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1. Proteolysis in septic shock patients: plasma peptidomic patterns are associated with mortality.

Author: Bauzá-Martinez, J, Aletti, F, Pinto, BB, Ribas, V, Odena, MA, Díaz, R, Romay, E, Ferrer, R, Kistler, EB, Tedeschi, G, Schmid-Schönbein, GW, Herpain, A, Bendjelid, K, and de Oliveira, E
Subjects: Humans, Sepsis, Shock, Septic, Matrix Metalloproteinases, Chymotrypsin, Peptides, Treatment Outcome, Critical Care, Hospital Mortality, Survival Analysis, Prospective Studies, Computer Simulation, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Young Adult, Proteolysis, in-hospital mortality, mass spectrometry, peptidomics, proteolysis, septic shock, Shock, Septic, and over, Anesthesiology, Clinical Sciences
Abstract: BackgroundUncontrolled proteolysis contributes to cell injury and organ dysfunction in animal models of circulatory shock. We investigated in humans the relationship between septic shock, proteolysis, and outcome.MethodsIntensive care patients with septic shock (n=29) or sepsis (n=6) and non-hospitalised subjects (n=9) were recruited as part of the prospective observational trial 'ShockOmics' (ClinicalTrials.gov Identifier NCT02141607). A mass spectrometry-based approach was used to analyse the plasma peptidomes and the origin of circulating peptides from proteolysis in the enrolled subjects.ResultsEvidence of systemic proteolysis was indicated by a larger number of circulating peptides in septic shock patients, compared with septic patients and non-hospitalised healthy subjects. The peptide count and abundance in the septic shock patients were greater in patients who died (n=6) than in survivors (n=23), suggesting an association between magnitude of proteolysis and outcome. In silico analysis of the peptide sequences and of the sites of cleavage on the proteins of origin indicated a predominant role for serine proteases, such as chymotrypsin, and matrix metalloproteases in causing the observed proteolytic degradation.ConclusionsSystemic proteolysis is a novel fundamental pathological mechanism in septic shock. Plasma peptidomics is proposed as a new tool to monitor clinical trajectory in septic shock patients.Clinical trial registrationNCT02141607.
Published: 2018

2. Caractéristiques des traitements en fonction du sexe et résultats de mortalité à 30 jours des patients atteints de COVID-19 gravement malades de plus de 70 ans—résultats de l’étude prospective COVIP

Author: Wolff, G, Wernly, B, Flaatten, H, Fjølner, J, Bruno, RR, Artigas, A, Pinto, BB, Schefold, JC, Kelm, M, Binneboessel, S, Baldia, P, Beil, M, Sivri, S, van Heerden, PV, Szczeklik, W, Elhadi, M, Joannidis, M, Oeyen, Sandra, Flamm, M, Zafeiridis, T, Marsh, B, Andersen, FH, Moreno, R, Boumendil, A, De Lange, DW, Guidet, B, Leaver, S, Jung, C, COVIP Study, Group, and NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
Subjects: Male, Aged, 80 and over, Frailty, Critical Illness, COVID-19, 610 Medicine & health, General Medicine, COVIP, mortality, elderly, Intensive Care Units, Anesthesiology and Pain Medicine, Medicine and Health Sciences, Humans, sex, critical illness, Female, Prospective Studies, 610 Medizin und Gesundheit, Pandemics, Aged, COVID
Abstract: Older critically ill patients with COVID-19 have been the most vulnerable during the ongoing pandemic, with men being more prone to hospitalization and severe disease than women. We aimed to explore sex-specific differences in treatment and outcome after intensive care unit (ICU) admission in this cohort.We performed a sex-specific analysis in critically ill patients ≥ 70 yr of age with COVID-19 who were included in the international prospective multicenter COVIP study. All patients were analyzed for ICU admission and treatment characteristics. We performed a multilevel adjusted regression analysis to elucidate associations of sex with 30-day mortality.A total of 3,159 patients (69.8% male, 30.2% female; median age, 75 yr) were included. Male patients were significantly fitter than female patients as determined by the Clinical Frailty Scale (fit, 67% vs 54%; vulnerable, 14% vs 19%; frail, 19% vs 27%; P0.001). Male patients more often underwent tracheostomy (20% vs 14%; odds ratio [OR], 1.57; P0.001), vasopressor therapy (69% vs 62%; OR, 1.25; P = 0.02), and renal replacement therapy (17% vs 11%; OR, 1.96; P0.001). There was no difference in mechanical ventilation, life-sustaining treatment limitations, and crude 30-day mortality (50% male vs 49% female; OR, 1.11; P = 0.19), which remained true after adjustment for disease severity, frailty, age and treatment limitations (OR, 1.17; 95% confidence interval, 0.94 to 1.45; P = 0.16).In this analysis of sex-specific treatment characteristics and 30-day mortality outcomes of critically ill patients with COVID-19 ≥ 70 yr of age, we found more tracheostomy and renal replacement therapy in male vs female patients, but no significant association of patient sex with 30-day mortality.www.gov (NCT04321265); registered 25 March 2020).RéSUMé: OBJECTIF: Les patients âgés gravement malades atteints de la COVID-19 ont été les plus vulnérables pendant la pandémie actuelle, les hommes étant plus sujets à l’hospitalisation et aux maladies graves que les femmes. Nous avons cherché à explorer les différences spécifiques au sexe dans le traitement et les devenirs après l’admission à l’unité de soins intensifs (USI) dans cette cohorte. MéTHODE: Nous avons effectué une analyse spécifique au sexe chez des patients gravement malades âgés de ≥ 70 ans atteints de COVID-19 qui ont été inclus dans l’étude prospective multicentrique internationale COVIP. Tous les patients ont été analysés pour connaître les détails de leur admission à l’USI et les caractéristiques de leur traitement. Nous avons réalisé une analyse de régression ajustée à plusieurs niveaux pour élucider les associations entre le sexe et la mortalité à 30 jours. RéSULTATS: Au total, 3159 patients (69,8 % d’hommes, 30,2 % de femmes; âge médian, 75 ans) ont été inclus. Les patients de sexe masculin étaient significativement plus en forme que les patientes, tel que déterminé par l’échelle de fragilité clinique (bonne santé, 67 % vs 54 %; vulnérables, 14 % vs 19 %; fragiles, 19 % vs 27 %; P0,001). Les patients de sexe masculin ont plus souvent bénéficié d’une trachéostomie (20 % vs 14 %; rapport de cotes [RC], 1,57; P0,001), d’un traitement vasopresseur (69 % vs 62 %; RC, 1,25; P = 0,02) et d’un traitement substitutif de l’insuffisance rénale (17 % vs 11 %; RC, 1,96; P0,001). Il n’y avait aucune différence en matière de ventilation mécanique, de limites des traitements de maintien en vie et de mortalité brute à 30 jours (50 % d’hommes vs 49 % de femmes; RC, 1,11; P = 0,19), ce qui est demeuré le cas après ajustement pour tenir compte de la gravité de la maladie, de la fragilité, de l’âge et des limites du traitement (RC, 1,17 ; intervalle de confiance à 95 %, 0,94 à 1,45; P = 0,16). CONCLUSION: Dans cette analyse des caractéristiques de traitement spécifiques au sexe et des résultats de mortalité à 30 jours des patients gravement malades atteints de COVID-19 de ≥ 70 ans, nous avons noté un nombre plus élevé de trachéotomies et de traitements substitutifs de l’insuffisance rénale chez les hommes vs les femmes, mais aucune association significative entre le sexe des patients et la mortalité à 30 jours. ENREGISTREMENT DE L’éTUDE: www.ClinicalTrials.gov (NCT04321265); enregistré le 25 mars 2020.
Published: 2022

3. Expert consensus on peri-operative myocardial injury screening in noncardiac surgery A literature review

Author: Puelacher, C, Pinto, BB, Mills, NL, Duceppe, E, Popova, E, Duma, A, Nagele, P, Omland, T, Hammerer-Lercher, A, and Buse, GL
Abstract: Peri-operative myocardial injury, detected by dynamic and elevated cardiac troponin (cTn) concentrations, is a common complication of noncardiac surgery that is strongly associated with 30-day mortality. Although active screening for peri-operative myocardial injury has been suggested in recent guidelines, clinical implementation remains tentative due to a lack of examples on how to tackle such an interdisciplinary project at a local level. Moreover, consensus on which assay and cTn cut-off values should be used has not yet been reached, and guidance on whom to screen is lacking. In this article, we aim to summarise local examples of successfully implemented cTn screening practices and review the current literature in order to provide information and suggestions for patient selection, organisation of a screening programme, caveats and a potential management pathway.
Published: 2021

4. In-hospital clinical outcomes after upper gastrointestinal surgery: Data from an international observational study

Author: Ahmad, T, Bouwman, RA, Grigoras, I, Aldecoa, C, Hofer, C, Hoeft, A, Holt, P, Fleisher, LA, Buhre, W, Pearse, RM, Ferguson, M, MacMahon, M, Shulman, M, Cherian, R, Currow, H, Kanathiban, K, Gillespie, D, Pathmanathan, E, Phillips, K, Reynolds, J, Rowley, J, Douglas, J, Kerridge, R, Garg, S, Bennett, M, Jain, M, Alcock, D, Terblanche, N, Cotter, R, Leslie, K, Stewart, M, Zingerle, N, Clyde, A, Hambidge, O, Rehak, A, Cotterell, S, Huynh, WBQ, McCulloch, T, Ben-Menachem, E, Egan, T, Cope, J, Halliwell, R, Fellinger, P, Haisjackl, M, Haselberger, S, Holaubek, C, Lichtenegger, P, Scherz, F, Schmid, W, Hoffer, F, Cakova, V, Eichwalder, A, Fischbach, N, Klug, R, Schneider, E, Vesely, M, Wickenhauser, R, Grubmueller, KG, Leitgeb, M, Lang, F, Toro, N, Bauer, M, Laengle, F, Haberl, C, Mayrhofer, T, Trybus, C, Buerkle, C, Forstner, K, Germann, R, Rinoesl, H, Schindler, E, Trampitsch, E, Bogner, G, Dankl, D, Duenser, M, Fritsch, G, Gradwohl-Matis, I, Hartmann, A, Hoelzenbein, T, Jaeger, T, Landauer, F, Lindl, G, Lux, M, Steindl, J, Stundner, O, Szabo, C, Bidgoli, J, Verdoodt, H, Forget, P, Kahn, D, Lois, F, Momeni, M, Pregardien, C, Pospiech, A, Steyaert, A, Veevaete, L, De Kegel, D, De Jongh, K, Foubert, L, Smitz, C, Vercauteren, M, Poelaert, J, Van Mossevelde, V, Abeloos, J, Bouchez, S, Coppens, M, De Baerdemaeker, L, Deblaere, I, De Bruyne, A, De Hert, S, Fonck, K, Heyse, B, Jacobs, T, Lapage, K, Moerman, A, Neckebroek, M, Parashchanka, A, Roels, N, Van Den Eynde, N, Vandenheuvel, M, Van Limmen, J, Vanluchene, A, Vanpeteghem, C, Wouters, P, Wyffels, P, Huygens, C, Vandenbempt, P, Van de Velde, M, Dylst, D, Janssen, B, Schreurs, E, Aleixo, FB, Candido, K, Batista, HD, Guimaraes, M, Guizeline, J, Hoffmann, J, Lobo, S, Marques Lobo, FR, Nascimento, V, Nishiyama, K, Pazetto, L, Souza, D, Rodrigues, RS, Vilela dos Santos, AM, Jardim, J, Sa Malbouisson, LM, Silva, J, do Nascimento Junior, P, Baio, TH, Pereira de Castro, GI, Watanabe Oliveira, HR, Amendola, CP, Cardoso, G, Ortega, D, Brotto, AF, De Oliveira, MC, Rea-Neto, A, Dias, F, Travi, ME, Zerman, L, Azambuja, P, Knibel, MF, Martins, A, Almeida, W, Neder Neto, C, Tardelli, MA, Caser, E, Machado, M, Aguzzoli, C, Baldisserotto, S, Tabajara, FB, Bettega, F, Rodrigues Junior, LHC, de Gasperi, J, Faina, L, Nolasco, MF, da Costa Fischer, BF, de Campos Ferreira, MF, Hartmann, C, Kliemann, M, Ribeiro, GLH, Fraga, JM, Netto, TM, Pozza, LV, Wendling, PR, Azevedo, C, Garcia, J, Lopes, M, Maia, B, Maselli, P, Melo, R, Mendes, W, Neves, M, Ney, J, Piras, C, Applewhaite, C, Carr, A, Chow, L, Duttchen, K, Foglia, J, Greene, M, Hinther, A, Houston, K, McCormick, TJ, Mikhayel, J, Montasser, S, Ragan, A, Suen, A, Woolsey, A, Yu, HC, Funk, D, Kowalski, S, Legaspi, R, McDonald, H, Siddiqui, F, Pridham, J, Rowe, B, Sampson, S, Thiessen, B, Zbitnew, G, Bernard, A, George, R, Jones, P, Moor, R, Siddiqui, N, Wolfer, A, Tran, D, Winch, D, Dobson, G, McCormick, T, Montasser, O, Hall, R, Baghirzada, L, Curley, G, Dai, SY, Hare, G, Lee, E, Shastri, U, Tsui, A, Yagnik, A, Alvares, D, Choi, S, Dwyer, H, Flores, K, McCartney, C, Somascanthan, P, Beattie, S, Carroll, J, Pazmino-Canizares, J, Wijeysundera, D, Ami, N, Chan, V, Perlas, A, Argue, R, Huang, Y, Lavis, K, Mayson, K, Cao, Y, Gao, H, Hu, T, Lv, J, Yang, J, Yang, Y, Zhong, Y, Zhou, J, Zou, X, He, M, Li, X, Luo, D, Wang, H, Yu, T, Chen, L, Wang, L, Cai, Y, Cao, Z, Li, Y, Lian, J, Sun, H, Wang, S, Wang, Z, Wang, K, Zhu, Y, Du, X, Fan, H, Fu, Y, Huang, L, Hwan, H, Luo, H, Qu, P-S, Tao, F, Wang, G, Zhang, Y, Zhang, X, Chen, C, Wang, W, Liu, Z, Fan, L, Tang, J, Chen, Y, Han, Y, Huang, C, Liang, G, Shen, J, Wang, J, Yang, Q, Zhen, J, Zhou, H, Chen, J, Chen, Z, Meng, B, Ye, H, Bi, Y, Cao, J, Guo, F, Lin, H, Liu, Y, Lv, M, Shi, P, Song, X, Sun, C, Sun, Y, Wang, Y, Zhang, M, Chen, R, Hou, J, Leng, Y, Meng, Q-T, Qian, L, Shen, Z-Y, Xia, Z-Y, Xue, R, Zhao, B, Zhou, X-J, Chen, Q, Guo, H, Guo, Y, Qi, Y, Wei, J, Zhang, W, Zheng, L, Bao, Q, Fei, Y, Hu, N, Hu, X, Lei, M, Lv, X, Miao, F, Ouyang, L, Shen, C, Wang, D, Wu, C, Xu, L, Yuan, J, Zhang, L, Zhang, H, Zhao, J, Zhao, C, Zhao, L, Zheng, T, Zhou, D, Zhou, C, Lu, K, Zhao, T, He, C, Chen, H, Chen, S, Cheng, B, He, J, Jin, L, Li, C, Li, H, Pan, Y, Shi, Y, Wen, XH, Wu, S, Xie, G, Zhang, K, Lu, X, Chen, F, Liang, Q, Lin, X, Ling, Y, Liu, G, Tao, J, Yang, L, Cheng, Z, Dai, H, Feng, Y, Hou, B, Gong, H, Hu, CH, Huang, H, Huang, J, Jiang, Z, Li, M, Lin, J, Liu, M, Liu, W, Luo, F, Ma, L, Min, J, Shi, X, Song, Z, Wan, X, Xiong, Y, Yang, S, Zhang, Q, Zhao, W, Zhu, X, Bai, Y, Dai, Q, Geng, W, Han, K, He, X, Ji, B, Jia, D, Jin, S, Li, Q, Liang, D, Luo, S, Lwang, L, Mo, Y, Qi, X, Qian, M, Qin, J, Ren, Y, Xie, J, Yan, Y, Yao, Y, Zhuang, X, Ai, Y, Du, F, He, L, Li, Z, Li, L, Meng, S, Yuan, Y, Zhang, E, Zhang, J, Zhao, S, Ji, Z, Pei, L, Dong, B, Li, J, Miao, Z, Mu, H, Qin, C, Su, L, Wen, Z, Xie, K, Yu, Y, Yuan, F, Xiao, W, Zhu, Z, Fu, K, Hu, R, Huang, S, Liang, Y, Yu, S, Guo, Z, Jing, Y, Tang, N, Wu, J, Yuan, D, Zhang, R, Zhao, X, Bai, H-P, Liu, C-X, Liu, F-F, Ren, W, Wang, X-L, Xu, G-J, Li, B, Ou, Y, Tang, Y, Yao, S, Zhang, S, Kong, C-C, Liu, B, Wang, T, Lu, B, Xia, Y, Cai, F, Chen, P, Hu, S, Xu, Q, Hu, L, Jing, L, Liu, Q, Peng, ZD, Qiu, X, Ren, Q, Tong, Y, Wen, Y, Wu, Q, Xia, J, Xiong, X, Xu, S, Yang, T, Yin, N, Zeng, Q, Zhang, B, Zheng, K, Cang, J, Fan, Y, Fu, S, Ge, X, Guo, B, Huang, W, Jiang, L, Jiang, X, Shan, Q, Wang, F, Christiansen, IC, Granum, SN, Rasmussen, BS, Daugaard, M, Gambhir, R, Brandsborg, B, Steingrimsdottir, GE, Jensen-Gadegaard, P, Olsen, KS, Siegel, H, Eskildsen, KZ, Gatke, MR, Wibrandt, I, Heintzelmann, SB, Lange, KHW, Lundsgaard, RS, Amstrup-Hansen, L, Hovendal, C, Larsen, M, Lenstrup, M, Kobborg, T, Larsen, JR, Pedersen, AB, Smith, SH, Oestervig, RM, Rasmussen, L, Afshari, A, Andersen, C, Ekelund, K, Secher, EL, Beloeil, H, Lasocki, S, Venara, A, Biais, M, Ouattara, A, Sineus, M, Molliex, S, Legouge, ML, Wallet, F, Tesniere, A, Gaudin, C, Lehur, P, Forsans, E, de Rudnicki, S, Maudet, VS, Mutter, D, Sojod, G, Ouaissi, M, Regimbeau, J-M, Futier, E, Desbordes, J, Comptaer, N, el Manser, D, Ethgen, S, Lebuffe, G, Auer, P, Haertl, C, Deja, M, Legashov, K, Sonnemann, S, Wiegand-Loehnert, C, Falk, E, Habicher, M, Angermair, S, Laetsch, B, Schmidt, K, Von Heymann, C, Ramminger, A, Jelschen, F, Pabel, S, Weyland, A, Czeslick, E, Gille, J, Malcharek, M, Sablotzki, A, Lueke, K, Wetzel, P, Weimann, J, Lenhart, F-P, Reichle, F, Schirmer, F, Hueppe, M, Klotz, K, Nau, C, Schoen, J, Mencke, T, Wasmund, C, Bankewitz, C, Baumgarten, G, Fleischer, A, Guttenthaler, V, Hack, Y, Kirchgaessner, K, Maenner, O, Schurig-Urbaniak, M, Struck, R, van Zyl, R, Wittmann, M, Goebel, U, Harris, S, Veit, S, Andreadaki, E, Souri, F, Katsiadramis, I, Skoufi, A, Vasileiou, M, Aimoniotou-Georgiou, E, Katsourakis, A, Veroniki, F, Vlachogianni, G, Petra, K, Chlorou, D, Oloktsidou, E, Ourailoglou, V, Papapostolou, K, Tsaousi, G, Daikou, P, Dedemadi, G, Kalaitzopoulos, I, Loumpias, C, Bristogiannis, S, Dafnios, N, Gkiokas, G, Kontis, E, Kozompoli, D, Papailia, A, Theodosopoulos, T, Bizios, C, Koutsikou, A, Moustaka, A, Plaitakis, I, Armaganidis, A, Christodoulopoulou, T, Lignos, M, Theodorakopoulou, M, Asimakos, A, Ischaki, E, Tsagkaraki, A, Zakynthinos, S, Antoniadou, E, Koutelidakis, I, Lathyris, D, Pozidou, I, Voloudakis, N, Dalamagka, M, Elena, G, Chronis, C, Manolakaki, D, Mosxogiannidis, D, Slepova, T, Tsakiridou, I-S, Lampiri, C, Vachlioti, A, Panagiotakis, C, Sfyras, D, Tsimpoukas, F, Tsirogianni, A, Axioti, E, Filippopoulos, A, Kalliafa, E, Kassavetis, G, Katralis, P, Komnos, I, Pilichos, G, Ravani, I, Totis, A, Apagaki, E, Efthymiadi, A, Kampagiannis, N, Paraforou, T, Tsioka, A, Georgiou, G, Vakalos, A, Bairaktari, A, Charitos, E, Markou, G, Niforopoulou, P, Papakonstantinou, N, Tsigou, E, Xifara, A, Zoulamoglou, M, Gkioni, P, Karatzas, S, Kyparissi, A, Mainas, E, Papapanagiotou, I, Papavasilopoulou, T, Fragandreas, G, Georgopoulou, E, Katsika, E, Psarras, K, Synekidou, E, Verroiotou, M, Vetsiou, E, Zaimi, D, Anagnou, A, Apostolou, K, Melissopoulou, T, Rozenberg, T, Tsigris, C, Boutsikos, G, Kalles, V, Kotsalas, N, Lavdaiou, C, Paikou, F, Panagou, G-L, Spring, A, Arvaniti, K, Botis, I, Drimala, M, Georgakakis, G, Kiourtzieva, E, Ntouma, P, Prionas, A, Xouplidis, K, Dalampini, E, Giannaki, C, Iasonidou, C, Ioannidis, O, Lavrentieva, A, Papageorgiou, G, Kokkinoy, M, Stafylaraki, M, Gaitanakis, S, Karydakis, P, Paltoglou, J, Ponireas, P, Chaloulis, P, Provatidis, A, Sousana, A, Gardikou, VV, Konstantivelli, M, Lataniotou, O, Lisari, E, Margaroni, M, Stamatiou, K, Nikolaidis, E, Pnevmatikos, I, Sertaridou, E, Andreou, A, Arkalaki, E, Athanasakis, E, Chaniotaki, F, Chatzimichali, CA, Christofaki, M, Dermitzaki, D, Fiorentza, K, Frantzeskos, G, Geromarkaki, E, Kafkalaki, K, Kalogridaki, M, Karydi, K, Kokkini, S, Kougentakis, G, Lefaki, T, Lilitsis, E, Makatounaki, A, Malliotakis, P, Michelakis, D, Neonaki, M, Nyktari, V, Palikyra, I, Papadakis, E, Papaioannou, A, Sfakianakis, K, Sgouraki, M, Souvatzis, X, Spartinou, A, Stefanidou, N, Syrogianni, P, Tsagkaraki, G, Arnaoutoglou, E, Arnaoutoglou, C, Bali, C, Bouris, V, Doumos, R, Gkini, K-P, Kapaktsi, C, Koulouras, V, Lena, A, Lepida, D, Michos, E, Papadopoulos, D, Paschopoulos, M, Rompou, VA, Siouti, I, Tsampalas, S, Ververidou, O, Zilis, G, Charlalampidoy, A, Christodoulidis, G, Flossos, A, Stamoulis, K, Chan, M, Tsang, MSC, Tsang, MS, Lai, ML, Yip, CP, Chan, HMH, Law, B, Li, WS, Chu, HM, Koo, EGY, Lam, CCJ, Cheng, KH, Lam, T, Chu, S, Lam, WY, Wong, KWK, Kwok, D, Hung, CYJ, Chan, WKJ, Wong, WL, Chung, CKE, Ma, SK, Kaushik, S, Shah, B, Shah, D, Shah, S, Ar, P, Muthuchellappan, R, Agarwal, V, Divatia, J, Kulkarni, A, Mishra, S, Nimje, G, Pande, S, Savarkar, S, Shrivastava, A, Thomas, M, Yegnaram, S, Hidayatullah, R, Chandra, S, Tantri, A, Puar, N, Niman, S, Indra, I, Hamzah, Z, Yuliana, A, Abidin, UN, Dursin, AN, Kurnia, A, Susanti, A, Handayani, D, Alit, MA, Arya, A, Senapathi, TGA, Utara, UH, Wid, WM, Wima, S, Wir, WM, Jehosua, B, Kaunang, J, Lantang, EY, Najoan, R, Waworuntu, N, Awad, H, Fuad, A, Geddoa, E, Geddoa, B, Khalaf, AR, Al hussaini, S, Albaj, S, Kenber, M, Bettinelli, A, Spadaro, S, Volta, CA, Giancarlo, L, Sottosanti, V, Copetti, E, Della Rocca, G, Spagnesi, L, Toretti, I, Alloj, C, Cardellino, S, Carmino, L, Costanzo, E, Fanfani, LC, Novelli, MT, Roasio, A, Bellandi, M, Beretta, L, Bignami, E, Bocchino, S, Cabrini, L, Corti, D, Landoni, G, Meroni, R, Moizo, E, Monti, G, Pintaudi, M, Plumari, VP, Taddeo, D, Testa, V, Winterton, D, Zangrillo, A, Cloro, LM, Colangelo, C, Colangelo, A, Rotunno, G, Paludi, MA, Maria, CP, Pata, A, Parrini, V, Gatta, A, Nastasi, M, Tinti, C, Baroselli, A, Arrigo, M, Benevento, A, Bottini, C, Cannavo, M, Gastaldi, C, Marchesi, A, Pascazio, A, Pata, F, Pozzi, E, Premoli, A, Tessera, G, Boschi, L, D'Andrea, R, Ghignone, F, Poggioli, G, Sibilio, A, Taffurelli, M, Ugolini, G, Ab Majid, MA, Ab Rahman, R, Joseph, J, Pathan, F, Shah, MHS, Yap, HL, Cheah, S, Chin, II, Looi, JK, Tan, SC, Visvalingam, S, Kwok, FY, Lee, CK, Tan, TS, Wong, SM, Abdullah, NH, Liew, CF, Luxuman, L, Zin, NHM, Norddin, MF, Alias, RLR, Wong, JY, Yong, J, Bin Mustapha, MT, Chan, WK, Dzulkipli, N, Kuan, PX, Lee, YC, Alias, A, Guok, EC, Jee, CC, Ramon, BR, Wong, CW, Ghafar, FNIA, Aziz, FZ, Hussain, N, Lee, HS, Sukawi, I, Woon, YL, Hadi, HZA, Azam, UAA, Alias, AH, Kesut, SA, Lee, JM, Ooi, DV, Sulaiman, HA, Lih, TAT, Mansor, M, Veerakumaran, J, Luna, P, Rojas, E, Resendiz, GEA, Zapata, DDM, Lopez, JCJA, Flores, AAA, Amador, JCB, Avila, EJD, Aquino, LPG, Rodriguez, RL, Landa, MT, Urias, E, Hollmann, M, Hulst, A, Preckel, OKB, Koopman-van Gemert, A, Bouwman, A, Buise, M, Tolenaar, N, Weber, E, de Fretes, J, Houweling, P, Ormskerk, P, Van Bommel, J, Lance, M, Smit-Fun, V, van Zundert, T, Baas, P, de Boer, HD, Sprakel, J, Elferink-Vonk, R, Noordzij, P, van Zeggeren, L, Brand, B, Spanjersberg, R, ten Bokkel-Andela, J, Numan, S, van 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Mulligan, J-P, Nicklin, P, Palipane, N, Parsons, T, Piper, R, Prakash, R, Ramesh, B, Rasip, S, Reading, J, Rela, M, Reyes, A, Stephens, R, Rooms, M, Shah, K, Simons, H, Solanki, S, Spowart, E, Stevens, A, Waggett, H, Yassaee, A, Kennedy, A, Scott, S, Somanath, S, Berg, A, Hernandez, M, Nanda, R, Tank, G, Wilson, N, Wilson, D, Al-Soudaine, Y, Baldwin, M, Cornish, J, Davies, Z, Davies, L, Edwards, M, Frewer, N, Gallard, S, Glasbey, J, Harries, R, Hopkins, L, Kim, T, Koompirochana, V, Lawson, S, Lewis, M, Makzal, Z, Scourfield, S, Ahmad, Y, Bates, S, Blackwell, C, Bryant, H, Collins, H, Coulter, S, Cruickshank, R, Daniel, S, Daubeny, T, Golder, K, Hawkins, L, Helen, B, Hinxman, H, Levett, D, Salmon, K, Seaward, L, Skinner, B, Tyrell, B, Wadams, B, Walsgrove, J, Dickson, J, Constantin, K, Karen, M, O'Brien, P, O'Donohoe, L, Payne, H, Sundayi, S, Walker, E, Brooke, J, Cardy, J, Humphreys, S, Kessack, L, Kubitzek, C, Kumar, S, Cotterill, D, Hodzovic, E, Hosdurga, G, Miles, E, Saunders, G, Campbell, M, Chan, P, Jemmett, K, Raj, A, Naik, A, Oshowo, A, Ramamoorthy, R, Shah, N, Sylvan, A, Blyth, K, Burtenshaw, A, Freeman, D, Johnson, E, Lo, P, Martin, T, Plunkett, E, Wollaston, J, Allison, J, Carroll, C, Craw, N, Craw, S, Pitt-Kerby, T, Rowland-Axe, R, Spurdle, K, McDonald, A, Simon, D, Sinha, V, Banner-Goodspeed, V, Boone, M, Campbell, K, Lu, F, Scannell, J, Sobol, J, Balajonda, N, Clemmons, K, Conde, C, Elgasim, M, Funk, B, Hopkins, T, Olaleye, O, Omer, O, Pender, M, Porto, A, Waweru, P, Yeh, E, Bodansky, D, Evans, A, Kleopoulos, S, Maril, R, Mathney, E, Sanchez, A, Tinuoye, E, Bateman, B, Eng, K, Jiang, N, Ladha, K, Needleman, J, Chen, L-L, Lane, R, Robinowitz, D, Ghushe, N, Irshad, M, O'Connor, J, Patel, S, Takemoto, S, Wallace, A, Mazzeffi, M, Rock, P, Wallace, K, Chua, P, Fleisher, L, Mattera, M, Sharar, R, Thilen, S, Treggiari, M, Morgan, A, Sofjan, I, Subramaniam, K, Avidan, M, Maybrier, H, Muench, M, Wildes, T, ISOS, ISOS, Int Surgical Outcomes Study ISOS, Anesthesiology, ACS - Diabetes & metabolism, ACS - Microcirculation, ACS - Amsterdam Cardiovascular Sciences, APH - Quality of Care, ACS - Heart failure & arrhythmias, and International Surgical Outcomes Study (ISOS) group
Subjects: Male, IMPACT, Cancer, Complication rate, Mortality, Oesophagectomy, Postoperative care, Upper gastrointestinal surgery, SURGICAL COMPLICATIONS, 0302 clinical medicine, Postoperative Complications, Risk Factors, Outcome Assessment, Health Care, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, ESOPHAGOGASTRIC CANCER, Prospective cohort study, Digestive System Surgical Procedures, RISK, Perioperative medicine, General Medicine, Middle Aged, Oncology, Length of Stay/statistics & numerical data, Elective Surgical Procedures, MORTALITY FOLLOWING ESOPHAGECTOMY, 030220 oncology & carcinogenesis, Female, Elective Surgical Procedure, Cohort study, medicine.medical_specialty, ENHANCED RECOVERY, PERIOPERATIVE MEDICINE, Postoperative Complications/mortality, NO, 03 medical and health sciences, Outcome Assessment (Health Care), MORBIDITY, medicine, Humans, Digestive System Surgical Procedures/mortality, business.industry, LONG-TERM SURVIVAL, Odds ratio, Length of Stay, CARE, medicine.disease, Confidence interval, Surgery, Human medicine, Complication, business
Abstract: Aims: Previous research suggests that patients undergoing upper gastrointestinal surgery are at high risk of poor postoperative outcomes. The aim of our study was to describe patient outcomes after elective upper gastrointestinal surgery at a global level.Methods: Prospective analysis of data collected during an international seven-day cohort study of 474 hospitals in 27 countries. Patients undergoing elective upper gastrointestinal. surgery were recruited. Outcome measures were in-hospital complications and mortality at 30-days. Results are presented as n(%) and odds ratios with 95% confidence intervals.Results: 2139 patients were included, of whom 498 (23.2%) developed one or more postoperative complications, with 30 deaths (1.4%). Patients with complications had longer median hospital stay 11 (6-18) days vs. 5 (2-10) days. Infectious complications were most frequent, affecting 368 (17.2%) patients. 328 (15.3%) patients were admitted to critical care postoperatively, of whom 161 (49.1%) developed a complication with 14 deaths (4.3%). In a multivariable logistic regression model we identified age (OR 1.02 [1.01-1.03]), American Society of Anesthesiologists physical status III (OR 2.12 [1.44-3.16]) and IV (OR 3.23 [1.72-6.09]), surgery for cancer (OR 1.63 [1.27-2.11]), open procedure (OR 1.40 [1.10-1.78]), intermediate surgery (OR 1.75 [1.12-2.81]) and major surgery (OR 2.65 [1.72-4.23]) as independent risk factors for postoperative complications. Patients undergoing major surgery for upper gastrointestinal cancer experienced twice the rate of complications compared to those undergoing other procedures (224/578 patients [38.8%] versus 274/1561 patients [17.6%]).Conclusions: Complications and death are common after upper gastrointestinal surgery. Patients undergoing major surgery for cancer are at greatest risk. (C) 2017 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Published: 2017

5. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries

Author: Ahmad, T, Bouwman, RA, Grigoras, I, Aldecoa, C, Hofer, C, Hoeft, A, Holt, P, Fleisher, LA, Buhre, W, Pearse, RM, Ferguson, M, MacMahon, M, Shulman, M, Cherian, R, Currow, H, Kanathiban, K, Gillespie, D, Pathmanathan, E, Phillips, K, Reynolds, J, Rowley, J, Douglas, J, Kerridge, R, Garg, S, Bennett, M, Jain, M, Alcock, D, Terblanche, N, Cotter, R, Leslie, K, Stewart, M, Zingerle, N, Clyde, A, Hambidge, O, Rehak, A, Cotterell, S, Huynh, WBQ, McCulloch, T, Ben-Menachem, E, Egan, T, Cope, J, Halliwell, R, Fellinger, P, Haisjackl, M, Haselberger, S, Holaubek, C, Lichtenegger, P, Scherz, F, Schmid, W, Hoffer, F, Cakova, V, Eichwalder, A, Fischbach, N, Klug, R, Schneider, E, Vesely, M, Wickenhauser, R, Grubmueller, KG, Leitgeb, M, Lang, F, Toro, N, Bauer, M, Laengle, F, Haberl, C, Mayrhofer, T, Trybus, C, Buerkle, C, Forstner, K, Germann, R, Rinoesl, H, Schindler, E, Trampitsch, E, Bogner, G, Dankl, D, Duenser, M, Fritsch, G, Gradwohl-Matis, I, Hartmann, A, Hoelzenbein, T, Jaeger, T, Landauer, F, Lindl, G, Lux, M, Steindl, J, Stundner, O, Szabo, C, Bidgoli, J, Verdoodt, H, Forget, P, Kahn, D, Lois, F, Momeni, M, Pregardien, C, Pospiech, A, Steyaert, A, Veevaete, L, De Kegel, D, De Jongh, K, Foubert, L, Smitz, C, Vercauteren, M, Poelaert, J, Van Mossevelde, V, Abeloos, J, Bouchez, S, Coppens, M, De Baerdemaeker, L, Deblaere, I, De Bruyne, A, De Hert, S, Fonck, K, Heyse, B, Jacobs, T, Lapage, K, Moerman, A, Neckebroek, M, Parashchanka, A, Roels, N, Van Den Eynde, N, Vandenheuvel, M, Van Limmen, J, Vanluchene, A, Vanpeteghem, C, Wouters, P, Wyffels, P, Huygens, C, Vandenbempt, P, Van de Velde, M, Dylst, D, Janssen, B, Schreurs, E, Aleixo, FB, Candido, K, Batista, HD, Guimaraes, M, Guizeline, J, Hoffmann, J, Lobo, S, Marques Lobo, FR, Nascimento, V, Nishiyama, K, Pazetto, L, Souza, D, Rodrigues, RS, Vilela dos Santos, AM, Jardim, J, Sa Malbouisson, LM, Silva, J, Do Nascimento Junior, P, Baio, TH, Pereira de Castro, GI, Watanabe Oliveira, HR, Amendola, CP, Cardoso, G, 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Lefaki, Tatiana, Lilitsis, Emmanouhl, Makatounaki, Aikaterini, Malliotakis, Polychroni, Michelakis, Dimostheni, Neonaki, Maria, Nyktari, Vasileia, Palikyra, Iliana, Papadakis, Eleftherio, Papaioannou, Alexandra, Sfakianakis, Konstantino, Sgouraki, Maria, Souvatzis, Xenia, Spartinou, Anastasia, Stefanidou, Nefeli, Syrogianni, Paulina, Tsagkaraki, Georgia, Arnaoutoglou, Elena, Arnaoutoglou, Christina, Bali, Christina, Bouris, Vasilio, Doumos, Rodamantho, Gkini, Konstantia-Paraskevi, Kapaktsi, Clio, Koulouras, Vasilio, Lena, Arian, Lepida, Dimitra, Michos, Evangelo, Papadopoulos, Dimitrio, Paschopoulos, Mina, Rompou, Vaia Aliki, Siouti, Ioanna, Tsampalas, Stavro, Ververidou, Ourania, Zilis, Georgio, Charlalampidoy, Alexandra, Christodoulidis, Gregory, Flossos, Andrea, Stamoulis, Konstantino, Tsang, Man Shing Caleb, Tang, Man Shing, Lai, Man Ling, Yip, Chi Pang, Chan, Hey Man Heyman, Law, Bassanio, Wing Sze, Li, Chu, Hiu Man, Koo, Emily Gar Yee, Lam, Chi Cheong Joe, Cheng, Ka Ho, Chan, Matthew, Lam, Tracy, Chu, Susanna, Lam, Wing Yan, Wong, Kin Wai Kevin, Kwok, Dily, Hung, Ching Yue Janice, Chan, Wai Kit Jacky, Wong, Wing Lam, Chung, Chun Kwong Eric, Shu Kai, Ma, Kaushik, Shuchi, Shah, Bhagyesh, Shah, Dhiren, Shah, Sanjay, Praburaj, Ar, Muthuchellappan, Radhakrishnan, Agarwal, Vandana, Divatia, Jigeeshu, Kulkarni, Atul, Mishra, Sanghamitra, Nimje, Ganesh, Pande, Swati, Savarkar, Sukhada, Shrivastava, Aditi, Thomas, Martin, Yegnaram, Shashikant, Hidayatullah, Rahmat, Chandra, Susilo, Tantri, Aida, Puar, Nasman, Niman, Sumara, Indra, Imai, Hamzah, Zulkarnain, Yuliana, Annika, Abidin, Ucu Nurhadiat, Dursin, Ade Nurkacan, Kurnia, Andri, Susanti, Ade, Handayani, Dini, Alit, Mahaalit Aribawa, Arya, Aryabiantara, Senapathi, Tjokorda Gde Agung, Utara, Utara Hartawan, Wid, Widnyana Made, Wima, Semarawima, Wir, Wiryana Made, Jehosua, Brillyan, Kaunang, Jonathan, Lantang, Eka Yudha, Najoan, Rini, Waworuntu, Neil, Awad, Hadi, Fuad, Akram, Geddoa, Emad, Geddoa, Burair, Khalaf, 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T., Loots, Emil, Madansein, Rajhmum, Madaree, Anil, Madiba, Thandinkosi E., Manzini, Vukani T., Mbuyisa, Mbali, Moodley, Rajan, Msomi, Mduduzi, Mukama, Innocent, Naidoo, Desigan, Naidoo, Rubeshan, Naidu, Tesuven K., Ntloko, Sindiswa, Padayachee, Eneshia, Padayachee, Lucelle, Phaff, Martijn, Pillay, Bala, Pillay, Desigan, Pillay, Lutchmee, Ramnarain, Anupa, Ramphal, Suren R., Ryan, Paul, Saloojee, Ahmed, Sebitloane, Motshedisi, Sigcu, Noluyolo, Taylor, Jenna L., Torborg, Alexandra, Visser, Linda, Anderson, Philip, Conradie, Alae, De Swardt, Mathew, De Villiers, Martin, Eikman, Johan, Liebenberg, Riaan, Mouton, Johan, Paton, Abbey, Van Der Merwe, Louwrence, Wilscott-Davids, Candice, Barrett, Wendy Joan, Bester, Marlet, De Beer, Johan, Geldenhuys, Jacque, Gouws, Hanni, Potgieter, Jan-Hendrik, Strydom, Magdel, Wilberforceturton, Edwin, Chetty, Rubendraj R., Chirkut, Subash, Cronje, Larissa, De Vasconcellos, Kim, Dube, Nokukhanya Z., Gama, N. 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Amir, Shekar, Priya, Adams, David, Harden, Catherine, Hollands, Heidi, King, Angela, March, Linda, Minto, Gary, Patrick, Abigail, Squire, Rosalyn, Waugh, Darren, Kumara, Paramesh, Simeson, Karen, Yarwood, Jamie, Browning, Julie, Hatton, Jonathan, Julian, Howe, Mitra, Atideb, Newton, Maria, Pernu, Pawan Kootelu, Wilson, Alison, Commey, Thelma, Foot, Helen, Glover, Lyn, Gupta, Ajay, Lancaster, Nicola, Levin, Jill, Mackenzie, Felicity, Mestanza, Claire, Nofal, Emma, Pout, Lauren, Varden, Rosanna, Wild, Jonathan, Jones, Stephanie, Moreton, Sarah, Pulletz, Mark, Davies, Charlotte, Martin, Matthew, Thomas, Sian, Burns, Karen, Mcarthur, Carol, Patel, Panna, Lau, Gary, Rich, Natalie, Davis, Fiona, Self, Jame, Lyons, Rachel, Port, Beth, Prout, Rachel, Smith, Christopher, Adelaja, Yemi, Bennett, Victoria, Bidd, Heena, Dumitrescu, Alexandra, Murphy, Jacqui Fox, Keen, Abigail, Mguni, Nhlanhla, Cheng, Ong, Adams, George, Boshier, Pier, Brown, Richard, Butryn, Izabella, Chatterjee, Jayanta, Freethy, Alexander, Lockwood, Geoffrey, Tsakok, Maria, Tsiligiannis, Sophia, Peat, William, Stephenson, Lorraine, Bradburn, Mike, Pick, Sara, Cunha, Pedro, Olagbaiye, Olufemi, Tayeh, Salim, Packianathaswamy, Balaji, Abernethy, Caroline, Balasubramaniam, Madhu, Bennett, Rachael, Bolton, David, Martinson, Victoria, Bell, Stephanie, Heather, Blaylock, Kushakovsky, Vlad, Alcock, Liam, Alexander, Hazel, Anderson, Colette, Baker, Paul, Brookes, Morag, Cawthorn, Louise, Cirstea, Emanuel, Clarkson, Rachel, Colling, Kerry, Coulter, Ian, Das, Suparna, Haigh, Kathryn, Hamdan, Alhafidz, Hugill, Keith, Kottam, Lucksy, Lisseter, Emily, Mawdsley, Matthew, Mcgivern, Julie, Padala, Krishnaveni, Phelps, Victoria, Kumar, Vineshykaa Ramesh, Stewart, Kirsten, Towse, Kayley, Tregonning, Julie, Vahedi, Ali, Walker, Alycon, Baines, Duncan, Bilolikar, Anjali, Chande, Shiv, Copley, Edward, Dunk, Nigel, Kulkarni, Raghavendra, Kumar, Pawan, Metodiev, Yavor, Ncomanzi, Dumisani, Raithatha, Bhavesh, Raymode, Parizade, Szafranski, Jan, Twohey, Linda, Watt, Philip, Weatherall, Lucie, Weatherill, J., Whitman, Zoe, Wighton, Elinor, Abayasinghe, Chamika, Chan, Alexander, Darwish, Sharif, Gill, Jame, Glasgow, Emma, Hadfield, Daniel, Harris, Clair, Hopkins, Phil, Kochhar, Arun, Kunst, Gudrun, Mellis, Clare, Pool, Andrew, Riozzi, Paul, Selman, Andrew, Smith, Emma-Jane, Vele, Liana, Gercek, Yuksel, Guy, Kramer, Holden, Dougla, Watson, Nichola, Whysall, Karen, Andreou, Prematie, Hales, Dawn, Thompson, Jonathan, Bowrey, Sarah, Mcdonald, Shara, Gilmore, Jemma, Hills, Vicky, Kelly, Chan, Kelly, Sinead, Lloyd, Geraint, Abbott, Tom, Gall, Lewi, Torrance, Hew, Vivian, Mark, Berntsen, Emer, Nolan, Tracey, Turner, Angu, Vohra, Akbar, Brown, Andrew, Clark, Richard, Coughlan, Elaine, Daniel, Conway, Patvardhan, Chinmay, Pearson, Rachel, Predeep, Sheba, Saad, Hesham, Shanmugam, Mohanakrishnan, Varley, Simon, Wylie, Katharine, Cooper, Lucy, Makowski, Arystarch, Misztal, Beata, Moldovan, Eliza, Pegg, Claire, Donovan, Andrew, Foot, Jayne, Large, Simon, Claxton, Andrew, Netke, Bhagyashree, Armstrong, Richard, Calderwood, Claire, Kwok, Andy, Mohr, Otto, Oyeniyi, Peter, Patnaik, Lisa, Post, Benjamin, Ali, Sarah, Arshad, Homa, Baker, Gerard, Brenner, Laura, Brincat, Maximilian, Brunswicker, Annemarie, Cox, Hannah, Cozar, Octavian Ionut, Cheong, Edward, Durst, Alexander, Fengas, Lior, Flatt, Jim, Glister, Georgina, Narwani, Vishal, Photi, Evangelo, Rankin, Adeline, Rosbergen, Melissa, Tan, Mark, Beaton, Ceri, Horn, Rachel, Hunt, Jane, Rousseau, Guy, Stancombe, Lucia, Absar, Mohammed, Allsop, Joanne, Drinkwater, Zoe, Hodgkiss, Tracey, Smith, Kirsty, Brown, Jamie, Alexander-Sefre, Farhad, Campey, Lorraine, Dudgeon, Lucy, Hall, Kathryn, Hitchcock, Rachael, James, Lynne, Smith, Kate, Winstone, Ulrika, Ahmad, Norfaizan, Bauchmuller, Kri, Harrison, Jonathan, Jeffery, Holly, Miller, Duncan, Pinder, Angela, Pothuneedi, Sailaja, Rosser, Jonathan, Sanghera, Sumayer, Swift, Diane, Walker, Rachel, Bester, Delia, Cavanagh, Sarah, Cripps, Heather, Daniel, Harvey, Lynch, Julie, Paton, Alison, Pyke, Shirley, Scholefield, John, Whitworth, Helen, Bottrill, Fiona, Ramalingam, Ganesh, Webb, Stephen, Akerman, Nik, Antill, Philip, Bourner, Lynsey, Buckley, Sarah, Castle, Gail, Charles, Rob, Eggleston, Christopher, Foster, Rebecca, Gill, Satwant, Lindley, Kate, Lklouk, Mohamed, Lowery, Tracey, Martin, Oliver, Milne, David, O'Connor, Patrick, Ratcliffe, Andrew, Rose, Alastair, Smith, Annie, Varma, Sandeep, Ward, Jackie, Barcraft-Barnes, Helena, Camsooksai, Julie, Colvin, Carolyn, Reschreiter, Henrik, Tbaily, Lee, Venner, Nicola, Hamilton, Caroline, Kelly, Lewi, Toth-Tarsoly, Piroska, Dodsworth, Kerry, Foord, Denise, Gordon, Paul, Hawes, Elizabeth, Lamb, Nikki, Mouland, Johanna, Nightingale, Jeremy, Rose, Steve, Schrieber, Joe, Al'Amri, Khalid, Aladin, Hafiz, Arshad, Mohammed Asif, Barraclough, Jame, Bentley, Conor, Bergin, Colin, Carrera, Ronald, Clarkson, Aisling, Collins, Michelle, Cooper, Lauren, Denham, Samuel, Griffiths, Ewen, Peter, Ip, Jeyanthan, Somasundaram, Joory, Kavita, Kaur, Satwant, Marriott, Paul, Mitchell, Natalie, Nagaiah, Sukumar, Nilsson, Annette, Parekh, Nilesh, Pope, Martin, Seager, Joseph, Serag, Hosam, Tameem, Alifia, Thomas, Anna, Thunder, Joanne, Torrance, Andrew, Vohra, Ravinder, Whitehouse, Arlo, Wong, Tony, Blunt, Mark, Wong, Kate, Giles, Julian, Reed, Isabelle, Weller, Debbie, Bell, Gillian, Birch, Julie, Damant, Rose, Maiden, Jane, Mewies, Clare, Prince, Claire, Radford, Jane, Reynolds, Tim, Balain, Birender, Banerjee, Robin, Barnett, Andrew, Burston, Ben, Davies, Kirsty, Edwards, Jayne, Evans, Chri, Ford, David, Gallacher, Pete, Hill, Simon, Jaffray, David, Karlakki, Sudheer, Kelly, Cormac, Kennedy, Julia, Kiely, Nigel, Lewthwaite, Simon, Marquis, Chri, Ockendon, Matthew, Phillips, Stephen, Pickard, Simon, Richardson, Jame, Roach, Richard, Smith, Tony, Spencer-Jones, Richard, Steele, Niall, Steen, Julie, Van Liefland, Marck, White, Steve, Faulds, Matthew, Harris, Meredyth, Kelly, Carrie, Nicol, Scott, Pearson, Sally Anne, Chukkambotla, Srikanth, Andrew, Alyson, Attrill, Elizabeth, Campbell, Graham, Datson, Amanda, Fouracres, Anna, Graterol, Juan, Graves, Lynne, Hong, Bosun, Ishimaru, Alexander, Karthikeyan, Arvind, King, Helen, Lawson, Tom, Lee, Gregory, Lyons, Saoirse, Hall, Andrew Macalister, Mathoulin, Sophie, Mcintyre, Eilidh, Mclaughlin, Danny, Mulcahy, Kathleen, Paddle, Jonathan, Ratcliffe, Anna, Robbins, Jame, Sung, Weilin, Tayo, Adeoluwa, Trembath, Lisa, Venugopal, Suneetha, Walker, Robert, Wigmore, Geoffrey, Boereboom, Catherine, Downes, Charlotte, Humphries, Ryan, Melbourne, Susan, Smith, Coral, Tou, Samson, Ullah, Shafa, Batchelor, Nick, Boxall, Leigh, Broomby, Rupert, Deen, Tariq, Hellewell, Alistair, Helliwell, Laurence, Hutchings, Melanie, Hutchins, David, Keenan, Samantha, Mackie, Donna, Potter, Alison, Smith, France, Stone, Lucy, Thorpe, Kevin, Wassall, Richard, Woodgate, Andrew, Baillie, Shelley, Campbell, Tara, James, Sarah, King, Chri, De Araujo, Daniela Marque, Martin, Danial, Morkane, Clare, Neely, Julia, Rajendram, Rajkumar, Burton, Megan, James, Kathryn, Keevil, Edward, Minik, Orsolya, Morgan, Jenna, Musgrave, Anna, Rajanna, Harish, Roberts, Tracey, Szakmany, Tama, Adamson, Michael, Jumbe, Sandra, Kendall, Jennie, Muthuswamy, Mohan Babu, Anderson, Charlotte, Cruikshanks, Andrew, Wrench, Ian, Zeidan, Lisa, Ardern, Diane, Harris, Benjamin, Hellstrom, Johanna, Martin, Jane, Thomas, Richard, Varsani, Nimu, Brown, Caroline Wrey, Docherty, Philip, Gillies, Michael, Mcgregor, Euan, Usher, Helen, Craig, Jayne, Smith, Andrew, Ahmad, Tahania, Bodger, Phoebe, Creary, Thai, Everingham, Kirsty, Fowler, Alexander, Hewson, Russell, Ijuo, Eke, Januszewska, Marta, Jones, Timothy, Kantsedikas, Ilya, Lahiri, Sumitra, Mclean, Aaron Lawson, Niebrzegowska, Edyta, Phull, Mandeep-Kaur, Wang, Difei, Wickboldt, Nadine, Baldwin, Jacqueline, Doyle, Donna, Mcmullan, Sean, Oladapo, Michelle, Owen, Thoma, Williams, Alexandra, Daniel, Hull, Gregory, Peter, Husain, Tauqeer, Kirk-Bayley, Justin, Mathers, Edward, Montague, Laura, Harper, Mark, White, Stuart, Jack, Jame, Ridley, Carrie, Avis, Joanne, Cook, Tim, Dali-Kemmery, Lola, Kerslake, Ian, Lambourne, Victoria, Pearson, Annabel, Boyd, Christine, Callaghan, Mark, Lawson, Cathy, Mccrossan, Roopa, Nesbitt, Vanessa, O'Connor, Laura, Scott, Julia, Sinclair, Rhona, Farid, Nahla, Morgese, Ciro, Bhatia, Kailash, Karmarkar, Swati, Ahmed, Jamil, Branagan, Graham, Hutton, Monica, Swain, Andrew, Brookes, Jamie, Cornell, Jonathan, Dolan, Rachael, Hulme, Jonathan, Van Vuuren, Amanda Jansen, Jowitt, Tom, Kalashetty, Gunasheela, Lloyd, Fran, Patel, Kiran, Sherwood, Nichola, Brown, Lynne, Chandler, Ben, Deighton, Kerry, Emma, Temlett, Haunch, Kirsty, Cheeseman, Michelle, Dent, Kathy, Garg, Sanjeev, Gray, Carol, Hood, Marion, Jones, Dawn, Juj, Joanne, Rao, Roshan, Walker, Tara, Al Anizi, Mashel, Cheah, Clarissa, Cheing, Yushio, Coutinho, Francisco, Gondo, Prisca, Hadebe, Bernard, Hove, Mazvangu Onie, Khader, Ahamed, Krishnachetty, Bobby, Rhodes, Karen, Sokhi, Jagdish, Baker, Katie-Anne, Bertram, Wendy, Looseley, Alex, Mouton, Ronelle, Hanna, George, Arnold, Glenn, Arya, Shobhit, Balfoussia, Danai, Baxter, Linden, Harris, Jame, Jones, Craig, Knaggs, Alison, Markar, Sheraz, Perera, Anisha, Scott, Alasdair, Shida, Asako, Sirha, Ravneet, Wright, Sally, Frost, Victoria, Gray, Catherine, Andrews, Emma, Arrandale, Lindsay, Barrett, Stephen, Cifra, Elna, Cooper, Mariese, Dragnea, Drago, Elna, Cifra, Maclean, Jennifer, Meier, Sonja, Milliken, Donald, Munns, Christopher, Ratanshi, Nadir, Ramessur, Suneil, Salvana, Abegail, Watson, Anthony, Hani, Ali, Campbell, Gill, Critchley, Rebecca, Endersby, Simon, Hicks, Catherine, Liddle, Alison, Pass, Marc, Ritchie, Charlotte, Thomas, Charlotte, Too, Lingxi, Welsh, Sarah, Gill, Talvinder, Johnson, Joanne, Reed, Joanne, Davis, Edward, Papadopoullos, Sam, Attwood, Clare, Biffen, Andrew, Boulton, Kerenza, Gray, Sophie, Hay, David, Mills, Sarah, Montgomery, Jane, Riddell, Rory, Simpson, Jame, Bhardwaj, Neeraj, Paul, Elaine, Uwubamwen, Nosakhare, Alexander, Maini, Arrich, Jame, Arumugam, Swarna, Blackwood, Dougla, Boggiano, Victoria, Brown, Robyn, Chan, Yik Lam, Chatterjee, Devnandan, Chhabra, Ashok, Christian, Rachel, Costelloe, Hannah, Matthewman, Madeline Coxwell, Dalton, Emma, Darko, Julia, Davari, Maria, Dave, Tejal, Deacon, Matthew, Deepak, Shantal, Edmond, Holly, Ellis, Jessica, El-Sayed, Ahmed, Eneje, Philip, English, Rose, Ewe, Renee, Foers, William, Franklin, John, Gallego, Laura, Garrett, Emily, Goldberg, Olivia, Goss, Harry, Greaves, Rosanna, Harris, Rudy, Hennings, Charle, Jones, Eleanor, Kamali, Nelson, Kokkinos, Naomi, Lewis, Cary, Lignos, Leda, Malgapo, Evaleen Victoria, Malik, Rizwana, Milne, Andrew, Mulligan, John-Patrick, Nicklin, Philippa, Palipane, Natasha, Parsons, Thoma, Piper, Rebecca, Prakash, Rohan, Ramesh, Byron, Rasip, Sarah, Reading, Jacob, Rela, Mariam, Reyes, Anna, Robert, Stephen, Rooms, Martin, Shah, Karishma, Simons, Henry, Solanki, Shalil, Spowart, Emma, Stevens, Amy, Thomas, Christopher, Waggett, Helena, Yassaee, Arrash, Kennedy, Anthony, Scott, Sara, Somanath, Sameer, Berg, Andrew, Miguel, Hernandez, Nanda, Rajesh, Tank, Ghanshyambhai, Wilson, Natalie, Wilson, Debbie, Al-Soudaine, Yassr, Baldwin, Matthew, Cornish, Julie, Davies, Zoe, Davies, Leigh, Edwards, Marc, Frewer, Natasha, Gallard, Sian, Glasbey, Jame, Harries, Rhiannon, Hopkins, Luke, Kim, Taeyang, Koompirochana, Vilavan, Lawson, Simon, Lewis, Megan, Makzal, Zaid, Scourfield, Sarah, Ahmad, Yousra, Bates, Sarah, Blackwell, Clare, Bryant, Helen, Collins, Hannah, Coulter, Suzanne, Cruickshank, Ro, Daniel, Sonya, Daubeny, Thoma, Edwards, Mark, Golder, Kim, Hawkins, Lesley, Helen, Bryant, Hinxman, Honor, Levett, Denny, Salmon, Karen, Seaward, Leanne, Skinner, Ben, Tyrell, Bryony, Wadams, Beverley, Walsgrove, Joseph, Dickson, Jane, Constantin, Kathryn, Karen, Markwell, O'Brien, Peter, O'Donohoe, Lynn, Payne, Hannah, Sundayi, Saul, Walker, Elaine, Brooke, Jenny, Cardy, Jon, Humphreys, Sally, Kessack, Laura, Kubitzek, Christiane, Kumar, Suha, Cotterill, Donna, Hodzovic, Emil, Hosdurga, Gurunath, Miles, Edward, Saunders, Glenn, Campbell, Marta, Chan, Peter, Jemmett, Kim, Raj, Ashok, Naik, Aditi, Oshowo, Ayo, Ramamoorthy, Rajarajan, Shah, Nimesh, Sylvan, Axel, Blyth, Katharine, Burtenshaw, Andrew, Freeman, David, Johnson, Emily, Philip, Lo, Martin, Terry, Plunkett, Emma, Wollaston, Julie, Allison, Joanna, Carroll, Christine, Craw, Nichola, Craw, Sarah, Pitt-Kerby, Tressy, Rowland-Axe, Rebecca, Spurdle, Katie, Mcdonald, Andrew, Simon, Davie, Sinha, Vivek, Smith, Thoma, Banner-Goodspeed, Valerie, Boone, Myle, Campbell, Kathleen, Fengxin, Lu, Scannell, Joseph, Sobol, Julia, Balajonda, Naraida, Clemmons, Karen, Conde, Carlo, Elgasim, Magdi, Funk, Bonita, Hall, Roger, Hopkins, Thoma, Olaleye, Omowunmi, Omer, Omer, Pender, Michelle, Porto, Angelo, Stevens, Alice, Waweru, Peter, Yeh, Erlinda, Bodansky, Daniella, Evans, Adam, Kleopoulos, Steven, Maril, Robert, Mathney, Edward, Sanchez, Angela, Tinuoye, Elizabeth, Bateman, Brian, Eng, Kristen, Jiang, Ning, Ladha, Karim, Needleman, Joseph, Chen, Lee-Lynn, Lane, Rondall, Robinowitz, David, Ghushe, Neil, Irshad, Mariam, O'Connor, John, Patel, Samir, Myles, Paul, Hiesmayr, Michael, Fang, Xiangming, Slim, Karem, Sander, Michael, Koulenti, Despoina, Chan, Mathew, Abbas, Muntadhar, Sivasakthi, Datin, Osinaike, Tunde, Matos, Ricardo, Grigoras, Ioana, Hubner, Martyn, Other departments, The International Surgical Outcomes Study, Group, Beretta, L, Landoni, G, and Zangrillo, A
Subjects: Critical Care/utilization, Postoperative Complications/epidemiology, Male, cohort studies, critical care/utilisation, operative/mortality, postoperative care/methods, postoperative care/statistics and numerical data, surgery, surgical procedures, Global Health, law.invention, surgery, Postoperative Complications, 0302 clinical medicine, Correction Notice, cohort studies, Anesthesiology, 030202 anesthesiology, law, cohort studiescritical care/utilisationoperative/mortalitypostoperative care/methodspostoperative care/statistics and numerical datasurgerysurgical procedures, 80 and over, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Aged, 80 and over, International Surgical Outcomes Study group, Elective Surgical Procedures/mortality, HCC NEF, Middle Aged, Elective Surgical Procedures/adverse effects, Intensive care unit, surgical procedure, 3. Good health, Treatment Outcome, Length of Stay/statistics & numerical data, operative/mortality, Elective Surgical Procedures, Female, Elective Surgical Procedure, Life Sciences & Biomedicine, Cohort study, Adult, medicine.medical_specialty, Adolescent, Critical Care, critical care/utilisation, postoperative care/methods, postoperative care/statistics and numerical data, surgical procedures, Aged, Humans, Length of Stay, Poverty, Socioeconomic Factors, Young Adult, Anesthesiology and Pain Medicine, NO, Clinical Practice, 03 medical and health sciences, Intensive care, Journal Article, medicine, postoperative care/method, Elective surgery, Science & Technology, business.industry, Postoperative complication, 030208 emergency & critical care medicine, 1103 Clinical Sciences, Surgery, Global Health/statistics & numerical data, Emergency medicine, business, cohort studie
Abstract: Background:As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. Methods:We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. Results:A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44814 patients with a median hospital stay of 4 (range 2–7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. Conclusions:Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. Study registration:ISRCTN51817007
Published: 2016

