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1. A randomized control trial evaluating the advice of a physiological-model/digital twin-based decision support system on mechanical ventilation in patients with acute respiratory distress syndrome

Author

Brijesh V. Patel, Sharon Mumby, Nicholas Johnson, Rhodri Handslip, Sunil Patel, Teresa Lee, Martin S. Andersen, Emanuela Falaschetti, Ian M. Adcock, Danny F. McAuley, Masao Takata, Thomas Staudinger, Dan S. Karbing, Matthieu Jabaudon, Peter Schellongowski, Stephen E. Rees, and On behalf of the DeVENT Study Group

Subjects
ARDS, mechanical ventilation, clinical decision support, respiratory mechanics, driving pressure, Medicine (General), R5-920
Abstract

BackgroundAcute respiratory distress syndrome (ARDS) is highly heterogeneous, both in its clinical presentation and in the patient’s physiological responses to changes in mechanical ventilator settings, such as PEEP. This study investigates the clinical efficacy of a physiological model-based ventilatory decision support system (DSS) to personalize ventilator therapy in ARDS patients.MethodsThis international, multicenter, randomized, open-label study enrolled patients with ARDS during the COVID-19 pandemic. Patients were randomized to either receive active advice from the DSS (intervention) or standard care without DSS advice (control). The primary outcome was to detect a reduction in average driving pressure between groups. Secondary outcomes included several clinically relevant measures of respiratory physiology, ventilator-free days, time from control mode to support mode, number of changes in ventilator settings per day, percentage of time in control and support mode ventilation, ventilation- and device-related adverse events, and the number of times the advice was followed.ResultsA total of 95 patients were randomized in this study. The DSS showed no significant effect on average driving pressure between groups. However, patients in the intervention arm had a statistically improved oxygenation index when in support mode ventilation (−1.41, 95% CI: −2.76, −0.08; p = 0.0370). Additionally, the ventilatory ratio significantly improved in the intervention arm for patients in control mode ventilation (−0.63, 95% CI: −1.08, −0.17, p = 0.0068). The application of the DSS led to a significantly increased number of ventilator changes for pressure settings and respiratory frequency.ConclusionThe use of a physiological model-based decision support system for providing advice on mechanical ventilation in patients with COVID-19 and non-COVID-19 ARDS showed no significant difference in driving pressure as a primary outcome measure. However, the application of approximately 60% of the DSS advice led to improvements in the patient’s physiological state.Clinical trial registrationclinicaltrials.gov, NCT04115709.

Published
2024
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2. Characteristics and outcomes of patients with acute myeloid leukemia admitted to intensive care unit with acute respiratory failure: a post-hoc analysis of a prospective multicenter study

Author

Carolina Secreto, Dara Chean, Andry van de Louw, Achille Kouatchet, Philippe Bauer, Marco Cerrano, Etienne Lengliné, Colombe Saillard, Laurent Chow-Chine, Anders Perner, Peter Pickkers, Marcio Soares, Jordi Rello, Frédéric Pène, Virginie Lemiale, Michael Darmon, Sofiane Fodil, Ignacio Martin-Loeches, Sangeeta Mehta, Peter Schellongowski, Elie Azoulay, and Djamel Mokart

Subjects
Acute myeloid leukemia, Acute respiratory failure, Intensive care unit, Hospital mortality, Cluster analysis, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Acute respiratory failure (ARF) is the leading cause of intensive care unit (ICU) admission in patients with Acute Myeloid Leukemia (AML) and data on prognostic factors affecting short-term outcome are needed. Methods This is a post-hoc analysis of a multicenter, international prospective cohort study on immunocompromised patients with ARF admitted to ICU. We evaluated hospital mortality and associated risk factors in patients with AML and ARF; secondly, we aimed to define specific subgroups within our study population through a cluster analysis. Results Overall, 201 of 1611 immunocompromised patients with ARF had AML and were included in the analysis. Hospital mortality was 46.8%. Variables independently associated with mortality were ECOG performance status ≥ 2 (OR = 2.79, p = 0.04), cough (OR = 2.94, p = 0.034), use of vasopressors (OR = 2.79, p = 0.044), leukemia-specific pulmonary involvement [namely leukostasis, pulmonary infiltration by blasts or acute lysis pneumopathy (OR = 4.76, p = 0.011)] and liver SOFA score (OR = 1.85, p = 0.014). Focal alveolar chest X-ray pattern was associated with survival (OR = 0.13, p = 0.001). We identified 3 clusters, that we named on the basis of the most frequently clinical, biological and radiological features found in each cluster: a “leukemic cluster”, with high-risk AML patients with isolated, milder ARF; a “pulmonary cluster”, consisting of symptomatic, highly oxygen-requiring, severe ARF with diffuse radiological findings in heavily immunocompromised patients; a clinical “inflammatory cluster”, including patients with multi-organ failures in addition to ARF. When included in the multivariate analysis, cluster 2 and 3 were independently associated with hospital mortality. Conclusions Among AML patients with ARF, factors associated with a worse outcome are related to patient’s background (performance status, leukemic pulmonary involvement), symptoms, radiological findings, the need for vasopressors and the liver SOFA score. We identified three specific ARF syndromes in AML patients, which showed a prognostic significance and could guide clinicians to optimize management strategies.

Published
2023
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3. Subjective and objective survival prediction in mechanically ventilated critically ill patients: a prospective cohort study

Author

Lucas Boeck, Hans Pargger, Peter Schellongowski, Charles-Edouard Luyt, Marco Maggiorini, Kathleen Jahn, Grégoire Muller, Rene Lötscher, Evelyne Bucher, Nadine Cueni, Thomas Staudinger, Jean Chastre, Martin Siegemund, Michael Tamm, and Daiana Stolz

Subjects
Risk stratification, Personalised medicine, Critical care, Scores, Outcome, Modelling, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background ICU risk assessment tools, routinely used for predicting population outcomes, are not recommended for evaluating individual risk. The state of health of single patients is mostly subjectively assessed to inform relatives and presumably to decide on treatment decisions. However, little is known how subjective and objective survival estimates compare. Methods We performed a prospective cohort study in mechanically ventilated critically ill patients across five European centres, assessed 62 objective markers and asked the clinical staff to subjectively estimate the probability of surviving 28 days. Results Within the 961 included patients, we identified 27 single objective predictors for 28-day survival (73.8%) and pooled them into predictive groups. While patient characteristics and treatment models performed poorly, the disease and biomarker models had a moderate discriminative performance for predicting 28-day survival, which improved for predicting 1-year survival. Subjective estimates of nurses (c-statistic [95% CI] 0.74 [0.70–0.78]), junior physicians (0.78 [0.74–0.81]) and attending physicians (0.75 [0.72–0.79]) discriminated survivors from non-survivors at least as good as the combination of all objective predictors (c-statistic: 0.67–0.72). Unexpectedly, subjective estimates were insufficiently calibrated, overestimating death in high-risk patients by about 20% in absolute terms. Combining subjective and objective measures refined discrimination and reduced the overestimation of death. Conclusions Subjective survival estimates are simple, cheap and similarly discriminative as objective models; however, they overestimate death risking that live-saving therapies are withheld. Therefore, subjective survival estimates of individual patients should be compared with objective tools and interpreted with caution if not agreeing. Trial registration ISRCTN ISRCTN59376582 , retrospectively registered October 31st 2013.

Published
2023
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4. Characteristics and outcome of critically ill patients with systemic rheumatic diseases referred to the intensive care unit

Author

Daniel Aletaha, Peter Schellongowski, Michael Zauner, Klaus P Machold, Gottfried Heinz, Thomas Staudinger, Christian Zauner, Gürkan Sengölge, Mathias Schneeweiss-Gleixner, Caroline Hillebrand, Stephanie Jaksits, Jonathan Fries, and Manuel Bécède

Subjects
Medicine
Abstract

Objectives Patients with systemic rheumatic diseases (SRDs) are at risk of admission to the intensive care unit (ICU). Data concerning these critically ill patients are limited to few retrospective studies.Methods This is a single-centre retrospective study of patients with SRDs admitted to an ICU at the Vienna General Hospital between 2012 and 2020. Single-predictor and multiple logistic regression analysis was performed to identify potential outcome determinants.Results A total of 144 patients accounting for 192 ICU admissions were included. Connective tissue diseases (CTDs), vasculitides and rheumatoid arthritis were the most common SRDs requiring ICU admission. Leading causes for ICU admission were respiratory failure and shock, as reflected by a high number of patients requiring mechanical ventilation (60.4%) and vasopressor therapy (72.9%). Overall, 29.2% of admissions were due to SRD-related critical illness. In 70.8% patients, co-existent SRD not responsible for the acute critical illness was documented. When comparing these subgroups, CTDs and vasculitides had a higher frequency in the patients with SRD-related critical illness. In a significantly higher proportion of patients in the SRD-related subgroup, diagnosis of SRD was made at the ICU. ICU and 6-month mortality in the overall population was 20.3% and 38.5%, respectively. Age, glucocorticoid therapy prior to hospital admission and disease severity were associated with poor outcome.Conclusions In this study, respiratory failure was the leading cause of ICU admission as reflected by high rates of required mechanical ventilation. Despite considerable severity of critical illness, survival rates were comparable to a general ICU population.

Published
2023
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5. Prevalence and Impact of Lupus Anticoagulant in Patients Receiving Extracorporeal Membrane Oxygenation

Author

Andrea Kornfehl MD, Roman Brock MD, Thomas Staudinger MD, Peter Schellongowski MD, Bernhard Nagler MD, Alexander Hermann MD, PhD, Oliver Robak MD, Michael Schwameis MD, Peter Quehenberger MD, and Nina Buchtele MD, PhD

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Monitoring of blood coagulation is essential in ECMO patients. We investigated the prevalence of lupus anticoagulant (LA) and its association with coagulation testing and hemostaseologic complications in patients treated with ECMO. Methods This is a retrospective analysis including adult patients who received ECMO at a medical intensive care unit at the Medical University of Vienna. The primary outcome was the prevalence of LA. Secondary outcomes included conditions associated with LA positivity, rates of bleeding and thromboembolic events, as well as the proportions of aPTT and antiXa measurements within the target range. Results Between 2013 and 2021 193 patients received ECMO, in 62 (32%) of whom LA diagnostics were performed. Twenty-two (35%) patients tested positive. LA positive patients had more frequently received VV ECMO (77.3% vs 34.3%; p = 0.002), were more frequently diagnosed with viral respiratory infections (SARS-CoV2: 45.5% vs 20%; p = 0.041, influenza virus: 22.7% vs 0%; p = 0.003), had a longer ECMO treatment duration (25 vs 10 days; p = 0.011) and a longer ICU stay (48 vs 25 days; p = 0.022), but similar rates of bleeding and thromboembolic events.

Published
2023
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6. Duration of invasive mechanical ventilation prior to extracorporeal membrane oxygenation is not associated with survival in acute respiratory distress syndrome caused by coronavirus disease 2019

Author

Martina Hermann, Daniel Laxar, Christoph Krall, Christina Hafner, Oliver Herzog, Oliver Kimberger, Sebastian Koenig, Felix Kraft, Mathias Maleczek, Klaus Markstaller, Oliver Robak, Bernhard Rössler, Eva Schaden, Peter Schellongowski, Mathias Schneeweiss-Gleixner, Thomas Staudinger, Roman Ullrich, Marion Wiegele, Harald Willschke, Christian Zauner, and Alexander Hermann

Subjects
Acute respiratory distress syndrome, Extracorporeal membrane oxygenation, COVID-19, Invasive mechanical ventilation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Duration of invasive mechanical ventilation (IMV) prior to extracorporeal membrane oxygenation (ECMO) affects outcome in acute respiratory distress syndrome (ARDS). In coronavirus disease 2019 (COVID-19) related ARDS, the role of pre-ECMO IMV duration is unclear. This single-centre, retrospective study included critically ill adults treated with ECMO due to severe COVID-19-related ARDS between 01/2020 and 05/2021. The primary objective was to determine whether duration of IMV prior to ECMO cannulation influenced ICU mortality. Results During the study period, 101 patients (mean age 56 [SD ± 10] years; 70 [69%] men; median RESP score 2 [IQR 1–4]) were treated with ECMO for COVID-19. Sixty patients (59%) survived to ICU discharge. Median ICU length of stay was 31 [IQR 20.7–51] days, median ECMO duration was 16.4 [IQR 8.7–27.7] days, and median time from intubation to ECMO start was 7.7 [IQR 3.6–12.5] days. Fifty-three (52%) patients had a pre-ECMO IMV duration of > 7 days. Pre-ECMO IMV duration had no effect on survival (p = 0.95). No significant difference in survival was found when patients with a pre-ECMO IMV duration of

Published
2022
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7. Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method

Author

Prashant Nasa, Elie Azoulay, Ashish K. Khanna, Ravi Jain, Sachin Gupta, Yash Javeri, Deven Juneja, Pradeep Rangappa, Krishnaswamy Sundararajan, Waleed Alhazzani, Massimo Antonelli, Yaseen M. Arabi, Jan Bakker, Laurent J. Brochard, Adam M. Deane, Bin Du, Sharon Einav, Andrés Esteban, Ognjen Gajic, Samuel M. Galvagno, Claude Guérin, Samir Jaber, Gopi C. Khilnani, Younsuck Koh, Jean-Baptiste Lascarrou, Flavia R. Machado, Manu L. N. G. Malbrain, Jordi Mancebo, Michael T. McCurdy, Brendan A. McGrath, Sangeeta Mehta, Armand Mekontso-Dessap, Mervyn Mer, Michael Nurok, Pauline K. Park, Paolo Pelosi, John V. Peter, Jason Phua, David V. Pilcher, Lise Piquilloud, Peter Schellongowski, Marcus J. Schultz, Manu Shankar-Hari, Suveer Singh, Massimiliano Sorbello, Ravindranath Tiruvoipati, Andrew A. Udy, Tobias Welte, and Sheila N. Myatra

Subjects
Respiratory distress syndrome adult, COVID-19 ventilatory management, COVID-19 respiratory management, COVID-19 acute respiratory distress syndrome, COVID-19 high flow nasal oxygen, COVID 19 invasive mechanical ventilation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. Methods Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ 2) test (p

Published
2021
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8. Acute respiratory failure in immunocompromised patients: outcome and clinical features according to neutropenia status

Author

Djamel Mokart, Michael Darmon, Peter Schellongowski, Peter Pickkers, Marcio Soares, Jordi Rello, Philippe R. Bauer, Andry van de Louw, Virginie Lemiale, Fabio Silvio Taccone, Ignacio Martin-Loeches, Jorge Salluh, Katerina Rusinova, Sangeeta Mehta, Massimo Antonelli, Achille Kouatchet, Andreas Barratt-Due, Miia Valkonen, Precious Pearl Landburg, Ramin Brandt Bukan, Frédéric Pène, Victoria Metaxa, Gaston Burghi, Colombe Saillard, Lene B. Nielsen, Emmanuel Canet, Magali Bisbal, Elie Azoulay, and for the Efraim investigators and the Nine-I study group

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The impact of neutropenia in critically ill immunocompromised patients admitted in a context of acute respiratory failure (ARF) remains uncertain. The primary objective was to assess the prognostic impact of neutropenia on outcomes of these patients. Secondary objective was to assess etiology of ARF according to neutropenia. Methods We performed a post hoc analysis of a prospective multicenter multinational study from 23 ICUs belonging to the Nine-I network. Between November 2015 and July 2016, all adult immunocompromised patients with ARF admitted to the ICU were included in the study. Adjusted analyses included: (1) a hierarchical model with center as random effect; (2) propensity score (PS) matched cohort; and (3) adjusted analysis in the matched cohort. Results Overall, 1481 patients were included in this study of which 165 had neutropenia at ICU admission (11%). ARF etiologies distribution was significantly different between neutropenic and non-neutropenic patients, main etiologies being bacterial pneumonia (48% vs 27% in neutropenic and non-neutropenic patients, respectively). Initial oxygenation strategy was standard supplemental oxygen in 755 patients (51%), high-flow nasal oxygen in 165 (11%), non-invasive ventilation in 202 (14%) and invasive mechanical ventilation in 359 (24%). Before adjustment, hospital mortality was significantly higher in neutropenic patients (54% vs 42%; p = 0.006). After adjustment for confounder and center effect, neutropenia was no longer associated with outcome (OR 1.40, 95% CI 0.93–2.11). Similar results were observed after matching (52% vs 46%, respectively; p = 0.35) and after adjustment in the matched cohort (OR 1.04; 95% CI 0.63–1.72). Conclusion Neutropenia at ICU admission is not associated with hospital mortality in this cohort of critically ill immunocompromised patients admitted for ARF. In neutropenic patients, main ARF etiologies are bacterial and fungal infections.

