, Ary Serpa Neto, Paolo Severgnini, Lorenzo Ball, Marcos F. Vidal Melo, Paolo Pelosi, Sabrine N T Hemmes, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Subjects: medicine.medical_specialty, business.industry, [SDV]Life Sciences [q-bio], Pulmonary Complication, Odds ratio, 3. Good health, Surgery, Relative risk, Propensity score matching, medicine, Clinical endpoint, Adverse effect, business, Abdominal surgery, Cohort study
Abstract: Background: It is uncertain whether associations between driving pressure (ΔP) during and occurrence of pulmonary complications after abdominal surgery depend on the surgical approach. Our primary objective was to test the time–weighted average ΔP (ΔPTW) association with postoperative pulmonary complications and our secondary objective was to test the association between ΔPTW and intraoperative Adverse Events. Methods: We realized a posthoc retrospective propensity score weighted cohort analysis of the ‘Local ASsessment of Ventilatory management during General Anesthesia for Surgery’ (LAS VEGAS) study including patients undergoing abdominal surgery from the study database including data from 146 hospitals across 29 countries. The primary endpoint was a composite of postoperative pulmonary complications. The secondary endpoint was the occurrence of intraoperative adverse events. Results: The analysis included 1,128 and 906 patients undergoing open or closed abdominal surgery repsectively. Absolute postoperative pulmonary complications rate was 5%. While driving pressure was lower in open abdominal surgery patients, time-weighted driving pressure was not different between groups. The association of ΔPTW with occurrence of postoperative pulmonary complications was significant in both groups, with a higher risk ratio in closed than in open abdominal surgery patients (1.11 [95%CI 1.10 to 1.20], PTW marginal effect estimation showed increased probability of pulmonary complication in both groups with a steeper increase in closed surgery patients at ΔPTW above 20 cmH2O∙hour-1. The association of ΔPTW with occurrence of intraoperative adverse events was also significant in both groups, with higher odds ratio in closed surgery (1.13 [95%CI 1.12 to 1.14]; PConclusions: Our results show how driving pressure represents a marker for pulmonary complications and adverse events in abdominal surgery regardless of surgical approach.Trial registration: LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223).
Published: 2020

25. Urinary neprilysin for early detection of acute kidney injury after cardiac surgery: A prospective observational study

Author: Matthias Kainz, Maximilian Edlinger-Stanger, Sylvia Ryz, Johannes Geilen, Martin H Bernardi, Ludwig Wagner, Larissa Nixdorf, Andrea Lassnigg, Michael Hiesmayr, and Juergen Puchinger
Subjects: Resuscitation, medicine.medical_specialty, Urinary system, urologic and male genital diseases, law.invention, Postoperative Complications, Interquartile range, law, Internal medicine, medicine, Cardiopulmonary bypass, Humans, Prospective Studies, Cardiac Surgical Procedures, Neprilysin, business.industry, Acute kidney injury, Acute Kidney Injury, medicine.disease, Cardiac surgery, Anesthesiology and Pain Medicine, Austria, Creatinine, Cardiology, business, Biomarkers, Kidney disease
Abstract: Background Acute kidney injury (AKI) predicts adverse outcomes after cardiac surgery. The accuracy of using changes in serum creatinine for diagnosis and grading of AKI is limited in the peri-operative cardiac surgical setting and AKI may be underdiagnosed due to haemodilution from cardiopulmonary bypass priming and the need for intra-operative and postoperative volume resuscitation. Objectives To determine whether the urinary biomarker neprilysin can be used as a marker for the early detection of AKI after cardiac surgery. Design Prospective, observational cohort study. Setting Austrian tertiary referral centre. Patients 96 Patients undergoing elective cardiac surgery with cardiopulmonary bypass. Main outcome measures Differences and discriminatory power of neprilysin levels early after cardiac surgery and on postoperative day 1 between patients with or without AKI, as defined by the Kidney Disease Improving Global Outcomes Group. Results AKI was found in 27% (n=26). The median neprilysin levels on postoperative day 1 were significantly higher in the AKI than in the non-AKI group, 4.0 [interquartile range (IQR): 2 to 6.25] vs. 2.0 ng ml [IQR: 1.0 to 4.5], P = 0.0246, respectively. In addition, the median neprilysin levels at the end of surgery were significantly different between both groups, 5.0 [IQR: 2.0 to 9.0] vs. 2.0 ng ml [IQR: 1.0 to 4.0], P = 0.0055, respectively. The discriminatory power of neprilysin for detecting early AKI corresponded to an area under the curve of 0.77 (95% confidence interval, 0.65 to 0.90). Conclusion Urinary neprilysin has potential as a biomarker for the early detection of AKI after cardiac surgery and has comparable discriminatory power to recently studied AKI biomarkers. Trial registration The trial was registered at ClinicalTrials.gov (NCT03854825, https://clinicaltrials.gov/ct2/show/NCT03854825).
Published: 2020

26. Hypophosphatemia in critically ill adults and children - A systematic review

Author: Carole Ichai, Olivier Joannes-Boyau, Angelique de Man, Sonja Fruhwald, Jan Gunst, Stéphane Dauger, Mette M. Berger, Annika Reintam Blaser, Maria Helena Perez, Kadri Tamme, Carina Benstoem, Michael P Casaer, Jan Wernerman, Stefan J. Schaller, Joel Starkopf, Manu L N G Malbrain, Guillaume Besch, Michael Hiesmayr, ACS - Diabetes & metabolism, Intensive care medicine, ACS - Atherosclerosis & ischemic syndromes, Supporting clinical sciences, and Intensive Care
Subjects: 0301 basic medicine, Adult, medicine.medical_specialty, Hypophosphatemia, Critical Illness, MEDLINE, 030209 endocrinology & metabolism, Phosphate, CINAHL, Critical Care and Intensive Care Medicine, law.invention, Refeeding syndrome, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intensive care, medicine, Prevalence, Humans, Intensive care medicine, Child, Outcome, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Retrospective cohort study, medicine.disease, Clinical research, outcome, Observational study, business, Critical illness
Abstract: BACKGROUND & AIMS: Phosphate is the main intracellular anion essential for numerous biological processes. Symptoms of hypophosphatemia are non-specific, yet potentially life-threatening. This systematic review process was initiated to gain a global insight into hypophosphatemia, associated morbidity and treatments. METHODS: A systematic review was conducted (PROSPERO CRD42020163191). Nine clinically relevant questions were generated, seven for adult and two for pediatric critically ill patients, and prevalence of hypophosphatemia was assessed in both groups. We identified trials through systematic searches of Medline, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. Quality assessment was performed using the Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. RESULTS: For all research questions, we identified 2727 titles in total, assessed 399 full texts, and retained 82 full texts for evidence synthesis, with 20 of them identified for several research questions. Only 3 randomized controlled trials were identified with two of them published only in abstract form, as well as 28 prospective and 31 retrospective studies, and 20 case reports. Relevant risk of bias regarding selection and comparability was identified for most of the studies. No meta-analysis could be performed. The prevalence of hypophosphatemia varied substantially in critically ill adults and children, but no study assessed consecutive admissions to intensive care. In both critically ill adults and children, several studies report that hypophosphatemia is associated with worse outcome (prolonged length of stay and the need for respiratory support, and higher mortality). However, there was insufficient evidence regarding the optimal threshold upon which hypophosphatemia becomes critical and requires treatment. We found no studies regarding the optimal frequency of phosphate measurements, and regarding the time window to correct hypophosphatemia. In adults, nutrient restriction on top of phosphate repletion in patients with refeeding syndrome may improve survival, although evidence is weak. CONCLUSIONS: Evidence on the definition, outcome and treatment of clinically relevant hypophosphatemia in critically ill adults and children is scarce and does not allow answering clinically relevant questions. High quality clinical research is crucial for the development of respective guidelines. ispartof: CLINICAL NUTRITION vol:40 issue:4 pages:1744-1754 ispartof: location:England status: published
Published: 2020
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27. Monitoring and parenteral administration of micronutrients, phosphate and magnesium in critically ill patients: The VITA-TRACE survey

Author: Jan Gunst, Kenneth B. Christopher, Danielle E. Bear, Karin Amrein, Joel Starkopf, Pierre Singer, Michael Hiesmayr, Steffen Weber-Carstens, Jan Wernerman, Carole Ichai, Valentin Fuhrmann, Michael P Casaer, Alexander Wilmer, Stephan M. Jakob, J.C. Montejo, Arthur R. H. van Zanten, Wouter Vankrunkelsven, Jean-Charles Preiser, Annika Reintam Blaser, Anne-Françoise Rousseau, Mette M. Berger, Sigismond Lasocki, Heleen M. Oudemans-van Straeten, Intensive care medicine, and ACS - Diabetes & metabolism
Subjects: 0301 basic medicine, Male, Pediatrics, Parenteral Nutrition, Soins intensifs réanimation, Vitamin b complex, Critical Care and Intensive Care Medicine, 0302 clinical medicine, Surveys and Questionnaires, Medicine, Magnesium, Micronutrients, Practice Patterns, Physicians', 610 Medicine & health, Child, Nutrition and Dietetics, Comparative trial, Middle Aged, Micronutrient, Current practice, Female, Multivitamin, Diététique, Adult, medicine.medical_specialty, Adolescent, Critical Care, Critical Illness, Nutritional Status, Phosphate, 030209 endocrinology & metabolism, Context (language use), Phosphates, Refeeding syndrome, 03 medical and health sciences, Young Adult, Humans, Nutrition, 030109 nutrition & dietetics, Critically ill, business.industry, Malnutrition, Magnesium measurement, Nutrition Assessment, Dietary Supplements, Critical illness, business, Deficiency Diseases, Magnesium Deficiency
Abstract: Background & aims: Despite the presumed importance of preventing and treating micronutrient and mineral deficiencies, it is still not clear how to optimize measurement and administration in critically ill patients. In order to design future comparative trials aimed at optimizing micronutrient and mineral management, an important first step is to gain insight in the current practice of micronutrient, phosphate and magnesium monitoring and administration. Methods: Within the metabolism-endocrinology-nutrition (MEN) section of the European Society of Intensive Care Medicine (ESICM), the micronutrient working group designed a survey addressing current practice in parenteral micronutrient and mineral administration and monitoring. Invitations were sent by the ESICM research department to all ESICM members and past members. Results: Three hundred thirty-four respondents completed the survey, predominantly consisting of physicians (321 [96.1%]) and participants working in Europe (262 [78.4%]). Eighty-one (24.3%) respondents reported to monitor micronutrient deficiencies through clinical signs and/or laboratory abnormalities, and 148 (44.3%) reportedly measure blood micronutrient concentrations on a routine basis. Two hundred ninety-two (87.4%) participants provided specific data on parenteral micronutrient supplementation, of whom 150 (51.4%) reported early administration of combined multivitamin and trace element preparations at least in selected patients. Among specific parenteral micronutrient preparations, thiamine (146 [50.0%]) was reported to be the most frequently administered micronutrient, followed by vitamin B complex (104 [35.6%]) and folic acid (86 [29.5%]). One hundred twenty (35.9%) and 113 (33.8%) participants reported to perform daily measurements of phosphate and magnesium, respectively, whereas 173 (59.2%) and 185 (63.4%) reported to routinely supplement these minerals parenterally. Conclusion: The survey revealed a wide variation in current practices of micronutrient, phosphate and magnesium measurement and parenteral administration, suggesting a risk of insufficient prevention, diagnosis and treatment of deficiencies. These results provide the context for future comparative studies, and identify areas for knowledge translation and recommendations., SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2020
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28. Intraoperative mechanical ventilation practice in thoracic surgery patients and its association with postoperative pulmonary complications: results of a multicenter prospective observational study

