@article{NotzHeylandLeeetal.2023, author = {Notz, Quirin and Heyland, Daren K. and Lee, Zheng-Yii and Menger, Johannes and Herrmann, Johannes and Chillon, Thilo S. and Fremes, Stephen and Mohammadi, Siamak and Elke, Gunnar and Mazer, C. David and Hill, Aileen and Velten, Markus and Ott, Sascha and Kleine-Brueggeney, Maren and Meybohm, Patrick and Schomburg, Lutz and Stoppe, Christian}, title = {Identifying a target group for selenium supplementation in high-risk cardiac surgery: a secondary analysis of the SUSTAIN CSX trial}, series = {Intensive Care Medicine Experimental}, volume = {11}, journal = {Intensive Care Medicine Experimental}, doi = {10.1186/s40635-023-00574-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357196}, year = {2023}, abstract = {Background Recent data from the randomized SUSTAIN CSX trial could not confirm clinical benefits from perioperative selenium treatment in high-risk cardiac surgery patients. Underlying reasons may involve inadequate biosynthesis of glutathione peroxidase (GPx3), which is a key mediator of selenium's antioxidant effects. This secondary analysis aimed to identify patients with an increase in GPx3 activity following selenium treatment. We hypothesize that these responders might benefit from perioperative selenium treatment. Methods Patients were selected based on the availability of selenium biomarker information. Four subgroups were defined according to the patient's baseline status, including those with normal kidney function, reduced kidney function, selenium deficiency, and submaximal GPx3 activity. Results Two hundred and forty-four patients were included in this analysis. Overall, higher serum concentrations of selenium, selenoprotein P (SELENOP) and GPx3 were correlated with less organ injury. GPx3 activity at baseline was predictive of 6-month survival (AUC 0.73; p = 0.03). While selenium treatment elevated serum selenium and SELENOP concentrations but not GPx3 activity in the full patient cohort, subgroup analyses revealed that GPx3 activity increased in patients with reduced kidney function, selenium deficiency and low to moderate GPx3 activity. Clinical outcomes did not vary between selenium treatment and placebo in any of these subgroups, though the study was not powered to conclusively detect differences in outcomes. Conclusions The identification of GPx3 responders encourages further refined investigations into the treatment effects of selenium in high-risk cardiac surgery patients.}, language = {en} } @article{StanglPoppReisetal.2024, author = {Stangl, Stephanie and Popp, Maria and Reis, Stefanie and Sitter, Magdalena and Saal-Bauernschubert, Lena and Schießer, Selina and Kranke, Peter and Choorapoikayil, Suma and Weibel, Stephanie and Meybohm, Patrick}, title = {Reported outcomes in patients with iron deficiency or iron deficiency anemia undergoing major surgery: a systematic review of outcomes}, series = {Systematic Reviews}, volume = {13}, journal = {Systematic Reviews}, doi = {10.1186/s13643-023-02431-x}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357213}, year = {2024}, abstract = {Background Iron deficiency (ID) is the leading cause of anemia worldwide. The prevalence of preoperative ID ranges from 23 to 33\%. Preoperative anemia is associated with worse outcomes, making it important to diagnose and treat ID before elective surgery. Several studies indicated the effectiveness of intravenous iron supplementation in iron deficiency with or without anemia (ID(A)). However, it remains challenging to establish reliable evidence due to heterogeneity in utilized study outcomes. The development of a core outcome set (COS) can help to reduce this heterogeneity by proposing a minimal set of meaningful and standardized outcomes. The aim of our systematic review was to identify and assess outcomes reported in randomized controlled trials (RCTs) and observational studies investigating iron supplementation in iron-deficient patients with or without anemia. Methods We searched MEDLINE, CENTRAL, and ClinicalTrials.gov systematically from 2000 to April 1, 2022. RCTs and observational studies investigating iron supplementation in patients with a preoperative diagnosis of ID(A), were included. Study characteristics and reported outcomes were extracted. Outcomes were categorized according to an established outcome taxonomy. Quality of outcome reporting was assessed with a pre-specified tool. Reported clinically relevant differences for sample size calculation were extracted. Results Out of 2898 records, 346 underwent full-text screening and 13 studies (five RCTs, eight observational studies) with sufficient diagnostic inclusion criteria for iron deficiency with or without anemia (ID(A)) were eligible. It is noteworthy to mention that 49 studies were excluded due to no confirmed diagnosis of ID(A). Overall, 111 outcomes were structured into five core areas including nine domains. Most studies (92\%) reported outcomes within the 'blood and lymphatic system' domain, followed by "adverse event" (77\%) and "need for further resources" (77\%). All of the latter reported on the need for blood transfusion. Reported outcomes were heterogeneous in measures and timing. Merely, two (33\%) of six prospective studies were registered prospectively of which one (17\%) showed no signs of selective outcome reporting. Conclusion This systematic review comprehensively depicts the heterogeneity of reported outcomes in studies investigating iron supplementation in ID(A) patients regarding exact definitions and timing. Our analysis provides a systematic base for consenting to a minimal COS. Systematic review registration PROSPERO CRD42020214247}, language = {en} } @article{StoppePatelZarbocketal.2023, author = {Stoppe, Christian and Patel, Jayshil J. and Zarbock, Alex and Lee, Zheng-Yii and Rice, Todd W. and Mafrici, Bruno and Wehner, Rebecca and Chan, Man Hung Manuel and Lai, Peter Chi Keung and MacEachern, Kristen and Myrianthefs, Pavlos and Tsigou, Evdoxia and Ortiz-Reyes, Luis and Jiang, Xuran and Day, Andrew G. and Hasan, M. Shahnaz and Meybohm, Patrick and Ke, Lu and Heyland, Daren K.