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1. Nasal high-flow versus noninvasive ventilation in patients with chronic hypercapnic COPD

Author

Bräunlich J, Dellweg D, Bastian A, Budweiser S, Randerath W, Triché D, Bachmann M, Kähler C, Bayarassou AH, Mäder I, Geiseler J, Köhler N, Petroff D, and Wirtz H

Subjects
noninvasive ventilation, nasal high-flow, COPD, hypercapnia, Diseases of the respiratory system, RC705-779
Abstract

Jens Bräunlich,1 Dominic Dellweg,2 Andreas Bastian,3 Stephan Budweiser,4 Winfried Randerath,5 Dora Triché,6 Martin Bachmann,7 Christian Kähler,8 Abdel Hakim Bayarassou,9 Irmhild Mäder,10 Jens Geiseler,11 Norbert Köhler,12 David Petroff,12 Hubert Wirtz11Department of Respiratory Medicine, University of Leipzig AöR, Leipzig, Germany; 2Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg Grafschaft, Germany; 3Pneumologie/Intensivmedizin/Infektiologie, Marienkrankenhaus Kassel, Kassel, Germany; 4Medizinische Klinik III, RoMed Klinikum Rosenheim, Rosenheim, Germany; 5Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen, Germany; 6Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Nürnberg, Germany; 7Intensivmedizin und Beatmungsmedizin, Klinik für Atemwegs-, Lungen- und Thoraxmedizin, Asklepios Klinikum Harburg, Hamburg, Germany; 8Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria; 9Klinik für Pneumologie, Kardiologie, Schlaf- und Beatmungsmedizin, Malteser Krankenhaus Seliger Gerhard, Bonn/Rhein-Sieg, Bonn, Germany; 10Zentralklinik Bad Berka GmbH, Klinik für Pneumologie, Bad Berka, Germany; 11Medizinische Klinik IV, Klinikum Vest - Paracelsus-Klinik Marl, Marl, Germany; 12Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, GermanyBackground: Despite the encouraging results of noninvasive ventilation (NIV) in chronic hypercapnic COPD patients, it is also evident that some patients do not tolerate NIV or do not benefit from it. We conducted a study in which COPD patients with stable, chronic hypercapnia were treated with NIV and nasal high-flow (NHF) to compare effectiveness.Methods: In a multi-centered, randomized, controlled, cross-over design, patients received 6 weeks of NHF ventilation followed by 6 weeks of NIV ventilation or vice-versa (TIBICO) between 2011 and 2016. COPD patients with stable daytime hypercapnia (pCO2≥50 mmHg) were recruited from 13 German centers. The primary endpoint was pCO2 changes from baseline blood gas, lung function, quality of life (QoL), the 6 min walking test, and duration of device use were secondary endpoints.Results: A total of 102 patients (mean±SD) age 65.3±9.3 years, 61% females, body mass index 23.1±4.8 kg/m,2 90% GOLD D, pCO2 56.5±5.4 mmHg were randomized. PCO2 levels decreased by 4.7% (n=94; full analysis set; 95% CI 1.8–7.5, P=0.002) using NHF and 7.1% (95% CI 4.1–10.1, P

Published
2019

2. Ethik und Palliativmedizin in Intensiv- und Beatmungsmedizin

Author

Geiseler, J. and Schönhofer, B.

Abstract

Ethik und Palliativmedizin besitzen einen hohen Stellenwert in der heutigen Zeit. Das gilt neben der Onkologie zunehmend auch für die Intensivmedizin und klinische sowie außerklinische Beatmungstherapie. Vor allem die große Zahl invasiv beatmeter Patienten mit Weaning-Versagen und ggf. invasiver außerklinischer Beatmung hat zu einer deutlichen Fokussierung auf diese zwar lebenserhaltende, aber eventuell auch ungewollt lebensverlängernde Therapie geführt. Neben technisch Machbarem rücken die Perspektive des Patienten und seiner Familie immer mehr in den Vordergrund. Gefragt ist hierbei palliativmedizinische Kompetenz, um den Patientenwillen zu eruieren und anschließend umzusetzen, auch wenn das einen Therapierückzug oder gar -abbruch bedeutet. Dem Begriff „Therapiezieländerung“ kommt in dieser Situation eine zunehmende Bedeutung zu. Im außerklinischen Bereich ist die Etablierung palliativmedizinischer Strukturen für chronisch kritisch kranke Patienten vor allem mit dem Symptom Atemnot von entscheidender Bedeutung, um durch frühzeitige Intervention in stabilen Krankheitsstadien das weitere Vorgehen zusammen mit dem Patienten zu planen und damit ungewollte Langzeitbeatmungen zu vermeiden. Ethics and palliative care have a growing impact at the present time. This is true not only in oncology but also increasingly more for intensive care medicine and home mechanical ventilation. In particular, the large number of invasively ventilated patients with weaning failure has led to a clear focus on this both life-sustaining and possibly undesired life-prolonging treatment. In addition to what is technically feasible, the perspectives of patients and their families are coming more into focus. Palliative care skills are needed to elicit and adequately react to the patient’s wishes, even if that leads to therapy withdrawal or withholding treatment. Changing the aim of the treatment is becoming increasingly more important. In the non-clinical area of home mechanical ventilation the establishment of palliative care structures for chronically critically ill patients mainly suffering from dyspnea are crucially needed. Early intervention in and counseling of patients with chronic diseases is helpful in avoiding futile long-term invasive mechanical ventilation.

