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3. Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

Author

Girardis, M., Bettex, D., Bojan, M., Demponeras, C., Fruhwald, S., Gál, J., Groesdonk, H. V., Guarracino, F., Guerrero-Orriach, J. L., Heringlake, M., Herpain, A., Heunks, L., Jin, J., Kindgen-Milles, D., Mauriat, P., Michels, G., Psallida, V., Rich, S., Ricksten, S-E, Rudiger, A., Siegemund, M., Toller, W., Treskatsch, S., Župan, Ž., and Pollesello, P.

Published
2022
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12. Intraoperative Beat-to-Beat Pulse Transit Time (PTT) Monitoring via Non-invasive Piezoelectric/Piezocapacitive Peripheral Sensors Can Predict Changes in Invasively Acquired Blood Pressure in High-Risk Surgical Patients

Author

Nordine, M, primary, Pille, M, additional, Kraemer, J, additional, Berger, C, additional, Brandhorst, P, additional, Kaeferstein, P, additional, Kopetsch, R, additional, Wessel, N, additional, Trauzeddel, R, additional, and Treskatsch, S, additional

Published
2023
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17. Kampf der Kompressionen: Wer reanimiert besser – 1. oder 10. Semester?

Author

Pawloy, K, Dohle, N, Treskatsch, S, and Degel, A

Subjects
ddc: 610, Medicine and health
Abstract

Fragestellung/Zielsetzung: In notfallmedizinischen Kursen werden zu Beginn des Medizinstudiums Schwerpunkte auf Basic Life Support (BLS) gelegt, während am Ende auf die erweiterten Maßnahmen des Advanced Life Support (ALS) fokussiert wird. Vergleiche der praktischen Fertigkeiten an Anfang [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Published
2021
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18. Critical Illness and Systemic Inflammation Are Key Risk Factors of Severe Acute Kidney Injury in Patients With COVID-19

Author

Hardenberg, J.H.B., Stockmann, H., Aigner, A., Gotthardt, I., Enghard, P., Hinze, C., Balzer, F., Schmidt, D., Zickler, D., Kruse, J., Körner, R., Stegemann, M., Schneider, T., Schumann, M., Müller-Redetzky, H., Angermair, S., Budde, K., Weber-Carstens, S., Witzenrath, M., Treskatsch, S., Siegmund, B., Spies, C., Suttorp, N., Rauch, G., Eckardt, K.U., and Schmidt-Ott, K.M.

Subjects
urogenital system, COVID-associated AKI, COVID-19, macromolecular substances, lcsh:Diseases of the genitourinary system. Urology, lcsh:RC870-923, urologic and male genital diseases, female genital diseases and pregnancy complications, kidney failure, acute kidney injury, Cardiovascular and Metabolic Diseases, Clinical Research, Nephrology, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
Abstract

Introduction Acute kidney injury (AKI) is an important complication in COVID-19, but its precise etiology has not fully been elucidated. Insights into AKI mechanisms may be provided by analyzing the temporal associations of clinical parameters reflecting disease processes and AKI development. Methods We performed an observational cohort study of 223 consecutive COVID-19 patients treated at 3 sites of a tertiary care referral center to describe the evolvement of severe AKI (Kidney Disease: Improving Global Outcomes stage 3) and identify conditions promoting its development. Descriptive statistics and explanatory multivariable Cox regression modeling with clinical parameters as time-varying covariates were used to identify risk factors of severe AKI. Results Severe AKI developed in 70 of 223 patients (31%) with COVID-19, of which 95.7% required kidney replacement therapy. Patients with severe AKI were older, predominantly male, had more comorbidities, and displayed excess mortality. Severe AKI occurred exclusively in intensive care unit patients, and 97.3% of the patients developing severe AKI had respiratory failure. Mechanical ventilation, vasopressor therapy, and inflammatory markers (serum procalcitonin levels and leucocyte count) were independent time-varying risk factors of severe AKI. Increasing inflammatory markers displayed a close temporal association with the development of severe AKI. Sensitivity analysis on risk factors of AKI stage 2 and 3 combined confirmed these findings. Conclusion Severe AKI in COVID-19 was tightly coupled with critical illness and systemic inflammation and was not observed in milder disease courses. These findings suggest that traditional systemic AKI mechanisms rather than kidney-specific processes contribute to severe AKI in COVID-19., Graphical abstract

Published
2021
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19. Perioperative optimization using hemodynamically focused echocardiography in high-risk patients-A practice guide

Author

Trauzeddel, R. F., Nordine, M., Groesdonk, H. V., Michels, G., Pfister, R., Reuter, D. A., Scheeren, T. W. L., Berger, C., Treskatsch, S., Trauzeddel, R. F., Nordine, M., Groesdonk, H. V., Michels, G., Pfister, R., Reuter, D. A., Scheeren, T. W. L., Berger, C., and Treskatsch, S.

Abstract

Background The number of high-risk patients undergoing surgery is steadily increasing. In order to maintain and, if necessary, optimize perioperative hemodynamics as well as the oxygen supply to the organs (DO2) in this patient population, a timely assessment of cardiac function and the underlying pathophysiological causes of hemodynamic instability is essential for the anesthesiologist. A variety of hemodynamic monitoring procedures are available for this purpose; however, due to method-immanent limitations they are often not able to directly identify the underlying cause of cardiovascular impairment. Objective To present a stepwise algorithm for a perioperative echocardiography-based hemodynamic optimization in noncardiac surgery high-risk patients. In this context, echocardiography on demand according to international guidelines can be performed under certain conditions (hemodynamic instability, nonresponse to hemodynamic treatment) as well as in the context of a planned intraoperative procedure, mostly as a transesophageal echocardiography. Methods and results Hemodynamically focused echocardiography as a rapidly available bedside method, enables the timely diagnosis and assessment of cardiac filling obstructions, volume status and volume response, right and left heart function, and the function of the heart valves. Conclusion Integrating all echocardiographic findings in a differentiated assessment of the patient's cardiovascular function enables a (patho)physiologically oriented and individualized hemodynamic treatment.

Published
2021

22. Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery

Author

Edwards M, Forbes G, Berdunov V, Mihaylova B, Dias P, Thomson A, Grocott M, Mythen M, Gillies M, Phan T, Evered L, Wijeysundera D, McCluskey S, Hofer C, Abukhudair H, Szczeklik W, Hajjar L, Kahan B, Pearse R, MacDonald N, Abbott T, Martin T, Januszewska M, Niebrzegowska E, Bekele S, Pates K, Haines R, Walker S, Fowler A, Oliveira M, Whalley J, Stephens T, Amaral V, May S, Manou V, Jones T, Dunkley S, Pakats M, Griffiths B, Fernandez M, Jonas M, Bolger C, Collings N, Burnish R, Kelleher M, Dawson H, Lang A, Campbell R, Rea N, Clark S, Blunt M, Rosbergen M, Hodgson R, Wittenberg M, Filipe H, Gleeson Y, Pakou G, Szakmany T, Gunter U, Hodkinson G, Reay M, Gidda R, Allcock C, Cole A, Watts A, Gardner W, Tindall M, Anumakonda V, Agarwal N, Price T, Clark P, Thompson R, Fowler S, Gray K, McGregor A, Smith T, Wilson T, Guha A, Hodgson A, McSkeane A, Barberis L, Mohamed M, Prentice S, Saunders Z, Ratnam V, Pawa N, Sayan A, Thankachen M, Svensson M, Raj A, Ahmad N, Ivermee C, Cashman J, Smee E, Kanapeckaite L, Corcoran P, Fitzgerald E, Peyton P, Buckley A, Baulch S, Claxton G, Harris S, Sidiropolous S, de Almeida J, Simoes C, Galas F, Camara L, Malbouisson L, Soares S, Fernandes C, Joaquim E, Stefani L, Falcao L, Salgado M, Guimaraes G, Gomes M, Lineburger E, Navarro L, Salles L, Azi L, Prado R, Benedetti R, de Godoy E, Bastos F, da Silva R, dos Santos W, Pazmino-Canizares J, Parotto M, Wasowicz M, Beattie S, Meineri M, Clarke H, Ladha K, Jerath A, Ayach N, Poonawala H, Sellers D, Duncan D, Carroll J, Hudson C, van Vlymen J, Jaeger M, Shelley J, Shore D, McQuaide S, Richebe P, Godin N, Gobert Q, Fortier L, Verdonck O, Sato H, Schricker T, Codere-Maruyama T, Lattermann R, Hatzakorzian R, Moore A, Sato T, Funk D, Kowalski S, Girling L, Monterola M, Fidler K, Sander M, Markmann M, Schulte D, Singer R, Koch C, Ruhrmann S, Habig L, Edinger F, Schneck E, Treskatsch S, Ertmer M, Trauzeddel R, Weyland A, Diers A, Grote T, Pabel S, Lipka A, Nannen L, Fleischer A, Wittmann M, Winkler A, Neumann C, Fingerhut M, Ehrentraut H, Guttenthaler V, Heringlake M, Brandt S, Olsson S, Schmidt C, Schemke S, Murat L, Abu Khudair H, Farhoud E, Ghidan A, Al Masri M, Abu Kwiak S, Abdel-Nabi H, Grigoras I, Ristescu I, Jitaru I, Manole M, Rusu D, Gata A, Aldecoa C, Gonzalez A, Alfonso S, Perz L, Feijoo J, Guerra Y, Herrero A, Ripolles-Melchor J, Abad-Motos A, de Pablo E, Martinez-Hurtado E, Abad-Gurumeta A, Salvachua-Fernandez R, Nozal-Mateo B, de Nadal M, Galan P, Visauta E, Peral E, Da Prat I, Suarez S, Peral C, Una-Orejon R, Caldera-Alvarez M, Fernandez-Francos S, Davila A, Ortola C, Gutierrez A, Mugarra A, Romero E, Soro M, Gracia E, Pozo N, Villafane A, Diez A, Sanchez C, Buron F, Blanco R, Duran M, Parada P, Torres M, Rivas M, Brage S, Castro A, Conde M, Pardal C, Ben M, Perez A, Sancho J, Alarcon M, Mariotti S, Marcolino I, Winter A, McGrane T, Craven D, Turnbo T, Mayo G, Campbell D, Klintworth S, Tilley A, Weinstein M, Horan A, Chowdary R, Carlon V, Balasinorwala T, Yang G, and OPTIMISE II Investigators

Published
2019

23. Safety of a Restrictive versus Liberal Approach to Red Blood Cell Transfusion on the Outcome of AKI in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial

Author

Garg A, Badner N, Bagshaw S, Cuerden M, Fergusson D, Gregory A, Hall J, Hare G, Khanykin B, McGuinness S, Parikh C, Roshanov P, Shehata N, Sontrop J, Syed S, Tagarakis G, Thorpe K, Verma S, Wald R, Whitlock R, Mazer C, de Medicis E, Masse M, Marchand J, MacAdams C, Seal D, Ferland A, Ali I, Maier K, Creary T, Tittley L, Spence J, Jaffer I, Brodutch S, Lellouche F, Bussieres J, Dagenais F, Lizotte P, Gagne N, Tremblay H, Breton C, Bouchard P, Bainbridge D, Bentall T, Beique F, Ramachandran S, Rochon A, Vervais M, Grenier S, Grocott H, Kashani H, Ambrose E, McVagh J, Mazer, Hare, Verma, Crescini C, Yagnik S, Slabiak A, Han K, Fremes S, Karkhanis R, Baig N, Sidhu S, MacArthur R, Reid K, Boehnke S, Hudson C, Rubens F, Winch D, Klein R, Grey R, Teoh K, Wiley W, Darby C, Ho A, Saha T, Shore D, Shelley J, Lamarche Y, Sirois C, Brown C, Dube C, Holden K, Roy L, Rolfe B, Brown S, Saczkowski R, Senner W, Carrier F, Noiseux N, Hebert P, Benettaib F, Ghamraoui A, Lebrasseur M, Beattie W, Carroll J, Poonawala H, Zbitnew G, Howells S, Mawhinney R, Sampson S, Yegappan C, Schroeder R, Perfect S, Jones M, Leff J, Nair S, Moncada K, Joco C, Harrison M, Greilich P, Landgraf K, Kramer R, Gallant B, Fontes M, Stavris K, Rosengart T, Debakey M, Omer S, Coffey K, Broussard E, Tseng E, London M, Stanley K, Casson L, Julien M, Myles P, Wallace S, Galagher W, Ditoro A, Royse A, Royse C, Williams Z, Tivendale L, Dong N, Judelman S, Leyden J, Yarad E, Doane M, Player C, Scott D, Slater B, Corcoran P, Hu R, Sidiropoulos S, Baulch S, Brewster D, Simpson S, Smith J, Hulley A, Painter T, de Prinse L, Bannon P, Turner L, Beattie L, Eslick A, Cope L, Sanderson B, Baker R, Pesudovs B, Bennetts J, Dimovski D, Duggan N, Ives K, Yap C, Byrne K, Mans G, Termaat J, Young P, Ridgeon E, Reddy S, Hurford S, Mackle D, Baker T, Hunt A, Cruz R, Henderson S, Mehrtens J, Parke R, Gilder E, Cowdrey K, Dalton J, Butler M, Long S, Lammert A, Blakemore A, Walker C, France D, Hutchison R, Xue S, Gu J, Chen X, Fan A, Suraya S, Raja N, Yusnida I, Azura T, Saibon T, Bing M, Hwang N, Tan R, Ang F, Chin T, Mehta C, Jain A, Sharma P, Shah R, Shaikh P, Kanchi M, Sigamani A, Anusha K, Johansson P, Anderson T, Olesen L, Lilleor N, Rasmussen S, Fenger A, Treskatsch S, Mezger V, Falk E, Habicher M, Sander M, Edinger F, Koch C, Boening A, Oswald I, Bulat-Genc S, Seeberger D, Fassl J, Seeberger E, Eberle B, Takala J, Stucki M, Mateo E, Moreno J, Gabaldon T, Cobo I, Pena J, Ferrer C, Carmona P, Lopez Cantero M, Pajares A, Zarragoikoetxea I, Galan J, Urrutia G, Martinez-Zapata M, Rivilla M, Cegarra V, Acosta-Isaac R, Gajate-Martin L, Candela-Toha A, Simopoulos V, Karangelis D, Filipescu D, Paunescu A, Fawzy H, Mawlana W, Preisman S, Raanani E, Kogan D, Matot I, Cattan A, Artsi H, Galhardo C, Olival S, Toledo R, Villar J, Hernandez E, Montes F, Vaquiro E, Garavito C, Abello M, Manrique E, Vasquez S, Aguilar L, Coral M, Rodriguez H, Tellez J, Martinez C, Biccard B, Alphonsus C, Spiess B, Hall R, Kent B, Denault A, Deschamps A, TRICS Investigators, and Perioperative Anesthesia Clinical