6. ESICM LIVES 2016: part two : Milan, Italy. 1-5 October 2016

Author: Sivakumar, S, Taccone, FS, Desai, KA, Lazaridis, C, Skarzynski, M, Sekhon, M, Henderson, W, Griesdale, D, Chapple, L, Deane, A, Williams, L, Ilia, S, Henderson, A, Hugill, K, Howard, P, Roy, A, Bonner, S, Monteiro, E, Baudouin, S, Ramírez, CS, Escalada, SH, Banaszewski, M, Sertedaki, A, Kaymak, Ç, Viera, MA, Santana, MC, Balcázar, LC, Monroy, NS, Campelo, FA, Vázquez, CF, Santana, PS, Cerejo, A, Santana, SR, Charmadari, E, Carteron, L, Kovach, L, Patet, C, Quintard, H, Solari, D, Bouzat, P, Oddo, M, Wollersheim, T, Malleike, J, Haas, K, Stratakis, CA, Rocha, AP, Carbon, N, Şencan, I, Schneider, J, Birchmeier, C, Fielitz, J, Spuler, S, Weber-Carstens, S, Enseñat, L, Pérez-Madrigal, A, Briassouli, E, Saludes, P, Proença, L, Elsayed, AA, Meço, B, Gruartmoner, G, Espinal, C, Mesquida, J, Huber, W, Eckmann, M, Elkmann, F, Goukos, D, Gruber, A, Lahmer, T, Mayr, U, Herner, A, Özçelik, M, Abougabal, AM, Schellnegger, R, Schmid, RM, Ayoub, W, Psarra, K, Samy, W, Esmat, A, Battah, A, Mukhtar, S, Mongkolpun, W, Ünal, N, Cortés, DO, Beshey, BN, Cordeiro, CP, Vincent, JL, Leite, MA, Creteur, J, Funcke, S, Groesdonk, H, Saugel, B, Wagenpfeil, G, Wagenpfeil, S, Reuter, DA, Fernandez, MM, Alzahaby, KM, Botoula, E, Fernandez, R, Magret, M, González-Castro, A, Bouza, MT, Ibañez, M, García, C, Balerdi, B, Jenni-Moser, B, Mas, A, Arauzo, V, Tsagarakis, S, Añón, JM, Pozzebon, S, Ruiz, F, Ferreres, J, Tomás, R, Alabert, M, Tizón, AI, Altaba, S, Jeitziner, MM, Llamas, N, Haroon, BA, Edul, VS, Goligher, EC, Fan, E, Herridge, M, Ortiz, AB, Vorona, S, Sklar, M, Dres, M, Rittayamai, N, Lanys, A, Schreiber, J, Mageira, E, Urrea, C, Tomlinson, G, Reid, WD, Rubenfeld, GD, Kavanagh, BP, Cristallini, S, Brochard, LJ, Ferguson, ND, Neto, AS, De Abreu, MG, Routsi, C, Imiela, J, Galassi, MS, Pelosi, P, Schultz, MJ, PRoVENT investigators and the PROVE Network, Guérin, C, Papazian, L, Reignier, J, Lheureux, O, Ayzac, L, Nanas, S, Loundou, A, Forel, JM, Sales, FL, Rolland-Debord, C, Bureau, C, Poitou, T, Clavel, M, Perbet, S, Terzi, N, Kouatchet, A, Briassoulis, G, Brasseur, A, Similowski, T, Demoule, A, De Moraes, KC, Hunfeld, N, Trogrlic, Z, Ladage, S, Osse, RJ, Koch, B, Rietdijk, W, Boscolo, A, Devlin, J, Van der Jagt, M, Picetti, E, Batista, CL, Ceccarelli, P, Mensi, F, Malchiodi, L, Risolo, S, Rossi, I, Bertini, D, Antonini, MV, Servadei, F, Caspani, ML, Roquilly, A, Júnior, JA, Lasocki, S, Seguin, P, Geeraerts, T, Perrigault, PF, Campello, E, Dahyot-Fizelier, C, Paugam-Burtz, C, Cook, F, Cinotti, R, Dit Latte, DD, Mahe, PJ, Marcari, TB, Fortuit, C, Feuillet, F, Lucchetta, V, Asehnoune, K, Marzorati, C, Spina, S, Scaravilli, V, Vargiolu, A, Riva, M, Giussani, C, Lobato, R, Sganzerla, E, Hravnak, M, Osaku, EF, Citerio, G, Barbadillo, S, De Molina, FJ, Álvarez-Lerma, F, Rodríguez, A, SEMICYUC/GETGAG Working Group, Zakharkina, T, Martin-Loeches, I, Castro, CS, Matamoros, S, Fuhrmann, V, Piasentini, E, Povoa, P, Yousef, K, Torres, A, Kastelijn, J, Hofstra, JJ, De Jong, M, Schultz, M, Sterk, P, Artigas, A, De Souza, LM, Aktepe, O, Bos, LJ, Moreau, AS, Chang, Y, Salluh, J, Rodriguez, A, Nseir, S, TAVeM study group, De Jong, E, Fildisis, G, Rodrigues, FF, Van Oers, JA, Beishuizen, A, Girbes, AR, Nijsten, MW, Crago, E, De Lange, DW, Bonvicini, D, Labate, D, Benacchio, L, Radu, CM, Olivieri, A, Stepinska, J, Wruck, ML, Pizzirani, E, Lopez-Delgado, JC, Gonzalez-Romero, M, Fuentes-Mila, V, Berbel-Franco, D, Friedlander, RM, Romera-Peregrina, I, Manesso, L, Martinez-Pascual, A, Perez-Sanchez, J, Abellan-Lencina, R, Correa, NG, Ávila-Espinoza, RE, Moreno-Gonzalez, G, Sbraga, F, Griffiths, S, Grocott, MP, Creagh-Brown, B, Simioni, P, Abdelmonem, SA, POPC-CB investigators, Doyle, J, Wilkerson, P, Pelegrini, AM, Soon, Y, Huddart, S, Dickinson, M, Riga, A, Zuleika, A, Ori, C, Miyamoto, K, Kawazoe, Y, Tahon, SA, Morimoto, T, Yamamoto, T, Eid, RA, Fuke, A, Hashimoto, A, Koami, H, Beppu, S, Su, H, Katayama, Y, Ito, M, Ohta, Y, Yamamura, H, Helmy, TA, DESIRE (DExmedetomidine for Sepsis in ICU Randomized Evaluation) Trial Investigators, Timenetsky, KT, Rygård, SL, Holst, LB, Wetterslev, J, Lam, YM, Johansson, PI, Perner, A, Soliman, IW, Van Dijk, D, Van Delden, JJ, Meligy, HS, Cazati, D, Cremer, OL, Slooter, AJ, Willis, K, Peelen, LM, McWilliams, D, Snelson, C, Neves, AD, Loudet, CI, Busico, M, Vazquez, D, Villalba, D, Lobato, M, Puig, F, Kott, M, Pullar, V, Veronesi, M, Lischinsky, A, López, FJ, Mori, LB, Plotnikow, G, Díaz, A, Giannasi, S, Hernandez, R, Krzisnik, L, Diniz, PS, Hubner, RP, Cecotti, C, Dunn-Siegrist, I, Viola, L, Lopez, R, Sottile, JP, Benavent, G, Estenssoro, E, Chen, CM, Lai, CC, Cheng, KC, Costa, CR, Rocha, LL, Chou, W, Chan, KS, Pugin, J, Roeker, LE, Horkan, CM, Gibbons, FK, Christopher, KB, Weijs, PJ, Mogensen, KM, Furche, M, Rawn, JD, Cavalheiro, AM, Robinson, MK, Tang, Z, Gupta, S, Qiu, C, Ouyang, B, Cai, C, Guan, X, Tsang, JL, Regueira, T, Cea, L, Topeli, A, Lucinio, NM, Carlos, SJ, Elisa, B, Puebla, C, Vargas, A, Govil, D, Poulsen, MK, De Guadiana-Romualdo, LG, Thomsen, LP, Kjærgaard, S, Rees, SE, Karbing, DS, Schwedhelm, E, Frank, S, Müller, MC, Carbon, NM, Skrypnikov, V, Rebollo-Acebes, S, Srinivasan, S, Pickerodt, PA, Falk, R, Mahlau, A, Santos, ER, Lee, A, Inglis, R, Morgan, R, Barker, G, Esteban-Torrella, P, Kamata, K, Abe, T, Patel, SJ, Saitoh, D, Tokuda, Y, Green, RS, Norrenberg, M, Butler, MB, Erdogan, M, Hwa, HT, Jiménez-Sánchez, R, Gil, LJ, Vaquero, RH, Rodriguez-Ruiz, E, Lago, AL, N, JK, Allut, JL, Gestal, AE, Gleize, A, Gonzalez, MA, Thomas-Rüddel, DO, Jiménez-Santos, E, Schwarzkopf, D, Fleischmann, C, Reinhart, K, Suwanpasu, S, Sattayasomboon, Y, Filho, NM, Gupta, A, Oliveira, JC, Preiser, JC, Ballalai, CS, Zitta, K, Ortín-Freire, A, De Lucia, CV, Araponga, GP, Veiga, LN, Silva, CS, Garrido, ME, Ramos, BB, Ricaldi, EF, Gomes, SS, Tomar, DS, Simón, IF, Hernando-Holgado, A, GEMINI, Gemmell, L, MacKay, A, Wright, C, Docking, RI, Doherty, P, Black, E, Stenhouse, P, Plummer, MP, Finnis, ME, Albaladejo-Otón, MD, Carmona, SA, Shafi, M, Phillips, LK, Kar, P, Bihari, S, Biradar, V, Moodie, S, Horowitz, M, Shaw, JE, Deane, AM, Coelho, L, Yatabe, T, Valhonrat, IL, Inoue, S, Harne, R, Sakaguchi, M, Egi, M, Abdelhamid, YA, Motta, MF, Domínguez, JP, Arora, DP, Hokka, M, Pattinson, KT, Mizobuchi, S, Pérez, AG, Abellán, AN, Plummer, M, Giersch, E, Talwar, N, Summers, M, Pelenz, M, Hatzinikolas, S, Heller, S, Chapman, M, Jones, K, Almudévar, PM, Schweizer, R, Jacquet-Lagreze, M, Portran, P, Rabello, L, Mazumdar, S, Junot, S, Allaouchiche, B, Fellahi, JL, Guerci, P, Ergin, B, Lange, K, Kapucu, A, Ince, C, Cioccari, L, Luethi, N, Crisman, M, Papakrivou, EE, Bellomo, R, Mårtensson, J, Shinotsuka, CR, Fagnoul, D, Kluge, S, Orbegozo, D, Makris, D, Thooft, A, Brimioulle, S, Dávila, F, Iwasaka, H, Brandt, B, Tahara, S, Nagamine, M, Ichigatani, A, Cabrera, AR, Zepeda, EM, Granillo, JF, Manoulakas, E, Sánchez, JS, Montoya, AA, Rubio, JJ, Montenegro, AP, Blanco, GA, Robles, CM, Drolz, A, Horvatits, T, Roedl, K, Rutter, K, Tsolaki, B, Funk, GC, Póvoa, P, Ramos, AJ, Schneeweiss, B, Sabetian, G, Pooresmaeel, F, Zand, F, Ghaffaripour, S, Farbod, A, Tabei, H, Taheri, L, TAVeM study Group, Karadodas, B, Reina, Á, Anandanadesan, R, Metaxa, V, Teixeira, C, Pereira, SM, Hernández-Marrero, P, Carvalho, AS, Beckmann, M, Hartog, CS, Varis, E, Raadts, A, López, NP, Zakynthinos, E, Robertsen, A, Førde, R, Skaga, NO, Helseth, E, Honeybul, S, Ho, K, Vazquez, AR, Lopez, PM, Gonzalez, MN, Ortega, PN, Pérez, MA, Sola, EC, Garcia, IP, Spasova, T, De la Torre-Prados, MV, Kopecky, O, Rusinova, K, Pettilä, V, Waldauf, P, Cepeplikova, Z, Balik, M, Ordoñez, PF, Apolo, DX, Almudevar, PM, Martin, AD, Muñoz, JJ, Poukkanen, M, Castañeda, DP, Villamizar, PR, Ramos, JV, Pérez, LP, Lucendo, AP, Villén, LM, Ejarque, MC, Estella, A, Camps, VL, Neitzke, NM, Encinares, VS, Martín, MC, Masnou, N, Bioethics work group of SEMICYUC, Barbosa, S, Varela, A, Palma, I, López, FM, Cristina, L, Nunes, E, Jacob, S, Pereira, I, Campello, G, Ibañez, MP, Granja, C, Pande, R, Pandey, M, Varghese, S, Chanu, M, García, IP, Van Dam, MJ, Schildhauer, C, Karlsson, S, Ter Braak, EW, Gracia, M, Viciana, R, Montero, JG, Recuerda, M, Fontaiña, LP, Tharmalingam, B, Kovari, F, Zöllner, C, Rose, L, Mcginlay, M, Amin, R, Burns, K, Connolly, B, Hart, N, Labrador, G, Jouvet, P, Katz, S, Leasa, D, Takala, J, Izurieta, JR, Mawdsley, C, Mcauley, D, Blackwood, B, Denham, S, Worrall, R, Arshad, M, Cangueiro, TC, Isherwood, P, Wilkman, E, Khadjibaev, A, Guerrero, JJ, Sabirov, D, Rosstalnaya, A, Parpibaev, F, Sharipova, V, Guzman, CI, FINNAKI Study Group, Poulose, V, Renal Transplantation HUVR, Lundberg, OH, Koh, J, Calvert, S, Cha, YS, Lee, SJ, Tyagi, N, Rajput, RK, Birri, PN, Taneja, S, Singh, VK, Sharma, SC, Mittal, S, Quint, M, Kam, JW, Rao, BK, Ayachi, J, Fraj, N, Romdhani, S, Bergenzaun, L, Khedher, A, Meddeb, K, Sma, N, Azouzi, A, Bouneb, R, Giribet, A, Adeniji, K, Chouchene, I, Yeter, H, El Ghardallou, M, Rydén, J, Boussarsar, M, Jennings, R, Walter, E, Ribeiro, JM, Moniz, I, Marçal, R, Santos, AC, Young, R, Candeias, C, E Silva, ZC, Rosenqvist, M, Kara, A, Gomez, SE, Nieto, OR, Gonzalez, JA, Cuellar, AI, Mildh, H, Korhonen, AM, Shevill, DD, Elke, G, Moraes, MM, Ala-Kokko, T, Reinikainen, M, Robertson, E, Garside, P, Tavladaki, T, Isotti, P, De Vecchi, MM, Perduca, AE, Cuervo, MA, Melander, O, Negro, A, Villa, G, Manara, DF, Cabrini, L, Zangrillo, A, Frencken, JF, Spanaki, AM, Van Baal, L, Donker, DW, Chew, MS, Cuervo, RA, Horn, J, Van der Poll, T, Van Klei, WA, Bonten, MJ, Menard, CE, Kumar, A, Dimitriou, H, Rimmer, E, Doucette, S, Esteban, MA, Turgeon, AF, Houston, BL, Houston, DS, Zarychanski, R, Pinto, BB, Carrara, M, Ferrario, M, Bendjelid, K, Kondili, E, Nunes, J, Fraile, LI, Diaz, P, Silva, G, Escórcio, S, Chaves, S, Jardim, M, Fernandes, N, Câmara, M, Duarte, R, Pereira, CA, Choulaki, C, Mittelbrum, CP, Vieira, J, Nóbrega, JJ, De Oca-Sandoval, MA, Sánchez-Rodríguez, A, Joya-Galeana, JG, Correa-Morales, A, Camarena-Alejo, G, Aguirre-Sánchez, J, Franco-Granillo, J, Albaiceta, GM, Meleti, E, Soliman, M, Al Azab, A, El Hossainy, R, Nagy, H, Nirmalan, M, Crippa, IA, Cavicchi, FZ, Koeze, J, Kafetzopoulos, D, Chaari, A, Hakim, KA, Hassanein, H, Etman, M, El Bahr, M, Bousselmi, K, Khalil, ES, Kauts, V, Tsolakoglou, I, Casey, WF, Imahase, H, Georgopoulos, D, Sakamoto, Y, Yamada, KC, Miike, T, Nagashima, F, Iwamura, T, Keus, F, Hummitzsch, L, Kishihara, Y, Heyland, D, Spiezia, L, Dieperink, W, Souza, RB, Yasuda, H, Martins, AM, Liberatore, AM, Kang, YR, Nakamae, MN, La Torre, AG, Vieira, JC, Koh, IH, Hanslin, K, Wilske, F, Van der Horst, IC, Jaskowiak, JL, Skorup, P, Sjölin, J, Lipcsey, M, Long, WJ, Zhen, CE, Vakalos, A, Avramidis, V, Wu, SH, Shyu, LJ, Rebollo, S, Van Meurs, M, Li, CH, Yu, CH, Chen, HC, Wang, CH, Lin, KH, Aray, ZE, Gómez, CF, Tsvetanova-Spasova, T, Tejero, AP, Monge, DD, Zijlstra, JG, Losada, VM, Tarancón, CM, Cortés, SD, Gutiérrez, AM, Álvarez, TP, Rouze, A, Jaffal, K, Six, S, Jimenez, R, Nuevo-Ortega, P, Stolz, K, Roberts, S, Cattoen, V, Arnal, JM, Saoli, M, Novotni, D, Garnero, A, Becher, T, Torrella, PE, Buchholz, V, Schädler, D, Rueda-Molina, C, Caballero, CH, Frerichs, I, Weiler, N, Eronia, N, Mauri, T, Gatti, S, Maffezzini, E, Fernandez, A, Bronco, A, Alban, L, Sasso, T, Marenghi, C, Isgro, G, Fernández-Porcel, A, Grasselli, G, Pesenti, A, Bellani, G, Al-Fares, A, Dubin, A, Del Sorbo, L, Anwar, S, Facchin, F, Azad, S, Zamel, R, Hall, D, Ferguson, N, Camara-Sola, E, Cypel, M, Keshavjee, S, Sanchez, S, Durlinger, E, Spoelstra-de Man, A, Smit, B, De Grooth, HJ, Girbes, A, Beitland, S, Straaten, HO, Smulders, Y, Salido-Díaz, L, Ortin, A, Alfaro, MA, Parrilla, F, Meli, A, Pellegrini, M, Rodriguez, N, Goyeneche, JM, Morán, I, Intas, G, Aguirre, H, Mancebo, J, Bassi, GL, Heines, SJ, García-Alcántara, A, Strauch, U, Bergmans, DC, Blankman, P, Shono, A, Hasan, D, Gommers, D, Trøseid, AM, Chung, WY, Prats, RG, Lee, KS, Jung, YJ, Park, JH, Sheen, SS, Park, KJ, Worral, R, Brusletto, BS, Larraza, S, Dey, N, Spadaro, S, Brohus, JB, Winding, RW, Volta, CA, Silva, MM, Waldum-Grevbo, BE, Ampatzidou, F, Vlachou, A, Kehagioglou, G, Karaiskos, T, Madesis, A, Mauromanolis, C, Michail, N, Drossos, G, Aguilera, E, Saraj, N, Berg, JP, Rijkenberg, S, Feijen, HM, Endeman, H, Donnelly, AA, Morgan, E, Garrard, H, Buckley, H, Russell, L, Marti, D, Haase, N, Sunde, K, Goh, C, Mouyis, K, Woodward, CL, Halliday, J, Encina, GB, Ros, J, Ranzani, OT, Lagunes, L, Tabernero, J, Huertas, DG, Bosch, F, Rello, J, Manzano, F, Morente-Constantin, E, Rivera-Ginés, B, Rigol, M, Colmenero-Ruiz, M, Meleti, DE, Sanz, JG, Dogliotti, A, Simon, IF, Valbuena, BL, Pais, M, Ramalingam, S, Quintana, MM, Díaz, C, Fox, L, Santafe, M, Fernandez, L, Barba, P, García, M, Leal, S, Pérez, M, Pérez, ML, Osuna, A, Ferrer, M, Veganzones, J, Martínez, N, Santiago-Ruiz, F, Moors, I, Mokart, D, Pène, F, Lambert, J, Mayaux, J, Vincent, F, Nyunga, M, Bruneel, F, Stergiannis, P, Laisne, L, Rabbat, A, Lebert, C, Perez, P, Suberviola, B, Chaize, M, Renault, A, Meert, AP, Hamidfar, R, Jourdain, M, Rodríguez-Mejías, C, Lanziotti, VS, Darmon, M, Schlemmer, B, Chevret, S, Lemiale, V, Azoulay, E, Rowland, MJ, Riera, J, Benoit, D, Martins-Branco, D, Sousa, M, Wangensteen, R, Marum, S, Bouw, MJ, Galstyan, G, Makarova, P, Parovichnikova, E, Kuzmina, L, Troitskaya, V, Rellan, L, Drize, N, Zaponi, RS, Gemdzhian, E, Jamaati, HR, Savchenko, V, Chao, HC, Kılıc, E, Demiriz, B, Uygur, ML, Sürücü, M, Cınar, K, Yıldırım, AE, Pulcheri, L, Sanchez, M, Kiss, K, Masjedi, M, Köves, B, Csernus, V, Molnár, Z, Ntantana, A, Matamis, D, Savvidou, S, Giannakou, M, Ribeiro, MO, Gouva, M, Nakos, G, Robles, JC, Koulouras, V, Gaffney, S, Docking, R, Judge, C, Drew, T, Barbosa, AP, Misran, H, Munshi, R, McGovern, L, Coyle, M, Hashemian, SM, Lopez, E, Dunne, L, Deasy, E, Lavin, P, Fahy, A, Antoniades, CA, Ramos, A, Darcy, DM, Donnelly, M, Ismail, NH, Hall, T, Wykes, K, Jack, J, Vicente, R, Ngu, WC, Morgan, P, E Silva, JR, Ruiz-Ramos, J, Ramirez, P, Gordon, M, Villarreal, E, Frasquet, J, Poveda-Andrés, JL, Abbasi, G, Castellanos, A, Ijssennagger, CE, Miñambres, E, Soares, M, Ten