Author: Christopher Uhlig, Ary Serpa Neto, Meta van der Woude, Thomas Kiss, Jakob Wittenstein, Benjamin Shelley, Helen Scholes, Michael Hiesmayr, Marcos Francisco Vidal Melo, Daniele Sances, Nesil Coskunfirat, Paolo Pelosi, Marcus Schultz, Marcelo Gama de Abreu, LAS VEGAS# investigators, Protective Ventilation Network (PROVEnet), Clinical Trial Network of the European Society of Anaesthesiology, Intensive Care Medicine, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, and ACS - Microcirculation
Subjects: Lung Diseases, Male, medicine.medical_specialty, medicine.medical_treatment, General anesthesia, Anesthesia, General, lcsh:RD78.3-87.3, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Mechanical ventilation, Postoperative Complications, 030202 anesthesiology, Anesthesiology, medicine, Tidal Volume, Humans, 030212 general & internal medicine, Prospective Studies, Fisher's exact test, Aged, business.industry, Perioperative complications, Incidence (epidemiology), Hazard ratio, Length of Stay, Middle Aged, Thoracic Surgical Procedures, Respiration, Artificial, One-Lung Ventilation, Clinical trial, Thoracic surgery, Anesthesiology and Pain Medicine, Cross-Sectional Studies, Cardiothoracic surgery, lcsh:Anesthesiology, Anesthesia, Breathing, symbols, Female, business, Research Article
Abstract: Background: Intraoperative mechanical ventilation may influence postoperative pulmonary complications (PPCs). Current practice during thoracic surgery is not well described. Methods: This is a post-hoc analysis of the prospective multicenter cross-sectional LAS VEGAS study focusing on patients who underwent thoracic surgery. Consecutive adult patients receiving invasive ventilation during general anesthesia were included in a one-week period in 2013. Baseline characteristics, intraoperative and postoperative data were registered. PPCs were collected as composite endpoint until the 5th postoperative day. Patients were stratified into groups based on the use of one lung ventilation (OLV) or two lung ventilation (TLV), endoscopic vs. non-endoscopic approach and ARISCAT score risk for PPCs. Differences between subgroups were compared using χ2 or Fisher exact tests or Student’s t-test. Kaplan–Meier estimates of the cumulative probability of development of PPC and hospital discharge were performed. Cox-proportional hazard models without adjustment for covariates were used to assess the effect of the subgroups on outcome. Results: From 10,520 patients enrolled in the LAS VEGAS study, 302 patients underwent thoracic procedures and were analyzed. There were no differences in patient characteristics between OLV vs. TLV, or endoscopic vs. open surgery. Patients received VT of 7.4 ± 1.6 mL/kg, a PEEP of 3.5 ± 2.4 cmH2O, and driving pressure of 14.4 ± 4.6 cmH2O. Compared with TLV, patients receiving OLV had lower VT and higher peak, plateau and driving pressures, higher PEEP and respiratory rate, and received more recruitment maneuvers. There was no difference in the incidence of PPCs in OLV vs. TLV or in endoscopic vs. open procedures. Patients at high risk had a higher incidence of PPCs compared with patients at low risk (48.1% vs. 28.9%; hazard ratio, 1.95; 95% CI 1.05–3.61; p = 0.033). There was no difference in the incidence of severe PPCs. The in-hospital length of stay (LOS) was longer in patients who developed PPCs. Patients undergoing OLV, endoscopic procedures and at low risk for PPC had shorter LOS. Conclusion: PPCs occurred frequently and prolonged hospital LOS following thoracic surgery. Proportionally large tidal volumes and high driving pressure were commonly used in this sub-population. However, large RCTs are needed to confirm these findings. Trial registration: This trial was prospectively registered at the Clinical Trial Register (www.clinicaltrials.gov; NCT01601223; registered May 17, 2012.)
Published: 2020

29. Exploring factors influencing dietary intake during hospitalization: Results from analyzing nutritionDay's database (2006-2013)

Author: Karin Schindler, Michail Chourdakis, I. Sulz, Michael Hiesmayr, Meropi D. Kontogianni, Fragkiskos G. Bersimis, and K.A. Poulia
Subjects: 0301 basic medicine, Adult, Male, Nausea, Endocrinology, Diabetes and Metabolism, Nutritional Status, 030209 endocrinology & metabolism, computer.software_genre, Affect (psychology), 03 medical and health sciences, Eating, 0302 clinical medicine, Medicine, Humans, Meal, 030109 nutrition & dietetics, Nutrition and Dietetics, Database, business.industry, Nutritional Support, Dietary intake, digestive, oral, and skin physiology, Middle Aged, medicine.disease, Hospitalization, Malnutrition, Cross-Sectional Studies, Gastrointestinal disorder, Vomiting, medicine.symptom, business, nutritionDay, computer
Abstract: Summary Background & aims Hospital food consumption can affect patients’ outcome leading to prolonged hospital stay or even increased mortality. In the present study, the nutritionDay database was analyzed (period 2006–2013) to explore the reasons for reduced food intake and associated factors during hospitalization as reported by the patients per se. Methods Data from 113,930 adult patients (male 49.9%; mean age 64.0 ± 18.1 y, mean BMI 25.7 ± 6.0 kg/m2) (from 4519 units, 1358 hospitals, 54 countries) were included. Dietary intake and reasons for reduced food intake were reported and analyzed. Results Only 41.6% of patients reported to have consumed all their served meal, whereas 9.3% ate nothing although allowed to eat. Variables like presence of caner, having nausea/vomiting, feeling tired, not feeling hungry and not liking food's taste increased the likelihood of consuming “¼ of the meal” but not “nothing”. Variables like having gastrointestinal disorder, being bedrest, receiving nutritional support and not liking food's smell increased the likelihood of both decreased (¼ compared to ½) and null (nothing compared to ¼) food consumption (all p Conclusions Food consumption during hospitalization is associated with variables related to both patients’ condition (e.g. clinical, physical) and factors related to the quality of hospital food.
Published: 2020

30. Perioperative nutrition: Recommendations from the ESPEN expert group

Author: Audrey Stockley, Luca Gianotti, Richard J E Skipworth, Paul L. Greenhaff, Michael Hiesmayr, Stanislaw Klek, Dorthe Hjort Jakobsen, Zeljko Krznaric, Arved Weimann, Rocco Barazzoni, Ralph Stockley, Dileep N. Lobo, Ketan Dhatariya, Nicolaas E. P. Deutz, Zeno Stanga, Olle Ljungqvist, Alfred Adiamah, Donald C. McMillan, Marina Panisic Sekeljic, Katie E. Rollins, Lobo, D, Gianotti, L, Adiamah, A, Barazzoni, R, Deutz, N, Dhatariya, K, Greenhaff, P, Hiesmayr, M, Hjort Jakobsen, D, Klek, S, Krznaric, Z, Ljungqvist, O, Mcmillan, D, Rollins, K, Panisic Sekeljic, M, Skipworth, R, Stanga, Z, Stockley, A, Stockley, R, Weimann, A, Lobo, D. N., Gianotti, L., Adiamah, A., Barazzoni, R., Deutz, N. E. P., Dhatariya, K., Greenhaff, P. L., Hiesmayr, M., Hjort Jakobsen, D., Klek, S., Krznaric, Z., Ljungqvist, O., Mcmillan, D. C., Rollins, K. E., Panisic Sekeljic, M., Skipworth, R. J. E., Stanga, Z., Stockley, A., Stockley, R., and Weimann, A.
Subjects: 0301 basic medicine, medicine.medical_specialty, Sarcopenia, Malnutrition, Nutritional assessment, Nutritional intervention, Perioperative care, Perioperative nutrition, Water-Electrolyte Imbalance, 030209 endocrinology & metabolism, Critical Care and Intensive Care Medicine, Cachexia, 03 medical and health sciences, 0302 clinical medicine, Weight loss, Diabetes mellitus, Medicine, Humans, Risk factor, Intensive care medicine, 610 Medicine & health, Societies, Medical, Glycemic, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Perioperative, Congresses as Topic, medicine.disease, Europe, Surgical Procedures, Operative, Practice Guidelines as Topic, Fluid Therapy, Nutrition Therapy, medicine.symptom, business
Abstract: BACKGROUND & AIMS: Malnutrition has been recognized as a major risk factor for adverse postoperative outcomes. The ESPEN Symposium on perioperative nutrition was held in Nottingham, UK, on 14-15 October 2018 and the aims of this document were to highlight the scientific basis for the nutritional and metabolic management of surgical patients.METHODS: This paper represents the opinion of experts in this multidisciplinary field and those of a patient and caregiver, based on current evidence. It highlights the current state of the art.RESULTS: Surgical patients may present with varying degrees of malnutrition, sarcopenia, cachexia, obesity and myosteatosis. Preoperative optimization can help improve outcomes. Perioperative fluid therapy should aim at keeping the patient in as near zero fluid and electrolyte balance as possible. Similarly, glycemic control is especially important in those patients with poorly controlled diabetes, with a stepwise increase in the risk of infectious complications and mortality per increasing HbA1c. Immobilization can induce a decline in basal energy expenditure, reduced insulin sensitivity, anabolic resistance to protein nutrition and muscle strength, all of which impair clinical outcomes. There is a role for pharmaconutrition, pre-, pro- and syn-biotics, with the evidence being stronger in those undergoing surgery for gastrointestinal cancer.CONCLUSIONS: Nutritional assessment of the surgical patient together with the appropriate interventions to restore the energy deficit, avoid weight loss, preserve the gut microbiome and improve functional performance are all necessary components of the nutritional, metabolic and functional conditioning of the surgical patient.
Published: 2020
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31. The determinants of reduced dietary intake in hospitalised colorectal cancer patients

Author: Jacqueline A.E. Langius, Karin Schindler, Marian A. E. de van der Schueren, I. Sulz, Alessandro Laviano, Katherine Arthey, Anne van der Werf, Michael Hiesmayr, Internal medicine, AGEM - Endocrinology, metabolism and nutrition, VU University medical center, CCA - Cancer Treatment and quality of life, APH - Aging & Later Life, and APH - Health Behaviors & Chronic Diseases
Subjects: Male, medicine.medical_specialty, Colorectal cancer, media_common.quotation_subject, Nutritional Status, Disease, 03 medical and health sciences, 0302 clinical medicine, Weight loss, Internal medicine, Surveys and Questionnaires, medicine, Humans, 030212 general & internal medicine, Determinants, media_common, Aged, Performance status, business.industry, Dietary intake, Malnutrition, Appetite, Odds ratio, Middle Aged, medicine.disease, Diet, Hospitalization, Oncology, 030220 oncology & carcinogenesis, Female, Original Article, medicine.symptom, nutritionDay, business, Colorectal Neoplasms
Abstract: Purpose: Patients with colorectal cancer (CRC) often experience malnutrition and weight loss, largely resulting from reduced dietary intake. The aim of this study was to identify determinants of reduced dietary intake in order to facilitate early recognition of malnutrition and optimise nutritional treatment. Methods: Data from nutritionDay, an international 1-day survey investigating patient, disease and food profiles, were used. To identify determinants of dietary intake, defined as normal vs. reduced in the last week, univariate and multivariate logistic regressions were performed. Results: Of 1131 hospitalised CRC patients, 54% reported reduced dietary intake. Patient- and disease-related characteristics significantly associated with reduced dietary intake were female gender (odds ratio (OR) 1.38), cancer stage III (OR 1.52) or IV (OR 1.70) vs. I, performance status 2 (OR 1.56), 3 (OR 2.37) or 4 (OR 4.15) vs. 0, duration since hospital admission of ≥ 4 days (OR 4–7 days, 1.91; 8–21 days, 1.97; > 21 days, 1.92) vs. < 4 days, and unintentional weight loss (OR 2.56). Additionally, higher symptom scores of pain, weakness, depression, tiredness and lack of appetite were associated with reduced intake. Conclusions: Patient- and disease-related determinants for reduced dietary intake were being female, higher cancer stage, worse performance status, duration since hospital admission ≥ 4 days and unintentional weight loss. Furthermore, multiple symptoms were associated with a reduced dietary intake. Future trials should assess whether early recognition of patients at risk of malnutrition and the combination of treating symptoms and dietary advice result in improved intake and treatment-related outcomes.
Published: 2018
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32. Prevalence of obesity in european nursing homes between 2007 and 2018 – a nutritionday analysis