Published
2024
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6. Positionspapier zur praktischen Umsetzung der apparativen Differenzialtherapie der akuten respiratorischen Insuffizienz bei COVID-19

Author

Pfeifer, M., Ewig, S., Voshaar, T., Randerath, W., Bauer, T., Geiseler, J., Dellweg, D., Westhoff, M., Windisch, W., Schönhofer, B., Kluge, S., and Lepper, P. M.

Subjects
Pulmonary and Respiratory Medicine, Respiratory Distress Syndrome, Noninvasive Ventilation, Continuous Positive Airway Pressure, Positionspapier der DGP, SARS-CoV-2, Pneumonia, Viral, COVID-19, Pulmonary Edema, Berlin, Positive-Pressure Respiration, Betacoronavirus, Practice Guidelines as Topic, Intubation, Intratracheal, Humans, Coronavirus Infections, Respiratory Insufficiency, Lung, Pandemics, Societies, Medical
Abstract

Against the background of the pandemic caused by infection with the SARS-CoV-2, the German Society for Pneumology and Respiratory Medicine (DGP e.V.), in cooperation with other associations, has designated a team of experts in order to answer the currently pressing questions about therapy strategies in dealing with COVID-19 patients suffering from acute respiratory insufficiency (ARI).The position paper is based on the current knowledge that is evolving daily. Many of the published and cited studies require further review, also because many of them did not undergo standard review processes.Therefore, this position paper is also subject to a continuous review process and will be further developed in cooperation with the other professional societies.This position paper is structured into the following five topics:1. Pathophysiology of acute respiratory insufficiency in patients without immunity infected with SARS-CoV-22. Temporal course and prognosis of acute respiratory insufficiency during the course of the disease3. Oxygen insufflation, high-flow oxygen, non-invasive ventilation and invasive ventilation with special consideration of infectious aerosol formation4. Non-invasive ventilation in ARI5. Supply continuum for the treatment of ARIKey points have been highlighted as core statements and significant observations. Regarding the pathophysiological aspects of acute respiratory insufficiency (ARI), the pulmonary infection with SARS-CoV-2 COVID-19 runs through three phases: early infection, pulmonary manifestation and severe hyperinflammatory phase.There are differences between advanced COVID-19-induced lung damage and those changes seen in Acute Respiratory Distress Syndromes (ARDS) as defined by the Berlin criteria. In a pathophysiologically plausible - but currently not yet histopathologically substantiated - model, two types (L-type and H-type) are distinguished, which correspond to an early and late phase. This distinction can be taken into consideration in the differential instrumentation in the therapy of ARI.The assessment of the extent of ARI should be carried out by an arterial or capillary blood gas analysis under room air conditions and must include the calculation of the oxygen supply (measured from the variables of oxygen saturation, the Hb value, the corrected values of the Hüfner number and the cardiac output). In principle, aerosols can cause transmission of infectious viral particles. Open systems or leakage systems (so-called vented masks) can prevent the release of respirable particles. Procedures in which the invasive ventilation system must be opened, and endotracheal intubation must be carried out are associated with an increased risk of infection.The protection of personnel with personal protective equipment should have very high priority because fear of contagion must not be a primary reason for intubation. If the specifications for protective equipment (eye protection, FFP2 or FFP-3 mask, gown) are adhered to, inhalation therapy, nasal high-flow (NHF) therapy, CPAP therapy or NIV can be carried out according to the current state of knowledge without increased risk of infection to the staff. A significant proportion of patients with respiratory failure presents with relevant hypoxemia, often also caused by a high inspiratory oxygen fraction (FiO2) including NHF, and this hypoxemia cannot be not completely corrected. In this situation, CPAP/NIV therapy can be administered under use of a mouth and nose mask or a respiratory helmet as therapy escalation, as long as the criteria for endotracheal intubation are not fulfilled.In acute hypoxemic respiratory insufficiency, NIV should be performed in an intensive care unit or in a comparable unit by personnel with appropriate expertise. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring with readiness to carry out intubation must be ensured at all times. If CPAP/NIV leads to further progression of ARI, intubation and subsequent invasive ventilation should be carried out without delay if no DNI order is in place.In the case of patients in whom invasive ventilation, after exhausting all guideline-based measures, is not sufficient, extracorporeal membrane oxygenation procedure (ECMO) should be considered to ensure sufficient oxygen supply and to remove COVor dem Hintergrund der Pandemie durch Infektionen mit dem SARS-CoV-2 hat die Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP e.V.) federführend in Kooperation mit weiteren Verbänden ein Expertenteam benannt, um die zur Zeit drängenden Fragen zu Therapiestrategien im Umgang mit COVID-19-Patienten, die an akut respiratorischer Insuffizienz (ARI) leiden, zu beantworten. Das Positionspapier basiert auf dem momentanen aktuellen Wissen, das sich täglich weiterentwickelt. Viele der publizierten und zitierten Studien bedürfen weiterer Überprüfungen, auch weil viele kein übliches Review-Verfahren durchlaufen haben Daher unterliegt auch dieses Positionspapier einer ständigen Überprüfung und wird in Zusammenarbeit in der Zusammenarbeit mit den anderen Fachgesellschaften weiterentwickelt.Dieses Positionspapier wurde in die folgenden fünf Themenfelder gegliedert:1. Pathophysiologie der akuten respiratorischen Insuffizienz bei Infektionen mit SARS-CoV-2 bei Patienten ohne Immunität2. Zeitlicher Verlauf und Prognose der akuten respiratorischen Insuffizienz im Laufe der Erkrankung3. Sauerstoff-Insufflation, High-Flow Sauerstoff, nicht-invasive Beatmung und invasive Beatmung unter besonderer Berücksichtigung der infektiösen Aerosolbildung4. Nicht-Invasive Beatmung bei der ARI5. Versorgungskontinuum zur Behandlung der ARIZentrale Punkte wurden hierbei als Kernaussagen und Feststellungen herausgehoben. Bezüglich pathophysiologischer Aspekte der akuten respiratorischen Insuffizienz (ARI) verläuft die pulmonale Infektion mit SARS-CoV-2 COVID-19 in drei Phasen: Frühe Infektion, pulmonale Manifestation und schwere hyperinflammatorische Phase.Der fortgeschrittene COVID-19-induzierte Lungenschaden weist häufig Unterschiede zu den bekannten Veränderungen entsprechend der Definition des Acute Respiratory Distress Syndrome (ARDS) nach den Berlin-Kriterien auf.In einem pathophysiologisch plausiblen – zur Zeit aber noch nicht histopathologisch untermauerten – Modell wird in zwei Typen (L-Typ und H-Typ) unterschieden, die einer frühen und späten Phase entsprechen. Diese Unterscheidung kann für die apparative Differenzialtherapie der ARI erwogen werden.Die Einschätzung des Ausmaßes der ARI soll durch eine arterielle oder kapilläre Blutgasanalyse bei Raumluft erfolgen und die Errechnung des Sauerstoffangebotes (bemisst sich aus den Variablen der Sauerstoffsättigung, des Hb-Wertes, der Hüfnerʼschen Korrekturzahl sowie des Herzminutenvolumens) beinhalten.Durch Aerosole ist eine Übertragung von infektiösen, Viren-haltigen Partikeln prinzipiell möglich. Offene Systeme bzw. Leckage-Systeme (sog. vented Masken) können die Abgabe von respirablen Partikeln erhöhen. Prozeduren, bei denen das invasive Beatmungssystem geöffnet werden muss, sowie die endotracheale Intubation sind mit einem erhöhten Infektionsrisiko verbunden.Der Schutz des Personals durch persönliche Schutzausrüstung soll sehr hohe Priorität haben, weil die Angst vor Ansteckung kein primärer Intubationsgrund sein darf. Bei Einhaltung der Vorgaben zu Schutzausrüstung (Augenschutz, FFP2- bzw. FFP-3 Maske, Kittel) kann eine Inhalationstherapie, nasale High Flow (NHF) -Therapie, eine CPAP-Therapie oder eine NIV nach jetzigem Kenntnisstand vom Personal ohne erhöhtes Infektionsrisiko durchgeführt werden.Ein signifikanter Anteil der respiratorisch insuffizienten Patienten präsentiert sich mit einer relevanten Hypoxämie, die häufig auch durch eine hohe inspiratorische Sauerstofffraktion (FiO2) inklusive NHF nicht vollständig korrigiert werden kann.In dieser Situation können die CPAP/NIV-Therapie unter Verwendung einer Mund-Nasen-Maske oder eines Beatmungshelms als Therapieeskalation durchgeführt werden, solange die Kriterien für eine endotracheale Intubation nicht erfüllt sind.Die NIV bei akuter hypoxämischer Insuffizienz sollte auf der Intensivstation oder in einer vergleichbaren Struktur mit entsprechender personeller Expertise erfolgen. Unter CPAP/NIV kann es zu einer raschen Verschlechterung kommen. Aus diesem Grund soll ein ständiges Monitoring unter ständiger Intubationsbereitschaft gewährleistet sein. Kommt es unter CPAP/NIV zur weiteren Progression des ARI, sollte ohne zeitliche Verzögerung die Intubation und nachfolgende invasive Beatmung erfolgen, wenn keine DNI-Order vorliegt.Bei Patienten, bei denen eine invasive Beatmung unter Ausschöpfung aller leitliniengerechter Maßnahmen nicht ausreicht, um eine ausreichende Sauerstoffaufnahme und CO