Abstract

Background Safely reducing red blood cell transfusions can prevent transfusion-related adverse effects, conserve the blood supply, and reduce health care costs. Both anemia and red blood cell transfusion are independently associated with AKI, but observational data are insufficient to determine whether a restrictive approach to transfusion can be used without increasing AKI risk. Methods In a prespecified kidney substudy of a randomized noninferiority trial, we compared a restrictive threshold for red blood cell transfusion (transfuse if hemoglobin= 0.3 mg/dl within 48 hours of surgery, or >= 50% within 7 days of surgery. Results Patients in the restrictive-threshold group received significantly fewer transfusions than patients in the liberal-threshold group (1.8 versus 2.9 on average, or 38% fewer transfusions in the restricted threshold group compared with the liberal-threshold group; P

Published
2019

24. Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery

Author

Edwards, MR, Forbes, G, MacDonald, N, Berdunov, V, Mihaylova, B, Dias, P, Thomson, A, Grocott, MPW, Mythen, MG, Gillies, MA, Sander, M, Phan, TD, Evered, L, Wijeysundera, DN, McCluskey, SA, Aldecoa, C, Ripolles-Melchor, J, Hofer, CK, Abukhudair, H, Szczeklik, W, Grigoras, I, Hajjar, LA, Kahan, BC, Pearse, RM, Abbott, T, Martin, T, Januszewska, M, Niebrzegowska, E, Bekele, S, Pates, K, Haines, R, Walker, S, Fowler, A, Oliveira, M, Whalley, J, Stephens, T, Amaral, VDS, May, S, Manou, V, Jones, T, Dunkley, S, Pakats, M-L, Griffiths, B, Fernandez, M, Edwards, M, Jonas, M, Bolger, C, Collings, N, Burnish, R, Kelleher, M, Dawson, H, Lang, A, Campbell, R, Rea, N, Clark, S, Blunt, M, Rosbergen, M, Hodgson, R, Wittenberg, M, Filipe, H, Gleeson, Y, Pakou, G, Szakmany, T, Gunter, U, Hodkinson, G, Reay, M, Gidda, R, Allcock, C, Cole, A, Watts, A, Gardner, W, Tindall, M, Anumakonda, V, Agarwal, N, Price, T, Clark, P, Thompson, R, Fowler, S, Gray, K, McGregor, A, Smith, T, Wilson, T, Guha, A, Hodgson, A, McSkeane, A, Barberis, L, Mohamed, M, Prentice, S, Saunders, Z, Ratnam, V, Pawa, N, Sayan, A, Thankachen, M, Svensson, M-L, Raj, A, Ahmad, N, Ivermee, C, Cashman, J, Smee, E, Kanapeckaite, L, Tuong, P, Corcoran, P, Fitzgerald, E, Peyton, P, Buckley, A, Baulch, S, Claxton, G, Harris, S, Sidiropolous, S, de Almeida, JP, Simoes, C, Galas, FRBG, Camara, L, Malbouisson, LMS, Soares, SD, Fernandes, CR, Joaquim, EHG, Stefani, LC, Falcao, LF, Salgado, M, Guimaraes, GN, Gomes, MDA, Lineburger, E, Navarro, L, Salles, LC, Azi, LMTDA, Prado, RG, Benedetti, RH, de Godoy, EP, Bastos, FA, da Silva, RJC, dos Santos, WF, McCluskey, S, Wijeysundera, D, Pazmino-Canizares, J, Parotto, M, Wasowicz, M, Beattie, S, Meineri, M, Clarke, H, Ladha, K, Jerath, A, Ayach, N, Poonawala, H, Sellers, D, Duncan, D, Carroll, J, Hudson, C, van Vlymen, J, Jaeger, M, Shelley, J, Shore, DD, McQuaide, S, Richebe, P, Godin, N, Gobert, Q, Fortier, LP, Verdonck, O, Sato, H, Schricker, T, Codere-Maruyama, T, Lattermann, R, Hatzakorzian, R, Moore, A, Sato, T, Funk, D, Kowalski, S, Girling, L, Monterola, M, Fidler, K, Markmann, M, Schulte, D, Singer, R, Koch, C, Ruhrmann, S, Habig, L, Edinger, F, Schneck, E, Treskatsch, S, Ertmer, M, Trauzeddel, R-F, Weyland, A, Diers, A, Grote, T, Pabel, S, Lipka, A, Nannen, L, Fleischer, A, Wittmann, M, Winkler, A, Neumann, C, Fingerhut, M-L, Ehrentraut, H, Guttenthaler, V, Heringlake, M, Brandt, S, Olsson, S, Schmidt, C, Schemke, S, Murat, L, Abu Khudair, H, Farhoud, E, Ghidan, A, Al Masri, M, Abu Kwiak, S, Abdel-Nabi, H, Ristescu, I, Jitaru, I, Manole, M, Rusu, D, Gata, A, Gonzalez, AP, Alfonso, SM, Perz, LV, Feijoo, JR, Guerra, Y, Herrero, A, Abad-Motos, A, de Pablo, EL, Martinez-Hurtado, E, Abad-Gurumeta, A, Salvachua-Fernandez, R, Nozal-Mateo, B, de Nadal, M, Galan, P, Visauta, EC, Peral, EC, Da Prat, IC, Suarez, SG, Peral, C, Una-Orejon, R, Caldera-Alvarez, MV, Fernandez-Francos, S, Davila, AS, Ortola, CF, Gutierrez, A, Mugarra, A, Romero, E, Soro, M, Gracia, E, Pozo, N, Villafane, AP, Diez, AF, Sanchez, CGM, Buron, FD, Blanco, RP, Duran, MV, Parada, PD, Torres, MB, Rivas, MC, Brage, SM, Castro, AMG, Conde, MJP, Pardal, CB, Ben, MRT, Perez, A, Sancho, JM, Alarcon, MM, Hofer, C, Mariotti, S, Marcolino, I, Winter, A, McGrane, T, Craven, D, Turnbo, T, Mayo, G, Campbell, D, Klintworth, S, Tilley, A, Weinstein, M, Horan, A, Chowdary, R, Carlon, VA, Balasinorwala, T, Yang, G, Edwards, MR, Forbes, G, MacDonald, N, Berdunov, V, Mihaylova, B, Dias, P, Thomson, A, Grocott, MPW, Mythen, MG, Gillies, MA, Sander, M, Phan, TD, Evered, L, Wijeysundera, DN, McCluskey, SA, Aldecoa, C, Ripolles-Melchor, J, Hofer, CK, Abukhudair, H, Szczeklik, W, Grigoras, I, Hajjar, LA, Kahan, BC, Pearse, RM, Abbott, T, Martin, T, Januszewska, M, Niebrzegowska, E, Bekele, S, Pates, K, Haines, R, Walker, S, Fowler, A, Oliveira, M, Whalley, J, Stephens, T, Amaral, VDS, May, S, Manou, V, Jones, T, Dunkley, S, Pakats, M-L, Griffiths, B, Fernandez, M, Edwards, M, Jonas, M, Bolger, C, Collings, N, Burnish, R, Kelleher, M, Dawson, H, Lang, A, Campbell, R, Rea, N, Clark, S, Blunt, M, Rosbergen, M, Hodgson, R, Wittenberg, M, Filipe, H, Gleeson, Y, Pakou, G, Szakmany, T, Gunter, U, Hodkinson, G, Reay, M, Gidda, R, Allcock, C, Cole, A, Watts, A, Gardner, W, Tindall, M, Anumakonda, V, Agarwal, N, Price, T, Clark, P, Thompson, R, Fowler, S, Gray, K, McGregor, A, Smith, T, Wilson, T, Guha, A, Hodgson, A, McSkeane, A, Barberis, L, Mohamed, M, Prentice, S, Saunders, Z, Ratnam, V, Pawa, N, Sayan, A, Thankachen, M, Svensson, M-L, Raj, A, Ahmad, N, Ivermee, C, Cashman, J, Smee, E, Kanapeckaite, L, Tuong, P, Corcoran, P, Fitzgerald, E, Peyton, P, Buckley, A, Baulch, S, Claxton, G, Harris, S, Sidiropolous, S, de Almeida, JP, Simoes, C, Galas, FRBG, Camara, L, Malbouisson, LMS, Soares, SD, Fernandes, CR, Joaquim, EHG, Stefani, LC, Falcao, LF, Salgado, M, Guimaraes, GN, Gomes, MDA, Lineburger, E, Navarro, L, Salles, LC, Azi, LMTDA, Prado, RG, Benedetti, RH, de Godoy, EP, Bastos, FA, da Silva, RJC, dos Santos, WF, McCluskey, S, Wijeysundera, D, Pazmino-Canizares, J, Parotto, M, Wasowicz, M, Beattie, S, Meineri, M, Clarke, H, Ladha, K, Jerath, A, Ayach, N, Poonawala, H, Sellers, D, Duncan, D, Carroll, J, Hudson, C, van Vlymen, J, Jaeger, M, Shelley, J, Shore, DD, McQuaide, S, Richebe, P, Godin, N, Gobert, Q, Fortier, LP, Verdonck, O, Sato, H, Schricker, T, Codere-Maruyama, T, Lattermann, R, Hatzakorzian, R, Moore, A, Sato, T, Funk, D, Kowalski, S, Girling, L, Monterola, M, Fidler, K, Markmann, M, Schulte, D, Singer, R, Koch, C, Ruhrmann, S, Habig, L, Edinger, F, Schneck, E, Treskatsch, S, Ertmer, M, Trauzeddel, R-F, Weyland, A, Diers, A, Grote, T, Pabel, S, Lipka, A, Nannen, L, Fleischer, A, Wittmann, M, Winkler, A, Neumann, C, Fingerhut, M-L, Ehrentraut, H, Guttenthaler, V, Heringlake, M, Brandt, S, Olsson, S, Schmidt, C, Schemke, S, Murat, L, Abu Khudair, H, Farhoud, E, Ghidan, A, Al Masri, M, Abu Kwiak, S, Abdel-Nabi, H, Ristescu, I, Jitaru, I, Manole, M, Rusu, D, Gata, A, Gonzalez, AP, Alfonso, SM, Perz, LV, Feijoo, JR, Guerra, Y, Herrero, A, Abad-Motos, A, de Pablo, EL, Martinez-Hurtado, E, Abad-Gurumeta, A, Salvachua-Fernandez, R, Nozal-Mateo, B, de Nadal, M, Galan, P, Visauta, EC, Peral, EC, Da Prat, IC, Suarez, SG, Peral, C, Una-Orejon, R, Caldera-Alvarez, MV, Fernandez-Francos, S, Davila, AS, Ortola, CF, Gutierrez, A, Mugarra, A, Romero, E, Soro, M, Gracia, E, Pozo, N, Villafane, AP, Diez, AF, Sanchez, CGM, Buron, FD, Blanco, RP, Duran, MV, Parada, PD, Torres, MB, Rivas, MC, Brage, SM, Castro, AMG, Conde, MJP, Pardal, CB, Ben, MRT, Perez, A, Sancho, JM, Alarcon, MM, Hofer, C, Mariotti, S, Marcolino, I, Winter, A, McGrane, T, Craven, D, Turnbo, T, Mayo, G, Campbell, D, Klintworth, S, Tilley, A, Weinstein, M, Horan, A, Chowdary, R, Carlon, VA, Balasinorwala, T, and Yang, G

Abstract

INTRODUCTION: Postoperative morbidity and mortality in older patients with comorbidities undergoing gastrointestinal surgery are a major burden on healthcare systems. Infections after surgery are common in such patients, prolonging hospitalisation and reducing postoperative short-term and long-term survival. Optimal management of perioperative intravenous fluids and inotropic drugs may reduce infection rates and improve outcomes from surgery. Previous small trials of cardiac-output-guided haemodynamic therapy algorithms suggested a modest reduction in postoperative morbidity. A large definitive trial is needed to confirm or refute this and inform widespread clinical practice. METHODS: The Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial is a multicentre, international, parallel group, open, randomised controlled trial. 2502 high-risk patients undergoing major elective gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intravenous fluid combined with low-dose inotrope infusion, or usual care. The trial intervention will be carried out during and for 4 hours after surgery. The primary outcome is postoperative infection of Clavien-Dindo grade II or higher within 30 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation; however, outcome assessors will be blinded when feasible. Participant recruitment started in January 2017 and is scheduled to last 3 years, within 50 hospitals worldwide. ETHICS/DISSEMINATION: The OPTIMISE II trial has been approved by the UK National Research Ethics Service and has been approved by responsible ethics committees in all participating countries. The findings will be disseminated through publication in a widely accessible peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: ISRCTN39653756.