Author: Karin Schindler, Eva Kiesswetter, Cornel C. Sieber, Michael Hiesmayr, Gabriel Torbahn, I. Galicia Ernst, and Dorothee Volkert
Subjects: medicine.medical_specialty, Nutrition and Dietetics, business.industry, Endocrinology, Diabetes and Metabolism, Family medicine, Medicine, business, medicine.disease, nutritionDay, Nursing homes, Obesity
Published: 2021
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33. Phase angle (pa) is a stronger predictor of hospital outcome than subjective global assessment (sga) - results from the prospective dessau malnutrition study

Author: P. Bauer, M. Viertel, I. Sulz, M. Plauth, and Michael Hiesmayr
Subjects: Malnutrition, Pediatrics, medicine.medical_specialty, Nutrition and Dietetics, Hospital outcomes, business.industry, Endocrinology, Diabetes and Metabolism, Phase angle, medicine, medicine.disease, business
Published: 2021
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34. Which ct cut-off for low muscle mass should we choose? prevalence of low muscle mass according to different ct cut-offs

Author: H. Ringl, A. Fischer, D. Tamandl, T. Siebenrock, R. Hahn, M. Pesta, M. Anwar, M. Posch, Michael Hiesmayr, A. Hertwig, J. Brugger, K. Liebau, and I. Timmermann
Subjects: Low muscle mass, Nutrition and Dietetics, business.industry, Endocrinology, Diabetes and Metabolism, Medicine, Cut-off, Nuclear medicine, business
Published: 2021
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35. Covid-19 hospitalized patients at nutritionday: use of enteral nutrition, parenteral nutrition or oral nutritional supplements is associated with being bedridden, not being allowed to eat, low appetite and low bmi

Author: Silvia Tarantino, Stéphane M. Schneider, Rocco Barazzoni, Michael Hiesmayr, C. Cuerda-Compes, and I. Sulz
Subjects: 2019-20 coronavirus outbreak, Pediatrics, medicine.medical_specialty, Nutrition and Dietetics, Coronavirus disease 2019 (COVID-19), Hospitalized patients, business.industry, Endocrinology, Diabetes and Metabolism, media_common.quotation_subject, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Appetite, Article, Parenteral nutrition, medicine, nutritionDay, business, media_common
Published: 2021
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36. Use of parenteral nutrition in European hospital wards is stable over time but differs across countries: a nutritionday analysis 2006-2019

Author: Silvia Tarantino, P. Garcia Lorda, I. Sulz, U. Mellino, and Michael Hiesmayr
Subjects: medicine.medical_specialty, Nutrition and Dietetics, Parenteral nutrition, business.industry, Endocrinology, Diabetes and Metabolism, medicine, nutritionDay, Intensive care medicine, business
Published: 2021
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37. Association of ct skeletal muscle area and density with age: a prospective study in 200 non-critically ill patients

Author: R. Hahn, Michael Hiesmayr, A. Hertwig, T. Siebenrock, I. Timmermann, M. Anwar, M. Pesta, H. Ringl, D. Tamandl, M. Posch, A. Fischer, J. Brugger, and K. Liebau
Subjects: medicine.medical_specialty, Nutrition and Dietetics, medicine.anatomical_structure, Critically ill, business.industry, Endocrinology, Diabetes and Metabolism, Internal medicine, medicine, Skeletal muscle, Prospective cohort study, business
Published: 2021
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38. Association between food intake and oral nutrition supplementation utilization among patients at malnutrition risk in Latin America: results from nutritionday

Author: Gabriel Gomez, I. Sulz, Michael Hiesmayr, Suela Sulo, Silvia Tarantino, and C. Brunton
Subjects: Nutrition supplementation, Malnutrition, Food intake, Nutrition and Dietetics, Latin Americans, business.industry, Endocrinology, Diabetes and Metabolism, Environmental health, medicine, medicine.disease, nutritionDay, business
Published: 2021
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39. Medical nutrition therapy in adult critically-ill intensive care unit (ICU) patients in Europe: results from the Europn study

Author: L. Krzych, A. Csomos, O. Huet, C. Vaquerizo Alonso, Olav Rooyackers, R. Tetamo, Wolfgang H. Hartl, Michael Hiesmayr, M. Matejovic, Gunnar Elke, Inga Tjäder, K. Dams, H. Kuechenhoff, and Zudin Puthucheary
Subjects: medicine.medical_specialty, Icu patients, Nutrition and Dietetics, business.industry, Critically ill, law, Endocrinology, Diabetes and Metabolism, medicine, Medical nutrition therapy, Intensive care medicine, business, Intensive care unit, law.invention
Published: 2021
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40. How does a previous icu stay modify nutrition support in the wards: a risk adjusted evaluation from 191 886 adult patients from nutritionday 2006-2019

Author: E. Pestana, A. Lassnigg, Cecilia Veraar, Silvia Tarantino, Michael Hiesmayr, and Alessandro Laviano
Subjects: medicine.medical_specialty, Nutrition and Dietetics, Adult patients, business.industry, Endocrinology, Diabetes and Metabolism, Emergency medicine, Nutrition support, Medicine, Icu stay, business, nutritionDay, Risk adjusted
Published: 2021
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41. Impact of medical nutrition therapy on clinical outcomes in adult critically ill intensive care unit (ICU) patients in Europe: results from the europn study

Author: L. Krzych, A. Csomos, Inga Tjäder, Gunnar Elke, H. Kuechenhoff, M. Matejovic, Zudin Puthucheary, Olav Rooyackers, O. Huet, C. Vaquerizo Alonso, K. Dams, Michael Hiesmayr, R. Tetamo, and Wolfgang H. Hartl
Subjects: Icu patients, medicine.medical_specialty, Nutrition and Dietetics, law, business.industry, Critically ill, Endocrinology, Diabetes and Metabolism, medicine, Medical nutrition therapy, Intensive care medicine, business, Intensive care unit, law.invention
Published: 2021
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42. Cut-off for risk increase with low bmi in hospitalized patients: A regional nutritionday analysis

Author: I. Sulz, Michael Hiesmayr, A. Fischer, Mohamed Mouhieddine, Christian Schuh, Cecilia Veraar, S. Moick, and Silvia Tarantino
Subjects: medicine.medical_specialty, Nutrition and Dietetics, business.industry, Hospitalized patients, Endocrinology, Diabetes and Metabolism, Emergency medicine, Medicine, business, nutritionDay
Published: 2020
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43. The effect of acute ventilation-perfusion mismatch on respiratory heat exchange in a porcine model

Author: Ayoubi Nathan, Neal Fleming, Stefan Böhme, Maximilian Edlinger-Stanger, Katharina Kovacs, Martin H Bernardi, Michael Mascha, Garry James, Nico Christofi, Thomas Neugebauer, Michael Hiesmayr, and Ogoh, Shigehiko
Subjects: 0301 basic medicine, Hot Temperature, Physiology, Swine, Dead space, Cardiovascular, Mass Spectrometry, 0302 clinical medicine, Enthalpy, Blood Flow, Medicine and Health Sciences, Cardiac Output, Pulmonary Arteries, Respiratory system, Acute Respiratory Distress Syndrome, Lung, Fluids, Assistive Technology, Multidisciplinary, Multiple inert gas elimination technique, Physics, Respiration, Arteries, Hematology, Left pulmonary artery, Body Fluids, Perfusion, Blood, medicine.anatomical_structure, Physical Sciences, Artificial, Respiratory, Breathing, Cardiology, Thermodynamics, Medicine, Gases, Anatomy, Research Article, States of Matter, medicine.medical_specialty, General Science & Technology, Science, Partial Pressure, Ventilation perfusion mismatch, Bioengineering, Respiratory physiology, 03 medical and health sciences, Rare Diseases, Internal medicine, medicine, Animals, Respiratory Physiology, Animal, business.industry, Hemodynamics, Biology and Life Sciences, Respiration, Artificial, Oxygen, Disease Models, Animal, 030104 developmental biology, Disease Models, Cardiovascular Anatomy, Blood Vessels, Physiological Processes, business, 030217 neurology & neurosurgery, Respiratory tract
Abstract: Background Respiratory heat exchange is an important physiological process occurring in the upper and lower respiratory tract and is usually completed when inspired gases reach the alveoli. Animal and human studies demonstrated that heat exchange can be modulated by altering pulmonary ventilation and perfusion. The purpose of this study was to examine the effect of acute ventilation-perfusion (V/Q) mismatch on respiratory heat exchange. In clinical practice, monitoring respiratory heat exchange might offer the possibility of real-time tracking of acute V/Q-mismatch. Methods In 11 anesthetized, mechanically ventilated pigs, V/Q-mismatch was established by means of four interventions: single lung ventilation, high cardiac output, occlusion of the left pulmonary artery and repeated whole-lung lavage. V/Q-distributions were determined by the multiple inert gas elimination technique (MIGET). Respiratory heat exchange was measured as respiratory enthalpy using the novel, pre-commercial VQm™ monitor (development stage, Rostrum Medical Innovations, Vancouver, CA). According to MIGET, shunt perfusion of low V/Q compartments increased during single lung ventilation, high cardiac output and whole-lung lavage, whereas dead space and ventilation of high V/Q compartments increased during occlusion of the left pulmonary artery and whole-lung lavage. Results Bohr dead space increased after pulmonary artery occlusion and whole-lung lavage, venous admixture increased during single lung ventilation and whole-lung lavage, PaO2/FiO2 was decreased during all interventions. MIGET confirmed acute V/Q-mismatch. Respiratory enthalpy did not change significantly despite significant acute V/Q-mismatch. Conclusion Clinically relevant V/Q-mismatch does not impair respiratory heat exchange in the absence of additional thermal stressors and may not have clinical utility in the detection of acute changes.
Published: 2021
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44. Who receives oral nutritional supplements in nursing homes? Results from the nutritionDay project

Author: Karin Schindler, Dorothee Volkert, Michael Hiesmayr, M. Streicher, Cornel C. Sieber, and M. Themessl-Huber
Subjects: Male, 0301 basic medicine, Pediatrics, medicine.medical_specialty, Multivariate analysis, Administration, Oral, Nutritional Status, Critical Care and Intensive Care Medicine, Logistic regression, Sensitivity and Specificity, Body Mass Index, 03 medical and health sciences, Weight loss, Surveys and Questionnaires, Environmental health, Weight Loss, medicine, Homes for the Aged, Humans, Geriatric Assessment, Aged, Aged, 80 and over, Univariate analysis, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Malnutrition, Odds ratio, medicine.disease, Confidence interval, Diet, Nursing Homes, Cross-Sectional Studies, Nutrition Assessment, Dietary Supplements, Female, medicine.symptom, nutritionDay, business
Abstract: Summary Background & aims Oral nutritional supplements (ONS) can be helpful for nursing home (NH) residents to prevent or treat malnutrition. Presently little is known about the use of ONS in NHs and the factors associated with its use. Thus, the aim of this analysis was to describe the use of ONS in NHs participating in the nutritionDay project and to determine characteristics of NH residents receiving ONS. Methods Data from nutritionDay (nD), a cross-sectional multicenter study with standardized questionnaires on resident and NH level were analyzed. NH residents participating between 2007 and 2014 aged 65 years or older were included. Unit characteristics (2 variables), general residents' characteristics (18), residents' nutritional status (3) and residents' nutrition (4) were of interest as potential predictors of the use of ONS (no vs yes). Univariate binary logistic regression (LR) analyses were performed for all variables, and significant predictors (p Results 13.9% of 23,689 NH residents received ONS. Univariate analysis identified all variables as predictors. After multivariate analysis 19 variables remained in the model (Nagelkerke's R2 = 0.319). Odds ratios (OR [95% Confidence Interval]) of receiving ONS were highest in residents receiving supplementary parenteral nutrition (29.05 [14.85–56.81]; however only 1.1% of all participants) and fortified diet (11.91 [8.52–16.64]; 5.7%). The odds ratio of receiving ONS was 3.26 ([2.86–3.71]; 18.3%) for residents being classified as at risk of malnutrition and 4.56 ([3.86–5.40]; 10.0%) for malnourished residents according to NH staff. Low BMI and weight loss in the last year increased the odds of receiving ONS by 2.34 ([1.93–2.84]; 16.0%) and 1.38 ([1.23–1.54]; 32.8%), respectively. Furthermore, increasing age, cognitive and functional impairment, low food intake on nD, neurological disease and cancer were associated with an increased likelihood of the use of ONS. In NH units with a nutritional expert (67.1%) and units performing a nutritional assessment at least once a month (71.6%), the odds of receiving ONS were also significantly increased (1.89 [1.71–2.10] and 1.17 [1.06–1.29]). Conclusion In NHs who participated in the nutritionDay, ONS are used for residents with poor nutritional and functional status and often in combination with other nutritional interventions. Future studies need to clarify the role of NH staff in the prescription and distribution of ONS and focus on the reasons for and adequacy of the use of ONS in NHs.
Published: 2017
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45. nutritionDay: 10 years of growth