}, title = {The impact of higher protein dosing on outcomes in critically ill patients with acute kidney injury: a post hoc analysis of the EFFORT protein trial}, series = {Critical Care}, volume = {27}, journal = {Critical Care}, doi = {10.1186/s13054-023-04663-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357221}, year = {2023}, abstract = {Background Based on low-quality evidence, current nutrition guidelines recommend the delivery of high-dose protein in critically ill patients. The EFFORT Protein trial showed that higher protein dose is not associated with improved outcomes, whereas the effects in critically ill patients who developed acute kidney injury (AKI) need further evaluation. The overall aim is to evaluate the effects of high-dose protein in critically ill patients who developed different stages of AKI. Methods In this post hoc analysis of the EFFORT Protein trial, we investigated the effect of high versus usual protein dose (≥ 2.2 vs. ≤ 1.2 g/kg body weight/day) on time-to-discharge alive from the hospital (TTDA) and 60-day mortality and in different subgroups in critically ill patients with AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria within 7 days of ICU admission. The associations of protein dose with incidence and duration of kidney replacement therapy (KRT) were also investigated. Results Of the 1329 randomized patients, 312 developed AKI and were included in this analysis (163 in the high and 149 in the usual protein dose group). High protein was associated with a slower time-to-discharge alive from the hospital (TTDA) (hazard ratio 0.5, 95\% CI 0.4-0.8) and higher 60-day mortality (relative risk 1.4 (95\% CI 1.1-1.8). Effect modification was not statistically significant for any subgroup, and no subgroups suggested a beneficial effect of higher protein, although the harmful effect of higher protein target appeared to disappear in patients who received kidney replacement therapy (KRT). Protein dose was not significantly associated with the incidence of AKI and KRT or duration of KRT. Conclusions In critically ill patients with AKI, high protein may be associated with worse outcomes in all AKI stages. Recommendation of higher protein dosing in AKI patients should be carefully re-evaluated to avoid potential harmful effects especially in patients who were not treated with KRT. Trial registration: This study is registered at ClinicalTrials.gov (NCT03160547) on May 17th 2017.}, language = {en} } @article{ZeinerSchroederMetzneretal.2023, author = {Zeiner, Carsten and Schr{\"o}der, Malte and Metzner, Selina and Herrmann, Johannes and Notz, Quirin and Hottenrott, Sebastian and R{\"o}der, Daniel and Meybohm, Patrick and Lepper, Philipp M. and Lotz, Christopher}, title = {High-dose methylprednisolone pulse therapy during refractory COVID-19 acute respiratory distress syndrome: a retrospective observational study}, series = {BMC Pulmonary Medicine}, volume = {23}, journal = {BMC Pulmonary Medicine}, doi = {10.1186/s12890-023-02664-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357231}, year = {2023}, abstract = {Background Current COVID-19 guidelines recommend the early use of systemic corticoids for COVID-19 acute respiratory distress syndrome (ARDS). It remains unknown if high-dose methylprednisolone pulse therapy (MPT) ameliorates refractory COVID-19 ARDS after many days of mechanical ventilation or rapid deterioration with or without extracorporeal membrane oxygenation (ECMO). Methods This is a retrospective observational study. Consecutive patients with COVID-19 ARDS treated with a parenteral high-dose methylprednisolone pulse therapy at the intensive care units (ICU) of two University Hospitals between January 1st 2021 and November 30st 2022 were included. Clinical data collection was at ICU admission, start of MPT, 3-, 10- and 14-days post MPT. Results Thirty-seven patients (mean age 55 ± 12 years) were included in the study. MPT started at a mean of 17 ± 12 days after mechanical ventilation. Nineteen patients (54\%) received ECMO support when commencing MPT. Mean paO2/FiO2 significantly improved 3- (p = 0.034) and 10 days (p = 0.0313) post MPT. The same applied to the necessary FiO2 10 days after MPT (p = 0.0240). There were no serious infectious complications. Twenty-four patients (65\%) survived to ICU discharge, including 13 out of 20 (65\%) needing ECMO support. Conclusions Late administration of high-dose MPT in a critical subset of refractory COVID-19 ARDS patients improved respiratory function and was associated with a higher-than-expected survival of 65\%. These data suggest that high-dose MPT may be a viable salvage therapy in refractory COVID-19 ARDS.