Published
2019

26. Fluid challenges in intensive care: the FENICE study: a global inception cohort study

Author

Cecconi, M1, Hofer, C, Teboul, Jl, Pettila, V, Wilkman, E, Molnar, Z, Della Rocca, G, Aldecoa, C, Artigas, A, Jog, S, Sander, M, Spies, C, Lefrant, Jy, De Backer, D, Silva, E, Zhang, X, Ospina-tascón, G, Arias, J, Gornik, I, Benes, J, Petersen, A, Zsolt, M, Sprung, C, Koch, M, Guttormsen, Ab, Tavares, M, Pettilä, V, Mikaszewska-sokolewicz, M, Bakker, J, Parke, R, Kirov, M, Wernerman, J, Esen, F, Cecconi, M, Cannesson, M, Njimi, H, François, G, Cueto, G, Hockley, S, Ambekar, H, Laterre, Pf, Dujardin, Mf, Damas, P, Deschamps, P, Glorieux, D, Hoste, E, Miribung, M, Devriendt, J, Haentjens, L, Biston, P, Dugernier, T, Bulpa, P, Dive, A, Debaveye, Y, Franck, S, Conde, K, Morsch, R, Ramos, M, Dias, F, Mataloun, S, Mendes, C, Silva, F, Grion, C, Knibel, M, Yang, C, Xiangyu, Z, Cai, G, Ortiz, G, Ospina-tascon, G, Yepes, D, Londono Arcila Hf, Molina, F, Pereira, F, Sanchez-galvez, Hf, Benitez, F, Arias Ortiz, J, Gonzalez Rojas, M, Cavric, G, Lukic, E, Zykova, I, Freml, P, Satinsky, I, Suk, P, Novak, I, Balik, M, Szturz, P, Kratochvil, M, Bestle, M, Strange, Dg, Perner, A, Rasmussen, Bs, Hauge, J, Meldgaard, M, Toome, V, Kuitunen, A, Varila, S, Hovilehto, S, Pulkkinen, A, Kiviniemi, O, Tallgren, M, Laitio, R, Mongardon, N, Dhonneur, G, Malledant, Y, Lepouse, C, Darmon, M, Mira, Jp, Chiche, Jd, Joannes-boyau, O, Preau, S, Larche, J, Mottard, N, Bengler, C, Argaud, L, Hamzaoui, O, Desebbe, O, Burtin, P, Reignier, J, Durand, M, Guitard, Pg, Asfar, P, Guillot, M, Boulain, T, Mekontso Dessap, A, Ducrocq, N, Lakhal, K, Gregoire, C, Schmauss, M, Zacharowski, K, Meybohm, P, Treskatsch, S, Bloos, F, Van Huelst, S, Baumann, H, Kersten, A, Goldmann, A, Gkiokas, G, Dimoula, A, Kofinas, G, Anthopoulos, G, Pankotai, B, Kopitko, C, Gartner, B, Schaffer, E, Fulesdi, B, Sarkany, A, Samavedam, S, Shah, B, Dixit, S, Toraskar, K, Nandakumar, S, Goila, Ak, Nayyar, A, Patel, M, Mitra, D, Jagiasi, B, Jakkinaboina, S, Goswami, J, Ghosh, S, Hashemian, M, Mahmoodpoor, A, Breen, D, Benbenishty, J, Kuniavsky, M, Kolpak, O, Castiglione, G, Monti, G, Molin, A, Martucci, G, Panarello, G, Raineri, Sm, Pota, V, Acquarolo, A, Ploner, F, Lapichino, G, Lombardo, A, Roasio, A, Cardelino, S, Pignataro, A, Oggioni, R, Mangani, V, Parrini, V, Spadaro, S, Volta, Ca, Alampi, D, Torrente, S, Monastra, L, Marini, F, Mazzini, P, Albanese, D, Riccardi, S, Ruberto, F, Belluomo, Ac, Silvestri, R, Citerio, G, Brienza, N, Brazzi, L, Protti, A, Bottino, N, David, A, Manzoni, D, Foti, G, Numis, F, Morimatsu, H, Shimizu, K, Munster, L, Rai, V, Buttigieg, M, Pickkers, P, Mijzen, L, Kesecioglu, J, Van Duijn, D, Ormskerk, P, Beck, O, Goodson, J, King, B, Koelle, J, Kantor, S, Gomez, O, Ramos, I, Jedynak, M, Sulkowski, W, Adamik, B, Chruscikowski, M, Wadelek, J, Korzybski, J, Misiewska-kaczur, A, Piasecka-twarog, M, Fijaikowska, A, Maciejewski, D, Smiechowicz, K, Milkowska, E, Czerwinska, A, Lukaszewska, A, Wieczorek, A, Czuczwar, M, Czerwiec, A, Tamowicz, B, Branco, V, Estilita, J, Basilio, C, Diogo, C, Toma, R, Bubenek-turconi, Si, Filipescu, D, Popescu, M, Titova, J, Belskiy, V, Smetkin, A, Grigoryev, E, Pugachev, S, Gasenkampf, A, Abouelala, A, Almekhlafi, G, Rupnik, E, Garcia-delgado, H, Saez Fernandez, A, Celaya Lopez, M, Ramasco, F, Planas, K, Zavala, E, De Nadal, M, Picos, Sa, Fernandez, S, Munoz, A, Herrera Para, L, Maseda, E, Rovira, A, Monge Garcia Mi, Ferrer, R, Sole Violan, J, Garcia Nogales, X, Torrents, E, Ripolles Melchor, J, Tomás Marsilla Ji, Araujo Aguilar, P, Aguilar, G, Menor, Em, Martinez, Mc, Leal Micharet Am, Ferri Riera, C, Mosquera, D, Astola, I, Freita-ramos, S, Garcia Olivares, P, Jimenez Bartolome Mb, Fernandez Gonzalez, I, Sanchez-izquierdo, Ja, Arribas, P, Gimenez-esparzavich, C, Anglada, M, Martin, S, Weerakoon, Rk, Bendjelid, K, Fumeaux, T, Maggiorini, M, Demirkiran, O, Adanir, T, Ergin Ozcan, P, Kelebek Girgin, N, Elahi, N, Kashef, S, Alsabbah, A, Lowe, A, Wise, M, Vizcaychipi, Mp, Baht, S, Webb, S, Friis, J, Boulanger, C, Gratrix, A, Harvey, D, Ferguson, A, Espie, L, Toth-tarsoly, P, Lewis, K, Shelley, B, Thuerey, J, Przemyslaw, D, Ranganathan, M, Hormis, A, Spivey, M, Henning, J, Saveker, R, Csabi, P, Bland, M, Barrera Groba, C, Al-subaie, N, Thomson, R, Hamilton, M, Iannuccelli, F, Roberts, C, Sherwood, N, Kasipandian, V, Silversides, J, Jonas, A, Szakmany, T, Vickers, E, Richards, J, Tham, L, Williams, D, Heenen, S, Hobrok, M, Walden, A, Raj, A, Bauer, P, Kashyap, R, Tolnai, P, Kjelle, Bj, Andersen, Fh, Palo, Je, Namendys-silva, S. A., Hôpital Bicêtre, Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Cecconi M., Hofer C., Teboul J.-L., Pettila V., Wilkman E., Molnar Z., Della Rocca G., Aldecoa C., Artigas A., Jog S., Sander M., Spies C., Lefrant J.-Y., De Backer D., Silva E., Zhang X., Ospina-Tascon G., Arias J., Gornik I., Benes J., Petersen A., Zsolt M., Sprung C., Koch M., Guttormsen A.B., Tavares M., Mikaszewska-Sokolewicz M., Bakker J., Parke R., Kirov M., Wernerman J., Esen F., Cannesson M., Njimi H., Francois G., Cueto G., Hockley S., Ambekar H., Laterre P.F., Dujardin M.F., Damas P., Deschamps P., Glorieux D., Hoste E., Miribung M., Devriendt J., Haentjens L., Biston P., Dugernier T., Bulpa P., Dive A., Debaveye Y., Franck S., Conde K., Morsch R., Ramos M., Dias F., Mataloun S., Mendes C., Silva F., Grion C., Knibel M., Yang C., Xiangyu Z., Cai G., Ortiz G., Yepes D., Londono Arcila H.F., Molina F., Pereira F., Sanchez-Galvez H.F., Benitez F., Arias Ortiz J., Gonzalez Rojas M., Cavric G., Lukic E., Zykova I., Freml P., Satinsky I., Suk P., Novak I., Balik M., Szturz P., Kratochvil M., Bestle M., Strange D.G., Perner A., Rasmussen B.S., Hauge J., Meldgaard M., Toome V., Kuitunen A., Varila S., Hovilehto S., Pulkkinen A., Kiviniemi O., Tallgren M., Laitio R., Mongardon N., Dhonneur G., Malledant Y., Lepouse C., Darmon M., Mira J.P., Chiche J.D., Joannes-Boyau O., Preau S., Larche J., Mottard N., Bengler C., Argaud L., Hamzaoui O., Desebbe O., Burtin P., Reignier J., Durand M., Guitard P.G., Asfar P., Guillot M., Boulain T., Mekontso Dessap A., Ducrocq N., Lakhal K., Gregoire C., Schmauss M., Zacharowski K., Meybohm P., Treskatsch S., Bloos F., van Huelst S., Baumann H., Kersten A., Goldmann A., Gkiokas G., Dimoula A., Kofinas G., Anthopoulos G., Pankotai B., Kopitko C., Gartner B., Schaffer E., Fulesdi B., Sarkany A., Samavedam S., Shah B., Dixit S., Toraskar K., Nandakumar S., Goila A.K., Nayyar A., Patel M., Mitra D., Jagiasi B., Jakkinaboina S., Goswami J., Ghosh S., Hashemian M., Mahmoodpoor A., Breen D., Benbenishty J., Kuniavsky M., Kolpak O., Castiglione G., Monti G., Molin A., Martucci G., Panarello G., Raineri S.M., Pota V., Acquarolo A., Ploner F., Lapichino G., Lombardo A., Roasio A., Cardelino S., Pignataro A., Oggioni R., Mangani V., Parrini V., Spadaro S., Volta C.A., Alampi D., Torrente S., Monastra L., Marini F., Mazzini P., Albanese D., Riccardi S., Ruberto F., Belluomo A.C., Silvestri R., Citerio G., Brienza N., Brazzi L., Protti A., Bottino N., David A., Manzoni D., Foti G., Numis F., Morimatsu H., Shimizu K., Munster L., Rai V., Buttigieg M., Pickkers P., Mijzen L., Kesecioglu J., Van Duijn D., Ormskerk P., Beck O., Goodson J., King B., Koelle J., Kantor S., Gomez O., Ramos I., Jedynak M., Sulkowski W., Adamik B., Chruscikowski M., Wadelek J., Korzybski J., Misiewska-Kaczur A., Piasecka-Twarog M., Fijaikowska A., Maciejewski D., Smiechowicz K., Milkowska E., Czerwinska A., Lukaszewska A., Wieczorek A., Czuczwar M., Czerwiec A., Tamowicz B., Branco V., Estilita J., Basilio C., Diogo C., Toma R., Bubenek-Turconi S.I., Filipescu D., Popescu M., Titova J., Belskiy V., Smetkin A., Grigoryev E., Pugachev S., Gasenkampf A., Abouelala A., Almekhlafi G., Rupnik E., Garcia-Delgado H., Saez Fernandez A., Celaya Lopez M., Ramasco F., Planas K., Zavala E., De Nadal M., Picos S.A., Fernandez S., Munoz A., Herrera Para L., Maseda E., Rovira A., Monge Garcia M.I., Ferrer R., Sole Violan J., Garcia Nogales X., Torrents E., Ripolles Melchor J., Tomas Marsilla J.I., Araujo Aguilar P., Aguilar G., Menor E.M., Martinez M.C., Leal Micharet A.M., Ferri Riera C., Mosquera D., Astola I., Freita-Ramos S., Garcia Olivares P., Jimenez Bartolome M.B., Fernandez Gonzalez I., Sanchez-Izquierdo J.A., Arribas P., Gimenez-Esparzavich C., Anglada M., Martin S., Weerakoon R.K., Bendjelid K., Fumeaux T., Maggiorini M., Demirkiran O., Adanir T., Ergin Ozcan P., Kelebek Girgin N., Elahi N., Kashef S., Alsabbah A., Lowe A., Wise M., Vizcaychipi M.P., Baht S., Webb S., Friis J., Boulanger C., Gratrix A., Harvey D., Ferguson A., Espie L., Toth-Tarsoly P., Lewis K., Shelley B., Thuerey J., Przemyslaw D., Ranganathan M., Hormis A., Spivey M., Henning J., Saveker R., Csabi P., Bland M., Barrera Groba C., Al-Subaie N., Thomson R., Hamilton M., Iannuccelli F., Roberts C., Sherwood N., Kasipandian V., Silversides J., Jonas A., Szakmany T., Vickers E., Richards J., Tham L., Williams D., Heenen S., Hobrok M., Walden A., Raj A., Bauer P., Kashyap R., Tolnai P., Kjelle B.J., Andersen F.H., Palo J.E., Namendys-Silva S.A., Cecconi, M, Hofer, C, Teboul, J, Pettila, V, Wilkman, E, Molnar, Z, Della Rocca, G, Aldecoa, C, Artigas, A, Jog, S, Sander, M, Spies, C, Lefrant, J, De Backer, D, Silva, E, Zhang, X, Ospina-Tascon, G, Arias, J, Gornik, I, Benes, J, Petersen, A, Zsolt, M, Sprung, C, Koch, M, Guttormsen, A, Tavares, M, Mikaszewska-Sokolewicz, M, Bakker, J, Parke, R, Kirov, M, Wernerman, J, Esen, F, Cannesson, M, Njimi, H, Francois, G, Cueto, G, Hockley, S, Ambekar, H, Laterre, P, Dujardin, M, Damas, P, Deschamps, P, Glorieux, D, Hoste, E, Miribung, M, Devriendt, J, Haentjens, L, Biston, P, Dugernier, T, Bulpa, P, Dive, A, Debaveye, Y, Franck, S, Conde, K, Morsch, R, Ramos, M, Dias, F, Mataloun, S, Mendes, C, Silva, F, Grion, C, Knibel, M, Yang, C, Xiangyu, Z, Cai, G, Ortiz, G, Yepes, D, Londono Arcila, H, Molina, F, Pereira, F, Sanchez-Galvez, H, Benitez, F, Arias Ortiz, J, Gonzalez Rojas, M, Cavric, G, Lukic, E, Zykova, I, Freml, P, Satinsky, I, Suk, P, Novak, I, Balik, M, Szturz, P, Kratochvil, M, Bestle, M, Strange, D, Perner, A, Rasmussen, B, Hauge, J, Meldgaard, M, Toome, V, Kuitunen, A, Varila, S, Hovilehto, S, Pulkkinen, A, Kiviniemi, O, Tallgren, M, Laitio, R, Mongardon, N, Dhonneur, G, Malledant, Y, Lepouse, C, Darmon, M, Mira, J, Chiche, J, Joannes-Boyau, O, Preau, S, Larche, J, Mottard, N, Bengler, C, Argaud, L, Hamzaoui, O, Desebbe, O, Burtin, P, Reignier, J, Durand, M, Guitard, P, Asfar, P, Guillot, M, Boulain, T, Mekontso Dessap, A, Ducrocq, N, Lakhal, K, Gregoire, C, Schmauss, M, Zacharowski, K, Meybohm, P, Treskatsch, S, Bloos, F, van Huelst, S, Baumann, H, Kersten, A, Goldmann, A, Gkiokas, G, Dimoula, A, Kofinas, G, Anthopoulos, G, Pankotai, B, Kopitko, C, Gartner, B, Schaffer, E, Fulesdi, B, Sarkany, A, Samavedam, S, Shah, B, Dixit, S, Toraskar, K, Nandakumar, S, Goila, A, Nayyar, A, Patel, M, Mitra, D, Jagiasi, B, Jakkinaboina, S, Goswami, J, Ghosh, S, Hashemian, M, Mahmoodpoor, A, Breen, D, Benbenishty, J, Kuniavsky, M, Kolpak, O, Castiglione, G, Monti, G, Molin, A, Martucci, G, Panarello, G, Raineri, S, Pota, V, Acquarolo, A, Ploner, F, Lapichino, G, Lombardo, A, Roasio, A, Cardelino, S, Pignataro, A, Oggioni, R, Mangani, V, Parrini, V, Spadaro, S, Volta, C, Alampi, D, Torrente, S, Monastra, L, Marini, F, Mazzini, P, Albanese, D, Riccardi, S, Ruberto, F, Belluomo, A, Silvestri, R, Citerio, G, Brienza, N, Brazzi, L, Protti, A, Bottino, N, David, A, Manzoni, D, Foti, G, Numis, F, Morimatsu, H, Shimizu, K, Munster, L, Rai, V, Buttigieg, M, Pickkers, P, Mijzen, L, Kesecioglu, J, Van Duijn, D, Ormskerk, P, Beck, O, Goodson, J, King, B, Koelle, J, Kantor, S, Gomez, O, Ramos, I, Jedynak, M, Sulkowski, W, Adamik, B, Chruscikowski, M, Wadelek, J, Korzybski, J, Misiewska-Kaczur, A, Piasecka-Twarog, M, Fijaikowska, A, Maciejewski, D, Smiechowicz, K, Milkowska, E, Czerwinska, A, Lukaszewska, A, Wieczorek, A, Czuczwar, M, Czerwiec, A, Tamowicz, B, Branco, V, Estilita, J, Basilio, C, Diogo, C, Toma, R, Bubenek-Turconi, S, Filipescu, D, Popescu, M, Titova, J, Belskiy, V, Smetkin, A, Grigoryev, E, Pugachev, S, Gasenkampf, A, Abouelala, A, Almekhlafi, G, Rupnik, E, Garcia-Delgado, H, Saez Fernandez, A, Celaya Lopez, M, Ramasco, F, Planas, K, Zavala, E, De Nadal, M, Picos, S, Fernandez, S, Munoz, A, Herrera Para, L, Maseda, E, Rovira, A, Monge Garcia, M, Ferrer, R, Sole Violan, J, Garcia Nogales, X, Torrents, E, Ripolles Melchor, J, Tomas Marsilla, J, Araujo Aguilar, P, Aguilar, G, Menor, E, Martinez, M, Leal Micharet, A, Ferri Riera, C, Mosquera, D, Astola, I, Freita-Ramos, S, Garcia Olivares, P, Jimenez Bartolome, M, Fernandez Gonzalez, I, Sanchez-Izquierdo, J, Arribas, P, Gimenez-Esparzavich, C, Anglada, M, Martin, S, Weerakoon, R, Bendjelid, K, Fumeaux, T, Maggiorini, M, Demirkiran, O, Adanir, T, Ergin Ozcan, P, Kelebek Girgin, N, Elahi, N, Kashef, S, Alsabbah, A, Lowe, A, Wise, M, Vizcaychipi, M, Baht, S, Webb, S, Friis, J, Boulanger, C, Gratrix, A, Harvey, D, Ferguson, A, Espie, L, Toth-Tarsoly, P, Lewis, K, Shelley, B, Thuerey, J, Przemyslaw, D, Ranganathan, M, Hormis, A, Spivey, M, Henning, J, Saveker, R, Csabi, P, Bland, M, Barrera Groba, C, Al-Subaie, N, Thomson, R, Hamilton, M, Iannuccelli, F, Roberts, C, Sherwood, N, Kasipandian, V, Silversides, J, Jonas, A, Szakmany, T, Vickers, E, Richards, J, Tham, L, Williams, D, Heenen, S, Hobrok, M, Walden, A, Raj, A, Bauer, P, Kashyap, R, Tolnai, P, Kjelle, B, Andersen, F, Palo, J, Namendys-Silva, S, De Backer, Daniel, Cecconi, M., Hofer, C., Teboul, J. -L., Pettila, V., Wilkman, E., Molnar, Z., Della Rocca, G., Aldecoa, C., Artigas, A., Jog, S., Sander, M., Spies, C., Lefrant, J. -Y., De Backer, D., Silva, E., Zhang, X., Ospina-Tascon, G., Arias, J., Gornik, I., Benes, J., Petersen, A., Zsolt, M., Sprung, C., Koch, M., Guttormsen, A. B., Tavares, M., Mikaszewska-Sokolewicz, M., Bakker, J., Parke, R., Kirov, M., Wernerman, J., Esen, F., Cannesson, M., Njimi, H., Francois, G., Cueto, G., Hockley, S., Ambekar, H., Laterre, P. F., Dujardin, M. F., Damas, P., Deschamps, P., Glorieux, D., Hoste, E., Miribung, M., Devriendt, J., Haentjens, L., Biston, P., Dugernier, T., Bulpa, P., Dive, A., Debaveye, Y., Franck, S., Conde, K., Morsch, R., Ramos, M., Dias, F., Mataloun, S., Mendes, C., Silva, F., Grion, C., Knibel, M., Yang, C., Xiangyu, Z., Cai, G., Ortiz, G., Yepes, D., Londono Arcila, H. F., Molina, F., Pereira, F., Sanchez-Galvez, H. F., Benitez, F., Arias Ortiz, J., Gonzalez Rojas, M., Cavric, G., Lukic, E., Zykova, I., Freml, P., Satinsky, I., Suk, P., Novak, I., Balik, M., Szturz, P., Kratochvil, M., Bestle, M., Strange, D. G., Perner, A., Rasmussen, B. S., Hauge, J., Meldgaard, M., Toome, V., Kuitunen, A., Varila, S., Hovilehto, S., Pulkkinen, A., Kiviniemi, O., Tallgren, M., Laitio, R., Mongardon, N., Dhonneur, G., Malledant, Y., Lepouse, C., Darmon, M., Mira, J. P., Chiche, J. D., Joannes-Boyau, O., Preau, S., Larche, J., Mottard, N., Bengler, C., Argaud, L., Hamzaoui, O., Desebbe, O., Burtin, P., Reignier, J., Durand, M., Guitard, P. G., Asfar, P., Guillot, M., Boulain, T., Mekontso Dessap, A., Ducrocq, N., Lakhal, K., Gregoire, C., Schmauss, M., Zacharowski, K., Meybohm, P., Treskatsch, S., Bloos, F., van Huelst, S., Baumann, H., Kersten, A., Goldmann, A., Gkiokas, G., Dimoula, A., Kofinas, G., Anthopoulos, G., Pankotai, B., Kopitko, C., Gartner, B., Schaffer, E., Fulesdi, B., Sarkany, A., Samavedam, S., Shah, B., Dixit, S., Toraskar, K., Nandakumar, S., Goila, A. K., Nayyar, A., Patel, M., Mitra, D., Jagiasi, B., Jakkinaboina, S., Goswami, J., Ghosh, S., Hashemian, M., Mahmoodpoor, A., Breen, D., Benbenishty, J., Kuniavsky, M., Kolpak, O., Castiglione, G., Monti, G., Molin, A., Martucci, G., Panarello, G., Raineri, S. M., Pota, V., Acquarolo, A., Ploner, F., Lapichino, G., Lombardo, A., Roasio, A., Cardelino, S., Pignataro, A., Oggioni, R., Mangani, V., Parrini, V., Spadaro, S., Volta, C. A., Alampi, D., Torrente, S., Monastra, L., Marini, F., Mazzini, P., Albanese, D., Riccardi, S., Ruberto, F., Belluomo, A. C., Silvestri, R., Citerio, G., Brienza, N., Brazzi, L., Protti, A., Bottino, N., David, A., Manzoni, D., Foti, G., Numis, F., Morimatsu, H., Shimizu, K., Munster, L., Rai, V., Buttigieg, M., Pickkers, P., Mijzen, L., Kesecioglu, J., Van Duijn, D., Ormskerk, P., Beck, O., Goodson, J., King, B., Koelle, J., Kantor, S., Gomez, O., Ramos, I., Jedynak, M., Sulkowski, W., Adamik, B., Chruscikowski, M., Wadelek, J., Korzybski, J., Misiewska-Kaczur, A., Piasecka-Twarog, M., Fijaikowska, A., Maciejewski, D., Smiechowicz, K., Milkowska, E., Czerwinska, A., Lukaszewska, A., Wieczorek, A., Czuczwar, M., Czerwiec, A., Tamowicz, B., Branco, V., Estilita, J., Basilio, C., Diogo, C., Toma, R., Bubenek-Turconi, S. I., Filipescu, D., Popescu, M., Titova, J., Belskiy, V., Smetkin, A., Grigoryev, E., Pugachev, S., Gasenkampf, A., Abouelala, A., Almekhlafi, G., Rupnik, E., Garcia-Delgado, H., Saez Fernandez, A., Celaya Lopez, M., Ramasco, F., Planas, K., Zavala, E., De Nadal, M., Picos, S. A., Fernandez, S., Munoz, A., Herrera Para, L., Maseda, E., Rovira, A., Monge Garcia, M. I., Ferrer, R., Sole Violan, J., Garcia Nogales, X., Torrents, E., Ripolles Melchor, J., Tomas Marsilla, J. I., Araujo Aguilar, P., Aguilar, G., Menor, E. M., Martinez, M. C., Leal Micharet, A. M., Ferri Riera, C., Mosquera, D., Astola, I., Freita-Ramos, S., Garcia Olivares, P., Jimenez Bartolome, M. B., Fernandez Gonzalez, I., Sanchez-Izquierdo, J. A., Arribas, P., Gimenez-Esparzavich, C., Anglada, M., Martin, S., Weerakoon, R. K., Bendjelid, K., Fumeaux, T., Maggiorini, M., Demirkiran, O., Adanir, T., Ergin Ozcan, P., Kelebek Girgin, N., Elahi, N., Kashef, S., Alsabbah, A., Lowe, A., Wise, M., Vizcaychipi, M. P., Baht, S., Webb, S., Friis, J., Boulanger, C., Gratrix, A., Harvey, D., Ferguson, A., Espie, L., Toth-Tarsoly, P., Lewis, K., Shelley, B., Thuerey, J., Przemyslaw, D., Ranganathan, M., Hormis, A., Spivey, M., Henning, J., Saveker, R., Csabi, P., Bland, M., Barrera Groba, C., Al-Subaie, N., Thomson, R., Hamilton, M., Iannuccelli, F., Roberts, C., Sherwood, N., Kasipandian, V., Silversides, J., Jonas, A., Szakmany, T., Vickers, E., Richards, J., Tham, L., Williams, D., Heenen, S., Hobrok, M., Walden, A., Raj, A., Bauer, P., Kashyap, R., Tolnai, P., Kjelle, B. J., Andersen, F. H., Palo, J. E., Namendys-Silva, S. A., Clinicum, Department of Diagnostics and Therapeutics, and Anestesiologian yksikkö