Hoorn, S, Van Wijk, A, Van den Broek, JM, Tuinman, PR, Elmenshawy, AM, Hammond, BD, Gibbon, G, Khaloo, V, Belcham, T, Burton, K, Salluh, JI, Taniguchi, LU, Santibañez, M, Ramos, FJ, Momma, AK, Martins-Filho, AP, Bartocci, JJ, Lopes, MF, Sad, MH, Tabei, SH, Rodrigues, CM, Pires, EM, Vieira, JM, Le Guen, M, Murbach, LD, Barreto, J, Duarte, ST, Taba, S, Kolaros, AA, Miglioranza, D, Gund, DP, Lordani, CF, Ogasawara, SM, Moore, J, Jorge, AC, Duarte, PA, Capuzzo, M, Marqués, MG, Kafilzadeh, A, Corte, FD, Terranova, S, Scaramuzzo, G, Fogagnolo, A, Bertacchini, S, Bellonzi, A, Garry, P, Mason, N, Ragazzi, R, Moreno, AP, Bakhodaei, HH, Cruz, C, Nunes, A, Pereira, FS, Aragão, I, Cardoso, AF, Santos, C, Malheiro, MJ, Castro, H, Abentroth, LR, Windpassinger, M, Cardoso, T, Diaz, JA, Paratz, J, Kenardy, J, Comans, T, Coyer, F, Thomas, P, Boots, R, Pereira, N, Pizarraya, AG, Vilas-Boas, A, Gomes, E, Plattner, O, Silva, R, Dias, C, Torres, J, Carvalho, D, Molinos, E, Vales, C, Araújo, R, Witter, T, Diaz, JP, Garcia, DJ, Mascha, E, Lovesio, C, Karnatovskaia, L, Philbrick, K, Ognjen, G, Clark, M, Montero, RM, Luis, E, Varas, JL, Sessler, DI, Sánchez-Elvira, LA, Delgado, CP, Díaz, PV, Ruiz, BL, Guerrero, AP, Galache, JA, Jiménez, R, Gomez, MN, Alejandro, O, Fernández, A, Research, O, Smani, Y, Moreno, S, Herrera, L, Ojados, A, Galindo, M, Murcia, J, Contreras, M, Sánchez-Argente, S, Soriano, R, Bonilla, Y, Rodríguez, MD, Connell, MM, Allegue, JM, Melia, U, Cakin, Ö, Parlak, H, Kirca, H, Mutlu, F, Aydınlı, B, Cengiz, M, Gonzalez, PL, Ramazanoglu, A, Zhang, LA, Jung, EJ, Oh, SY, Lee, H, Fontanet, J, Ibrahim, IA, Parker, RS, Van den Berg, JP, Domenech, JC, Montalvo, AP, Banerjee, I, Chalari, E, Chornet, TC, Martinez, PC, Ribas, MP, Costa, RG, Ortega, AC, Forbes, C, Struys, MM, Prescott, H, Lal, A, Clermont, G, Khan, FA, Rafik, MM, Dela Pena, EG, Dizon, JS, Perez, PP, Wong, CM, Garach, MM, Romero, OM, Puerta, RR, Westbrook, J, Norberg, E, Vereecke, HE, Diaz, FA, Al-Ansary, AM, Bailon, AM, Pinel, AC, Maldonado, LP, Kalaiselvan, MS, Kumar, RL, Renuka, MK, Kumar, AS, Myatra, SN, De Rosa, S, Ferrari, F, Jensen, EW, Algendi, MA, Checcacci, SC, Rigobello, A, Joannidis, M, Politi, F, Pellizzari, A, Bonato, R, Oras, J, Fernandez-Carmona, A, Macias-Guarasa, I, Gutierrez-Rodriguez, R, Martinez-Lopez, P, Ali, AA, Rood, PJ, Diaz-Castellanos, MA, EDISVAL Group, Arias-Diaz, M, Vaara, ST, Aguilar-Alonso, E, Nikandish, RN, Van de Schoor, F, Artemenko, V, Budnyuk, A, Delile, E, Senussi, T, Idone, F, Xiol, EA, Travierso, C, Chiurazzi, C, Motos, A, Amaro, R, Van Tertholen, K, Cuisinier, A, Hua, Y, Fernández-Barat, L, Bobi, Q, Youn, A, Hwang, JG, Maufrais, C, Pickkers, P, Ossorio, ME, Figueira, H, Payen, JF, Oliveira, R, Mota, A, Van den Boogaard, M, Kamp, O, Cruciger, O, Aach, M, Kaczmarek, C, Waydhas, C, Nottin, S, Schildhauer, TA, Hamsen, U, Camprubí-Rimblas, M, Chimenti, L, Guillamat-Prats, R, Beardow, ZJ, Lebouvier, T, Bringué, J, Tijero, J, Gómez, MN, Walther, G, Benten, D, Blanch, L, Tagliabue, G, Ji, M, Jagers, JV, Easton, PA, Redhead, H, Athanasiadou, E, Hong, JY, Shin, MH, Park, MS, Paramasivam, K, Albrecht, M, Arib, S, Pomprapa, A, Kluwe, J, Hofferberth, MB, Russ, M, Braun, W, Walter, M, Francis, R, Lachmann, B, Leonhardt, S, Bilotta, F, Corkill, R, Numan, T, Siedler, S, Landaverde-López, A, Canedo-Castillo, NA, Badenes, R, Esquivel-Chávez, A, Arvizu-Tachiquín, PC, Sánchez-Hurtado, LA, Baltazar-Torres, JA, Cardoso, V, Krystopchuk, A, Castro, S, Melão, L, Firmino, S, Marreiros, A, Almaziad, S, Kubbara, A, Adedugbe, I, Barnett, W, Kamper, AM, Nakity, R, Alamoudi, W, Strickland, R, Altook, R, Tarazi, T, Fida, M, Safi, F, Assaly, R, Santini, A, Bird, GT, Milesi, M, Maraffi, T, Rood, P, Rubulotta, F, Pugni, P, Andreis, DT, Cavenago, M, Gattinoni, L, Protti, A, Perchiazzi, G, Borges, JB, Queen Square Neuroanaesthesia and Neurocritical Care Resreach Group, Bayat, S, Porra, L, Mirek, S, Broche, L, Hedenstierna, G, Larsson, A, Kennedy, RM, Roneus, A, Segelsjö, M, Vestito, MC, Zeman, PM, Gremo, E, Nyberg, A, Castegren, M, Pikwer, A, Sharma, S, Monfort, B, Yoshida, T, Engelberts, D, Otulakowski, G, Katira, B, Post, M, Brochard, L, Amato, MB, Stazi, E, PLUG Working group, Koch, N, Hoellthaler, J, Mair, S, Phillip, V, Van Ewijk, CE, Beitz, A, González, LR, Roig, AL, Baladrón, V, Yugi, G, Calvo, FJ, Padilla, D, Villarejo, P, Villazala, R, Yuste, AS, Bejarano, N, Steenstra, RJ, Jacobs, GE, Banierink, H, Hof, J, Martika, A, Hoekstra, M, Sterz, F, Horvatits, K, Herkner, H, Magnoni, S, Marando, M, Faivre, V, Pifferi, S, Conte, V, Ortolano, F, Alonso, DC, Carbonara, M, Bertani, G, Scola, E, Cadioli, M, Triulzi, F, Colombo, A, Nevière, R, Stocchetti, N, Fatania, G, Hernández-Sánchez, N, Rotzel, HB, Lázaro, AS, Prada, DA, Guimillo, MR, Piqueras, CS, Guia, JR, Simon, MG, Thiébaut, PA, Arizmendi, AM, Carratalá, A, Sánchez, RDEP, El Maraghi, S, Yehia, A, Bakry, M, Shoman, A, Backes, FN, Bianchin, MM, Vieira, SR, Maupoint, J, De Souza, A, Lucas, JH, Backes, AN, Klein, C, García-Guillen, FJ, Arunkumar, AS, Lozano, A, Mulder, P, Gallaher, C, Cattlin, S, Ñamendys-Silva, SA, Gordon, S, Picard, J, Fontana, V, Bond, O, Coquerel, D, Nobile, L, Mrozek, S, Delamarre, L, Maghsoudi, B, Capilla, F, Al-Saati, T, Fourcade, O, Renet, S, Dominguez-Berrot, AM, Gonzalez-Vaquero, M, Vallejo-Pascual, ME, Gupta, D, Ivory, BD, Chopra, M, Emami, M, Khaliq, W, McCarthy, J, Felderhof, CL, Do Rego, JC, MacNeil, C, Maggiorini, M, Duska, F, Department of Professional Development, ESICM, Fumis, RR, Junior, JM, Khosravi, MB, Amarante, G, Rieusset, J, Skorko, A, Sanders, S, Aron, J, Kroll, RJ, Redfearn, C, Harish, MM, Krishnan, P, Khalil, JE, Kongpolprom, N, Richard, V, Gulia, V, Lourenço, E, Duro, C, Baptista, G, Alves, A, Arminda, B, Rodrigues, M, Tamion, F, Tabatabaie, HR, Hayward, J, Baldwin, F, Gray, R, Katinakis, PA, Stijf, M, Ten Kleij, M, Jansen-Frederiks, M, Broek, R, De Bruijne, M, Mengelle, C, Spronk, PE, Sinha, K, Luney, M, Palmer, K, Keating, L, Abu-Habsa, M, Bahl, R, Baskaralingam, N, Ahmad, A, Kanapeckaite, L, Bhatti, P, Strong, AJ, Sabetiyan, G, Glace, S, Jeyabraba, S, Lewis, HF, Kostopoulos, A, Raja, M, West, A, Ely, A, Turkoglu, LM, Zolfaghari, P, Baptista, JP, Mokri, A, Marques, MP, Martins, P, Pimentel, J, Su, YC, Singer, M, Villacres, S, Stone, ME, Parsikia, A, Medar, S, O'Dea, KP, Nurses of the Central and General ICUs of Shiraz Namazi Hospital, Porter, J, Tirlapur, N, Jonathan, JM, Singh, S, Takata, M, Critical Care Research Group, McWhirter, E, Lyon, R, Troubleyn, J, Hariz, ML, Ferlitsch, A, Azmi, E, Alkhan, J, Smulders, YM, Movsisyan, V, Petrikov, S, Marutyan, Z, Aliev, I, Evdokimov, A, Antonucci, E, Diltoer, M, Merz, T, Hartmann, C, De Waard, MC, Calzia, E, Radermacher, P, Nußbaum, B, Huber-Lang, M, Fauler, G, Gröger, M, Jacobs, R, Zaleska-Kociecka, M, Van Straaten, HM, Trauner, M, Svoren-Jabalera, E, Davenport, EE, Humburg, P, Nguyen, DN, Knight, J, Hinds, CJ, Jun, IJ, Prabu, NR, Kim, WJ, Lee, EH, Besch, G, Perrotti, A, Puyraveau, M, Baltres, M, Eringa, EC, De Waele, E, Samain, E, Chocron, S, Pili-Floury, S, Plata-Menchaca, EP, Sabater-Riera, J, Estruch, M, Boza, E, Toscana-Fernández, J, Man, AM, Bruguera-Pellicer, E, De Regt, J, Ordoñez-Llanos, J, Pérez-Fernández, XL, SIRAKI group, Cavaleiro, P, Tralhão, A, Arrigo, M, Lopes, JP, Lebrun, M, Favier, B, Pischke, S, Cholley, B, PerezVela, JL, Honoré, PM, MarinMateos, H, Rivera, JJ, Llorente, MA, De Marcos, BG, Fernandez, FJ, Laborda, CG, Zamora, DF, Fischer, L, Alegría, L, Grupo ESBAGA, Delgado, JC, Imperiali, C, Myers, RB, Van Gorp, V, Dastis, M, Thaiss, F, Soto, D, Górka, J, Spapen, HD, Górka, K, Iwaniec, T, Koch, M, Frołow, M, Polok, K, Luengo, C, Fronczek, J, Kózka, M, Musiał, J, Szczeklik, W, Contreras, RS, Bangert, K, Gomez, J, Sileli, M, Havaldar, AA, Toapanta, ND, Jarufe, N, Moursia, C, Maleoglou, H, Leleki, K, Uz, Z, Ince, Y, Papatella, R, Bulent, E, Moreno, G, Grabowski, M, Bruhn, A, De Mol, B, Vicka, V, Gineityte, D, Ringaitiene, D, Norkiene, I, Sipylaite, J, Möller, C, Sabater, J, Castro, R, Thomas-Rueddel, DO, Vlasakov, V, Lohse, AW, Rochwerg, B, Theurer, P, Al Sibai, JZ, Camblor, PM, Kattan, E, Torrado, H, Siddiqui, S, Fernandez, PA, Gala, JM, Guisasola, JS, Tamura, T, Miyajima, I, Yamashita, K, Yokoyama, M, Tapia, P, Nashan, B, Gonzalez, M, Dalampini, E, Nastou, M, Baddour, A, Ignatiadis, A, Asteri, T, Hathorn, KE, Sterneck, M, Rebolledo, R, Purtle, SW, Marin, M, Viana, MV, Tonietto, TA, Gross, LA, Costa, VL, Faenza, S, Tavares, AL, Payen, D, Lisboa, BO, Moraes, RB, Farigola, E, Viana, LV, Azevedo, MJ, Ceniccola, GD, Pequeno, RS, Siniscalchi, A, Holanda, TP, Mendonça, VS, Achurra, P, Araújo, WM, Carvalho, LS, Segaran, E, Vickers, L, Gonzalez, A, Brinchmann, K, Pierucci, E, Wignall, I, De Brito-Ashurst, I, Ospina-Tascón, G, Del Olmo, R, Esteban, MJ, Vaquerizo, C, Carreño, R, Gálvez, V, Kaminsky, G, Mancini, E, Fernandez, J, Nieto, B, Fuentes, M, De la Torre, MA, Bakker, J, Torres, E, Alonso, A, Velayos, C, Saldaña, T, Escribá, A, Krishna, B, Grip, J, Kölegård, R, Vera, A, Sundblad, P, Rooyackers, O, Hernández, G, Naser, B, Jaziri, F, Jazia, AB, Barghouth, M, Ricci, D, Hentati, O, Skouri, W, El Euch, M, Mahfoudhi, M, Gisbert, X, Turki, S, Dąbrowski, M, Bertini, P, Abdelghni, KB, Abdallah, B, Gemelli, C, Maha, BN, Cánovas, J, Sotos, F, López, A, Lorente, M, Burruezo, A, Torres, D, Juliá, C, Guarracino, F, Cuoghi, A, Włudarczyk, A, Hałek, A, Bargouth, M, Bennasr, M, Baldassarri, R, Magnani, S, Uya, J, Abdelghani, KB, Abdallah, TB, Geenen, IL, Parienti, JJ, Straaten, HM, Shum, HP, King, HS, Kulkarni, AP, Pinsky, MR, Chan, KC, Corral, L, Yan, WW, Londoño, JG, Cardenas, CL, Pedrosa, MM, Gubianas, CM, Bertolin, CF, Batllori, NV, Atti, M, Sirvent, JM, Sedation an Delirium Group Hospital Universitari de Bellvitge, Mukhopadhyay, A, Chan, HY, Kowitlawakul, Y, Remani, D, Leong, CS, Henry, CJ, Vera, M, Puthucheary, ZA, Mendsaikhan, N, Begzjav, T, Elias-Jones, I, Lundeg, G, Dünser, M, Espinoza, ED, Welsh, SP, Guerra, E, Poppe, A, Zerpa, MC, Zechner, F, Berdaguer, F, Risso-Vazquez, A, Masevicius, FD, Greaney, D, Dreyse, J, Magee, A, Fitzpatrick, G, Lugo-Cob, RG, Jermaine, CM, Tejeda-Huezo, BC, Cano-Oviedo, AA, Carpio, D, Aydogan, MS, Togal, T, Taha, A, Chai, HZ, Sriram, S, Kam, C, Razali, SS, Sivasamy, V, Randall, D, Kuan, LY, Henriquez, C, Morales, MA, Pires, T, Adwaney, A, Wozniak, S, Gajardo, D, Herrera-Gutierrez, ME, Azevedo, LC, Blunden, M, Prowle, JR, Kirwan, CJ, Thomas, N, Martin, A, Owen, H, Darwin, L, Robertson, CS, Bravo, S, Barrueco-Francioni, J, Conway, D, Atkinson, D, Sharman, M, Barbanti, C, Amour, J, Gaudard, P, Rozec, B, Mauriat, P, M'rini, M, Arias-Verdú, D, Rusin, CG, Leger, PL, Cambonie, G, Liet, JM, Girard, C, Laroche, S, Damas, P, Assaf, Z, Loron, G, Lozano-Saez, R, Lecourt, L, Pouard, P, Hofmeijer, J, Kim, SH, Divatia, JV, Na, S, Kim, J, Jung, CW, Sondag, L, Yoo, SH, Min, SH, Chung, EJ, Quesada-Garcia, G, Lee, NJ, Lee, KW, Suh, KS, Ryu, HG, Marshall, DC, Goodson, RJ, Tjepkema-Cloostermans, MC, Salciccioli, JD, Shalhoub, J, Seller-Pérez, G, Potter, EK, Kirk-Bayley, J, Karanjia, ND, Forni, LG, Kim, S, Creagh-Brown, BC, Bossy, M, Nyman, M, Tailor, A, Figueiredo, A, SPACeR group (Surrey Peri-operative, Anaesthesia and Critical Care Collaborative Research Group), D'Antini, D, Valentino, F, Winkler, MS, Sollitto, F, Cinnella, G, Mirabella, L, Anzola, Y, Bosch, FH, Baladron, V, Villajero, P, Lee, M, Redondo, J, Liu, J, Shen, F, Teboul, JL, Anguel, N, Van Putten, MJ, Beurton, A, Bezaz, N, Richard, C, Park, SY, Monnet, X, Fossali, T, Pereira, R, Colombo, R, Ottolina, D, Rossetti, M, Mazzucco, C, Marchi, A, Porta, A, Catena, E, Piotrowska, K, So, S, Bento, L, Tollisen, KH, Andersen, G, Heyerdahl, F, Jacobsen, D, Van IJzendoorn, MC, Buter, H, Kingma, WP, Navis, GJ, Boerma, EC, Rulisek, J, Zacharov, S, Kim, HS, Jeon, SJ, Namgung, H, Lee, E, Lai, M, Kačar, MB, Cho, YJ, Lee, YJ, Huang, A, Deiana, M, Forsberg, M, Edman, G, Kačar, SM, Höjer, J, Forsberg, S, Freile, MT, Hidalgo, FN, Molina, JA, Lecumberri, R, Rosselló, AF, Travieso, PM, Leon, GT, Uddin, I, Sanchez, JG, Ali, MA, Frias, LS, Rosello, DB, Verdejo, JA, Serrano, JA, Winterwerp, D, Van Galen, T, Vazin, A, Karimzade, I, Belhaj, AM, Zand, A, Ozen, E, Ekemen, S, Akcan, A, Sen, E, Yelken, BB, Kureshi, N, Fenerty, L, Thibault-Halman, G, Aydın, MA, Walling, S, Almeida, R, Seller-Perez, G, Clarke, DB, Briassoulis, P, Kalimeris, K, Ntzouvani, A, Nomikos, T, Papaparaskeva, K, Avsec, D, Politi, E, Kostopanagiotou, G, Crewdson, K, Vardas, K, Rehn, M, Vaz-Ferreira, A, Weaver, A, Brohi, K, Lockey, D, Wright, S, Thomas, K, Mudersbach, E, Baker, C, Mansfield, L, Pozo, MO, Stafford, V, Wade, C, Watson, G, Silva, J, Bryant, A, Chadwick, T, Shen, J, Wilkinson, J, Kapuağası, A, Furneval, J, and Clinical Neurophysiology
Subjects: Queen Square Neuroanaesthesia and Neurocritical Care Resreach Group, TAVeM study Group, Renal Transplantation HUVR, Flow (psychology), lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Critical Care and Intensive Care Medicine, Grupo ESBAGA, GEMINI, 03 medical and health sciences, chemistry.chemical_compound, SPACeR group (Surrey Peri-operative, Anaesthesia and Critical Care Collaborative Research Group), 0302 clinical medicine, Critical Care Research Group, Journal Article, PRoVENT investigators and the PROVE Network, Medicine, Sedation an Delirium Group Hospital Universitari de Bellvitge, 030212 general & internal medicine, Bioethics work group of SEMICYUC, GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries), SEMICYUC/GETGAG Working Group, FINNAKI Study Group, POPC-CB investigators, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], SIRAKI group, 030208 emergency & critical care medicine, EDISVAL Group, PLUG Working group, DESIRE (DExmedetomidine for Sepsis in ICU Randomized Evaluation) Trial Investigators, chemistry, Anesthesia, Carbon dioxide, Breathing, Department of Professional Development, ESICM, business, Nurses of the Central and General ICUs of Shiraz Namazi Hospital
Abstract: Contains fulltext : 172382.pdf (Publisher’s version ) (Open Access)
Published: 2016

