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1. Improving competence and safety in pain medicine: a practical clinical teaching strategy for students combining simulation and bedside teaching

Author: Sandra Kurz, Jana Lohse, Holger Buggenhagen, Irene Schmidtmann, Rita Laufenberg-Feldmann, and Kristin Engelhard
Subjects: Medical training, Multi-professional education, Simulated patients, Interactive medical training, Curriculum innovation, Bedside teaching, Special aspects of education, LC8-6691, Medicine
Abstract: Abstract Background Pain is a devastating sensation and has to be treated immediately. Therefore, we developed a training program to improve the knowledge of medical students in the field of pain medicine. In the present study, the applicability and efficacy of this training program was tested. Methods Half of the students attended first a training with simulated patients (SP) followed by bedside teaching (Group 1). Group 2 performed the training programs in reverse order. The evaluation based on standardized questionnaires completed by students (self-assessment) and all students took part in two practical examinations after the learning interventions. Results This study included 35 students. The quality of the simulation was evaluated by the students with average grade 1.1 (1 = very good, 6 = very bad). The practical work on the ward with patients was rated with grade 1.4 of 6, the whole course with 1.1. Students of Group A were significantly better in the final examination (grade 1.7 vs. grade 2.2, p
Published: 2021
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2. Liberal transfusion strategy to prevent mortality and anaemia-associated, ischaemic events in elderly non-cardiac surgical patients – the study design of the LIBERAL-Trial

Author: Patrick Meybohm, Simone Lindau, Sascha Treskatsch, Roland Francis, Claudia Spies, Markus Velten, Maria Wittmann, Erdem Gueresir, Christian Stoppe, Ana Kowark, Mark Coburn, Sixten Selleng, Marcel Baschin, Gregor Jenichen, Melanie Meersch, Thomas Ermert, Alexander Zarbock, Peter Kranke, Markus Kredel, Antonia Helf, Rita Laufenberg-Feldmann, Marion Ferner, Eva Wittenmeier, Karl-Heinz Gürtler, Peter Kienbaum, Marcel Gama de Abreu, Michael Sander, Michael Bauer, Timo Seyfried, Matthias Gruenewald, Suma Choorapoikayil, Markus M. Mueller, Erhard Seifried, Oana Brosteanu, Holger Bogatsch, Dirk Hasenclever, Kai Zacharowski, and LIBERAL Collaboration Group
Subjects: Red blood cell transfusion, anaemia, surgery, elderly patients, Medicine (General), R5-920
Abstract: Abstract Background Perioperative anaemia leads to impaired oxygen supply with a risk of vital organ ischaemia. In healthy and fit individuals, anaemia can be compensated by several mechanisms. Elderly patients, however, have less compensatory mechanisms because of multiple co-morbidities and age-related decline of functional reserves. The purpose of the study is to evaluate whether elderly surgical patients may benefit from a liberal red blood cell (RBC) transfusion strategy compared to a restrictive transfusion strategy. Methods The LIBERAL Trial is a prospective, randomized, multicentre, controlled clinical phase IV trial randomising 2470 elderly (≥ 70 years) patients undergoing intermediate- or high-risk non-cardiac surgery. Registered patients will be randomised only if Haemoglobin (Hb) reaches ≤9 g/dl during surgery or within 3 days after surgery either to the LIBERAL group (transfusion of a single RBC unit when Hb ≤ 9 g/dl with a target range for the post-transfusion Hb level of 9–10.5 g/dl) or the RESTRICTIVE group (transfusion of a single RBC unit when Hb ≤ 7.5 g/dl with a target range for the post-transfusion Hb level of 7.5–9 g/dl). The intervention per patient will be followed until hospital discharge or up to 30 days after surgery, whichever occurs first. The primary efficacy outcome is defined as a composite of all-cause mortality, acute myocardial infarction, acute ischaemic stroke, acute kidney injury (stage III), acute mesenteric ischaemia and acute peripheral vascular ischaemia within 90 days after surgery. Infections requiring iv antibiotics with re-hospitalisation are assessed as important secondary endpoint. The primary endpoint will be analysed by logistic regression adjusting for age, cancer surgery (y/n), type of surgery (intermediate- or high-risk), and incorporating centres as random effect. Discussion The LIBERAL-Trial will evaluate whether a liberal transfusion strategy reduces the occurrence of major adverse events after non-cardiac surgery in the geriatric population compared to a restrictive strategy within 90 days after surgery. Trial registration ClinicalTrials.gov (identifier: NCT03369210).
Published: 2019
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3. Genome-wide association study of myocardial infarction, atrial fibrillation, acute stroke, acute kidney injury and delirium after cardiac surgery – a sub-analysis of the RIPHeart-Study

Author: Sabine Westphal, Christian Stoppe, Matthias Gruenewald, Berthold Bein, Jochen Renner, Jochen Cremer, Mark Coburn, Gereon Schaelte, Andreas Boening, Bernd Niemann, Frank Kletzin, Jan Roesner, Ulrich Strouhal, Christian Reyher, Rita Laufenberg-Feldmann, Marion Ferner, Ivo F. Brandes, Martin Bauer, Andreas Kortgen, Sebastian N. Stehr, Maria Wittmann, Georg Baumgarten, Rafael Struck, Tanja Meyer-Treschan, Peter Kienbaum, Matthias Heringlake, Julika Schoen, Michael Sander, Sascha Treskatsch, Thorsten Smul, Ewa Wolwender, Thomas Schilling, Frauke Degenhardt, Andre Franke, Soeren Mucha, Lukas Tittmann, Madeline Kohlhaas, Georg Fuernau, Oana Brosteanu, Dirk Hasenclever, Kai Zacharowski, Patrick Meybohm, and RIPHeart-Study Collaborators
Subjects: Genome-wide association study, Cardiac surgery, Atrial fibrillation, Delirium, Myocardial infarction, Acute kidney injury, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Background The aim of our study was the identification of genetic variants associated with postoperative complications after cardiac surgery. Methods We conducted a prospective, double-blind, multicenter, randomized trial (RIPHeart). We performed a genome-wide association study (GWAS) in 1170 patients of both genders (871 males, 299 females) from the RIPHeart-Study cohort. Patients undergoing non-emergent cardiac surgery were included. Primary endpoint comprises a binary composite complication rate covering atrial fibrillation, delirium, non-fatal myocardial infarction, acute renal failure and/or any new stroke until hospital discharge with a maximum of fourteen days after surgery. Results A total of 547,644 genotyped markers were available for analysis. Following quality control and adjustment for clinical covariate, one SNP reached genome-wide significance (PHLPP2, rs78064607, p = 3.77 × 10− 8) and 139 (adjusted for all other outcomes) SNPs showed promising association with p
Published: 2019
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4. Anxiety and its predictive value for pain and regular analgesic intake after lumbar disc surgery - a prospective observational longitudinal study

Author: Rita Laufenberg-Feldmann, Bernd Kappis, Rafael J. A. Cámara, and Marion Ferner
Subjects: Lumbar, Spine surgery, Anxiety, Postoperative pain, Prediction, Analgesics, Psychiatry, RC435-571
Abstract: Abstract Background Ongoing pain after surgery is a major problem and influences recovery and the quality of life of the patient. Associations between anxiety and their impact on postoperative pain after herniated disc surgery have been reported, but the results are inconsistent. The aim of the present longitudinal study was to evaluate the predictive value of preoperative anxiety for postoperative ongoing pain and prolonged analgesic intake after herniated disc surgery. Methods 106 patients with lumbar disc herniation were evaluated in the study. Anxiety was measured with the Generalized Anxiety Disorder 7-Item Scale (GAD-7) before surgery. Pain intensity was assessed on a numeric rating scale (NRS) at baseline, 6-weeks and 6-months after surgery. Regression analysis was performed to identify independent predictors of pain and regular utilization of analgesics up to 6 months after surgery while controlling for confounding variables. Results 42.5% of the patients were rated as anxiety cases (sum scores GAD-7 > 5), mean scores of anxiety showed mild to moderate symptom severity, and 43% suffered from chronic pain before surgery. Six months after surgery, 55.6% of the patients indicated pain levels of 4/10 (NRS) or higher and about 40% still took pain medication on a regular basis, regardless of their preoperative classification as anxiety-case (37.7% and 41.5%). The preoperative pain level was statistically significant for ongoing postsurgical pain in all four analyses (p
Published: 2018
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5. RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study: Myocardial Dysfunction, Postoperative Neurocognitive Dysfunction, and 1 Year Follow‐Up

Author: Patrick Meybohm, Madeline Kohlhaas, Christian Stoppe, Matthias Gruenewald, Jochen Renner, Berthold Bein, Martin Albrecht, Jochen Cremer, Mark Coburn, Gereon Schaelte, Andreas Boening, Bernd Niemann, Michael Sander, Jan Roesner, Frank Kletzin, Haitham Mutlak, Sabine Westphal, Rita Laufenberg‐Feldmann, Marion Ferner, Ivo F. Brandes, Martin Bauer, Sebastian N. Stehr, Andreas Kortgen, Maria Wittmann, Georg Baumgarten, Tanja Meyer‐Treschan, Peter Kienbaum, Matthias Heringlake, Julika Schoen, Sascha Treskatsch, Thorsten Smul, Ewa Wolwender, Thomas Schilling, Georg Fuernau, Holger Bogatsch, Oana Brosteanu, Dirk Hasenclever, and Kai Zacharowski
Subjects: cardio‐vascular surgery, ischemia/reperfusion injury, remote ischemic preconditioning, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: BackgroundRemote ischemic preconditioning (RIPC) has been suggested to protect against certain forms of organ injury after cardiac surgery. Previously, we reported the main results of RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study, a multicenter trial randomizing 1403 cardiac surgery patients receiving either RIPC or sham‐RIPC. Methods and ResultsIn this follow‐up paper, we present 1‐year follow‐up of the composite primary end point and its individual components (all‐cause mortality, myocardial infarction, stroke and acute renal failure), in a sub‐group of patients, intraoperative myocardial dysfunction assessed by transesophageal echocardiography and the incidence of postoperative neurocognitive dysfunction 5 to 7 days and 3 months after surgery. RIPC neither showed any beneficial effect on the 1‐year composite primary end point (RIPC versus sham‐RIPC 16.4% versus 16.9%) and its individual components (all‐cause mortality [3.4% versus 2.5%], myocardial infarction [7.0% versus 9.4%], stroke [2.2% versus 3.1%], acute renal failure [7.0% versus 5.7%]) nor improved intraoperative myocardial dysfunction or incidence of postoperative neurocognitive dysfunction 5 to 7 days (67 [47.5%] versus 71 [53.8%] patients) and 3 months after surgery (17 [27.9%] versus 18 [27.7%] patients), respectively. ConclusionsSimilar to our main study, RIPC had no effect on intraoperative myocardial dysfunction, neurocognitive function and long‐term outcome in cardiac surgery patients undergoing propofol anesthesia. Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01067703.
Published: 2018
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6. Neuropathischer Schmerz bei Palliativpatienten

Author: Marion Ferner and Rita Laufenberg-Feldmann
Subjects: business.industry, Medicine, business
Published: 2021
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7. Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials

Author: Niklas S. Campos, Thomas Bluth, Sabrine N.T. Hemmes, Julian Librero, Natividad Pozo, Carlos Ferrando, Lorenzo Ball, Guido Mazzinari, Paolo Pelosi, Marcelo Gama de Abreu, Marcus J. Schultz, A. Serpa Neto, Sabrine NT. Hemmes, Paolo Severgnini, Markus W. Hollmann, Jan M. Binnekade, Hermann Wrigge, Jaume Canet, Michael Hiesmayr, Werner Schmid, Edda Tschernko, Samir Jaber, Göran Hedenstierna, Christian Putensen, Agnes Marti, Alessandro Bacuzzi, Alexander Brodhun, Alexandre Molin, Alfred Merten, Ana Parera, Andrea Brunelli, Andrea Cortegiani, Andreas Güldner, Andreas W. Reske, Angelo Gratarola, Antonino Giarratano, Bea Bastin, Bjorn Heyse, Branka Mazul-Sunko, Bruno Amantea, Bruno Barberis, Christopher Uhlig, Conrado Minguez Marín, Cristian Celentano, Daniela La Bella, David D’Antini, David Velghe, Demet Sulemanji, Edoardo De Robertis, Eric Hartmann, Francesca Montalto, Francesco Tropea, Gary H. Mills, Gilda Cinnella, Giorgio Della Rocca, Girolamo Caggianelli, Giulia Pellerano, Giuseppina Mollica, Guillermo Bugedo, Jan-Paul Mulier, Jeroen Vandenbrande, Johann Geib, Jonathan Yaqub, Jorge Florez, Juan F. Mayoral, Juraj Sprung, Jurgen Van Limmen, Lieuwe DJ. Bos, Luc de Baerdemaeker, Luc Jamaer, Luigi Spagnolo, Lydia Strys, Manuel Granell Gil, Marcos F. Vidal Melo, Maria Carmen Unzueta, Maria Victoria Moral, Marion Ferner, Martin Weiss, Massimo Vanoni, Maximilian S. Schaefer, Mercè Prieto, Michele Grio, Peter Markus Spieth, Philipp Simon, Phoebe Bodger, Pilar Sierra, Rita Laufenberg-Feldmann, Roberta Rusca, Rodolfo Proietti, Santi Maurizio Raineri, Santo Caroleo, Sergi Sabaté, Stefan De Hert, Stefano Pezzato, Tanja A. Treschan, Tatjana Goranovic, Thea Koch, Thomas Kiss, Valter Perilli, Virginia Cegarra, Javier Belda, Marina Soro, Carmen Unzueta, Fernando Suarez-Sipmann, Julián Librero, Alicia Llombart, Lucas Rovira, Manuel Granell, César Aldecoa, Oscar Diaz-Cambronero, Jaume Balust, Ignacio Garutti, Rafael Gonzalez, Lucia Gallego, Santiago Garcia del Valle, Javier Redondo, David Pestaña, Aurelio Rodríguez, Javier García, Manuel de la Matta, Maite Ibáñez, Francisco Barrios, Samuel Hernández, Vicente Torres, Salvador Peiró, Abigail Villena, Albert Carramiñana, Alberto Gallego-Casilda, Alejandro Duca, Amalia Alcón, Amanda Miñana, Ana Asensio, Ana Colás, Ana Isabel Galve, Ana Izquierdo, Ana Jurado, Ana María Pérez, Ana Mugarra, Andrea Gutierrez, Ángeles De Miguel, Angels Lozano, Antonio Katime, Antonio Romero, Beatriz Garrigues, Begoña Ayas, Blanca Arocas, Carlos Delgado, Carmen Fernández, Carolina Romero, Clara Gallego, Cristina Garcés, Cristina Lisbona, Cristina Parrilla, Daniel López-Herrera, Domingo González, Eduardo Llamazares, Elena Del Rio, Elena Lozano, Ernesto Pastor, Estefanía Chamorro, Estefanía Gracia, Ester Sánchez, Esther Romero, Fernando Díez, Ferran Serralta, Francisco Daviu, Francisco Sandín, Gerardo Aguilar, Gerardo Tusman, Gonzalo Azparren, Graciela Martínez-Pallí, Inmaculada Benítez, Inmaculada Hernandéz, Inmaculada India, Irene León, Isabel Fuentes, Isabel Ruiz, Jaume Puig, Javie Ignacio Román, Jesús Acosta, Jesús Rico-Feijoo, Jonathan Olmedo, Jose A. Carbonell, Jose M. Alonso, Jose María Pérez, Jose Miguel Marcos, Jose Navarro, Jose Valdivia, Juan Carrizo, Laura Piqueras, Laura Soriano, Laura Vaquero, Lisset Miguel, Lorena Muñoz, Lucia Valencia, Luis Olmedilla, Mᵃ Justina Etulain, Manuel Tisner, María Barrio, María Dolores Alonso, María García, María J. Hernández, María José Alberola, María Parra, María Pilar Argente, María Vila, Mario De Fez, Marta Agilaga, Marta Gine, Mercedes Ayuso, Mercedes García, Natalia Bejarano, Natalia Peña, Nazario Ojeda, Nilda Martínez, Nuria García, Oto Padrón, Pablo García, Paola Valls, Patricia Cruz, Patricia Piñeiro, Pedro Charco, Rafael Anaya, Ramiro López, Rayco Rodríguez, Rocío Martínez, Roger Pujol, Rosa Dosdá, Rosa Lardies, Ruben Díaz, Rubén Villazala, Sara Zapatero, Sergio Cabrera, Sergio Sánchez, Silvia Martin, Suzana Diaz, Tania Franco, Tania Moreno, Tania Socorro, Vicente Gilabert, Victor Balandrón, Victoria Moral, Virgina Cegarra, Viviana Varón, Fernando Abelha, Sühayla Abitağaoğlu, Marc Achilles, Afeez Adebesin, Ine Adriaensens, Charles Ahene, Fatima Akbar, Mohammed Al Harbi, Rita Al Khoury al Kallab, Xavier Albanel, Florence Aldenkortt, Rawan Abdullah Saleh Alfouzan, Reef Alruqaie, Fernando Altermatt, Bruno Luís de Castro Araujo, Genaro Arbesú, Hanna Artsi, Caterina Aurilio, Omer Hilmi Ayanoglu, Harris Baig, Yolanda Baird, Konstantin Balonov, Samantha Banks, Xiaodong Bao, Mélanie Baumgartner, Isabel Belda Tortosa, Alice Bergamaschi, Lars Bergmann, Luca Bigatello, Elena Biosca Pérez, Katja Birr, Elird Bojaxhi, Chiara Bonenti, Iwona Bonney, Elke M.E. Bos, Sara Bowman, Leandro Gobbo Braz, Elisa Brugnoni, Sorin J. Brull, Iole Brunetti, Andrea Bruni, Shonie L. Buenvenida, Cornelius Johannes Busch, Giovanni Camerini, Beatrice Capatti, Javiera Carmona, Jaime Carungcong, Marta Carvalho, Anat Cattan, Carla Cavaleiro, Davide Chiumello, Stefano Ciardo, Mark Coburn, Umberto Colella, Victor Contreras, Pelin Corman Dincer, Elizabeth Cotter, Marcia Crovetto, William Darrah, Simon Davies, Enrique Del Cojo Peces, Ellise Delphin, John Diaper, Paulo do Nascimento Junior, Valerio Donatiello, Jing Dong, Maria do Socorro Dourado, Alexander Dullenkopf, Felix Ebner, Hamed Elgendy, Christoph Ellenberger, Dilek Erdoğan Arı, Thomas Ermert, Fadi Farah, Ana Fernandez-Bustamante, Cristina Ferreira, Marco Fiore, Ana Fonte, Christina Fortià Palahí, Andrea Galimberti, Najia Garofano, Luca Gregorio Giaccari, Fernando Gilsanz, Felix Girrbach, Luca Gobbi, Marc Bernard Godfried, Nicolai Goettel, Peter A. Goldstein, Or Goren, Andrew Gorlin, Juan Graterol, Pierre Guyon, Kevin Haire, Philippe Harou, Antonia Helf, Gunther Hempel, María José Hernández Cádiz, Björn Heyse, Ivan Huercio, Jasmina Ilievska, Lien Jakus, Vijay Jeganath, Yvonne Jelting, Minoa Jung, Barbara Kabon, Aalok Kacha, Maja Karaman Ilić, Arunthevaraja Karuppiah, Ayse Duygu Kavas, Gleicy Keli Barcelos, Todd A. Kellogg, Johann Kemper, Romain Kerbrat, Suraya Khodr, Peter Kienbaum, Bunyamin Kir, Selin Kivrak, Vlasta Klarić, Ceren Köksal, Ana Kowark, Peter Kranke, Bahar Kuvaki, Biljana Kuzmanovska, John Laffey, Mirko Lange, Marília Freitas de Lemos, Marc-Joseph Licker, Manuel López-Baamonde, Antonio López-Hernández, Mercedes Lopez-Martinez, Stéphane Luise, Mark MacGregor, Danielle Magalhães, Julien Maillard, Patrizia Malerbi, Natesan Manimekalai, Michael Margarson, Klaus Markstaller, Archer K. Martin, David P. Martin, Yvette N. Martin, Julia Martínez-Ocon, Ignacio Martin-Loeches, Emilio Maseda, Idit Matot, Niamh McAuliffe, Travis J. McKenzie, Paulina Medina, Melanie Meersch, Angelika Menzen, Els Mertens, Bernd Meurer, Tanja Meyer-Treschan, Changhong Miao, Camilla Micalizzi, Morena Milić, Norma Sueli Pinheiro Módolo, Pierre Moine, Patrick Mölders, Ana Montero-Feijoo, Enrique Moret, Markus K. Muller, Zoe Murphy, Pramod Nalwaya, Filip Naumovski, Paolo Navalesi, Lais Helena Navarro e Lima, Višnja Nesek Adam, Claudia Neumann, Christopher Newell, Zoulfira Nisnevitch, Junaid Nizamuddin, Cecilia Novazzi, Michael O'Connor, Günther Oprea, Mukadder Orhan Sungur, Şule Özbilgin, Maria Caterina Pace, Marcos Pacheco, Balaji Packianathaswamy, Estefania Palma Gonzalez, Fotios Papaspyros, Sebastián Paredes, Maria Beatrice Passavanti, Juan Cristobal Pedemonte, Sanja Peremin, Christoph Philipsenburg, Daniela Pinho, Silvia Pinho, Linda M. Posthuma, Vincenzo Pota, Benedikt Preckel, Paolo Priani, Mohamed Aymen Rached, Aleksandar Radoeshki, Riccardo Ragazzi, Tamilselvan Rajamanickam, Arthi Rajamohan, Harish Ramakrishna, Desikan Rangarajan, Christian Reiterer, J. Ross Renew, Thomas Reynaud, Rhidian Rhys, Eva Rivas, Luisa Robitzky, Rolf Rossaint, Francesca Rubulotta, Humberto S. Machado, Catarina S. Nunes, Giovanni Sabbatini, Jon D. Samuels, Josep Martí Sanahuja, Pasquale Sansone, Alice Santos, Mohamed Sayedalahl, Martin Scharffenberg, Eduardo Schiffer, Nadja Schliewe, Raoul Schorer, Roman Schumann, Gabriele Selmo, Mar Sendra, Mert Senturk, Kate Shaw, Mirjana Shosholcheva, Abdulrazak Sibai, Francesca Simonassi, Claudia Sinno, Nukhet Sivrikoz, Vasiliki Skandalou, Neil Smith, Maria Soares, Tania Socorro Artiles, Diogo Sousa Castro, Miguel Sousa, Savino Spadaro, Emmanouil Stamatakis, Luzius A. Steiner, Andrea Stevenazzi, Alejandro Suarez-de-la-Rica, Mélanie Suppan, Robert Teichmann, José Maria Tena Guerrero, Bram Thiel, Raquel Tolós, Gulbin Tore Altun, Michelle Tucci, Zachary A. Turnbull, Žana Turudić, Matthias Unterberg, Yves Van Nieuwenhove, Julia Van Waesberghe, Marcos Francisco Vidal Melo, Bibiana Vitković, Luigi Vivona, Marcela Vizcaychipi, Carlo Alberto Volta, Anne Weber, Toby N. Weingarten, Jakob Wittenstein, Piet Wyffels, Julio Yagüe, David Yates, Ayşen Yavru, Lilach Zac, Jing Zhong, Anesthesiology, Intensive Care Medicine, ACS - Pulmonary hypertension & thrombosis, ACS - Diabetes & metabolism, ACS - Microcirculation, Campos, Niklas S, Bluth, Thoma, Hemmes, Sabrine N T, Librero, Julian, Pozo, Natividad, Ferrando, Carlo, Ball, Lorenzo, Mazzinari, Guido, Pelosi, Paolo, Gama de Abreu, Marcelo, Schultz, Marcus J, Serpa Neto, A, investigators for the PROVHILO study including, Cortegiani, Andrea, Raineri, Santi Maurizio, and Giarratano, Antonino
Subjects: Adult, Lung Diseases, PEEP, postoperative pulmonary complications, mechanical ventilation, Positive-Pressure Respiration, surgery, Anesthesiology and Pain Medicine, Postoperative Complications, Tidal Volume, Humans, Postoperative Period, Lung, Randomized Controlled Trials as Topic
Abstract: BACKGROUND: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. METHODS: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperative pulmonary complications within the first week, analysed using mixed-effect logistic regression. Pre-specified subgroup analyses of nine patient characteristics and seven procedure and care-delivery characteristics were also performed. RESULTS: Complete datasets were available for 1913 participants ventilated with high PEEP and recruitment manoeuvres, compared with 1924 participants who received low PEEP. The primary outcome occurred in 562/1913 (29.4%) participants randomised to high PEEP, compared with 620/1924 (32.2%) participants randomised to low PEEP (unadjusted odds ratio [OR]=0.87; 95% confidence interval [95% CI], 0.75-1.01; P=0.06). Higher PEEP resulted in 87/1913 (4.5%) participants requiring interventions for desaturation, compared with 216/1924 (11.2%) participants randomised to low PEEP (OR=0.34; 95% CI, 0.26-0.45). Intraoperative hypotension was associated more frequently (784/1913 [41.0%]) with high PEEP, compared with low PEEP (579/1924 [30.1%]; OR=1.87; 95% CI, 1.60-2.17). CONCLUSIONS: High PEEP combined with recruitment manoeuvres during low tidal volume ventilation in patients undergoing major surgery did not reduce postoperative pulmonary complications. CLINICAL TRIAL REGISTRATION: NCT03937375 (Clinicaltrials.gov).
Published: 2022

8. Palliativmedizin meets Intensivmedizin

Author: Friedemann Nauck, Marion Ferner, and Rita Laufenberg-Feldmann
Subjects: Palliative care, Symptom management, business.industry, MEDLINE, General Medicine, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Quality of life (healthcare), 030228 respiratory system, Nursing, Intensive care, Emergency Medicine, Terminal care, Medicine, 030212 general & internal medicine, business
Abstract: ZusammenfassungDie Bedeutung moderner Intensivmedizin für schwerstkranke Patienten ist unbestritten. Dennoch stellt sich die Frage nach der Sinnhaftigkeit maximaler Intensivtherapie, wenn sie zwar eine Lebensverlängerung erreicht, aber die Lebensqualität stark beeinträchtigt. Mit dem Wissen und der Akzeptanz, realistische Therapieziele im Sinne des Patienten festzulegen, gewinnen palliativmedizinische Aspekte auf der Intensivstation zunehmend an Bedeutung.
Published: 2020
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9. Is ‘anxiety sensitivity’ predictive of postoperative nausea and vomiting?