Subjects
Male, Soins intensifs réanimation, medicine.medical_treatment, Cohort Studies, Female, Humans, Middle Aged, Practice Patterns, Physicians', Critical Care, Fluid Therapy, Critical Care and Intensive Care Medicine, Practice Patterns, ESICM Trial Group, RESPONSIVENESS, Seven-Day Profile Publication, Medicine and Health Sciences, FENICE Investigators, CIRCULATORY SHOCK, intensive care, ddc:617, RENAL REPLACEMENT THERAPY, 3. Good health, OF-THE-LITERATURE, SHOCK, lipids (amino acids, peptides, and proteins), Erratum, intensive care, fluid therapy, fluids, Life Sciences & Biomedicine, CRITICALLY-ILL PATIENTS, Human, Cohort study, medicine.medical_specialty, HYDROXYETHYL STARCH 130/0.4, MEDLINE, 1117 Public Health and Health Services, NO, fluid therapy, Critical Care Medicine, CIRCULATORY, General & Internal Medicine, Intensive care, Anesthesiology, PATIENTS, medicine, cohort study, Renal replacement therapy, Intensive care medicine, Physicians', Science & Technology, CRITICALLY-ILL, business.industry, Septic shock, SEPTIC SHOCK, 1103 Clinical Sciences, 3126 Surgery, anesthesiology, intensive care, radiology, medicine.disease, Emergency & Critical Care Medicine, ARTERIAL-PRESSURE, SEVERE SEPSIS, Clinical trial, Observational study, Cohort Studie, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, TASK-FORCE
Abstract

Background: Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC. Methods: This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC. Results: 2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500–1000). The median time was 24 min (40–60 min), and the median rate of FC was 1000 [500–1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57–61 %). In 43 % (CI 41–45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34–37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20–24 %). No safety variable for the FC was used in 72 % (CI 70–74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response. Conclusions: The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2015