7. Selective V1-agonism and selective V2-antagonism are superior to arginine vasopressin in ovine septic shock

Author: Rehberg, S, primary, Ertmer, C, additional, Pinto, BB, additional, Traber, DL, additional, Van Aken, H, additional, Su, F, additional, Vincent, JL, additional, and Westphal, M, additional
Published: 2009
Full Text: View/download PDF

8. Vasopressin and terlipressin as first-line therapy in fulminant ovine septic shock

Author: Rehberg, S, primary, Ertmer, C, additional, Lange, M, additional, Pinto, BB, additional, Morelli, A, additional, Van Aken, H, additional, Su, F, additional, Vincent, JL, additional, and Westphal, M, additional
Published: 2008
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9. INFUSION OF BALANCED 6% HES 130/0.4 REDUCES PERICAPILLARY EDEMA FORMATION IN THE MYOCARDIUM OF ENDOTOXEMIC SHEEP

Author: Ertmer, C, Rehberg, S, Kohler, G, Kampmeier, Tg, Hohn, C, Morelli, A, Pinto, Bb, Lange, M, Van Aken, H, and Westphal, M
Subjects: Critical Care

10. The surgical safety checklist and patient outcomes after surgery

Author: T.E.F. Abbott, T. Ahmad, M.K. Phull, A.J. Fowler, R. Hewson, B.M. Biccard, M.S. Chew, M. Gillies, R.M. Pearse, Rupert M. Pearse, Scott Beattie, Pierre-Alain Clavien, Nicolas Demartines, Lee A. Fleisher, Mike Grocott, James Haddow, Andreas Hoeft, Peter Holt, Rui Moreno, Naomi Pritchard, Andrew Rhodes, Duminda Wijeysundera, Matt Wilson, Tahania Ahmed, Kirsty Everingham, Russell Hewson, Marta Januszewska, Mandeep-Kaur Phull, Richard Halliwell, Mark Shulman, Paul Myles, Werner Schmid, Michael Hiesmayr, Patrick Wouters, Stefan de Hert, Suzana Lobo, Xiangming Fang, Lars Rasmussen, Emmanuel Futier, Matthieu Biais, Aurélien Venara, Karem Slim, Michael Sander, Despoina Koulenti, Kostoula Arvaniti, Mathew Chan, Atul Kulkarni, Susilo Chandra, Aida Tantri, Emad Geddoa, Muntadhar Abbas, Giorgio Della Rocca, Datin Sivasakthi, Marzida Mansor, Pastor Luna, Arthur Bouwman, Wolfgang Buhre, Vanessa Beavis, Douglas Campbell, Tim Short, Tunde Osinaike, Ricardo Matos, Ioana Grigoras, Mikhail Kirov, Denis Protsenko, Bruce Biccard, Cesar Aldecoa, Michelle Chew, Christoph Hofer, Martin Hubner, James Ditai, Tamas Szakmany, Lee Fleisher, Marissa Ferguson, Michael MacMahon, Ritchie Cherian, Helen Currow, Kathirgamanathan Kanathiban, David Gillespie, Edward Pathmanathan, Katherine Phillips, Jenifer Reynolds, Joanne Rowley, Jeanene Douglas, Ross Kerridge, Sameer Garg, Michael Bennett, Megha Jain, David Alcock, Nico Terblanche, Rochelle Cotter, Kate Leslie, Marcelle Stewart, Nicolette Zingerle, Antony Clyde, Oliver Hambidge, Adam Rehak, Sharon Cotterell, Wilson Binh Quan Huynh, Timothy McCulloch, Erez Ben-Menachem, Thomas Egan, Jennifer Cope, Paul Fellinger, Markus Haisjackl, Simone Haselberger, Caroline Holaubek, Paul Lichtenegger, Florian Scherz, Franz Hoffer, Veronika Cakova, Andreas Eichwalder, Norbert Fischbach, Reinhold Klug, Elisabeth Schneider, Martin Vesely, Reinhart Wickenhauser, Karl Gernot Grubmueller, Marion Leitgeb, Friedrich Lang, Nancy Toro, Marlene Bauer, Friedrich Laengle, Claudia Haberl, Thomas Mayrhofer, Christoph Trybus, Christian Buerkle, Karin Forstner, Reinhard Germann, Harald Rinoesl, Elke Schindler, Ernst Trampitsch, Gerhard Bogner, Daniel Dankl, Martin Duenser, Gerhard Fritsch, Ilse Gradwohl-Matis, Andreas Hartmann, Thomas Hoelzenbein, Tarkan Jaeger, Franz Landauer, Gregor Lindl, Michael Lux, Johannes Steindl, Ottokar Stundner, Christian Szabo, Jawad Bidgoli, Hans Verdoodt, Patrice Forget, David Kahn, Fernande Lois, Mona Momeni, Caroline Prégardien, Audrey Pospiech, Arnaud Steyaert, Laurent Veevaete, Dirk De Kegel, Karen De Jongh, Luc Foubert, Carine Smitz, Marcel Vercauteren, Jan Poelaert, Veerle Van Mossevelde, Jacques Abeloos, Stefaan Bouchez, Marc Coppens, Luc De Baerdemaeker, Isabel Deblaere, Ann De Bruyne, Kristine Fonck, Bjorn Heyse, Tom Jacobs, Koen Lapage, Anneliese Moerman, Martine Neckebroek, Aliaksandra Parashchanka, Nathalie Roels, Nancy Van Den Eynde, Michael Vandenheuvel, JurgenVan Limmen, Ann Vanluchene, Caroline Vanpeteghem, Piet Wyffels, Christel Huygens, Punitha Vandenbempt, Marc Van de Velde, Dimitri Dylst, Bruno Janssen, Evelien Schreurs, Fábia Berganton Aleixo, Keulle Candido, Hugo Dias Batista, Mario Guimarães, Jaqueline Guizeline, João Hoffmann, Francisco Ricardo Marques Lobo, Vinícius Nascimento, Katia Nishiyama, Lucas Pazetto, Daniela Souza, Rodrigo Souza Rodrigues, Ana Maria Vilela dos Santos, Jaquelline Jardim, Luiz Marcelo Sá Malbouisson, Joao Silva, Paulo do Nascimento Junior, Thalissa Hermínia Baio, Gabriel Isaac Pereira de Castro, Henri Roger Watanabe Oliveira, Cristina Prata Amendola, Gutemberg Cardoso, Daniela Ortega, Ana Flavia Brotto, Mirella Cristine De Oliveira, Álvaro Réa-Neto, Fernando Dias, Maria Eduarda Travi, Luiza Zerman, Pedro Azambuja, Marcos Freitas Knibel, Antonio Martins, William Almeida, Calim Neder Neto, Maria Angela Tardelli, Eliana Caser, Marcio Machado, Crisitiano Aguzzoli, Sérgio Baldisserotto, Fernanda Beck Tabajara, Fernanda Bettega, La Hore Correa Rodrigues Júnior, Julia de Gasperi, Lais Faina, Marcos Farias Nolasco, Bruna Ferreira da Costa Fischer, Mariana Fosch de Campos Ferreira, Cristina Hartmann, Marta Kliemann, Gustavo Luis Hubert Ribeiro, Julia Merladete Fraga, Thiago Motta Netto, Laura Valduga Pozza, Paulo Rafael Wendling, Caroline Azevedo, Juliana Garcia, Marcel Lopes, Bernardo Maia, Paula Maselli, Ralph Melo, Weslley Mendes, Matheus Neves, Jacqueline Ney, Claudio Piras, Christopher Applewhaite, Adrienne Carr, Lorraine Chow, Kaylene Duttchen, Julena Foglia, Michael Greene, Ashley Hinther, Kendra Houston, Thomas Jared McCormick, Jennifer Mikhayel, Sam Montasser, Alex Ragan, Andrew Suen, Adrianna Woolsey, Hai Chuan Yu, Duane Funk, Stephen Kowalski, Regina Legaspi, Heather McDonald, Faisal Siddiqui, Jeremy Pridham, Bernadette Rowe, Sonia Sampson, Barton Thiessen, Geoff Zbitnew, Andre Bernard, Ronald George, Philip Jones, Rita Moor, Naveed Siddiqui, Alexandra Wolfer, Diem Tran, Denyse Winch, Gary Dobson, Thomas McCormick, Osama Montasser, Richard Hall, Leyla Baghirzada, Gerard Curley, Si Yuan Dai, Gregory Hare, Esther Lee, Uma Shastri, Albert Tsui, Anmol Yagnik, Danielle Alvares, Stephen Choi, Heather Dwyer, Kathrina Flores, 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Adeolu, Tinuola Adigun, Mukaila Akinwale, Oluyemi Fasina, Olalere Gbolahan, Olusola Idowu, Rotimi Peter Olonisakin, Babatunde Babasola Osinaike, Felicia Asudo, Danladi Mshelia, Lukman Abdur-Rahman, Olayide Agodirin, Jibril Bello, Benjamin Bolaji, Olanrewaju Olubukola Oyedepo, Humphrey Ezike, Ikechukwu Iloabachie, Ikemefuna Okonkwo, Elias Onuora, Tonia Onyeka, Innocent Ugwu, Friday Umeh, Olubusola Alagbe-Briggs, Amabra Dodiyi-Manuel, Richard Echem, Bright Obasuyi, Bisola Onajin-Obembe, Maria Expedito Bandeira, Alda Martins, Miguel Tomé, Ana Cristina Miranda Martins Costa, Andriy Krystopchuk, Teresa Branco, Simao Esteves, Marco António Melo, Júlia Monte, Fernando Rua, Isabel Martins, Vítor Miguel Pinho-Oliveira, Carla Maria Rodrigues, Raquel Cabral, Sofia Marques, Sara Rêgo, Joana Sofia Teixeira Jesus, Maria Conceição Marques, Cristina Romao, Sandra Dias, Ana Margarida Santos, Maria Joao Alves, Cristina Salta, Salome Cruz, Célia Duarte, António Armando Furtado Paiva, Tiago do Nascimento Cabral, Dionisio Faria e Maia, Rui Freitas Mendonça Correia da Silva, Anuschka Langner, Hernâni Oliveira Resendes, Maria da Conceição Soares, Alexandra Abrunhosa, Filomena Faria, Lina Miranda, Helena Pereira, Sofia Serra, Daniela Ionescu, Simona Margarit, Calin Mitre, Horatiu Vasian, Gratiela Manga, Andreea Stefan, Dana Tomescu, Daniela Filipescu, Marilena-Alina Paunescu, Mihai Stefan, Radu Stoica, Laura Gavril, Emilia Pătrășcanu, Irina Ristescu, Daniel Rusu, Ciresica Diaconescu, Gabriel Florin Iosep, Dorin Pulbere, Irina Ursu, Andreea Balanescu, Ioana Grintescu, Liliana Mirea, Irina Rentea, Mihaela Vartic, Mary-Nicoleta Lupu, Dorin Stanescu, Lavinea Streanga, Oana Antal, Natalia Hagau, Dumitru Patras, Cristina Petrisor, Flaviu Tosa, Sebastian Tranca, Sanda Maria Copotoiu, Liviu Lucian Ungureanu, Cristian Remus Harsan, Marius Papurica, Daniela Denisa Cernea, Nicoleta Alice Dragoescu, Laura Aflori CarmenVaida, Oana Roxana Ciobotaru, Mariana Aignatoaie, Cristina Paula Carp, Isabelle Cobzaru, Oana Mardare, Bianca Purcarin, Valentin Tutunaru, Victor Ionita, Mirela Arustei, Anisoara Codita, Mihai Busuioc, Ion Chilinciuc, Cristina Ciobanu, Ioana Belciu, Eugen Tincu, Mihaela Blaj, Ramona - Mihaela Grosu, Gigel Sandu, Dana Bruma, Dan Corneci, Madalina Dutu, Adriana Krepil, Elena Copaciu, Clementina Oana Dumitrascu, Ramona Jemna, Florentina Mihaescu, Raluca Petre, Cristina Tudor, Elena Ursache, Alexander Kulikov, Andrey Lubnin, Evgeny Grigoryev, Stanislav Pugachev, Alexander Tolmasov, Ayyaz Hussain, Yana Ilyina, Anna Roshchina, Aleksandr Iurin, Elena Chazova, Artem Dunay, Alexey Karelov, Irina Khvedelidze, Olga Voldaeva, Vladislav Belskiy, Parvin Dzhamullaev, Elena Grishkowez, Vladimir Kretov, Valeriy Levin, Aleksandr Molkov, Sergey Puzanov, Aleksandr Samoilenko, Aleksandr Tchekulaev, Valentina Tulupova, Ivan Utkin, Nikki Leigh Allorto, David Gray Bishop, Pierre Monji Builu, Carel Cairns, Ashish Dasrath, Jacques de Wet, Marielle den Hoedt, Ben Grey, Morgan Philip Hayes, Belinda Senta Küsel, Nomcebo Shangase, Robert Wise, Sharon Cacala, Zane Farina, Vishendran Govindasamy, Carl-Heinz Kruse, Carolyn Lee, Leonard Marais, Thinagrin Dhasarthun Naidoo, Chantal Rajah, Reitze Nils Rodseth, Lisa Ryan, Richard von Rhaden, Suwayba Adam, Christella Alphonsus, Yusuf Ameer, Frank Anderson, Sujith Basanth, Sudha Bechan, Chettan Bhula, Bruce M. Biccard, Thuli Biyase, Ines Buccimazza, Jorge Cardosa, James Chen, Bhavika Daya, Leanne Drummond, Ali Elabib, Ehab Helmy Abdel Goad, Ismail E. Goga, Riaz Goga, R. Harrichandparsad, Richard E. Hodgson, J. Jordaan, Nicky Kalafatis, Christian Kampik, A.T. Landers, Emil Loots, Rajhmum Madansein, Anil Madaree, Thandinkosi E. Madiba, Vukani T. Manzini, Mbali Mbuyisa, Rajan Moodley, Mduduzi Msomi, Innocent Mukama, Desigan Naidoo, Rubeshan Naidoo, Tesuven K. Naidu, Sindiswa Ntloko, Eneshia Padayachee, Lucelle Padayachee, Martijn Phaff, Bala Pillay, Desigan Pillay, Lutchmee Pillay, Anupa Ramnarain, Suren R. Ramphal, Paul Ryan, Ahmed Saloojee, Motshedisi Sebitloane, Noluyolo Sigcu, Jenna L. Taylor, Alexandra Torborg, Linda Visser, Philip Anderson, Alae Conradie, Mathew de Swardt, Martin de Villiers, Johan Eikman, Riaan Liebenberg, Johan Mouton, Abbey Paton, Louwrence van der Merwe, Candice Wilscott-Davids, Wendy Joan Barrett, Marlet Bester, Johan de Beer, Jacques Geldenhuys, Hanni Gouws, Jan-Hendrik Potgieter, Magdel Strydom, Edwin WilberforceTurton, Rubendraj R. Chetty, Subash Chirkut, Larissa Cronje, Kim de Vasconcellos, Nokukhanya Z. Dube, N. Sibusiso Gama, Garyth M. Green, Randolph Green-Thompson, Suman Mewa Kinoo, Prenolin Kistnasami, Kapil Maharaj, Manogaran S. Moodley, Sibongile J. Mothae, Ruvashni Naidoo, M. Aslam F Noorbhai, Vivesh Rughubar, Jenendhiran Reddy, Avesh Singh, David L. Skinner, Murray J. Smith, Bhagwan Singh, Ravi Misra, Maheshwar Naidoo, Pireshin Ramdharee, Yvonne Selibea, Selina Sewpersad, Shailendra Sham, Joseph D. Wessels, Cucu Africander, Tarek Bejia, Stephen P. Blakemore, Marisa Botes, Bimalshakth Bunwarie, Carlos B. Hernandez, Mohammud A. Jeeraz, Dagmara A. Legutko, Acela G. Lopez, Jenine N. De Meyer, Tanaka Muzenda, Noel Naidoo, Maryam Patel, Rao Pentela, Marina Junge, Naj Mansoor, Lana Rademan, Pawel Scislowski, Ismail Seedat, Bianca van den Berg, Doreen van der Merwe, Steyn van Wyk, Komalan Govender, Darshan Naicker, Rajesh Ramjee, Mueen Saley, Warren Paul Kuhn, Roel Matos-Puig, Zaheer Moolla Alberto Lisi, Gisela Perez, Anna Valle Beltran, Angels Lozano, Carlos Delgado Navarro, Alejandro Duca, Ernesto Pastor Martinez Ernesto, Carlos Ferrando, Isabel Fuentes, Maria Luisa García-Pérez, Estefania Gracia, Ana Izquierdo Palomares, Antonio Katime, Amanda Miñana, Raul Raul Incertis, Esther Romero, Carolina Soledad Romero Garcia, Concepcion Rubio, Tania Socorro Artiles, Marina Soro, Paola Valls, Gisela Alaman Laguarda, Pau Benavent, Vicente Chisbert Cuenca, Andreu Cueva, Matilde Lafuente, Asuncion Marques Parra, Alejandra Romero Rodrigo, Silvia Sanchez-Morcillo, Sergi Tormo, Francisco Javier Redondo, José Antonio De Andrés Ibanez, Lorena Gómez Diago, Maria José Hernández Cádiz, Granell Gil Manuel, Raquel Peris, Cristina Saiz, Jose Tatay Vivo, Maria Teresa Tebar Soto, Tamara Brunete, David Cancho, David R. Delgado García, Diana Zamudio, Santiago Garcia Del Valle, M. Luz Serrano, Eduardo Alonso, Victor Anillo, Emilio Maseda, Patricia Salgado, Luis Suarez, Alejandro Suarez-de-la-Rica, María José Villagrán, José Ignacio Alonso, Estefania Cabezuelo, Irene Garcia-Saiz, Olga Lopez del Moral, Silvia Martín, Alba Perez Gonzalez, Ma Sherezade Tovar Doncel, Martin Agüero Vera, Francisco José Ávila Sánchez, Beatriz Castaño, Beatriz Castaño Moreira, Sahely Flores Risco, Daniel Paz Martín, Fernando Pérez Martín, Paloma Poza, Adela Ruiz, Wilson Fabio Serna Martínez, Bárbara Vázquez Vicente, Saul Velaz Dominguez, Salvador Fernández, Alfonso Munoz-López, Maria Jose Bernat, Arantxa Mas, Kenneth Planas, Monir Jawad, Yousif Saeed, Annika Hedin, Helena Levander, Sandra Holmström, David Lönn, Frank Zoerner, Irene Åkring, Carl Widmark, Jan Zettergren, Victor Aspelund Liljequist, Lena Nystrom, Suzanne Odeberg-Wernerman, Anders Oldner, Malin Jonsson Fagerlund, Patrik Reje, Sara Lyckner, Jesper Sperber, Anne Adolfsson, Bengt Klarin, Katrin Ögren, Jean-Pierre Barras, Thomas Bührer, Vasileios Despotidis, Naeder Helmy, Stephan Holliger, Dimitri Aristotle Raptis, Roger Schmid, Antoine Meyer, Yves Jaquet, Ulf Kessler, Mirza Muradbegovic, Solange R. 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V., Naylor, C., Bell, S., Heather, B., Kushakovsky, V., Alcock, L., Alexander, H., Anderson, C., Baker, P., Brookes, M., Cawthorn, L., Cirstea, E., Clarkson, R., Colling, K., Coulter, I., Das, S., Haigh, K., Hamdan, A., Hugill, K., Kottam, L., Lisseter, E., Mawdsley, M., McGivern, J., Padala, K., Phelps, V., Ramesh Kumar, V., Stewart, K., Towse, K., Tregonning, J., Vahedi, A., Walker, A., Baines, D., Bilolikar, A., Chande, S., Copley, E., Dunk, N., Kulkarni, R., Kumar, P., Metodiev, Y., Ncomanzi, D., Raithatha, B., Raymode, P., Szafranski, J., Twohey, L., Watt, P., Weatherall, L., Weatherill, J., Whitman, Z., Wighton, E., Abayasinghe, C., Chan, A., Darwish, S., Gill, J., Glasgow, E., Hadfield, D., Harris, C., Hopkins, P., Kochhar, A., Kunst, G., Mellis, C., Pool, A., Riozzi, P., Selman, A., Smith, E.J., Vele, L., Gercek, Y., Guy, K., Holden, D., Watson, N., Whysall, K., Andreou, P., Hales, D., Thompson, J., Bowrey, S., McDonald, S., Gilmore, J., Hills, V., Kelly, C., Kelly, S., Lloyd, G., Abbott, T., Gall, L., Torrance, H., Vivian, M., Berntsen, E., Nolan, T., Turner, A., Vohra, A., Brown, A., Clark, R., Coughlan, E., Daniel, C., Patvardhan, C., Pearson, R., Predeep, S., Saad, H., Shanmugam, M., Varley, S., Wylie, K., Cooper, L., Makowski, A., Misztal, B., Moldovan, E., Pegg, C., Donovan, A., Foot, J., Large, S., Claxton, A., Netke, B., Armstrong, R., Calderwood, C., Kwok, A., Mohr, O., Oyeniyi, P., Patnaik, L., Post, B., Ali, S., Arshad, H., Baker, G., Brenner, L., Brincat, M., Brunswicker, A., Cox, H., Cozar, O.I., Cheong, E., Durst, A., Fengas, L., Flatt, J., Glister, G., Narwani, V., Photi, E., Rankin, A., Rosbergen, M., Beaton, C., Horn, R., Hunt, J., Rousseau, G., Stancombe, L., Absar, M., Allsop, J., Drinkwater, Z., Hodgkiss, T., Smith, K., Alexander-Sefre, F., Campey, L., Dudgeon, L., Hall, K., Hitchcock, R., James, L., Winstone, U., Ahmad, N., Bauchmuller, K., Harrison, J., Jeffery, H., Miller, D., Pinder, A., Pothuneedi, S., Rosser, J., Sanghera, S., Swift, D., Walker, R., Bester, D., Cavanagh, S., Cripps, H., Daniel, H., Lynch, J., Pyke, S., Scholefield, J., Whitworth, H., Bottrill, F., Ramalingam, G., Webb, S., Akerman, N., Antill, P., Bourner, L., Buckley, S., Castle, G., Charles, R., Eggleston, C., Foster, R., Gill, S., Lindley, K., Lklouk, M., Lowery, T., Martin, O., Milne, D., O'Connor, P., Ratcliffe, A., Rose, A., Smith, A., Varma, S., Ward, J., Barcraft-Barnes, H., Camsooksai, J., Colvin, C., Reschreiter, H., Tbaily, L., Venner, N., Hamilton, C., Kelly, L., Toth-Tarsoly, P., Dodsworth, K., Foord, D., Gordon, P., Hawes, E., Lamb, N., Mouland, J., Nightingale, J., Rose, S., Schrieber, J., Al'Amri, K., Aladin, H., Arshad, M.A., Barraclough, J., Bentley, C., Bergin, C., Carrera, R., Clarkson, A., Collins, M., Denham, S., Griffiths, E., Ip, P., Jeyanthan, S., Joory, K., Kaur, S., Marriott, P., Mitchell, N., Nagaiah, S., Nilsson, A., Parekh, N., Pope, M., Seager, J., Serag, H., Tameem, A., Thomas, A., Thunder, J., Torrance, A., Vohra, R., Whitehouse, A., Wong, T., Blunt, M., Wong, K., Giles, J., Reed, I., Weller, D., Bell, G., Birch, J., Damant, R., Maiden, J., Mewies, C., Prince, C., Radford, J., Reynolds, T., Balain, B., Banerjee, R., Barnett, A., Burston, B., Edwards, J., Evans, C., Ford, D., Gallacher, P., Hill, S., Jaffray, D., Karlakki, S., Kennedy, J., Kiely, N., Lewthwaite, S., Marquis, C., Ockendon, M., Phillips, S., Pickard, S., Richardson, J., Roach, R., Smith, T., Spencer-Jones, R., Steele, N., Steen, J., Van Liefland, M., White, S., Faulds, M., Harris, M., Nicol, S., Pearson, S.A., Chukkambotla, S., Andrew, A., Attrill, E., Campbell, G., Datson, A., Fouracres, A., Graterol, J., Graves, L., Hong, B., Ishimaru, A., Karthikeyan, A., King, H., Lawson, T., Lee, G., Lyons, S., Hall, A.M., Mathoulin, S., Mcintyre, E., Mclaughlin, D., Mulcahy, K., Paddle, J., Robbins, J., Sung, W., Tayo, A., Trembath, L., Venugopal, S., Wigmore, G., Boereboom, C., Downes, C., Humphries, R., Melbourne, S., Tou, S., Ullah, S., Batchelor, N., Boxall, L., Broomby, R., Deen, T., Hellewell, A., Helliwell, L., Hutchings, M., Hutchins, D., Keenan, S., Mackie, D., Potter, A., Smith, F., Stone, L., Thorpe, K., Wassall, R., Woodgate, A., Baillie, S., Campbell, T., James, S., King, C., Marques de Araujo, D., Martin, D., Morkane, C., Neely, J., Rajendram, R., Burton, M., James, K., Keevil, E., Minik, O., Morgan, J., Musgrave, A., Rajanna, H., Roberts, T., Adamson, M., Jumbe, S., Kendall, J., Muthuswamy, M.B., Cruikshanks, A., Wrench, I., Zeidan, L., Ardern, D., Harris, B., Hellstrom, J., Martin, J., Thomas, R., Varsani, N., Brown, C.W., Docherty, P., Gillies, M., McGregor, E., Usher, H., Craig, J., Ahmad, T., Bodger, P., Creary, T., Fowler, A., Ijuo, E., Jones, T., Kantsedikas, I., Lahiri, S., McLean, A.L., Niebrzegowska, E., Phull, M., Wickboldt, N., Baldwin, J., Doyle, D., Mcmullan, S., Oladapo, M., Owen, T., Williams, A., Gregory, P., Husain, T., Kirk-Bayley, J., Mathers, E., Montague, L., Harper, M., Jack, J., Ridley, C., Avis, J., Cook, T., Dali-Kemmery, L., Kerslake, I., Lambourne, V., Pearson, A., Boyd, C., Callaghan, M., Lawson, C., McCrossan, R., Nesbitt, V., O'connor, L., Sinclair, R., Farid, N., Morgese, C., Bhatia, K., Karmarkar, S., Ahmed, J., Branagan, G., Hutton, M., Swain, A., Brookes, J., Cornell, J., Dolan, R., Hulme, J., Jansen van Vuuren, A., Jowitt, T., Kalashetty, G., Lloyd, F., Patel, K., Sherwood, N., Brown, L., Chandler, B., Deighton, K., Emma, T., Haunch, K., Cheeseman, M., Dent, K., Gray, C., Hood, M., Jones, D., Juj, J., Rao, R., Walker, T., Al Anizi, M., Cheah, C., Cheing, Y., Coutinho, F., Gondo, P., Hadebe, B., Hove, M.O., Khader, A., Krishnachetty, B., Rhodes, K., Sokhi, J., Baker, K.A., Bertram, W., Looseley, A., Mouton, R., Hanna, G., Arnold, G., Arya, S., Balfoussia, D., Baxter, L., Harris, J., Jones, C., Knaggs, A., Markar, S., Perera, A., Scott, A., Shida, A., Sirha, R., Wright, S., Frost, V., Andrews, E., Arrandale, L., Barrett, S., Cifra, E., Cooper, M., Dragnea, D., Elna, C., Maclean, J., Meier, S., Milliken, D., Munns, C., Ratanshi, N., Ramessur, S., Salvana, A., Watson, A., Ali, H., Critchley, R., Endersby, S., Hicks, C., Liddle, A., Pass, M., Ritchie, C., Thomas, C., Too, L., Welsh, S., Gill, T., Johnson, J., Reed, J., Davis, E., Papadopoullos, S., Attwood, C., Biffen, A., Boulton, K., Gray, S., Hay, D., Mills, S., Montgomery, J., Riddell, R., Simpson, J., Bhardwaj, N., Paul, E., Uwubamwen, N., Alexander, M., Arrich, J., Arumugam, S., Blackwood, D., Boggiano, V., Chan, Y.L., Chatterjee, D., Chhabra, A., Christian, R., Costelloe, H., Matthewman, M.C., Dalton, E., Darko, J., Davari, M., Dave, T., Deacon, M., Deepak, S., Edmond, H., Ellis, J., El-Sayed, A., Eneje, P., English, R., Ewe, R., Foers, W., Franklin, J., Gallego, L., Garrett, E., Goldberg, O., Goss, H., Greaves, R., Harris, R., Hennings, C., Jones, E., Kamali, N., Kokkinos, N., Lewis, C., Lignos, L., Malgapo, E.V., Malik, R., Milne, A., Mulligan, J.P., Nicklin, P., Palipane, N., Parsons, T., Piper, R., Prakash, R., Ramesh, B., Rasip, S., Reading, J., Rela, M., Reyes, A., Stephens, R., Rooms, M., Shah, K., Simons, H., Solanki, S., Spowart, E., Stevens, A., Waggett, H., Yassaee, A., Kennedy, A., Scott, S., Somanath, S., Berg, A., Hernandez, M., Nanda, R., Tank, G., Wilson, N., Wilson, D., Al-Soudaine, Y., Baldwin, M., Cornish, J., Davies, Z., Davies, L., Edwards, M., Frewer, N., Gallard, S., Glasbey, J., Harries, R., Hopkins, L., Kim, T., Koompirochana, V., Lawson, S., Lewis, M., Makzal, Z., Scourfield, S., Ahmad, Y., Bates, S., Blackwell, C., Bryant, H., Collins, H., Coulter, S., Cruickshank, R., Daniel, S., Daubeny, T., Golder, K., Hawkins, L., Helen, B., Hinxman, H., Levett, D., Salmon, K., Seaward, L., Skinner, B., Tyrell, B., Wadams, B., Walsgrove, J., Dickson, J., Constantin, K., Karen, M., O'Brien, P., O'Donohoe, L., Payne, H., Sundayi, S., Walker, E., Brooke, J., Cardy, J., Humphreys, S., Kessack, L., Kubitzek, C., Kumar, S., Cotterill, D., Hodzovic, E., Hosdurga, G., Miles, E., Saunders, G., Campbell, M., Chan, P., Jemmett, K., Raj, A., Naik, A., Oshowo, A., Ramamoorthy, R., Shah, N., Sylvan, A., Blyth, K., Burtenshaw, A., Freeman, D., Johnson, E., Lo, P., Martin, T., Plunkett, E., Wollaston, J., Allison, J., Carroll, C., Craw, N., Craw, S., Pitt-Kerby, T., Rowland-Axe, R., Spurdle, K., McDonald, A., Simon, D., Sinha, V., Banner-Goodspeed, V., Boone, M., Campbell, K., Lu, F., Scannell, J., Sobol, J., Balajonda, N., Clemmons, K., Conde, C., Elgasim, M., Funk, B., Hopkins, T., Olaleye, O., Omer, O., Pender, M., Porto, A., Waweru, P., Yeh, E., Bodansky, D., Evans, A., Kleopoulos, S., Maril, R., Mathney, E., Sanchez, A., Tinuoye, E., Bateman, B., Eng, K., Jiang, N., Ladha, K., Needleman, J., Chen, L.L., Lane, R., Robinowitz, D., Ghushe, N., Irshad, M., O'Connor, J., Patel, S., Takemoto, S., Wallace, A., Mazzeffi, M., Rock, P., Wallace, K., Chua, P., Mattera, M., Sharar, R., Thilen, S., Treggiari, M., Morgan, A., Sofjan, I., Subramaniam, K., Avidan, M., Maybrier, H., Muench, M., and Wildes, T.
Subjects: Male, Postoperative Complications/epidemiology, Hospital mortality, [SDV]Life Sciences [q-bio], surgery, Postoperative Complications, 0302 clinical medicine, cohort studies, 030202 anesthesiology, patient safety, 030212 general & internal medicine, Postoperative Period, Medicine(all), Middle Aged, Checklist, 3. Good health, Treatment Outcome, operative/mortality, Elective Surgical Procedures, Surgical Procedures, Operative, Meta-analysis, Cohort, Cohort studies, Female, Elective Surgical Procedure, postoperative care/methods, postoperative care/statistics and numerical data, surgical procedures, Anesthesiology and Pain Medicine, Cohort study, Adult, medicine.medical_specialty, Evidence-based medicine, NO, 03 medical and health sciences, Patient safety, medicine, postoperative care/method, Humans, Elective Surgical Procedures/standards, Aged, Cohort Studies, Evidence-Based Medicine, Hospital Mortality, Patient Safety, Postoperative Complications/mortality, Postoperative Complications/prevention & control, Surgical Procedures, Operative/methods, business.industry, Odds ratio, Surgery, Observational study, business, cohort studie
Abstract: BACKGROUND: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool.METHODS: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals.RESULTS: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); PCONCLUSIONS: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
Published: 2018

