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Purpose: Early mobilization within 72 h of intensive care unit (ICU) admission improves functional status at hospital discharge. We aimed to assess the effectiveness of early, goal-directed mobilization in critically ill patients across a broad spectrum of initial consciousness levels.Methods: Post hoc analysis of the international, randomized, controlled, outcome-assessor blinded SOMS trial conducted 2011-2015. Randomization was stratified according to the immediate post-injury Glasgow Coma Scale (GCS) (≤ 8 or > 8). Patients received either SOMS-guided mobility treatment with a facilitator or standard care. We used general linear models to test the hypothesis that immediate post-randomization GCS modulates the intervention effects on functional independence at hospital discharge.Results: Two hundred patients were included in the intention-to-treat analysis. The significant effect of early, goal-directed mobilization was consistent across levels of GCS without evidence of effect modification, for the primary outcome functional independence at hospital discharge (p = 0.53 for interaction), as well as average achieved mobility level during ICU stay (mean achieved SOMS level) and functional status at hospital discharge measured with the functional independence measure. In patients with low GCS, delay to first mobilization therapy was longer (0.7 ± 0.2 days vs. 0.2 ± 0.1 days, p = 0.008), but early, goal-directed mobilization compared with standard care significantly increased functional independence at hospital discharge in this subgroup of patients with immediate post-randomization GCS ≤ 8 (OR 3.67; 95% CI 1.02-13.14; p = 0.046).Conclusion: This post hoc analysis of a randomized controlled trial suggests that early, goal-directed mobilization in patients with an impaired initial conscious state (GCS ≤ 8) is not harmful but effective. [ABSTRACT FROM AUTHOR]

The recently introduced multislice data acquisition for computed tomography (CT) is based on multirow detector design, increased rotation speed, and advanced z-interpolation and z-filtering algorithms. We evaluated slice sensitivity profiles (SSPs) and noise of a clinical multislice spiral CT (MSCT) scanner with M = 4 simultaneously acquired slices and adaptive axial interpolator (AAI) reconstruction software [11]. SSPs were measured with a small gold disk of 50 [micro]m thickness and 2-mm diameter located at the center of rotation (COR) and 100 mm off center. The standard deviation of CT values within a 20-cm water phantom was used as a measure of image noise. With a detector slice collimation of S = 1.0 mm, we varied spiral pitch p from 0.25 to 2.0 in steps of 0.025. Nominal reconstructed slice thicknesses were 1.25, 1.5, and 2.1) mm. For all possible pitch values, we found the full-width at half maximum (FWHM) of the respective sensitivity profile at the COR equivalent to the selected nominal slice thickness. The profiles at 100 mm off center are broadened less than 7% on the average compared with the FWHM at the COR. In addition, variation of the full-width at tenth maximum (FWTM) at the COR was below 10% for p [is less than or equal to] 1.75. Within this range, image noise varied less than 10% with respect to the mean noise level. The slight increase in measured slice-width above p = 1.75 for nominal slice-widths of 1.25 and 1.50 mm is accompanied by a decrease of noise according to the inverse square root relationship. The MSCT system that we scrutinized provides reconstructed slice-widths and image noise, which can be regarded as constant within a wide range of table speeds. With respect: to this, MSCT is superior to single-slice spiral CT. These facts can be made use of when defining and optimizing clinical protocols: the spiral pitch can be selected almost freely, and scan protocols can follow the diagnostic requirements without technical restrictions. In summary, MSCT offers constant image quality while scan times are reduced drastically. Volume scans with three-dimensional (3-D) isotropic resolution are routinely feasible for complete anatomical regions. Index Terms--Computed tomography (CT), image quality (IQ), multirow detector system, multislice spiral CT (MSCT), noise, slice sensitivity profile (SSP).