}, language = {en} } @article{SchmidEckertMeixneretal.2023, author = {Schmid, Benedikt and Eckert, Dominik and Meixner, Andreas and Pistner, Paul and Malzahn, Uwe and Berberich, Monika and Happel, Oliver and Meybohm, Patrick and Kranke, Peter}, title = {Conventional versus video-assisted laryngoscopy for perioperative endotracheal intubation (COVALENT) - a randomized, controlled multicenter trial}, series = {BMC Anesthesiology}, volume = {23}, journal = {BMC Anesthesiology}, doi = {10.1186/s12871-023-02083-3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357207}, year = {2023}, abstract = {Background Data on the routine use of video-assisted laryngoscopy in peri-operative intubations are rather inconsistent and ambiguous, in part due to small populations and non-uniform outcome measures in past trials. Failed or prolonged intubation procedures are a reason for relevant morbidity and mortality. This study aims to determine whether video-assisted laryngoscopy (with both Macintosh-shaped and hyperangulated blades) is at least equal to the standard method of direct laryngoscopy with respect to the first-pass success rate. Furthermore, validated tools from the field of human factors will be applied to examine within-team communication and task load during this critical medical procedure. Methods In this randomized, controlled, three-armed parallel group design, multi-centre trial, a total of more than 2500 adult patients scheduled for perioperative endotracheal intubation will be randomized. In equally large arms, video-assisted laryngoscopy with a Macintosh-shaped or a hyperangulated blade will be compared to the standard of care (direct laryngoscopy with Macintosh blade). In a pre-defined hierarchical analysis, we will test the primary outcome for non-inferiority first. If this goal should be met, the design and projected statistical power also allow for subsequent testing for superiority of one of the interventions. Various secondary outcomes will account for patient safety considerations as well as human factors interactions within the provider team and will allow for further exploratory data analysis and hypothesis generation. Discussion This randomized controlled trial will provide a solid base of data in a field where reliable evidence is of major clinical importance. With thousands of endotracheal intubations performed every day in operating rooms around the world, every bit of performance improvement translates into increased patient safety and comfort and may eventually prevent significant burden of disease. Therefore, we feel confident that a large trial has the potential to considerably benefit patients and anaesthetists alike. Trial registration ClincalTrials.gov NCT05228288. Protocol version 1.1, November 15, 2021.}, language = {en} } @article{HerrmannMuellerNotzetal.2023, author = {Herrmann, Johannes and M{\"u}ller, Kerstin and Notz, Quirin and H{\"u}bsch, Martha and Haas, Kirsten and Horn, Anna and Schmidt, Julia and Heuschmann, Peter and Maschmann, Jens and Frosch, Matthias and Deckert, J{\"u}rgen and Einsele, Hermann and Ertl, Georg and Frantz, Stefan and Meybohm, Patrick and Lotz, Christopher}, title = {Prospective single-center study of health-related quality of life after COVID-19 in ICU and non-ICU patients}, series = {Scientific Reports}, volume = {13}, journal = {Scientific Reports}, doi = {10.1038/s41598-023-33783-y}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357174}, year = {2023}, abstract = {Long-term sequelae in hospitalized Coronavirus Disease 2019 (COVID-19) patients may result in limited quality of life. The current study aimed to determine health-related quality of life (HRQoL) after COVID-19 hospitalization in non-intensive care unit (ICU) and ICU patients. This is a single-center study at the University Hospital of Wuerzburg, Germany. Patients eligible were hospitalized with COVID-19 between March 2020 and December 2020. Patients were interviewed 3 and 12 months after hospital discharge. Questionnaires included the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L), patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder 7 scale (GAD-7), FACIT fatigue scale, perceived stress scale (PSS-10) and posttraumatic symptom scale 10 (PTSS-10). 85 patients were included in the study. The EQ5D-5L-Index significantly differed between non-ICU (0.78 ± 0.33 and 0.84 ± 0.23) and ICU (0.71 ± 0.27; 0.74 ± 0.2) patients after 3- and 12-months. Of non-ICU 87\% and 80\% of ICU survivors lived at home without support after 12 months. One-third of ICU and half of the non-ICU patients returned to work. A higher percentage of ICU patients was limited in their activities of daily living compared to non-ICU patients. Depression and fatigue were present in one fifth of the ICU patients. Stress levels remained high with only 24\% of non-ICU and 3\% of ICU patients (p = 0.0186) having low perceived stress. Posttraumatic symptoms were present in 5\% of non-ICU and 10\% of ICU patients. HRQoL is limited in COVID-19 ICU patients 3- and 12-months post COVID-19 hospitalization, with significantly less improvement at 12-months compared to non-ICU patients. Mental disorders were common highlighting the complexity of post-COVID-19 symptoms as well as the necessity to educate patients and primary care providers about monitoring mental well-being post COVID-19.