27. Fluid challenges in intensive care: the FENICE study: A global inception cohort study

Author

Cecconi, M, Hofer, C, Teboul, J, Pettila, V, Wilkman, E, Molnar, Z, Della Rocca, G, Aldecoa, C, Artigas, A, Jog, S, Sander, M, Spies, C, Lefrant, J, De Backer, D, Silva, E, Zhang, X, Ospina-Tascon, G, Arias, J, Gornik, I, Benes, J, Petersen, A, Zsolt, M, Sprung, C, Koch, M, Guttormsen, A, Tavares, M, Mikaszewska-Sokolewicz, M, Bakker, J, Parke, R, Kirov, M, Wernerman, J, Esen, F, Cannesson, M, Njimi, H, Francois, G, Cueto, G, Hockley, S, Ambekar, H, Laterre, P, Dujardin, M, Damas, P, Deschamps, P, Glorieux, D, Hoste, E, Miribung, M, Devriendt, J, Haentjens, L, Biston, P, Dugernier, T, Bulpa, P, Dive, A, Debaveye, Y, Franck, S, Conde, K, Morsch, R, Ramos, M, Dias, F, Mataloun, S, Mendes, C, Silva, F, Grion, C, Knibel, M, Yang, C, Xiangyu, Z, Cai, G, Ortiz, G, Yepes, D, Londono Arcila, H, Molina, F, Pereira, F, Sanchez-Galvez, H, Benitez, F, Arias Ortiz, J, Gonzalez Rojas, M, Cavric, G, Lukic, E, Zykova, I, Freml, P, Satinsky, I, Suk, P, Novak, I, Balik, M, Szturz, P, Kratochvil, M, Bestle, M, Strange, D, Perner, A, Rasmussen, B, Hauge, J, Meldgaard, M, Toome, V, Kuitunen, A, Varila, S, Hovilehto, S, Pulkkinen, A, Kiviniemi, O, Tallgren, M, Laitio, R, Mongardon, N, Dhonneur, G, Malledant, Y, Lepouse, C, Darmon, M, Mira, J, Chiche, J, Joannes-Boyau, O, Preau, S, Larche, J, Mottard, N, Bengler, C, Argaud, L, Hamzaoui, O, Desebbe, O, Burtin, P, Reignier, J, Durand, M, Guitard, P, Asfar, P, Guillot, M, Boulain, T, Mekontso Dessap, A, Ducrocq, N, Lakhal, K, Gregoire, C, Schmauss, M, Zacharowski, K, Meybohm, P, Treskatsch, S, Bloos, F, van Huelst, S, Baumann, H, Kersten, A, Goldmann, A, Gkiokas, G, Dimoula, A, Kofinas, G, Anthopoulos, G, Pankotai, B, Kopitko, C, Gartner, B, Schaffer, E, Fulesdi, B, Sarkany, A, Samavedam, S, Shah, B, Dixit, S, Toraskar, K, Nandakumar, S, Goila, A, Nayyar, A, Patel, M, Mitra, D, Jagiasi, B, Jakkinaboina, S, Goswami, J, Ghosh, S, Hashemian, M, Mahmoodpoor, A, Breen, D, Benbenishty, J, Kuniavsky, M, Kolpak, O, Castiglione, G, Monti, G, Molin, A, Martucci, G, Panarello, G, Raineri, S, Pota, V, Acquarolo, A, Ploner, F, Lapichino, G, Lombardo, A, Roasio, A, Cardelino, S, Pignataro, A, Oggioni, R, Mangani, V, Parrini, V, Spadaro, S, Volta, C, Alampi, D, Torrente, S, Monastra, L, Marini, F, Mazzini, P, Albanese, D, Riccardi, S, Ruberto, F, Belluomo, A, Silvestri, R, Citerio, G, Brienza, N, Brazzi, L, Protti, A, Bottino, N, David, A, Manzoni, D, Foti, G, Numis, F, Morimatsu, H, Shimizu, K, Munster, L, Rai, V, Buttigieg, M, Pickkers, P, Mijzen, L, Kesecioglu, J, Van Duijn, D, Ormskerk, P, Beck, O, Goodson, J, King, B, Koelle, J, Kantor, S, Gomez, O, Ramos, I, Jedynak, M, Sulkowski, W, Adamik, B, Chruscikowski, M, Wadelek, J, Korzybski, J, Misiewska-Kaczur, A, Piasecka-Twarog, M, Fijaikowska, A, Maciejewski, D, Smiechowicz, K, Milkowska, E, Czerwinska, A, Lukaszewska, A, Wieczorek, A, Czuczwar, M, Czerwiec, A, Tamowicz, B, Branco, V, Estilita, J, Basilio, C, Diogo, C, Toma, R, Bubenek-Turconi, S, Filipescu, D, Popescu, M, Titova, J, Belskiy, V, Smetkin, A, Grigoryev, E, Pugachev, S, Gasenkampf, A, Abouelala, A, Almekhlafi, G, Rupnik, E, Garcia-Delgado, H, Saez Fernandez, A, Celaya Lopez, M, Ramasco, F, Planas, K, Zavala, E, De Nadal, M, Picos, S, Fernandez, S, Munoz, A, Herrera Para, L, Maseda, E, Rovira, A, Monge Garcia, M, Ferrer, R, Sole Violan, J, Garcia Nogales, X, Torrents, E, Ripolles Melchor, J, Tomas Marsilla, J, Araujo Aguilar, P, Aguilar, G, Menor, E, Martinez, M, Leal Micharet, A, Ferri Riera, C, Mosquera, D, Astola, I, Freita-Ramos, S, Garcia Olivares, P, Jimenez Bartolome, M, Fernandez Gonzalez, I, Sanchez-Izquierdo, J, Arribas, P, Gimenez-Esparzavich, C, Anglada, M, Martin, S, Weerakoon, R, Bendjelid, K, Fumeaux, T, Maggiorini, M, Demirkiran, O, Adanir, T, Ergin Ozcan, P, Kelebek Girgin, N, Elahi, N, Kashef, S, Alsabbah, A, Lowe, A, Wise, M, Vizcaychipi, M, Baht, S, Webb, S, Friis, J, Boulanger, C, Gratrix, A, Harvey, D, Ferguson, A, Espie, L, Toth-Tarsoly, P, Lewis, K, Shelley, B, Thuerey, J, Przemyslaw, D, Ranganathan, M, Hormis, A, Spivey, M, Henning, J, Saveker, R, Csabi, P, Bland, M, Barrera Groba, C, Al-Subaie, N, Thomson, R, Hamilton, M, Iannuccelli, F, Roberts, C, Sherwood, N, Kasipandian, V, Silversides, J, Jonas, A, Szakmany, T, Vickers, E, Richards, J, Tham, L, Williams, D, Heenen, S, Hobrok, M, Walden, A, Raj, A, Bauer, P, Kashyap, R, Tolnai, P, Kjelle, B, Andersen, F, Palo, J, Namendys-Silva, S, Cecconi M., Hofer C., Teboul J. -L., Pettila V., Wilkman E., Molnar Z., Della Rocca G., Aldecoa C., Artigas A., Jog S., Sander M., Spies C., Lefrant J. -Y., De Backer D., Silva E., Zhang X., Ospina-Tascon G., Arias J., Gornik I., Benes J., Petersen A., Zsolt M., Sprung C., Koch M., Guttormsen A. B., Tavares M., Mikaszewska-Sokolewicz M., Bakker J., Parke R., Kirov M., Wernerman J., Esen F., Cannesson M., Njimi H., Francois G., Cueto G., Hockley S., Ambekar H., Laterre P. F., Dujardin M. F., Damas P., Deschamps P., Glorieux D., Hoste E., Miribung M., Devriendt J., Haentjens L., Biston P., Dugernier T., Bulpa P., Dive A., Debaveye Y., Franck S., Conde K., Morsch R., Ramos M., Dias F., Mataloun S., Mendes C., Silva F., Grion C., Knibel M., Yang C., Xiangyu Z., Cai G., Ortiz G., Yepes D., Londono Arcila H. F., Molina F., Pereira F., Sanchez-Galvez H. F., Benitez F., Arias Ortiz J., Gonzalez Rojas M., Cavric G., Lukic E., Zykova I., Freml P., Satinsky I., Suk P., Novak I., Balik M., Szturz P., Kratochvil M., Bestle M., Strange D. G., Perner A., Rasmussen B. S., Hauge J., Meldgaard M., Toome V., Kuitunen A., Varila S., Hovilehto S., Pulkkinen A., Kiviniemi O., Tallgren M., Laitio R., Mongardon N., Dhonneur G., Malledant Y., Lepouse C., Darmon M., Mira J. P., Chiche J. D., Joannes-Boyau O., Preau S., Larche J., Mottard N., Bengler C., Argaud L., Hamzaoui O., Desebbe O., Burtin P., Reignier J., Durand M., Guitard P. G., Asfar P., Guillot M., Boulain T., Mekontso Dessap A., Ducrocq N., Lakhal K., Gregoire C., Schmauss M., Zacharowski K., Meybohm P., Treskatsch S., Bloos F., van Huelst S., Baumann H., Kersten A., Goldmann A., Gkiokas G., Dimoula A., Kofinas G., Anthopoulos G., Pankotai B., Kopitko C., Gartner B., Schaffer E., Fulesdi B., Sarkany A., Samavedam S., Shah B., Dixit S., Toraskar K., Nandakumar S., Goila A. K., Nayyar A., Patel M., Mitra D., Jagiasi B., Jakkinaboina S., Goswami J., Ghosh S., Hashemian M., Mahmoodpoor A., Breen D., Benbenishty J., Kuniavsky M., Kolpak O., Castiglione G., Monti G., Molin A., Martucci G., Panarello G., Raineri S. M., Pota V., Acquarolo A., Ploner F., Lapichino G., Lombardo A., Roasio A., Cardelino S., Pignataro A., Oggioni R., Mangani V., Parrini V., Spadaro S., Volta C. A., Alampi D., Torrente S., Monastra L., Marini F., Mazzini P., Albanese D., Riccardi S., Ruberto F., Belluomo A. C., Silvestri R., Citerio G., Brienza N., Brazzi L., Protti A., Bottino N., David A., Manzoni D., Foti G., Numis F., Morimatsu H., Shimizu K., Munster L., Rai V., Buttigieg M., Pickkers P., Mijzen L., Kesecioglu J., Van Duijn D., Ormskerk P., Beck O., Goodson J., King B., Koelle J., Kantor S., Gomez O., Ramos I., Jedynak M., Sulkowski W., Adamik B., Chruscikowski M., Wadelek J., Korzybski J., Misiewska-Kaczur A., Piasecka-Twarog M., Fijaikowska A., Maciejewski D., Smiechowicz K., Milkowska E., Czerwinska A., Lukaszewska A., Wieczorek A., Czuczwar M., Czerwiec A., Tamowicz B., Branco V., Estilita J., Basilio C., Diogo C., Toma R., Bubenek-Turconi S. I., Filipescu D., Popescu M., Titova J., Belskiy V., Smetkin A., Grigoryev E., Pugachev S., Gasenkampf A., Abouelala A., Almekhlafi G., Rupnik E., Garcia-Delgado H., Saez Fernandez A., Celaya Lopez M., Ramasco F., Planas K., Zavala E., De Nadal M., Picos S. A., Fernandez S., Munoz A., Herrera Para L., Maseda E., Rovira A., Monge Garcia M. I., Ferrer R., Sole Violan J., Garcia Nogales X., Torrents E., Ripolles Melchor J., Tomas Marsilla J. I., Araujo Aguilar P., Aguilar G., Menor E. M., Martinez M. C., Leal Micharet A. M., Ferri Riera C., Mosquera D., Astola I., Freita-Ramos S., Garcia Olivares P., Jimenez Bartolome M. B., Fernandez Gonzalez I., Sanchez-Izquierdo J. A., Arribas P., Gimenez-Esparzavich C., Anglada M., Martin S., Weerakoon R. K., Bendjelid K., Fumeaux T., Maggiorini M., Demirkiran O., Adanir T., Ergin Ozcan P., Kelebek Girgin N., Elahi N., Kashef S., Alsabbah A., Lowe A., Wise M., Vizcaychipi M. P., Baht S., Webb S., Friis J., Boulanger C., Gratrix A., Harvey D., Ferguson A., Espie L., Toth-Tarsoly P., Lewis K., Shelley B., Thuerey J., Przemyslaw D., Ranganathan M., Hormis A., Spivey M., Henning J., Saveker R., Csabi P., Bland M., Barrera Groba C., Al-Subaie N., Thomson R., Hamilton M., Iannuccelli F., Roberts C., Sherwood N., Kasipandian V., Silversides J., Jonas A., Szakmany T., Vickers E., Richards J., Tham L., Williams D., Heenen S., Hobrok M., Walden A., Raj A., Bauer P., Kashyap R., Tolnai P., Kjelle B. J., Andersen F. H., Palo J. E., Namendys-Silva S. A., Cecconi, M, Hofer, C, Teboul, J, Pettila, V, Wilkman, E, Molnar, Z, Della Rocca, G, Aldecoa, C, Artigas, A, Jog, S, Sander, M, Spies, C, Lefrant, J, De Backer, D, Silva, E, Zhang, X, Ospina-Tascon, G, Arias, J, Gornik, I, Benes, J, Petersen, A, Zsolt, M, Sprung, C, Koch, M, Guttormsen, A, Tavares, M, Mikaszewska-Sokolewicz, M, Bakker, J, Parke, R, Kirov, M, Wernerman, J, Esen, F, Cannesson, M, Njimi, H, Francois, G, Cueto, G, Hockley, S, Ambekar, H, Laterre, P, Dujardin, M, Damas, P, Deschamps, P, Glorieux, D, Hoste, E, Miribung, M, Devriendt, J, Haentjens, L, Biston, P, Dugernier, T, Bulpa, P, Dive, A, Debaveye, Y, Franck, S, Conde, K, Morsch, R, Ramos, M, Dias, F, Mataloun, S, Mendes, C, Silva, F, Grion, C, Knibel, M, Yang, C, Xiangyu, Z, Cai, G, Ortiz, G, Yepes, D, Londono Arcila, H, Molina, F, Pereira, F, Sanchez-Galvez, H, Benitez, F, Arias Ortiz, J, Gonzalez Rojas, M, Cavric, G, Lukic, E, Zykova, I, Freml, P, Satinsky, I, Suk, P, Novak, I, Balik, M, Szturz, P, Kratochvil, M, Bestle, M, Strange, D, Perner, A, Rasmussen, B, Hauge, J, Meldgaard, M, Toome, V, Kuitunen, A, Varila, S, Hovilehto, S, Pulkkinen, A, Kiviniemi, O, Tallgren, M, Laitio, R, Mongardon, N, Dhonneur, G, Malledant, Y, Lepouse, C, Darmon, M, Mira, J, Chiche, J, Joannes-Boyau, O, Preau, S, Larche, J, Mottard, N, Bengler, C, Argaud, L, Hamzaoui, O, Desebbe, O, Burtin, P, Reignier, J, Durand, M, Guitard, P, Asfar, P, Guillot, M, Boulain, T, Mekontso Dessap, A, Ducrocq, N, Lakhal, K, Gregoire, C, Schmauss, M, Zacharowski, K, Meybohm, P, Treskatsch, S, Bloos, F, van Huelst, S, Baumann, H, Kersten, A, Goldmann, A, Gkiokas, G, Dimoula, A, Kofinas, G, Anthopoulos, G, Pankotai, B, Kopitko, C, Gartner, B, Schaffer, E, Fulesdi, B, Sarkany, A, Samavedam, S, Shah, B, Dixit, S, Toraskar, K, Nandakumar, S, Goila, A, Nayyar, A, Patel, M, Mitra, D, Jagiasi, B, Jakkinaboina, S, Goswami, J, Ghosh, S, Hashemian, M, Mahmoodpoor, A, Breen, D, Benbenishty, J, Kuniavsky, M, Kolpak, O, Castiglione, G, Monti, G, Molin, A, Martucci, G, Panarello, G, Raineri, S, Pota, V, Acquarolo, A, Ploner, F, Lapichino, G, Lombardo, A, Roasio, A, Cardelino, S, Pignataro, A, Oggioni, R, Mangani, V, Parrini, V, Spadaro, S, Volta, C, Alampi, D, Torrente, S, Monastra, L, Marini, F, Mazzini, P, Albanese, D, Riccardi, S, Ruberto, F, Belluomo, A, Silvestri, R, Citerio, G, Brienza, N, Brazzi, L, Protti, A, Bottino, N, David, A, Manzoni, D, Foti, G, Numis, F, Morimatsu, H, Shimizu, K, Munster, L, Rai, V, Buttigieg, M, Pickkers, P, Mijzen, L, Kesecioglu, J, Van Duijn, D, Ormskerk, P, Beck, O, Goodson, J, King, B, Koelle, J, Kantor, S, Gomez, O, Ramos, I, Jedynak, M, Sulkowski, W, Adamik, B, Chruscikowski, M, Wadelek, J, Korzybski, J, Misiewska-Kaczur, A, Piasecka-Twarog, M, Fijaikowska, A, Maciejewski, D, Smiechowicz, K, Milkowska, E, Czerwinska, A, Lukaszewska, A, Wieczorek, A, Czuczwar, M, Czerwiec, A, Tamowicz, B, Branco, V, Estilita, J, Basilio, C, Diogo, C, Toma, R, Bubenek-Turconi, S, Filipescu, D, Popescu, M, Titova, J, Belskiy, V, Smetkin, A, Grigoryev, E, Pugachev, S, Gasenkampf, A, Abouelala, A, Almekhlafi, G, Rupnik, E, Garcia-Delgado, H, Saez Fernandez, A, Celaya Lopez, M, Ramasco, F, Planas, K, Zavala, E, De Nadal, M, Picos, S, Fernandez, S, Munoz, A, Herrera Para, L, Maseda, E, Rovira, A, Monge Garcia, M, Ferrer, R, Sole Violan, J, Garcia Nogales, X, Torrents, E, Ripolles Melchor, J, Tomas Marsilla, J, Araujo Aguilar, P, Aguilar, G, Menor, E, Martinez, M, Leal Micharet, A, Ferri Riera, C, Mosquera, D, Astola, I, Freita-Ramos, S, Garcia Olivares, P, Jimenez Bartolome, M, Fernandez Gonzalez, I, Sanchez-Izquierdo, J, Arribas, P, Gimenez-Esparzavich, C, Anglada, M, Martin, S, Weerakoon, R, Bendjelid, K, Fumeaux, T, Maggiorini, M, Demirkiran, O, Adanir, T, Ergin Ozcan, P, Kelebek Girgin, N, Elahi, N, Kashef, S, Alsabbah, A, Lowe, A, Wise, M, Vizcaychipi, M, Baht, S, Webb, S, Friis, J, Boulanger, C, Gratrix, A, Harvey, D, Ferguson, A, Espie, L, Toth-Tarsoly, P, Lewis, K, Shelley, B, Thuerey, J, Przemyslaw, D, Ranganathan, M, Hormis, A, Spivey, M, Henning, J, Saveker, R, Csabi, P, Bland, M, Barrera Groba, C, Al-Subaie, N, Thomson, R, Hamilton, M, Iannuccelli, F, Roberts, C, Sherwood, N, Kasipandian, V, Silversides, J, Jonas, A, Szakmany, T, Vickers, E, Richards, J, Tham, L, Williams, D, Heenen, S, Hobrok, M, Walden, A, Raj, A, Bauer, P, Kashyap, R, Tolnai, P, Kjelle, B, Andersen, F, Palo, J, Namendys-Silva, S, Cecconi M., Hofer C., Teboul J. -L., Pettila V., Wilkman E., Molnar Z., Della Rocca G., Aldecoa C., Artigas A., Jog S., Sander M., Spies C., Lefrant J. -Y., De Backer D., Silva E., Zhang X., Ospina-Tascon G., Arias J., Gornik I., Benes J., Petersen A., Zsolt M., Sprung C., Koch M., Guttormsen A. B., Tavares M., Mikaszewska-Sokolewicz M., Bakker J., Parke R., Kirov M., Wernerman J., Esen F., Cannesson M., Njimi H., Francois G., Cueto G., Hockley S., Ambekar H., Laterre P. F., Dujardin M. F., Damas P., Deschamps P., Glorieux D., Hoste E., Miribung M., Devriendt J., Haentjens L., Biston P., Dugernier T., Bulpa P., Dive A., Debaveye Y., Franck S., Conde K., Morsch R., Ramos M., Dias F., Mataloun S., Mendes C., Silva F., Grion C., Knibel M., Yang C., Xiangyu Z., Cai G., Ortiz G., Yepes D., Londono Arcila H. F., Molina F., Pereira F., Sanchez-Galvez H. F., Benitez F., Arias Ortiz J., Gonzalez Rojas M., Cavric G., Lukic E., Zykova I., Freml P., Satinsky I., Suk P., Novak I., Balik M., Szturz P., Kratochvil M., Bestle M., Strange D. G., Perner A., Rasmussen B. S., Hauge J., Meldgaard M., Toome V., Kuitunen A., Varila S., Hovilehto S., Pulkkinen A., Kiviniemi O., Tallgren M., Laitio R., Mongardon N., Dhonneur G., Malledant Y., Lepouse C., Darmon M., Mira J. P., Chiche J. D., Joannes-Boyau O., Preau S., Larche J., Mottard N., Bengler C., Argaud L., Hamzaoui O., Desebbe O., Burtin P., Reignier J., Durand M., Guitard P. G., Asfar P., Guillot M., Boulain T., Mekontso Dessap A., Ducrocq N., Lakhal K., Gregoire C., Schmauss M., Zacharowski K., Meybohm P., Treskatsch S., Bloos F., van Huelst S., Baumann H., Kersten A., Goldmann A., Gkiokas G., Dimoula A., Kofinas G., Anthopoulos G., Pankotai B., Kopitko C., Gartner B., Schaffer E., Fulesdi B., Sarkany A., Samavedam S., Shah B., Dixit S., Toraskar K., Nandakumar S., Goila A. K., Nayyar A., Patel M., Mitra D., Jagiasi B., Jakkinaboina S., Goswami J., Ghosh S., Hashemian M., Mahmoodpoor A., Breen D., Benbenishty J., Kuniavsky M., Kolpak O., Castiglione G., Monti G., Molin A., Martucci G., Panarello G., Raineri S. M., Pota V., Acquarolo A., Ploner F., Lapichino G., Lombardo A., Roasio A., Cardelino S., Pignataro A., Oggioni R., Mangani V., Parrini V., Spadaro S., Volta C. A., Alampi D., Torrente S., Monastra L., Marini F., Mazzini P., Albanese D., Riccardi S., Ruberto F., Belluomo A. C., Silvestri R., Citerio G., Brienza N., Brazzi L., Protti A., Bottino N., David A., Manzoni D., Foti G., Numis F., Morimatsu H., Shimizu K., Munster L., Rai V., Buttigieg M., Pickkers P., Mijzen L., Kesecioglu J., Van Duijn D., Ormskerk P., Beck O., Goodson J., King B., Koelle J., Kantor S., Gomez O., Ramos I., Jedynak M., Sulkowski W., Adamik B., Chruscikowski M., Wadelek J., Korzybski J., Misiewska-Kaczur A., Piasecka-Twarog M., Fijaikowska A., Maciejewski D., Smiechowicz K., Milkowska E., Czerwinska A., Lukaszewska A., Wieczorek A., Czuczwar M., Czerwiec A., Tamowicz B., Branco V., Estilita J., Basilio C., Diogo C., Toma R., Bubenek-Turconi S. I., Filipescu D., Popescu M., Titova J., Belskiy V., Smetkin A., Grigoryev E., Pugachev S., Gasenkampf A., Abouelala A., Almekhlafi G., Rupnik E., Garcia-Delgado H., Saez Fernandez A., Celaya Lopez M., Ramasco F., Planas K., Zavala E., De Nadal M., Picos S. A., Fernandez S., Munoz A., Herrera Para L., Maseda E., Rovira A., Monge Garcia M. I., Ferrer R., Sole Violan J., Garcia Nogales X., Torrents E., Ripolles Melchor J., Tomas Marsilla J. I., Araujo Aguilar P., Aguilar G., Menor E. M., Martinez M. C., Leal Micharet A. M., Ferri Riera C., Mosquera D., Astola I., Freita-Ramos S., Garcia Olivares P., Jimenez Bartolome M. B., Fernandez Gonzalez I., Sanchez-Izquierdo J. A., Arribas P., Gimenez-Esparzavich C., Anglada M., Martin S., Weerakoon R. K., Bendjelid K., Fumeaux T., Maggiorini M., Demirkiran O., Adanir T., Ergin Ozcan P., Kelebek Girgin N., Elahi N., Kashef S., Alsabbah A., Lowe A., Wise M., Vizcaychipi M. P., Baht S., Webb S., Friis J., Boulanger C., Gratrix A., Harvey D., Ferguson A., Espie L., Toth-Tarsoly P., Lewis K., Shelley B., Thuerey J., Przemyslaw D., Ranganathan M., Hormis A., Spivey M., Henning J., Saveker R., Csabi P., Bland M., Barrera Groba C., Al-Subaie N., Thomson R., Hamilton M., Iannuccelli F., Roberts C., Sherwood N., Kasipandian V., Silversides J., Jonas A., Szakmany T., Vickers E., Richards J., Tham L., Williams D., Heenen S., Hobrok M., Walden A., Raj A., Bauer P., Kashyap R., Tolnai P., Kjelle B. J., Andersen F. H., Palo J. E., and Namendys-Silva S. A.