Author: I. Sulz, Dorothee Volkert, Claude Pichard, Karin Schindler, M. Streicher, Michael Hiesmayr, Pierre Singer, Olle Ljungqvist, André Van Gossum, and Peter Bauer
Subjects: 0301 basic medicine, medicine.medical_specialty, Population, Nutritional Status, Critical Care and Intensive Care Medicine, Body Mass Index, law.invention, 03 medical and health sciences, Documentation, Nursing, law, Surveys and Questionnaires, Intensive care, Health care, Prevalence, medicine, Humans, education, education.field_of_study, 030109 nutrition & dietetics, Nutrition and Dietetics, Nutritional Support, business.industry, Data Collection, Malnutrition, Benchmarking, Nutrition Surveys, medicine.disease, Intensive care unit, Nursing Homes, Hospitalization, Intensive Care Units, Nutrition Assessment, Family medicine, business, nutritionDay
Abstract: Despite high prevalence at hospital admission, disease related malnutrition (DRM) remains under recognized and undertreated. DRM is associated with increased morbidity, hospital readmission rate, and burden for the healthcare system. The compelling need to increase awareness and knowledge through an international survey has triggered the launch of the nutritionDay (ND) concept.ND is a worldwide annual systematic collection and analysis of data in hospital wards, intensive care units and nursing homes. ND is based on questionnaires to systematically collect and analyze the patient's characteristics, food intake and nutrition support, as well as the determinants of their environment (facility, health care personal, etc …). Questionnaires, outcome documentation sheets and step-by-step guidance are available as download in 30 languages.ND has described the nutritional status and behavior of over 150,000 hospitalized patients and nursing home's patients in over 56 participating countries. These data allowed a local, regional, national and international benchmarking at different levels (i.e. type of medical pathologies, care facilities, etc.) and over time. Sixteen peer-reviewed publications have already been released and picture the international scene of DRM.This review presents the 10-year of the ND project development and shows how ND serves all health care professionals to optimize nutrition care and nutrition related structures. ND keeps progressing and is likely to become a standard tool for determining the nutritional status and behavior of hospitalized patients and nursing home's population.
Published: 2017
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46. Can Early Rehabilitation on the General Ward After an Intensive Care Unit Stay Reduce Hospital Length of Stay in Survivors of Critical Illness?

Author: Tatjana Paternostro-Sluga, Wolfgang Gruther, Irene Steiner, Cornelia Hein, Karin Pieber, and Jörg Michael Hiesmayr
Subjects: Male, Patient Transfer, medicine.medical_specialty, Time Factors, Critical Illness, Length of hospitalization, Walk Test, Physical Therapy, Sports Therapy and Rehabilitation, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Patients' Rooms, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Early Ambulation, Physical Therapy Modalities, APACHE, Aged, Pain Measurement, Intention-to-treat analysis, Primary Health Care, business.industry, Rehabilitation, 030208 emergency & critical care medicine, Recovery of Function, Length of Stay, Middle Aged, Intensive care unit, humanities, Intention to Treat Analysis, Intensive Care Units, Treatment Outcome, Critical illness, Emergency medicine, Female, General ward, business, Early rehabilitation
Abstract: The aim of this study was to evaluate if an early rehabilitation program for survivors of critical illness improves functional recovery, reduces length of stay, and reduces hospital costs.This was a prospective randomized controlled trial. Fifty-three consecutive survivors of critical illness were included in the study. After discharge from the intensive care unit, the intervention group received an early rehabilitation program, and the standard-care group received physical therapy as ordered by the primary care team. Length of stay at the general ward after transfer from the intensive care unit was recorded. In addition, Early Rehabilitation Barthel Index, visual analog scale for pain, 3-minute walk test, Beck Depression Inventory, State-Trait Anxiety Inventory, and Medical Research Council scale were used.In the per-protocol analysis, length of stay at the general ward was a median 14 days (interquartile range [IQR], 12-20 days) in the early rehabilitation and 21 days [IQR, 13-34 days) in the standard-care group. This significant result could not be confirmed by the intention-to-treat analysis (16 days [IQR, 13-23 days] vs. 21 days [IQR, 13-34 days]). Secondary outcomes were similar between the groups. Hospital costs were lower in the intervention group. No adverse effects were detected.An early rehabilitation program in survivors of critical illness led to an earlier discharge from the hospital, improved functional recovery, and was also cost-effective and safe.Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) delineate the benefits of early rehabilitation on a general medicine ward after an intensive care unit stay, (2) recognize the safety of appropriately implemented early rehabilitation, and (3) incorporate early rehabilitation on the general medical ward as applicable.Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Published: 2017
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47. NutritionDay ICU: A 7 year worldwide prevalence study of nutrition practice in intensive care

Author: Itai Bendavid, Miriam Theilla, M. Themessl-Huber, Pierre Singer, Christian Schuh, Mohamed Mouhieddine, B. Mora, Michael Hiesmayr, and I. Sulz
Subjects: Adult, Male, 0301 basic medicine, Parenteral Nutrition, Pediatrics, medicine.medical_specialty, Calorie, Adolescent, Population, Comorbidity, Global Health, Critical Care and Intensive Care Medicine, Enteral administration, Cohort Studies, 03 medical and health sciences, Enteral Nutrition, Spatio-Temporal Analysis, 0302 clinical medicine, Intensive care, Prevalence, Humans, Medicine, Practice Patterns, Physicians', Child, education, education.field_of_study, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Malnutrition, 030208 emergency & critical care medicine, Intensive Care Units, Cross-Sectional Studies, Parenteral nutrition, Health Care Surveys, Practice Guidelines as Topic, Female, SOFA score, Energy Intake, nutritionDay, business, Cohort study
Abstract: Summary Introduction To determine the nutrition practice in intensive care units and the associated outcome across the world, a yearly 1 day cross sectional audit was performed from 2007 to 2013. The data of this initiative called “nutritionDay ICU” were analyzed. Material and methods A questionnaire translated in 17 languages was used to determine the unit's characteristics, patient's condition, nutrition condition and therapy as well as outcome. All the patients present in the morning of the 1 day prevalence study were included from 2007 to 2013. Results 9777 patients from 46 countries and 880 units were included. Their SAPS 2 was median 38 (IQR 27–51), predicted mortality was 30.7% ± 26.9, and their SOFA score 4.5 ± 3.4 with median 4 (IQR 2–7). Administration of calories did not appear to be related to actual or ideal body weight within all BMI groups. Patients with a BMI 40 received slightly less calories than all other BMI groups. Two third of the patients were either ventilated or were in the ICU for longer than 24 h at nutritionDay. Routes of feeding used were the oral, enteral and parenteral routes. More than 40% of the patients were not fed during the first day. The mean energy administered using enteral route was 1286 ± 663 kcal/day and using parenteral nutrition 1440 ± 652 kcal/day. 60 days mortality was 26.0%. Discussion This very large collaborative cohort study shows that most of the patients are underfed during according to actual recommendations their ICU stay. Prescribed calories appear to be ordered regardless to the ideal weight of the patient. Nutritional support is slow to start and never reaches the recommended targets. Parenteral nutrition prescription is increasing during the ICU stay but reaching only 20% of the population studied if ICU stay is one week or longer. The nutritional support worldwide does not seem to be guided by weight or disease but more to be standardized and limited to a certain level of calories. These observations are showing the poor observance to guidelines.
Published: 2017
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48. Critical care admission following elective surgery was not associated with survival benefit