}, language = {en} } @article{HelmerRodemersHottenrottetal.2023, author = {Helmer, Philipp and Rodemers, Philipp and Hottenrott, Sebastian and Leppich, Robert and Helwich, Maja and Pryss, R{\"u}diger and Kranke, Peter and Meybohm, Patrick and Winkler, Bernd E. and Sammeth, Michael}, title = {Evaluating blood oxygen saturation measurements by popular fitness trackers in postoperative patients: a prospective clinical trial}, series = {iScience}, volume = {26}, journal = {iScience}, number = {11}, issn = {2589-0042}, doi = {10.1016/j.isci.2023.108155}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349913}, year = {2023}, abstract = {Summary Blood oxygen saturation is an important clinical parameter, especially in postoperative hospitalized patients, monitored in clinical practice by arterial blood gas (ABG) and/or pulse oximetry that both are not suitable for a long-term continuous monitoring of patients during the entire hospital stay, or beyond. Technological advances developed recently for consumer-grade fitness trackers could—at least in theory—help to fill in this gap, but benchmarks on the applicability and accuracy of these technologies in hospitalized patients are currently lacking. We therefore conducted at the postanaesthesia care unit under controlled settings a prospective clinical trial with 201 patients, comparing in total >1,000 oxygen blood saturation measurements by fitness trackers of three brands with the ABG gold standard and with pulse oximetry. Our results suggest that, despite of an overall still tolerable measuring accuracy, comparatively high dropout rates severely limit the possibilities of employing fitness trackers, particularly during the immediate postoperative period of hospitalized patients. Highlights •The accuracy of O2 measurements by fitness trackers is tolerable (RMSE ≲4\%) •Correlation with arterial blood gas measurements is fair to moderate (PCC = [0.46; 0.64]) •Dropout rates of fitness trackers during O2 monitoring are high (∼1/3 values missing) •Fitness trackers cannot be recommended for O2 measuring during critical monitoring}, language = {en} } @article{LambertiniHartrampfHiguchietal.2022, author = {Lambertini, Alessandro and Hartrampf, Philipp E. and Higuchi, Takahiro and Serfling, Sebastian E. and Meybohm, Patrick and Schirbel, Andreas and Buck, Andreas K. and Werner, Rudolf A.}, title = {CXCR4-targeted molecular imaging after severe SARS-Cov-2 infection}, series = {European Journal of Nuclear Medicine and Molecular Imaging}, volume = {50}, journal = {European Journal of Nuclear Medicine and Molecular Imaging}, number = {1}, doi = {10.1007/s00259-022-05932-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-324619}, pages = {228-229}, year = {2022}, abstract = {No abstract available.}, language = {en} } @article{BergauerAkbasBraunetal.2023, author = {Bergauer, Lisa and Akbas, Samira and Braun, Julia and Ganter, Michael T. and Meybohm, Patrick and Hottenrott, Sebastian and Zacharowski, Kai and Raimann, Florian J. and Rivas, Eva and L{\´o}pez-Baamonde, Manuel and Spahn, Donat R. and Noethiger, Christoph B. and Tscholl, David W. and Roche, Tadzio R.}, title = {Visual Blood, visualisation of blood gas analysis in virtual reality, leads to more correct diagnoses: a computer-based, multicentre, simulation study}, series = {Bioengineering}, volume = {10}, journal = {Bioengineering}, number = {3}, issn = {2306-5354}, doi = {10.3390/bioengineering10030340}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-310979}, year = {2023}, abstract = {Interpreting blood gas analysis results can be challenging for the clinician, especially in stressful situations under time pressure. To foster fast and correct interpretation of blood gas results, we developed Visual Blood. This computer-based, multicentre, noninferiority study compared Visual Blood and conventional arterial blood gas (ABG) printouts. We presented six scenarios to anaesthesiologists, once with Visual Blood and once with the conventional ABG printout. The primary outcome was ABG parameter perception. The secondary outcomes included correct clinical diagnoses, perceived diagnostic confidence, and perceived workload. To analyse the results, we used mixed models and matched odds ratios. Analysing 300 within-subject cases, we showed noninferiority of Visual Blood compared to ABG printouts concerning the rate of correctly perceived ABG parameters (rate ratio, 0.96; 95\% CI, 0.92-1.00; p = 0.06). Additionally, the study revealed two times higher odds of making the correct clinical diagnosis using Visual Blood (OR, 2.16; 95\% CI, 1.42-3.29; p < 0.001) than using ABG printouts. There was no or, respectively, weak evidence for a difference in diagnostic confidence (OR, 0.84; 95\% CI, 0.58-1.21; p = 0.34) and perceived workload (Coefficient, 2.44; 95\% CI, -0.09-4.98; p = 0.06). This study showed that participants did not perceive the ABG parameters better, but using Visual Blood resulted in more correct clinical diagnoses than using conventional ABG printouts. This suggests that Visual Blood allows for a higher level of situation awareness beyond individual parameters' perception. However, the study also highlighted the limitations of today's virtual reality headsets and Visual Blood.}, language = {en} } @article{SchweigerMalorgioHenckertetal.2023, author = {Schweiger, Giovanna and Malorgio, Amos and Henckert, David and Braun, Julia and Meybohm, Patrick and Hottenrott, Sebastian and Froehlich, Corinna and Zacharowski, Kai and Raimann, Florian J. and Piekarski, Florian and Noethiger, Christoph B. and Spahn, Donat R. and Tscholl, David W. and Roche, Tadzio R.