Author: Marion Ferner, Bernd Kappis, Kristin Engelhard, Michael Müller, and Rita Laufenberg-Feldmann
Subjects: Adult, Laparoscopic surgery, medicine.medical_specialty, medicine.medical_treatment, Anesthesia, General, Anxiety, Risk Assessment, Predictive Value of Tests, Risk Factors, Internal medicine, Humans, Medicine, General anaesthesia, Prospective Studies, Risk factor, Elective surgery, Aged, Psychological Tests, business.industry, Incidence, Age Factors, Odds ratio, Middle Aged, Prognosis, Anesthesiology and Pain Medicine, Elective Surgical Procedures, Postoperative Nausea and Vomiting, Anxiety sensitivity, Antiemetics, Feasibility Studies, Female, Observational study, medicine.symptom, business, Postoperative nausea and vomiting
Abstract: BACKGROUND Postoperative nausea and vomiting (PONV) is an extremely distressing side effect for patients. Despite PONV prophylaxis guided by well established scoring systems, the incidence of PONV is still high. OBJECTIVE The aim of the current study was to investigate the predictive value of anxiety sensitivity as an additional independent risk factor for PONV in patients with an increased risk of PONV. DESIGN A noninterventional, observational study. SETTING A tertiary care university hospital. PATIENTS Patients with an increased risk of PONV (i.e. female, nonsmoking) undergoing elective surgery (general, gynaecological, urological, musculoskeletal or neurosurgical) under general anaesthesia. MAIN OUTCOME MEASURES The number of patients with anxiety sensitivity assessed pre-operatively with the Anxiety Sensitivity Index-3 questionnaire, the number of patients experiencing PONV, predictive value of anxiety sensitivity compared with other established risk factors for PONV. RESULTS Some 41.5% of the patients experienced PONV within the first 24 h after surgery. In these patients increased anxiety sensitivity (Anxiety Sensitivity Index-3 score higher than seven points) was associated with a five-fold increase in the odds ratio (OR) for PONV. From the regression model, the risk of PONV was increased by lack of PONV prophylaxis (OR, 3.68), the postoperative administration of opioids (OR, 3.60) and patient age (OR, 1.03), but laparoscopic surgery did not increase the risk. CONCLUSION In addition to the well established risk factors, anxiety sensitivity can help to predict the risk of PONV. It seems justifiable to add psychological factors such as anxiety sensitivity to PONV risk-scores. PONV prophylaxis should be considered when anxiety sensitivity is high. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01875120.
Published: 2019
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10. Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