Author: Kahan, Brennan C., Desponia, Koulenti, Kostoula, Arvaniti, Vanessa, Beavis, Douglas, Campbell, Matthew, Chan, Rui, Moreno, Pearse, Rupert M., Scott, Beattie, Pierre-Alain, Clavien, Nicolas, Demartines, Lee, A Fleisher, Mike, Grocott, James, Haddow, Andreas, Hoeft, Peter, Holt, Naomi, Pritchard, Andrew, Rhodes, Duminda, Wijeysundera, Matt, Wilson, Tahania, Ahmed, Kirsty, Everingham, Russell, Hewson, Marta, Januszewska, Rupert, M Pearse, Mandeep-Kaur, Phull, Richard, Halliwell, Mark, Shulman, Paul, Myles, Werner, Schmid, Michael, Hiesmayr, Patrick, Wouters, Stefan de Hert, Suzana, Lobo, Xiangming, Fang, Lars, Rasmussen, Emmanuel, Futier, Matthieu, Biais, Aurélien, Venara, Karem, Slim, Michael, Sander, Despoina, Koulenti, Mathew, Chan, Atul, Kulkarni, Susilo, Chandra, Aida, Tantri, Emad, Geddoa, Muntadhar, Abbas, Giorgio Della Rocca, Datin, Sivasakthi, Marzida, Mansor, Pastor, Luna, Arthur, Bouwman, Wolfgang, Buhre, Tim, Short, Tunde, Osinaike, Ricardo, Matos, Ioana, Grigoras, Mikhail, Kirov, Denis, Protsenko, Bruce, Biccard, Cesar, Aldecoa, Michelle, Chew, Christoph, Hofer, Martin, Hubner, James, Ditai, Tamas, Szakmany, Lee, Fleisher, Marissa, Ferguson, Michael, Macmahon, Ritchie, Cherian, Helen, Currow, Kathirgamanathan, Kanathiban, David, Gillespie, Edward, Pathmanathan, Katherine, Phillips, Jenifer, Reynolds, Joanne, Rowley, Jeanene, Douglas, Ross, Kerridge, Sameer, Garg, Michael, Bennett, Megha, Jain, David, Alcock, Nico, Terblanche, Rochelle, Cotter, Kate, Leslie, Marcelle, Stewart, Nicolette, Zingerle, Antony, Clyde, Oliver, Hambidge, Adam, Rehak, Sharon, Cotterell, Wilson Binh Quan Huynh, Timothy, Mcculloch, Erez, Ben-Menachem, Thomas, Egan, Jennifer, Cope, Paul, Fellinger, Simone, Haselberger, Caroline, Holaubek, Paul, Lichtenegger, Florian, Scherz, Franz, Hoffer, Veronika, Cakova, Andreas, Eichwalder, Norbert, Fischbach, Reinhold, Klug, Elisabeth, Schneider, Martin, Vesely, Reinhart, Wickenhauser, Karl Gernot Grubmueller, Marion, Leitgeb, Friedrich, Lang, Nancy, Toro, Marlene, Bauer, Friedrich, Laengle, Thomas, Mayrhofer, Christian, Buerkle, Karin, Forstner, Reinhard, Germann, Harald, Rinoesl, Elke, Schindler, Ernst, Trampitsch, Gerhard, Fritsch, Christian, Szabo, Jawad, Bidgoli, Hans, Verdoodt, Patrice, Forget, David, Kahn, Fernande, Lois, Mona, Momeni, Caroline, Prégardien, Audrey, Pospiech, Arnaud, Steyaert, Laurent, Veevaete, Dirk De Kegel, Karen De Jongh, Luc, Foubert, Carine, Smitz, Marcel, Vercauteren, Jan, Poelaert, Veerle Van Mossevelde, Jacques, Abeloos, Stefaan, Bouchez, Marc, Coppens, Luc De Baerdemaeker, Isabel, Deblaere, Ann De Bruyne, Stefan De Hert, Kristine, Fonck, Bjorn, Heyse, Tom, Jacobs, Koen, Lapage, Anneliese, Moerman, Martine, Neckebroek, Aliaksandra, Parashchanka, Nathalie, Roels, Nancy Van Den Eynde, Michael, Vandenheuvel, Jurgen Van Limmen, Ann, Vanluchene, Caroline, Vanpeteghem, Piet, Wyffels, Christel, Huygens, Punitha, Vandenbempt, Marc Van de Velde, Dimitri, Dylst, Bruno, Janssen, Evelien, Schreurs, Fábia Berganton Aleixo, Keulle, Candido, Hugo Dias Batista, Mario, Guimarães, Jaqueline, Guizeline, João, Hoffmann, Suzana, M Lobo, Francisco Ricardo Lobo, Vinícius, Nascimento, Katia, Nishiyama, Lucas, Pazetto, Daniela, Souza, Rodrigo Souza Rodrigues, Ana Maria Vilela Dos Santos, Jaquelline, Jardim, Joao, Silva, Paulo do Nascimento Junior, Thalissa Hermínia Baio, Gabriel Isaac Pereira de Castro, Henri Roger Watanabe Oliveira, Cristina Prata Amendola, Gutemberg, Cardoso, Daniela, Ortega, Ana Flavia Brotto, Mirella Cristine De Oliveira, Álvaro, Réa-Neto, Fernando, Dias, Pedro, Azambuja, Marcos Freitas Knibel, Antonio, Martins, William, Almeida, Calim Neder Neto, Maria Angela Tardelli, Eliana, Caser, Marcio, Machado, Crisitiano, Aguzzoli, Sérgio, Baldisserotto, Fernanda Beck Tabajara, Fernanda, Bettega, La Hore Correa Rodrigues Júnior, Julia de Gasperi, Lais, Faina, Marcos Farias Nolasco, Bruna Ferreira da Costa Fischer, Mariana Fosch de Campos Ferreira, Cristina, Hartmann, Marta, Kliemann, Gustavo Luis Hubert Ribeiro, Julia Merladete Fraga, Thiago Motta Netto, Laura Valduga Pozza, Paulo Rafael Wendling, Caroline, Azevedo, Juliana, Garcia, Marcel, Lopes, Bernardo, Maia, Paula, Maselli, Ralph, Melo, Weslley, Mendes, Matheus, Neves, Jacqueline, Ney, Claudio, Piras, Christopher, Applewhaite, Adrienne, Carr, Lorraine, Chow, Kaylene, Duttchen, Julena, Foglia, Michael, Greene, Ashley, Hinther, Kendra, Houston, Thomas Jared McCormick, Jennifer, Mikhayel, Sam, Montasser, Alex, Ragan, Andrew, Suen, Adrianna, Woolsey, Hai Chuan Yu, Duane, Funk, Stephen, Kowalski, Regina, Legaspi, Heather, Mcdonald, Faisal, Siddiqui, Jeremy, Pridham, Bernadette, Rowe, Sonia, Sampson, Barton, Thiessen, Geoff, Zbitnew, Andre, Bernard, Ronald, George, Philip, Jones, Rita, Moor, Naveed, Siddiqui, Alexandra, Wolfer, Diem, Tran, Denyse, Winch, Gary, Dobson, Thomas, Mccormick, Osama, Montasser, Richard, Hall, Leyla, Baghirzada, Si Yuan Dai, Gregory, Hare, Esther, Lee, Uma, Shastri, Albert, 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Fan, Yu, Shuying, Fu, Xiaodong, Ge, Baolei, Guo, Wenhui, Huang, Linghui, Jiang, Xinmei, Jiang, Liu, Yi, Yan, Pan, Yun, Ren, Shan, Qi, Jiaxing, Wang, Fei, Wang, Chi, Wu, Xiaoguang, Zhang, Ida Cecilie Christiansen, Simon Nørgaard Granum, Bodil Steen Rasmussen, Morten, Daugaard, Rajiv, Gambhir, Guðný Erla Steingrímsdóttir, Peter, Jensen-Gadegaard, Karsten Skovgaard Olsen, Hanna, Siegel, Katrine Zwicky Eskildsen, Mona Ring Gätke, Ida, Wibrandt, Simon Bisgaard Heintzelmann, Kai Henrik Wiborg Lange, Rune Sarauw Lundsgaard, Louise, Amstrup-Hansen, Claus, Hovendal, Michael, Larsen, Mette, Lenstrup, Tina, Kobborg, Jens Rolighed Larsen, Anette Barbre Pedersen, Søren Hübertz Smith, Rebecca Monett Oestervig, Arash, Afshari, Cheme, Andersen, Kim, Ekelund, Erik Lilja Secher, Birgitte, Brandsborg, Helene, Beloeil, Sigismond, Lasocki, Alexandre, Ouattara, Marlene, Sineus, Serge, Molliex, Marie Lim Legouge, Florent, Wallet, Antoine, Tesniere, Christophe, Gaudin, Paul, Lehur, Emma, Forsans, Stéphane de Rudnicki, Valerie Serra Maudet, Didier, Mutter, Ghassan, Sojod, Mehdi, Ouaissi, Jean-Marc, Regimbeau, Jacques, Desbordes, Nicolas, Comptaer, Diae El Manser, Sabine, Ethgen, Gilles, Lebuffe, Patrick, Auer, Christine, Härtl, Maria, Deja, Kirill, Legashov, Susanne, Sonnemann, Carola, Wiegand-Loehnert, Elke, Falk, Marit, Habicher, Stefan, Angermair, Beatrix, Laetsch, Katrin, Schmidt, Christian Von Heymann, Axel, Ramminger, Florian, Jelschen, Svenja, Pabel, Andreas, Weyland, Elke, Czeslick, Jochen, Gille, Michael, Malcharek, Armin, Sablotzki, Katharina, Lueke, Peter, Wetzel, Joerg, Weimann, Franz-Peter, Lenhart, Florian, Reichle, Frederike, Schirmer, Michael, Hüppe, Karl, Klotz, Carla, Nau, Julika, Schön, Thomas, Mencke, Christina, Wasmund, Carla, Bankewitz, Georg, Baumgarten, Andreas, Fleischer, Vera, Guttenthaler, Yvonne, Hack, Katharina, Kirchgaessner, Olja, Männer, Marlen, Schurig-Urbaniak, Rafael, Struck, Rebekka van Zyl, Maria, Wittmann, Ulrich, Goebel, Sarah, Harris, Siegfried, Veit, Evangelia, Andreadaki, Flora, Souri, Ioannis, Katsiadramis, Anthi, Skoufi, Maria, Vasileiou, Eleni, Aimoniotou-Georgiou, Anastasios, Katsourakis, Fotini, Veroniki, Glyceria, Vlachogianni, Konstantina, Petra, Dimitra, Chlorou, Eirini, Oloktsidou, Vasileios, Ourailoglou, Konstantinos, Papapostolou, Georgia, Tsaousi, Panagoula, Daikou, Georgia, Dedemadi, Ioannis, Kalaitzopoulos, Christos, Loumpias, Sotirios, Bristogiannis, Nikolaos, Dafnios, Georgios, Gkiokas, Elissaios, Kontis, Dimitra, Kozompoli, Aspasia, Papailia, Theodosios, Theodosopoulos, Christol, Bizios, Anastasia, Koutsikou, Aleaxandra, Moustaka, Ioannis, Plaitakis, Apostolos, Armaganidis, Theodora, Christodoulopoulou, Mihail, Lignos, Maria, Theodorakopoulou, Andreas, Asimakos, Eleni, Ischaki, Angeliki, Tsagkaraki, Spyros, Zakynthinos, Eleni, Antoniadou, Ioannis, Koutelidakis, Dimitrios, Lathyris, Irene, Pozidou, Nikolaos, Voloudakis, Maria, Dalamagka, Elena, Gkonezou, Christos, Chronis, Dimitra, Manolakaki, Dimitris, Mosxogiannidis, Tatiana, Slepova, Isaia-Sissy, Tsakiridou, Claire Lampiri Lampiri, Anastasia Vachlioti Vachlioti, Christos Panagiotakis Panagiotakis, Dimitrios Sfyras Sfyras, Fotios Tsimpoukas Tsimpoukas, Athanasia, Tsirogianni, Elena, Axioti, Andreas, Filippopoulos, Elli, Kalliafa, George, Kassavetis, Petros, Katralis, Ioannis, Komnos, Georgios, Pilichos, Ifigenia, Ravani, Antonis, Totis, Eymorfia, Apagaki, Andromachi, Efthymiadi, Nikolaos, Kampagiannis, Theoniki, Paraforou, Agoritsa, Tsioka, Georgios, Georgiou, Aristeidis, Vakalos, Aggeliki, Bairaktari, Efthimios, Charitos, George, Markou, Panagiota, Niforopoulou, Nikolaos, Papakonstantinou, Evdoxia, Tsigou, Archontoula, Xifara, Menelaos, Zoulamoglou, Panagiota, Gkioni, Stylianos, Karatzas, Aikaterini, Kyparissi, Efstratios, Mainas, Ioannis, Papapanagiotou, Theonymfi, Papavasilopoulou, George, Fragandreas, Eleni, Georgopoulou, Eleni, Katsika, Kyriakos, Psarras, Eirini, Synekidou, Maria, Verroiotou, Evangelia, Vetsiou, Donika, Zaimi, Athina, Anagnou, Konstantinos, Apostolou, Theodora, Melissopoulou, Theophilos, Rozenberg, Christos, Tsigris, Georgios, Boutsikos, Vasileios, Kalles, Nikolaos, Kotsalas, Christina, Lavdaiou, Fotini, Paikou, Georgia-Laura, Panagou, Anna, Spring, Ioannis, Botis, Maria, Drimala, Georgios, Georgakakis, Ellada, Kiourtzieva, Panagiota, Ntouma, Apostolos, Prionas, Kyriakos, Xouplidis, Eleftheria, Dalampini, Chrysavgi, Giannaki, Christina, Iasonidou, Orestis, Ioannidis, Athina, Lavrentieva, Athena, Lavrentieva, George, Papageorgiou, Maria, Kokkinoy, Maria, Stafylaraki, Stylianos, Gaitanakis, Periclis, Karydakis, Josef, Paltoglou, Panagiotis, Ponireas, Panagiotis, Chaloulis, Athanasios, Provatidis, Anisoglou, Sousana, Varvara Vanessa Gardikou, Maria, Konstantivelli, Olga, Lataniotou, Elisavet, Lisari, Maria, Margaroni, Konstantinos, Stamatiou, Edouardos, Nikolaidis, Ioannis, Pnevmatikos, Eleni, Sertaridou, Alexandros, Andreou, Eleni, Arkalaki, Elias, Athanasakis, Fotini, Chaniotaki, Aikaterini, Chatzimichali, Maria, Christofaki, Despina, Dermitzaki, Klara, Fiorentza, Georgios, Frantzeskos, Elisavet, Geromarkaki, Kalliopi, Kafkalaki, Marina, Kalogridaki, Konstyllia, Karydi, Sofia, Kokkini, Georgios, Kougentakis, Tatiana, Lefaki, Emmanouhl, Lilitsis, Aikaterini, Makatounaki, Polychronis, Malliotakis, Dimosthenis, Michelakis, Maria, Neonaki, Vasileia, Nyktari, Iliana, Palikyra, Eleftherios, Papadakis, Alexandra, Papaioannou, Konstantinos, Sfakianakis, Maria, Sgouraki, Xenia, Souvatzis, Anastasia, Spartinou, Nefeli, Stefanidou, Paulina, Syrogianni, Georgia, Tsagkaraki, Elena, Arnaoutoglou, Christina, Arnaoutoglou, Christina, Bali, Vasilios, Bouris, Rodamanthos, Doumos, Konstantia-Paraskevi, Gkini, Clio, Kapaktsi, Vasilios, Koulouras, Arian, Lena, Dimitra, Lepida, Evangelos, Michos, Dimitrios, Papadopoulos, Minas, Paschopoulos, Vaia Aliki Rompou, Ioanna, Siouti, Stavros, Tsampalas, Ourania, Ververidou, Georgios, Zilis, Alexandra, Charlalampidoy, Gregory, Christodoulidis, Andreas, 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Biccard, Bruce M., Biyase, Thuli, Buccimazza, Ine, Cardosa, Jorge, Chen, Jame, Daya, Bhavika, Drummond, Leanne, Elabib, Ali, Goad, Ehab Helmy Abdel, Goga, Ismail E., Goga, Riaz, Harrichandparsad, R., Hodgson, Richard E., Jordaan, J., Kalafatis, Nicky, Kampik, Christian, Landers, At, Loots, Emil, Madansein, Rajhmum, Madaree, Anil, Madiba, Thandinkosi E., Manzini, Vukani T., Mbuyisa, Mbali, Moodley, Rajan, Msomi, Mduduzi, Mukama, Innocent, Naidoo, Desigan, Naidoo, Rubeshan, Naidu, Tesuven K., Ntloko, Sindiswa, Padayachee, Eneshia, Padayachee, Lucelle, Phaff, Martijn, Pillay, Bala, Pillay, Desigan, Pillay, Lutchmee, Ramnarain, Anupa, Ramphal, Suren R., Ryan, Paul, Saloojee, Ahmed, Sebitloane, Motshedisi, Sigcu, Noluyolo, Taylor, Jenna L., Torborg, Alexandra, Visser, Linda, Anderson, Philip, Conradie, Alae, de Swardt, Mathew, de Villiers, Martin, Eikman, Johan, Liebenberg, Riaan, Mouton, Johan, Paton, Abbey, van der Merwe, Louwrence, Wilscott-Davids, Candice, Barrett, Wendy Joan, Bester, Marlet, de Beer, Johan, Geldenhuys, Jacque, Gouws, Hanni, Potgieter, Jan-Hendrik, Strydom, Magdel, Wilberforce-Turton, Edwin, Chetty, Rubendraj R., Chirkut, Subash, Cronje, Larissa, de Vasconcellos, Kim, Dube, Nokukhanya Z., Sibusiso Gama, N., Green, Garyth M., Green-Thompson, Randolph, Kinoo, Suman Mewa, Kistnasami, Prenolin, Maharaj, Kapil, Moodley, Manogaran S., Mothae, Sibongile J., Naidoo, Ruvashni, Aslam, M., Noorbhai, F., Rughubar, Vivesh, Reddy, Jenendhiran, Singh, Avesh, Skinner, David L., Smith, Murray J., Singh, Bhagwan, Misra, Ravi, Naidoo, Maheshwar, Ramdharee, Pireshin, Selibea, Yvonne, Sewpersad, Selina, Sham, Shailendra, Wessels, Joseph D., Africander, Cucu, Bejia, Tarek, Blakemore, Stephen P., Botes, Marisa, Bunwarie, Bimalshakth, Hernandez, Carlos B., Jeeraz, Mohammud A., Legutko, Dagmara A., Lopez, Acela G., De Meyer, Jenine N., Muzenda, Tanaka, Naidoo, Noel, Patel, Maryam, Pentela, Rao, Junge, Marina, Mansoor, Naj, Rademan, Lana, Scislowski, Pawel, Seedat, Ismail, van den Berg, Bianca, van der Merwe, Doreen, van Wyk, Steyn, Govender, Komalan, Naicker, Darshan, Ramjee, Rajesh, Saley, Mueen, Kuhn, Warren Paul, Matos-Puig, Roel, Moolla, Zaheer, Lisi, Alberto, Perez, Gisela, Valle Beltran, Anna, Lozano, Angel, Delgado Navarro, Carlo, Duca, Alejandro, Pastor Martinez, Ernesto, Ferrando, Carlo, Fuentes, Isabel, García-Pérez, Maria Luisa, Gracia, Estefania, Izquierdo Palomares, Ana, Katime, Antonio, Miñana, Amanda, Incertis, Raul, Romero, Esther, Romero Garcia, Carolina Soledad, Rubio, Concepcion, Socorro Artiles, Tania, Soro, Marina, Valls, Paola, Laguarda, Gisela Alaman, Benavent, Pau, Cuenca, Vicente Chisbert, Cueva, Andreu, Lafuente, Matilde, Parra, Asuncion Marque, Rodrigo, Alejandra Romero, Sanchez-Morcillo, Silvia, Tormo, Sergi, Redondo, Francisco Javier, De Andres, Jose, Gómez Diago, Lorena, Hernández Cádiz, Maria José, Manuel, Granell Gil, Peris, Raquel, Saiz, Cristina, Tatay, Jose, Tebar Soto, Maria Teresa, Brunete, Tamara, Cancho, David, Delgado García, David R., Zamudio, Diana, Garcia Del Valle, Santiago, Luz Serrano, M., Alonso, Eduardo, Anillo, Victor, Maseda, Emilio, Salgado, Patricia, Suarez, Lui, Suarez-de-la-Rica, Alejandro, Villagrán, María José, Alonso, José Ignacio, Cabezuelo, Estefania, Garcia-Saiz, Irene, Lopez del Moral, Olga, Martín, Silvia, Perez Gonzalez, Alba, Tovar Doncel, Sherezade, Vera, Martin Agüero, Ávila Sánchez, Francisco José, Castaño, Beatriz, Castaño Moreira, Beatriz, Flores Risco, Sahely, Paz Martín, Daniel, Pérez Martín, Fernando, Poza, Paloma, Ruiz, Adela, Serna Martínez, Wilson Fabio, Vicente, Bárbara Vázquez, Dominguez, Saul Velaz, Fernández, Salvador, Munoz-López, Alfonso, Bernat, Maria Jose, Mas, Arantxa, Planas, Kenneth, Jawad, Monir, Saeed, Yousif, Hedin, Annika, Levander, Helena, Holmström, Sandra, Lönn, David, Zoerner, Frank, Åkring, Irene, Widmark, Carl, Zettergren, Jan, Liljequist, Victor Aspelund, Nystrom, Lena, Odeberg-Wernerman, Suzanne, Oldner, Ander, Reje, Patrik, Lyckner, Sara, Sperber, Jesper, Adolfsson, Anne, Klarin, Bengt, Ögren, Katrin, Barras, Jean-Pierre, Bührer, Thoma, Despotidis, Vasileio, Helmy, Naeder, Holliger, Stephan, Raptis, Dimitri Aristotle, Schmid, Roger, Meyer, Antoine, Jaquet, Yve, Kessler, Ulf, Muradbegovic, Mirza, Nahum, Solange R., Rotunno, Teresa, Schiltz, Bori, Voruz, Françoi, Worreth, Marc, Christoforidis, Dimitri, Popeskou, Sotirios Georgio, Furrer, Marku, Prevost, Gian Andrea, Stocker, Andrea, Lang, Klau, Breitenstein, Stefan, Ganter, Michael T., Geisen, Martin, Soll, Christopher, Korkmaz, Michelle, Lubach, Iri, Schmitz, Michael, Meyer zu Schwabedissen, Moritz, Zingg, Ur, Hillermann, Thoma, Wildi, Stefan, Pinto, Bernardo Bollen, Walder, Bernhard, Hübner, Martin, Mariotti, Giustina, Slankamenac, Ksenija, Namuyuga, Mirioce, Kyomugisha, Edward, Kituuka, Olivia, Wesonga Shikanda, Anne, Kakembo, Nasser, Otim Tom, Charle, Webombesa, Antonina, Bua, Emmanuel, Ssettabi, Eden Michael, Epodoi, Joseph, Kabagenyi, Fiona, Kirya, Fred, Dempsey, Ged, Seasman, Colette, Basit Nawaz Khan, Raja, Kurasz, Claire, Macgregor, Mark, Shawki, Burhan, Hariharan, Vimal, Chau, Simon, Ellis, Kate, Butt, Georgina, Chicken, Dennis-Wayne, Christmas, Natasha, Allen, Samantha, Daniel, Gayatri