Published
2020
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9. Influenza and associated co-infections in critically ill immunosuppressed patients

Author

Ignacio Martin-Loeches, Virginie Lemiale, Pierce Geoghegan, Mary Aisling McMahon, Peter Pickkers, Marcio Soares, Anders Perner, Tine Sylvest Meyhoff, Ramin Brandt Bukan, Jordi Rello, Philippe R. Bauer, Andry van de Louw, Fabio Silvio Taccone, Jorge Salluh, Pleun Hemelaar, Peter Schellongowski, Katerina Rusinova, Nicolas Terzi, Sangeeta Mehta, Massimo Antonelli, Achille Kouatchet, Pål Klepstad, Miia Valkonen, Precious Pearl Landburg, Andreas Barratt-Due, Fabrice Bruneel, Frédéric Pène, Victoria Metaxa, Anne Sophie Moreau, Virginie Souppart, Gaston Burghi, Christophe Girault, Ulysses V. A. Silva, Luca Montini, Francois Barbier, Lene B. Nielsen, Benjamin Gaborit, Djamel Mokart, Sylvie Chevret, Elie Azoulay, and For the Efraim investigators and the Nine-I study group

Subjects
Influenza, Respiratory failure, Sepsis, Critical illness, Immunosuppression, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P

Published
2019
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10. Influence of neutropenia on mortality of critically ill cancer patients: results of a meta-analysis on individual data

Author

Quentin Georges, Elie Azoulay, Djamel Mokart, Marcio Soares, Kyeongman Jeon, Sandra Oeyen, Chin Kook Rhee, Pascale Gruber, Marlies Ostermann, Quentin A. Hill, Pieter Depuydt, Christelle Ferra, Anne-Claire Toffart, Peter Schellongowski, Alice Müller, Virginie Lemiale, Fabien Tinquaut, Aurélie Bourmaud, and Michaël Darmon

Subjects
Prognosis, Outcomes, Hematologic, Neoplasms, Intensive care units, Mechanical ventilation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The study objective was to assess the influence of neutropenia on outcome of critically ill cancer patients by meta-analysis of individual data. Secondary objectives were to assess the influence of neutropenia on outcome of critically ill patients in prespecified subgroups (according to underlying tumor, period of admission, need for mechanical ventilation and use of granulocyte colony stimulating factor (G-CSF)). Methods Data sources were PubMed and the Cochrane database. Study selection included articles focusing on critically ill cancer patients published in English and studies in humans from May 2005 to May 2015. For study selection, the study eligibility was assessed by two investigators. Individual data from selected studies were obtained from corresponding authors. Results Overall, 114 studies were identified and authors of 30 studies (26.3% of selected studies) agreed to participate in this study. Of the 7515 included patients, three were excluded due to a missing major variable (neutropenia or mortality) leading to analysis of 7512 patients, including 1702 neutropenic patients (22.6%). After adjustment for confounders, and taking study effect into account, neutropenia was independently associated with mortality (OR 1.41; 95% CI 1.23–1.62; P = 0.03). When analyzed separately, neither admission period, underlying malignancy nor need for mechanical ventilation modified the prognostic influence of neutropenia on outcome. However, among patients for whom data on G-CSF administration were available (n = 1949; 25.9%), neutropenia was no longer associated with outcome in patients receiving G-CSF (OR 1.03; 95% CI 0.70–1.51; P = 0.90). Conclusion Among 7512 critically ill cancer patients included in this systematic review, neutropenia was independently associated with poor outcome despite a meaningful survival. Neutropenia was no longer significantly associated with outcome in patients treated by G-CSF, which may suggest a beneficial effect of G-CSF in neutropenic critically ill cancer patients. Systematic review registration PROSPERO CRD42015026347. Date of registration: Sept 18 2015

Published
2018
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11. Acid–base status and its clinical implications in critically ill patients with cirrhosis, acute-on-chronic liver failure and without liver disease

Author

Andreas Drolz, Thomas Horvatits, Kevin Roedl, Karoline Rutter, Richard Brunner, Christian Zauner, Peter Schellongowski, Gottfried Heinz, Georg-Christian Funk, Michael Trauner, Bruno Schneeweiss, and Valentin Fuhrmann

Subjects
Acid–base, Cirrhosis, Acute-on-chronic liver failure, Mortality, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Acid–base disturbances are frequently observed in critically ill patients at the intensive care unit. To our knowledge, the acid–base profile of patients with acute-on-chronic liver failure (ACLF) has not been evaluated and compared to critically ill patients without acute or chronic liver disease. Results One hundred and seventy-eight critically ill patients with liver cirrhosis were compared to 178 matched controls in this post hoc analysis of prospectively collected data. Patients with and without liver cirrhosis showed hyperchloremic acidosis and coexisting hypoalbuminemic alkalosis. Cirrhotic patients, especially those with ACLF, showed a marked net metabolic acidosis owing to increased lactate and unmeasured anions. This metabolic acidosis was partly antagonized by associated respiratory alkalosis, yet with progression to ACLF resulted in acidemia, which was present in 62% of patients with ACLF grade III compared to 19% in cirrhosis patients without ACLF. Acidemia and metabolic acidosis were associated with 28-day mortality in cirrhosis. Patients with pH values

Published
2018
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12. A case report of septic shock syndrome caused by S. pneumoniae in an immunocompromised patient despite of vaccination

Author

Josef Singer, Christoph Testori, Peter Schellongowski, Ammon Handisurya, Catharina Müller, Eva-Maria Reitter, Wolfgang Graninger, Paul Knöbl, Thomas Staudinger, Stefan Winkler, and Florian Thalhammer

Subjects
Case report, Streptococcus pneumoniae Serovar 24F, Autoimmune lymphoproliferative syndrome (ALPS), Overwhelming post-splenectomy infection (OPSI), Vaccination, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background and case presentation We report a case of septic shock syndrome caused by Streptococcus pneumoniae in a patient who had undergone splenectomy due to an autoimmune lymphoproliferative syndrome (ALPS), which is characterized as a dysfunction of immunoregulation. Although the patient was vaccinated with a conjugated polysaccharide vaccine after the splenectomy, he was still susceptible to S. pneumoniae infection, because the isolated serovar (24F), a serovar long thought to be apathogenic, is not covered by any vaccine currently approved, neither a conjugated nor an unconjugated polysaccharide one. Conclusions This case demonstrates that, due to presence of different serovars, also infections with bacteria against which patients are vaccinated have to be considered as differential diagnosis. Although vaccine development has extended the coverage of S. pneumoniae from 7 to 23 serovars within recent years, there is still demand for novel vaccines which can provide broader protection also against so-thought “apathogenic” strains, especially for groups at high risk.

Published
2017
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13. New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management

Author

Frank Kroschinsky, Friedrich Stölzel, Simone von Bonin, Gernot Beutel, Matthias Kochanek, Michael Kiehl, Peter Schellongowski, and on behalf of the Intensive Care in Hematological and Oncological Patients (iCHOP) Collaborative Group

Subjects
Cancer, Targeted therapy, Immunotherapy, Toxicity, Interdisciplinary management, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Pharmacological and cellular treatment of cancer is changing dramatically with benefits for patient outcome and comfort, but also with new toxicity profiles. The majority of adverse events can be classified as mild or moderate, but severe and life-threatening complications requiring ICU admission also occur. This review will focus on pathophysiology, symptoms, and management of these events based on the available literature. While standard antineoplastic therapy is associated with immunosuppression and infections, some of the recent approaches induce overwhelming inflammation and autoimmunity. Cytokine-release syndrome (CRS) describes a complex of symptoms including fever, hypotension, and skin reactions as well as lab abnormalities. CRS may occur after the infusion of monoclonal or bispecific antibodies (MABs, BABs) targeting immune effectors and tumor cells and is a major concern in recipients of chimeric antigen receptor (CAR) modified T lymphocytes as well. BAB and CAR T-cell treatment may also be compromised by central nervous system (CNS) toxicities such as encephalopathy, cerebellar alteration, disturbed consciousness, or seizures. While CRS is known to be induced by exceedingly high levels of inflammatory cytokines, the pathophysiology of CNS events is still unclear. Treatment with antibodies against inhibiting immune checkpoints can lead to immune-related adverse events (IRAEs); colitis, diarrhea, and endocrine disorders are often the cause for ICU admissions. Respiratory distress is the main reason for ICU treatment in cancer patients and is attributable to infectious agents in most cases. In addition, some of the new drugs are reported to cause non-infectious lung complications. While drug-induced interstitial pneumonitis was observed in a substantial number of patients treated with phosphoinositol-3-kinase inhibitors, IRAEs may also affect the lungs. Inhibitors of angiogenetic pathways have increased the antineoplastic portfolio. However, vessel formation is also essential for regeneration and tissue repair. Therefore, severe vascular side effects, including thromboembolic events, gastrointestinal bleeding or perforation, hypertension, and congestive heart failure, compromise antitumor efficacy. The limited knowledge of the pathophysiology and management of life-threatening complications relating to new cancer drugs presents a need to provide ICU staff, oncologists, and organ specialists with evidence-based algorithms.

Published
2017
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14. Prevalence and Impact of Vitamin D Deficiency in Critically Ill Cancer Patients Admitted to the Intensive Care Unit

Author

Nina Buchtele, Elisabeth Lobmeyr, Julia Cserna, Christian Zauner, Gottfried Heinz, Gürkan Sengölge, Wolfgang R. Sperr, Thomas Staudinger, Peter Schellongowski, and Philipp Wohlfarth

Subjects
vitamin D, intensive care unit, cancer, oncology, hematology, Nutrition. Foods and food supply, TX341-641
Abstract

Vitamin D deficiency is frequent in cancer patients and a risk factor for morbidity and mortality during critical illness. This single-center retrospective study analyzed 25-hydroxyvitamin D levels in critically ill cancer patients (n = 178; hematologic, n = 108; solid, n = 70) enrolled in a prospective ICU registry. The primary analysis was the prevalence of vitamin D deficiency (p < 0.05). After adjusting for relapsed/refractory disease, infection, the SOFA score, and the early need for life-supporting interventions, severe vitamin D deficiency was an independent predictor of hospital mortality (OR: 2.21, 95% CI: 1.03–4.72, p = 0.04) and 1-year mortality (OR: 3.40, 95% CI: 1.50–7.71, p < 0.01), but not of ICU mortality. Conclusion: Vitamin D deficiency is common in critically ill cancer patients requiring ICU admission, but its impact on short-term mortality in this group is uncertain. The observed association of severe vitamin D deficiency with the post-ICU outcome warrants clinical consideration and further study.

Published
2020
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15. Interpretation of results of PCR and B-D-glucan for the diagnosis of Pneumocystis Jirovecii Pneumonia in immunocompromised adults with acute respiratory failure

Author

Calvet, Laure, Lemiale, Virginie, Mokart, Djamel, Peter, Schellongowski, Peter, Pickkers, Demoule, Alexande, Mehta, Sangeeta, Kouatchet, Achille, Rello, Jordi, Bauer, Philippe, Martin-Loeches, Ignacio, Seguin, Amelie, Metaxa, Victoria, Bisbal, Magali, Azoulay, Elie, and Darmon, Michael

Published
2024
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16. Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience

Author

Peter Schellongowski, Thomas Staudinger, Michael Kundi, Klaus Laczika, Gottfried J. Locker, Andja Bojic, Oliver Robak, Valentin Fuhrmann, Ulrich Jäger, Peter Valent, and Wolfgang R. Sperr

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Background Acute myeloid leukemia is a life-threatening disease associated with high mortality rates. A substantial number of patients require intensive care. This investigation analyzes risk factors predicting admission to the intensive care unit in patients with acute myeloid leukemia eligible for induction chemotherapy, the outcome of these patients, and prognostic factors predicting their survival.Design and Methods A total of 406 consecutive patients with de novo acute myeloid leukemia (15–89 years) were analyzed retrospectively. Markers recorded at the time of diagnosis included karyotype, fibrinogen, C-reactive protein, and Charlson comorbidity index. In patients requiring critical care, the value of the Simplified Acute Physiology Score II, the need for mechanical ventilation, and vasopressor support were recorded at the time of intensive care unit admission. The independent prognostic relevance of the parameters was tested by multivariate analysis.Results Sixty-two patients (15.3%) required intensive care, primarily due to respiratory failure (50.0%) or life-threatening bleeding (22.6%). Independent risk factors predicting intensive care unit admission were lower fibrinogen concentration, the presence of an infection, and comorbidity. The survival rate was 45%, with the Simplified Acute Physiology Score II being the only independent prognostic parameter (P0.05).Conclusions Ongoing infections, low fibrinogen and comorbidity are predictive for intensive care unit admission in acute myeloid leukemia. Although admission was a risk factor for survival, continuous complete remission and survival of patients alive at day 30 were similar in patients who were admitted or not admitted to an intensive care unit.

Published
2011
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17. Extracorporeal membrane oxygenation in adults receiving haematopoietic cell transplantation: an international expert statement

Author

Matteo Di Nardo, Graeme MacLaren, Peter Schellongowski, Elie Azoulay, Amy E DeZern, Cristina Gutierrez, Massimo Antonelli, Marta V Antonini, Gernot Beutel, Alain Combes, Rodrigo Diaz, Ibrahim Fawzy Hassan, Jo-Anne Fowles, In-Seok Jeong, Matthias Kochanek, Tobias Liebregts, Catherina Lueck, Karen Moody, Jessica A Moore, Laveena Munshi, Matthew Paden, Frédéric Pène, Kathryn Puxty, Matthieu Schmidt, Dawid Staudacher, Thomas Staudinger, Joachim Stemmler, R Scott Stephens, Lisa Vande Vusse, Philipp Wohlfarth, Roberto Lorusso, Antonio Amodeo, Kris M Mahadeo, and Daniel Brodie

Subjects
Pulmonary and Respiratory Medicine
Abstract

Combined advances in haematopoietic cell transplantation (HCT) and intensive care management have improved the survival of patients with haematological malignancies admitted to the intensive care unit. In cases of refractory respiratory failure or refractory cardiac failure, these advances have led to a renewed interest in advanced life support therapies, such as extracorporeal membrane oxygenation (ECMO), previously considered inappropriate for these patients due to their poor prognosis. Given the scarcity of evidence-based guidelines on the use of ECMO in patients receiving HCT and the need to provide equitable and sustainable access to ECMO, the European Society of Intensive Care Medicine, the Extracorporeal Life Support Organization, and the International ECMO Network aimed to develop an expert consensus statement on the use of ECMO in adult patients receiving HCT. A steering committee with expertise in ECMO and HCT searched the literature for relevant articles on ECMO, HCT, and immune effector cell therapy, and developed opinion statements through discussions following a Quaker-based consensus approach. An international panel of experts was convened to vote on these expert opinion statements following the Research and Development/University of California, Los Angeles Appropriateness Method. The Appraisal of Guidelines for Research and Evaluation statement was followed to prepare this Position Paper. 36 statements were drafted by the steering committee, 33 of which reached strong agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and expert panel, and rephrased before an additional round of voting. At the conclusion of the process, 33 statements received strong agreement and three weak agreement. This Position Paper could help to guide intensivists and haematologists during the difficult decision-making process regarding ECMO candidacy in adult patients receiving HCT. The statements could also serve as a basis for future research focused on ECMO selection criteria and bedside management.