11. Diabetes mellitus is associated with 90-day mortality in old critically ill COVID-19 patients: a multicenter prospective observational cohort study.

Author: Mayerhöfer T, Klein S, Wernly B, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Artigas A, van Heerden PV, Pinto BB, Schefold JC, Moreno R, Cecconi M, Szczeklik W, Jung C, and Joannidis M
Subjects: Humans, Aged, Aged, 80 and over, Prospective Studies, SARS-CoV-2, Critical Illness, Intensive Care Units, COVID-19, Diabetes Mellitus epidemiology
Abstract: Background: Several studies have found an association between diabetes mellitus, disease severity and outcome in COVID-19 patients. Old critically ill patients are particularly at risk. This study aimed to investigate the impact of diabetes mellitus on 90-day mortality in a high-risk cohort of critically ill patients over 70 years of age., Methods: This multicentre international prospective cohort study was performed in 151 ICUs across 26 countries. We included patients ≥ 70 years of age with a confirmed SARS-CoV-2 infection admitted to the intensive care unit from 19th March 2020 through 15th July 2021. Patients were categorized into two groups according to the presence of diabetes mellitus. Primary outcome was 90-day mortality. Kaplan-Meier overall survival curves until day 90 were analysed and compared using the log-rank test. Mixed-effect Weibull regression models were computed to investigate the influence of diabetes mellitus on 90-day mortality., Results: This study included 3420 patients with a median age of 76 years were included. Among these, 37.3% (n = 1277) had a history of diabetes mellitus. Patients with diabetes showed higher rates of frailty (32% vs. 18%) and several comorbidities including chronic heart failure (20% vs. 11%), hypertension (79% vs. 59%) and chronic kidney disease (25% vs. 11%), but not of pulmonary comorbidities (22% vs. 22%). The 90-day mortality was significantly higher in patients with diabetes than those without diabetes (64% vs. 56%, p < 0.001). The association of diabetes and 90-day mortality remained significant (HR 1.18 [1.06-1.31], p = 0.003) after adjustment for age, sex, SOFA-score and other comorbidities in a Weibull regression analysis., Conclusion: Diabetes mellitus was a relevant risk factor for 90-day mortality in old critically ill patients with COVID-19., Study Registration: NCT04321265, registered March 19th, 2020., (© 2023. The Author(s).)
Published: 2023
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12. Outcomes of patients aged ≥80 years with respiratory failure initially treated with non-invasive ventilation in European intensive care units before and during COVID-19 pandemic.

Author: Polok K, Fronczek J, Guidet B, Artigas A, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Pinto BB, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Flaatten H, Jung C, and Szczeklik W
Abstract: Background: Non-invasive ventilation (NIV) has been commonly used to treat acute respiratory failure due to COVID-19. In this study we aimed to compare outcomes of older critically ill patients treated with NIV before and during the COVID-19 pandemic., Methods: We analysed a merged cohort of older adults admitted to intensive care units (ICUs) due to respiratory failure. Patients were enrolled into one of two prospective observational studies: before COVID-19 (VIP2-2018 to 2019) and admitted due to COVID-19 (COVIP-March 2020 to January 2023). The outcomes included: 30-day mortality, intubation rate and NIV failure (death or intubation within 30 days)., Results: The final cohort included 1986 patients (1292 from VIP2, 694 from COVIP) with a median age of 83 years. NIV was used as a primary mode of respiratory support in 697 participants (35.1%). ICU admission due to COVID-19 was associated with an increased 30-day mortality (65.5% vs. 36.5%, HR 2.18, 95% CI 1.71 to 2.77), more frequent intubation (36.9% vs. 17.5%, OR 2.63, 95% CI 1.74 to 3.99) and NIV failure (76.2% vs. 45.3%, OR 4.21, 95% CI 2.84 to 6.34) compared to non-COVID causes of respiratory failure. Sensitivity analysis after exclusion of patients in whom life supporting treatment limitation was introduced during primary NIV confirmed higher 30-day mortality in patients with COVID-19 (52.5% vs. 23.4%, HR 2.64, 95% CI 1.83 to 3.80)., Conclusion: The outcomes of patients aged ≥80 years treated with NIV during COVID-19 pandemic were worse compared then those treated with NIV in the pre-pandemic era., (© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF).)
Published: 2023
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13. In reply: Sex-specific outcomes in COVID-19: missing pieces of the puzzle.

Author: Wolff G, Wernly B, Flaatten H, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Binneboessel S, Baldia P, Beil M, Sivri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Flamm M, Marsh B, Andersen FH, Moreno R, Boumendil A, De Lange DW, Guidet B, Leaver S, and Jung C
Subjects: Male, Female, Humans, SARS-CoV-2, COVID-19
Published: 2023
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14. The association of prior paracetamol intake with outcome of very old intensive care patients with COVID-19: results from an international prospective multicentre trial.

Author: Baldia PH, Wernly B, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Kelm M, Beil M, Bruno RR, Binnebößel S, Wolff G, Erkens R, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Leaver S, De Lange DW, Guidet B, and Jung C
Subjects: Humans, Acetaminophen therapeutic use, Prospective Studies, Critical Illness, Pandemics, Critical Care methods, COVID-19
Abstract: Background: In the early COVID-19 pandemic concerns about the correct choice of analgesics in patients with COVID-19 were raised. Little data was available on potential usefulness or harmfulness of prescription free analgesics, such as paracetamol. This international multicentre study addresses that lack of evidence regarding the usefulness or potential harm of paracetamol intake prior to ICU admission in a setting of COVID-19 disease within a large, prospectively enrolled cohort of critically ill and frail intensive care unit (ICU) patients., Methods: This prospective international observation study (The COVIP study) recruited ICU patients ≥ 70 years admitted with COVID-19. Data on Sequential Organ Failure Assessment (SOFA) score, prior paracetamol intake within 10 days before admission, ICU therapy, limitations of care and survival during the ICU stay, at 30 days, and 3 months. Paracetamol intake was analysed for associations with ICU-, 30-day- and 3-month-mortality using Kaplan Meier analysis. Furthermore, sensitivity analyses were used to stratify 30-day-mortality in subgroups for patient-specific characteristics using logistic regression., Results: 44% of the 2,646 patients with data recorded regarding paracetamol intake within 10 days prior to ICU admission took paracetamol. There was no difference in age between patients with and without paracetamol intake. Patients taking paracetamol suffered from more co-morbidities, namely diabetes mellitus (43% versus 34%, p < 0.001), arterial hypertension (70% versus 65%, p = 0.006) and had a higher score on Clinical Frailty Scale (CFS; IQR 2-5 versus IQR 2-4, p < 0.001). Patients under prior paracetamol treatment were less often subjected to intubation and vasopressor use, compared to patients without paracetamol intake (65 versus 71%, p < 0.001; 63 versus 69%, p = 0.007). Paracetamol intake was not associated with ICU-, 30-day- and 3-month-mortality, remaining true after multivariate adjusted analysis., Conclusion: Paracetamol intake prior to ICU admission was not associated with short-term and 3-month mortality in old, critically ill intensive care patients suffering from COVID-19., Trial Registration: This prospective international multicentre study was registered on ClinicalTrials.gov with the identifier "NCT04321265" on March 25, 2020., (© 2022. The Author(s).)
Published: 2022
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15. COVID-19 machine learning model predicts outcomes in older patients from various European countries, between pandemic waves, and in a cohort of Asian, African, and American patients.

Author: Mamandipoor B, Bruno RR, Wernly B, Wolff G, Fjølner J, Artigas A, Pinto BB, Schefold JC, Kelm M, Beil M, Sigal S, Leaver S, De Lange DW, Guidet B, Flaatten H, Szczeklik W, Jung C, and Osmani V
Abstract: Background: COVID-19 remains a complex disease in terms of its trajectory and the diversity of outcomes rendering disease management and clinical resource allocation challenging. Varying symptomatology in older patients as well as limitation of clinical scoring systems have created the need for more objective and consistent methods to aid clinical decision making. In this regard, machine learning methods have been shown to enhance prognostication, while improving consistency. However, current machine learning approaches have been limited by lack of generalisation to diverse patient populations, between patients admitted at different waves and small sample sizes., Objectives: We sought to investigate whether machine learning models, derived on routinely collected clinical data, can generalise well i) between European countries, ii) between European patients admitted at different COVID-19 waves, and iii) between geographically diverse patients, namely whether a model derived on the European patient cohort can be used to predict outcomes of patients admitted to Asian, African and American ICUs., Methods: We compare Logistic Regression, Feed Forward Neural Network and XGBoost algorithms to analyse data from 3,933 older patients with a confirmed COVID-19 diagnosis in predicting three outcomes, namely: ICU mortality, 30-day mortality and patients at low risk of deterioration. The patients were admitted to ICUs located in 37 countries, between January 11, 2020, and April 27, 2021., Results: The XGBoost model derived on the European cohort and externally validated in cohorts of Asian, African, and American patients, achieved AUC of 0.89 (95% CI 0.89-0.89) in predicting ICU mortality, AUC of 0.86 (95% CI 0.86-0.86) for 30-day mortality prediction and AUC of 0.86 (95% CI 0.86-0.86) in predicting low-risk patients. Similar AUC performance was achieved also when predicting outcomes between European countries and between pandemic waves, while the models showed high calibration quality. Furthermore, saliency analysis showed that FiO2 values of up to 40% do not appear to increase the predicted risk of ICU and 30-day mortality, while PaO2 values of 75 mmHg or lower are associated with a sharp increase in the predicted risk of ICU and 30-day mortality. Lastly, increase in SOFA scores also increase the predicted risk, but only up to a value of 8. Beyond these scores the predicted risk remains consistently high., Conclusion: The models captured both the dynamic course of the disease as well as similarities and differences between the diverse patient cohorts, enabling prediction of disease severity, identification of low-risk patients and potentially supporting effective planning of essential clinical resources., Trial Registration Number: NCT04321265., Competing Interests: JCS report grants from Orion Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A., Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, Glaxo Smith Kline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter, Astellas, Astra Zeneca, CSL Behring, Novartis, Covidien, Phagenesis, and Nycomed outside the submitted work. The money was paid into departmental funds. No personal financial gain applied. The other authors declare no Competing Financial or Non-Financial Interests., (Copyright: © 2022 Mamandipoor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Published: 2022
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16. Sex-specific treatment characteristics and 30-day mortality outcomes of critically ill COVID-19 patients over 70 years of age-results from the prospective COVIP study.