Author: Grusser L., Keszei A., Coburn M., Rossaint R., Ziemann S., Kowark A, Daniela Filipescu, Sibylle Kozek-Langenecker, Juan V Llau Pitarch, Susan Mallett, Peter Martus, Idit Matot, Jens Meier, Axel Unterrainer, Dieter Adelmann, Daniel von Langen, Petra Innerhofer, Nicole Innerhofer-Pompernigg, Stefan De Hert, Luc De Baerdemaeker, Jurgen van Limmen, Piet Wyffels, Björn Heyse, Margot Vanderlaenen, Maud Beran, David Kahn, Audrey Prospiech, Luc Jamaer, Freya Mulders, Stefan Jacobs, Wannes Baeten, Sofie Platteau, Isabelle Maquoi, Severine Lauwick, Marc Senard, Vincent Ninane, Jean-Pierre Lecoq, Pierre Boveroux, Grégory Hans, Marcel Vercauteren, Brigitte Leva, Benoit Plichon, Vojislav Vujanovič, Ismet Suljevic, Hened Kelle, Denis Gustin, Matea Bogdanovic Dvorscak, Tamara Lupis, Jadranka Pavičić Šarić, Nataša Paklar, Dagmar Oberhofer, Ira Skok, Borana Kirigin, Ikic Visnja, Marina Kresic, Slavica Kvolik, Renatas Krobot, Vladimir Cerny, Jana Striteska, Marcela Bilska, Petr Štourač, Hana Harazim, Olga Smékalová, Martina Kosinová, Jozef Klučka, Rita Pacasová, Kim Ekelund, Indrek Rätsep, Juri Oganjan, Nadezda Smirnova, Peeter Kivik, Juri Karjagin, Alar Rokk, Alar Sõrmus, Bertrand Rozec, Jean-Christophe Rigal, Jean-Pierre Gouraud, Anne-Marie Chupin, Xavier Ambrosi, Laurent Brisard, Sylvie Decagny, Charles Marc Samama, Lionel Lidzborski, Matthieu Boisson, Anne-Laure Arcade, Gilbert Lorre, Peter Rosenberger, Hannah Merz, Ulrich Goebel, Bettina Schnitter, Hartmut Buerkle, Roland Tomasi, Vera von Dossow-Hanfstingl, Florian Brettner, Andreas Bayer, André Gottschalk, Nicolas Jakobs, Mark Coburn, Ana Kowark, Rolf Rossaint, Rita Laufenberg, Marion Ferner, Michael Schuster, Lydia Strys, Susanne Mauff, Kornel Skitek, Ewa Zielinska-Skitek, Gregor Schittek, Andreas Hoeft, Andreas Fleischer, Maria Wittmann, Florian Kessler, Anne Rohner, Peter Kranke, Christian Wunder, Johanna Jokinen, Kristin Budow, Christopher Prasser, Eva Werner, Alina Balandin, Norbert Ahrens, Kai Zacharowski, Patrick Meybohm, Kassiani Theodoraki, George Giokas, Tasoulis Marios-Konstantinos, Ageliki Pandazi, Aikaterini Kyttari, Eygenia Koursoumi, Georgios Anthopoulos, Antonis Andreou, Athanasios Rantis, Dimitrios Valsamidis, Pelagia Klimi, Konstantinos Katsanoulas, Demetrios Korfiotis, Christos Soumelidis, Fotios Papaspyros, Olga Kiskira, Tilemachos Paraskeuopoulos, Donal Buggy, Mortimer Kelleher, Liz Coghlan, Vladimir Verenkin, Anat Cattan, Francesco Bona, Felicino Debernardi, Andrea Cortegiani, Santi Maurizio Raineri, Giuseppe Accurso, Elena Gramigni, Leonardo Cenni, Laura Campiglia, Irene Lorenzi, Maria Grazia Militello, Tamara Biscioni, Andrius Macas, Daiva Apanaviciute, Darius Trepenaitis, Arunas Gelmanas, Diana Bilshiene, Jurate Sipylaite, Gabija Tomkute, Egle Kontrimaviciut, Renatas Tikuisis, Francis Borg, Ion Chesov, Serghei Cobiletchi, Victoria Moghildea, Bas Verdouw, J F van Poorten, Nick van Dasselaar, Marcus Daniel Lance, Britta de Waal, Lucienne Kropman, Peter van Noord, Benedikt Preckel, Lena Koers, Markus W Hollmann, Holger Baumann, Ankie W M M Koopman-van Gemert, Tore Reikvam, Tore Hervig, Kasper Gymoese Berthelsen, Ingvild Hausberg Sørvoll, Mirosław Czuczwar, Michał Borys, Paweł Piwowarczyk, Suzana Parente, Diogo Martins, Gloria Tareco, Ligia Reis, Joana Amaral, Daniel Ferreira, José Manuel Gonçalves Aguiar, Zélia Moreira, Filipa Lagarto, Filipa Pereira, Maria Lina Miranda, Sofia Serra, Alexandre Carrilho, José Pinto, Sandra Dias, Rita Poeria, Filipe Linda, Silvia Pica, Helder Martinho, Francisco Matias, Claudia Alves, Valentina Almeida, Margarida Marques, Emilia Martires, Piedade Gomes, Elizabete Pereira, Joana Jesus, Claudia Carreira, Carlos Seco, Carlos Bento, Helena Vieira, Luciane Pereira, Fernando Pinto, Luisa Silva, Marta Azenha, Maged Zarif, Ana Bernardino, Ana Raimundo, Ana Lopes, Melissa Fernandes, Beatriz Campos, Ana Macedo, Filipe Pinheiro, Sonia Duarte, Alexandra Saraiva, Catia Real, Marilena Alina Paunescu, Alexandru Bogdan Prodan, Mihai Stefan, Cristian Boros, Marius Tifrea, Anca Dragan, Horhota Lucian, Alida Moise, Carmen Arion-Balescu, Natalia Mincu, Viorel Gherghina, Iulia Cindea, Dan Costea, Ravzan Popescu, Dana Tomescu, Ecaterina Scarlatescu, Esenia Calancea, Ruxandra Copotoiu, Sanda Maria Copotoiu, Victoria Barsan, Dan Corneci, Rely Manolescu, Toma Diana, Denisa Nitu, Georgian Popica, Gabriela Droc, Nicoleta Jipa Lavina, Roxana Ciobanasu, Anna Maria Munteanu, Denisa Anastase, Iona Grintescu, Liliana Mirea, Alexandra Manoleli, Ciobanu Elena, Mary Nicoleta Lupu, Madalina Nina Sandu, Bicolae Bacalbasa, Florenta Calarasu, Alexey Grytsan, Andrey Gasenkampf, Alexander Kulikov, Alexander Shmigelsky, Vojislava Nescovic, Rade Vukovic, Uros Petrovic, Milic Veljovic, Dragana Unic-Stojanovic, Gordana Jovanovic, Ivana Kvrgic, Dragana Rakic, Roman Záhorec, Daniel Cintula, Tomas Veselovsky, Katarina Galkova, Jordana Stevikova, Andrea Číková, Zora Flassikova, Anna Dobisova, Jasmina Markovic Bozic, Minca Voje, Andriy Grynyuk, Alenka Spindler Yesel, Sabina Stivan, Peter Poredos, Darja Kasnik, Jasna Uranjek, Raquel Ferrandis, Sofia Machado, Liliana Henao, Tania Moreno, Ana Izquierdo, Carlos Delgado, Angela Camps, Susana Manrique, Alejandro Arbelaez, Pilar Tormos, Helena Serrano, Irene Garcia, Elvira Bisbe Vives, Luís Moltó, Tania Villar, Enrique Moret, Raquel Tolós, Esther Martínez, Misericordia Basora, Beatriz Tena, Roger Pujol, Jorge Vera Bella, Thomas Mallor, Pablo Mondero, Luis Lopez, Francisco Hidalgo, Maria Bermudez Lopez, Ana Velasco, Begona Bascuas, Victoria Moral, Diana Gómez Martinez, Alfredo Merten, J A Fernández, Nadia Diana Kinast, A Font, Maggi Genaro, Emilia Guasch, Fernando Gilsanz, Raul Martinez, Renato Schiraldi, Ever Martinez, Marta Barquero López, Alexo Lopez Alvarez, Yvan Enrique Sanchez Sanchez, Adriana Roman Fernandez, Olalla Varela Garcia, Marian Angeles Orallo Moran, Veronica Gonzalez Monzon, Óscar Sánchez López, David Sanchez Perez, Pablo Molano Diaz, Concepcion Cassinello, Maria Pilar Jubera, Maria Soler Pedrola, Julio Belmonte Cuenca, Sören Söndergaard, Till Rudolph, Kristin Åkeröy, Monir Jawad, Yousif Saeed, Sergej Safonov, Mona Andersson, Jan Wernerman, Suzanne Odeberg-Wernerman, Tommi Blom, Nesil Deger Coskunfirat, Zekiye Bigat, Suat Sanlı, O Koray Coskunfirat, Atilla Ramazanoğlu, Neval Boztug Uz, Ali Emre Camci, Omur Aksoy, Esra Saka, Oguzhan Arun, Sevda Ozkardesler, Dilek Omur, Mert Akan, Zuleyha Kazak Bengisun, Hakan Yılmaz, Perihan Ekmekci, Onur Selvi, Neslihan Alkis, Çiğdem Yıldırım, Başak Ceyda Meço, Zekeriyye Alanoğlu, Sergiy Vorotyntsev, Yevgen Yakymenko, Galina Troyan, Mohammed Alousi, Sarah James, Paula Meale, Ahmed Chishti, Matt Garner, Rita Singh, Nicola Hirschauer, Charley Higham, Andrea Bell, Alistair Cain, Chris Perry, Katy Davies, Claire Leech, Verity Calder, Shaman Jhanji, Varma Sandeep, Karen Simeson, Philip Watt, Nigel Dunk, Rosemary Ferrie, Margaret Wright, Lynn Everett, Andrew Ferguson, Laura Espie, Gail Browne, Matthew Dickinson, Ashok Nair, Deborah Clements, Peter Carvalho, Thomas Collyer, Jens Bolten, Lajos Zsisku, Attila Petri, Mohammed Ramadan, Tracey Ellimah, Martus, Peter, Laufenberg, Rita, Ferner, Marion, Schuster, Michael, Strys, Lydia, Mauff, Susanne, Skitek, Kornel, Zielinska-Skitek, Ewa, Schittek, Gregor, Hoeft, Andreas, Fleischer, Andreas, Matot, Idit, Wittmann, Maria, Kessler, Florian, Rohner, Anne, Kranke, Peter, Wunder, Christian, Jokinen, Johanna, Budow, Kristin, Prasser, Christopher, Werner, Eva, Balandin, Alina, Meier, Jens, Ahrens, Norbert, Zacharowski, Kai, Meybohm, Patrick, Theodoraki, Kassiani, Giokas, George, Marios-Konstantinos, Tasoulis, Pandazi, Ageliki, Kyttari, Aikaterini, Koursoumi, Eygenia, Anthopoulos, Georgios, Unterrainer, Axel, Andreou, Antonis, Rantis, Athanasios, Valsamidis, Dimitrios, Klimi, Pelagia, Katsanoulas, Konstantinos, Korfiotis, Demetrios, Soumelidis, Christos, Papaspyros, Fotios, Kiskira, Olga, Paraskeuopoulos, Tilemachos, Adelmann, Dieter, Buggy, Donal, Kelleher, Mortimer, Coghlan, Liz, Verenkin, Vladimir, Cattan, Anat, Bona, Francesco, Debernardi, Felicino, Cortegiani, Andrea, Raineri, Santi Maurizio, Accurso, Giuseppe, von Langen, Daniel, Gramigni, Elena, Cenni, Leonardo, Campiglia, Laura, Lorenzi, Irene, Militello, Maria Grazia, Biscioni, Tamara, Macas, Andrius, Apanaviciute, Daiva, Trepenaitis, Darius, Gelmanas, Arunas, Innerhofer, Petra, Bilshiene, Diana, Sipylaite, Jurate, Tomkute, Gabija, Kontrimaviciut, Egle, Tikuisis, Renatas, Borg, Francis, Chesov, Ion, Cobiletchi, Serghei, Moghildea, Victoria, Verdouw, Bas, Innerhofer-Pompernigg, Nicole, van Poorten, J. F., van Dasselaar, Nick, Lance, Marcus Daniel, de Waal, Britta, Kropman, Lucienne, van Noord, Peter, Preckel, Benedikt, Koers, Lena, Hollmann, Markus W., Baumann, Holger, De Hert, Stefan, Koopman-van Gemert, Ankie W. M. M., Reikvam, Tore, Hervig, Tore, Berthelsen, Kasper Gymoese, Sørvoll, Ingvild Hausberg, Czuczwar, Mirosław, Borys, Michał, Piwowarczyk, Paweł, Parente, Suzana, Martins, Diogo, De Baerdemaeker, Luc, Tareco, Gloria, Reis, Ligia, Amaral, Joana, Ferreira, Daniel, Gonçalves Aguiar, José Manuel, Moreira, Zélia, Lagarto, Filipa, Pereira, Filipa, Miranda, Maria Lina, Serra, Sofia, van Limmen, Jurgen, Carrilho, Alexandre, Pinto, José, Dias, Sandra, Poeria, Rita, Linda, Filipe, Pica, Silvia, Martinho, Helder, Matias, Francisco, Alves, Claudia, Almeida, Valentina, Wyffels, Piet, Marques, Margarida, Martires, Emilia, Gomes, Piedade, Pereira, Elizabete, Jesus, Joana, Carreira, Claudia, Seco, Carlos, Bento, Carlos, Vieira, Helena, Pereira, Luciane, Heyse, Björn, Pinto, Fernando, Silva, Luisa, Azenha, Marta, Zarif, Maged, Bernardino, Ana, Raimundo, Ana, Lopes, Ana, Fernandes, Melissa, Campos, Beatriz, Macedo, Ana, Vanderlaenen, Margot, Pinheiro, Filipe, Duarte, Sonia, Saraiva, Alexandra, Real, Catia, Paunescu, Marilena Alina, Bogdan Prodan, Alexandru, Stefan, Mihai, Boros, Cristian, Tifrea, Marius, Dragan, Anca, Beran, Maud, Lucian, Horhota, Moise, Alida, Arion-Balescu, Carmen, Mincu, Natalia, Gherghina, Viorel, Cindea, Iulia, Costea, Dan, Popescu, Ravzan, Tomescu, Dana, Scarlatescu, Ecaterina, Kahn, David, Calancea, Esenia, Copotoiu, Ruxandra, Copotoiu, Sanda Maria, Barsan, Victoria, Corneci, Dan, Manolescu, Rely, Diana, Toma, Nitu, Denisa, Popica, Georgian, Droc, Gabriela, Prospiech, Audrey, Jipa Lavina, Nicoleta, Ciobanasu, Roxana, Munteanu, Anna Maria, Anastase, Denisa, Grintescu, Iona, Mirea, Liliana, Manoleli, Alexandra, Elena, Ciobanu, Lupu, Mary Nicoleta, Sandu, Madalina Nina, Jamaer, Luc, Bacalbasa, Bicolae, Calarasu, Florenta, Grytsan, Alexey, Gasenkampf, Andrey, Kulikov, Alexander, Shmigelsky, Alexander, Nescovic, Vojislava, Vukovic, Rade, Petrovic, Uros, Veljovic, Milic, Mulders, Freya, Unic-Stojanovic, Dragana, Jovanovic, Gordana, Kvrgic, Ivana, Rakic, Dragana, Záhorec, Roman, Cintula, Daniel, Veselovsky, Tomas, Galkova, Katarina, Stevikova, Jordana, Číková, Andrea, Jacobs, Stefan, Flassikova, Zora, Dobisova, Anna, Markovic Bozic, Jasmina, Voje, Minca, Grynyuk, Andriy, Spindler Yesel, Alenka, Stivan, Sabina, Poredos, Peter, Kasnik, Darja, Uranjek, Jasna, Baeten, Wannes, Ferrandis, Raquel, Machado, Sofia, Henao, Liliana, Moreno, Tania, Izquierdo, Ana, Delgado, Carlos, Camps, Angela, Manrique, Susana, Arbelaez, Alejandro, Tormos, Pilar, Platteau, Sofie, Serrano, Helena, Garcia, Irene, Bisbe Vives, Elvira, Moltó, Luís, Villar, Tania, Moret, Enrique, Tolós, Raquel, Martínez, Esther, Basora, Misericordia, Tena, Beatriz, Maquoi, Isabelle, Pujol, Roger, Vera Bella, Jorge, Mallor, Thomas, Mondero, Pablo, Lopez, Luis, Hidalgo, Francisco, Bermudez Lopez, Maria, Velasco, Ana, Bascuas, Begona, Moral, Victoria, Lauwick, Severine, Gómez Martinez, Diana, Merten, Alfredo, Fernández, J. A., Kinast, Nadia Diana, Font, A., Genaro, Maggi, Guasch, Emilia, Gilsanz, Fernando, Martinez, Raul, Schiraldi, Renato, Senard, Marc, Martinez, Ever, Barquero López, Marta, Lopez Alvarez, Alexo, Sanchez Sanchez, Yvan Enrique, Roman Fernandez, Adriana, Varela Garcia, Olalla, Orallo Moran, Marian Angeles, Gonzalez Monzon, Veronica, Sánchez López, Óscar, Sanchez Perez, David, Ninane, Vincent, Molano Diaz, Pablo, Cassinello, Concepcion, Pilar Jubera, Maria, Soler Pedrola, Maria, Belmonte Cuenca, Julio, Söndergaard, Sören, Rudolph, Till, Åkeröy, Kristin, Jawad, Monir, Saeed, Yousif, Lecoq, Jean-Pierre, Safonov, Sergej, Andersson, Mona, Wernerman, Jan, Odeberg-Wernerman, Suzanne, Blom, Tommi, Deger Coskunfirat, Nesil, Bigat, Zekiye, Sanlı, Suat, Coskunfirat, O. Koray, Ramazanoğlu, Atilla, Boveroux, Pierre, Boztug Uz, Neval, Camci, Ali Emre, Aksoy, Omur, Saka, Esra, Arun, Oguzhan, Ozkardesler, Sevda, Omur, Dilek, Akan, Mert, Bengisun, Zuleyha Kazak, Yılmaz, Hakan, Hans, Grégory, Ekmekci, Perihan, Selvi, Onur, Alkis, Neslihan, Yıldırım, Çiğdem, Ceyda Meço, Başak, Alanoğlu, Zekeriyye, Vorotyntsev, Sergiy, Yakymenko, Yevgen, Troyan, Galina, Alousi, Mohammed, Vercauteren, Marcel, James, Sarah, Meale, Paula, Chishti, Ahmed, Garner, Matt, Singh, Rita, Hirschauer, Nicola, Higham, Charley, Bell, Andrea, Cain, Alistair, Perry, Chris, Leva, Brigitte, Davies, Katy, Leech, Claire, Calder, Verity, Jhanji, Shaman, Sandeep, Varma, Simeson, Karen, Watt, Philip, Dunk, Nigel, Ferrie, Rosemary, Wright, Margaret, Plichon, Benoit, Everett, Lynn, Ferguson, Andrew, Espie, Laura, Browne, Gail, Dickinson, Matthew, Nair, Ashok, Clements, Deborah, Carvalho, Peter, Collyer, Thomas, Bolten, Jens, Vujanovič, Vojislav, Zsisku, Lajos, Petri, Attila, Ramadan, Mohammed, Ellimah, Tracey, Suljevic, Ismet, Kelle, Hened, Gustin, Denis, Bogdanovic Dvorscak, Matea, Lupis, Tamara, Pavičić Šarić, Jadranka, Paklar, Nataša, Oberhofer, Dagmar, Skok, Ira, Kirigin, Borana, Visnja, Ikic, Kresic, Marina, Kvolik, Slavica, Krobot, Renatas, Cerny, Vladimir, Striteska, Jana, Bilska, Marcela, Filipescu, Daniela, Štourač, Petr, Harazim, Hana, Smékalová, Olga, Kosinová, Martina, Klučka, Jozef, Pacasová, Rita, Ekelund, Kim, Rätsep, Indrek, Oganjan, Juri, Smirnova, Nadezda, Kozek-Langenecker, Sibylle, Kivik, Peeter, Karjagin, Juri, Rokk, Alar, Sõrmus, Alar, Rozec, Bertrand, Rigal, Jean-Christophe, Gouraud, Jean-Pierre, Chupin, Anne-Marie, Ambrosi, Xavier, Brisard, Laurent, Llau Pitarch, Juan V., Decagny, Sylvie, Samama, Charles Marc, Lidzborski, Lionel, Boisson, Matthieu, Arcade, Anne-Laure, Lorre, Gilbert, Rosenberger, Peter, Merz, Hannah, Goebel, Ulrich, Schnitter, Bettina, Mallett, Susan, Buerkle, Hartmut, Tomasi, Roland, von Dossow-Hanfstingl, Vera, Brettner, Florian, Bayer, Andreas, Gottschalk, André, Jakobs, Nicolas, Coburn, Mark, Kowark, Ana, Rossaint, Rolf, Grusser L., Keszei A., Coburn M., Rossaint R., Ziemann S., Kowark A, Daniela Filipescu, Sibylle Kozek-Langenecker, Juan V Llau Pitarch, Susan Mallett, Peter Martus, Idit Matot, Jens Meier, Axel Unterrainer, Dieter Adelmann, Daniel von Langen, Petra Innerhofer, Nicole Innerhofer-Pompernigg, Stefan De Hert, Luc De Baerdemaeker, Jurgen van Limmen, Piet Wyffels, Björn Heyse, Margot Vanderlaenen, Maud Beran, David Kahn, Audrey Prospiech, Luc Jamaer, Freya Mulders, Stefan Jacobs, Wannes Baeten, Sofie Platteau, Isabelle Maquoi, Severine Lauwick, Marc Senard, Vincent Ninane, Jean-Pierre Lecoq, Pierre Boveroux, Grégory Hans, Marcel Vercauteren, Brigitte Leva, Benoit Plichon, Vojislav Vujanovič, Ismet Suljevic, Hened Kelle, Denis Gustin, Matea Bogdanovic Dvorscak, Tamara Lupis, Jadranka Pavičić Šarić, Nataša Paklar, Dagmar Oberhofer, Ira Skok, Borana Kirigin, Ikic Visnja, Marina Kresic, Slavica Kvolik, Renatas Krobot, Vladimir Cerny, Jana Striteska, Marcela Bilska, Petr Štourač, Hana Harazim, Olga Smékalová, Martina Kosinová, Jozef Klučka, Rita Pacasová, Kim Ekelund, Indrek Rätsep, Juri Oganjan, Nadezda Smirnova, Peeter Kivik, Juri Karjagin, Alar Rokk, Alar Sõrmus, Bertrand Rozec, Jean-Christophe Rigal, Jean-Pierre Gouraud, Anne-Marie Chupin, Xavier Ambrosi, Laurent Brisard, Sylvie Decagny, Charles Marc Samama, Lionel Lidzborski, Matthieu Boisson, Anne-Laure Arcade, Gilbert Lorre, Peter Rosenberger, Hannah Merz, Ulrich Goebel, Bettina Schnitter, Hartmut Buerkle, Roland Tomasi, Vera von Dossow-Hanfstingl, Florian Brettner, Andreas Bayer, André Gottschalk, Nicolas Jakobs, Mark Coburn, Ana Kowark, Rolf Rossaint, Rita Laufenberg, Marion Ferner, Michael Schuster, Lydia Strys, Susanne Mauff, Kornel Skitek, Ewa Zielinska-Skitek, Gregor Schittek, Andreas Hoeft, Andreas Fleischer, Maria Wittmann, Florian Kessler, Anne Rohner, Peter Kranke, Christian Wunder, Johanna Jokinen, Kristin Budow, Christopher Prasser, Eva Werner, Alina Balandin, Norbert Ahrens, Kai Zacharowski, Patrick Meybohm, Kassiani Theodoraki, George Giokas, Tasoulis Marios-Konstantinos, Ageliki Pandazi, Aikaterini Kyttari, Eygenia Koursoumi, Georgios Anthopoulos, Antonis Andreou, Athanasios Rantis, Dimitrios Valsamidis, Pelagia Klimi, Konstantinos Katsanoulas, Demetrios Korfiotis, Christos Soumelidis, Fotios Papaspyros, Olga Kiskira, Tilemachos Paraskeuopoulos, Donal Buggy, Mortimer Kelleher, Liz Coghlan, Vladimir Verenkin, Anat Cattan, Francesco Bona, Felicino Debernardi, Andrea Cortegiani, Santi Maurizio Raineri, Giuseppe Accurso, Elena Gramigni, Leonardo Cenni, Laura Campiglia, Irene Lorenzi, Maria Grazia Militello, Tamara Biscioni, Andrius Macas, Daiva Apanaviciute, Darius Trepenaitis, Arunas Gelmanas, Diana Bilshiene, Jurate Sipylaite, Gabija Tomkute, Egle Kontrimaviciut, Renatas Tikuisis, Francis Borg, Ion Chesov, Serghei Cobiletchi, Victoria Moghildea, Bas Verdouw, J F van Poorten, Nick van Dasselaar, Marcus Daniel Lance, Britta de Waal, Lucienne Kropman, Peter van Noord, Benedikt Preckel, Lena Koers, Markus W Hollmann, Holger Baumann, Ankie W M M Koopman-van Gemert, Tore Reikvam, Tore Hervig, Kasper Gymoese Berthelsen, Ingvild Hausberg Sørvoll, Mirosław Czuczwar, Michał Borys, Paweł Piwowarczyk, Suzana Parente, Diogo Martins, Gloria Tareco, Ligia Reis, Joana Amaral, Daniel Ferreira, José Manuel Gonçalves Aguiar, Zélia Moreira, Filipa Lagarto, Filipa Pereira, Maria Lina Miranda, Sofia Serra, Alexandre Carrilho, José Pinto, Sandra Dias, Rita Poeria, Filipe Linda, Silvia Pica, Helder Martinho, Francisco Matias, Claudia Alves, Valentina Almeida, Margarida Marques, Emilia Martires, Piedade Gomes, Elizabete Pereira, Joana Jesus, Claudia Carreira, Carlos Seco, Carlos Bento, Helena Vieira, Luciane Pereira, Fernando Pinto, Luisa Silva, Marta Azenha, Maged Zarif, Ana Bernardino, Ana Raimundo, Ana Lopes, Melissa Fernandes, Beatriz Campos, Ana Macedo, Filipe Pinheiro, Sonia Duarte, Alexandra Saraiva, Catia Real, Marilena Alina Paunescu, Alexandru Bogdan Prodan, Mihai Stefan, Cristian Boros, Marius Tifrea, Anca Dragan, Horhota Lucian, Alida Moise, Carmen Arion-Balescu, Natalia Mincu, Viorel Gherghina, Iulia Cindea, Dan Costea, Ravzan Popescu, Dana Tomescu, Ecaterina Scarlatescu, Esenia Calancea, Ruxandra Copotoiu, Sanda Maria Copotoiu, Victoria Barsan, Dan Corneci, Rely Manolescu, Toma Diana, Denisa Nitu, Georgian Popica, Gabriela Droc, Nicoleta Jipa Lavina, Roxana Ciobanasu, Anna Maria Munteanu, Denisa Anastase, Iona Grintescu, Liliana Mirea, Alexandra Manoleli, Ciobanu Elena, Mary Nicoleta Lupu, Madalina Nina Sandu, Bicolae Bacalbasa, Florenta Calarasu, Alexey Grytsan, Andrey Gasenkampf, Alexander Kulikov, Alexander Shmigelsky, Vojislava Nescovic, Rade Vukovic, Uros Petrovic, Milic Veljovic, Dragana Unic-Stojanovic, Gordana Jovanovic, Ivana Kvrgic, Dragana Rakic, Roman Záhorec, Daniel Cintula, Tomas Veselovsky, Katarina Galkova, Jordana Stevikova, Andrea Číková, Zora Flassikova, Anna Dobisova, Jasmina Markovic Bozic, Minca Voje, Andriy Grynyuk, Alenka Spindler Yesel, Sabina Stivan, Peter Poredos, Darja Kasnik, Jasna Uranjek, Raquel Ferrandis, Sofia Machado, Liliana Henao, Tania Moreno, Ana Izquierdo, Carlos Delgado, Angela Camps, Susana Manrique, Alejandro Arbelaez, Pilar Tormos, Helena Serrano, Irene Garcia, Elvira Bisbe Vives, Luís Moltó, Tania Villar, Enrique Moret, Raquel Tolós, Esther Martínez, Misericordia Basora, Beatriz Tena, Roger Pujol, Jorge Vera Bella, Thomas Mallor, Pablo Mondero, Luis Lopez, Francisco Hidalgo, Maria Bermudez Lopez, Ana Velasco, Begona Bascuas, Victoria Moral, Diana Gómez Martinez, Alfredo Merten, J A Fernández, Nadia Diana Kinast, A Font, Maggi Genaro, Emilia Guasch, Fernando Gilsanz, Raul Martinez, Renato Schiraldi, Ever Martinez, Marta Barquero López, Alexo Lopez Alvarez, Yvan Enrique Sanchez Sanchez, Adriana Roman Fernandez, Olalla Varela Garcia, Marian Angeles Orallo Moran, Veronica Gonzalez Monzon, Óscar Sánchez López, David Sanchez Perez, Pablo Molano Diaz, Concepcion Cassinello, Maria Pilar Jubera, Maria Soler Pedrola, Julio Belmonte Cuenca, Sören Söndergaard, Till Rudolph, Kristin Åkeröy, Monir Jawad, Yousif Saeed, Sergej Safonov, Mona Andersson, Jan Wernerman, Suzanne Odeberg-Wernerman, Tommi Blom, Nesil Deger Coskunfirat, Zekiye Bigat, Suat Sanlı, O Koray Coskunfirat, Atilla Ramazanoğlu, Neval Boztug Uz, Ali Emre Camci, Omur Aksoy, Esra Saka, Oguzhan Arun, Sevda Ozkardesler, Dilek Omur, Mert Akan, Zuleyha Kazak Bengisun, Hakan Yılmaz, Perihan Ekmekci, Onur Selvi, Neslihan Alkis, Çiğdem Yıldırım, Başak Ceyda Meço, Zekeriyye Alanoğlu, Sergiy Vorotyntsev, Yevgen Yakymenko, Galina Troyan, Mohammed Alousi, Sarah James, Paula Meale, Ahmed Chishti, Matt Garner, Rita Singh, Nicola Hirschauer, Charley Higham, Andrea Bell, Alistair Cain, Chris Perry, Katy Davies, Claire Leech, Verity Calder, Shaman Jhanji, Varma Sandeep, Karen Simeson, Philip Watt, Nigel Dunk, Rosemary Ferrie, Margaret Wright, Lynn Everett, Andrew Ferguson, Laura Espie, Gail Browne, Matthew Dickinson, Ashok Nair, Deborah Clements, Peter Carvalho, Thomas Collyer, Jens Bolten, Lajos Zsisku, Attila Petri, Mohammed Ramadan, Tracey Ellimah, Anesthesiology, ACS - Diabetes & metabolism, APH - Quality of Care, ACS - Heart failure & arrhythmias, APH - Global Health, and ACS - Microcirculation
Subjects: Clinical Oncology, Male, Science, Clinical Decision-Making, Cancer Treatment, Surgical and Invasive Medical Procedures, Geographical Locations, Diagnostic Medicine, Outcome Assessment, Health Care, Medicine and Health Sciences, Humans, Blood Transfusion, Prospective Studies, Aged, Aged, 80 and over, Intraoperative Care, Multidisciplinary, Transfusion Medicine, Anemia, Hematology, Clinical Laboratory Sciences, Health Care, Europe, Surgical Oncology, Oncology, Age Groups, Elective Surgical Procedures, People and Places, Medicine, Population Groupings, Female, Geriatric Care, Clinical Medicine, Erythrocyte Transfusion, Research Article
Abstract: PLOS ONE 17(1), e0262110 (2022). doi:10.1371/journal.pone.0262110, Published by PLOS, San Francisco, California, US
Published: 2022
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11. Palliative Therapiekonzepte in der Intensivmedizin