This paper presents the adaptive axial interpolator (AAI), a novel spiral interpolation approach for multislice spiral computed tomography (CT) implemented in a clinical multislice CT scanner, the SOMATOM Volume Zoom (Siemens Medical Systems, Forchheim, Germany). The method works on parallel-beam data generated from the acquired fan-beam data by azimuthal rebinning. Spiral interpolation is performed by distance-dependent weighting; i.e., for each ray, its distance to the image plane is evaluated and serves as an argument to a freely selectable weighting function, resulting in a weight factor. A normalization step is applied to the weight factors to ensure that the sum of all corresponding weights (i.e., the weights applied to rays that contribute to the same ray in the interpolated sinogram) is 1. By selection of appropriate weighting functions and suitable adjustment of the tube current, it is possible to keep the slice sensitivity profiles (SSP) as well as the pixel noise constant for all pitch values in the relevant range. Also, a large range of slice-thickness can be reconstructed from a given collimation. The method is, thus, very versatile. Further advantages are that it uses the entire applied dose for imaging and allows for efficient implementation using a table lookup approach. Index Terms--Multislice CT, spiral interpolation.

• The German network for Early Mobilization is an open network to distribute knowledge to clinicians. • Monthly newsletters may support implementation of evidence based knowledge. • The Network conducted 14 different research projects in its eight-year existence. • According to participants, membership improved personal development and career. • Membership in the Network led to a perceived quality improvement on workplaces. Professional networks support health care providers in implementing evidence based knowledge. The German Network for Early Mobilization in Intensive Care Units (ICU) was founded in 2011 and serves for more than 300 critical care team members today. The mobilization network is connected to other professional networks and contributed to the development of national guidelines and quality indicators. Several research projects were conducted. Members of the mobilization network perceived benefits for themselves and their workplace. The network increased participants' knowledge and contributed to quality improvement projects on ICUs. Without having significant resources, this network development may serve as an example for other networks. [ABSTRACT FROM AUTHOR]

Muscle changes of critical illness are attributed to systemic inflammatory responses and disuse atrophy. GTS-21 (3-(2,4-dimethoxy-benzylidene)anabaseine), also known as DMBX-A) is a synthetic derivative of the natural product anabaseine that acts as an agonist at α7-acetylcholine receptors (α7nAChRs). Hypothesis tested was that modulation of inflammation by agonist GTS-21 (10 mg/kg b.i.d. intraperitoneally) will attenuate body weight (BW) and muscle changes. Systemic sham inflammation was produced in 125 rats by Cornyebacterium parvum (C.p.) or saline injection on days 0/4/8. Seventy-four rats had one immobilized-limb producing disuse atrophy. GTS-21 effects on BW, tibialis muscle mass (TMM), and function were assessed on day 12. Systemically, methemoglobin levels increased 26-fold with C.p. (p < 0.001) and decreased significantly (p < 0.033) with GTS-21. Control BW increased (+ 30 ± 9 g, mean ± SD) at day 12, but decreased with C.p. and superimposed disuse (p = 0.005). GTS-21 attenuated BW loss in C.p. (p = 0.005). Compared to controls, TMM decreased with C.p. (0.43 ± 0.06 g to 0.26 ± 0.03 g) and with superimposed disuse (0.18 ± 0.04 g); GTS-21 ameliorated TMM loss to 0.32 ± 0.04 (no disuse, p = 0.028) and to 0.22 ± 0.03 (with disuse, p = 0.004). Tetanic tensions decreased with C.p. or disuse and GTS-21 attenuated tension decrease in animals with disuse (p = 0.006) and in animals with C.p. and disuse (p = 0.029). C.p.-induced 11-fold increased muscle α7nAChR expression was decreased by > 60% with GTS-21 treatment. In conclusion, GTS-21 modulates systemic inflammation, evidenced by both decreased methemoglobin levels and decrease of α7nAChR expression, and mitigates inflammation-mediated loss of BW, TMM, fiber size, and function. [ABSTRACT FROM AUTHOR]