Published
2020

11. Position Paper for the State of the Art Application of Respiratory Support in Patients with COVID-19 German Respiratory Society

Author

Pfeifer, M., Ewig, S., Voshaar, T., Randerath, W., Bauer, T., Geiseler, J., Dellweg, D., Westhoff, M., Windisch, W., Schoenhofer, B., Kluge, S., Lepper, P. M., Pfeifer, M., Ewig, S., Voshaar, T., Randerath, W., Bauer, T., Geiseler, J., Dellweg, D., Westhoff, M., Windisch, W., Schoenhofer, B., Kluge, S., and Lepper, P. M.

Abstract

Against the background of the pandemic caused by infection with the SARS-CoV-2, the German Society for Pneumology and Respiratory Medicine (DGP e.V.), in cooperation with other associations, has designated a team of experts in order to answer the currently pressing questions about therapy strategies in dealing with COVID-19 patients suffering from acute respiratory insufficiency (ARI). The position paper is based on the current knowledge that is evolving daily. Many of the published and cited studies require further review, also because many of them did not undergo standard review processes.Therefore, this position paper is also subject to a continuous review process and will be further developed in cooperation with the other professional societies. This position paper is structured into the following five topics: 1. Pathophysiology of acute respiratory insufficiency in patients without immunity infected with SARS-CoV-2 2. Temporal course and prognosis of acute respiratory insufficiency during the course of the disease 3. Oxygen insufflation, high-flow oxygen, non-invasive ventilation and invasive ventilation with special consideration of infectious aerosol formation 4. Non-invasive ventilation in ARI 5. Supply continuum for the treatment of ARI Key points have been highlighted as core statements and significant observations. Regarding the pathophysiological aspects of acute respiratory insufficiency (ARI), the pulmonary infection with SARS-CoV-2 COVID-19 runs through three phases: early infection, pulmonary manifestation and severe hyperinflammatory phase. There are differences between advanced COVID-19-induced lung damage and those changes seen in Acute Respiratory Distress Syndromes (ARDS) as defined by the Berlin criteria. In a pathophysiologically plausible - but currently not yet histopathologically substantiated - model, two types (L-type and H-type) are distinguished, which correspond to an early and late phase. This distinction can be taken into considerati

Published
2020

14. Nasal High-Flow Versus Non-Invasive Ventilation in Patients with Chronic Hypercapnic COPD

Author

Braunlich, J., primary, Dellweg, D., additional, Bastian, A., additional, Blum, T., additional, Budweiser, S., additional, Randerath, W.J., additional, Triché, D., additional, Bachmann, M., additional, Kähler, C., additional, Bayarassou, A.H., additional, Mäder, I., additional, Geiseler, J., additional, Petroff, D., additional, and Wirtz, H.R., additional

Published
2020
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15. Nasal high-flow versus nicht-invasive Beatmung bei Patienten mit stabil chronisch hyperkapnischer COPD

Author

Bräunlich, J, additional, Dellweg, D, additional, Bastian, A, additional, Blum, TG, additional, Budweiser, S, additional, Randerath, WJ, additional, Triché, D, additional, Bachmann, M, additional, Kähler, C, additional, Bayarassou, AH, additional, Mäder, I, additional, Geiseler, J, additional, Köhler, N, additional, Petroff, D, additional, and Wirtz, H, additional

Published
2020
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19. Entwöhnung von der mechanischen Beatmung

Author

Kelbel C and Geiseler J

Subjects
Mechanical ventilation, medicine.medical_specialty, business.industry, Sedation, medicine.medical_treatment, Emergency Nursing, Critical Care and Intensive Care Medicine, medicine.disease, Comorbidity, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Intensive care, Health care, Emergency Medicine, Internal Medicine, Breathing, Medicine, Weaning, Noninvasive ventilation, 030212 general & internal medicine, medicine.symptom, business, Intensive care medicine
Abstract

The international classification of three weaning categories (simple weaning, difficult weaning, prolonged weaning) has been modified in the German weaning guidelines: the group of prolonged weaning has been subclassified into weaning without noninvasive ventilation (NIV), weaning with NIV, if necessary with continuing NIV in the form of home mechanical ventilation, and weaning failure.Strategies to prevent prolonged weaning comprise daily interruption of sedation, daily screening of capability of spontaneous breathing by a spontaneous breathing trial (SBT) and early implementation of NIV instead of continuing invasive mechanical ventilation especially in hypercapnic patients. The comorbidity left heart failure plays a major role in weaning failure and need for re-intubation-in this case early diagnosis and if necessary modification of heart therapy are important.Specialised weaning-centres offer the option for successful weaning for about 50-60 % of patients declared as unweanable by usual intensive care units. A multimodal therapy concept with respiratory therapists, physiotherapists and speech therapy is necessary to reach this goal. In case of weaning failure a professional discharge management to invasive home mechanical ventilation is important. Competent care by physicians in the out-of-hospital area is restricted by the sectoral division of responsibility by the German health care system. Improvement in this area is urgently needed.