Published
2023

18. Transfusion practice in patients receiving VV ECMO (PROTECMO): a prospective, multicentre, observational study

Author

Gennaro Martucci, Matthieu Schmidt, Cara Agerstrand, Ali Tabatabai, Fabio Tuzzolino, Marco Giani, Raj Ramanan, Giacomo Grasselli, Peter Schellongowski, Jordi Riera, Ali Ait Hssain, Thibault Duburcq, Vojka Gorjup, Gennaro De Pascale, Sarah Buabbas, Whitney D Gannon, Kyeongman Jeon, Brian Trethowan, Vito Fanelli, Juan I Chico, Martin Balik, Lars M Broman, Antonio Pesenti, Alain Combes, Marco V Ranieri, Giuseppe Foti, Hergen Buscher, Kenichi Tanaka, Roberto Lorusso, Antonio Arcadipane, Daniel Brodie, Matteo Brioni, Luca Montini, Linda Bosa, Pierfrancesco Curcio, Eugenio Garofalo, Luis Martin-Villen, Raquel Garcìa-Álvarez, Marta Lopez Sanchez, Nuno Principe, Violeta Chica Saez, Juan Ignacio Chico, Vanesa Gomez, Joaquin Colomina-Climent, Andres Francisco Pacheco, Julien Goutay, Duburcq Thibault, Konstanty Szułdrzyński, Philipp Eller, Elisabeth Lobmeyr, Silvia Mariani, Marco V. Ranieri, Pavel Suk, Michal Maly, Jakob Forestier, Lars Mikael Broman, Monica Rizzo, Tyler Holsworth, Alexis Serra, Dan Brodie, Yiorgos Alexandros Cavayas, Jay Menaker, Samuel Galvagno, Whitney D. Gannon, Todd W. Rice, Wilson E. Grandin, Jose Nunez, Collette Cheplic, Ryan Rivosecchi, Young-Jae Cho, Ming Chit Kwan, Hend Sallam, Joy Ann Villanueva, Jeffrey Aliudin, Kota Hoshino, Yoshitaka Hara, Kollengode Ramanathan, Graeme Maclaren, RS: Carim - V04 Surgical intervention, CTC, and MUMC+: MA Cardiothoracale Chirurgie (3)

Subjects
Pulmonary and Respiratory Medicine, N/a, Settore MED/41 - ANESTESIOLOGIA
Abstract

BACKGROUND: In patients receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO) packed red blood cell (PRBC) transfusion thresholds are usually higher than in other patients who are critically ill. Available guidelines suggest a restrictive approach, but do not provide specific recommendations on the topic. The main aim of this study was, in a short timeframe, to describe the actual values of haemoglobin and the rate and the thresholds for transfusion of PRBC during VV ECMO.METHODS: PROTECMO was a multicentre, prospective, cohort study done in 41 ECMO centres in Europe, North America, Asia, and Australia. Consecutive adult patients with acute respiratory distress syndrome (ARDS) who were receiving VV ECMO were eligible for inclusion. Patients younger than 18 years, those who were not able to provide informed consent when required, and patients with an ECMO stay of less than 24 h were excluded. Our main aim was to monitor the daily haemoglobin concentration and the value at the point of PRBC transfusion, as well as the rate of transfusions. The practice in different centres was stratified by continent location and case volume per year. Adjusted estimates were calculated using marginal structural models with inverse probability weighting, accounting for baseline and time varying confounding.FINDINGS: Between Dec 1, 2018, and Feb 22, 2021, 604 patients were enrolled (431 [71%] men, 173 [29%] women; mean age 50 years [SD 13·6]; and mean haemoglobin concentration at cannulation 10·9 g/dL [2·4]). Over 7944 ECMO days, mean haemoglobin concentration was 9·1 g/dL (1·2), with lower concentrations in North America and high-volume centres. PRBC were transfused on 2432 (31%) of days on ECMO, and 504 (83%) patients received at least one PRBC unit. Overall, mean pretransfusion haemoglobin concentration was 8·1 g/dL (1·1), but varied according to the clinical rationale for transfusion. In a time-dependent Cox model, haemoglobin concentration of less than 7 g/dL was consistently associated with higher risk of death in the intensive care unit compared with other higher haemoglobin concentrations (hazard ratio [HR] 2·99 [95% CI 1·95-4·60]); PRBC transfusion was associated with lower risk of death only when transfused when haemoglobin concentration was less than 7 g/dL (HR 0·15 [0·03-0·74]), although no significant effect in reducing mortality was reported for transfusions for other haemoglobin classes (7·0-7·9 g/dL, 8·0-9·9 g/dL, or higher than 10 g/dL).INTERPRETATION: During VV ECMO, there was no universally accepted threshold for transfusion, but PRBC transfusion was invariably associated with lower mortality only when done with haemoglobin concentration of less than 7 g/dL.FUNDING: Extracorporeal Life Support Organization.

Published
2023

19. International survey of antibiotic dosing and monitoring in adult intensive care units

Author

Williams, Paul G, Tabah, Alexis, Cotta, Menino Osbert, Sandaradura, Indy, Kanji, Salmaan, Scheetz, Marc H, Imani, Sahand, Elhadi, Muhammed, Luque-Pardos, Sònia, Schellack, Natalie, Sanches, Cristina, Timsit, Jean-Francois, Xie, Jiao, Farkas, Andras, Wilks, Kathryn, Roberts, Jason A, Alexander Brinkmann, Mahesh Ramanan, Despoina Koulenti, Mohan Gurjar, Helmi Sulaiman, Gentle Shrestha, Andrea Cortegiani, Monica Crespo, Lowell Ling, Khalid Abidi, Peter Schellongowski, Williams, Paul G, Tabah, Alexi, Cotta, Menino Osbert, Sandaradura, Indy, Kanji, Salmaan, Scheetz, Marc H, Imani, Sahand, Elhadi, Muhammed, Luque-Pardos, Sònia, Schellack, Natalie, Sanches, Cristina, Timsit, Jean-Francoi, Xie, Jiao, Farkas, Andra, Wilks, Kathryn, Roberts, Jason A, and Alexander Brinkmann, Mahesh Ramanan, Despoina Koulenti, Mohan Gurjar, Helmi Sulaiman, Gentle Shrestha, Andrea Cortegiani, Monica Crespo, Lowell Ling, Khalid Abidi & Peter Schellongowski

Subjects
Aminoglycosides, Intensive care units, Vancomycin, Beta-lactams, Drug monitoring
Abstract

Background: In recent years, numerous dosing studies have been conducted to optimize therapeutic antibiotic exposures in patients with serious infections. These studies have led to the inclusion of dose optimization recommendations in international clinical practice guidelines. The last international survey describing dosing, administration and monitoring of commonly prescribed antibiotics for critically ill patients was published in 2015 (ADMIN-ICU 2015). This study aimed to describe the evolution of practice since this time. Methods: A cross-sectional international survey distributed through professional societies and networks was used to obtain information on practices used in the dosing, administration and monitoring of vancomycin, piperacillin/tazobactam, meropenem and aminoglycosides. Results: A total of 538 respondents (71% physicians and 29% pharmacists) from 409 hospitals in 45 countries completed the survey. Vancomycin was mostly administered as an intermittent infusion, and loading doses were used by 74% of respondents with 25mg/kg and 20mg/kg the most favoured doses for intermittent and continuous infusions, respectively. Piperacillin/tazobactam and meropenem were most frequently administered as an extended infusion (42% and 51%, respectively). Therapeutic drug monitoring was undertaken by 90%, 82%, 43%, and 39% of respondents for vancomycin, aminoglycosides, piperacillin/tazobactam, and meropenem, respectively, and was more frequently performed in high-income countries. Respondents rarely used dosing software to guide therapy in clinical practice and was most frequently used with vancomycin (11%). Conclusions: We observed numerous changes in practice since the ADMIN-ICU 2015 survey was conducted. Beta-lactams are more commonly administered as extended infusions, and therapeutic drug monitoring use has increased, which align with emerging evidence.

Published
2023

20. Comparative outcomes of extracorporeal membrane oxygenation for COVID-19 delivered in experienced European centres during successive SARS-CoV-2 variant outbreaks (ECMO-SURGES): an international, multicentre, retrospective cohort study

Author

Matthieu Schmidt, David Hajage, Micha Landoll, Benjamin Pequignot, Elise Langouet, Matthieu Amalric, Armand Mekontso-Dessap, Luis Chiscano-Camon, Katy Surman, Dylan Finnerty, Patricia Santa-Teresa, Antonio Arcadipane, Pablo Millán, Roberto Roncon-Albuquerque, Aaron Blandino-Ortiz, Pablo Blanco-Schweizer, Pilar Ricart, Ricardo Gimeno-Costa, Carlos Luis Albacete, Philip Fortuna, Peter Schellongowski, Dieter Dauwe, Hadrien Winiszewski, Antoine Kimmoun, Bruno Levy, Greet Hermans, Giacomo Grasselli, Guillaume Lebreton, Christophe Guervilly, Gennaro Martucci, Christian Karagiannidis, Jordi Riera, Alain Combes, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre d'investigation clinique Paris Est [CHU Pitié Salpêtrière] (CIC Paris-Est), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Pharmacoépidémiologie et évaluation des soins [iPLesp] (PEPITES), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Sorbonne Université (SU), Universität Witten Herdecke, Rheinisch-Westfälische Technische Hochschule Aachen University (RWTH), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), CHU Marseille, IMRB - 'Biomechanics and Respiratory Apparatus' [Créteil] (U955 Inserm - UPEC), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Henri Mondor, Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis) (CARMAS), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-CHU Henri Mondor [Créteil], Vall d'Hebron University Hospital [Barcelona], Royal Papworth Hospital [Cambridge, UK] (RPH), Hospital General Universitario 'Gregorio Marañón' [Madrid], Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Universidad Loyola Andalucía = Loyola University Andalucía, Hospital de São João [Porto], Hospital Universitario Ramón y Cajal [Madrid], Universidad de Alcalá - University of Alcalá (UAH), Rio Hortega University Hospital (Hospital Universitario Río Hortega) [Valladolid, Spain] (RHUH), Germans Trias i Pujol University Hospital [Badalona, Barcelona, Spain] (GTPUH), Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe, Hospital Clínico Universitario Virgen de la Arrixaca = University Hospital Virgen de la Arrixaca [Murcia], Centro Hospitalar de Lisboa Central E.P.E, Medizinische Universität Wien = Medical University of Vienna, University Hospitals Leuven [Leuven], Service d'anesthésie et soins intensifs [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920) (PCVP / CARDIO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), and Vall d’Hebron Research Institute (VHIR)

Subjects
Pulmonary and Respiratory Medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Abstract

International audience

Published
2023

21. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study

Author

Roberto Lorusso, Maria Elena De Piero, Silvia Mariani, Michele Di Mauro, Thierry Folliguet, Fabio Silvio Taccone, Luigi Camporota, Justyna Swol, Dominik Wiedemann, Mirko Belliato, Lars Mikael Broman, Alain Vuylsteke, Yigal Kassif, Anna Mara Scandroglio, Vito Fanelli, Philippe Gaudard, Stephane Ledot, Julian Barker, Udo Boeken, Sven Maier, Alexander Kersten, Bart Meyns, Matteo Pozzi, Finn M Pedersen, Peter Schellongowski, Kaan Kirali, Nicholas Barrett, Jordi Riera, Thomas Mueller, Jan Belohlavek, Valeria Lo Coco, Iwan C C Van der Horst, Bas C T Van Bussel, Ronny M Schnabel, Thijs Delnoij, Gil Bolotin, Luca Lorini, Martin O Schmiady, David Schibilsky, Mariusz Kowalewski, Luis F Pinto, Pedro E Silva, Igor Kornilov, Aaron Blandino Ortiz, Leen Vercaemst, Simon Finney, Peter P Roeleveld, Matteo Di Nardo, Felix Hennig, Marta Velia Antonini, Mark Davidson, Tim J Jones, Thomas Staudinger, Peter Mair, Juliane Kilo, Christoph Krapf, Kathrin Erbert, Andreas Peer, Nikolaos Bonaros, Florian Kotheletner, Niklas Krenner Mag, Liana Shestakova, Greet Hermans, Dieter Dauwe, Philippe Meersseman, Bernard Stockman, Leda Nobile, Olivier Lhereux, Alexandre Nrasseurs, Jacques Creuter, Daniel De Backer, Simone Giglioli, Gregoire Michiels, Pierre Foulon, Matthias Raes, Inez Rodrigus, Matthias Allegaert, Philippe Jorens, Gerd Debeucklare, Michael Piagnerelli, Patrick Biston, Harlinde Peperstraete, Komeel Vandewiele, Olivier Germay, Dimitri Vandeweghe, Sven Havrin, Marc Bourgeois, Marc-Gilbert Lagny, Genette Alois, Nathalie Lavios, Benoit Misset, Romain Courcelle, Philippe J Timmermans, Alaaddin Yilmaz, Michiel Vantomout, Jerone Lehaen, Ame Jassen, Herbert Guterman, Maarten Strauven, Piet Lormans, Bruno Verhamme, catherine Vandewaeter, Frederik Bonte, Dominique Vionne, Martin Balik, Jan Blàha, Michal Lips, Michal Othal, Filip Bursa, Radim Spacek, Steffen Christensen, Vibeke Jorgensen, Marc Sorensen, Soren A Madsen, Severin Puss, Aleksandr Beljantsev, gabriel Saiydoun, Antonio Fiore, Pascal Colson, Florian Bazalgette, Xavier Capdevila, Sebastien Kollen, Laurent Muller, Jean-Francois Obadia, Pierre-Yves Dubien, Lucrezia Ajrhourh, Pierre G Guinot, Jonathan Zarka, Patricia Besserve, Maximilian V Malfertheiner, Esther Dreier, Birgit Heinze, Payam Akhyari, Artur Lichtenberg, Hug Aubin, Alexander Assman, Diyar Saeed, Holger Thiele, Matthias Baumgaertel, Jan D Schmitto, Natanov Ruslan, Axel Haverich, Matthias Thielmann, Thorsten Brenner, Arjang Ruhpawar, Christoph Benk, Martin Czerny, Dawid L Staudacher, Fridhelm Beyersdorf, Johannes Kalbhenn, Philipp Henn, Aron-Frederik Popov, Torje Iuliu, Ralf Muellenbach, Christian Reyher, Caroline Rolfes, Gosta Lotz, Michael Sonntagbauer, Helen Winkels, Julia Fichte, Robert Stohr, Sebastian Kalverkamp, Christian Karagiannidis, Simone Schafer, Alexei Svetlitchny, Hans-Bernd Hopf, Dominik Jarczak, Heinirich Groesdonk, Magdalena Rommer, Jan Hirsch, Christian Kaehny, Dimitros Soufleris, Georgios Gavriilidis, Kostantinos Pontikis, Magdalini Kyriakopoulou, Anna Kyriakoudi, Serena O'Brien, Ian Conrick-Martin, Edmund Carton, Maged Makhoul, Josef Ben-Ari, Amir Hadash, Alexander Kogan, Reut Kassif Lerner, Anas Abu-Shakra, Moshe Matan, Ahmad Balawona, Erez Kachel, Roman Altshuler, Ori Galante, Lior Fuchs, Yaniv Almog, Yaron S Ishay, Yael Lichter, Amir Gal-oz, Uri Carmi, Asaph Nini, Arie Soroksky, Hagi Dekel, Ziv Rozman, Emad Tayem, Eduard Ilgiyaev, Yuval Hochman, daniel Miltau, Avigal Rapoport, Arieh Eden, Dmitry Kompanietz, Michael Yousif, Miri Golos, Lorenzo Grazioli, Davide Ghitti, Antonio Loforte, Daniela Di Luca, Massimo Baiocchi, Davide Pacini, Antioco Cappai, Paolo Meani, Michele Mondino, Claudio F Russo, Marco Ranucci, Dario Fina, Marco Cotza, Andrea Ballotta, Giovanni Landoni, Pasquale Nardelli, Eygeny V Fominski, Luca Brazzi, Giorgia Montrucchio, Gabriele Sales, Umberto Simonetti, Sergio Livigni, Daniela Silengo, Giulia Arena, Stefania S Sovatzis, Antonella Degani, Mariachiara Riccardi, Elisa Milanesi, Giuseppe Raffa, Gennaro Martucci, Antonio Arcadipane, Giovanna Panarello, Giovanni Chiarini, Sergio Cattaneo, Carmine Puglia, Stefano Benussi, Giuseppe Foti, Marco Giani, Michela Bombino, Maria Cristina Costa, Roberto Rona, Leonello Avalli, Abele Donati, Roberto Carozza, Francesco Gasparri, Andrea Carsetti, Marco Picichè, Anna Marinello, Vinicio Danzi, Anita Zanin, Ignazio Condello, Flavio Fiore, Marco Moscarelli, Giuseppe Nasso, Giuseppe Speziale, Luca Sandrelli, Andrea Montalto, Francesco Musumeci, Alessandro Circelli, Emanuele Russo, Vanni Agnoletti, Ruggero Rociola, Aldo D Milano, Emanuele Pilato, Giuseppe Comentale, Andrea Montisci, Francesco Alessandri, Antonella Tosi, Francesco Pugliese, Giovanni Giordano, Simone Carelli, Domenico L Grieco, Antonio M Dell'Anna, Massimo Antonelli, Enrico Ramoni, Josè Zulueta, Mauro Del Giglio, Sebastiano Petracca, Pietro Bertini, Fabio Guarracino, Luigi De Simone, Paolo M Angeletti, Francesco Forfori, Francesco Taraschi, Veronica N Quintiliani, Robertas Samalavicius, Agne Jankuviene, Nadezda Scupakova, Karolis Urbonas, Juozas Kapturauskas, Gro Soerensen, Piotr Suwalski, Luis Linhares Santos, Ana Marques, Marisa Miranda, Sonia Teixeira, Andrea Salgueiro, Filipe Pereira, Michail Ketskalo, Sergey Tsarenko, Alexandra Shilova, Ivan Afukov, Konstantin Popugaev, Sergei Minin, Daniil Shelukhin, Olga Malceva, Moroz Gleb, Alexander Skopets, Roman Kornelyuk, Alexandr Kulikov, Vadim Okhrimchuk, Alexandr Turchaninov, Maxim Petrushin, Anastasia Sheck, Akhmed Mekulov, Svetlana Ciryateva, Dmitry Urusov, Vojka Gorjup, Alenka Golicnik, Tomaz Goslar, Ricard Ferrer, Maria Martinez-Martinez, Eduard Argudo, Neiser Palmer, Raul De Pablo Sanchez, Lucas Juan Higuera, Lucas Arnau Blasco, Josè A Marquez, Fabrizio Sbraga, Mari Paz Fuset, Pablo Ruiz De Gopegui, Luis M Claraco, Josè A De Ayala, Maranta Peiro, Pilar Ricart, Sergio Martinez, Fernando Chavez, Marc Fabra, elena Sandoval, David Toapanta, Albert Carraminana, Adrian Tellez, Jeysson Ososio, Pablo Milan, Jorge Rodriguez, Garcia Andoni, Carola Gutierrez, Enrique Perez de la Sota, Andrea Eixeres-Esteve, Maria Teresa Garcia-Maellas, Judit Gutierrez-Gutierrez, Rafael Arboleda-Salazar, Patricia Santa Teresa, Alexis Jaspe, Alberto Garrido, Galo Castaneda, Sara Alcantara, Nuria Martinez, Marina Perez, Hector Villanueva, Anxela Vidal Gonzalez, Juan Paez, Arnoldo Santon, Cesar Perez, Marta Lopez, Maria Isabel Rubio Lopez, Antonio Gordillo, Jose Naranjo-Izurieta, Javier Munoz, Immaculada Alcalde, Fernando Onieva, Ricardo Gimeno Costa, Francisco Perez, Isabel Madrid, Monica Gordon, Carlos L Albacete Moreno, Daniel Perez, Nayara Lopez, Domingo Martinenz, Pablo Blanco-Schweizer, Cristina Diez, David Perez, Ana Prieto, Gloria Renedo, Elena Bustamante, Ramon Cicuendez, Rafael Citores, Victoria Boado, Katherine Garcia, Roberto Voces, Monica Domezain, Jose Maria Nunez Martinez, Raimundo Vicente, David Martin, Antonio Andreu, Vanesa Gomez Casal, Ignacio Chico, Eva Maria Menor, Sabela Vara, Jose Gamacho, Helen Perez-Chomon, Francisco Javier Gonzales, Irene Barrero, Luis Martin-Villen, Esperanza Fernandez, Maria Mendoza, Joaquin Navarro, Joaquin Colomina Climent, Alfredo Gonzales-Perez, Guillermo Muniz-Albaceita, Laura Amado, Raquel Rodriguez, Emilio Ruiz, Maria Eiras, Edgars Grins, Rosen Magnus, Mikael Kanetoft, Marcus Eidevald, Pia Watson, Paul R Vogt, Peter Steiger, Tobias Aigner, Alberto Weber, Jurg Grunefelder, Martin Kunz, Martin Grapow, Thierry Aymard, Diana Reser, Gianluca Agus, Jolanda Consiglio, Matthias Haenggi, Jenni Hansjoerg, Manuela Iten, Thomas Doeble, Urs Zenklusen, Xavier Bechtold, Giovanni Faedda, Manuel Iafrate, Amanda Rohjer, Layla Bergamaschi, Jos Maessen, Dinis Reis Miranda, H Endeman, D Gommers, C Meuwese, Jacinta Maas, MJ Van Gijlswijk, RN Van Berg, Dario Candura, Marcel Van der Linden, Merijin Kant, JJ Van der Heijden, Eric Scholten, Nicole Van Belle-van Haren, WK Lagrand, Alexander P Vlaar, Syste De Jong, Basar Cander, Murat Sargin, Murat Ugur, Mehmet A Kaygin, Kathleen Daly, Nicola Agnew, Laura Head, Laura Kelly, Gunawardena Anoma, Clare Russell, Verna Aquino, Ian Scott, Lucy Flemming, Stuart Gillon, Olivia Moore, Elton Gelandt, George Auzinger, Sameer Patel, Robert Loveridge, MUMC+: MA Cardiothoracale Chirurgie (3), CTC, RS: Carim - V04 Surgical intervention, University of Zurich, and Lorusso, Roberto