Background: Despite evidence supporting the effectiveness of prehabilitation as a new preoperative care pathway to optimise perioperative outcomes, its implementation into routine health care is widely pending. Frail patients might particularly benefit from prehabilitation interventions, but facilitating and hindering factors need to be considered in the implementation process. Thus, our aim was to derive a programme theory on what prehabilitation programmes work for frail patients in what circumstances and why. Methods: Following Pawson's realist review approach, preliminary programme theories on facilitators and barriers were established. General and topic-specific databases were searched systematically for facilitators and barriers to the implementation of prehabilitation for frail patients. Articles were included if they dealt with multimodal prehabilitation programmes prior to surgery in a frail population and if they contained information on facilitators and barriers during the implementation process in the full text. Based on these articles, refined programme theories were generated. Results: From 2,609 unique titles, 34 were retained for the realist synthesis. Facilitating factors included the individualisation of prehabilitation programmes to meet the patients' needs and abilities, multimodality, adaption to the local setting and health care system, endorsement by an ambassador and sharing of responsibilities among a multidisciplinary team. Central barriers for frail patients were transportation, lack of social support, and inadequate, overwhelming information provision. Conclusions: Implementing prehabilitation as a new care pathway for frail patients requires organisational readiness and adaptability to the local setting. On an individual level, a clear understanding of responsibilities and of the intervention's goal among patients and providers are necessary. Added attention must be paid to the individualisation to fit the needs and restrictions of frail patients. This makes prehabilitation a resource-intense, but promising intervention for frail surgery patients. Trial registration: PROSPERO (CRD42022335282). [ABSTRACT FROM AUTHOR]

Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome assessor-blinded trial. B Correction: Trials 23, 468 (2022) b B https://doi.org/10.1186/s13063-022-06401-x b Following publication of the original article [[1]], it came to the authors' attention that, as a result of the names of the PRAEP-GO investigators not being detailed in the Acknowledgements declaration (they were only provided in additional file 1), the names of these investigators were not showing in PubMed. [Extracted from the article]

Objectives Chronic administration of morphine and midazolam, alone or in combination, can induce tolerance to their effects. Data showed that co-administration of morphine and midazolam increased effective dose requirement of morphine, exceeding that observed with morphine alone. Methods To elucidate the pharmacokinetic component to the tolerance, we administered midazolam (2 mg/kg) and morphine (10 mg/kg) alone or their combination daily to rats for 12 days followed by a pharmacokinetic study on day 13. On the study day, each animal received a single bolus dose of 5 mg/kg morphine, and 2 mg/kg of midazolam 30 s later. Multiple blood samples were obtained for 6 h. Plasma drug concentrations were assayed by mass spectrometry optimized for small samples. Key findings Mean morphine clearance was as follows: 22.2, 27.2, 26.0 and 23.4 l/h per kg in the saline-saline, saline-midazolam, saline-morphine and midazolam-morphine groups, respectively. Corresponding midazolam clearances were 32.8, 23.0, 22.2 and 31.1 l/h per kg. ANOVA indicated no significant differences among the four groups in the clearances, half-lives, and volumes of distribution. Morphine and midazolam clearances were significantly correlated ( R2 = 0.48, P < 0.001). Conclusions This animal model suggests that altered pharmacokinetics cannot explain tolerance evidenced as increased dose requirement for morphine or midazolam, when administered alone or combination, for extended periods. [ABSTRACT FROM AUTHOR]

Correction to: Intensive Care Med (2022) 48:227-230 https://doi.org/10.1007/s00134-021-06591-... In this article the author name Mellinghoff was incorrectly written as Mellinhgoff. The original article can be found online at https://doi.org/10.1007/s00134-021-06591-z. [Extracted from the article]

Sugammadex is the first clinical representative of a new class of drugs called selective relaxant binding agents. It has revolutionized the way anesthesiologists think about drug reversal. Sugammadex selectively binds rocuronium or vecuronium, thereby reversing their neuromuscular blocking action. Due to its 1:1 binding of rocuronium or vecuronium, it is able to reverse any depth of neuromuscular block. So far, it has been approved for use in adult patients and for pediatric patients over 2 years. Since its approval in Europe, Japan, and Australia, further insight on its use in special patient populations and specific diseases have become available. Due to its pharmacodynamic profile, sugammadex, in combination with rocuronium, may have the potential to displace succinylcholine as the 'gold standard' muscle relaxant for rapid sequence induction. The use of rocuronium or vecuronium, with the potential of reverse of their action with sugammadex, seems to be safe in patients with impaired neuromuscular transmission, ie, neuromuscular diseases, including myasthenia gravis. Data from long-term use of sugammadex is not yet available. Evidence suggesting an economic advantage of using sugammadex and justifying its relatively high cost for an anesthesia-related drug, is missing. [ABSTRACT FROM AUTHOR]