Abstract

Background: Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC. Methods: This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC. Results: 2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500–1000). The median time was 24 min (40–60 min), and the median rate of FC was 1000 [500–1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57–61 %). In 43 % (CI 41–45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34–37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20–24 %). No safety variable for the FC was used in 72 % (CI 70–74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response. Conclusions: The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account.

Published
2015

28. S1-Leitlinie Die geburtshilfliche Analgesie und Anästhesie.

Author

Bremerich, D., Annecke, T., Chappell, D., Hanß, R., Kaufner, L., Kehl, F., Kranke, P., Girard, T., Gogarten, W., Greve, S., Neuhaus, S., Schlembach, D., Schlösser, L., Standl, T., Treskatsch, S., Volk, T., Wallenborn, J., Weber, S., and Wenk, M.

Abstract

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2020
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32. Perioperative echocardiography-guided hemodynamic therapy in high-risk patients: a practical expert approach of hemodynamically focused echocardiography

Author

Trauzeddel, R. F., Ertmer, M., Nordine, M., Groesdonk, H. V., Michels, G., Pfister, R., Reuter, D., Scheeren, T. W. L., Berger, C., Treskatsch, S., Trauzeddel, R. F., Ertmer, M., Nordine, M., Groesdonk, H. V., Michels, G., Pfister, R., Reuter, D., Scheeren, T. W. L., Berger, C., and Treskatsch, S.

Abstract

The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. Various techniques are available to monitor the hemodynamic status of the patient, however due to intrinsic limitations, many of these methods may not be able to directly identify the underlying cause of cardiovascular impairment. Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy.

33. Perioperative echocardiography-guided hemodynamic therapy in high-risk patients: a practical expert approach of hemodynamically focused echocardiography

Author

Trauzeddel, R. F., Ertmer, M., Nordine, M., Groesdonk, H. V., Michels, G., Pfister, R., Reuter, D., Scheeren, T. W. L., Berger, C., Treskatsch, S., Trauzeddel, R. F., Ertmer, M., Nordine, M., Groesdonk, H. V., Michels, G., Pfister, R., Reuter, D., Scheeren, T. W. L., Berger, C., and Treskatsch, S.

Abstract

The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. Various techniques are available to monitor the hemodynamic status of the patient, however due to intrinsic limitations, many of these methods may not be able to directly identify the underlying cause of cardiovascular impairment. Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy.

34. European Association of Cardiothoracic Anesthesiology and Intensive Care Pediatric Cardiac Anesthesia Fellowship Curriculum: First Edition

Author

Ricard Navarro-Ripoll, Marc Vives, Steffen Rex, P. Matute, R. Peter Alston, Theofili Kousi, Simon J. Howell, Mona Momeni, Hossam El-Ashmawi, Fawzia Aboulfetouh, M. Granell, Aniruddha R. Janai, Gabor Erdoes, Caetano Nigro Neto, Alberto Hernandez Martinez, Sascha Treskatsch, Gianluca Paternoster, Theofani Antoniou, Anna Flo Forner, Kirstin Wilkinson, Giovanni Landoni, Joost M.A.A. van der Maaten, Joachim Erb, Philippe Gaudard, Philippe Burtin, E Schindler, Andrea Székely, Alain Vuylsteke, Laszlo L. Szegedi, Vera von Dossow, Jens Fassl, Chirojit Mukherjee, Mohamed R. El-Tahan, Fabio Guarracino, Dominique Bettex, Maria Benedetto, Dieter Van Beersel, Jan-Uwe Schreiber, Patrick Wouters, Dragana Unic-Stojanovic, Mansoura University [Egypt], University of Bern, University Medical Center Groningen [Groningen] (UMCG), University Hospital Southampton NHS Foundation Trust, Onassis Cardiac Surgery Center [Athens] (OCSC), Ruhr University Bochum (RUB), Instituto de Cardiologia Dante Pazzanese (IDPC), University Hospital Bonn, Semmelweis University [Budapest], University of Leipzig [Leipzig, Allemagne], University Department of Fundamental and Applied Medical Sciences and Clinical Department of Anesthesiology and Perioperative Medicine, Ghent, Belgium, Azienda Ospedaliera Universitaria Pisana, Clinique du Millénaire - Oc Santé [Montpellier], Oc Santé [Montpellier], University of Belgrade [Belgrade], Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Hospital Clinic [Barcelona, Spain], Misr University for Science & Technology (MUST), Technische Universität Dresden = Dresden University of Technology (TU Dresden), University hospital of Zurich [Zurich], Sant'Orsola-Malpighi Hospital [Bologna, Italy], Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Royal Infirmary of Edinburgh, IRCCS San Raffaele Scientific Institute [Milan, Italie], University General Hospital of Valencia, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Charité Campus Benjamin Franklin, University Hospitals Leuven [Leuven], Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom., University of Leeds, Hospital Universitario de Bellvitge, University Hospital Basel [Basel], Hospital Dr Josep Trueta, Cairo University, Department of Anesthesia & Intensive Care, Helios Clinic for Cardiac Surgery, Karlsruhe, Germany., Hospital Clinico San Carlos, Hospital Clínico San Carlos, Cliniques Universitaires Saint-Luc [Bruxelles], Université Catholique de Louvain = Catholic University of Louvain (UCL), UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service d'anesthésiologie, El-Tahan, M. R., Erdoes, G., van der Maaten, J., Wilkinson, K., Kousi, T., Antoniou, T., von Dossow, V., Neto, C. N., Schindler, E., Szekely, A., Forner, A. F., Wouters, P. F., Guarracino, F., Burtin, P., Unic-Stojanovic, D., Schreiber, J. -U., Matute, P., Aboulfetouh, F., Navarro-Ripoll, R., Fassl, J., Bettex, D., Benedetto, M., Szegedi, L., Alston, R. P., Landoni, G., Granell, M., Gaudard, P., Treskatsch, S., Van Beersel, D., Vuylsteke, A., Howell, S., Janai, A. R., Martinez, A. H., Erb, J. M., Vives, M., El-Ashmawi, H., Rex, S., Mukherjee, C., Paternoster, G., Momeni, M., MUMC+: MA Anesthesiologie (9), and RS: MHeNs - R3 - Neuroscience