Subjects
Pulmonary and Respiratory Medicine, 2740 Pulmonary and Respiratory Medicine, 610 Medicine & health, 10023 Institute of Intensive Care Medicine
Abstract

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation.METHODS: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing.FINDINGS: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms.INTERPRETATION: Patient's age, timing of cannulation (FUNDING: None.

Published
2023

22. Impact of chronic graft-versus-host-disease on intensive care outcome in allogeneic hematopoietic stem cell recipients

Author

Catherina Lueck, Asterios Tzalavras, Philipp Wohlfarth, Elisabeth Meedt, Michael Kiehl, Amin T. Turki, Marius M. Hoeper, Matthias Eder, Julia Cserna, Nina Buchtele, Daniel Wolff, Peter Schellongowski, Gernot Beutel, and Tobias Liebregts

Subjects
Transplantation, Medizin, Hematology
Abstract

Chronic graft-vs-host-disease (cGvHD) is the most relevant long-term complication after allogeneic stem cell transplantation (HSCT) with major impact on non-relapse mortality, but data on intensive care unit (ICU) outcome are missing. In this retrospective, multicenter study we analyzed 174 adult HSCT recipients with cGvHD requiring intensive care treatment. Skin, pulmonary, liver, and intestinal involvement were present in 76.7%, 47.1%, 38.1% and 24.1%, respectively, and a total of 63.2% had severe cGvHD. Main reasons for ICU admission were respiratory failure (69.7%) and sepsis (34.3%). Hospital- and 3-year OS rates were 51.7% and 28.6%, respectively. Global severity of cGvHD did not impact short- and long-term survival. However, patients with severe liver cGvHD or the overlap subtype had a reduced hospital survival, while severe pulmonary cGvHD was associated with worse long-term survival. In multivariate analysis need for invasive ventilation (HR 1.08 (95% CI 1.02–1.14)) or hemodialysis (HR 1.73 (95% CI 1.14–2.62)) and

Published
2022

24. The Effect of an Accelerated Renal Replacement Therapy Initiation Is Not Modified by Baseline Risk

Author

Federico Angriman, Bruno L. Ferreyro, Natalia Angeloni, Bruno R. da Costa, Ron Wald, Sean M. Bagshaw, Neill K.J. Adhikari, Rinaldo Bellomo, Didier Dreyfuss, Bin Du, Martin P. Gallagher, Stéphane Gaudry, François Lamontagne, Michael Joannidis, Kathleen D. Liu, Daniel F. McAuley, Shay P. McGuinness, Alistair D. Nichol, Marlies Ostermann, Paul M. Palevsky, Haibo Qiu, Ville Pettilä, Antoine G. Schneider, Orla M. Smith, Suvi T. Vaara, Matthew Weir, Glenn M. Eastwood, Leah Peck, Helen Young, Peter Kruger, Gordon Laurie, Emma Saylor, Jason Meyer, Ellen Venz, Krista Wetzig, Craig French, Forbes McGain, John Mulder, Gerard Fennessy, Sathyajith Koottayi, Samantha Bates, Miriam Towns, Rebecca Morgan, Anna Tippett, Andrew Udy, Chris Mason, Elisa Licari, Dashiell Gantner, Jason McClure, Alistair Nichol, Phoebe McCracken, Jasmin Board, Emma Martin, Shirley Vallance, Meredith Young, Chelsey Vladic, Steve McGloughlin, David Gattas, Heidi Buhr, Jennifer Coles, Debra Hutch, James Wun, Louise Cole, Christina Whitehead, Julie Lowrey, Kristy Masters, Rebecca Gresham, Victoria Campbell, David Gutierrez, Jane Brailsford, Loretta Forbes, Lauren Murray, Teena Maguire, Martina NiChonghaile, Neil Orford, Allison Bone, Tania Elderkin, Tania Salerno, Tim Chimunda, Jason Fletcher, Emma Broadfield, Sanjay Porwal, Cameron Knott, Catherine Boschert, Julie Smith, Angus Richardson, Dianne Hill, Graeme Duke, Peter Oziemski, Santiago Cegarra, Peter Chan, Deborah Welsh, Stephanie Hunter, Owen Roodenburg, John Dyett, Nicos Kokotsis, Max Moser, Yang Yang, Laven Padayachee, Joseph Vetro, Himangsu Gangopadhyay, Melissa Kaufman, Angaj Ghosh, Simone Said, Alpesh Patel, Shailesh Bihari, Elisha Matheson, Xia Jin, Tapaswi Shrestha, Kate Schwartz, Rosalba Cross, Winston Cheung, Helen Wong, Mark Kol, Asim Shah, Amanda Y. Wang, Zoltan Endre, Celia Bradford, Pierre Janin, Simon Finfer, Naomi Diel, Jonathan Gatward, Naomi Hammond, Anthony Delaney, Frances Bass, Elizabeth Yarad, Hergen Buscher, Claire Reynolds, Nerilee Baker, Romuald Bellmann, Andreas Peer, Julia Hasslacher, Paul Koglberger, Sebastian Klein, Klemens Zotter, Anna Brandtner, Armin Finkenstedt, Adelheid Ditlbacher, Frank Hartig, Dietmar Fries, Mirjam Bachler, Bettina Schenk, Martin Wagner, Philipp Eller, Thomas Staudinger, Esther Tiller, Peter Schellongowski, Andja Bojic, Eric A. Hoste, Stephanie Bracke, Luc De Crop, Daisy Vermeiren, Fernando Thome, Bianca Chiella, Lucia Fendt, Veronica Antunes, Frédérick D'Aragon, Charles St-Arnaud, Michael Mayette, Élaine Carbonnaeu, Joannie Marchand, Marie-Hélène Masse, Marilène Ladouceur, Alexis F. Turgeon, François Lauzier, David Bellemare, Charles Langis Francoeur, Guillaume LeBlanc, Gabrielle Guilbault, Stéphanie Grenier, Eve Cloutier, Annick Boivin, Charles Delisle-Thibault, Panagiota Giannakouros, Olivier Costerousse, Jean-François Cailhier, François-Martin Carrier, Ali Ghamraoui, Martine Lebrasseur, Fatna Benettaib, Maya Salamé, Dounia Boumahni, Ying Tung Sia, Jean-François Naud, Isabelle Roy, Henry T. Stelfox, Stacey Ruddell, Braden J. Manns, Shelley Duggan, Dominic Carney, Jennifer Barchard, Richard P. Whitlock, Emilie Belley-Cote, Nevena Savija, Alexandra Sabev, Troy Campbell, Thais Creary, Kelson Devereaux, Shira Brodutch, Claudio Rigatto, Bojan Paunovic, Owen Mooney, Anna Glybina, Oksana Harasemiw, Michelle Di Nella, John Harmon, Navdeep Mehta, Louis Lakatos, Nicole Haslam, Francois Lellouche, Mathieu Simon, Ying Tung, Patricia Lizotte, Pierre-Alexandre Bourchard, Bram Rochwerg, Tim Karachi, Tina Millen, John Muscedere, David Maslove, J. Gordon Boyd, Stephanie Sibley, John Drover, Miranda Hunt, Ilinca Georgescu, Randy Wax, Ilan Lenga, Kavita Sridhar, Andrew Steele, Kelly Fusco, Taneera Ghate, Michael Tolibas, Holly Robinson, Matthew A. Weir, Ravi Taneja, Ian M. Ball, Amit Garg, Eileen Campbell, Athena Ovsenek, Sean van Diepen, Nadia Baig, Sheldon Magder, Han Yao, Ahsan Alam, Josie Campisi, Erika MacIntyre, Ella Rokosh, Kimberly Scherr, Stephen Lapinsky, Sangeeta Mehta, Sumesh Shah, Daniel J. Niven, Michael Russell, Kym Jim, Gillian Brown, Kerry Oxtoby, Adam Hall, Luc Benoit, Colleen Sokolowski, Bhanu Prasad, Jag Rao, Shelley Giebel, Demetrios J. Kutsogiannis, Patricia Thompson, Tayne Thompson, Robert Cirone, Kanthi Kavikondala, Mark Soth, France Clarke, Alyson Takaoka, David Mazer, Karen Burns, Jan Friedrich, David Klein, Gyan Sandhu, Marlene Santos, Imrana Khalid, Jennifer Hodder, Peter Dodek, Najib Ayas, Victoria Alcuaz, Gabriel Suen, Oleksa Rewa, Gurmeet Singh, Sean Norris, Neil Gibson, Castro Arias, Aysha Shami, Celine Pelletier, Alireza Zahirieh, Andre Amaral, Nicole Marinoff, Navjot Kaur, Adic Perez, Jane Wang, Gregory Haljan, Christopher Condin, Lauralyn McIntyre, Brigette Gomes, Rebecca Porteous, Irene Watpool, Swapnil Hiremath, Edward Clark, Margaret S. Herridge, Felicity Backhouse, M. Elizabeth Wilcox, Karolina Walczak, Vincent Ki, Asheer Sharman, Martin Romano, R.T. Noel Gibney, Adam S. Romanovsky, Lorena McCoshen, Gordon Wood, Daniel Ovakim, Fiona Auld, Gayle Carney, Meili Duan, Xiaojun Ji, Dongchen Guo, Zhili Qi, Jin Lin, Meng Zhang, Lei Dong, Jingfeng Liu, Pei Liu, Deyuan Zhi, Guoqiang Bai, Yu Qiu, Ziqi Yang, Jing Bai, Zhuang Liu, Haizhou Zhuang, Haiman Wang, Jian Li, Mengya Zhao, Xiao Zhou, Xianqing Shi, Baning Ye, Manli Liu, Jing Wu, Yongjian Fu, Dali Long, Yu Pan, Jinlong Wang, Huaxian Mei, Songsong Zhang, Mingxiang Wen, Enyu Yang, Sijie Mu, Jianquan Li, Tingting Hu, Bingyu Qin, Min Li, Cunzhen Wang, Xin Dong, Kaiwu Wang, Haibo Wang, Jianxu Yang, Chuanyao Wang, Dongxin Wang, Nan Li, Zhui Yu, Song Xu, Lan Yao, Guo Hou, Zhou Liu, Liping Lu, Yingtao Lian, Chunting Wang, Jichen Zhang, Ruiqi Ding, Guoqing Qi, Qizhi Wang, Peng Wang, Zhaoli Meng, Man Chen, Xiaobo Hu, Xiandi He, Shibing Zhao, Lele Hang, Rui Li, Suhui Qin, Kun Lu, Shijuan Dun, Cheng Liu, Qi Zhou, Zhenzhen Chen, Jing Mei, Minwei Zhang, Hao Xu, Jincan Lin, Qindong Shi, Lijuan Fu, Qinjing Zeng, Hongye Ma, Jinqi Yan, Lan Gao, Hongjuan Liu, Lei Zhang, Hao Li, Xiaona He, Jingqun Fan, Litao Guo, Yu Liu, Xue Wang, Jingjing Sun, Zhongmin Liu, Juan Yang, Lili Ding, Lulu Sheng, Xingang Liu, Jie Yan, Quihui Wang, Yifeng Wang, Dan Zhao, Shuangping Zhao, Chenghuan Hu, Jing Li, Fuxing Deng, Haibo Qui, Yi Yang, Min Mo, Chun Pan, Changde Wu, Yingzi Huang, Lili Huang, Airan Liu, Anna-Maija Korhonen, Sanna Törnblom, Sari Sutinen, Leena Pettilä, Jonna Heinonen, Eliria Lappi, Taria Suhonen, Sari Karlsson, Sanna Hoppu, Ville Jalkanen, Anne Kuitunen, Markus Levoranta, Jaakko Långsjö, Sanna Ristimäki, Kaisa Malila, Anna Wootten, Simo Varila, Mikko J Järvisalo, Outi Inkinen, Satu Kentala, Keijo Leivo, Paivi Haltia, Jean-Damien Ricard, Jonathan Messika, Abirami Tiagarajah, Malo Emery, Aline Dechanet, Coralie Gernez, Damien Roux, Laurent Martin-Lefevre, Maud Fiancette, Isabelle Vinatier, Jean Claude Lacherade, Gwenhaël Colin, Christine Lebert, Marie-Ange Azais, Aihem Yehia, Caroline Pouplet, Matthieu Henry- Lagarrigue, Amélie Seguin, Laura Crosby, Julien Maizel, Dimitri Titeca-Beauport, Alain Combes, Ania Nieszkowska, Paul Masi, Alexandre Demoule, Julien Mayaux, Martin Dres, Elise Morawiec, Maxens Decalvele, Suela Demiri, Morgane Faure, Clémence Marios, Maxime Mallet, Marie Amélie Ordon, Laura Morizot, Marie Cantien, François Pousset, Florent Poirson, Yves Cohen, Laurent Argaud, Martin Cour, Laurent Bitker, Marie Simon, Romain Hernu, Thomas Baudry, Sylvie De La Salle, Adrien Robine, Nicholas Sedillot, Xavier Tchenio, Camille Bouisse, Sylvie Roux, Fabienne Tamion, Steven Grangé, Dorothée Carpentier, Guillaume Chevrel, Luis Ensenyat-Martin, Sophie Marque, Jean-Pierre Quenot, Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Chudeau, Mickael Landais, Benoit Derrien, Jean Christophe Callahan, Christophe Guitton, Charlène Le Moal, Alain Robert, Karim Asehnoune, Raphaël Cinotti, Nicolas Grillot, Dominique Demeure, Christophe Vinsonneau, Imen Rahmani, Mehdi Marzouk, Thibault Dekeyser, Caroline Sejourne, Mélanie Verlay, Fabienne Thevenin, Lucie Delecolle, Didier Thevenin, Bertrand Souweine, Elisabeth Coupez, Mireille Adda, Jean-Pierre Eraldi, Antoine Marchalot, Nicolas De Prost, Armand Mekontso Dessap, Keyvan Razazi, Ferhat Meziani, Julie Boisrame-Helms, Raphael Clere-Jehl, Xavier Delabranche, Christine Kummerlen, Hamid Merdji, Alexandra Monnier, Yannick Rabouel, Hassene Rahmani, Hayat Allam, Samir Chenaf, Vincenta Franja, Bertrand Pons, Michel Carles, Frédéric Martino, Régine Richard, Benjamin Zuber, Guillaume Lacave, Karim Lakhal, Bertrand Rozec, Hoa Dang Van, Éric Boulet, Fouad Fadel, Cedric Cleophax, Nicolas Dufour, Caroline Grant, Marie Thuong, Jean Reignier, Emmanuel Canet, Laurent Nicolet, Thierry Boulain, Mai-Anh Nay, Dalila Benzekri, François Barbier, Anne Bretagnol, Toufik Kamel, Armelle Mathonnet, Grégoire Muller, Marie Skarzynski, Julie Rossi, Amandine Pradet, Sandra Dos Santos, Aurore Guery, Lucie Muller, Luis Felix, Julien Bohé, Guillaume Thiéry, Nadia Aissaoui, Damien Vimpere, Morgane Commeureuc, Jean-Luc Diehl, Emmanuel Guerot, Orfeas Liangos, Monika Wittig, Alexander Zarbock, Mira Küllmar, Thomas van Waegeningh, Nadine Rosenow, Kathy Brickell, Peter Doran, Patrick T. Murray, Giovanni Landoni, Rosalba Lembo, Alberto Zangrillo, Giacomo Monti, Margherita Tozzi, Matteo Marzaroli, Gaetano Lombardi, Gianluca Paternoster, Michelangelo Vitiello, Shay McGuinness, Rachael Parke, Magdalena Butler, Eileen Gilder, Keri-Anne Cowdrey, Samantha Wallace, Jane Hallion, Melissa Woolett, Philippa Neal, Karina Duffy, Stephanie Long, Colin McArthur, Catherine Simmonds, Yan Chen, Rachael McConnochie, Lynette Newby, David Knight, Seton Henderson, Jan Mehrtens, Stacey Morgan, Anna Morris, Kymbalee Vander Hayden, Tara Burke, Matthew Bailey, Ross Freebairn, Lesley Chadwick, Penelope Park, Christine Rolls, Liz Thomas, Ulrike Buehner, Erin Williams, Jonathan Albrett, Simon Kirkham, Carolyn Jackson, Troy Browne, Jennifer Goodson, David Jackson, James Houghton, Owen Callender, Vicki Higson, Owen Keet, Clive Dominy, Paul Young, Anna Hunt, Harriet Judd, Cassie Lawrence, Shaanti Olatunji, Yvonne Robertson, Charlotte Latimer-Bell, Deborah Hendry, Agnes Mckay-Vucago, Nina Beehre, Eden Lesona, Leanlove Navarra, Chelsea Robinson, Ryan Jang, Andrea Junge, Bridget Lambert, Michel Thibault, Philippe Eckert, Sébastien Kissling, Erietta Polychronopoulos, Elettra Poli, Marco Altarelli, Madeleine Schnorf, Samia Abed Mallaird, Claudia Heidegger, Aurelie Perret, Philippe Montillier, Frederic Sangla, Seigenthaller Neils, Aude De Watteville, Mandeep-Kaur Phull, Aparna George, Nauman Hussain, Tatiana Pogreban, Steve Lobaz, Alison Daniels, Mishell Cunningham, Deborah Kerr, Alice Nicholson, Pradeep Shanmugasundaram, Judith Abrams, Katarina Manso, Geraldine Hambrook, Elizabeth McKerrow, Juvy Salva, Stephen Foulkes, Matthew Wise, Matt Morgan, Jenny Brooks, Jade Cole, Tracy Michelle Davies, Helen Hill, Emma Thomas, Marcela Vizcaychipi, Behrad Baharlo, Jaime Carungcong, Patricia Costa, Laura Martins, Ritoo Kapoor, Tracy Hazelton, Angela Moon, Janine Musselwhite, Ben Shelley, Philip McCall, Gill Arbane, Aneta Bociek, Martina Marotti, Rosario Lim, Sara Campos, Neus Grau Novellas, Armando Cennamo, Andrew Slack, Duncan Wyncoll, Luigi Camporota, Simon Sparkes, Rosalinde Tilley, Austin Rattray, Gayle Moreland, Jane Duffy, Elizabeth McGonigal, Philip Hopkins, Clare Finney, John Smith, Harriet Noble, Hayley Watson, Claire-Louise Harris, Emma Clarey, Eleanor Corcoran, James Beck, Clare Howcroft, Nora Youngs, Elizabeth Wilby, Bethan Ogg, Adam Wolverson, Sandra Lee, Susie Butler, Maryanne Okubanjo, Julia Hindle, Ingeborg Welters, Karen Williams, Emily Johnson, Julie Patrick-Heselton, David Shaw, Victoria Waugh, Richard Stewart, Esther Mwaura, Lynn Wren, Louise Mew, Sara-Beth Sutherland, Jane Adderley, Jim Ruddy, Margaret Harkins, Callum Kaye, Teresa Scott, Wendy Mitchell, Felicity Anderson, Fiona Willox, Vijay Jagannathan, Michele Clark, Sarah Purv, Andrew Sharman, Megan Meredith, Lucy Ryan, Louise Conner, Cecilia Peters, Dan Harvey, Ashraf Roshdy, Amy Collins, Malcolm Sim, Steven Henderson, Nigel Chee, Sally Pitts, Katie Bowman, Maria Dilawershah, Luke Vamplew, Elizabeth Howe, Paula Rogers, Clara Hernandez, Clara Prendergast, Jane Benton, Alex Rosenberg, Lui G. Forni, Alice Grant, Paula Carvelli, Ajay Raithatha, Sarah Bird, Max Richardson, Matthew Needham, Claire Hirst, Jonathan Ball, Susannah Leaver, Luisa Howlett, Carlos Castro Delgado, Sarah Farnell-Ward, Helen Farrah, Geraldine Gray, Gipsy Joseph, Francesca Robinson, Ascanio Tridente, Clare Harrop, Karen Shuker, Derek McLaughlan, Judith Ramsey, Sharon Meehan, Bernd Oliver Rose, Rosie Reece-Anthony, Babita Gurung, Tony Whitehouse, Catherine Snelson, Tonny Veenith, Andy Johnston, Lauren Cooper, Ron Carrera, Karen Ellis, Emma Fellows, Samanth Harkett, Colin Bergin, Elaine Spruce, Liesl Despy, Stephanie Goundry, Natalie Dooley, Tracy Mason, Amy Clark, Gemma Dignam, Geraldine Ward, Ben Attwood, Penny Parsons, Sophie Mason, Michael Margarson, Jenny Lord, Philip McGlone, Luke E. Hodgson, Indra Chadbourn, Raquel Gomez, Jordi Margalef, Rinus Pretorius, Alexandra Hamshere, Joseph Carter, Hazel Cahill, Lia Grainger, Kate Howard, Greg Forshaw, Zoe Guy, Kianoush B. Kashani, Robert C. Albright, Amy Amsbaugh, Anita Stoltenberg, Alexander S. Niven, Matthew Lynch, AnnMarie O'Mara, Syed Naeem, Sairah Sharif, Joyce McKenney Goulart, Ashita Tolwani, Claretha Lyas, Laura Latta, Azra Bihorac, Haleh Hashemighouchani, Philip Efron, Matthew Ruppert, Julie Cupka, Sean Kiley, Joshua Carson, Peggy White, George Omalay, Sherry Brown, Laura Velez, Alina Marceron, Javier A. Neyra, Juan Carlos Aycinena, Madona Elias, Victor M. Ortiz-Soriano, Caroline Hauschild, and Robert Dorfman