Published
2016

26. MOR103, a human monoclonal antibody to granulocyte-macrophage colony-stimulating factor, in the treatment of patients with moderate rheumatoid arthritis

Author

Behrens, F., Tak, P.P., Østergaard, M., Stoilov, R., Wiland, P., Huizinga, T.W., Berenfus, V.Y., Vladeva, S., Rech, J., Rubbert-Roth, A., Korkosz, M., Rekalov, D., Zupanets, I.A., Ejbjerg, B.J., Geiseler, J., Fresenius, J., Korolkiewicz, R.P., Schottelius, A.J., Burkhardt, H., and Publica

Abstract

Objectives: To determine the safety, tolerability and signs of efficacy of MOR103, a human monoclonal antibody to granulocyte-macrophage colony-stimulating factor (GM-CSF), in patients with rheumatoid arthritis (RA). Methods: Patients with active, moderate RA were enrolled in a randomised, multicentre, double-blind, placebo-controlled, dose-escalation trial of intravenous MOR103 (0.3, 1.0 or 1.5 mg/kg) once a week for 4 weeks, with follow-up to 16 weeks. The primary outcome was safety. Results: Of the 96 randomised and treated subjects, 85 completed the trial (n=27, 24, 22 and 23 for pooled placebo and MOR103 0.3, 1.0 and 1.5 mg/kg, respectively). Treatment emergent adverse events (AEs) in the MOR103 groups were mild or moderate in intensity and generally reported at frequencies similar to those in the placebo group. The most common AE was nasopharyngitis. In two cases, AEs were classified as serious because of hospitalisation: paronychia in a placebo subject and pleuri sy in a MOR103 0.3 mg/kg subject. Both patients recovered fully. In exploratory efficacy analyses, subjects in the MOR103 1.0 and 1.5 mg/kg groups showed significant improvements in Disease Activity Score-28 scores and joint counts and significantly higher European League Against Rheumatism response rates than subjects receiving placebo. MOR103 1.0 mg/kg was associated with the largest reductions in disease activity parameters. Conclusions: MOR103 was well tolerated and showed preliminary evidence of efficacy in patients with active RA. The data support further investigation of this monoclonal antibody to GM-CSF in RA patients and potentially in those with other immune-mediated inflammatory diseases.

Published
2015

27. Respiratory critical care HERMES syllabus: defining competencies for respiratory doctors

Author

Artigas A, Pelosi P, Dellweg D, Brochard L, Ferrer M, Geiseler J, Larsson A, NAVA, STEFANO, Navalesi P, Noël JL, Orfanos S, Palange P, Schoenhofer B, Vassilakopoulos T, Simonds A, ERS Educational Task Force on Respiratory Critical Care HERMES, Artigas A, Pelosi P, Dellweg D, Brochard L, Ferrer M, Geiseler J, Larsson A, Nava S, Navalesi P, Noël JL, Orfanos S, Palange P, Schoenhofer B, Vassilakopoulos T, Simonds A, and ERS Educational Task Force on Respiratory Critical Care HERMES

Subjects
Pulmonary and Respiratory Medicine, Respiratory Therapy, Critical Care, Lifelong learning, respiratory doctors, History, 21st Century, Syllabus, Nursing, Intensive care, Humans, Medicine, media_common.cataloged_instance, European Union, European union, Erasmus+, media_common, Respiratory Care Units, Scope (project management), business.industry, Core competency, History, 20th Century, Directive, Treatment Outcome, Education, Medical, Graduate, syllabu, Clinical Competence, business, competencie
Abstract