Author: Marion Ferner, M. Bodenstein, M. Schuster, and Rita Laufenberg-Feldmann
Subjects: Advance care planning, Gynecology, medicine.medical_specialty, Palliative care, Surgical Intensive Care, business.industry, General Medicine, Palliative Therapy, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030220 oncology & carcinogenesis, Medicine, 030212 general & internal medicine, business
Abstract: Palliative-Care-Konzepte sind in der Behandlung kritisch kranker Patienten auf operativ-interdisziplinaren Intensivstationen in Deutschland bisher kaum etabliert. Ziel solcher Konzepte ist die Verbesserung der Versorgungs- und Lebensqualitat durch die interdisziplinare Behandlung krankheitsbedingter Symptome, aber auch durch Beratung und Begleitung von Patienten und ihren Angehorigen unter Berucksichtigung der aktuellen korperlichen, seelischen, sozialen und spirituellen Situation. Der palliativmedizinische Bedarf eines Patienten lasst sich durch Anwendung von definierten Screeningkriterien prufen. Palliative-Care-Konzepte konnen entweder „konsultativ“ durch externe arztliche oder pflegerische Konsiliare oder „integrativ“ durch systematische Integration palliativmedizinischer Strukturen in den Stationsablauf der „intensive care unit“ (ICU) umgesetzt werden. Durch fruhzeitige Implementierung von Palliative-Care-Konzepten im Sinne eines „advance care planning“ (ACP) kann erreicht werden, dass Therapiezielgesprache fruher und haufiger stattfinden sowie Mortalitat, Krankenhausverweildauer und Lebensqualitat der Patienten uber den Intensivstationsaufenthalt gunstig beeinflusst werden. Daruber hinaus konnen Belastungsreaktionen von Angehorigen und Behandlern reduziert und eine hohere Behandlungszufriedenheit erzielt werden. Eine Schlusselrolle in der Therapiezielfindung kommt der professionellen und strukturierten Kommunikation mit Patient und Angehorigen sowie der Behandler untereinander zu. Die Berucksichtigung palliativmedizinsicher Grundsatze durch ein integratives Palliative-Care-Konzept kann helfen, komplexe intensivmedizinische Krankheitsverlaufe wurdevoll und zielfuhrend zu gestalten, ohne sie aktiv voranzutreiben.
Published: 2017
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12. Kinetics of plasma biomarkers of inflammation and lung injury in surgical patients with or without postoperative pulmonary complications

Author: Serpa Neto A, Lieuwe D. J. Bos, Demet Sulemanji, Melo Mf, Paolo Pelosi, Boer Am, Juraj Sprung, M. W. Hollmann, Carmen Unzueta, Thomas Bluth, Marcus J. Schultz, Marion Ferner, India I, Sabrine N.T. Hemmes, Toby N. Weingarten, Campos Pp, Thomas Kiss, Rita Laufenberg-Feldmann, Andreas Güldner, Gama de Abreu M, Intensive Care Medicine, AII - Inflammatory diseases, Anesthesiology, ACS - Heart failure & arrhythmias, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, and ACS - Microcirculation
Subjects: Adult, Male, medicine.medical_specialty, Inflammation, Lung injury, Gastroenterology, Article, law.invention, Positive-Pressure Respiration, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, 030202 anesthesiology, law, Internal medicine, medicine, Humans, Lung, Receiver operating characteristic, business.industry, Lung Injury, Anesthesiology and Pain Medicine, medicine.anatomical_structure, 030228 respiratory system, Anesthesia, Biomarkers, Female, Inflammation Mediators, Biomarker (medicine), medicine.symptom, business, Abdominal surgery, Blood sampling
Abstract: Background Postoperative pulmonary complications (PPCs) are common after major abdominal surgery. The kinetics of plasma biomarkers could improve identification of patients developing PPCs, but the kinetics may depend on intraoperative ventilator settings. Objective To test whether the kinetics of plasma biomarkers are capable of identifying patients who will develop PPCs, and whether the kinetics depend on the intraoperative level of positive end-expiratory pressure (PEEP). Design A preplanned substudy of a randomised controlled trial. Setting Operation room of five centres. Patients Two hundred and forty-two adult patients scheduled for abdominal surgery at risk of developing PPCs. Interventions High (12 cmH2O) versus low (≤2 cmH2O) levels of PEEP. Main outcome measures Individual PPCs were combined as a composite endpoint. Plasma samples were collected before surgery, directly after surgery and on the fifth postoperative day. The levels of the following were measured: tumour necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8, the soluble form of the Receptor for Advanced Glycation End-products (sRAGE), Surfactant Protein (SP)-D, Clara Cell protein (CC)-16 and Krebs von den Lungen 6 (KL6). Results Blood sampling was complete in 242 patients: 120 patients in the high PEEP group and 122 patients in the low PEEP group. Increases in plasma levels of TNF- IL-6, IL-8 and CC-16, and a decrease in plasma levels of SP-D were greater in patients who developed PPCs; however, the area under the receiver operating characteristic curve was low for all biomarkers. CC-16 was the only biomarker whose level increased more in patients who had received high levels of PEEP. Conclusion In patients undergoing abdominal surgery and at risk of developing PPCs, plasma levels of biomarkers for inflammation or lung injury showed distinct kinetics with development of PPCs, but none of the biomarkers showed sufficient prognostic value. The use of high levels of PEEP was associated with increased levels of CC-16, suggesting lung overdistension. Trial registration The PROVHILO trial, including this substudy, was registered at clinicaltrials.gov (NCT01441791).
Published: 2017
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13. [Palliative Care in Intensive Care Units]

Author: Marion, Ferner, Friedemann, Nauck, and Rita, Laufenberg-Feldmann
Subjects: Intensive Care Units, Terminal Care, Critical Care, Palliative Care, Quality of Life, Humans
Abstract: Palliative care is becoming increasingly important in intensive care units. The main goal of palliative treatment is to improve quality of life in patients with critical and life-threatening conditions when curative therapies can no longer be achieved. Treatment is not limited to end-of-life care, but also includes relief of distressing symptoms such as pain, nausea, vomiting, dyspnea, delirium or anxiety, as well as communication with patients and their families. Defining patient-centred goals of care together with patients, relatives and intensive care staff supports shared decision-making. Aspects of palliative care can be integrated in the ICU in different ways. The "integrative model" presumes that all patients with critical illness may benefit from palliative care principles and interventions practiced by the ICU team. The "consultative model" involves palliative care consultants in the care of ICU patients with palliative care need that may be identified using trigger criteria. This article gives an overview on different aspects of palliative care in intensive care units and provides practical advice for the implementation of palliative care in the ICU.Die Bedeutung moderner Intensivmedizin für schwerstkranke Patienten ist unbestritten. Dennoch stellt sich die Frage nach der Sinnhaftigkeit maximaler Intensivtherapie, wenn sie zwar eine Lebensverlängerung erreicht, aber die Lebensqualität stark beeinträchtigt. Mit dem Wissen und der Akzeptanz, realistische Therapieziele im Sinne des Patienten festzulegen, gewinnen palliativmedizinische Aspekte auf der Intensivstation zunehmend an Bedeutung.
Published: 2020