Subjects
Renal Replacement Therapy, Pulmonary and Respiratory Medicine, Critical Illness, Medicine and Health Sciences, Humans, Acute Kidney Injury
Published
2022

26. In Vivo Suction Pressures of Venous Cannulas During Veno-venous Extracorporeal Membrane Oxygenation

Author

Oliver Robak, Theresa Grafeneder-Weissteiner, Peter Schellongowski, Andja Bojic, Christopher Paschen, Alexander Hermann, and Thomas Staudinger

Subjects
Biomaterials, Extracorporeal Membrane Oxygenation, Biomedical Engineering, Biophysics, Humans, Cannula, Bioengineering, Prospective Studies, General Medicine, Suction, Hemolysis
Abstract

Extracorporeal lung support includes the risk of hemolysis due to suction pressures. Manufacturers measure the negative suction pressure across drainage cannulas for their products in vitro using water. Clinical experience suggests that hemolysis occurs in vivo already at much lower flow rates. The aim of this study was to analyze the in vivo suction pressure for veno-venous extracorporeal membrane oxygenation (VV-ECMO) cannulas. Prospective, observational study at a tertiary-care intensive care unit: 15 patients on VV-ECMO for severe ARDS were prospectively included. In vitro , the 25 Fr drainage cannula pressure drops below a critical level of around -100 mm Hg at a flow rate of 7.9 L/min, the 23 Fr drainage cannula at 6.6 L/min. In the clinical setting, critical suction pressures were reached at much lower flow rates (5.5 and 4.7 L/min; p0.0001, nonlinear regression). The in vitro data largely overestimate the safely achievable flow rates in daily clinical practice by 2.4 L/min (or 44%, 25 Fr) and 1.9 L/min (or 41%, 23 Fr). In vivo measurement of suction pressure of venous drainage cannulas differed significantly from in vitro derived measurements as the latter largely underestimate the resulting suction pressure.

Published
2022

27. Comparison of Hemostatic Changes in Pump-driven Extracorporeal Carbon Dioxide Removal and Venovenous Extracorporeal Membrane Oxygenation

Author

Bernhard Nagler, Andreas Gleiss, Lisa Füreder, Nina Buchtele, Alexander Hermann, Andja Bojic, Peter Schellongowski, Thomas Staudinger, and Oliver Robak

Subjects
Biomaterials, Extracorporeal Membrane Oxygenation, Biomedical Engineering, Biophysics, Humans, Fibrinogen, Bioengineering, General Medicine, Carbon Dioxide, Hemostatics, Retrospective Studies
Abstract

Extracorporeal carbon dioxide removal (ECCO 2 R) has gained widespread use as a supposedly less invasive alternative for hypercapnic respiratory failure besides venovenous extracorporeal membrane oxygenation (VV ECMO). Despite technological advances, coagulation-related adverse events remain a major challenge in both therapies. The overlapping operating areas of VV ECMO and pump-driven ECCO 2 R could allow for a device selection targeted at the lowest risk of such complications. This retrospective analysis of 47 consecutive patients compared hemostatic changes between pump-driven ECCO 2 R (n = 23) and VV ECMO (n = 24) by application of linear mixed effect models. A significant decrease in platelet count, increase in D-dimer levels, and decrease of fibrinogen levels were observed. However, except for fibrinogen, the type of extracorporeal support did not have a significant effect on the time course of these parameters. Our findings suggest that in terms of hemocompatibility, pump-driven ECCO 2 R is not significantly different from VV ECMO.

Published
2022

28. Critical care management of chimeric antigen receptor T‐cell therapy recipients

Author

Peter Schellongowski, Victoria Metaxa, Michael von Bergwelt-Baildon, Boris Böll, Sandrine Valade, Alexander Shimabukuro-Vornhagen, and Elie Azoulay

Subjects
Oncology, medicine.medical_specialty, Critical Care, Immunotherapy, Adoptive, law.invention, Cell therapy, Refractory, law, Internal medicine, medicine, Humans, Receptors, Chimeric Antigen, Medical treatment, business.industry, Hematology, medicine.disease, Intensive care unit, Chimeric antigen receptor, Cytokine release syndrome, Treatment Outcome, Hematologic Neoplasms, Neurotoxicity Syndromes, Chimeric Antigen Receptor T-Cell Therapy, Refractory lymphoma, Cytokine Release Syndrome, business, human activities
Abstract

Chimeric antigen receptor (CAR) T-cell therapy is a promising immunotherapeutic treatment concept that is changing the treatment approach to hematologic malignancies. The development of CAR T-cell therapy represents a prime example for the successful bench-to-bedside translation of advances in immunology and cellular therapy into clinical practice. The currently available CAR T-cell products have shown high response rates and long-term remissions in patients with relapsed/refractory acute lymphoblastic leukemia and relapsed/refractory lymphoma. However, CAR T-cell therapy can induce severe life-threatening toxicities such as cytokine release syndrome, neurotoxicity, or infection, which require rapid and aggressive medical treatment in the intensive care unit setting. In this review, the authors provide an overview of the state-of-the-art in the clinical management of severe life-threatening events in CAR T-cell recipients. Furthermore, key challenges that have to be overcome to maximize the safety of CAR T cells are discussed.

Published
2021

29. Extracellular Vesicles and Citrullinated Histone H3 in Coronavirus Disease 2019 Patients

Author

Heinz Burgmann, Ludwig Traby, Marietta Kollars, Paul A. Kyrle, Bernhard Rössler, Alexander Hermann, Thomas Staudinger, Matthias Karer, Elisabeth Lobmeyr, Sabine Eichinger, Manuel Kussmann, Peter Schellongowski, and Hana Šinkovec

Subjects
Adult, Blood Platelets, Male, 0301 basic medicine, Coronavirus disease 2019 (COVID-19), Disease, 030204 cardiovascular system & hematology, Extracellular Traps, Severity of Illness Index, Flow cytometry, Histones, Extracellular Vesicles, 03 medical and health sciences, Histone H3, 0302 clinical medicine, Immune system, medicine, Humans, Thrombus, Pandemics, Aged, Thromboinflammation, medicine.diagnostic_test, SARS-CoV-2, business.industry, COVID-19, Hematology, Middle Aged, medicine.disease, Pathophysiology, 030104 developmental biology, Case-Control Studies, Immunoassay, Immunology, Citrullination, Female, business, Biomarkers
Abstract

Objectives Pulmonary thrombus formation is a hallmark of coronavirus disease 2019 (COVID-19). A dysregulated immune response culminating in thromboinflammation has been described, but the pathomechanisms remain unclear. Methods We studied 41 adult COVID-19 patients with positive results on reverse-transcriptase polymerase-chain-reaction assays and 37 sex- and age-matched healthy controls. Number and surface characteristics of extracellular vesicles (EVs) and citrullinated histone H3 levels were determined in plasma upon inclusion by flow cytometry and immunoassay. Results In total, 20 patients had severe and 21 nonsevere disease. The number of EV (median [25th, 75th percentile]) was significantly higher in patients compared with controls (658.8 [353.2, 876.6] vs. 435.5 [332.5, 585.3], geometric mean ratio [95% confidence intervals]: 2.6 [1.9, 3.6]; p Conclusion EV and citrullinated histone H3 are associated with COVID-19 and could provide information regarding pathophysiology of the disease.

Published
2021

30. End of life decisions in immunocompromised patients with acute respiratory failure

Author

Gaston Burghi, Victoria Metaxa, Peter Pickkers, Marcio Soares, Jordi Rello, Philippe R. Bauer, Andry van de Louw, Fabio Silvio Taccone, Ignacio Martin Loeches, Peter Schellongowski, Katerina Rusinova, Massimo Antonelli, Achille Kouatchet, Andreas Barratt-Due, Miia Valkonen, Frédéric Pène, Djamel Mokart, Samir Jaber, Elie Azoulay, and Audrey De Jong

Subjects
Death, Intensive Care Units, Immunocompromised Host, Respiratory Distress Syndrome, All institutes and research themes of the Radboud University Medical Center, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Humans, Prospective Studies, Critical Care and Intensive Care Medicine, Respiratory Insufficiency
Abstract

To identify patient, disease and organizational factors associated with decisions to forgo life-sustaining therapies (DFLSTs) in critically ill immunocompromised patients admitted to the intensive care unit (ICU) for acute respiratory failure.We performed a secondary analysis of the international EFRAIM prospective study, which enrolled 1611 immunocompromised patients with acute respiratory failure admitted to 68 ICUs in 16 countries between October 2015 and June 2016. Multivariate logistic analysis was performed to identify independent predictors of DFLSTs.The main causes of immunosuppression were hematological malignancies (50%) and solid tumor (38%). Patients had a median age of 63 yo (54-71). A pulmonologist was involved in the patient management in 38% of cases. DFLSTs had been implemented in 28% of the patients. The following variables were independently associated with DFLSTs: 1) patient-related: older age (OR 1.02 per one year increase, 95% confidence interval(CI) 1.01-1.03,P0.001), poor performance status (OR 2.79, 95% CI 1.98-3.93, P0.001); 2) disease-related: shock (OR 2.00, 95% CI 1.45-2.75, P0.001), liver failure (OR 1.59, 95% CI 1.14-2.21, P = 0.006), invasive mechanical ventilation (OR 1.79, 95% CI 1.31-2.46, P0.001); 3) organizational: having a pulmonologist involved in patient management (OR 1.85, 95% CI 1.36-2.52, P0.001), and the presence of a critical care outreach services (OR 1.63, 95% CI 1.11-2.38, P = 0.012).A DFLST is made in one in four immunocompromised patient admitted to the ICU for acute respiratory failure. Involving a pulmonologist in patient's management is associated with less non beneficial care.