Subjects
medicine.medical_specialty, Critical Care, [SDV]Life Sciences [q-bio], education, MEDLINE, Subspecialty, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Pediatric anesthesiology, Anesthesiology, Intensive care, Anesthesia, Cardiac Procedures, Medicine, Humans, Fellowships and Scholarships, 610 Medicine & health, Child, Curriculum, Cardiothoracic anesthesiology, business.industry, General surgery, 030208 emergency & critical care medicine, 3. Good health, Cardiac Anesthesia, Anesthesiology and Pain Medicine, Perioperative care, cardiovascular system, Cardiology and Cardiovascular Medicine, business
Abstract

International audience; Pediatric cardiac anesthesia is a subspecialty of cardiac and pediatric anesthesiology dedicated to the perioperative care of patients with congenital heart disease. Members of the Congenital and Education Subcommittees of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) agreed on the necessity to develop an EACTAIC pediatric cardiac anesthesia fellowship curriculum. This manuscript represents a consensus on the composition and the design of the EACTAIC Pediatric Cardiac Anesthesia Fellowship program. This curriculum provides a basis for the training of future pediatric cardiac anesthesiologists by clearly defining the theoretical and practical requirements for fellows and host centers.

Published
2021

35. Editorial: Organ support in cardiac intensive care.

Author

Tu GW, Treskatsch S, and Kasai T

Abstract

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Published
2024
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36. Impact of arm position compared to tourniquet and general anesthesia on peripheral vein width in supine adult patients: a prospective, monocentric, cross-sectional study.

Author

Berger C, Brandhorst P, Asen E, Grallert S, Treskatsch S, and Weigeldt M

Subjects
Humans, Cross-Sectional Studies, Prospective Studies, Male, Female, Middle Aged, Supine Position, Adult, Ultrasonography methods, Patient Positioning methods, Aged, Tourniquets, Anesthesia, General methods, Arm blood supply, Veins diagnostic imaging, Veins anatomy & histology
Abstract

Background: IV access is a commonly performed procedure that is often taught based on tradition rather than evidence. The effect of arm retroflexion on vein width, either alone or in combination with a tourniquet or general anesthesia (GA), remains unclear. In this case, the sonographically measured vein width is a surrogate parameter for the success of the puncture., Methods: Prospective, cross-sectional study involving 57 patients scheduled for surgery in general anesthesia. We analyzed the impact of arm retroflexion, tourniquet, general anesthesia, and their combinations on the antebrachial veins in supine patients by ultrasound. Measurements were taken awake and during general anesthesia, each with and without the application of a tourniquet, and in three different arm positions (0°, 30°, and max° retroflexion) each. Data are presented as median and interquartile range [IQR]., Results: Tourniquet application (AT) had the greatest single effect on Cubital vein outer diameter compared to the baseline value of all measures (3.9 mm [3.4-5.1]; 4.8 mm [4.1-5.7], P = 0.001, r = 0.515). This effect was surpassed by the combination of AT and GA (5.1 mm [4.6-6.6], P = 0.001, r = 0.889). In contrast, retroflexion alone did not result in an increase at either 30° (4.2 mm [3.7-5.1], p = 1.0, r = 0.12) or max° (4.2 mm [3.6-4.9], p = 0.72, r = 0.23). With GA and AT, no further enlargement was measurable by 30° (5.4 mm [4.6-6.6], p = 1.0, r = 0.15) or max° (5.4 mm [4.6-6.6], p = 1.0, r = 0.07) retroflexion compared to GA-AT-0° (5.1 mm [4.6-6.6], p = 1.0, r = 0.15)., Conclusions: This study provides evidence that retroflexion of the arm in supine patients, whether alone or in addition to a tourniquet or general anesthesia, does not have any additional effect on vein width as a surrogate parameter for successful IV success. It shows for the first time that general anesthesia effectively increases vein diameter., Trial Registration: DRKS00029603 (date of registration 07.07.2022)., (© 2024. The Author(s).)

Published
2024
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37. Intraoperative haemodynamic monitoring and management of adults having non-cardiac surgery: Guidelines of the German Society of Anaesthesiology and Intensive Care Medicine in collaboration with the German Association of the Scientific Medical Societies.

Author

Saugel B, Annecke T, Bein B, Flick M, Goepfert M, Gruenewald M, Habicher M, Jungwirth B, Koch T, Kouz K, Meidert AS, Pestel G, Renner J, Sakka SG, Sander M, Treskatsch S, Zitzmann A, and Reuter DA

Subjects
Adult, Humans, Germany, Perioperative Care methods, Perioperative Care standards, Societies, Scientific, Surgical Procedures, Operative, Review Literature as Topic, Anesthesiology methods, Anesthesiology standards, Critical Care methods, Critical Care standards, Hemodynamic Monitoring methods, Hemodynamics, Monitoring, Intraoperative methods, Monitoring, Intraoperative standards, Societies, Medical
Abstract

Haemodynamic monitoring and management are cornerstones of perioperative care. The goal of haemodynamic management is to maintain organ function by ensuring adequate perfusion pressure, blood flow, and oxygen delivery. We here present guidelines on "Intraoperative haemodynamic monitoring and management of adults having non-cardiac surgery" that were prepared by 18 experts on behalf of the German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin; DGAI)., (© 2024. The Author(s).)

Published
2024
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38. In-hospital mortality after prehospital endotracheal intubation versus alternative methods of airway management in trauma patients. A cohort study from the TraumaRegister DGU®.

Author

Weigeldt M, Schulz-Drost S, Stengel D, Lefering R, Treskatsch S, and Berger C

Subjects
Humans, Male, Female, Germany epidemiology, Middle Aged, Retrospective Studies, Adult, Aged, Abbreviated Injury Scale, Intubation, Intratracheal, Hospital Mortality, Emergency Medical Services methods, Airway Management methods, Registries, Wounds and Injuries mortality, Wounds and Injuries therapy, Injury Severity Score
Abstract

Purpose: Prehospital airway management in trauma is a key component of care and is associated with particular risks. Endotracheal intubation (ETI) is the gold standard, while extraglottic airway devices (EGAs) are recommended alternatives. There is limited evidence comparing their effectiveness. In this retrospective analysis from the TraumaRegister DGU®, we compared ETI with EGA in prehospital airway management regarding in-hospital mortality in patients with trauma., Methods: We included cases only from German hospitals with a minimum Abbreviated Injury Scale score ≥ 2 and age ≥ 16 years. All patients without prehospital airway protection were excluded. We performed a multivariate logistic regression to adjust with the outcome measure of hospital mortality., Results: We included n = 10,408 cases of whom 92.5% received ETI and 7.5% EGA. The mean injury severity score was higher in the ETI group (28.8 ± 14.2) than in the EGA group (26.3 ± 14.2), and in-hospital mortality was comparable: ETI 33.0%; EGA 30.7% (27.5 to 33.9). After conducting logistic regression, the odds ratio for mortality in the ETI group was 1.091 (0.87 to 1.37). The standardized mortality ratio was 1.04 (1.01 to 1.07) in the ETI group and 1.1 (1.02 to 1.26) in the EGA group., Conclusions: There was no significant difference in mortality rates between the use of ETI or EGA, or the ratio of expected versus observed mortality when using ETI., (© 2024. The Author(s).)

Published
2024
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39. In-hospital survival of critically ill COVID-19 patients treated with glucocorticoids: a multicenter real-world data study.

Author

Angermair S, Hardenberg JH, Rubarth K, Balzer F, Akbari N, Menk M, Spies C, Eckardt KU, Poddubnyy D, Siegmund B, Schneider T, and Treskatsch S

Subjects
Humans, Male, Female, Aged, Middle Aged, Retrospective Studies, Intensive Care Units, Dexamethasone therapeutic use, Dexamethasone administration & dosage, SARS-CoV-2 isolation & purification, Aged, 80 and over, Critical Illness mortality, Glucocorticoids therapeutic use, Glucocorticoids administration & dosage, COVID-19 mortality, COVID-19 Drug Treatment, Hospital Mortality
Abstract

The COVID-19 pandemic has posed a major challenge to healthcare systems globally. Millions of people have been infected, and millions of deaths have been reported worldwide. Glucocorticoids have attracted worldwide attention for their potential efficacy in the treatment of COVID-19. Various glucocorticoids with different dosages and treatment durations have been studied in patients with different severities, with a suitable dosage and treatment duration not yet defined. This study aimed to investigate whether in-hospital survival differs between critically ill patients treated with low-dose glucocorticoids, high-dose glucocorticoids or no glucocorticoids. All critically ill patients admitted to the intensive care unit of the Charité Hospital-Universitätsmedizin Berlin between February 2020 and December 2021 with COVID-19 pneumonia receiving supplemental oxygen were eligible to participate in this multicenter real-world data study. Patients were retrospectively assigned to one of three groups: the high corticosteroid dose (HighC) group (receiving 6 mg parenteral dexamethasone or an equivalent corticosteroid dosage for ten days), the low corticosteroid dose (LowC) group (receiving less than 6 mg parenteral dexamethasone or an equivalent corticosteroid dosage for ten days), or the no corticosteroid (NoC) group. Overall survival and risk effects were compared among groups within the total observation period, as well as at 35 days after the onset of COVID-19 symptoms. Adjusted multivariable Cox proportional hazard regression analysis was performed to compare the risk of death between the treatment groups. Out of 1561 critically ill COVID-19 patients, 1014 were included in the baseline analysis. In the survival study, 1009 patients were assigned to the NoC (n = 346), HighC (n = 552), or LowC group (n = 111). The baseline characteristics were balanced between groups, except for age, BMI, APACHE II score, SOFA and SAPS II. While the 35-day survival did not show any differences, a landmark analysis of the patients surviving beyond 35 days revealed differences between groups. The restricted mean survival time was 112 days in the LowC group [95% CI: 97 - 128], 133 days in the HighC group [95% CI: 124 - 141] and 144 days in the NoC group [95% CI: 121 - 167]. The multivariable-adjusted Cox proportional hazard analysis indicated that, regardless of age, sex, health status or invasive oxygenation, a low-dose treatment increased the hazard of death of critically ill COVID-19 patients by a factor of 2.09 ([95% CI: 0.99, 4.4], p = 0.05) and a high-dose corticosteroid treatment increased the risk by a factor of 1.07 ([95% CI: 0.53, 2.15], p = 0.85) compared to no treatment with glucocorticoids. The analysis reveals that corticosteroid treatment does not influence the survival of critically ill COVID-19 patients in the intensive care unit within 35 days. Our evaluations further suggest that regardless of ventilation status, the decision-making process for administering corticosteroid therapy should account for the individual severity of the illness., (© 2024. The Author(s).)

Published
2024
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40. How Would I Treat My Own Thoracoabdominal Aortic Aneurysm: Perioperative Considerations From the Anesthesiologist Perspective.

Author

Berger C, Greiner A, Brandhorst P, Reimers SC, Kniesel O, Omran S, and Treskatsch S

Subjects
Humans, Anesthesiologists, Treatment Outcome, Retrospective Studies, Risk Factors, Postoperative Complications surgery, Aortic Aneurysm, Thoracoabdominal, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation methods, Endovascular Procedures methods
Abstract

A thoracoabdominal aortic aneurysm (TAAA) can be potentially life-threatening due to its associated risk of rupture. Thoracoabdominal aortic aneurysm repair, performed as endovascular repair and/or open surgery, is the recommended therapy of choice. Hemodynamic instability, severe blood loss, and spinal cord or cerebral ischemia are some potential hazards the perioperative team has to face during these procedures. Therefore, preoperative risk assessment and intraoperative anesthesia management addressing these potential hazards are essential to improving patients' outcomes. Based on a presented index case, an overview focusing on anesthetic measures to identify perioperatively and manage these risks in TAAA repair is provided., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Published
2024
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41. The influence of concomitant antidepressant and antipsychotic medication on antidepressant effect and seizure duration of electroconvulsive therapy.

Author

Mohamad S, Trumm S, Treskatsch S, Drevs A, Bajbouj M, and Wiedemann L

Abstract

Background: A significant proportion of patients with a depressive disorder show resistance to pharmacological and psychotherapeutic antidepressant treatments. Electroconvulsive therapy (ECT) is still one of the most effective treatment methods, especially in the acute phase. In everyday clinical practice, this usually accompanies pharmacological treatment. It has been shown that pharmacological treatment following acute ECT treatment reduces the rate of relapses. However, the effect of various antidepressants (ADs) and antipsychotics (APs) on the effect during the course of ECT has rarely been investigated., Methods: In this retrospective chart review study, the data of 104 depressive patients treated with ECT were examined. We analyzed the influence of concomitant administration of AD and AP or no psychotropic medication on the effect of ECT using the Montgomery-Åsberg Depression Rating Scale (MADRS). We further analyzed the influence of the ADs Bupropion, Venlafaxine, and Sertraline or no AD and the influence of augmentation with Aripiprazole or Quetiapine or Olanzapine., Results/discussion: Psychotropic medication did not have an impact on antidepressant efficacy of ECT as measured with the MADRS scores. In addition, the comparison between the antidepressant or antipsychotic medications themselves did not show any significant difference. However, we found a significantly different seizure duration depending on the antidepressant substance that patients received during ECT ( p = .008). ECT treatment itself led to a highly significant reduction of 13.3 points in the MADRS ( p <.001)., Conclusion: Taken together, our study underlines that concomitant psychotropic medication while doing electroconvulsive therapy does not bare the risk of prolonged seizure duration or does it reduce the effectiveness of ECT. To the best of our knowledge, this study is the first to examine the effect of treatment with antidepressants in combination with antipsychotics while doing ECT. In light of our results, this combination therapy is safe and effective. Bearing in mind the delay in onset of antidepressant action of medication and the importance of antidepressant medication for relapse prevention, this study further supports the recommendation that psychotropic medication should be given in adjunction to ECT., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mohamad, Trumm, Treskatsch, Drevs, Bajbouj and Wiedemann.)