14. Development of a prediction model for postoperative pneumonia: A multicentre prospective observational study

Author: Russotto, Vincenzo, Sabate, Sergi, Canet, Jaume, Langeron, Olivier, de Abreu, Marcelo Gama, Gallart, Lluis, Javier Belda, F., Pelosi, Paolo, Hoeft, Andreas, Mazo, Valentin, Leva, Brigitte, Burimi, Jonela, Halefi, Toma, Hoxha, Aleksander, Pilika, Kliti, Selmani, Imelda, Daout, Ve'ronique, Gauthier, Caroline, Kahn, David, Momeni, Mona, Watremez, Christine, Straus, Slavenka, Djonovic-manovic, Dejana, Juros-Zovko, Marina, Komen-Usljebrka, Helga, Orlic, Vlasta, Stuck, Ivana, Balakova, Lenka, Kosinova, Martina, Krikava, Ivo, Stoudek, Roman, Stourac, Petr, Zadrazilova, Katarina, Janvekar, Sanober, Karjagin, Juri, Roivassepp, Kadri, Sormus, Alar, Cuvillon, Philippe, Ibanez-Esteve, Cristina, Raux, Mathieu, Nicolas-Robin, Armelle, Winter, Andre, Brunier, Malte, Engelhard, Kristin, Feldmann, Rita Laufenberg, Lindemann, Raphaele, Mauff, Susanne, Sebastiani, Anne, Zamperoni, Camila, Kessler, Florian, Wittmann, Maria, Bluth, Thomas, Guldner, Andreas, Kiss, Thomas, Braz, Kristina, Ruszkai, Csilla, Micaglio, Massimo, Ori, Carlo, Parotto, Matteo, Persona, Paolo, Giuseppe, Coletta, Carnesecchi, Paolo, Lazzeroni, Denise, Lorenzi, Irene, Castellani, Gianluca, Sances, Daniele, Spano, Gianluca, Tredici, Stefano, Vezzoli, Dario, Brunetti, Iole, Di Noto, Anna, Gratarola, Angelo, Molin, Alexandre, Montagnani, Luca, Pellerano, Giulia, Fusari, Maurizio, Camici, Laura, Guzzetti, Luca, Marangoni, Fabio, Severgnini, Paolo, Di Mauro, Piero, Rapido, Francesca, Tommasino, Concezione, Nemme, Ieva, Nemme, Janis, Blieka, Justinas, Borodiciene, Jurgita, Budryte, Brigita, Karbonskiene, Aurika, Kiudulaite, Inga, Milieskaite, Egle, Rasimaviciute, Renata, Sireviciene, Ugne, Stasaityte, Ramune, Usas, Edgaras, Zarskiene, Giedre, Kontrimaviciute, Egle, Sipylaite, Jurate, Tomkute, Gabija, Bardea, Petra, Klop, Marco, Koch, Marc, Bozilow, Dominika, Goch, Robert, Bonifacio, Joao, Marques, Sofia, dos Santos Ralha, Tania Teresa, Alves, Daniel, Carvalho, Ines, Da Cruz Parente, Josefina Suzana, Tome, Sara, Carmona, Cristina, Costa, Miranda, Lina, Maria, Sierra, Sofia, Balcan, Alina, Cindea, Iulia, Gherghina, Viorel Ionel, Grasa, Catalin, Copotoiu, Ruxandra, Copotoiu, Sanda-Maria, Kovacs, Judit, Szederjesi, Janos, Theil, Arthur, Filipescu, Daniela, Grytsan, Alexey, Kapkan, Tatiana, Rostovtsev, Sergey, Yushkova, Anastasia, Calderon, Ricardo, Cacho, Elena, Marginet, Carolina, Monedero, Pablo, Jose Yepes, Maria, Esparza Minana, Jose Miguel, Granell Gil, Manuel, Rico Portoles, Gabriel, Lisi, Alberto, Perez, Gisela, Poch, Nuria, Arganaraz Quinteros, Mauricio Roberto, Font Bosch, Carme, Torrellardona Llobera, Jordi, Sierra, Pilar, Matute, Mercedes, Alcon Dominguez, Amalia, Jose Arguis, Maria, Belda, Isabel, Carrero, Enrique, Moreno, Jacobo, Rovira, Irene, Ubre, Marta, Castillo, Roberto, Herrero, Silvia, Ballester Lujan, Maria Teresa, Carbonell, Jose, Gencheva, Geri, Gutierrez, Andrea, Llorens, Julio, Machado, Sofia, Llobell, Francisca, Paz Martin, Daniel, Javier Garcia-Miguel, Francisco, Perez Garcia, Anibal, Company, Roque, Ahamdanech Idrissi, Aixa, del Fresno Canaveras, Josefina, Navarro Martinez, Jose Alejandro, Paya Martinez, Estefania, Sanchez Garcia, Ester, Vera Bella, Jorge, India Aldana, Inmaculada, Manuel Campos, J., Pelaez Vaamonde, Xavier, Torra, Montserrat, Arroyo, Raquel, Carlos Cabrera, Juan, Carazo Cordobes, Jesus, Rojo, Amelia, Javier Santiveri, Francisco, Gonzalez, Miriam, Jimenez, Anabel, Jimenez, Yolanda, Marti, Agnes, Moret, Enrique, Rodriguez Nunez, Monica, Velasco, Joaquin, Calderon, Adriana, Gonzalez, Matide, Gonzalez, Olga, Hermira Anchuelo, Ana, Lopez, Eloisa, Sanchez, Esther, Aznarez Zango, Blanca, Garcia Corral, Francisco Jose, Mata Mena, Esperanza, Planas Roca, Antonio, Ayala Soto, Raquel Fernandez Rocio, Quintana, Borja, Rabanal Llevot, Jose Manuel, Williams Camus, Monica Mercedes, Palacios Blanco, Alba, Largo Ruiz, Angela, Rico Feijoo, Jesus, Castellano Garijo, Elvira, Belmonte Cuenca, Julio, Bonet Binimelis, Marcos Jose, Grigorov, Ivaylo, Lluis Aguilar, Josep, De Nadal Clanchet, Miriam, Guerrero Vinas, Encarnacion, Manrique Muniz, Susana, Martin Mora, Victor, Munar Bauza, Francisca, Nunez Aguado, Sonia, Olive Vidal, Montserrat, Panos Gozalo, Maria Luisa, Sanchez Marin, Marcos, Suescun Lopez, Maria Carmen, Maino, Paolo, Yevstratov, Yevhen Eugene, Kucukgoncu, Semra, Senturk, Nuzhet Mert, Ulke, Zerrin Sungur, Russotto, V, Sabate, S, and Canet, J
Subjects: Male, medicine.medical_specialty, Prognosi, MEDLINE, Hospital mortality, Models, Biological, Risk Assessment, 03 medical and health sciences, Postoperative complications, 0302 clinical medicine, Postoperative Complications, 030202 anesthesiology, Odds Ratio, Medicine, Humans, Anesthesia, PULMONARY COMPLICATIONS, HYDROXYETHYL STARCH, HEMORRHAGIC-SHOCK, RISK, RESUSCITATION, VALIDATION, INFECTION, SCORE, Hospital Mortality, Prospective Studies, Prospective cohort study, Aged, business.industry, 030208 emergency & critical care medicine, Odds ratio, Pneumonia, Postoperative pneumonia, Surgical procedures, Middle Aged, Prognosis, respiratory tract diseases, Europe, Prospective Studie, Anesthesiology and Pain Medicine, Multicenter study, Surgical Procedures, Operative, Emergency medicine, Observational study, Female, Postoperative Complication, business, Respiratory insufficiency, Human
Abstract: BACKGROUNDPostoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems.OBJECTIVETo identify independent variables associated with the occurrence of postoperative pneumonia.DESIGNA prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database).SETTINGSixty-three hospitals in Europe.PATIENTSPatients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period.MAIN OUTCOME MEASUREThe primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 °C; leucocyte count more than 12 000 μl-1.RESULTSPostoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P < 0.001). We identified five variables independently associated with postoperative pneumonia: functional status [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.58 to 3.12], pre-operative SpO2 values while breathing room air (OR 0.83, 95% CI 0.78 to 0.84), intra-operative colloid administration (OR 2.97, 95% CI 1.94 to 3.99), intra-operative blood transfusion (OR 2.19, 95% CI 1.41 to 4.71) and surgical site (open upper abdominal surgery OR 3.98, 95% CI 2.19 to 7.59). The model had good discrimination (c-statistic 0.89) and calibration (Hosmer-Lemeshow P = 0.572).CONCLUSIONWe identified five variables independently associated with postoperative pneumonia. The model performed well and after external validation may be used for risk stratification and management of patients at risk of postoperative pneumonia.TRIAL REGISTRATIONNCT 01346709 (ClinicalTrials.gov).
Published: 2018

15. Genome-wide association study of myocardial infarction, atrial fibrillation, acute stroke, acute kidney injury and delirium after cardiac surgery - a sub-analysis of the RIPHeart-Study

Author: Sabine, Westphal, Christian, Stoppe, Matthias, Gruenewald, Berthold, Bein, Jochen, Renner, Jochen, Cremer, Mark, Coburn, Gereon, Schaelte, Andreas, Boening, Bernd, Niemann, Frank, Kletzin, Jan, Roesner, Ulrich, Strouhal, Christian, Reyher, Rita, Laufenberg-Feldmann, Marion, Ferner, Ivo F, Brandes, Martin, Bauer, Andreas, Kortgen, Sebastian N, Stehr, Maria, Wittmann, Georg, Baumgarten, Rafael, Struck, Tanja, Meyer-Treschan, Peter, Kienbaum, Matthias, Heringlake, Julika, Schoen, Michael, Sander, Sascha, Treskatsch, Thorsten, Smul, Ewa, Wolwender, Thomas, Schilling, Frauke, Degenhardt, Andre, Franke, Soeren, Mucha, Lukas, Tittmann, Madeline, Kohlhaas, Georg, Fuernau, Oana, Brosteanu, Dirk, Hasenclever, Kai, Zacharowski, Patrick, Meybohm, and Norbert, Roewer
Subjects: Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Myocardial Infarction, 030204 cardiovascular system & hematology, 0302 clinical medicine, Risk Factors, Atrial Fibrillation, Clinical endpoint, Phosphoprotein Phosphatases, Multicenter Studies as Topic, 030212 general & internal medicine, Myocardial infarction, Stroke, Randomized Controlled Trials as Topic, Acute kidney injury, Atrial fibrillation, Acute Kidney Injury, Middle Aged, Cardiac surgery, 3. Good health, Treatment Outcome, Cohort, Cardiology, Dual-Specificity Phosphatases, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Research Article, medicine.medical_specialty, Genome-wide association study, Polymorphism, Single Nucleotide, 03 medical and health sciences, Internal medicine, medicine, Humans, Genetic Predisposition to Disease, Cardiac Surgical Procedures, Aged, business.industry, HSC70 Heat-Shock Proteins, Delirium, Ryanodine Receptor Calcium Release Channel, medicine.disease, Cytoskeletal Proteins, lcsh:RC666-701, Mitogen-Activated Protein Kinase Phosphatases, business
Abstract: Background The aim of our study was the identification of genetic variants associated with postoperative complications after cardiac surgery. Methods We conducted a prospective, double-blind, multicenter, randomized trial (RIPHeart). We performed a genome-wide association study (GWAS) in 1170 patients of both genders (871 males, 299 females) from the RIPHeart-Study cohort. Patients undergoing non-emergent cardiac surgery were included. Primary endpoint comprises a binary composite complication rate covering atrial fibrillation, delirium, non-fatal myocardial infarction, acute renal failure and/or any new stroke until hospital discharge with a maximum of fourteen days after surgery. Results A total of 547,644 genotyped markers were available for analysis. Following quality control and adjustment for clinical covariate, one SNP reached genome-wide significance (PHLPP2, rs78064607, p = 3.77 × 10− 8) and 139 (adjusted for all other outcomes) SNPs showed promising association with p
Published: 2018

16. Opioid Rotation in Cancer Pain Treatment

Author: Florian Heid, Rita Laufenberg-Feldmann, Oliver Bayer, and Michael Schuster
Subjects: business.industry, General Medicine, Hydromorphone, Equianalgesic, Fentanyl, 03 medical and health sciences, 0302 clinical medicine, Opioid, Oxymorphone, 030220 oncology & carcinogenesis, Anesthesia, medicine, 030212 general & internal medicine, business, Oxycodone, medicine.drug, Methadone, Buprenorphine
Abstract: Background Rotating several different WHO level III opioid drugs is a therapeutic option for patients with chronic cancer-related pain who suffer from inadequate analgesia and/or intolerable side effects. The evidence favoring opioid rotation is controversial, and the current guidelines in Germany and other countries contain only weak recommendations for it. Methods This review is based on pertinent publications retrieved by a systematic review of the literature on opioid rotation for adult patients with chronic cancerrelated pain who are regularly taking WHO level III opioids by the oral or trans - dermal route. Results 9 individual studies involving a total of 725 patients were included in the analysis, and 3 previous systematic reviews of studies involving a total of 2296 patients were also analyzed. Morphine, oxycodone, fentanyl, hydromorphone, and buprenorphine were used as first-line opioid drugs, and hydromorphone, bupre - norphine, tapentadol, fentanyl, morphine, oxymorphone, and methadone were used as second-line opioid drugs. In all of the studies, pain control was achieved for 14 days after each rotation. In most of them, the dose of the new drug introduced in each rotation needed to be increased above the dose initially calculated from a rotation ratio, with the exception of rotations to methadone. The frequency of side effects was only rarely lessened, but patients largely considered the result of opioid rotation to be positive. No particular opioid drug was found to be best. Conclusion Opioid rotation can improve analgesia and patient satisfaction. The success of opioid rotation appears to depend on the magnitude of the initial dose, among other factors. Tables of equianalgesic doses should be considered no more than a rough guide for determining the dose of the new drug. Rotations to methadone should be carried out under clinical supervision in experienced hands.
Published: 2018
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17. Bedeutung präoperativer Angst für den postoperativen Verlauf bei urologischen Patienten

Author: Bernd Kappis, Marion Ferner, M. Schuster, and Rita Laufenberg-Feldmann
Subjects: medicine.medical_specialty, business.industry, Postoperative pain, Psychological intervention, Urological surgery, Surgery, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, Female patient, medicine, Physical therapy, Postoperative outcome, Anxiety, Observational study, Premedication, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: Background Preoperative anxiety is not systematically assessed during premedication appointments, although it may influence the postoperative course and outcome. Objectives The aim of this study was to assess preoperative anxiety in a sample of patients before major urological surgery and to characterize the impact on postoperative pain. An additional aim was to analyze the agreement between patients' self-ratings and physicians' anxiety ratings. Patients and methods In all, 127 male and 27 female patients participated in a prospective observational study. Preoperative anxiety was assessed with two validated instruments - the APAIS (Amsterdam Preoperative Anxiety and Information Scale) and the State Scale of the STOA questionnaire (State-Trait Operation Anxiety) - during the premedication appointment. Physicians provided their subjective ratings on patients' anxiety and need for information using the APAIS. The predictive value of preoperative anxiety for postoperative pain was evaluated. Results Nearly four out of ten patients were identified as "anxiety cases"; thereof women were more afraid than men were. Preoperative anxiety was not correctly assessed by physicians, who overestimated patients' anxiety. In female patients, preoperative anxiety was predictive of increased postoperative pain scores. Conclusion Preoperative anxiety is a frequent concern and often not correctly assessed by physicians. The use of scoring systems to detect preoperative anxiety is useful in clinical routine and helps to decide on therapeutic interventions.
Published: 2015
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18. Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis

Author: Ary Serpa Neto, Marcos F. Vidal Melo, Markus W. Hollmann, Toby N. Weingarten, Marion Ferner, Sabrine N.T. Hemmes, Marcus J. Schultz, Carolyn S. Calfee, Provhilo, Pedro P Z A Campos, Lieuwe D. J. Bos, Paolo Pelosi, Juraj Sprung, Thomas Bluth, Demet Sulemanji, Carmen Unzueta, Inmaculada India, Rita Laufenberg-Feldmann, Marcelo Gama de Abreu, Andreas Güldner, Anita M. Tuip-de Boer, Thomas Kiss, Intensive Care Medicine, Anesthesiology, ACS - Heart failure & arrhythmias, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, and ACS - Microcirculation
Subjects: Lung Diseases, Male, medicine.medical_specialty, Internationality, Lung injury, Disease cluster, law.invention, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Internal medicine, Preoperative Care, Medicine, Cluster Analysis, Humans, 030212 general & internal medicine, Aged, business.industry, Incidence (epidemiology), Middle Aged, Phenotype, Anesthesiology and Pain Medicine, 030228 respiratory system, Breathing, Biomarker (medicine), Female, Inflammation Mediators, business, Biomarkers, Abdominal surgery
Abstract: BACKGROUND: Biological phenotypes have been identified within several heterogeneous pulmonary diseases, with potential therapeutic consequences. OBJECTIVE: To assess whether distinct biological phenotypes exist within surgical patients, and whether development of postoperative pulmonary complications (PPCs) and subsequent dependence of intra-operative positive end-expiratory pressure (PEEP) differ between such phenotypes. SETTING: Operating rooms of six hospitals in Europe and USA. DESIGN: Secondary analysis of the 'PROtective Ventilation with HIgh or LOw PEEP' trial. PATIENTS: Adult patients scheduled for abdominal surgery who are at risk of PPCs. INTERVENTIONS: Measurement of pre-operative concentrations of seven plasma biomarkers associated with inflammation and lung injury. MAIN OUTCOME MEASURES: We applied unbiased cluster analysis to identify biological phenotypes. We then compared the proportion of patients developing PPCs within each phenotype, and associations between intra-operative PEEP levels and development of PPCs among phenotypes. RESULTS: In total, 242 patients were included. Unbiased cluster analysis clustered the patients within two biological phenotypes. Patients with phenotype 1 had lower plasma concentrations of TNF-α (3.8 [2.4 to 5.9] vs. 10.2 [8.0 to 12.1] pg ml; P
Published: 2018

19. Assessing preoperative anxiety using a questionnaire and clinical rating

Author: Bernd Kappis and Rita Laufenberg-Feldmann
Subjects: Adult, Male, medicine.medical_specialty, Psychological intervention, MEDLINE, Anxiety, Older patients, Germany, Physicians, Surveys and Questionnaires, Preoperative Care, Humans, Medicine, Prospective Studies, Elective surgery, Prospective cohort study, Aged, Health Services Needs and Demand, business.industry, Age Factors, Middle Aged, Clinical trial, Anesthesiology and Pain Medicine, Elective Surgical Procedures, Physical therapy, Female, Observational study, Self Report, medicine.symptom, business
Abstract: Background Preoperative anxiety and need for information can be detected during preoperative consultation via structured and standardised screening by the Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire. Objective To identify the prevalence of preoperative anxiety and need for information, with regard to influencing factors such as age, sex, previous operation and grade of surgery, and to examine the level of agreement between patients' self-rating and physicians' ratings. Design Prospective observational study. Setting Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany. Patients Two hundred seventeen patients scheduled for elective surgery. Interventions The patients completed questionnaires prior to the interaction with the anaesthesiologist. Physicians were blinded to the patients' ratings and provided their subjective ratings about patients' anxiety and need for information immediately after seeing the patient. Main outcome measure Degree of anxiety and need for information, agreement of patients' self-reports and physician's rating. Results 18.9% of patients were classified as 'anxiety cases' (31.8% in women and 10.6% in men). The grade of the intended surgery but no other investigated factor was related to patients' anxiety. Age (older patients) was correlated with information requirement (r = 0.21, P = 0.002). Analysis of agreement showed only weak correlations between patients' self-reports and physicians' ratings, demonstrated in low weighted Kappa-coefficients (0.12 to 0.32). Conclusion The APAIS is a useful instrument to assess the level of patients' preoperative anxiety and the need for information. Given the relationship between preoperative anxiety and postoperative outcome, it seems justified to incorporate this approach into the preoperative consultation. Trial registration German Clinical Trials Register DRKS00003084.
Published: 2013
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20. Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

Author: Gilles Montalescot, Arnoud W. van ’t Hof, Leonardo Bolognese, Warren J. Cantor, Angel Cequier, Mohamed Chettibi, Jean-Philippe Collet, Shaun G. Goodman, Christopher J. Hammett, Kurt Huber, Magnus Janzon, Frédéric Lapostolle, Jens Flensted Lassen, Muriel Licour, Béla Merkely, Néjoua Salhi, Johanne Silvain, Robert F. Storey, Jurriën M. ten Berg, Anne Tsatsaris, Uwe Zeymer, Eric Vicaut, Christian W. Hamm, Rachid Bougherbal, Mohamed Tahar Bouafia, Djamaleddine Nibouche, Abdelkader Moklati, Ahmed Benalia, Omar Kaid, Messaad Krim, Christopher Hammett, Paul Garrahy, Rohan Jayasinghe, Stephen Rashford, Thomas Neunteufl, Helmut Brussee, Hannes Alber, Franz Weidinger, Michael Brunner, Johann Sipoetz, Gerhard Prause, Michael Baubin, Dieter Sebald, Warren Cantor, Ram Vijayaraghavan, Iqbal Bata, Andrea Lavoie, Jan Ravkilde, Lisette Okkels Jensen, Alf Møl Christensen, Marianne Toftegaard, Dennis Köhler, Gregory Ducrocq, Nicolas Danchin, Patrick Henry, Bernard Livarek, Romain Berthier, Thomas Hovasse, Philippe Garot, Laurent Payot, Hakim Benamer, Jean Baptiste Esteve, Simon Elhadad, Emmanuel Teiger, Jean Louis Bonnet, Franck Paganelli, Yves Cottin, François Schiele, Christophe Thuaire, Guillaume Cayla, Pierre Coste, Patrick Ohlmann, Eric Bonnefoy Cudraz, Pierre Lantelme, Thibault Perret, Christophe Tron, Axel De Labriolle, Edouardo Aptecar, Olivier Beliard, Olivier Varenne, Rami El Mahmoud, Emmanuelle Filippi-Codaccioni, Denis Angoulvant, Patrick Peycher, Olivier Poitrineau, Xavier Tabone, Patrick Ecollan, Claire Broche, Yves Lambert, Nicolas Briole, Arielle Beruben, Nicolas Porcher, Jean-Pierre Auffray, Marc Freysz, Franck Depardieu, David Poubel, Jean-Emmanuel De La Cousaye, Jean-Claude Bartier, Benoît Jardel, Bertrand Boulanger, Hervé Labourel, Louis-Christophe Soulat, Véronique Julie, Michel Thicoipe, Olivier Capel, Olivier Stibbe, Pierre Carli, Karim Tazarourte, Fabrice Alcouffe, David Aboucaya, Gaële Aubert, Gérald Kierzek, Séverine Cahun-Giraud, Christian Hamm, Thomas Dengler, Roland Prondzinsky, Paul Marc Biever, Andreas Schäfer, Melchior Seyfarth, Bernd Lemke, Gerald Werner, Holger Nef, Holger Steiger, Matthias Leschke, Thomas Münzel, Marco Campo Dell Orto, Christian Loges, Monika Schinke, Frank Koberne, Hans Peter Reiffen, Klaus Tiroch, Dirk Wierich, Michael Kneussel, Simon Little, Hartmut Sauer, Rita Laufenberg-Feldmann, Imre Ungi, Iván Horváth, István Édes, István Mártai, Sergio Berti, Francesco Chiarella, Paolo Calabria, Massimo Fineschi, Marcello Galvani, Marco Valgimigli, Luciano Moretti, Maurizio Tespili, Massimo Mandó, Francesco Bermano, Robusto Biagioni, Andrea Fabbri, Adelina Ricciardelli, Maria Romana Petroni, Umberto Roberto Vatteroni, Francesco Palumbo, Frank F. Willems, Amar Al Mafragi, Ton A.A.C.M. Heestermans, Martijn J. Van Eck, Wim M.J.M. Heutz, H.H. Meppelder, Anika Roukema-de Jong, Harm Van de Pas, Ángel Cequier Fillat, Manel Sabaté Tenas, Josepa Mauri Ferrer, Antoni Serra Peñaranda, Joan Ángel Ferrer, Bruno García Del Blanco, Faustino Miranda Guardiola, Juan Miguel Ruiz Nodar, Andrés Íñiguez Romo, Nicolás Vázquez González, Ramiro Trillo Nouche, Luis Díaz De La Llera, José María Hernández García, Fernando Rivero-Crespo, Felipe Hernández Hernández, José Luis Zamorano Gómez, Xavier Jiménez Fárega, Gilberto Alonso Fernández, José Luis Toboso, Mercedes Carrasco, Victoria Barreiro, José Antonio Iglesias Vázquez, María del Mar Ruiz Montero, Fernando Rosell Ortiz, Guillermo Garcia Escudero, Vicente Sánchez-Brunete Ingelmo, Antonio Lara García, Jonas Oldgren, Fredrik Calais, Robert Kastberg, Per-Adolf Bergsten, Hans Blomberg, Kristian Thörn, Gunnar Skoog, Azfar Zaman, Robert Gerber, Alisdair Ryding, Mark Spence, Neil Swanson, Martin Been, Konrad Grosser, Peter Schofield, David Mackin, Paul Fell, Tom Quinn, Teresa Foster, David McManus, Andy Carson, Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), AstraZeneca, Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP], Hôpital avicenne, Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Avicenne, and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7)
Subjects: medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Coronary thrombosis, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, ST segment, 030212 general & internal medicine, Myocardial infarction, thrombosis, business.industry, Percutaneous coronary intervention, medicine.disease, 3. Good health, reperfusion, myocardial infarction, stents, Conventional PCI, platelets, Cardiology, Platelet aggregation inhibitor, Cardiology and Cardiovascular Medicine, business, Ticagrelor, TIMI, medicine.drug
Abstract: Objectives The aim of this landmark exploratory analysis, ATLANTIC-H 24 , was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery) study. Background The ATLANTIC trial in patients with ongoing ST-segment elevation myocardial infarction showed that pre-hospital ticagrelor was safe but did not improve pre-PCI coronary reperfusion compared with in-hospital ticagrelor. We hypothesized that the effect of pre-hospital ticagrelor may not have manifested until after PCI due to the rapid transfer time (31 min). Methods The ATLANTIC-H 24 analysis included 1,629 patients who underwent PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction flow grade 3, ≥70% ST-segment elevation resolution, and clinical endpoints over the first 24 h. Results Following PCI, largest between-group differences in platelet reactivity occurred at 1 to 6 h; coronary reperfusion rates numerically favored pre-hospital ticagrelor, and the degree of ST-segment elevation resolution was significantly greater in the pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At 24 h, the composite ischemic endpoint was lower with pre-hospital ticagrelor (10.4% vs. 13.7%; p = 0.039), as were individual endpoints of definite stent thrombosis (p = 0.0078) and myocardial infarction (p = 0.031). All endpoints except death (1.1% vs. 0.2%; p = 0.048) favored pre-hospital ticagrelor, with no differences in bleeding events. Conclusions The effects of pre-hospital ticagrelor became apparent after PCI, with numerical differences in platelet reactivity and immediate post-PCI reperfusion, associated with reductions in ischemic endpoints, over the first 24 h, whereas there was a small excess of mortality. (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial infarction to open the Coronary artery [ATLANTIC, NCT01347580 ])
Published: 2016
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21. Akutschmerztherapie in Pädiatrie und Geriatrie – Akutschmerztherapie im Alter –ein ganzheitlicher Ansatz

Author: Jürgen Jage and Rita Laufenberg-Feldmann
Subjects: medicine.medical_specialty, Constipation, business.industry, Geriatric assessment, General Medicine, Pain management, Critical Care and Intensive Care Medicine, Medical care, Anesthesiology and Pain Medicine, Increased risk, Patient satisfaction, Opioid, Emergency Medicine, Physical therapy, Medicine, Medical history, medicine.symptom, business, medicine.drug
Abstract: Post-operative pain management of elderly patients requires special attention. In addition to the organic functional impairments, age-related changes in psychological and social factors play an important role. Also life experiences, painful medical history and a range of different complaints of old age influence the expectations to the treatment of pain. Several factors have to be considered, so 1) age-appropriate preoperative assessment of organic, psychological and social factors, 2) a selection of regularly administered non-opioid, or combination of two different effective non-opioids, notably on the contra-indications and dose limits, 3) if necessary careful titration of the strong opioid with patient adjustment further doses in the recovery room ("start low, go slow"), 4) if necessary, supplement the non-opioid with a strong, not retarded opioid (subcutaneous or oral administration) on the ward, 5) restrictive indication for retarded opioids because of increased risk to fall and constipation, 6) more frequent control of side effects than for younger patients, 7) medical care with increased acceptance of autonomy, to allow trust to improve the often limited compliance and to achieve high patient satisfaction.
Published: 2011
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22. A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery

Author: Matthias Gruenewald, Mark Coburn, Jochen Cremer, Christian Reyher, Julika Schön, Bernd Niemann, Peter Kienbaum, Rita Laufenberg-Feldmann, Andreas Böning, Matthias Heringlake, Marion Ferner, Michael Sander, Martin Bauer, U. Strouhal, Andreas Kortgen, Oana Brosteanu, Thorsten Smul, Sascha Treskatsch, Tanja Meyer-Treschan, Christian Stoppe, Thomas F. Schilling, Sebastian Stehr, I. F. Brandes, Georg Fuernau, Maria Wittmann, Kai Zacharowski, Berthold Bein, Jan P. Roesner, G. Schaelte, Ewa Wolwender, Patrick Meybohm, Georg Baumgarten, Dirk Hasenclever, and Frank Kletzin
Subjects: Male, medicine.medical_specialty, Kaplan-Meier Estimate, law.invention, Upper Extremity, Postoperative Complications, Randomized controlled trial, Double-Blind Method, law, Ischemia, Multicenter trial, medicine, Cardiopulmonary bypass, Clinical endpoint, Humans, Myocardial infarction, Prospective Studies, Treatment Failure, Cardiac Surgical Procedures, Ischemic Preconditioning, Stroke, Propofol, Aged, Cardiopulmonary Bypass, business.industry, Sham Intervention, General Medicine, Length of Stay, Middle Aged, medicine.disease, Heart Surgery, Troponin, 3. Good health, Surgery, Cardiac surgery, Elective Surgical Procedures, Anesthesia, Anesthesia, Intravenous, Female, business
Abstract: BACKGROUND: Remote ischemic preconditioning (RIPC) is reported to reduce biomarkers of ischemic and reperfusion injury in patients undergoing cardiac surgery, but uncertainty about clinical outcomes remains. METHODS: We conducted a prospective, double-blind, multicenter, randomized, controlled trial involving adults who were scheduled for elective cardiac surgery requiring cardiopulmonary bypass under total anesthesia with intravenous propofol. The trial compared upper-limb RIPC with a sham intervention. The primary end point was a composite of death, myocardial infarction, stroke, or acute renal failure up to the time of hospital discharge. Secondary end points included the occurrence of any individual component of the primary end point by day 90. RESULTS: A total of 1403 patients underwent randomization. The full analysis set comprised 1385 patients (692 in the RIPC group and 693 in the sham-RIPC group). There was no significant between-group difference in the rate of the composite primary end point (99 patients [14.3%] in the RIPC group and 101 [14.6%] in the sham-RIPC group, P=0.89) or of any of the individual components: death (9 patients [1.3%] and 4 [0.6%], respectively; P=0.21), myocardial infarction (47 [6.8%] and 63 [9.1%], P=0.12), stroke (14 [2.0%] and 15 [2.2%], P=0.79), and acute renal failure (42 [6.1%] and 35 [5.1%], P=0.45). The results were similar in the per-protocol analysis. No treatment effect was found in any subgroup analysis. No significant differences between the RIPC group and the sham-RIPC group were seen in the level of troponin release, the duration of mechanical ventilation, the length of stay in the intensive care unit or the hospital, new onset of atrial fibrillation, and the incidence of postoperative delirium. No RIPC-related adverse events were observed. CONCLUSIONS: Upper-limb RIPC performed while patients were under propofol-induced anesthesia did not show a relevant benefit among patients undergoing elective cardiac surgery. (Funded by the German Research Foundation; RIPHeart ClinicalTrials.gov number, NCT01067703.). peerReviewed
Published: 2015

23. Palliativmedizin - 1000 Fragen

Author: Matthias Richter, Roman Rolke, Frauke Musial, Karin Jaroslawski, Karin Kast, Martin Smitka, Carsten Klein, Christian Menzel, Karsten Münstedt, Beate Hornemann, Peter Nieland, Franziska Hessel, Peer-Wolfgang Kämmerer, Heiner Melching, Tobias Steigleder, Sonja Hofmann, Heidrun Golla, Justus Benrath, Markus Schuler, Matthias Helmut Schmidt, Eva-Maria Sprengard, Linda Fendel, Rainer Sabatowski, Piret Paal, Klaus Maria Perrar, Friedemann Nauck, Ruth Heineck, Stephanie Neuberger, Maria Janisch, Christoph Ostgathe, R. Scharnagel, Silke Nolte-Buchholtz, Jan Gärtner, Martin Mücke, Dominik Irnich, Barbara Schubert, Bernd Oliver Maier, Walter Bruchhausen, Julia Grüninger-Endres, Johannes Bükki, Gerhild Becker, Bastian Jaeschke, Traugott Roser, Lucie Heinzerling, Helmut Hoffmann-Menzel, Rita Laufenberg-Feldmann, Eva Schildmann, Monika Daubländer, Bernd Alt-Epping, Susanne Heller, Stefan Lorenzl, Mathias Pfisterer, Stephanie Stiel, Rainer Schwab, Ulrich Schuler, Jan Schildmann, Martin Liebetrau, Jan Gramm, and Ingmar Hornke
Published: 2013
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24. [Acute pain management in the elderly - Pharmaceutics and psychosocial approaches]

Author: Rita, Laufenberg-Feldmann and Jürgen, Jage
Subjects: Aged, 80 and over, Male, Psychotherapy, Analgesics, Acute Disease, Humans, Pain, Pain Management, Social Support, Female, Geriatric Assessment, Aged, Pain Measurement
Abstract: Post-operative pain management of elderly patients requires special attention. In addition to the organic functional impairments, age-related changes in psychological and social factors play an important role. Also life experiences, painful medical history and a range of different complaints of old age influence the expectations to the treatment of pain. Several factors have to be considered, so 1) age-appropriate preoperative assessment of organic, psychological and social factors, 2) a selection of regularly administered non-opioid, or combination of two different effective non-opioids, notably on the contra-indications and dose limits, 3) if necessary careful titration of the strong opioid with patient adjustment further doses in the recovery room ("start low, go slow"), 4) if necessary, supplement the non-opioid with a strong, not retarded opioid (subcutaneous or oral administration) on the ward, 5) restrictive indication for retarded opioids because of increased risk to fall and constipation, 6) more frequent control of side effects than for younger patients, 7) medical care with increased acceptance of autonomy, to allow trust to improve the often limited compliance and to achieve high patient satisfaction.
Published: 2011

25. Characterization of polymorphisms in the toxin A and B genes of Clostridium difficile

Author: Florian Soehn, Rita Laufenberg-Feldmann, Veit Braun, Miha Janc, Christoph von Eichel-Streiber, Monika Hofstetter, and Maja Rupnik
Subjects: Genetics, Polymorphism, Genetic, Clostridioides difficile, Bacterial Toxins, Clostridium difficile toxin A, Clostridium difficile toxin B, Biology, Clostridium difficile, Microbiology, Molecular biology, Polymerase Chain Reaction, law.invention, Restriction site, Enterotoxins, Bacterial Proteins, law, Genes, Bacterial, Genotype, Typing, Restriction fragment length polymorphism, Molecular Biology, Polymerase chain reaction, Polymorphism, Restriction Fragment Length
Abstract: We have used six independent polymerase chain reactions (A1–A3 and B1–B3) for amplification of the entire sequence of the two toxin genes tcdA and tcdB of several Clostridium difficile strains. With this approach we have detected (1) restriction site polymorphisms which are distributed all over the genes, and (2) deletions that could be found only in tcdA. Characteristic differences between strains were mainly focused to the 5′ third of tcdB (B1 fragment) and/or the 3′ third of tcdA (A3 fragment). The possible use of our approach for typing of C. difficile toxin genes is discussed.
Published: 1997

26. Comparative sequence analysis of the Clostridium difficile toxins A and B

Author: S. Sartingen, Rita Laufenberg-Feldmann, Markus Sauerborn, von Eichel-Streiber C, and J Schulze
Subjects: DNA, Bacterial, Sequence analysis, Bacterial Toxins, Blotting, Western, Molecular Sequence Data, Restriction Mapping, DNA, Recombinant, Locus (genetics), Cross Reactions, Homology (biology), Enterotoxins, Bacterial Proteins, Sequence Homology, Nucleic Acid, Gene duplication, Genetics, Amino Acid Sequence, Molecular Biology, Gene, Repetitive Sequences, Nucleic Acid, biology, Base Sequence, Clostridioides difficile, Nucleic acid sequence, Antibodies, Monoclonal, Nucleic Acid Hybridization, Molecular biology, Recombinant Proteins, Open reading frame, Polyclonal antibodies, biology.protein
Abstract: The six clones pTB112, pTB324, pTBs12, pCd122, pCd14 and pCd13 cover the tox locus of Clostridium difficile VPI 10463. This region of 19 kb of chromosomal DNA contains four open reading frames including the complete toxB and toxA genes. The two toxins show 63% amino acid (aa) homology, a relatedness that had been predicted by the cross-reactivity of some monoclonal antibodies (mAb) but that is in contrast to the toxin specificity of polyclonal antisera. A special feature of ToxA and ToxB is their repetitive C-termini. We define herein 19 individual CROPs (combined repetitive oligopeptides of 20-50 aa length) in the ToxB C-terminus, which are separable into five homologous groups. Comparison of the aa sequences of the N-terminal two-thirds of ToxA and ToxB revealed three marked structures, a cluster of 172 hydrophobic, highly conserved aa in the centre of both toxins, a sequence of 120 residues with an accumulation of highly conserved arginine, cysteine, histidine, methionine, and tryptophan residues, and a stretch of 248 less conserved aa. The probable function of these domains is discussed. Structural and functional homologies of ToxA and ToxB indicate that both genes have a common ancestor and may have evolved by gene duplication, with subsequent recombination and mutation, as has been reported for streptococcal glucosyltransferases (Gtf).
Published: 1992

27. Cloning of Clostridium difficile toxin B gene and demonstration of high N-terminal homology between toxin A and B

Author: C. von Eichel-Streiber, J Schulze, S. Sartingen, Rita Laufenberg-Feldmann, and Markus Sauerborn
Subjects: Microbiology (medical), DNA, Bacterial, Immunology, Bacterial Toxins, Molecular Sequence Data, Restriction Mapping, Clostridium difficile toxin A, Clostridium difficile toxin B, Molecular cloning, Biology, Cross Reactions, Homology (biology), Restriction map, Bacterial Proteins, Sequence Homology, Nucleic Acid, Immunology and Allergy, Amino Acid Sequence, Cloning, Molecular, Peptide sequence, Genetics, Base Sequence, Clostridioides difficile, Nucleic acid sequence, General Medicine, Molecular biology, Antibodies, Bacterial, Open reading frame, Genes, Bacterial, DNA Probes
Abstract: High titered Clostridium sordellii lethal toxin antiserum, cross-reactive with C. difficile cytotoxin B (ToxB), was used to isolate toxB fragments from a C. difficile expression library. Recombinant clones containing toxB fragments of the 5' and 3' end were isolate. A 2.5-kb HincII fragment of chromosomal DNA overlaps both groups of clones. A partial restriction map of the total toxB gene is presented. The gene is positioned upstream of utxA and toxA, toxB has a size of 6.9 kb, corresponding to a 250-kDa polypeptide. A partial sequence of the 5' end of toxB was determined. The sequence contains 398 bp upstream of toxB with a putative Shine-Dalgarno box (AGGAGA) and 609 bp of the toxB open reading frame. The N-terminal 203 amino acids of ToxB were compared with the N-terminal amino acids of the enterotoxin A (ToxA). A homology of 64% of the residues was detected, which proves the relatedness of ToxA and ToxB of C. difficile.
Published: 1990

28. Proactive Palliative Care Intervention in a Surgical ICU: Influence on Family Satisfaction and Patient Distress (PALL-ICU)

Author: Rita Laufenberg-Feldmann, M.D., Anaesthesiologist, Head of Clinical Trial Unit
Published: 2017

29. Study to Evaluate Anxiety Sensitivity and Somatic Symptoms as Risk Factors for PONV (somPONV)

Author: Rita Laufenberg-Feldmann, M.D., Deputy senior physician, head of clinical trial unit
Published: 2013

30. Mainz Outcome Predictor Studies: An Observational Clinical Trial Investigating Predictors for Postoperative Outcome (MOPS)

Author: Rita Laufenberg-Feldmann, M.D., Principal Investigator
Published: 2013

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30 results on '"Rita Laufenberg"'

1. Improving competence and safety in pain medicine: a practical clinical teaching strategy for students combining simulation and bedside teaching

2. Liberal transfusion strategy to prevent mortality and anaemia-associated, ischaemic events in elderly non-cardiac surgical patients – the study design of the LIBERAL-Trial

3. Genome-wide association study of myocardial infarction, atrial fibrillation, acute stroke, acute kidney injury and delirium after cardiac surgery – a sub-analysis of the RIPHeart-Study

4. Anxiety and its predictive value for pain and regular analgesic intake after lumbar disc surgery - a prospective observational longitudinal study

5. RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study: Myocardial Dysfunction, Postoperative Neurocognitive Dysfunction, and 1 Year Follow‐Up

6. Neuropathischer Schmerz bei Palliativpatienten

7. Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials

8. Palliativmedizin meets Intensivmedizin

9. Is ‘anxiety sensitivity’ predictive of postoperative nausea and vomiting?

10. Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

11. Palliative Therapiekonzepte in der Intensivmedizin

12. Kinetics of plasma biomarkers of inflammation and lung injury in surgical patients with or without postoperative pulmonary complications

13. [Palliative Care in Intensive Care Units]

14. Development of a prediction model for postoperative pneumonia: A multicentre prospective observational study

15. Genome-wide association study of myocardial infarction, atrial fibrillation, acute stroke, acute kidney injury and delirium after cardiac surgery - a sub-analysis of the RIPHeart-Study

16. Opioid Rotation in Cancer Pain Treatment

17. Bedeutung präoperativer Angst für den postoperativen Verlauf bei urologischen Patienten

18. Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis

19. Assessing preoperative anxiety using a questionnaire and clinical rating

20. Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

21. Akutschmerztherapie in Pädiatrie und Geriatrie – Akutschmerztherapie im Alter –ein ganzheitlicher Ansatz

22. A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery

23. Palliativmedizin - 1000 Fragen

24. [Acute pain management in the elderly - Pharmaceutics and psychosocial approaches]

25. Characterization of polymorphisms in the toxin A and B genes of Clostridium difficile

26. Comparative sequence analysis of the Clostridium difficile toxins A and B

27. Cloning of Clostridium difficile toxin B gene and demonstration of high N-terminal homology between toxin A and B

28. Proactive Palliative Care Intervention in a Surgical ICU: Influence on Family Satisfaction and Patient Distress (PALL-ICU)

29. Study to Evaluate Anxiety Sensitivity and Somatic Symptoms as Risk Factors for PONV (somPONV)

30. Mainz Outcome Predictor Studies: An Observational Clinical Trial Investigating Predictors for Postoperative Outcome (MOPS)

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