Published
2022

31. A bi‐centric experience of extracorporeal carbon dioxide removal (ECCO 2 R) for acute hypercapnic respiratory failure following allogeneic hematopoietic stem cell transplantation

Author

Alexander Hermann, Nina Buchtele, Asterios Tzalavras, Werner Rabitsch, Amin T. Turki, Thomas Staudinger, Philipp Wohlfarth, Peter Schellongowski, and Tobias Liebregts

Subjects
Adult, Male, medicine.medical_treatment, 0206 medical engineering, Biomedical Engineering, Graft vs Host Disease, Medicine (miscellaneous), Bioengineering, 02 engineering and technology, Hematopoietic stem cell transplantation, 030204 cardiovascular system & hematology, intensive care unit, Extracorporeal, Biomaterials, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Main Text Articles, medicine, Humans, Decompensation, Survival rate, Retrospective Studies, extracorporeal CO2 removal, Mechanical ventilation, Acute leukemia, Main Text Article, hematology, business.industry, Hematopoietic Stem Cell Transplantation, General Medicine, Middle Aged, Prognosis, medicine.disease, 020601 biomedical engineering, Pneumonia, surgical procedures, operative, Anesthesia, Female, Blood Gas Analysis, medicine.symptom, Respiratory Insufficiency, business, Hypercapnia
Abstract

Acute respiratory failure (ARF) is the main reason for ICU admission following allogeneic hematopoietic stem cell transplantation (HSCT). Extracorporeal CO2 removal (ECCO2R) can be used as an adjunct to mechanical ventilation in patients with severe hypercapnia but has not been assessed in HSCT recipients. Retrospective analysis of all allogeneic HSCT recipients ≥18 years treated with ECCO2R at two HSCT centers. 11 patients (m:f = 4:7, median age: 45 [IQR: 32‐58] years) were analyzed. Acute leukemia was the underlying hematologic malignancy in all patients. The time from HSCT to ICU admission was 37 [8‐79] months, and 9/11 (82%) suffered from chronic graft‐versus‐host disease (GVHD) with lung involvement. Pneumonia was the most frequent reason for ventilatory decompensation (n = 9). ECCO2R was initiated for severe hypercapnia (PaCO2: 96 [84‐115] mm Hg; pH: 7.13 [7.09‐7.27]) despite aggressive mechanical ventilation (invasive, n = 9; non‐invasive, n = 2). ECCO2R effectively resolved blood gas disturbances in all patients, but only 2/11 (18%) could be weaned off ventilatory support, and one (9%) patient survived hospital discharge. Progressive respiratory and multiorgan dysfunction were the main reasons for treatment failure. ECCO2R was technically feasible but resulted in a low survival rate in our cohort. A better understanding of the prognosis of ARF in patients with chronic GVHD and lung involvement is necessary before its use can be reconsidered in this setting., ECCO2R is technically feasible but results in low survival in patients with chronic GVHD and lung involvement after hematopoietic stem cell transplantation. Further study on the prognosis of respiratory failure in these patients is necessary before ECCO2R can be reconsidered in this setting

Published
2021

32. Penetration of echinocandins into wound secretion of critically ill patients

Author

Thomas Staudinger, Romuald Bellmann, Tobias Santner, Michael Joannidis, Peter Schellongowski, Ingo H. Lorenz, Karin Burgmann, Stephan Eschertzhuber, Jana Marx, Tiziana Gasperetti, René Welte, Andrea Griesmacher, Maria Aigner, Philipp Eller, Hartwig Pfisterer, and Herbert Oberacher

Subjects
0301 basic medicine, Microbiology (medical), Adult, medicine.medical_specialty, Antifungal Agents, Echinocandin, Wound infection, Critical Illness, 030106 microbiology, Microbial Sensitivity Tests, Gastroenterology, 03 medical and health sciences, chemistry.chemical_compound, Echinocandin antifungals, Echinocandins, Lipopeptides, 0302 clinical medicine, Target-site pharmacokinetics, Internal medicine, Medicine, Humans, Secretion, Candidiasis, Invasive, 030212 general & internal medicine, Original Paper, business.industry, Critically ill, Micafungin, General Medicine, Penetration (firestop), bacterial infections and mycoses, Invasive candidiasis, Infectious Diseases, chemistry, Anidulafungin, Caspofungin, business, Vacuum assisted closure therapy, medicine.drug
Abstract

Purpose Wound infections caused by Candida are life-threatening and difficult to treat. Echinocandins are highly effective against Candida species and recommended for treatment of invasive candidiasis. As penetration of echinocandins into wounds is largely unknown, we measured the concentrations of the echinocandins anidulafungin (AFG), micafungin (MFG), and caspofungin (CAS) in wound secretion (WS) and in plasma of critically ill patients. Methods We included critically ill adults with an indwelling wound drainage or undergoing vacuum-assisted closure therapy, who were treated with an echinocandin for suspected or proven invasive fungal infection. Concentrations were measured by liquid chromatography with UV (AFG and MFG) or tandem mass spectrometry detection (CAS). Results Twenty-one patients were enrolled. From eight patients, serial WS samples and simultaneous plasma samples were obtained within a dosage interval. AFG concentrations in WS amounted to Conclusion Echinocandin penetration into WS displays a high inter-individual variability. In WS of some of the patients, concentrations may be sub-therapeutic. However, the relevance of sub-therapeutic concentrations is unknown as no correlation has been established between concentration data and clinical outcome. Nevertheless, in the absence of clinical outcome studies, our data do not support the use of echinocandins at standard doses for the treatment of fungal wound infections, but underline the pivotal role of surgical debridement.

Published
2021

33. Outcomes in patients treated with chimeric antigen receptor T-cell therapy who were admitted to intensive care (CARTTAS): an international, multicentre, observational cohort study

Author

Marie-Therese Rubio, Roberta Di Blasi, Gilles Salles, Miguel A Perales, Kada Klouche, Muriel Picard, Pierre Sesques, Eric Mariotte, Michael Darmon, Boris Böll, Philippe R. Bauer, Sanjay Chawla, Kevin Rakszawski, Nahema Issa, Anne Huynh, Guillaume Cartron, Florence Rabian, Peter Borchmann, Michael Joannidis, Sabine Furst, Sophie de Guibert, Lara Zafrani, Patrice Ceballos, Nicolas Boissel, David Beauvais, Catherine Thieblemont, François-Xavier Gros, Alberto Mussetti, Gabriel Moreno-González, Adel Maamar, Florent Wallet, Faezeh Legrand, Julien Leroy, Quentin Quelven, Djamel Mokart, Valentin Ortiz, Christian Recher, Jakob Rudzki, Laura Platon, Pleun Hemelaar, Benoit Tessoulin, Reuben Benjamin, Sandrine Valade, Pedro Castro, Gennadii Galstian, Amélie Seguin, Peter Schellongowski, Anna Sureda, Alice Gallo De Moraes, Philipp Wohlfarth, Bruno Levy, Andry Van de Louw, Jorge Garcia Borrega, Julio Delgado, Ibrahim Yakoub-Agha, Nathalie Fégueux, Laveena Munshi, Yi Lin, Emmanuel Bachy, Stéphanie Harel, Sara Fernández, Bertrand Arnulf, Thomas Gastinne, Elie Azoulay, Didier Blaise, Amandine Le Bourgeois, Louis Voigt, Cécile Borel, Anne-Sophie Moreau, Christian Chabannon, Ulrich Jäger, Virginie Lemiale, Olga Gavrilina, Victoria Metaxa, Thomas Staudingert, Edouard Forcade, Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Barcelona, CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), King's College Hospital (KCH), Mayo Clinic [Rochester], Memorial Sloane Kettering Cancer Center [New York], Weill Medical College of Cornell University [New York], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), 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), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Roger Salengro [Lille], Penn State Health Milton S. Hershey Medical Center, Pennsylvania Commonwealth System of Higher Education (PCSHE)-Penn State System, Centre hospitalier universitaire de Nantes (CHU Nantes), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Universitätsklinikum Köln (Uniklinik Köln), Hôpital Saint-André, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Radboud University Medical Center [Nijmegen], Universitat de Barcelona (UB), University of Toronto, Medizinische Universität Wien = Medical University of Vienna, Leopold Franzens Universität Innsbruck - University of Innsbruck, Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut de Génétique Moléculaire de Montpellier (IGMM), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Soins Intensifs [CHRU Nancy], Radboud University Medical Centre [Nijmegen, The Netherlands], University of Innsbruck, and National Research Center for Hematology [Moscow, Russia]

Subjects
Male, MESH: Neurotoxicity Syndromes, MESH: Registries, [SDV]Life Sciences [q-bio], MESH: Multiple Myeloma, Immunotherapy, Adoptive, Severity of Illness Index, law.invention, MESH: Proportional Hazards Models, Medicina intensiva, Clinical trials, 0302 clinical medicine, law, Clinical endpoint, Medicine, Infection control, Registries, MESH: Treatment Outcome, MESH: Middle Aged, Medical record, Hazard ratio, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, Hematology, MESH: Follow-Up Studies, Middle Aged, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Intensive care unit, 3. Good health, Survival Rate, Cytokine release syndrome, Intensive Care Units, Treatment Outcome, 030220 oncology & carcinogenesis, MESH: Immunotherapy, Adoptive, Female, Neurotoxicity Syndromes, Lymphoma, Large B-Cell, Diffuse, Cytokine Release Syndrome, Multiple Myeloma, Care of the sick, Cohort study, Adult, medicine.medical_specialty, Critical Care, MESH: Survival Rate, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], MESH: Cytokine Realease Syndrome, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, MESH: Critical Care, Internal medicine, Intensive care, MESH: Severity of Illness Index, Humans, Cura dels malalts, Critical care medicine, Proportional Hazards Models, MESH: Precursor Cell Lymphoblastic Leukemia-Lymphoma, MESH: Humans, business.industry, MESH: Lymphomz, Large B-Cell, Diffuse, MESH: Adult, MESH: Intensive care Units, medicine.disease, MESH: Male, business, MESH: Female, Assaigs clínics, 030215 immunology, Follow-Up Studies
Abstract

Summary Background Chimeric antigen receptor (CAR) T-cell therapy can induce side-effects such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS), which often require intensive care unit admission. The aim of this study was to describe management of critically ill CAR T-cell recipients in intensive care. Methods This international, multicentre, observational cohort study was done in 21 intensive care units in France, Spain, the USA, the UK, Russia, Canada, Germany, and Austria. Eligible patients were aged 18 years or older; had received CAR T-cell therapy in the past 30 days; and had been admitted to intensive care for any reason. Investigators retrospectively included patients admitted between Feb 1, 2018, and Feb 1, 2019, and prospectively included patients admitted between March 1, 2019, and Feb 1, 2020. Demographic, clinical, laboratory, treatment, and outcome data were extracted from medical records. The primary endpoint was 90-day mortality. Factors associated with mortality were identified using a Cox proportional hazard model. Findings 942 patients received CAR T-cell therapy, of whom 258 (27%) required admission to intensive care and 241 (26%) were included in the analysis. Admission to intensive care was needed within median 4·5 days (IQR 2·0–7·0) of CAR T-cell infusion. 90-day mortality was 22·4% (95% CI 17·1–27·7; 54 deaths). At initial evaluation on admission, isolated cytokine release syndrome was identified in 101 patients (42%), cytokine release syndrome and ICANS in 93 (39%), and isolated ICANS in seven (3%) patients. Grade 3–4 cytokine release syndrome within 1 day of admission to intensive care was found in 50 (25%) of 200 patients and grade 3–4 ICANS in 38 (35%) of 108 patients. Bacterial infection developed in 30 (12%) patients. Life-saving treatments were used in 75 (31%) patients within 24 h of admission to intensive care, primarily vasoactive drugs in 65 (27%) patients. Factors independently associated with 90-day mortality by multivariable analysis were frailty (hazard ratio 2·51 [95% CI 1·37–4·57]), bacterial infection (2·12 [1·11–4·08]), and lifesaving therapy within 24 h of admission (1·80 [1·05–3·10]). Interpretation Critical care management is an integral part of CAR T-cell therapy and should be standardised. Studies to improve infection prevention and treatment in these high-risk patients are warranted. Funding Groupe de Recherche Respiratoire en Reanimation Onco-Hematologique.

Published
2021

34. Transfusion practice in patients receiving VV ECMO (PROTECMO): a prospective, multicentre, observational study

Author

Martucci, Gennaro, Schmidt, Matthieu, Agerstrand, Cara, Tabatabai, Ali, Tuzzolino, Fabio, Giani, Marco, Ramanan, Raj, Grasselli, Giacomo, Schellongowski, Peter, Riera, Jordi, Hssain, Ali Ait, Duburcq, Thibault, Gorjup, Vojka, De Pascale, Gennaro, Buabbas, Sarah, Gannon, Whitney D, Jeon, Kyeongman, Trethowan, Brian, Fanelli, Vito, Chico, Juan I, Balik, Martin, Broman, Lars M, Pesenti, Antonio, Combes, Alain, Ranieri, Marco V, Foti, Giuseppe, Buscher, Hergen, Tanaka, Kenichi, Lorusso, Roberto, Arcadipane, Antonio, Brodie, Daniel, Gennaro, Martucci, Antonio, Arcadipane, Antonio, Pesenti, Giacomo, Grasselli, Matteo, Brioni, Montini, Luca, Marco, Giani, Giuseppe, Foti, Linda, Bosa, Pierfrancesco, Curcio, Vito, Fanelli, Eugenio, Garofalo, Luis, Martin-Villen, Raquel, Garcìa-Álvarez, Marta Lopez Sanchez, Nuno, Principe, Violeta Chica Saez, Juan Ignacio Chico, Vanesa, Gomez, Joaquin, Colomina-Climent, Jordi, Riera, Andres Francisco Pacheco, Vojka, Gorjup, Julien, Goutay, Konstanty, Szułdrzyński, Philipp, Eller, Elisabeth, Lobmeyr, Peter, Schellongowski, Matthieu, Schmidt, Alain, Combe, Roberto, Lorusso, Silvia, Mariani, Marco, V Ranieri, Pavel, Suk, Michal, Maly, Martin, Balik, Jakob, Forestier, Lars Mikael Broman, Monica, Rizzo, Fabio, Tuzzolino, Kenichi, Tanaka, Tyler, Holsworth, Brian, Trethowan, Alexis, Serra, Cara, Agerstrand, Dan, Brodie, Yiorgos Alexandros Cavayas, Ali, Tabatabai, Jay, Menaker, Samuel, Galvagno, Whitney, D Gannon, Todd, W Rice, Wilson, E Grandin, Jose, Nunez, Collette, Cheplic, Raj, Ramanan, Ryan, Rivosecchi, Young-Jae, Cho, Sarah, Buabba, Kyeongman, Jeon, Ming Chit Kwan, Hend, Sallam, Joy Ann Villanueva, Jeffrey, Aliudin, Ali Ait Hssain, Kota, Hoshino, Yoshitaka, Hara, Kollengode, Ramanathan, Graeme, Maclaren, Hergen, Buscher, De Pascale, Gennaro (ORCID:0000-0002-8255-0676), Gennaro De Pascale (ORCID:0000-0002-8255-0676), Luca Montini (ORCID:0000-0003-4602-5134), Martucci, Gennaro, Schmidt, Matthieu, Agerstrand, Cara, Tabatabai, Ali, Tuzzolino, Fabio, Giani, Marco, Ramanan, Raj, Grasselli, Giacomo, Schellongowski, Peter, Riera, Jordi, Hssain, Ali Ait, Duburcq, Thibault, Gorjup, Vojka, De Pascale, Gennaro, Buabbas, Sarah, Gannon, Whitney D, Jeon, Kyeongman, Trethowan, Brian, Fanelli, Vito, Chico, Juan I, Balik, Martin, Broman, Lars M, Pesenti, Antonio, Combes, Alain, Ranieri, Marco V, Foti, Giuseppe, Buscher, Hergen, Tanaka, Kenichi, Lorusso, Roberto, Arcadipane, Antonio, Brodie, Daniel, Gennaro, Martucci, Antonio, Arcadipane, Antonio, Pesenti, Giacomo, Grasselli, Matteo, Brioni, Montini, Luca, Marco, Giani, Giuseppe, Foti, Linda, Bosa, Pierfrancesco, Curcio, Vito, Fanelli, Eugenio, Garofalo, Luis, Martin-Villen, Raquel, Garcìa-Álvarez, Marta Lopez Sanchez, Nuno, Principe, Violeta Chica Saez, Juan Ignacio Chico, Vanesa, Gomez, Joaquin, Colomina-Climent, Jordi, Riera, Andres Francisco Pacheco, Vojka, Gorjup, Julien, Goutay, Konstanty, Szułdrzyński, Philipp, Eller, Elisabeth, Lobmeyr, Peter, Schellongowski, Matthieu, Schmidt, Alain, Combe, Roberto, Lorusso, Silvia, Mariani, Marco, V Ranieri, Pavel, Suk, Michal, Maly, Martin, Balik, Jakob, Forestier, Lars Mikael Broman, Monica, Rizzo, Fabio, Tuzzolino, Kenichi, Tanaka, Tyler, Holsworth, Brian, Trethowan, Alexis, Serra, Cara, Agerstrand, Dan, Brodie, Yiorgos Alexandros Cavayas, Ali, Tabatabai, Jay, Menaker, Samuel, Galvagno, Whitney, D Gannon, Todd, W Rice, Wilson, E Grandin, Jose, Nunez, Collette, Cheplic, Raj, Ramanan, Ryan, Rivosecchi, Young-Jae, Cho, Sarah, Buabba, Kyeongman, Jeon, Ming Chit Kwan, Hend, Sallam, Joy Ann Villanueva, Jeffrey, Aliudin, Ali Ait Hssain, Kota, Hoshino, Yoshitaka, Hara, Kollengode, Ramanathan, Graeme, Maclaren, Hergen, Buscher, De Pascale, Gennaro (ORCID:0000-0002-8255-0676), Gennaro De Pascale (ORCID:0000-0002-8255-0676), and Luca Montini (ORCID:0000-0003-4602-5134)