Daniel, Dempster, Angie, Kemp, Juliette, Matthews, Lewi, Mcglone, Philip, Tambellini, Joanne, Trodd, Dawn, Freitas, Katie, Garg, Atul, Karpate, Shilpaja, Kulkarni, Aditi, O’Hara, Chloe, Troko, Jtroko, Angus, Kirsty, Bradley, Jacqueline, Brennan, Emma, Brooks, Carolyn, Brown, Janette, Brown, Gemma, Finch, Amanda, Gratrix, Karen, Hesketh, Sue, Hill, Gillian, Jeffs, Carol, Morgan, Maureen, Pemberton, Chri, Slawson, Nicola, Spickett, Helen, Swarbrick, Gemma, Thomas, Megan, Van Duyvenvoorde, Greta, Brennan, Andrew, Briscoe, Richard, Cooper, Sarah, Lawton, Tom, Northey, Martin, Senaratne, Rashmi, Stanworth, Helen, Burrows, Lorna, Cain, Helen, Craven, Rachael, Davies, Keith, Jonas, Attila, Pachucki, Marcin, Walkden, Graham, Davies, Helen, Gudaca, Mariethel, Hobrok, Maria, Arawwawala, Dilshan, Fergey, Lauren, Gardiner, Matthew, Gunn, Jacqueline, Johnson, Lyndsay, Lofting, Amanda, Lyle, Amanda, Mc Neela, Fiona, Smolen, Susan, Topliffe, Joanne, Williams, Sarah, Bland, Martin, Kaura, Vika, Lanka, Prasad, Naylor, Chardé, Smith, Neil, Ahmed, Ahmed, Myatt, John, Shenoy, Ravikiran, Soon, Wai Cheong, Tan, Jessica, Karadia, Sunny, Self, Jame, Durant, Emma, Tripathi, Shiva, Bullock, Clare, Campbell, Debbie, Ghosh, Alison, Hughes, Thoma, Zsisku, Lajo, Bengeri, Sheshagiri, Cowton, Amanda, Khalid, Mohammed Shazad, Limb, Jame, McAdam, Colin, Porritt, Mandy, Rafi, M. Amir, Shekar, Priya, Harden, Catherine, Hollands, Heidi, King, Angela, March, Linda, Minto, Gary, Patrick, Abigail, Waugh, Darren, Kumara, Paramesh, Simeson, Karen, Yarwood, Jamie, Browning, Julie, Hatton, Jonathan, Julian, Howe, Mitra, Atideb, Newton, Maria, Pernu, Pawan, Wilson, Alison, Commey, Thelma, Foot, Helen, Glover, Lyn, Gupta, Ajay, Lancaster, Nicola, Levin, Jill, Mackenzie, Felicity, Mestanza, Claire, Nofal, Emma, Pout, Lauren, Varden, Rosanna, Wild, Jonathan, Jones, Stephanie, Moreton, Sarah, Pulletz, Mark, Davies, Charlotte, Martin, Matthew, Thomas, Sian, Burns, Karen, McArthur, Carol, Patel, Panna, Lau, Gary, Rich, Natalie, Davis, Fiona, Lyons, Rachel, Port, Beth, Prout, Rachel, Smith, Christopher, Adelaja, Yemi, Bennett, Victoria, Bidd, Heena, Dumitrescu, Alexandra, Murphy, Jacqui Fox, Keen, Abigail, Mguni, Nhlanhla, Ong, Cheng, Adams, George, Boshier, Pier, Brown, Richard, Butryn, Izabella, Chatterjee, Jayanta, Freethy, Alexander, Lockwood, Geoffrey, Tsakok, Maria, Tsiligiannis, Sophia, Peat, William, Stephenson, Lorraine, Bradburn, Mike, Pick, Sara, Cunha, Pedro, Olagbaiye, Olufemi, Tayeh, Salim, Abernethy, Caroline, Balasubramaniam, Madhu, Bennett, Rachael, Bolton, David, Martinson, Victoria, Naylor, Charde, Bell, Stephanie, Heather, Blaylock, Kushakovsky, Vlad, Alcock, Liam, Alexander, Hazel, Anderson, Colette, Baker, Paul, Brookes, Morag, Cawthorn, Louise, Cirstea, Emanuel, Colling, Kerry, Coulter, Ian, Das, Suparna, Haigh, Kathryn, Hamdan, Alhafidz, Hugill, Keith, Kottam, Lucksy, Lisseter, Emily, Mawdsley, Matthew, McGivern, Julie, Padala, Krishnaveni, Phelps, Victoria, kumar, Vineshykaa Ramesh, Stewart, Kirsten, Towse, Kayley, Tregonning, Julie, Vahedi, Ali, Walker, Alycon, Baines, Duncan, Bilolikar, Anjali, Chande, Shiv, Copley, Edward, Dunk, Nigel, Kulkarni, Raghavendra, Kumar, Pawan, Metodiev, Yavor, Ncomanzi, Dumisani, Raithatha, Bhavesh, Raymode, Parizade, Szafranski, Jan, Twohey, Linda, Watt, Philip, Weatherall, Lucie, Weatherill, J., Whitman, Zoe, Wighton, Elinor, Abayasinghe, Chamika, Chan, Alexander, Darwish, Sharif, Gill, Jame, Glasgow, Emma, Hadfield, Daniel, Harris, Clair, Kochhar, Arun, Mellis, Clare, Pool, Andrew, Riozzi, Paul, Selman, Andrew, Smith, Emma-Jane, Vele, Liana, Gercek, Yuksel, Guy, Kramer, Holden, Dougla, Watson, Nichola, Whysall, Karen, Andreou, Prematie, Hales, Dawn, Thompson, Jonathan, Bowrey, Sarah, McDonald, Shara, Gilmore, Jemma, Hills, Vicky, Kelly, Chan, Kelly, Sinead, Lloyd, Geraint, Abbott, Tom, Gall, Lewi, Torrance, Hew, Vivian, Mark, Berntsen, Emer, Nolan, Tracey, Turner, Angu, Vohra, Akbar, Brown, Andrew, Clark, Richard, Coughlan, Elaine, Daniel, Conway, Patvardhan, Chinmay, Pearson, Rachel, Predeep, Sheba, Saad, Hesham, Shanmugam, Mohanakrishnan, Varley, Simon, Wylie, Katharine, Cooper, Lucy, Makowski, Arystarch, Misztal, Beata, Moldovan, Eliza, Pegg, Claire, Donovan, Andrew, Foot, Jayne, Large, Simon, Claxton, Andrew, Netke, Bhagyashree, Armstrong, Richard, Calderwood, Claire, Kwok, Andy, Mohr, Otto, Oyeniyi, Peter, Patnaik, Lisa, Post, Benjamin, Ali, Sarah, Arshad, Homa, Baker, Gerard, Brenner, Laura, Brincat, Maximilian, Brunswicker, Annemarie, Cox, Hannah, Cozar, Octavian Ionut, Durst, Alexander, Fengas, Lior, Flatt, Jim, Glister, Georgina, Narwani, Vishal, Photi, Evangelo, Rankin, Adeline, Rosbergen, Melissa, Tan, Mark, Beaton, Ceri, Horn, Rachel, Hunt, Jane, Rousseau, Guy, Stancombe, Lucia, Absar, Mohammed, Allsop, Joanne, Drinkwater, Zoe, Hodgkiss, Tracey, Smith, Kirsty, Brown, Jamie, Alexander-Sefre, Farhad, Campey, Lorraine, Dudgeon, Lucy, Hall, Kathryn, Hitchcock, Rachael, James, Lynne, Smith, Kate, Winstone, Ulrika, Ahmad, Norfaizan, Bauchmuller, Kri, Harrison, Jonathan, Jeffery, Holly, Miller, Duncan, Pinder, Angela, Pothuneedi, Sailaja, Rosser, Jonathan, Sanghera, Sumayer, Swift, Diane, Walker, Rachel, Bester, Delia, Cavanagh, Sarah, Cripps, Heather, Daniel, Harvey, Lynch, Julie, Paton, Alison, Pyke, Shirley, Scholefield, John, Whitworth, Helen, Bottrill, Fiona, Ramalingam, Ganesh, Webb, Stephen, Akerman, Nik, Antill, Philip, Bourner, Lynsey, Buckley, Sarah, Castle, Gail, Charles, Rob, Eggleston, Christopher, Foster, Rebecca, Gill, Satwant, Lindley, Kate, Lklouk, Mohamed, Lowery, Tracey, Martin, Oliver, Milne, David, O’Connor, Patrick, Ratcliffe, Andrew, Rose, Alastair, Smith, Annie, Varma, Sandeep, Ward, Jackie, Barcraft-Barnes, Helena, Camsooksai, Julie, Colvin, Carolyn, Reschreiter, Henrik, Tbaily, Lee, Venner, Nicola, Hamilton, Caroline, Kelly, Lewi, Toth-Tarsoly, Piroska, Dodsworth, Kerry, Foord, Denise, Gordon, Paul, Hawes, Elizabeth, Lamb, Nikki, Mouland, Johanna, Nightingale, Jeremy, Rose, Steve, Schrieber, Joe, Al ‘Amri, Khalid, Aladin, Hafiz, Arshad, Mohammed Asif, Barraclough, Jame, Bentley, Conor, Bergin, Colin, Carrera, Ronald, Clarkson, Aisling, Collins, Michelle, Cooper, Lauren, Denham, Samuel, Griffiths, Ewen, Ip, Peter, Jeyanthan, Somasundaram, Joory, Kavita, Kaur, Satwant, Marriott, Paul, Mitchell, Natalie, Nagaiah, Sukumar, Nilsson, Annette, Parekh, Nilesh, Pope, Martin, Seager, Joseph, Serag, Hosam, Tameem, Alifia, Thomas, Anna, Thunder, Joanne, Torrance, Andrew, Vohra, Ravinder, whitehouse, Arlo, Wong, Tony, Blunt, Mark, Wong, Kate, Giles, Julian, Reed, Isabelle, Weller, Debbie, Bell, Gillian, Birch, Julie, Damant, Rose, Maiden, Jane, Mewies, Clare, Prince, Claire, Radford, Jane, Balain, Birender, Banerjee, Robin, Barnett, Andrew, Burston, Ben, Davies, Kirsty, Edwards, Jayne, Evans, Chri, Ford, David, Gallacher, Pete, Hill, Simon, Jaffray, David, Karlakki, Sudheer, Kelly, Cormac, Kennedy, Julia, Kiely, Nigel, Lewthwaite, Simon, Marquis, Chri, Ockendon, Matthew, Phillips, Stephen, Pickard, Simon, Richardson, Jame, Roach, Richard, Smith, Tony, Spencer-Jones, Richard, Steele, Niall, Steen, Julie, Van Liefland, Marck, White, Steve, Faulds, Matthew, Harris, Meredyth, Kelly, Carrie, Nicol, Scott, Pearson, Sally Anne, Chukkambotla, Srikanth, Andrew, Alyson, Attrill, Elizabeth, Campbell, Graham, Datson, Amanda, Fouracres, Anna, Graterol, Juan, Graves, Lynne, Hong, Bosun, Ishimaru, Alexander, Karthikeyan, Arvind, King, Helen, Lawson, Tom, Lee, Gregory, Lyons, Saoirse, Macalister Hall, Andrew, Mathoulin, Sophie, Mcintyre, Eilidh, Mclaughlin, Danny, Mulcahy, Kathleen, Ratcliffe, Anna, Robbins, Jame, Sung, Weilin, Tayo, Adeoluwa, Trembath, Lisa, Venugopal, Suneetha, Walker, Robert, Wigmore, Geoffrey, Boereboom, Catherine, Downes, Charlotte, Humphries, Ryan, Melbourne, Susan, Smith, Coral, Tou, Samson, Ullah, Shafa, Batchelor, Nick, Boxall, Leigh, Broomby, Rupert, Deen, Tariq, Hellewell, Alistair, Helliwell, Laurence, Hutchings, Melanie, Hutchins, David, Keenan, Samantha, Mackie, Donna, Donna, Alison, Smith, France, Stone, Lucy, Thorpe, Kevin, Wassall, Richard, Woodgate, Andrew, Baillie, Shelley, Campbell, Tara, James, Sarah, King, Chri, Marques de Araujo, Daniela, Martin, Daniel, Morkane, Clare, Neely, Julia, Rajendram, Rajkumar, Burton, Megan, James, Kathryn, Keevil, Edward, Minik, Orsolya, Morgan, Jenna, Musgrave, Anna, Rajanna, Harish, Roberts, Tracey, Adamson, Michael, Jumbe, Sandra, Kendall, Jennie, Muthuswamy, Mohan Babu, Anderson, Charlotte, Cruikshanks, Andrew, Wrench, Ian, Zeidan, Lisa, Ardern, Diane, Harris, Benjamin, Hellstrom, Johanna, Martin, Jane, Thomas, Richard, Varsani, Nimu, Wrey Brown, Caroline, Docherty, Philip, Gillies, Michael, McGregor, Euan, Usher, Helen, Craig, Jayne, Smith, Andrew, Ahmad, Tahania, Bodger, Phoebe, Creary, Thai, Fowler, Alexander, Hewson, Ru, Ijuo, Eke, Jones, Timothy, Kantsedikas, Ilya, Lahiri, Sumitra, McLean, Aaron Lawson, Niebrzegowska, Edyta, Phull, Mandeep, Wang, Difei, Wickboldt, Nadine, Baldwin, Jacqueline, Doyle, Donna, Mcmullan, Sean, Oladapo, Michelle, Owen, Thoma, Williams, Alexandra, Daniel, Hull, Gregory, Peter, Husain, Tauqeer, Kirk-Bayley, Justin, Mathers, Edward, Montague, Laura, White, Stuart, Avis, Joanne, Cook, Tim, Dali-Kemmery, Lola, Kerslake, Ian, Lambourne, Victoria, Pearson, Annabel, Boyd, Christine, Callaghan, Mark, Lawson, Cathy, McCrossan, Roopa, Nesbitt, Vanessa, O’connor, Laura, Scott, Julia, Sinclair, Rhona, Farid, Nahla, Morgese, Ciro, Bhatia, Kailash, Karmarkar, Swati, Ahmed, Jamil, Branagan, Graham, Hutton, Monica, Swain, Andrew, Brookes, Jamie, Cornell, Jonathan, Dolan, Rachael, Hulme, Jonathan, Jansen van Vuuren, Amanda, Jowitt, Tom, Kalashetty, Gunasheela, Lloyd, Fran, Patel, Kiran, Sherwood, Nichola, Brown, Lynne, Chandler, Ben, Deighton, Kerry, Emma, Temlett, Haunch, Kirsty, Cheeseman, Michelle, Dent, Kathy, Garg, Sanjeev, Gray, Carol, Hood, Marion, Jones, Dawn, Juj, Joanne, Rao, Roshan, Walker, Tara, Al Anizi, Mashel, Cheah, Clarissa, Cheing, Yushio, Coutinho, Francisco, Gondo, Prisca, Hadebe, Bernard, Onie Hove, Mazvangu, khader, Ahamed, Krishnachetty, Bobby, Rhodes, Karen, Sokhi, Jagdish, Baker, Katie-Anne, Bertram, Wendy, Looseley, Alex, Mouton, Ronelle, Arnold, Glenn, Arya, Shobhit, Balfoussia, Danai, Baxter, Linden, Harris, Jame, Jones, Craig, Knaggs, Alison, Markar, Sheraz, Perera, Anisha, Scott, Alasdair, Shida, Asako, Sirha, Ravneet, Wright, Sally, Frost, Victoria, Gray, Catherine, MacGregor, Mark, Andrews, Emma, Arrandale, Lindsay, Barrett, Stephen, Cifra, Elna, Cooper, Mariese, Dragnea, Drago, Elna, Cifra, Maclean, Jennifer, Meier, Sonja, Milliken, Donald, Munns, Christopher, Ratanshi, Nadir, Salvana, Abegail, Watson, Anthony, Ali, Hani, Campbell, Gill, Critchley, Rebecca, Hicks, Catherine, Liddle, Alison, Pass, Marc, Ritchie, Charlotte, Thomas, Charlotte, Too, Lingxi, Welsh, Sarah, Gill, Talvinder, Johnson, Joanne, Reed, Joanne, Davis, Edward, Papadopoullos, Sam, Attwood, Clare, Biffen, Andrew, Boulton, Kerenza, Gray, Sophie, Hay, David, Mills, Sarah, Montgomery, Jane, Riddell, Rory, Simpson, Jame, Bhardwaj, Neeraj, Paul, Elaine, Uwubamwen, Nosakhare, Alexander, Maini, Arrich, Jame, Arumugam, Swarna, Blackwood, Dougla, Boggiano, Victoria, Brown, Robyn, Lam Chan, Yik, Chatterjee, Devnandan, Chhabra, Ashok, Christian, Rachel, Costelloe, Hannah, Coxwell Matthewman, Madeline, Dalton, Emma, Darko, Julia, Davari, Maria, Dave, Tejal, Deacon, Matthew, Deepak, Shantal, Edmond, Holly, Ellis, Jessica, El-Sayed, Ahmed, Eneje, Philip, English, Rose, Ewe, Renee, Foers, William, Franklin, John, Gallego, Laura, Garrett, Emily, Goldberg, Olivia, Goss, Harry, Greaves, Rosanna, Harris, Rudy, Hennings, Charle, Jones, Eleanor, Kamali, Nelson, Kokkinos, Naomi, Lewis, Cary, Lignos, Leda, Malgapo, Evaleen Victoria, Malik, Rizwana, Milne, Andrew, Mulligan, John-Patrick, Nicklin, Philippa, Palipane, Natasha, Parsons, Thoma, Piper, Rebecca, Prakash, Rohan, Ramesh, Byron, Rasip, Sarah, Reading, Jacob, Rela, Mariam, Reyes, Anna, Robert, Stephen, Rooms, Martin, Shah, Karishma, Simons, Henry, Solanki, Shalil, Spowart, Emma, Stevens, Amy, Thomas, Christopher, Waggett, Helena, Yassaee, Arrash, Kennedy, Anthony, Scott, Sara, Somanath, Sameer, Berg, Andrew, Hernandez, Miguel, Nanda, Rajesh, Tank, Ghanshyambhai, Wilson, Natalie, Wilson, Debbie, Al-Soudaine, Yassr, Baldwin, Matthew, Cornish, Julie, Davies, Zoe, Davies, Leigh, Edwards, Marc, Frewer, Natasha, Gallard, Sian, Glasbey, Jame, Harries, Rhiannon, Hopkins, Luke, Kim, Taeyang, Koompirochana, Vilavan, Lawson, Simon, Lewis, Megan, Makzal, Zaid, Scourfield, Sarah, Ahmad, Yousra, Bates, Sarah, Blackwell, Clare, Bryant, Helen, Coulter, Suzanne, Cruickshank, Ro, Daniel, Sonya, Daubeny, Thoma, Edwards, Mark, Golder, Kim, Hawkins, Lesley, Helen, Bryant, Hinxman, Honor, Levett, Denny, Skinner, Ben, Walsgrove, Joseph, Dickson, Jane, Constantin, Kathryn, Karen, Markwell, O’Brien, Peter, O’Donohoe, Lynn, Payne, Hannah, Sundayi, Saul, Walker, Elaine, Brooke, Jenny, Cardy, Jon, Humphreys, Sally, Kessack, Laura, Kubitzek, Christiane, Kumar, Suha, Cotterill, Donna, Hodzovic, Emil, Hosdurga, Gurunath, Miles, Edward, Saunders, Glenn, Campbell, Marta, Chan, Peter, Jemmett, Kim, Raj, Ashok, Naik, Aditi, Ramamoorthy, Rajarajan, Shah, Nimesh, Sylvan, Axel, Blyth, Katharine, Burtenshaw, Andrew, Freeman, David, Johnson, Emily, Lo, Philip, Martin, Terry, Plunkett, Emma, Wollaston, Julie, Allison, Joanna, Carroll, Christine, Craw, Nichola, Craw, Sarah, Pitt-Kerby, Tressy, Rowland-Axe, Rebecca, Spurdle, Katie, McDonald, Andrew, Simon, Davie, Sinha, Vivek, Smith, Thoma, Banner-Goodspeed, Valerie, Boone, Myle, Campbell, Kathleen, Lu, Fengxin, Scannell, Joseph, Sobol, Julia, Balajonda, Naraida, Clemmons, Karen, Conde, Carlo, Funk, Bonita, Hall, Roger, Hopkins, Thoma, Olaleye, Omowunmi, Omer, Omer, Pender, Michelle, Porto, Angelo, Stevens, Alice, Waweru, Peter, Yeh, Erlinda, Bodansky, Daniella, Evans, Adam, Kleopoulos, Steven, Maril, Robert, Mathney, Edward, Sanchez, Angela, Tinuoye, Elizabeth, Bateman, Brian, Eng, Kristen, Jiang, Ning, Ladha, Karim, Needleman, Joseph, Chen, Lee-lynn, Lane, Rondall, Robinowitz, David, Ghushe, Neil, Irshad, Mariam, Patel, Samir, Takemoto, Steven, Wallace, Art, Mazzeffi, Michael, Rock, Peter, Wallace, Karin, Zhu, Xiaomao, Chua, 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Subjects: Male, HSJ UCI, Critical Care and Intensive Care Medicine, law.invention, Perioperative Care/methods, 0302 clinical medicine, Surgical procedures, 030202 anesthesiology, law, Critical care/utilisation, Postoperative care/methods, Postoperative care/statistics and numerical data, Surgical procedures, operative/mortality, statistics and numerical data, Prospective Studies, Postoperative Period, Postoperative care/methods, education.field_of_study, Postoperative care/method, Elective Surgical Procedures/mortality, fluid output, Middle Aged, fluid administration, Intensive care unit, Hospitalization, Length of Stay/statistics & numerical data, operative/mortality, Intensive Care Units/statistics & numerical data, outcome, Female, Elective Surgical Procedure, Human, Adult, medicine.medical_specialty, Logistic Model, Postoperative care/statistics and numerical data, Critical care/utilisation, Population, Intensive Care Unit, Elective Surgical Procedures/statistics & numerical data, Hospitalization/statistics & numerical data, Humans, Logistic Models, Surgical procedures, operative/mortality, Postoperative care, methods, Perioperative Care, NO, 03 medical and health sciences, Anesthesiology, Intensive care, medicine, Elective surgery, Intensive care medicine, education, business.industry, 030208 emergency & critical care medicine, Perioperative, Length of Stay, Clinical trial, Prospective Studie, septic shock, business
Abstract: PURPOSE: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. METHODS: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. RESULTS: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10-5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. CONCLUSIONS: We did not identify any survival benefit from critical care admission following surgery. info:eu-repo/semantics/publishedVersion
Published: 2017
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49. Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group