“Coming together is a beginning, staying together is progress and working together is success.” Henry Ford (1863–1947). From a medical perspective, European countries are growing closer together. An increasing number of physicians are crossing borders and swapping workplaces. In order to facilitate this development, the European Union (EU) adopted a directive dictating the equality of diplomas and medical board certificates within the EU [1]. Despite a number of initiatives, such as the “Lifelong Learning Programme: education and training opportunities”, for which the ERASMUS (European Region Action Scheme for the Mobility of University Students) is a sub-programme aimed at harmonising medical education during the early phases of medical training [2], there is a need to standardise knowledge and skills at later career stages in order to guarantee and harmonise the quality of patient care in Europe. To address this, the HERMES project (Harmonised Education in Respiratory Medicine for European Specialists) was launched by the European Respiratory Society (ERS) in 2005 in order to harmonise education and training in respiratory medicine. With the success of this project, the ERS extended its scope to include a Paediatric Respiratory Medicine HERMES and subspecialty-focused HERMES projects. Thus, the Respiratory Critical Care HERMES project was launched in 2009. The project aims to provide educational standards and a training framework for respiratory critical care medicine using standardised modified Delphi surveys, facilitated group discussions and plenary sessions. This is consistent with the ERS mission and has the ultimate goal of providing better patient care. Similar projects in critical care have been launched in the past, such as the multi-society task force on competencies in pulmonary and critical care medicine reported by Buckley et al. [3] in 2009 and the development of core competencies for an international training programme in intensive care …

Published
2012

28. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

Author

Keth, Th, Azoulay, E, Echeverria, Pm, Vincent, Jl, Collaboratorsmargarit, A, Valentini, R, Alan Javier, Z, Bevilacqua, C, Curone, M, Rabuffetti, R, Comignani, P, Torres Boden, M, Chertcoff, F, Cardonatti, G, Adén, F, Marcos, L, Dónofrio, M, Fernández, R, Lamberghini, R, Balasini, S, Teves, J, Las Heras, M, Sinner, J, Ceraso, D, Curcio, D, Aguilar, L, Weller, C, Cardonnet, L, Santa Cruz, R, Manrique, E, Bernardez, D, Iolster, T, Chiappero, G, Ramos, P, Vergara, J, Moine, I, Ilutovich, S, Jannello, G, Waschbusch, M, Rios Picaza, G, Raimondi, A, Miriam, M, Lovesio, C, Caridi, M, Leong, T, Orford, N, Reece, G, Ernest, D, Hawker, F, Tan, J, Giannellis, C, Ihle, B, Bersten, A, Mcinnes, J, Tallott, M, Mcfadyen, B, Vibert, J, Parr, M, Tran, K, Sutton, J, Webb, S, Groves, N, Cole, L, Long, D, Bass, F, Erickson, S, Lipman, J, Delzoppo, C, Thomas, J, Dobb, G, Daley, M, Roberts, B, Santamaria, J, Young, J, Festa, M, Holland, R, Mullany, D, Williams, P, Corkeron, M, Gales, M, Banerjee, A, Yung, M, Mutz, N, Hiesmayr, M, Faybik, P, Fitzgerald, R, Firlinger, F, Zasmeta, G, Zink, M, Sieber, W, Hildegard, J, Bakondy, R, Schlieber, J, Filzwieser, G, Beer, R, Joannidis, M, Schuster, R, Scherzer, W, Smolle, K, Fitzal, S, Manzoor, R, Brunain, J, D'Hondt, A, Huylenbroeck, G, Van der Schueren, M, 't Kindt, H, Slock, E, Rijckaert, D, Raemaekers, J, Bourgeois, M, Van Cotthem, I, Nackaerts, G, Gusu, D, Gadisseux, P, Vancollie, O, Lignian, H, Michel, P, Fraipont, V, Vander Stappen, M, Forêt, F, De Bels, D, Devriendt, J, Massaut, J, Biston, P, Roman, A, Lambermont, B, De Meulder, A, Frederic, V, Sottiaux, T, Ruyffelaere, P, Collin, V, Anane, S, Kleiren, P, Simon, M, Machayekhi, S, Frans, E, Leroy, G, Berghmans, T, Joseph, R, Eerens, J, Laterre, P, Lagrou, B, Rutsaert, R, Pisarek, W, Dive, A, De Waele, J, Spapen, H, Damas, P, Malbrain, M, Hidalgo, J, Baptista, M, Salgado, D, Braga, M, Avila, C, Westphal, G, Caser, E, Alves, A, Friedman, G, Luz, M, Assuncao, M, Reis, H, Gomes, A, Silva, U, Nogueira Fh, W, El Dash, S, Valiatti, J, Barbosa, A, Coelho, C, Knibel, M, Minelli, C, Caovilla, J, Teixeira, G, Hovnanian, A, Rea Neto, A, Lobo, S, Lugarinho, M, Souza, P, Ferreira, D, Duarte, P, Oliveira, M, Marques, J, Machado, R, Rehder, P, Mataloun, S, Grilo, M, Quesado, P, Moock, M, Ferreira, F, Teles, J, Silva, E, Morais, A, Bruzzi de Carvalho, F, Wanderley, M, Velasco, M, Brandão da Silva, N, Feijó, J, Souza Dantas, V, Costa Filho, R, Japiassú, A, Villela, D, Santos, C, Passos, R, Alheira Rocha, R, Silva, R, Houly, J, Aldrighi, J, Hatum, R, Suparregui Dias, F, Ferreira, L, Ferro, L, Gomez, J, Fleury, R, David, C, Resener, T, Mendes, C, Germano, A, De Marco, F, Lage, S, Salluh, J, Torelly, A, Sad, R, Oliveira, G, Lima, R, Paranhos, J, Rocha, M, Bitencourt, W, Grion, C, Forte, D, Guimarães, H, Piras, C, Stephanova, L, Lyubenov, L, Tsarianski, G, Dimov, G, Green, R, Levasseur, J, Ward, R, Lesur, O, Poirier, G, Wax, R, Wood, G, Cook, D, Marshall, J, Herridge, M, Ferguson, N, 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Nguyen Huu, C.