Abstract

Background: In patients receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO) packed red blood cell (PRBC) transfusion thresholds are usually higher than in other patients who are critically ill. Available guidelines suggest a restrictive approach, but do not provide specific recommendations on the topic. The main aim of this study was, in a short timeframe, to describe the actual values of haemoglobin and the rate and the thresholds for transfusion of PRBC during VV ECMO. Methods: PROTECMO was a multicentre, prospective, cohort study done in 41 ECMO centres in Europe, North America, Asia, and Australia. Consecutive adult patients with acute respiratory distress syndrome (ARDS) who were receiving VV ECMO were eligible for inclusion. Patients younger than 18 years, those who were not able to provide informed consent when required, and patients with an ECMO stay of less than 24 h were excluded. Our main aim was to monitor the daily haemoglobin concentration and the value at the point of PRBC transfusion, as well as the rate of transfusions. The practice in different centres was stratified by continent location and case volume per year. Adjusted estimates were calculated using marginal structural models with inverse probability weighting, accounting for baseline and time varying confounding. Findings: Between Dec 1, 2018, and Feb 22, 2021, 604 patients were enrolled (431 [71%] men, 173 [29%] women; mean age 50 years [SD 13·6]; and mean haemoglobin concentration at cannulation 10·9 g/dL [2·4]). Over 7944 ECMO days, mean haemoglobin concentration was 9·1 g/dL (1·2), with lower concentrations in North America and high-volume centres. PRBC were transfused on 2432 (31%) of days on ECMO, and 504 (83%) patients received at least one PRBC unit. Overall, mean pretransfusion haemoglobin concentration was 8·1 g/dL (1·1), but varied according to the clinical rationale for transfusion. In a time-dependent Cox model, haemoglobin concentration of less than 7 g/dL was c

Published
2022

35. Hämatoonkologie und Intensivmedizin

Author

Oncologic Patients, Peter Schellongowski, P. Wohlfarth, and Initiative „Intensive Care in Hematologic

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, 030220 oncology & carcinogenesis, Emergency Medicine, Internal Medicine, Medicine, 030212 general & internal medicine, Emergency Nursing, Theology, Critical Care and Intensive Care Medicine, business
Abstract

ZusammenfassungIntensivmediziner werden im Kontext der Versorgung von kritisch kranken Krebspatienten vor eine zunehmende Bandbreite spezifischer Herausforderungen gestellt. Neben einer adäquaten Therapiezielfindung umfasst diese die Versorgung des akuten respiratorischen Versagens (ARV) mit speziellen differenzialdiagnostischen Überlegungen, das Management immunologischer Nebenwirkungen innovativer Krebstherapien sowie eine Vielzahl an Krankheitsbildern, die ausschließlich bei Krebspatienten auftreten. Um diesen Herausforderungen gerecht werden zu können, widmet sich die Initiative „Intensive Care in Hematologic and Oncologic Patients (iCHOP)“ seit einigen Jahren diesen Themen. Unterstützt durch mehrere österreichische und deutsche Fachgesellschaften für Intensivmedizin, Hämatologie und Onkologie wurde kürzlich der „1. Konsens zur Versorgung kritisch kranker Krebspatienten“ mit Empfehlungen zum klinischen Management sowie infrastrukturellen und ausbildungsassoziierten Themen verfasst. Das Auftreten eines ARV steht bei kritisch kranken Krebspatienten seit jeher im Fokus der Forschung. Während die nichtinvasive Beatmung lange als Goldstandard der Therapie galt, zeigen hochqualitative Studien jedoch keine relevanten klinischen Vorteile dieser Techniken inklusive der High-flow-nasal-oxygen-Therapie im Vergleich zur konventionellen Sauerstofftherapie. Hingegen rückt eine nichtgeklärte Ätiologie des ARV als einziger potenziell modifizierbarer Risikofaktor in den Fokus. Dementsprechend sind evidenzbasierte und rigoros angewendete Diagnosealgorithmen bei diesen Patienten von eminenter Bedeutung. Des Weiteren stellen das Erkennen und das Management der immer häufiger vorkommenden vielgestaltigen immuntherapieassoziierten Toxizität Intensivmediziner vor zunehmende Herausforderungen.

Published
2020

36. Long-term Respiratory Extracorporeal Membrane Oxygenation and Prognosis: A Retrospective Analysis

Author

Alexander Hermann, Thomas Staudinger, Bernhard Nagler, Nina Buchtele, Wolfgang Lamm, Peter Schellongowski, Andja Bojic, and Oliver Robak

Subjects
Adult, Male, ARDS, Time Factors, medicine.medical_treatment, Biomedical Engineering, Biophysics, Bioengineering, 030204 cardiovascular system & hematology, Malignancy, Biomaterials, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Risk Factors, Interquartile range, Neoplasms, medicine, Extracorporeal membrane oxygenation, Retrospective analysis, Humans, Lung transplantation, In patient, Respiratory system, Retrospective Studies, business.industry, Recovery of Function, General Medicine, Middle Aged, Prognosis, medicine.disease, Treatment Outcome, surgical procedures, operative, 030228 respiratory system, Anesthesia, Female, Respiratory Insufficiency, business
Abstract

The duration of extracorporeal membrane oxygenation (ECMO) treatments increases, however, data presented from prolonged support is limited. We retrospectively analyzed all patients during a 4-year period undergoing respiratory ECMO for duration of therapy, demographics, therapy-associated parameters, and outcome according to ECMO duration (

Published
2020

37. Recommendations for extracorporeal membrane oxygenation (ECMO) in COVID-19 patients

Author

Alexander Hermann, Christian Hengstenberg, Georg Goliasch, Ingrid Anna Maria Magnet, Thomas Staudinger, Martin H Bernardi, Günther Laufer, Paul Simon, Andrea Lassnigg, Dominik Wiedemann, Edda Tschernko, Roman Ullrich, Bernhard Rössler, György Lang, Peter Schellongowski, Klaus Markstaller, Michael Holzer, Klaus Distelmaier, Konrad Hoetzenecker, Walter Klepetko, Daniel Zimpfer, and M. Röggla

Subjects
Corona virus, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Pneumonia, Viral, CIRCULATORY FAILURE, Staffing, 030204 cardiovascular system & hematology, Extracorporeal life support, Betacoronavirus, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Health care, Extracorporeal membrane oxygenation, Humans, Medicine, In patient, ddc:610, 030212 general & internal medicine, Child, Intensive care medicine, Pandemics, Aged, Pandemic, SARS-CoV-2, business.industry, COVID-19, Main Topic, General Medicine, surgical procedures, operative, ECMO, Coronavirus Infections, business, Working environment, Healthcare system
Abstract

SummaryThe pandemic from the SARS-CoV‑2 virus is currently challenging healthcare systems all over the world. Maintaining appropriate staffing and resources in healthcare facilities is essential to guarantee a safe working environment for healthcare personnel and safe patient care. Extracorporeal membrane oxygenation (ECMO) represents a valuable therapeutic option in patients with severe heart or lung failure. Although only a limited proportion of COVID-19 patients develop respiratory or circulatory failure that is refractory to conventional treatment, it is of utmost importance to clearly define criteria for the use of ECMO in this steadily growing patient population. The ECMO working group of the Medical University of Vienna has established the following recommendations for ECMO support in COVID-19 patients.

Published
2020

38. Empfehlungen für ECMO bei COVID-19-Patienten

Author

Klaus Markstaller, Ingrid A Magnet, Peter Schellongowski, Alexander Hermann, Thomas Staudinger, Georg Goliasch, Günther Laufer, Paul Simon, Martin H. Bernardi, Roman Ullrich, Andrea Lassnigg, Edda Tschernko, Daniel Zimpfer, Konrad Hoetzenecker, Michael Holzer, Klaus Distelmaier, G. Lang, Christian Hengstenberg, Dominik Wiedemann, Walter Klepetko, Martin Röggla, and Bernhard Rössler

Subjects
Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, Medicine public health, medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology, business
Abstract

Zusammenfassung Die aktuelle COVID-19-Pandemie, die durch das SARS-CoV‑2 ausgelöst wird, hat bereits in vielen betroffenen Ländern zu gravierenden Ressourcenengpässen der jeweiligen Gesundheitssysteme geführt. Obwohl sehr viele COVID-19-Patienten nur moderate Symptome zeigen, entwickelt eine Subgruppe ein schweres respiratorisches oder auch kardiales Versagen. Die extrakorporale Membranoxygenierung (ECMO) stellt eine wertvolle Therapieoption für Patienten mit therapierefraktärem Lungen- oder Herzversagen dar. Es bedarf klarer Empfehlungen, die den ECMO-Einsatz in dieser zahlenmäßig stetig steigenden Patientenpopulation regeln. Die ECMO-Arbeitsgruppe der Medizinischen Universität Wien hat daher die folgenden Empfehlungen für eine ECMO-Unterstützung bei COVID-19-Patienten formuliert.

Published
2020

39. In-Hospital and 6-Month Outcomes of COVID-19 Patients Supported with Extracorporeal Membrane Oxygenation: The EuroECMO-COVID Multicenter Prospective Observational Study

Author

Roberto Lorusso, Maria Elena De Piero, Silvia Mariani, Michele Di Mauro, Valeria Lo Coco, Thierry Folliguet, Fabio Silvio Taccone, Luigi Camporota, Iwan C.C. van der Horst, Bas van Bussel, Ronny M. Schnabel, Thijs Delnoij, Justyna Swol, Dominik Wiedemann, Mirko Belliato, Lars Mikael Broman, Alain Vuylsteke, Gil Bolotin, Yigal Kassif, Anna M. Scandroglio, Vito Fanelli, Philippe Gaudard, Luca Lorini, Stephane ledot, Julian Barker, Martin O. Schmiady, Udo Boeken, David Schibilsky, Sven Maier, Alexander Kersten, Bart Meyns, Matteo Pozzi, Mariusz Kowalewski, Finn M. Pedersen, Peter Schellongowski, Luis F. Pinto, Pedro Eduardo Silva, Igor Kornilov, Mehmet K. Kirali, Aarón Blandino, Leen Vercaemst, Simon Finney, Peter P. Roeleveld, Matteo Di Nardo, Felix Hennig, Velia M. Antonini, Mark Davidson, Tim Jones, Nicholas Barrett, Jordi Riera, Thomas Mueller, and Jan Bělohlávek

Subjects
History, Polymers and Plastics, Business and International Management, Industrial and Manufacturing Engineering
Published
2022

40. Veno-venous extracorporeal membrane oxygenation (vv-ECMO) for severe respiratory failure in adult cancer patients: a retrospective multicenter analysis

Author

Matthias Kochanek, Jan Kochanek, Boris Böll, Dennis A. Eichenauer, Gernot Beutel, Hendrik Bracht, Stephan Braune, Florian Eisner, Sigrun Friesecke, Ulf Günther, Gottfried Heinz, Michael Hallek, Christian Karagiannidis, Stefan Kluge, Klaus Kogelmann, Pia Lebiedz, Philipp M. Lepper, Tobias Liebregts, Catherina Lueck, Ralf M. Muellenbach, Matthias Hansen, Christian Putensen, Peter Schellongowski, Jens-Christian Schewe, Kathrin Schumann-Stoiber, Frederik Seiler, Peter Spieth, Steffen Weber-Carstens, Daniel Brodie, Elie Azoulay, and Alexander Shimabukuro-Vornhagen

Subjects
Adult, Male, Respiratory Distress Syndrome, Extracorporeal Membrane Oxygenation, surgical procedures, operative, Neoplasms, Medizin, Humans, Middle Aged, Critical Care and Intensive Care Medicine, Respiratory Insufficiency, Aged, Retrospective Studies
Abstract

Purpose: The question of whether cancer patients with severe respiratory failure benefit from veno-venous extracorporeal membrane oxygenation (vv-ECMO) remains unanswered. We, therefore, analyzed clinical characteristics and outcomes of a large cohort of cancer patients treated with vv-ECMO with the aim to identify prognostic factors. Methods: 297 cancer patients from 19 German and Austrian hospitals who underwent vv-ECMO between 2009 and 2019 were retrospectively analyzed. A multivariable cox proportional hazards analysis for overall survival was performed. In addition, a propensity score-matched analysis and a latent class analysis were conducted. Results: Patients had a median age of 56 (IQR 44–65) years and 214 (72%) were males. 159 (54%) had a solid tumor and 138 (47%) a hematologic malignancy. The 60-day overall survival rate was 26.8% (95% CI 22.1–32.4%). Low platelet count (HR 0.997, 95% CI 0.996–0.999; p = 0.0001 per 1000 platelets/µl), elevated lactate levels (HR 1.048, 95% CI 1.012–1.084; p = 0.0077), and disease status (progressive disease [HR 1.871, 95% CI 1.081–3.238; p = 0.0253], newly diagnosed [HR 1.571, 95% CI 1.044–2.364; p = 0.0304]) were independent adverse prognostic factors for overall survival. A propensity score-matched analysis with patients who did not receive ECMO treatment showed no significant survival advantage for treatment with ECMO. Conclusion: The overall survival of cancer patients who require vv-ECMO is poor. This study shows that the value of vv-ECMO in cancer patients with respiratory failure is still unclear and further research is needed. The risk factors identified in the present analysis may help to better select patients who may benefit from vv-ECMO.

Published
2022

41. Validation of bedside ultrasound to predict lumbar muscle area in the computed tomography in 200 non-critically ill patients: The USVALID prospective study

Author

Arabella Fischer, Anatol Hertwig, Ricarda Hahn, Martin Anwar, Timo Siebenrock, Maximilian Pesta, Konstantin Liebau, Isabel Timmermann, Jonas Brugger, Martin Posch, Helmut Ringl, Dietmar Tamandl, Michael Hiesmayr, Anton Laggner, Dominik Roth, Christoph Zielinski, Ulrich Jäger, Thomas Staudinger, Peter Schellongowski, Irene Lang, Michael Gottsauner-Wolf, Julia Mascherbauer, Gottfried Heinz, Rainer Oberbauer, Michael Trauner, Arnulf Ferlitsch, Christian Zauner, Peter Wolf Husslein, Petra Krepler, Shahrokh Shariat, Michael Gnant, Klaus Sahora, Günther Laufer, Shahrokh Taghavi, Ihor Huk, Christine Radtke, Klaus Markstaller, Bernhard Rössler, Eva Schaden, Andreas Bacher, Peter Faybik, Roman Ullrich, Walter Plöchl, Gerald Ihra, Bruno Schäfer, Mohamed Mouhieddine, Thomas Neugebauer, Peter Mares, Barbara Steinlechner, Arno Schiferer, and Edda Tschernko

Subjects
Male, Sarcopenia, Nutrition and Dietetics, Humans, Bayes Theorem, Female, Prospective Studies, Critical Care and Intensive Care Medicine, Muscle, Skeletal, Tomography, X-Ray Computed, Ultrasonography
Abstract

Skeletal muscle area (SMA) in the computed tomography (CT) at the third lumbar vertebra (L3) level is a proxy for whole-body muscle mass but is only performed for clinical reasons. Ultrasound is a promising tool to determine muscle mass at the bedside. It is still unclear how well ultrasound and which ultrasound measuring points can predict CT L3 SMA.This prospective observational trial included 200 non-critically ill patients, who underwent an abdominal CT scan for any clinical reason within 48 h before the ultrasound examination. Ultrasound muscle thickness was evaluated at 3 measuring points on the thigh and 2 measuring points on the upper arm with minimal compression. On the CT scan, the entire L3 SMA was measured based on Hounsfield units. Using a model selection algorithm based on the Bayesian information criterion (BIC) and clinical considerations, a linear prediction model for CT L3 SMA based on the ultrasound muscle thickness and other independent variables was fitted and assessed with cross-validation.67,5% and 32,5% of the patients were from surgical and medical wards, respectively. Mean ultrasound muscle thickness values were between 2,2 and 3,6 cm on the thigh and between 1,4 and 2,8 cm on the upper arm. All ultrasound muscle thickness values were higher in men than in women (P 0,05). CT L3 SMA was 40 cmOne single ultrasound measuring point at the thigh together with sex, height and weight very well predicts CT L3 SMA across different clinical populations. Ultrasound is a safe and bedside method to measure muscle thickness longitudinally to monitor the effects of nutrition and physical therapy.