Author: Claudia Paula Heidegger, Claude Pichard, Michael Hiesmayr, Anne Berit Guttormsen, Pierre Singer, Mette M. Berger, Elisabeth De Waele, Jan Wernerman, Taku Oshima, Faculty of Medicine and Pharmacy, and Supporting clinical sciences
Subjects: 0301 basic medicine, Databases, Factual, Critical Illness, Rest, Carbon dioxide production (VCO ), Indirect calorimetry, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Basic knowledge, Intensive care, Outpatients, Humans, Medicine, Oxygen consumption (VO ), Indirect calorimetry, Energy expenditure (EE), Respiratory, quotient (RQ), Oxygen consumption (VO2), Carbon dioxide production (VCO2), Resting energy expenditure (REE), Medical nutrition therapy, Energy expenditure (EE), ddc:616, Respiratory quotient (RQ), Inpatients, 030109 nutrition & dietetics, Nutrition and Dietetics, Nutritional Support, Critically ill, business.industry, Resting energy expenditure (REE), Nutritional Requirements, Calorimetry, Indirect, 030208 emergency & critical care medicine, Clinical Practice, Intensive Care Units, Risk analysis (engineering), Energy expenditure, Position paper, Current technology, Energy Metabolism, business
Abstract: Summary Background & aims This review aims to clarify the use of indirect calorimetry (IC) in nutritional therapy for critically ill and other patient populations. It features a comprehensive overview of the technical concepts, the practical application and current developments of IC. Methods Pubmed-referenced publications were analyzed to generate an overview about the basic knowledge of IC, to describe advantages and disadvantages of the current technology, to clarify technical issues and provide pragmatic solutions for clinical practice and metabolic research. The International Multicentric Study Group for Indirect Calorimetry (ICALIC) has generated this position paper. Results IC can be performed in in- and out-patients, including those in the intensive care unit, to measure energy expenditure (EE). Optimal nutritional therapy, defined as energy prescription based on measured EE by IC has been associated with better clinical outcome. Equations based on simple anthropometric measurements to predict EE are inaccurate when applied to individual patients. An ongoing international academic initiative to develop a new indirect calorimeter aims at providing innovative and affordable technical solutions for many of the current limitations of IC. Conclusion Indirect calorimetry is a tool of paramount importance, necessary to optimize the nutrition therapy of patients with various pathologies and conditions. Recent technical developments allow broader use of IC for in- and out-patients.
Published: 2017
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50. nutritionDay in Nursing Homes—The Association of Nutritional Intake and Nutritional Interventions With 6-Month Mortality in Malnourished Residents