Published
2011

30. S2k-Guideline “Prolonged Weaning”

Author

Schönhofer, B., additional, Geiseler, J., additional, Dellweg, D., additional, Moerer, O., additional, Barchfeld, T., additional, Fuchs, H., additional, Karg, O., additional, Rosseau, S., additional, Sitter, H., additional, Weber-Carstens, S., additional, Westhoff, M., additional, and Windisch, W., additional

Published
2015
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34. Defining a training framework for clinicians in respiratory critical care

Author

Artigas, A., primary, Noel, J.-L., additional, Brochard, L., additional, Busari, J. O., additional, Dellweg, D., additional, Ferrer, M., additional, Geiseler, J., additional, Larsson, A., additional, Nava, S., additional, Navalesi, P., additional, Orfanos, S., additional, Palange, P., additional, Pelosi, P., additional, Rohde, G., additional, Schoenhofer, B., additional, Vassilakopoulos, T., additional, and Simonds, A. K., additional

Published
2014
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37. Respiratory Critical Care HERMES: European curriculum recommendations

Author

Artigas, A., primary, Noel, J.-L., additional, Brochard, L., additional, Busari, J. O., additional, Dellweg, D., additional, Ferrer, M., additional, Geiseler, J., additional, Larsson, A., additional, Nava, S., additional, Navalesi, P., additional, Orfanos, S., additional, Palange, P., additional, Pelosi, P., additional, Rohde, G., additional, Schoenhofer, B., additional, Vassilakopoulos, T., additional, and Simonds, A. K., additional

Published
2014
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38. Prolongiertes Weaning

Author

Schönhofer, B., additional, Geiseler, J., additional, Dellweg, D., additional, Moerer, O., additional, Barchfeld, T., additional, Fuchs, H., additional, Karg, O., additional, Rosseau, S., additional, Sitter, H., additional, Weber-Carstens, S., additional, Westhoff, M., additional, and Windisch, W., additional

Published
2014
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39. First in patient study of anti-GM-CSF monoclonal antibody (MOR103) in active rheumatoid arthritis: Results of a phase 1b/2a randomized, double-blind, placebo-controlled trial.

Author

Behrens, F., Østergaard, Mikkel, Stoilov, R., Wiland, P., Huizinga, T.W., Berenfus, V.Y., Tak, P.-P., Vladeva, S., Rech, J., Rubbert-Roth, A., Korkosz, M., Rekalov, D., Zupanets, I.A., Ejbjerg, B.J., Geiseler, J., Fresenius, J., Korolkiewicz, R.P., Schottelius, A.J., Burkhardt, H., Behrens, F., Østergaard, Mikkel, Stoilov, R., Wiland, P., Huizinga, T.W., Berenfus, V.Y., Tak, P.-P., Vladeva, S., Rech, J., Rubbert-Roth, A., Korkosz, M., Rekalov, D., Zupanets, I.A., Ejbjerg, B.J., Geiseler, J., Fresenius, J., Korolkiewicz, R.P., Schottelius, A.J., and Burkhardt, H.

Published
2012

40. Invasive home mechanical ventilation, mainly focused on neuromuscular disorders

Author

Geiseler, J, Karg, O, Börger, S, Becker, K, Zimolong, A, Geiseler, J, Karg, O, Börger, S, Becker, K, and Zimolong, A