Author: Wolff G, Wernly B, Flaatten H, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Binneboessel S, Baldia P, Beil M, Sivri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Flamm M, Zafeiridis T, Marsh B, Andersen FH, Moreno R, Boumendil A, De Lange DW, Guidet B, Leaver S, and Jung C
Subjects: Humans, Female, Male, Aged, Aged, 80 and over, Critical Illness, Prospective Studies, Pandemics, Intensive Care Units, COVID-19 therapy, Frailty
Abstract: Purpose: Older critically ill patients with COVID-19 have been the most vulnerable during the ongoing pandemic, with men being more prone to hospitalization and severe disease than women. We aimed to explore sex-specific differences in treatment and outcome after intensive care unit (ICU) admission in this cohort., Methods: We performed a sex-specific analysis in critically ill patients ≥ 70 yr of age with COVID-19 who were included in the international prospective multicenter COVIP study. All patients were analyzed for ICU admission and treatment characteristics. We performed a multilevel adjusted regression analysis to elucidate associations of sex with 30-day mortality., Results: A total of 3,159 patients (69.8% male, 30.2% female; median age, 75 yr) were included. Male patients were significantly fitter than female patients as determined by the Clinical Frailty Scale (fit, 67% vs 54%; vulnerable, 14% vs 19%; frail, 19% vs 27%; P < 0.001). Male patients more often underwent tracheostomy (20% vs 14%; odds ratio [OR], 1.57; P < 0.001), vasopressor therapy (69% vs 62%; OR, 1.25; P = 0.02), and renal replacement therapy (17% vs 11%; OR, 1.96; P < 0.001). There was no difference in mechanical ventilation, life-sustaining treatment limitations, and crude 30-day mortality (50% male vs 49% female; OR, 1.11; P = 0.19), which remained true after adjustment for disease severity, frailty, age and treatment limitations (OR, 1.17; 95% confidence interval, 0.94 to 1.45; P = 0.16)., Conclusion: In this analysis of sex-specific treatment characteristics and 30-day mortality outcomes of critically ill patients with COVID-19 ≥ 70 yr of age, we found more tracheostomy and renal replacement therapy in male vs female patients, but no significant association of patient sex with 30-day mortality., Study Registration: www., Clinicaltrials: gov (NCT04321265); registered 25 March 2020)., (© 2022. The Author(s).)
Published: 2022
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17. A retrospective cohort study comparing differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in European tax-based healthcare systems (THS) versus social health insurance systems.

Author: Wernly B, Flaatten H, Beil M, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Rezar R, Oeyen S, Wolff G, Marsh B, Andersen FH, Moreno R, Wernly S, Leaver S, Boumendil A, De Lange DW, Guidet B, Perings S, and Jung C
Subjects: Humans, Retrospective Studies, Intensive Care Units, Delivery of Health Care, Insurance, Health, Critical Illness, COVID-19
Abstract: In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill ≥ 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 ± 3 vs. 5 ± 3; p = 0.002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0.09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0.001) were found in SHI (aOR 0.61 95%CI 0.40-0.92; p = 0.02). No differences regarding intubation rates (68% vs. 70%; p = 0.33), vasopressor use (67% vs. 67%; p = 0.90) and 30-day-mortality rates (47% vs. 50%; p = 0.16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients ≥ 70 years with COVID-19 in Europe., (© 2022. The Author(s).)
Published: 2022
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18. Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe.

Author: Wernly B, Rezar R, Flaatten H, Beil M, Fjølner J, Bruno RR, Artigas A, Pinto BB, Schefold JC, Kelm M, Sigal S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Wolff G, Marsh B, Andersen FH, Moreno R, Leaver S, Wernly S, Boumendil A, De Lange DW, Guidet B, and Jung C
Subjects: Aged, Aged, 80 and over, Critical Illness epidemiology, Critical Illness therapy, Europe epidemiology, Humans, Intensive Care Units, Prospective Studies, COVID-19 epidemiology, COVID-19 therapy, Terminal Care
Abstract: Background: Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe., Objectives: The purpose of this post-hoc analysis of the prospective multicentre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic., Methods: A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 1573; Northern Europe: n = 821; Southern Europe: n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aORs) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (gross domestic product, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day mortality was a secondary outcome., Results: The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%) and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95% confidence interval [CI] 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78)., Conclusion: This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results., (© 2022 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)
Published: 2022
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19. Short-term mortality of patients ≥80 years old admitted to European intensive care units: an international observational study.

Author: Fronczek J, Flaatten H, Guidet B, Polok K, Andersen FH, Andrew BY, Artigas A, Beil M, Cecconi M, Christensen S, de Lange DW, Fjølner J, Górka J, Joannidis M, Jung C, Kusza K, Leaver S, Marsh B, Morandi A, Moreno R, Oeyen S, Owczuk R, Agvald-Öhman C, Pinto BB, Rhodes A, Schefold JC, Soliman IW, Valentin A, Walther S, Watson X, Zafeiridis T, and Szczeklik W
Subjects: Aged, Aged, 80 and over, Critical Illness, Hospital Mortality, Humans, Prospective Studies, Hospitalization, Intensive Care Units
Abstract: Background: Limited evidence suggests variation in mortality of older critically ill adults across Europe. We aimed to investigate regional differences in mortality among very old ICU patients., Methods: Multilevel analysis of two international prospective cohort studies. We included patients ≥80 yr old from 322 ICUs located in 16 European countries. The primary outcome was mortality within 30 days from admission to the ICU. Results are presented as n (%) with 95% confidence intervals and odds ratios (ORs)., Results: Of 8457 patients, 2944 (36.9% [35.9-38.0%]) died within 30 days. Crude mortality rates varied widely between participating countries (from 10.1% [6.4-15.6%] to 45.1% [41.1-49.2%] in the ICU and from 21.3% [16.3-28.9%] to 55.3% [51.1-59.5%] within 30 days). After adjustment for confounding variables, the variation in 30-day mortality between countries was substantially smaller than between ICUs (median OR 1.14 vs 1.58). Healthcare expenditure per capita (OR=0.84 per $1000 [0.75-0.94]) and social health insurance framework (OR=1.43 [1.01-2.01]) were associated with ICU mortality, but the direction and magnitude of these relationships was uncertain in 30-day follow-up. Volume of admissions was associated with lower mortality both in the ICU (OR=0.81 per 1000 annual ICU admissions [0.71-0.94]) and in 30-day follow-up (OR=0.86 [0.76-0.97])., Conclusion: The apparent variation in short-term mortality rates of older adults hospitalised in ICUs across Europe can be largely attributed to differences in the clinical profile of patients admitted. The volume-outcome relationship identified in this population requires further investigation., (Copyright © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
Published: 2022
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20. Correction to: Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19.

Author: Guidet B, Jung C, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Beil M, Sigal S, van Heerden PV, Szczeklik W, Joannidis M, Oeyen S, Kondili E, Marsh B, Andersen FH, Moreno R, Cecconi M, Leaver S, De Lange DW, and Boumendil A
Published: 2022
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21. Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19.

Author: Guidet B, Jung C, Flaatten H, Fjølner J, Artigas A, Pinto BB, Schefold JC, Beil M, Sigal S, van Heerden PV, Szczeklik W, Joannidis M, Oeyen S, Kondili E, Marsh B, Andersen FH, Moreno R, Cecconi M, Leaver S, De Lange DW, and Boumendil A
Subjects: Critical Care, Critical Illness, Humans, Intensive Care Units, SARS-CoV-2, COVID-19 therapy, Respiratory Insufficiency therapy
Abstract: Purpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST., Methods: Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death., Results: 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients., Conclusion: Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear., (© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.)
Published: 2022
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22. Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units.

Author: Polok K, Fronczek J, van Heerden PV, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Artigas A, Pinto BB, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Jung C, and Szczeklik W
Subjects: Aged, Correlation of Data, Europe, Female, Humans, Intensive Care Units statistics & numerical data, Length of Stay, Male, Prospective Studies, Respiration, Artificial, Survival Rate trends, Time Factors, Treatment Outcome, COVID-19 mortality, COVID-19 therapy, Critical Care methods, Critical Care statistics & numerical data, Critical Illness mortality, Tracheostomy mortality, Tracheostomy statistics & numerical data
Abstract: Background: Tracheostomy is performed in patients expected to require prolonged mechanical ventilation, but to date optimal timing of tracheostomy has not been established. The evidence concerning tracheostomy in COVID-19 patients is particularly scarce. We aimed to describe the relationship between early tracheostomy (≤10 days since intubation) and outcomes for patients with COVID-19., Methods: This was a prospective cohort study performed in 152 centres across 16 European countries from February to December 2020. We included patients aged ≥70 yr with confirmed COVID-19 infection admitted to an intensive care unit, requiring invasive mechanical ventilation. Multivariable analyses were performed to evaluate the association between early tracheostomy and clinical outcomes including 3-month mortality, intensive care length of stay, and duration of mechanical ventilation., Results: The final analysis included 1740 patients with a mean age of 74 yr. Tracheostomy was performed in 461 (26.5%) patients. The tracheostomy rate varied across countries, from 8.3% to 52.9%. Early tracheostomy was performed in 135 (29.3%) patients. There was no difference in 3-month mortality between early and late tracheostomy in either our primary analysis (hazard ratio [HR]=0.96; 95% confidence interval [CI], 0.70-1.33) or a secondary landmark analysis (HR=0.78; 95% CI, 0.57-1.06)., Conclusions: There is a wide variation across Europe in the timing of tracheostomy for critically ill patients with COVID-19. However, we found no evidence that early tracheostomy is associated with any effect on survival amongst older critically ill patients with COVID-19., Clinical Trial Registration: ClinicalTrials.gov NCT04321265., (Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)
Published: 2022
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23. Management and outcomes in critically ill nonagenarian versus octogenarian patients.

Author: Bruno RR, Wernly B, Kelm M, Boumendil A, Morandi A, Andersen FH, Artigas A, Finazzi S, Cecconi M, Christensen S, Faraldi L, Lichtenauer M, Muessig JM, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Leaver S, Boulanger C, Walther S, Schefold JC, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Zafeiridis T, De Lange DW, Guidet B, Flaatten H, and Jung C
Subjects: Aged, 80 and over, Cohort Studies, Critical Care, Hospitalization, Humans, Critical Illness therapy, Frailty
Abstract: Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients., Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (> 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians., Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 + 5 vs. 7 + 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19))., Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions., Trial Registration: NCT03134807 and NCT03370692 ., (© 2021. The Author(s).)
Published: 2021
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24. Publisher Correction: Sex-specific outcome disparities in very old patients admitted to intensive care medicine: a propensity matched analysis.

Author: Wernly B, Bruno RR, Kelm M, Boumendil A, Morandi A, Andersen FH, Artigas A, Finazzi S, Cecconi M, Christensen S, Faraldi L, Lichtenauer M, Muessig JM, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Niederseer D, Valentin A, Watson X, Leaver S, Boulanger C, Walther S, Schefold JC, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Zafeiridis T, De Lange DW, Guidet B, Flaatten H, and Jung C
Published: 2021
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25. Inhibitors of the renin-angiotensin-aldosterone system and COVID-19 in critically ill elderly patients.

Author: Jung C, Bruno RR, Wernly B, Joannidis M, Oeyen S, Zafeiridis T, Marsh B, Andersen FH, Moreno R, Fernandes AM, Artigas A, Pinto BB, Schefold J, Wolff G, Kelm M, De Lange DW, Guidet B, Flaatten H, and Fjølner J
Subjects: Aged, Aged, 80 and over, Critical Illness, Female, Humans, Intensive Care Units, Male, Prospective Studies, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, COVID-19 mortality, SARS-CoV-2
Published: 2021
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26. Sex-specific outcome disparities in very old patients admitted to intensive care medicine: a propensity matched analysis.

Author: Wernly B, Bruno RR, Kelm M, Boumendil A, Morandi A, Andersen FH, Artigas A, Finazzi S, Cecconi M, Christensen S, Faraldi L, Lichtenauer M, Muessig JM, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Niederseer D, Valentin A, Watson X, Leaver S, Boulanger C, Walther S, Schefold JC, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Zafeiridis T, De Lange DW, Guidet B, Flaatten H, and Jung C
Subjects: Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Male, Propensity Score, Critical Care, Patient Admission, Sex Factors, Treatment Outcome
Abstract: Female and male very elderly intensive patients (VIPs) might differ in characteristics and outcomes. We aimed to compare female versus male VIPs in a large, multinational collective of VIPs with regards to outcome and predictors of mortality. In total, 7555 patients were included in this analysis, 3973 (53%) male and 3582 (47%) female patients. The primary endpoint was 30-day-mortality. Baseline characteristics, data on management and geriatric scores including frailty assessed by Clinical Frailty Scale (CFS) were documented. Two propensity scores (for being male) were obtained for consecutive matching, score 1 for baseline characteristics and score 2 for baseline characteristics and ICU management. Male VIPs were younger (83 ± 5 vs. 84 ± 5; p < 0.001), less often frail (CFS > 4; 38% versus 49%; p < 0.001) but evidenced higher SOFA (7 ± 6 versus 6 ± 6 points; p < 0.001) scores. After propensity score matching, no differences in baseline characteristics could be observed. In the paired analysis, the mortality in male VIPs was higher (mean difference 3.34% 95%CI 0.92-5.76%; p = 0.007) compared to females. In both multivariable logistic regression models correcting for propensity score 1 (aOR 1.15 95%CI 1.03-1.27; p = 0.007) and propensity score 2 (aOR 1.15 95%CI 1.04-1.27; p = 0.007) male sex was independently associated with higher odds for 30-day-mortality. Of note, male gender was not associated with ICU mortality (OR 1.08 95%CI 0.98-1.19; p = 0.14). Outcomes of elderly intensive care patients evidenced independent sex differences. Male sex was associated with adverse 30-day-mortality but not ICU-mortality. Further research to identify potential sex-specific risk factors after ICU discharge is warranted.Trial registration: NCT03134807 and NCT03370692; Registered on May 1, 2017 https://clinicaltrials.gov/ct2/show/NCT03370692 .
Published: 2020
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27. A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention.

Author: Jung C, Wernly B, Muessig JM, Kelm M, Boumendil A, Morandi A, Andersen FH, Artigas A, Bertolini G, Cecconi M, Christensen S, Faraldi L, Fjølner J, Lichtenauer M, Bruno RR, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Zafeiridis T, De Lange DW, Guidet B, and Flaatten H
Subjects: Acute Disease, Aged, 80 and over, Cohort Studies, Elective Surgical Procedures mortality, Female, Frailty mortality, Hospital Mortality, Humans, Intensive Care Units statistics & numerical data, Logistic Models, Male, Postoperative Care statistics & numerical data, Prospective Studies, Wounds and Injuries mortality, Wounds and Injuries surgery, Critical Care statistics & numerical data, Elective Surgical Procedures statistics & numerical data, Frail Elderly statistics & numerical data, Frailty surgery, Hospitalization statistics & numerical data
Abstract: Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed., Methods: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality., Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02)., Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery., Trial Registration: NCT03134807. Registered 1st May 2017., (Copyright © 2019 Elsevier Inc. All rights reserved.)
Published: 2019
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28. Differential Effects of Selective and Nonselective Potassium Channel Inhibitors in Ovine Endotoxemic Shock (Macrocirculation) and in a Rat Model of Septic Shock (Microcirculation).

Author: Hessler M, Pinto BB, Arnemann PH, Kampmeier TG, Seidel L, Morelli A, Van Aken H, Westphal M, Rehberg S, and Ertmer C
Subjects: Animals, Female, Male, Rats, Rats, Sprague-Dawley, Sheep, Endotoxemia blood, Endotoxemia chemically induced, Endotoxemia drug therapy, Endotoxemia physiopathology, Glipizide pharmacology, Microcirculation drug effects, Potassium Channel Blockers pharmacology, Shock, Septic blood, Shock, Septic chemically induced, Shock, Septic drug therapy, Shock, Septic physiopathology, Vascular Resistance drug effects
Abstract: Background: Potassium-(K)-channel inhibitors may increase systemic vascular resistance in vasodilatory shock states., Objective: The purpose of the present study was to compare the macro- and microvascular effects of the adenosine triphosphate-sensitive K-channel-(KATP)-inhibitor glipizide and the nonselective K-channel inhibitor tetraethylammonium (TEA) in ovine endotoxemic shock and septic shock in rats., Design: Two randomized, controlled laboratory studies., Animals: Thirty female sheep and 40 male Sprague Dawley rats., Setting: Animal research facility INTERVENTION:: Systemic hemodynamics were analyzed in ovine endotoxemic shock with guideline-oriented supportive therapy. Sheep were allocated to three treatment groups for 12 h: glipizide 10 mg kg·h, TEA 8 mg kg·h, or 0.9% saline. The microvascular effects of each drug were evaluated in septic rats (cecal ligation and puncture model) receiving a 2-h infusion of each study drug: glipizide 20 mg kg·h; TEA 50 mg kg·h, or 0.9% saline, respectively, followed by intravital microscopy of villi microcirculation., Results: Compared with the control group, glipizide infusion increased systemic vascular resistance index and decreased cardiac index and heart rate (HR) in sheep (P < 0.05), whereas TEA infusion decreased HR and resulted in a decreased survival time (P = 0.001). In rats, glipizide infusion resulted in an increase in mean arterial pressure and a decrease in HR compared with baseline measurement (P < 0.05) without relevant effects on the villi microcirculation. TEA decreased HR and decreased capillary perfusion of the villi microcirculation compared with the sham group (P = 0.002)., Conclusions: Selective inhibition of KATP-channels in ovine endotoxemic shock with glipizide partially restored vasomotor tone without exerting harmful effects on intestinal microcirculation in septic shock in rats. On the contrary, nonselective K-channel inhibition with TEA showed deleterious effects in both models, including impaired microcirculation and decreased survival time. Future research on glipizide in vasodilatory shock may be warranted.
Published: 2019
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29. Feature selection for the accurate prediction of septic and cardiogenic shock ICU mortality in the acute phase.

Author: Aushev A, Ripoll VR, Vellido A, Aletti F, Pinto BB, Herpain A, Post EH, Medina ER, Ferrer R, Baselli G, and Bendjelid K
Subjects: APACHE, Female, Hospital Mortality, Humans, Male, Models, Theoretical, Predictive Value of Tests, Intensive Care Units, Shock, Cardiogenic mortality, Shock, Septic mortality
Abstract: Circulatory shock is a life-threatening disease that accounts for around one-third of all admissions to intensive care units (ICU). It requires immediate treatment, which is why the development of tools for planning therapeutic interventions is required to deal with shock in the critical care environment. In this study, the ShockOmics European project original database is used to extract attributes capable of predicting mortality due to shock in the ICU. Missing data imputation techniques and machine learning models were used, followed by feature selection from different data subsets. Selected features were later used to build Bayesian Networks, revealing causal relationships between features and ICU outcome. The main result is a subset of predictive features that includes well-known indicators such as the SOFA and APACHE II scores, but also less commonly considered ones related to cardiovascular function assessed through echocardiograpy or shock treatment with pressors. Importantly, certain selected features are shown to be most predictive at certain time-steps. This means that, as shock progresses, different attributes could be prioritized. Clinical traits obtained at 24h. from ICU admission are shown to accurately predict cardiogenic and septic shock mortality, suggesting that relevant life-saving decisions could be made shortly after ICU admission., Competing Interests: The authors have declared that no competing interests exist.
Published: 2018
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30. Correction to: Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit.

Author: Guidet B, Flaatten H, Boumendil A, Morandi A, Andersen FH, Artigas A, Bertolini G, Cecconi M, Christensen S, Faraldi L, Fjølner J, Jung C, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Zafeiridis T, and De Lange DW
Abstract: In the original publication Dr Patrick Meybohm of the Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt University Hospital, Frankfurt, Germany was inadvertently omitted from the list of investigators.
Published: 2018
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31. Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit.

Author: Guidet B, Flaatten H, Boumendil A, Morandi A, Andersen FH, Artigas A, Bertolini G, Cecconi M, Christensen S, Faraldi L, Fjølner J, Jung C, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Zafeiridis T, and De Lange DW
Subjects: Aged, 80 and over, Decision Making, Europe, Humans, Intensive Care Units, Male, Prospective Studies, Life Support Care, Withholding Treatment
Abstract: Purpose: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU., Methods: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up., Results: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries., Conclusions: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country., Trial Registration: ClinicalTrials.gov (ID: NTC03134807).
Published: 2018
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32. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years).

Author: Flaatten H, De Lange DW, Morandi A, Andersen FH, Artigas A, Bertolini G, Boumendil A, Cecconi M, Christensen S, Faraldi L, Fjølner J, Jung C, Marsh B, Moreno R, Oeyen S, Öhman CA, Pinto BB, Soliman IW, Szczeklik W, Valentin A, Watson X, Zaferidis T, and Guidet B
Subjects: Aged, 80 and over, Critical Illness mortality, Europe epidemiology, Euthanasia, Passive, Female, Frailty classification, Frailty diagnosis, Frailty therapy, Geriatric Assessment, Humans, Length of Stay statistics & numerical data, Male, Outcome Assessment, Health Care, Proportional Hazards Models, Prospective Studies, Quality of Life, Severity of Illness Index, Time Factors, Frail Elderly statistics & numerical data, Frailty mortality, Hospital Mortality, Intensive Care Units statistics & numerical data
Abstract: Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population., Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days., Results: A total of 5021 patients with a median age of 84 years (IQR 81-86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38-1.73) for frail versus non-frail., Conclusions: Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group., Trial Registration: ClinicalTrials.gov (ID: NCT03134807).
Published: 2017
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33. The use of the oesophageal Doppler in perioperative medicine: new opportunities in research and clinical practice.

Author: Pinto BB, Atlas G, Geerts BF, and Bendjelid K
Subjects: Aorta physiology, Aorta, Thoracic diagnostic imaging, Arterial Pressure, Blood Flow Velocity, Cardiac Output physiology, Critical Care, Echocardiography, Doppler, Echocardiography, Transesophageal, Fluid Therapy, Hemodynamics, Humans, Intensive Care Units, Kinetics, Myocardial Contraction, Perioperative Period, Pressure, Stroke Volume, Ventricular Function, Left, Esophagus diagnostic imaging, Ultrasonography, Doppler
Abstract: The oesophageal Doppler (OD) is a minimally invasive haemodynamic monitor used in the surgical theatre and the ICU. Using the OD, goal-directed therapy (GDT) has been shown to reduce perioperative complications in high-risk surgical patients. However, most GDT protocols currently in use are limited to stroke volume optimisation. In the present manuscript, we examine the conceptual models behind new OD-based measurements. These would provide the clinician with a comprehensive view of haemodynamic pathophysiology; including pre-load, contractility, and afterload. Specifically, volume status could be estimated using mean systemic filling pressure (MSFP), the pressure to which all intravascular pressures equilibrate during asystole. Using the OD, MSFP could be readily estimated by simultaneous measurements of aortic blood flow and arterial pressure with sequential manoeuvres of increasing airway pressure. This would result in subsequent reductions in cardiac output and arterial pressure and would allow for a linear extrapolation of a static MSFP value to a "zero flow" state. In addition, we also demonstrate that EF is proportional to mean blood flow velocity measured in the descending thoracic aorta with the OD. Furthermore, OD-derived indexes of blood flow velocity and acceleration, as well as force and kinetic energy, can be derived and used for continuous assessment of cardiac contractility at the bedside. Using OD-derived parameters, the different components of afterload: inertia, resistance and elastance, could also be individually determined. The integration of these additional haemodynamic parameters could assist the clinician in optimising and individualising haemodynamic performance in unstable patients.
Published: 2017
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34. Reply to: risk prediction instruments in geriatric surgery are available but often ignored.

Author: Pinto BB, Rached MAKB, and Walder B
Subjects: Aged, Humans, Risk Assessment, Risk Factors, Surgical Procedures, Operative adverse effects
Published: 2017
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35. Effects of local pressure on cutaneous blood flow in pigs.