Published
2024
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42. Feasibility of Goal-Directed Fluid Therapy in Patients with Transcatheter Aortic Valve Replacement - An Ambispective Analysis.

Author

Trauzeddel RF, Nordine M, Fucini GB, Sander M, Dreger H, Stangl K, Treskatsch S, and Habicher M

Subjects
Humans, Adolescent, Retrospective Studies, Prospective Studies, Feasibility Studies, Goals, Fluid Therapy methods, Aortic Valve surgery, Treatment Outcome, Risk Factors, Length of Stay, Transcatheter Aortic Valve Replacement adverse effects, Delirium etiology, Delirium surgery, Aortic Valve Stenosis surgery
Abstract

Introduction: Goal-directed fluid therapy (GDFT) has been shown to reduce postoperative complications. The feasibility of GDFT in transcatheter aortic valve replacement (TAVR) patients under general anesthesia has not yet been demonstrated. We examined whether GDFT could be applied in patients undergoing TAVR in general anesthesia and its impact on outcomes., Methods: Forty consecutive TAVR patients in the prospective intervention group with GDFT were compared to 40 retrospective TAVR patients without GDFT. Inclusion criteria were age ≥ 18 years, elective TAVR in general anesthesia, no participation in another interventional study. Exclusion criteria were lack of ability to consent study participation, pregnant or nursing patients, emergency procedures, preinterventional decubitus, tissue and/or extremity ischemia, peripheral arterial occlusive disease grade IV, atrial fibrillation or other severe heart rhythm disorder, necessity of usage of intra-aortic balloon pump. Stroke volume and stroke volume variation were determined with uncalibrated pulse contour analysis and optimized according to a predefined algorithm using 250 ml of hydroxyethyl starch., Results: Stroke volume could be increased by applying GDFT. The intervention group received more colloids and fewer crystalloids than control group. Total volume replacement did not differ. The incidence of overall complications as well as intensive care unit and hospital length of stay were comparable between both groups. GDFT was associated with a reduced incidence of delirium. Duration of anesthesia was shorter in the intervention group. Duration of the interventional procedure did not differ., Conclusion: GDFT in the intervention group was associated with a reduced incidence of postinterventional delirium.

Published
2024
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43. Influence of a chronic beta-blocker therapy on perioperative opioid consumption - a post hoc secondary analysis.

Author

Trauzeddel RF, Rothe LM, Nordine M, Dehé L, Scholtz K, Spies C, Hadzidiakos D, Winterer G, Borchers F, Kruppa J, and Treskatsch S

Subjects
Humans, Male, Female, Aged, Morphine, Pain, Postoperative drug therapy, Analgesics, Opioid therapeutic use, Cardiovascular Diseases
Abstract

Background: Beta-blocker (BB) therapy plays a central role in the treatment of cardiovascular diseases. An increasing number of patients with cardiovascular diseases undergoe noncardiac surgery, where opioids are an integral part of the anesthesiological management. There is evidence to suggest that short-term intravenous BB therapy may influence perioperative opioid requirements due to an assumed cross-talk between G-protein coupled beta-adrenergic and opioid receptors. Whether chronic BB therapy could also have an influence on perioperative opioid requirements is unclear., Methods: A post hoc analysis of prospectively collected data from a multicenter observational (BioCog) study was performed. Inclusion criteria consisted of elderly patients (≥ 65 years) undergoing elective noncardiac surgery as well as total intravenous general anesthesia without the use of regional anesthesia and duration of anesthesia ≥ 60 min. Two groups were defined: patients with and without BB in their regular preopreative medication. The administered opioids were converted to their respective morphine equivalent doses. Multiple regression analysis was performed using the morphine-index to identify independent predictors., Results: A total of 747 patients were included in the BioCog study in the study center Berlin. 106 patients fulfilled the inclusion criteria. Of these, 37 were on chronic BB. The latter were preoperatively significantly more likely to have arterial hypertension (94.6%), chronic renal failure (27%) and hyperlipoproteinemia (51.4%) compared to patients without BB. Both groups did not differ in terms of cumulative perioperative morphine equivalent dose (230.9 (BB group) vs. 214.8 mg (Non-BB group)). Predictive factors for increased morphine-index were older age, male sex, longer duration of anesthesia and surgery of the trunk. In a model with logarithmised morphine index, only gender (female) and duration of anesthesia remained predictive factors., Conclusions: Chronic BB therapy was not associated with a reduced perioperative opioid consumption., Trial Registration: This study was registered at ClinicalTrials.gov ( NCT02265263 ) on the 15.10.2014 with the principal investigator being Univ.-Prof. Dr. med. Claudia Spies., (© 2024. The Author(s).)

Published
2024
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45. Cross-regulation of antibody responses against the SARS-CoV-2 Spike protein and commensal microbiota via molecular mimicry.

Author

Bondareva M, Budzinski L, Durek P, Witkowski M, Angermair S, Ninnemann J, Kreye J, Letz P, Ferreira-Gomes M, Semin I, Guerra GM, Momsen Reincke S, Sánchez-Sendin E, Yilmaz S, Sempert T, Heinz GA, Tizian C, Raftery M, Schönrich G, Matyushkina D, Smirnov IV, Govorun VM, Schrezenmeier E, Stefanski AL, Dörner T, Zocche S, Viviano E, Klement N, Sehmsdorf KJ, Lunin A, Chang HD, Drutskaya M, Kozlovskaya L, Treskatsch S, Radbruch A, Diefenbach A, Prüss H, Enghard P, Mashreghi MF, and Kruglov AA

Subjects
Humans, Animals, Mice, Spike Glycoprotein, Coronavirus, Antibody Formation, Molecular Mimicry, SARS-CoV-2, Antibodies, Monoclonal, Antibodies, Viral, Immunoglobulin A, Secretory, Immunoglobulin G, Antibodies, Neutralizing, COVID-19, Microbiota
Abstract

The commensal microflora provides a repertoire of antigens that illicit mucosal antibodies. In some cases, these antibodies can cross-react with host proteins, inducing autoimmunity, or with other microbial antigens. We demonstrate that the oral microbiota can induce salivary anti-SARS-CoV-2 Spike IgG antibodies via molecular mimicry. Anti-Spike IgG antibodies in the saliva correlated with enhanced abundance of Streptococcus salivarius 1 month after anti-SARS-CoV-2 vaccination. Several human commensal bacteria, including S. salivarius, were recognized by SARS-CoV-2-neutralizing monoclonal antibodies and induced cross-reactive anti-Spike antibodies in mice, facilitating SARS-CoV-2 clearance. A specific S. salivarius protein, RSSL-01370, contains regions with homology to the Spike receptor-binding domain, and immunization of mice with RSSL-01370 elicited anti-Spike IgG antibodies in the serum. Additionally, oral S. salivarius supplementation enhanced salivary anti-Spike antibodies in vaccinated individuals. Altogether, these data show that distinct species of the human microbiota can express molecular mimics of SARS-CoV-2 Spike protein, potentially enhancing protective immunity., Competing Interests: Declaration of interests Related to this work, Deutsches Rheuma-Forschungszentrum (DRFZ) has filed a patent application., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Published
2023
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47. The role of beta-blocker drugs in critically ill patients: a SIAARTI expert consensus statement.

Author

Guarracino F, Cortegiani A, Antonelli M, Behr A, Biancofiore G, Del Gaudio A, Forfori F, Galdieri N, Grasselli G, Paternoster G, Rocco M, Romagnoli S, Sardo S, Treskatsch S, Tripodi VF, and Tritapepe L

Abstract

Background: The role of β-blockers in the critically ill has been studied, and data on the protective effects of these drugs on critically ill patients have been repeatedly reported in the literature over the last two decades. However, consensus and guidelines by scientific societies on the use of β-blockers in critically ill patients are still lacking. The purpose of this document is to support the clinical decision-making process regarding the use of β-blockers in critically ill patients. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient's care process., Methods: The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) selected a panel of experts and asked them to define key aspects underlying the use of β-blockers in critically ill adult patients. The methodology followed by the experts during this process was in line with principles of modified Delphi and RAND-UCLA methods. The experts developed statements and supportive rationales in the form of informative text. The overall list of statements was subjected to blind votes for consensus., Results: The literature search suggests that adrenergic stress and increased heart rate in critically ill patients are associated with organ dysfunction and increased mortality. Heart rate control thus seems to be critical in the management of the critically ill patient, requiring careful clinical evaluation aimed at both the differential diagnosis to treat secondary tachycardia and the treatment of rhythm disturbance. In addition, the use of β-blockers for the treatment of persistent tachycardia may be considered in patients with septic shock once hypovolemia has been ruled out. Intravenous application should be the preferred route of administration., Conclusion: β-blockers protective effects in critically ill patients have been repeatedly reported in the literature. Their use in the acute treatment of increased heart rate requires understanding of the pathophysiology and careful differential diagnosis, as all causes of tachycardia should be ruled out and addressed first., (© 2023. Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care.)

Published
2023
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48. A prospective phase IIA multicenter double-blinded randomized placebo-controlled clinical trial evaluating the efficacy and safety of inhaled Tobramycin in patients with ventilator-associated pneumonia (iToVAP).

Author

Angermair S, Deja M, Thronicke A, Grehn C, Akbari N, Uhrig A, Asgarpur G, Spies C, Treskatsch S, and Schwarz C

Subjects
Humans, Prospective Studies, Administration, Inhalation, Anti-Bacterial Agents, Treatment Outcome, Tobramycin adverse effects, Pneumonia, Ventilator-Associated drug therapy, Pneumonia, Ventilator-Associated microbiology
Abstract

Objective: Treatment of ventilated pneumonia is often unsuccessful, even when patients are treated according to current guidelines. Therefore, we aimed to investigate the efficacy of the adjunctive inhaled Tobramycin in patients with pneumonia caused by Gram-negative pathogens in addition to the standard systemic treatment., Design: Prospective, multicenter, double-blinded, randomized, placebo-controlled clinical trial., Setting: 26 patients in medical and surgical ICUs., Patients: Patients with ventilator-associated pneumonia caused by Gram-negative pathogens., Measurement and Main Results: Fourteen patients were assigned to the Tobramycin Inhal group and 12 patients to the control group. The microbiological eradication of the Gram-negative pathogens was significantly higher in the intervention group than in the control group (p < 0.001). The probability of eradication was 100% in the intervention group [95% Confidence Interval: 0.78-1.0] and 25% in the control group [95% CI: 0.09-0.53]. The increased eradication frequency was not associated with increased patient survival., Conclusion: Inhaled aerosolized Tobramycin demonstrated clinically meaningful efficacy in patients with Gram-negative ventilator-associated pneumonia. The probability of eradication in the intervention group was 100%. However, the successful eradication was not associated with a reduction in systemic anti-infective therapy, a shorter ICU stay, or even a survival benefit. In the presence of multidrug-resistant Gram-negative pathogens that are sensitive only to colistin and/or aminoglycosides, supplemental inhaled therapy with nebulizers suitable for this purpose should be considered in addition to systemic antibiotic therapy., (Copyright © 2023 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Published
2023
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49. Serum TGF-β as a predictive biomarker for severe disease and fatality of COVID-19.

Author

Frischbutter S, Durek P, Witkowski M, Angermair S, Treskatsch S, Maurer M, Radbruch A, and Mashreghi MF

Subjects
Humans, Biomarkers, Dexamethasone therapeutic use, Disease Progression, Transforming Growth Factor beta, COVID-19
Abstract

For targeted intervention in coronavirus disease 2019 (COVID-19), there is a high medical need for biomarkers that predict disease progression and severity in the first days after symptom onset. This study assessed the utility of early transforming growth factor β (TGF-β) serum levels in COVID-19 patients to predict disease severity, fatality, and response to dexamethasone therapy. Patients with severe COVID-19 had significantly higher TGF-β levels (416 pg/mL) as compared to patients with mild (165 pg/mL, p < 0.0001) or moderate COVID-19 (241 pg/mL; p < 0.0001). Receiver operating characteristics area under the curve values were 0.92 (95% confidence interval [CI] 0.85-0.99, cut-off: 255 pg/mL) for mild versus severe COVID-19, and 0.83 (95% CI 0.65-1.0, cut-off: 202 pg/mL) for moderate versus severe COVID-19. Patients who died of severe COVID-19 had significantly higher TGF-β levels (453 pg/mL) as compared to convalescent patients (344 pg/mL), and TGF-β levels predicted fatality (area under the curve: 0.75, 95% CI 0.53-0.96). TGF-β was significantly reduced in severely ill patients treated with dexamethasone (301 pg/mL) as compared to untreated patients (416 pg/mL; p < 0.05). Early TGF-β serum levels in COVID-19 patients predict, with high accuracy, disease severity, and fatality. In addition, TGF-β serves as a specific biomarker to assess response to dexamethasone treatment., (© 2023 The Authors. European Journal of Immunology published by Wiley-VCH GmbH.)

Published
2023
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50. Die perioperative Gabe von Tranexamsäure.

Author

Perka C, von Heymann C, Lier H, Kaufner L, and Treskatsch S

Subjects
Humans, Blood Loss, Surgical prevention & control, Blood Transfusion, Antifibrinolytic Agents therapeutic use, Antifibrinolytic Agents adverse effects, Tranexamic Acid therapeutic use
Abstract

The application of tranexamic acid (TXA) during endoprosthetic surgical procedures has significantly increased in recent years. Due its ability to reduce perioperative blood loss and avert the need for blood transfusions as well as wound drainage, TXA is becoming part of a 'standard practice'. However, TXA is currently not approved for the application during endoprosthetic procedures and therefore, a benefit-risk analysis should always be conducted. Prophylactic administration of TXA without prior patient consent is only justified if fibrinolytic bleeding is expected and there are no contraindications or relevant risk factors for thromboembolic complications. Respectively, no patient consent is required when a therapeutic dose of TXA is administered in the context of fibrinolytic bleeding. The following guidelines provide updated recommendations based on the current state of knowledge on TXA optimal timing, routes of administration and dosing regimen., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Published
2023
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