Author: Dorothee Volkert, Karin Schindler, M. Themessl-Huber, M. Streicher, Cornel C. Sieber, and Michael Hiesmayr
Subjects: Male, 0301 basic medicine, Gerontology, Psychological intervention, 03 medical and health sciences, 0302 clinical medicine, Weight loss, Environmental health, Humans, Medicine, 030212 general & internal medicine, General Nursing, Aged, 80 and over, Univariate analysis, 030109 nutrition & dietetics, business.industry, Health Policy, Mortality rate, Malnutrition, General Medicine, Nutrition Surveys, medicine.disease, Nursing Homes, Cross-Sectional Studies, Nutrition Assessment, Parenteral nutrition, Female, Geriatrics and Gerontology, medicine.symptom, business, nutritionDay, Body mass index
Abstract: Malnutrition in older persons is associated with an increased risk of mortality. Useful strategies to counteract malnutrition are nutritional interventions, such as fortified diets, oral nutritional supplements (ONS), tube feeding, and parenteral nutrition. Presently, it is not known if these strategies can reduce mortality risk of nursing home (NH) residents who are malnourished or at risk of malnutrition. Thus, the aim of this study was to investigate if nutritional intake and interventions are associated with mortality in this specific population.One-day cross-sectional study with outcome evaluation after 6 months, repeated in yearly intervals since 2007.A total of 507 NH units from 15 countries.NH residents participating in the nutritionDay between 2007 and 2014, aged 65 years or older with a poor nutritional status (body mass index20 kg/mData on resident and unit level were collected on nutritionDay and mortality status was assessed 6 months later. Residents' nutrition (intake at lunch on nutritionDay) and nutritional interventions (diet, use of ONS, supplementary tube feeding, supplementary parenteral nutrition) were of interest as influencing factors of 6-month mortality, adjusted for 23 potential confounders (residents' nutritional status, general residents' characteristics, and unit characteristics). Univariate generalized estimating equations were performed for all variables and significant predictors (P .01) included in a multivariate analysis.Six-month mortality rate of the included 4857 NH residents was 20.3%. Univariate analysis identified residents' diet, use of ONS, intake at lunch, and 14 confounders as predictors of mortality. Intake at lunch and 7 confounders remained in the multivariate model [area under the receiver operating curve = 0.687; 95% confidence interval (CI) 0.669-0.706; P .001]. The less residents ate for lunch, the higher was the risk of mortality, with the highest odds ratio (OR) for residents who ate nothing (OR 3.38; 95% CI 2.58-4.42). Mortality risk was OR 2.36; 95% CI 1.91-2.92, and OR 1.64; 95% CI 1.29-2.07 times higher for immobile and partially mobile compared with mobile residents. Cancer, dysphagia, weight loss5 kg in the last year, body mass index20 kg/mPoor intake at lunch on nutritionDay was a strong predictor of mortality, whereas the use of nutritional interventions was not associated with 6-month mortality in NH residents who are malnourished or at risk of malnutrition. The reasons for these findings need to be clarified.
Published: 2017
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