Published
2021

42. Predictors of Non-invasive Ventilation Response Do Not Indicate Response to High Flow Nasal Oxygen: A Bicentric Observational Study

Author

Andja Bojic, Johann Auer, Peter Schellongowski, Oliver Robak, Thomas Staudinger, Lena-Franziska Lauschke-Leberfinger, Robin Ristl, Irene Steiner, Alexander Hermann, and Ludwig Traby

Subjects
medicine.medical_specialty, chemistry, business.industry, Internal medicine, Cardiology, medicine, chemistry.chemical_element, Observational study, High flow, business, Oxygen
Abstract

BackgroundIn patients receiving high flow nasal oxygen (HFNO), predicting chance of response is crucial in order to avoid unnecessary delay of intubation. Whether commonly used predictors of non-invasive ventilation (NIV) response may be as applicable for HFNO, is unclear.MethodsWe conducted a retrospective bi-centric analysis of adults treated with HFNO in two Austrian medical intensive care units from 01/2014 until 09/2017. Predictive value of respiratory rate, PaO2, PaCO2, SpO2, ROX index, pH, heart rate, base excess, SOFA-Score and SAPS III was analysed by means of logistic regression with HFNO responding as dependent variable. Calculations were also done separately in patients receiving HFNO as post-extubation support (Group A) and all other indications (Group B). ResultsWe registered 127 patients (m:f = 70:57, median age: 67 [IQR 53-77] years). Forty-eight patients (37.8%) received HFNO as post-extubation support and were assigned to group A. Seventy-nine patients (62.2%) received HFNO due to any other indication and were assigned to group B. Criteria of HFNO response were fulfilled by 42 patients (87.5%) of group A and 53 (67.1%) of group B patients.Whereas respiratory rate, PaO2, PaCO2, SpO2, pH, heart rate, base excess, SOFA-Score and SAPS III did not differ between responders and non-responders, ROX index showed significant association with HFNO success in all patients. With increasing ROX index, the odds for response increased (OR [95% CI]: baseline: 1.21 [1.05, 1.38], p = 0.0069, after 2 hours: 1.19 [1.05; 1.34], p = 0.0061, after 6 hours: 1.23 [1.06; 1.42], p = 0.0049). Subgroup analyses revealed similar odds ratios for ROX index (baseline: group A: 1.17 [0.90; 1.52], p = 0.24; group B: 1.22 [1.04; 1.43], p = 0.015; after 2 hours: 1.30 [0.94; 1.82], p = 0.12, group B: 1.18 [1.03; 1.34], p = 0.014; after 6 hours: 1.76 [1.01; 3.06], p = 0.047, group B: 1.19 [1.03; 1.37], p = 0.022). ConclusionsCriteria of HFNO success deviate from criteria for response to NIV. ROX index indicated HFNO response in a wide range of indications.

Published
2021

44. Intraoperative Off-Label Reversal of Apixaban by Andexanet Alfa while on VA-ECMO Immediately After Emergent Surgery for Acute Type A Aortic Dissection

Author

Matthias Kainz, Paul Bsuchner, Peter Schellongowski, and Martin Dworschak

Subjects
Aortic dissection, medicine.medical_specialty, business.industry, medicine.medical_treatment, 030204 cardiovascular system & hematology, medicine.disease, Prothrombin complex concentrate, Extracorporeal, Surgery, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Life support, Deep hypothermic circulatory arrest, Extracorporeal membrane oxygenation, Medicine, Apixaban, Cardiology and Cardiovascular Medicine, business, medicine.drug, Andexanet alfa
Abstract

The authors report a case of intraoperative reversal of apixaban with andexanet alfa in a patient supported with venoarterial extracorporeal membrane oxygenation due to low- cardiac-output immediately after surgery for acute type A aortic dissection and massive intraoperative transfusion with administration of procoagulants. In this patient, andexanet alfa's off-label use was not associated with acute thrombotic complications despite being given during extracorporeal life support and after previous administration of prothrombin complex concentrates.

Published
2021

45. Prevalence and Clinical Impact of Reduced Coagulation Factor XII Activity in Patients Receiving Extracorporeal Membrane Oxygenation

Author

Paul Knöbl, Bernd Jilma, Nina Buchtele, Thomas Staudinger, Ludwig Traby, Monika Schmid, Peter Schellongowski, Harald Herkner, Michael Schwameis, Christian Schoergenhofer, and Peter Quehenberger

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, Coagulation Factor XII, Critical Care and Intensive Care Medicine, Gastroenterology, Cohort Studies, Extracorporeal Membrane Oxygenation, Interquartile range, Internal medicine, Prevalence, medicine, Extracorporeal membrane oxygenation, Humans, Prospective Studies, Prospective cohort study, Retrospective Studies, medicine.diagnostic_test, business.industry, Heparin, Odds ratio, Coagulation, Austria, Factor XII, Partial Thromboplastin Time, business, circulatory and respiratory physiology, medicine.drug, Partial thromboplastin time
Abstract

OBJECTIVES Extracorporeal membrane oxygenation provides large surface exposure to human blood leading to coagulation activation. Only limited clinical data are available on contact activation and coagulation factor XII activity in extracorporeal membrane oxygenation patients. DESIGN Prospective cohort study. SETTING Three medical ICUs at the Medical University of Vienna. PATIENTS Adult patients receiving venovenous or venoarterial extracorporeal membrane oxygenation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was the change in coagulation factor XII activity in response to extracorporeal membrane oxygenation. Secondary outcomes included the prevalence of reduced coagulation factor XII activity (< 60%) among patients receiving extracorporeal membrane oxygenation and association of coagulation factor XII activity with thromboembolic and bleeding complications. An exploratory endpoint was the association of coagulation factor XII activity and activated partial thromboplastin time in heparinase-treated samples in vitro. Fifty-one patients with a total of 117 samples were included in the study between July 2018 and February 2020. Fifty patients (98%) had reduced coagulation factor XII activity at any timepoint during extracorporeal membrane oxygenation. Median coagulation factor XII activity during extracorporeal membrane oxygenation treatment was 30% (interquartile range, 21.5-41%) and increased after discontinuation (p = 0.047). Patients with thromboembolic complications had higher median coagulation factor XII activity during extracorporeal membrane oxygenation (34% vs 23%; p = 0.023). The odds of a thromboembolic event increased by 200% per tertile of median coagulation factor XII activity (crude odds ratio, 3.034; 95% CI, 1.21-7.63). No association with bleeding was observed. In heparinase-treated samples, coagulation factor XII activity correlated well with activated partial thromboplastin time (r = -0.789; p = 0.007). CONCLUSIONS We observed a high prevalence of reduced coagulation factor XII activity in adult patients on extracorporeal membrane oxygenation, which may confound activated partial thromboplastin time measurements and limit its clinical usefulness for monitoring and titrating anticoagulation with unfractionated heparin. Lower coagulation factor XII activity was associated with less thromboembolic complications, which may highlight the potential of coagulation factor XII to serve as a target for anticoagulation in extracorporeal membrane oxygenation.

Published
2021

46. Incidence and Etiology of System Exchanges in Patients Receiving Extracorporeal Membrane Oxygenation

Author

Christian Zauner, Dominik Wiedemann, Gottfried Heinz, Nina Buchtele, Bernhard Nagler, Alexander Hermann, Felix Kraft, Oliver Robak, Wolfgang Lamm, Max-Paul Winter, Thomas Staudinger, Martin H Bernardi, Andja Bojic, Monika Schmid, Peter Schellongowski, and Roman Ullrich

Subjects
medicine.medical_treatment, Biomedical Engineering, Biophysics, Hemodynamics, Bioengineering, 030204 cardiovascular system & hematology, Extracorporeal, Biomaterials, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, Refractory, Extracorporeal membrane oxygenation, Medicine, Humans, Renal replacement therapy, Blood Coagulation, Coagulation Disorder, Retrospective Studies, Respiratory Distress Syndrome, business.industry, Incidence, Retrospective cohort study, General Medicine, 030228 respiratory system, Anesthesia, Etiology, business
Abstract

Extracorporeal membrane oxygenation (ECMO) has established as a cornerstone therapy in severe acute respiratory distress syndrome and refractory hemodynamic failure. As circuit integrity is crucial for adequate organ support, component failure may necessitate a system exchange. In this retrospective study, incidence and etiology of system exchanges during applications of venovenous, venoarterial ECMO, and extracorporeal CO2 removal were examined. Sixty-three (44.4%) of 142 patients were affected by one or more exchanges, totaling 105 replaced circuits. The predominant exchange reason was clotting (n = 20), followed by hemolysis (n = 19), systemic coagulation disorders (n = 13), reconfiguration (n = 13), impaired gas exchange (n = 10), mechanical complications (n = 8), bleeding (n = 6), failed weaning (n = 5), prophylactic exchange (n = 3), and undocumented/other (n = 8). Nineteen (18.1%) events were classified as acute and 70 (66.7%) events as elective exchanges. Patients with circuit exchanges more frequently underwent renal replacement therapy at ECMO initiation (49.2% vs. 29.1%; p = 0.023), had a longer ECMO treatment duration (18 vs. 7.5 days, p < 0.001), and lower hospital survival (29.5% vs. 57.1%; p = 0.002). Considering the high occurrence of coagulation complications, further optimization of coagulation management is deemed necessary.

Published
2021

48. Immunonkologie trifft Intensivmedizin: CAR-T-Zellen

Author

Marion Subklewe, Jorge Garcia Borrega, Peter Schellongowski, Michael von Bergwelt-Baildon, and Boris Böll

Subjects
Gynecology, medicine.medical_specialty, Anakinra, business.industry, medicine.medical_treatment, Neoplasms therapy, General Medicine, Immunotherapy, 030204 cardiovascular system & hematology, medicine.disease, Bioinformatics, Genetically modified organism, 03 medical and health sciences, Cytokine release syndrome, chemistry.chemical_compound, 0302 clinical medicine, Tocilizumab, Oncology, chemistry, 030220 oncology & carcinogenesis, medicine, 030212 general & internal medicine, Car t cells, business, medicine.drug
Abstract

CAR-T cells, genetically modified tumor-targeted t-cells, revolutionized the treatment of refractory B-cell malignancies. CAR-T cell treatment however, is invariably associated with severe immune-mediated toxicities, namely Cytokine Release Syndrome (CRS) and neurological toxicity (CRES/ICANS). Although knowledge on the pathomechanism of these toxicities is still very limited, recent findings including mouse models might allow prediction, earlier recognition and targeted treatment of patients suffering from these potentially life-threatening side effects. This article summarizes current knowledge and recent findings on the management of severe CAR-T associated toxicities and gaps of knowledge stressing the importance of an interdisciplinary approach including hematology-oncology and Intensive Care Medicine.

Published
2019

49. Prevalence of cancer patients in German intensive care units

Author

Gernot Beutel, R Schneider, Stefan Kluge, Frank Kroschinsky, Alexander Shimabukuro-Vornhagen, Boris Böll, C. Lueck, Peter Schellongowski, M von Bergwelt-Baildon, Michael G. Kiehl, Matthias Kochanek, Tobias Liebregts, and K Rüß

Subjects
Gynecology, medicine.medical_specialty, business.industry, Medizin, Emergency Nursing, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Emergency Medicine, Internal Medicine, medicine, 030212 general & internal medicine, business
Abstract

In den vergangenen Jahren nahm die Anzahl von Krebspatienten durch die demographische Entwicklung der Bevolkerung, zunehmende Komorbiditaten und eine insgesamt steigende Lebenserwartung von Krebspatienten auf deutschen Intensivstationen kontinuierlich zu. Trotz dieser Entwicklung ist die Pravalenz und Versorgungsstruktur von Patienten mit hamatologisch-onkologischen(HO)-Erkrankungen auf deutschen Intensivstationen kaum bekannt. Ziel dieser Arbeit war die Erhebung der Pravalenz und Versorgung dieses Patientenkollektivs an 2 Stichtagen. An 2 Stichtagen wurde die Pravalenz von Krebspatienten (Punktpravalenz) auf deutschen Intensivstationen anhand eines Onlinefragebogens prospektiv erhoben. Angaben zur Struktur der jeweiligen Klinik und Intensivstation und demographische Daten der am Erhebungstag stationaren Krebspatienten wurden von den teilnehmenden Zentren anonymisiert in ein eCRF eingegeben. Deutschlandweit haben 4 % der angeschriebenen Intensivstationen an der Studie teilgenommen. Annahernd jeder 4. Patient auf der ICU/IMC-Station wies eine Krebserkrankung auf (n = 316/1319; 24 %; HO-Patienten). Die haufigsten Aufnahmegrunde auf die ICU/IMC-Station waren postoperative Uberwachung (n = 83/221; 38 %), respiratorische Instabilitat (n = 79/221; 36 %), kardial bedingte Kreislaufinstabilitat (n = 52/221; 24 %) und Sepsis (n = 47/221; 21 %). 67 % (n = 147/221) der Patienten hatten einen soliden Tumor und 22 % (n = 48/221) eine hamatologische Grunderkrankung. 78 % (n = 173/221) der dokumentierten Krebspatienten erhielten ein „Full-Code“-Intensivmanagement. 43 % (n = 94/221) der HO-Patienten wurden beatmet und 41 % (n = 90/221) erhielten Katecholamine. Der mediane SAPS-II-Score (Simplified Acute Physiology Score) war 35 (interquartile range [IQR] = 24–48) und der mediane TISS-Score (Therapeutic Intervention Scoring System) betrug 10 (IQR = 10–15). Analyse und Auswertung der zentrumsubergreifend erhobenen Daten erlauben erstmalig fur Deutschland die Bestimmung der Pravalenz und Versorgungssituation von hamatologischen und onkologischen Patienten auf ICU/IMC-Stationen. Jeder 4. Patient in der vorliegenden Studie wies als Haupt- oder Nebendiagnose eine maligne Grunderkrankung auf (n = 316/1319 = 24 %). Das Versorgungsmanagement bei dieser Patientengruppe ist komplex und bedarf einer engen interdisziplinaren Zusammenarbeit.

Published
2019

50. ECMO without anticoagulation in patients with disease‐related severe thrombocytopenia: Feasible but futile?

Author

Alexander Hermann, Oliver Robak, Thomas Staudinger, Nina Buchtele, Peter Schellongowski, and Andja Bojic

Subjects
Adult, Male, medicine.medical_treatment, Biomedical Engineering, Medicine (miscellaneous), Hemorrhage, Bioengineering, Disease, Biomaterials, Extracorporeal Membrane Oxygenation, Extracorporeal membrane oxygenation, medicine, Humans, In patient, Contraindication, Retrospective Studies, Intracerebral hemorrhage, Platelet Count, business.industry, Anticoagulants, General Medicine, Heparin, Middle Aged, medicine.disease, Thrombocytopenia, Severe thrombocytopenia, surgical procedures, operative, Anesthesia, Female, Systemic anticoagulation, business, medicine.drug
Abstract

Severe thrombocytopenia poses a high risk for bleeding thus representing a relative contraindication for anticoagulation and therefore extracorporeal membrane oxygenation (ECMO). We herein report on a series of immunocompromised patients with severe thrombocytopenia undergoing long-term ECMO without systemic anticoagulation. We retrospectively identified seven adult patients with anticoagulation withdrawal for ≥3 days (range 5-317) during venovenous ECMO therapy due to thrombocytopenia < 50 G/L treated in a university-affiliated hospital from January 2013 to April 2017. All ECMO systems used were heparin coated. Overall, 530 ECMO days were observed, 404 (76%) of them without systemic anticoagulation. Platelet count during ECMO treatment was 24 G/L (median, range 1-138), ECMO duration was 35 days (5-317), and ECMO was run without any anticoagulation for 20 days (5-317). Altogether, five clotting events were seen leading to oxygenator exchanges. Bleeding was common including one fatal intracerebral hemorrhage. Altogether, 29 platelet concentrates per patient (7-207) were administered, which correspond to 0.8 per day (0.6-1.3). One patient survived ICU and hospital. In patients with thrombocytopenia, ECMO can be run without anticoagulation even for considerably long periods of time. Bleeding remains common, while clotting events seem to be rare. However, prognosis of this patient population undergoing ECMO support seems grim.

Published
2019

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