}, title = {Visual Blood, a 3D animated computer model to optimize the interpretation of blood gas analysis}, series = {Bioengineering}, volume = {10}, journal = {Bioengineering}, number = {3}, issn = {2306-5354}, doi = {10.3390/bioengineering10030293}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304150}, year = {2023}, abstract = {Acid-base homeostasis is crucial for all physiological processes in the body and is evaluated using arterial blood gas (ABG) analysis. Screens or printouts of ABG results require the interpretation of many textual elements and numbers, which may delay intuitive comprehension. To optimise the presentation of the results for the specific strengths of human perception, we developed Visual Blood, an animated virtual model of ABG results. In this study, we compared its performance with a conventional result printout. Seventy physicians from three European university hospitals participated in a computer-based simulation study. Initially, after an educational video, we tested the participants' ability to assign individual Visual Blood visualisations to their corresponding ABG parameters. As the primary outcome, we tested caregivers' ability to correctly diagnose simulated clinical ABG scenarios with Visual Blood or conventional ABG printouts. For user feedback, participants rated their agreement with statements at the end of the study. Physicians correctly assigned 90\% of the individual Visual Blood visualisations. Regarding the primary outcome, the participants made the correct diagnosis 86\% of the time when using Visual Blood, compared to 68\% when using the conventional ABG printout. A mixed logistic regression model showed an odds ratio for correct diagnosis of 3.4 (95\%CI 2.00-5.79, p < 0.001) and an odds ratio for perceived diagnostic confidence of 1.88 (95\%CI 1.67-2.11, p < 0.001) in favour of Visual Blood. A linear mixed model showed a coefficient for perceived workload of -3.2 (95\%CI -3.77 to -2.64) in favour of Visual Blood. Fifty-one of seventy (73\%) participants agreed or strongly agreed that Visual Blood was easy to use, and fifty-five of seventy (79\%) agreed that it was fun to use. In conclusion, Visual Blood improved physicians' ability to diagnose ABG results. It also increased perceived diagnostic confidence and reduced perceived workload. This study adds to the growing body of research showing that decision-support tools developed around human cognitive abilities can streamline caregivers' decision-making and may improve patient care.}, language = {en} } @article{HenckertMalorgioSchweigeretal.2023, author = {Henckert, David and Malorgio, Amos and Schweiger, Giovanna and Raimann, Florian J. and Piekarski, Florian and Zacharowski, Kai and Hottenrott, Sebastian and Meybohm, Patrick and Tscholl, David W. and Spahn, Donat R. and Roche, Tadzio R.}, title = {Attitudes of anesthesiologists toward artificial intelligence in anesthesia: a multicenter, mixed qualitative-quantitative study}, series = {Journal of Clinical Medicine}, volume = {12}, journal = {Journal of Clinical Medicine}, number = {6}, issn = {2077-0383}, doi = {10.3390/jcm12062096}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-311189}, year = {2023}, abstract = {Artificial intelligence (AI) is predicted to play an increasingly important role in perioperative medicine in the very near future. However, little is known about what anesthesiologists know and think about AI in this context. This is important because the successful introduction of new technologies depends on the understanding and cooperation of end users. We sought to investigate how much anesthesiologists know about AI and what they think about the introduction of AI-based technologies into the clinical setting. In order to better understand what anesthesiologists think of AI, we recruited 21 anesthesiologists from 2 university hospitals for face-to-face structured interviews. The interview transcripts were subdivided sentence-by-sentence into discrete statements, and statements were then grouped into key themes. Subsequently, a survey of closed questions based on these themes was sent to 70 anesthesiologists from 3 university hospitals for rating. In the interviews, the base level of knowledge of AI was good at 86 of 90 statements (96\%), although awareness of the potential applications of AI in anesthesia was poor at only 7 of 42 statements (17\%). Regarding the implementation of AI in anesthesia, statements were split roughly evenly between pros (46 of 105, 44\%) and cons (59 of 105, 56\%). Interviewees considered that AI could usefully be used in diverse tasks such as risk stratification, the prediction of vital sign changes, or as a treatment guide. The validity of these themes was probed in a follow-up survey of 70 anesthesiologists with a response rate of 70\%, which confirmed an overall positive view of AI in this group. Anesthesiologists hold a range of opinions, both positive and negative, regarding the application of AI in their field of work. Survey-based studies do not always uncover the full breadth of nuance of opinion amongst clinicians. Engagement with specific concerns, both technical and ethical, will prove important as this technology moves from research to the clinic.