Abstract

Introduction and background Invasive home mechanical ventilation is used for patients with chronic respiratory insufficiency. This elaborate and technology-dependent ventilation is carried out via an artificial airway (tracheal cannula) to the trachea. Exact numbers about the incidence of home mechanical ventilation are not available. Patients with neuromuscular diseases represent a large portion of it. Research questions Specific research questions are formulated and answered concerning the dimensions of medicine/nursing, economics, social, ethical and legal aspects. Beyond the technical aspect of the invasive home, mechanical ventilation, medical questions also deal with the patient's symptoms and clinical signs as well as the frequency of complications. Economic questions pertain to the composition of costs and the differences to other ways of homecare concerning costs and quality of care. Questions regarding social aspects consider the health-related quality of life of patients and caregivers. Additionally, the ethical aspects connected to the decision of home mechanical ventilation are viewed. Finally, legal aspects of financing invasive home mechanical ventilation are discussed. Methods Based on a systematic literature search in 2008 in a total of 31 relevant databases current literature is viewed and selected by means of fixed criteria. Randomized controlled studies, systematic reviews and HTA reports (health technology assessment), clinical studies with patient numbers above ten, health-economic evaluations, primary studies with particular cost analyses and quality-of-life studies related to the research questions are included in the analysis. Results and discussion Invasive mechanical ventilation may improve symptoms of hypoventilation, as the analysis of the literature shows. An increase in life expectancy is likely, but for ethical reasons it is not confirmed by premium-quality studies. Complications (e. g. pneumonia) are rare. Mobile home ventilators are, Einleitung und Hintergrund Die invasive Heimbeatmung wird bei Patienten mit chronisch respiratorischer Insuffizienz (unzureichender Atemfähigkeit) durchgeführt. Die aufwendige und technologielastige Beatmung erfolgt über einen künstlichen Zugang (Trachealkanüle) zur Luftröhre. Genaue Zahlen über die Häufigkeit dieser Form von Beatmung in häuslicher Umgebung liegen nicht vor. Patienten mit neuromuskulären Erkrankungen machen einen großen Anteil aus. Forschungsfragen Zu unterschiedlichen Dimensionen Medizin/Pflege, Ökonomie, Soziales, Ethik und Recht werden spezifische Forschungsfragen formuliert und beantwortet. Medizinische Fragen behandeln neben technischen Aspekten der häuslichen invasiven Beatmung, die Symptomatik bzw. die klinischen Befunde der Patienten sowie die Häufigkeit von Komplikationen. Ökonomische Fragestellungen beziehen sich auf die Zusammensetzung der Kosten und die Unterschiede zu anderen Versorgungsformen bezüglich Kosten und Qualität der Pflege. Fragestellungen zu sozialen Aspekten berücksichtigen die gesundheitsbezogene Lebensqualität der Patienten und Betreuungspersonen. Zusätzlich werden die mit der Entscheidung zu Heimbeatmung verbundenen ethischen Gesichtspunkte betrachtet. Zuletzt werden rechtliche Aspekte der Finanzierung der invasiven Heimbeatmung erörtert. Methodik Auf Basis einer systematischen Literatursuche 2008 in insgesamt 31 relevanten Datenbanken wird die derzeit aktuelle Literatur gesichtet und anhand festgelegter Kriterien ausgewählt. Randomisierte kontrollierte Studien, systematische Reviews und HTA-Berichte (HTA = Health Technology Assessment), klinische Studien mit Patientenzahlen über zehn, gesundheitsökonomische Evaluationen, Primärstudien ggf. mit eigenen Kostenberechnungen und Lebensqualitätsstudien mit Bezug zu den Forschungsfragen führen zum Einschluss in die Analyse. Ergebnisse und Diskussion Invasive Beatmung kann die Symptome der Hypoventilation verbessern, wie sich aus der Analyse der Literatur ergibt. Darüber hinaus

Published
2010

44. Respiratory Critical Care HERMES: a European core syllabus in respiratory critical care medicine

Author

Artigas, A, primary, Vassilakopoulos, T, additional, Brochard, L, additional, Dellweg, D, additional, Farr, A, additional, Ferrer, M, additional, Geiseler, J, additional, Larsson, A, additional, Nava, S, additional, Navalesi, P, additional, Noe¨l, J-L, additional, Orfanos, S, additional, Palange, P, additional, Schoenhofer, B, additional, Simonds, A, additional, and Pelosi, P, additional

Published
2012
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46. Nichtinvasive und invasive Beatmung als Therapie der chronischen respiratorischen Insuffizienz

Author

Windisch, W., primary, Brambring, J., additional, Budweiser, S., additional, Dellweg, D., additional, Geiseler, J., additional, Gerhard, F., additional, Köhnlein, T., additional, Mellies, U., additional, Schönhofer, B., additional, Schucher, B., additional, Siemon, K., additional, Walterspacher, S., additional, Winterholler, M., additional, and Sitter, H., additional

Published
2010
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47. Palliativmedizin in der Pneumologie

Author

Magnussen, H., primary, Heigener, D., additional, Bausewein, C., additional, Thomas, M., additional, Eschbach, C., additional, Schütte, W., additional, Blankenburg, T., additional, Steins, M., additional, Bischoff, H., additional, Schucher, B., additional, Rosseau, S., additional, Schütz, A., additional, Geiseler, J., additional, Kampf, S., additional, and Karg, O., additional

Published
2009
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49. Der Atmungstherapeut

Author

Karg, O., primary, Bubulj, C., additional, Esche, B., additional, Geiseler, J., additional, Bonnet, R., additional, and Mäder, I., additional

Published
2008
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