Author: Vaena MLHT, Sinnecker JP, Pinto BB, Neves MFT, Serra-Guimarães F, and Marques RG
Subjects: Animals, Regional Blood Flow, Swine, Pressure adverse effects, Skin blood supply
Abstract: Objective: to evaluate the effects of increasing pressures on the cutaneous blood flow in the skin of pigs., Methods: we conducted an experimental study in pigs submitted to subcutaneous magnetic implants (n=30). After healing, were applied external magnets with varying magnetic forces to the skin, generating compression. We evaluated the cutaneous circulation of the skin under compression by the Laser Speckle Contrast Imaging (LSCI) technique. We measured the depth of the implants by ultrasonography, and applied computational simulations to the calculation of the different pressure values, considering the different distances between implants and external magnets., Results: nineteen implants presented complications. The remaining 11 were submitted to different magnetic compression forces and perfusion analysis. Two linear regression models showed an inverse correlation between exerted pressure and cutaneous perfusion, with significant variation, mainly in the initial pressure increases, of up to 20mmHg., Conclusion: The main reduction in cutaneous blood flow resulted from initial increases of up to 20 mmHg. The results suggest that tissue ischemia can occur even in low-pressure regimes, which could contribute to the appearance of skin lesions, particularly ulcers related to medical devices.
Published: 2017
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36. Characterization of a metabolomic profile associated with responsiveness to therapy in the acute phase of septic shock.

Author: Cambiaghi A, Pinto BB, Brunelli L, Falcetta F, Aletti F, Bendjelid K, Pastorelli R, and Ferrario M
Subjects: Aged, Aged, 80 and over, Female, Humans, Male, Mass Spectrometry, Metabolomics, Middle Aged, Survival Analysis, Time Factors, Treatment Outcome, Critical Care methods, Metabolome, Plasma chemistry, Resuscitation methods, Shock, Septic pathology, Shock, Septic therapy
Abstract: The early metabolic signatures associated with the progression of septic shock and with responsiveness to therapy can be useful for developing target therapy. The Sequential Organ Failure Assessment (SOFA) score is used for stratifying risk and predicting mortality. This study aimed to verify whether different responses to therapy, assessed as changes in SOFA score at admission (T1, acute phase) and 48 h later (T2, post-resuscitation), are associated with different metabolite patterns. We examined the plasma metabolome of 21 septic shock patients (pts) enrolled in the Shockomics clinical trial (NCT02141607). Patients for which SOFA T2 was >8 and Δ = SOFA T1 - SOFA T2 < 5, were classified as not responsive to therapy (NR, 7 pts), the remaining 14 as responsive (R). We combined untargeted and targeted mass spectrometry-based metabolomics strategies to cover the plasma metabolites repertoire as far as possible. Metabolite concentration changes from T1 to T2 (Δ = T2 - T1) were used to build classification models. Our results support the emerging evidence that lipidome alterations play an important role in individual patients' responses to infection. Furthermore, alanine indicates a possible alteration in the glucose-alanine cycle in the liver, providing a different picture of liver functionality from bilirubin. Understanding these metabolic disturbances is important for developing any effective tailored therapy for these patients.
Published: 2017
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37. Improved Survival in a Long-Term Rat Model of Sepsis Is Associated With Reduced Mitochondrial Calcium Uptake Despite Increased Energetic Demand.

Author: Pinto BB, Dyson A, Umbrello M, Carré JE, Ritter C, Clatworthy I, Duchen MR, and Singer M
Subjects: Animals, Dobutamine pharmacology, Echocardiography, Male, Microscopy, Electron, NAD metabolism, Rats, Rats, Wistar, Calcium metabolism, Mitochondria metabolism, Myocytes, Cardiac metabolism, Sarcoplasmic Reticulum metabolism, Sepsis physiopathology
Abstract: Objectives: To investigate the relationship between prognosis, changes in mitochondrial calcium uptake, and bioenergetic status in the heart during sepsis., Design: In vivo and ex vivo controlled experimental studies., Setting: University research laboratory., Subjects: Male adult Wistar rats., Interventions: Sepsis was induced by intraperitoneal injection of fecal slurry. Sham-operated animals served as controls. Confocal microscopy was used to study functional and bioenergetic parameters in cardiomyocytes isolated after 24-hour sepsis. Electron microscopy was used to characterize structural changes in mitochondria and sarcoplasmic reticulum. The functional response to dobutamine was assessed in vivo by echocardiography., Measurements and Main Results: Peak aortic blood flow velocity measured at 24 hours was a good discriminator for 72-hour survival (area under the receiver operator characteristic, 0.84 ± 0.1; p = 0.03) and was used in ex vivo experiments at 24 hours to identify septic animals with good prognosis. Measurements from animals with good prognostic showed 1) a smaller increase in mitochondrial calcium content and in nicotinamide adenine dinucleotide fluorescence following pacing and 2) increased distance between mitochondria and sarcoplasmic reticulum on electron microscopy, and 3) nicotinamide adenine dinucleotide redox potential and adenosine triphosphate/adenosine diphosphate failed to reach a new steady state following pacing, suggesting impaired matching of energy supply and demand. In vivo, good prognosis animals had a blunted response to dobutamine with respect to stroke volume and kinetic energy., Conclusions: In situations of higher energetic demand decreased mitochondrial calcium uptake may constitute an adaptive cellular response that confers a survival advantage in response to sepsis at a cost of decreased oxidative capacity.
Published: 2017
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38. Characterization of Brain-Heart Interactions in a Rodent Model of Sepsis.

Author: Pinto BB, Ritter C, Michels M, Gambarotta N, Ferrario M, Dal-Pizzol F, and Singer M
Subjects: Animals, Biomarkers metabolism, Cytokines blood, Disease Models, Animal, Heart Rate, Hemodynamics, Hormones blood, Humans, Inflammation pathology, Kaplan-Meier Estimate, Male, Myocardial Contraction, Myocardium pathology, Nitrosative Stress, Oxidative Stress, Rats, Wistar, Rodentia, Sepsis blood, Brain pathology, Brain physiopathology, Heart physiopathology, Sepsis pathology, Sepsis physiopathology
Abstract: Loss of heart rate variability (HRV) and autonomic dysfunction are associated with poor outcomes in critically ill patients. Neuronal networks comprising brainstem and hypothalamus are involved in the "flight-or-fight" response via control over the autonomic nervous system and circulation. We hypothesized that sepsis-induced inflammation in brain regions responsible for autonomic control is associated with sympathovagal imbalance and depressed contractility. Sepsis was induced by fecal slurry injection in fluid-resuscitated rats. Sham-operated animals served as controls. Echocardiography-derived peak velocity (PV) was used to separate septic animals into good (PV ≥0.93 m/s, low 72-h mortality) and bad (PV <0.93, high 72-h mortality) prognosis. Cytokine protein levels were assessed by ELISA. All experiments were performed at 24 h post-insult. Increased levels of inflammation and oxidative injury were observed in the hypothalamus (TNF-α, IL-10, nitrite and nitrate and carbonyl groups) and brainstem (IL-1, IL-6, IL-10, nitrite and nitrate and carbonyl groups) of the septic animals (p < 0.05 vs. sham), but not in the pre-frontal cortex, an area not directly implicated in control of the autonomic nervous system. Good prognosis septic animals had increased sympathetic output and increased left ventricular contractility (p < 0.05 vs. sham). There was a significant inverse correlation between high frequency power (a marker of parasympathetic outflow) and contractility (r = -0.73, p < 0.05). We found no correlation between the degree of inflammation or injury to autonomic centers and cardiovascular function. In conclusion, control of autonomic centers and cardiac function in our long-term rodent model of sepsis was related to clinical severity but not directly to the degree of inflammation.
Published: 2017
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39. Risk prediction instruments to guide perioperative care in elderly patients with advanced disease: A basic necessity.

Author: Pinto BB, Rached MA, and Walder B
Subjects: Aged, Aged, 80 and over, Critical Illness therapy, Humans, Postoperative Complications diagnosis, Postoperative Complications prevention & control, Predictive Value of Tests, Risk Factors, Frail Elderly, Perioperative Care methods, Risk Assessment methods
Published: 2016
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40. Heterotopic cervical pregnancy management after a high-complexity assisted reproduction procedure.

Author: Pinto BB, Torres TP, Narváez MB, Rojas XB, Burgos IA, and Constante PE
Subjects: Adult, Curettage, Ecuador, Female, Humans, Pregnancy, Pregnancy Reduction, Multifetal, Pregnancy, Heterotopic diagnostic imaging, Pregnancy, Heterotopic surgery, Sperm Injections, Intracytoplasmic
Abstract: Heterotopic cervical pregnancies with a viable intrauterine pregnancy are rare, the conservative and prudent management of these cases should be focused on the selective reduction of cervical pregnancies in order to maintain eutopic pregnancy. This paper reports the first case in Ecuador of a heterotopic cervical pregnancy after ICSI procedure and its proper management by ultrasound-guided curettage, allowing the normal development as an intrauterine pregnancy.
Published: 2016
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41. VV-ECMO and brave heart: A subtle competition?

Author: Pinto BB, Siegenthaler N, Tassaux D, Banfi C, Bendjelid K, and Giraud R
Subjects: Adult, Humans, Male, Respiratory Distress Syndrome blood, Extracorporeal Membrane Oxygenation methods, Oxygen Consumption physiology, Respiratory Distress Syndrome therapy
Published: 2015
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42. Lateral sphenoid sinus recess cerebrospinal fluid leak: a case series.

Author: Melo NA, Borges BB, Magliarelli Filho PA, Godoy MD, Pereira LV, Pinna Fde R, and Voegels RL
Subjects: Adult, Cerebrospinal Fluid Leak diagnosis, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Middle Aged, Sphenoid Sinus, Tomography, X-Ray Computed, Cerebrospinal Fluid Leak surgery, Natural Orifice Endoscopic Surgery methods, Otorhinolaryngologic Surgical Procedures methods, Sphenoid Bone surgery
Abstract: The lateral recess of the sphenoid sinus is one of the most common sites of meningocele and spontaneous cerebrospinal fluid (CSF) leak. Despite the availability of several techniques for closure of skull base defects occurring in this location, recurrence still poses a major challenge. This report reviews the experience of surgical repair of lateral sphenoid sinus recess CSF leak at a tertiary referral center and provides a brief discussion of this rare lesion. Nine surgeries were performed for six cases of spontaneous lateral sphenoid sinus recess CSF leak (two revisions and one repair of a new defect). Two patients presented with intracranial hypertension (ICH) and four with meningocele or meningoencephalocele. The transpterygoid approach was used in two procedures. A multilayer graft was used in seven cases and a nasoseptal flap in two. Three patients received lumbar or ventricular shunts, and one received acetazolamide for ICH management. Two minor complications were recorded, and the overall surgical success rate was 78 %. We conclude that nasoseptal flaps are a valid option for repair of recurrent CSF leaks, particularly in the lateral sphenoid sinus recess. Furthermore, identification and correction of ICH plays an essential role in the success of treatment in this patient population.
Published: 2014
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43. Inflammation biomarkers and delirium in critically ill patients.

Author: Ritter C, Tomasi CD, Dal-Pizzol F, Pinto BB, Dyson A, de Miranda AS, Comim CM, Soares M, Teixeira AL, Quevedo J, and Singer M
Subjects: Adult, Aged, Biomarkers blood, Cohort Studies, Female, Humans, Intensive Care Units trends, Male, Middle Aged, Prospective Studies, Critical Illness, Delirium blood, Delirium diagnosis
Abstract: Introduction: Delirium is a common occurrence in critically ill patients and is associated with an increase in morbidity and mortality. Septic patients with delirium may differ from a general critically ill population. The aim of this investigation was to study the relationship between systemic inflammation and the development of delirium in septic and non-septic critically ill patients., Methods: We performed a prospective cohort study in a 20-bed mixed intensive care unit (ICU) including 78 (delirium = 31; non-delirium = 47) consecutive patients admitted for more than 24 hours. At enrollment, patients were allocated to septic or non-septic groups according to internationally agreed criteria. Delirium was diagnosed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) during the first 72 hours of ICU admission. Blood samples were collected within 12 hours of enrollment for determination of tumor necrosis factor (TNF)-α, soluble TNF Receptor (STNFR)-1 and -2, interleukin (IL)-1β, IL-6, IL-10 and adiponectin., Results: Out of all analyzed biomarkers, only STNFR1 (P = 0.003), STNFR2 (P = 0.005), adiponectin (P = 0.005) and IL-1β (P < 0.001) levels were higher in delirium patients. Adjusting for sepsis and sedation, these biomarkers were also independently associated with delirium occurrence. However, none of them were significant influenced by sepsis., Conclusions: STNFR1, STNFR2, adiponectin and IL-1β were associated with delirium. Sepsis did not modify the relationship between the biomarkers and delirium occurrence.
Published: 2014
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44. Main causes and diagnostic evaluation in patients with primary complaint of olfactory disturbances.

Author: Fornazieri MA, Borges BB, Bezerra TF, Pinna Fde R, and Voegels RL
Subjects: Adult, Craniocerebral Trauma complications, Female, Humans, Male, Nasal Polyps complications, Respiratory Tract Infections complications, Respiratory Tract Infections virology, Retrospective Studies, Rhinitis complications, Sinusitis complications, Olfaction Disorders diagnosis, Olfaction Disorders etiology
Abstract: Introduction: Establishing a diagnosis in patients with olfactory disturbances has always been challenging for physicians.One reason for this is the rarity of some of the diseases that affect this sense, such as Kallmann's syndrome and post-viral olfactory loss., Objective: To identify the major causes of olfactory disturbances and to describe the diagnostic evaluation in outpatients attended to at an ambulatory clinic specialized in olfaction disorders., Methods: A retrospective analysis was performed in outpatients with primary olfactory complaint attended to between June 1, 2011 and September 30, 2013 in a center specialized in olfactory disorders. Patient history, nasofibroscopy, and the University of Pennsylvania Smell Identification Test (UPSIT) comprised the examination., Results: Sixty-two patients were evaluated. The major causes were chronic rhinosinusitis (31%); rhinitis, primarily the allergic type (19%); post-viral olfactory loss (13%); and post-traumatic loss (8%). UPSIT scores were statistically different among different etiologies (p = 0.01)., Conclusions: The major diagnoses that should be part of the physician assessment when a patient complains of olfactory disturbance are chronic rhinosinusitis with and without polyps, allergic rhinitis, post-viral olfactory loss, and post-traumatic loss.
Published: 2014
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45. Short-term hypoxic vasodilation in vivo is mediated by bioactive nitric oxide metabolites, rather than free nitric oxide derived from haemoglobin-mediated nitrite reduction.

Author: Umbrello M, Dyson A, Pinto BB, Fernandez BO, Simon V, Feelisch M, and Singer M
Subjects: Adaptation, Physiological, Animals, Blood Flow Velocity, Blood Pressure, Free Radicals, Male, Oxidation-Reduction, Oxygen Consumption, Rats, Wistar, Aorta physiopathology, Hemoglobins metabolism, Hypoxia physiopathology, Nitric Oxide metabolism, Nitrites metabolism, Oxygen metabolism, Vasodilation
Abstract: Local increases in blood flow--'hypoxic vasodilation'--confer cellular protection in the face of reduced oxygen delivery. The physiological relevance of this response is well established, yet ongoing controversy surrounds its underlying mechanisms. We sought to confirm that early hypoxic vasodilation is a nitric oxide (NO)-mediated phenomenon and to study putative pathways for increased levels of NO, namely production from NO synthases, intravascular nitrite reduction, release from preformed stores and reduced deactivation by cytochrome c oxidase. Experiments were performed on spontaneously breathing, anaesthetized, male Wistar rats undergoing short-term systemic hypoxaemia, who received pharmacological inhibitors and activators of the various NO pathways. Arterial blood pressure, cardiac output, tissue oxygen tension and the circulating pool of NO metabolites (oxidation, nitrosation and nitrosylation products) were measured in plasma and erythrocytes. Hypoxaemia caused a rapid and sustained vasodilation, which was only partially reversed by non-selective NO synthase inhibition. This was associated with significantly lower plasma nitrite, and marginally elevated nitrate levels, suggestive of nitrite bioinactivation. Administration of sodium nitrite had little effect in normoxia, but produced significant vasodilation and increased nitrosylation during hypoxaemia that could not be reversed by NO scavenging. Methodological issues prevented assessment of the contribution, if any, of reduced deactivation of NO by cytochrome c oxidase. In conclusion, acute hypoxic vasodilation is an adaptive NO-mediated response conferred through bioactive metabolites rather than free NO from haemoglobin-mediated reduction of nitrite.
Published: 2014
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46. The metabolic phenotype of rodent sepsis: cause for concern?

Author: Zolfaghari PS, Pinto BB, Dyson A, and Singer M
Abstract: Purpose: Rodent models of sepsis are frequently used to investigate pathophysiological mechanisms and to evaluate putative therapeutic strategies. However, preclinical efficacy in these models has failed to translate to the clinical setting. We thus questioned the representativeness of such models and herein report a detailed comparison of the metabolic and cardiovascular phenotypes of long-term faecal peritonitis in fluid-resuscitated rats and mice with similar mortality profiles., Methods: We conducted prospective laboratory-controlled studies in adult male Wistar rats and C57 black mice. Animals were made septic by intraperitoneal injection of faecal slurry. Rats received continuous intravenous fluid resuscitation, whereas mice received intermittent fluid boluses subcutaneously. Sham-treated animals served as controls. Survival was assessed over 72 h. In separate studies, whole body metabolism (O2 consumption, CO2 production) was measured over 24 h with echocardiography performed at early (6 h) and established (24 h) phases of sepsis. Blood gas analysis was performed at 6 h (rats) and 24 h (rats, mice)., Results: Similar survival curves were seen in both rodent models with approximately 75% mortality at 72 h. In mice, sepsis caused severity-dependent falls in core temperature and global metabolism. Oxygen consumption in severely septic mice fell by 38% within 2 h, and 80% at 22 h compared with baseline values. This was only partially restored by external warming. By contrast, septic rats maintained core temperature; only severely affected animals showed a pre-mortem decline in oxygen consumption. Significant myocardial dysfunction was seen in mice during early and established sepsis, whereas peak velocity and other hemodynamic variables in rats were similar at 6 h and significantly worse by 24 h in severely septic animals only., Conclusions: Markedly differing metabolic and cardiovascular profiles were seen in long-term fluid-resuscitated rat and mouse models of bacterial sepsis despite similar mortality. The mouse model, in particular, does not represent the human condition. We urge caution in applying findings in murine models to septic patients, both with regard to our understanding of pathophysiology and the failure to translate preclinical efficacy into successful clinical trials.
Published: 2013
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47. Giant cell bone lesions in the craniofacial region: a diagnostic and therapeutic challenge.

Author: Borges BB, Fornazieri MA, Bezerra AP, Martins LA, Pinna Fde R, and Voegels RL
Subjects: Adult, Aged, Child, Diagnosis, Differential, Female, Giant Cell Tumor of Bone surgery, Granuloma, Giant Cell surgery, Humans, Middle Aged, Skull Neoplasms surgery, Facial Bones, Giant Cell Tumor of Bone diagnosis, Granuloma, Giant Cell diagnosis, Skull Neoplasms diagnosis
Abstract: Background: Giant cell tumors of bone (GCTs) are common in the long bones, but rare in the craniofacial region, with only 1% of cases occurring in the latter. Clinical, radiological, and anatomical diagnosis of this locally aggressive disease, which occurs in response to trauma or neoplastic transformation, poses a major challenge in clinical practice., Methods: The present study describes a series of 4 cases and highlights the main features of the differential diagnosis and treatment of these lesions: GCT, giant cell reparative granuloma (GCRG), and the brown tumor of hyperparathyroidism., Results: GCT presents as a benign neoplasm, most typically affecting the knees, and rarely in the temporal and sphenoid bones. It is radiologically indistinguishable from GCRG due to its lytic, poorly defined appearance. The distinction can only be made microscopically, as the presence of multinucleated giant cells scattered throughout the stroma and the absence of a history of trauma favor a diagnosis of GCT. The brown tumor of hyperparathyroidism occurs with rapid, localized osteoclast activity secondary to the effects of increased parathyroid hormone (PTH) levels; parathyroid examination is indispensable., Conclusion: The diagnosis and treatment of these lesions poses a major challenge due to their similar clinical presentation and radiological appearance. Accurate diagnosis is essential for definition of appropriate management, as complete resection is the goal in GCT and GCRG to avoid recurrence, whereas the brown tumor often yields to treatment of the underlying hyperparathyroidism., (Copyright © 2012 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.)
Published: 2012
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48. Renal effects of saline-based 10% pentastarch versus 6% tetrastarch infusion in ovine endotoxemic shock.

Author: Ertmer C, Köhler G, Rehberg S, Morelli A, Lange M, Ellger B, Pinto BB, Rübig E, Erren M, Fischer LG, Van Aken H, and Westphal M
Subjects: Animals, Body Weight, Creatinine blood, Diuresis, Endotoxins toxicity, Female, Hemodynamics physiology, Kidney ultrastructure, Kidney Function Tests, Kidney Tubules pathology, Lipopolysaccharides toxicity, Microscopy, Electron, Microscopy, Electron, Transmission, Osmotic Pressure, Oxygen Consumption drug effects, Proteins metabolism, Renal Circulation drug effects, Renal Circulation physiology, Sheep, Urea blood, Endotoxemia pathology, Hydroxyethyl Starch Derivatives toxicity, Kidney pathology, Kidney Diseases chemically induced, Kidney Diseases pathology, Plasma Substitutes toxicity, Shock, Septic pathology
Abstract: Background: Conflicting data exist on the renal effects of hydroxyethyl starch (HES) preparations. The current study evaluates the effects of saline-based 6% HES 130/0.4, 10% HES 200/0.5, and a balanced isotonic crystalloid on renal function and microscopic changes in ovine endotoxemic shock., Methods: Thirty sheep were subjected to endotoxin infusion (Salmonella typhosa) at incremental doses until mean arterial pressure was less than 65 mmHg. Animals were randomized to receive fluid resuscitation with saline-based 6% HES 130/0.4, 10% HES 200/0.5, or a balanced isotonic crystalloid (n = 10 each). Animals surviving the 12-h intervention period were anesthetized and killed. Kidney samples were taken for microscopic analyses., Results: Endotoxemia was associated with hemoconcentration, protein extravasation, and arterial hypotension. Fluid resuscitation established a hypotensive-hyperdynamic circulation with increased cardiac index and oxygen delivery and decreased afterload. Diuresis was lowest in animals treated with 10% HES 200/0.5. In addition, plasma creatinine and urea concentrations increased in sheep treated with 10% HES 200/0.5 (1.2 +/- 0.1 and 19 +/- 2 mg/dl) when compared with the other two groups (0.9 +/- 0.1 and 15 +/- 1 mg/dl, 6% HES 130/0.4; 0.9 +/- 0.1 and 15 +/- 1 mg/dl, crystalloids; each P < 0.05). Electron microscopic tubular injury score was highest in sheep treated with 10% HES 200/0.5 (P < 0.001 vs. 6% HES 130/0.4)., Conclusions: In ovine endotoxemic shock, saline-based 10% HES 200/0.5 was linked to impaired renal function and more pronounced tubular epithelial injury when compared with 6% HES 130/0.4 and balanced crystalloids.
Published: 2010
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49. Role of levosimendan in sepsis and septic shock.

Author: Pinto BB, Rehberg S, Ertmer C, and Westphal M
Subjects: Animals, Calcium metabolism, Dose-Response Relationship, Drug, Drug Interactions, Endotoxemia drug therapy, Heart Failure drug therapy, Humans, Hydrazones adverse effects, Hydrazones pharmacology, Potassium Channels drug effects, Pyridazines adverse effects, Pyridazines pharmacology, Simendan, Hydrazones therapeutic use, Pyridazines therapeutic use, Sepsis drug therapy, Shock, Septic drug therapy
Abstract: Purpose of Review: To present the pharmacologic and biologic profile of levosimendan and discuss potential indications in the treatment of sepsis and septic shock, with a special focus on myocardial and pulmonary dysfunction., Recent Findings: In animal models of endotoxic shock, levosimendan improved both left ventricular systolic and diastolic dysfunction, as well as ventriculovascular coupling. In addition, positive effects have been reported on right ventricular performance and pulmonary circulation. Two randomized, controlled trials in patients with septic shock revealed levosimendan provided consistent beneficial effects on cardiopulmonary performance, global oxygen transport, splanchnic perfusion and renal function. These effects have been reported as superior to placebo and the classic inotropic agent dobutamine. Due to its vasodilatory effects, combination with vasoconstrictor agents may be crucial in the presence of arterial hypotension., Summary: There is increasing evidence that levosimendan exerts beneficial effects in the treatment of sepsis-induced myocardial and pulmonary dysfunction. Future large-scale multicenter clinical trials are now needed to clarify whether levosimendan improves the overall outcome of patients with sepsis and septic shock.
Published: 2008
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