}, language = {en} } @article{KippnichKippnichErhardetal.2022, author = {Kippnich, Maximilian and Kippnich, Uwe and Erhard, Harald and Meybohm, Patrick and Wurmb, Thomas}, title = {Weiterentwicklung im Katastrophenschutz: Ziel, Strategie und Taktik am Beispiel der Hochwasserkatastrophe 2021 im Ahrtal}, series = {Notfall + Rettungsmedizin}, journal = {Notfall + Rettungsmedizin}, issn = {1434-6222}, doi = {10.1007/s10049-022-01089-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-346737}, pages = {1-10}, year = {2022}, abstract = {Hintergrund und Fragestellung Im Rahmen der {\"u}ber{\"o}rtlichen Katastrophenhilfe war die Medizinische Task Force 47 (Unterfranken) im Juli 2021 bei der Hochwasserkatastrophe in Rheinland-Pfalz (Ahrtal) im Einsatz. Mit dem Ziel, m{\"o}gliche Verbesserungen im Katastrophenschutz aus Sicht einer {\"u}berregionalen Einheit aus dem Einsatz ableiten zu k{\"o}nnen, wurde dieser wissenschaftlich evaluiert und die Erkenntnisse in einen {\"u}bergeordneten Kontext gesetzt. Material und Methoden Nach Definition eines konkreten Auswerteprozesses wurden durch ein interdisziplin{\"a}res Expertengremium Einsatzunterlagen und relevante Konzepte des Bayerischen Roten Kreuzes gesichtet. Auf dieser Basis wurden Strategien und Taktiken entwickelt, um die vordefinierten Ziele zu erreichen. Ergebnisse Die Leistungsf{\"a}higkeit der Einsatzeinheiten k{\"o}nnte durch moderne Einsatzmittel (E-Bike, Drohnen, hochgel{\"a}ndeg{\"a}ngige Fahrzeuge) gesteigert werden. Zur Erh{\"o}hung der Reaktionsf{\"a}higkeit k{\"o}nnten neue Schnell-Einsatz-Gruppen (SEG) erforderlich sein, die als Teil von BOS-{\"u}bergreifenden Erkundungseinheiten agieren und in unwegsamen Gel{\"a}nden autark Einsatzauftr{\"a}ge abarbeiten k{\"o}nnen (SEG Erkundung und SEG Gel{\"a}nde-Infrastruktur-Logistik-Transport). Die taktischen Einheiten k{\"o}nnten in die regionale und {\"u}berregionale Katastrophenhilfe eingebunden und synchronisiert werden. Diskussion F{\"u}r den weitestgehend ehrenamtlich organisierten Katastrophenschutz in Deutschland k{\"o}nnte es in Zukunft erschwert sein, die Vielzahl m{\"o}glicher modernster Einsatzmittel im hochkomplexen Umfeld einer Katastrophe sicher einsetzen zu k{\"o}nnen. Eine Teilprofessionalisierung durch hauptamtliche F{\"u}hrungs- und Einsatzkr{\"a}fte k{\"o}nnte eine L{\"o}sung hierf{\"u}r sein.}, language = {de} } @article{SchmittMeybohmNeefetal.2022, author = {Schmitt, Elke and Meybohm, Patrick and Neef, Vanessa and Baumgarten, Peter and Bayer, Alexandra and Choorapoikayil, Suma and Friederich, Patrick and Friedrich, Jens and Geisen, Christof and G{\"u}resir, Erdem and Gr{\"u}newald, Matthias and Gutjahr, Martin and Helmer, Philipp and Herrmann, Eva and M{\"u}ller, Markus and Narita, Diana and Raadts, Ansgar and Schwendner, Klaus and Seifried, Erhard and Stark, Patrick and Steinbicker, Andrea U. and Thoma, Josef and Velten, Markus and Weigt, Henry and Wiesenack, Christoph and Wittmann, Maria and Zacharowski, Kai and Piekarski, Florian}, title = {Preoperative anaemia and red blood cell transfusion in patients with aneurysmal subarachnoid and intracerebral haemorrhage - a multicentre subanalysis of the German PBM Network Registry}, series = {Acta Neurochirurgica}, volume = {164}, journal = {Acta Neurochirurgica}, organization = {German PBM Network Collaborators}, doi = {10.1007/s00701-022-05144-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-346754}, pages = {985-999}, year = {2022}, abstract = {Purpose Anaemia is common in patients presenting with aneurysmal subarachnoid (aSAH) and intracerebral haemorrhage (ICH). In surgical patients, anaemia was identified as an idenpendent risk factor for postoperative mortality, prolonged hospital length of stay (LOS) and increased risk of red blood cell (RBC) transfusion. This multicentre cohort observation study describes the incidence and effects of preoperative anaemia in this critical patient collective for a 10-year period. Methods This multicentre observational study included adult in-hospital surgical patients diagnosed with aSAH or ICH of 21 German hospitals (discharged from 1 January 2010 to 30 September 2020). Descriptive, univariate and multivariate analyses were performed to investigate the incidence and association of preoperative anaemia with RBC transfusion, in-hospital mortality and postoperative complications in patients with aSAH and ICH. Results A total of n = 9081 patients were analysed (aSAH n = 5008; ICH n = 4073). Preoperative anaemia was present at 28.3\% in aSAH and 40.9\% in ICH. RBC transfusion rates were 29.9\% in aSAH and 29.3\% in ICH. Multivariate analysis revealed that preoperative anaemia is associated with a higher risk for RBC transfusion (OR = 3.25 in aSAH, OR = 4.16 in ICH, p < 0.001), for in-hospital mortality (OR = 1.48 in aSAH, OR = 1.53 in ICH, p < 0.001) and for several postoperative complications. Conclusions Preoperative anaemia is associated with increased RBC transfusion rates, in-hospital mortality and postoperative complications in patients with aSAH and ICH.}, language = {en} } @article{KippnichSkazelKlingshirnetal.2022, author = {Kippnich, Maximilian and Skazel, Tobias and Klingshirn, Hanna and Gerken, Laura and Heuschmann, Peter and Haas, Kirsten and Schutzmeier, Martha and Brandstetter, Lilly and Weismann, Dirk and Reuschenbach, Bernd and Meybohm, Patrick and Wurmb, Thomas}, title = {Analyse des Weaningprozesses bei Intensivpatienten im Hinblick auf Dokumentation und Verlegung in weiterbehandelnde Einheiten}, series = {Medizinische Klinik, Intensivmedizin und Notfallmedizin}, volume = {118}, journal = {Medizinische Klinik, Intensivmedizin und Notfallmedizin}, doi = {10.1007/s00063-022-00941-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-346742}, pages = {269-276}, year = {2022}, abstract = {Hintergrund und Fragestellung Die Entw{\"o}hnung von Beatmungsger{\"a}ten wird nicht immer auf der prim{\"a}r behandelnden Intensivstation abgeschlossen. Die Weiterverlegung in andere Behandlungseinrichtungen stellt einen sensiblen Abschnitt in der Behandlung und Rehabilitation des Weaningpatienten dar. Ziel der vorliegenden Studie war die Untersuchung des {\"U}berleitungsmanagements und des Interhospitaltransfers von Weaningpatienten unter besonderer Ber{\"u}cksichtigung der Dokumentationsqualit{\"a}t. Methodik Es erfolge eine retrospektive Datenanalyse eines Jahrs (2018) auf 2 Intensivstationen eines Universit{\"a}tsklinikums. Eingeschlossen wurden alle beatmeten Patienten mit folgenden Tracerdiagnosen: COPD, Asthma, Polytrauma, Pneumonie, Sepsis, ARDS und Reanimation (Beatmung > 24 h). Ergebnisse Insgesamt konnten 750 Patienten in die Untersuchung eingeschlossen werden (Alter 64 [52, 8-76; Median, IQR]; 32 \% weiblich). Davon waren 48 (6,4 \%) Patienten zum Zeitpunkt der Verlegung nicht entw{\"o}hnt (v. a. Sepsis und ARDS). Die Routinedokumentation war bei den Abschnitten „Spontaneous Breathing Trial", „Bewertung der Entw{\"o}hungsbereitschaft" und „vermutete Entw{\"o}hnbarkeit" ausreichend, um die Erf{\"u}llung der Parameter der S2k-Leitlinie „Prolongiertes Weaning" ad{\"a}quat zu beurteilen. Vorwiegend wurden diese Patienten mit Tracheostoma (76 \%) in Rehabilitationskliniken (44 \%) mittels spezialisierten Rettungsmitteln des arztbegleiteten Patiententransports verlegt (75 \%). Diskussion Die Verlegung nicht entw{\"o}hnter Patienten nach initialem Intensivaufenthalt ist ein relevantes Thema f{\"u}r den Interhospitaltransfer. Die Routinedokumentation eines strukturierten Weaningprozesses ist in Kernelementen ausreichend, um den Weaningprozess l{\"u}ckenlos zu beschreiben. Dies ist f{\"u}r die Kontinuit{\"a}t in der Weiterbehandlung dieser Patienten von großer Bedeutung.}, language = {de} } @article{SitterFroehlichKrankeetal.2023, author = {Sitter, Magdalena and Fr{\"o}hlich, Corinna and Kranke, Peter and Markus, Christian and W{\"o}ckel, Achim and Rehn, Monika and Bartmann, Catharina and Frieauff, Eric and Meybohm, Patrick and Pecks, Ulrich and R{\"o}der, Daniel}, title = {ECMO-Therapie bei COVID-19-ARDS in der Schwangerschaft erm{\"o}glicht den Erhalt einer Schwangerschaft mit termingerechter Entbindung}, series = {Die Anaesthesiologie}, volume = {72}, journal = {Die Anaesthesiologie}, number = {3}, doi = {10.1007/s00101-022-01232-6}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-346762}, pages = {166-170}, year = {2023}, abstract = {No abstract available.}, language = {de} } @article{SchorscherKippnichMeybohmetal.2022, author = {Schorscher, Nora and Kippnich, Maximilian and Meybohm, Patrick and Wurmb, Thomas}, title = {Lessons learned from terror attacks: thematic priorities and development since 2001 - results from a systematic review}, series = {European Journal of Trauma and Emergency Surgery}, volume = {48}, journal = {European Journal of Trauma and Emergency Surgery}, issn = {1863-9941}, doi = {10.1007/s00068-021-01858-y}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-264862}, pages = {2613-2638}, year = {2022}, abstract = {PURPOSE The threat of national and international terrorism remains high. Preparation is the key requirement for the resilience of hospitals and out-of-hospital rescue forces. The scientific evidence for defining medical and tactical strategies often feeds on the analysis of real incidents and the lessons learned derived from them. This systematic review of the literature aims to identify and systematically report lessons learned from terrorist attacks since 2001. METHODS PubMed was used as a database using predefined search strategies and eligibility criteria. All countries that are part of the Organization for Economic Cooperation and Development (OECD) were included. The time frame was set between 2001 and 2018. RESULTS Finally 68 articles were included in the review. From these, 616 lessons learned were extracted and summarized into 15 categories. The data shows that despite the difference in attacks, countries, and casualties involved, many of the lessons learned are similar. We also found that the pattern of lessons learned is repeated continuously over the time period studied. CONCLUSIONS The lessons from terrorist attacks since 2001 follow a certain pattern and remained constant over time. Therefore, it seems to be more accurate to talk about lessons identified rather than lessons learned. To save as many victims as possible, protect rescue forces from harm, and to prepare hospitals at the best possible level it is important to implement the lessons identified in training and preparation.}, language = {en} } @article{LindhoffLastBirschmannBidenharnetal.2022, author = {Lindhoff-Last, Edelgard and Birschmann, Ingvild and Bidenharn, Antonia J. and Kuhn, Joachim and Lindau, Simone and Konstantinides, Stavros and Grottke, Oliver and Nowak-G{\"o}ttl, Ulrike and Lucks, Jessica and Zydek, Barbara and Heymann, Christian von and S{\"u}mnig, Ariane and Beyer-Westendorf, Jan and Schellong, Sebastian and Meybohm, Patrick and Greinacher, Andreas and Herrmann, Eva}, title = {Pharmacokinetics of phenprocoumon in emergency situations - results of the prospective observational RADOA-registry (reversal agent use in patients treated with direct oral anticoagulants or vitamin K antagonists registry)}, series = {Pharmaceuticals}, volume = {15}, journal = {Pharmaceuticals}, number = {11}, issn = {1424-8247}, doi = {10.3390/ph15111437}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-297226}, year = {2022}, abstract = {Background: Phenprocoumon has been used as an oral anticoagulant in patients with thromboembolic disease for more than 40 years. So far its pharmacokinetics have not been analyzed in emergency situations. Methods: Phenprocoumon-treated patients with major bleeding or urgent surgery were included in a prospective, observational registry. Phenprocoumon drug concentrations were analyzed in samples, collected as part of routine care using ultraperformance liquid chromatography tandem mass spectrometry. Moreover, anticoagulant intensity and drug half-life (t1/2) were calculated. Results: 115 patients were included. Phenprocoumon levels declined over time with a half-life of 5.27 and 5.29 days in patients with major bleedings (n = 82) and with urgent surgery (n = 33). Baseline phenprocoumon levels were 2.2 times higher in the bleeding group compared to the surgery group (1.92 vs. 0.87 ng/mL, p < 0.0001). International normalized ratio (INR) values decreased rapidly during the first 24 h. In 27.6\% of patients a rebound of INR (recurrent increase > 1.5) was observed which was associated with significantly increased bleeding rates (22\% vs. 4.2\% in patients with or without INR rebound, p = 0.012). Conclusions: In emergency situations, the long half-life of phenprocoumon may cause INR rebound and associated recurrent bleedings. Optimal management may need to include repeated vitamin K supplementation over days.}, language = {en} } @article{FiedlerMuellenbachRolfesetal.2022, author = {Fiedler, Mascha O. and Muellenbach, Ralf M. and Rolfes, Caroline and Lotz, Christopher and Nickel, Felix and M{\"u}ller-Stich, Beat P. and Supady, Alexander and Lepper, Philipp M. and Weigand, Markus A. and Meybohm, Patrick and Kalenka, Armin and Reyher, Christian}, title = {Pumpless extracorporeal hemadsorption technique (pEHAT): a proof-of-concept animal study}, series = {Journal of Clinical Medicine}, volume = {11}, journal = {Journal of Clinical Medicine}, number = {22}, issn = {2077-0383}, doi = {10.3390/jcm11226815}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-297347}, year = {2022}, abstract = {Background: Extracorporeal hemadsorption eliminates proinflammatory mediators in critically ill patients with hyperinflammation. The use of a pumpless extracorporeal hemadsorption technique allows its early usage prior to organ failure and the need for an additional medical device. In our animal model, we investigated the feasibility of pumpless extracorporeal hemadsorption over a wide range of mean arterial pressures (MAP). Methods: An arteriovenous shunt between the femoral artery and femoral vein was established in eight pigs. The hemadsorption devices were inserted into the shunt circulation; four pigs received CytoSorb\(^®\) and four Oxiris\(^®\) hemadsorbers. Extracorporeal blood flow was measured in a range between mean arterial pressures of 45-85 mmHg. Mean arterial pressures were preset using intravenous infusions of noradrenaline, urapidil, or increased sedatives. Results: Extracorporeal blood flows remained well above the minimum flows recommended by the manufacturers throughout all MAP steps for both devices. Linear regression resulted in CytoSorb\(^®\) blood flow [mL/min] = 4.226 × MAP [mmHg] - 3.496 (R-square 0.8133) and Oxiris\(^®\) blood flow [mL/min] = 3.267 × MAP [mmHg] + 57.63 (R-square 0.8708), respectively. Conclusion: Arteriovenous pumpless extracorporeal hemadsorption resulted in sufficient blood flows through both the CytoSorb\(^®\) and Oxiris\(^®\) devices over a wide range of mean arterial blood pressures and is likely an intriguing therapeutic option in the early phase of septic shock or hyperinflammatory syndromes.}, language = {en} } @article{NowackaChmielewskaGrabowskaGrabowskietal.2022, author = {Nowacka-Chmielewska, Marta and Grabowska, Konstancja and Grabowski, Mateusz and Meybohm, Patrick and Burek, Malgorzata and Małecki, Andrzej}, title = {Running from stress: neurobiological mechanisms of exercise-induced stress resilience}, series = {International Journal of Molecular Sciences}, volume = {23}, journal = {International Journal of Molecular Sciences}, number = {21}, issn = {1422-0067}, doi = {10.3390/ijms232113348}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-297407}, year = {2022}, abstract = {Chronic stress, even stress of a moderate intensity related to daily life, is widely acknowledged to be a predisposing or precipitating factor in neuropsychiatric diseases. There is a clear relationship between disturbances induced by stressful stimuli, especially long-lasting stimuli, and cognitive deficits in rodent models of affective disorders. Regular physical activity has a positive effect on the central nervous system (CNS) functions, contributes to an improvement in mood and of cognitive abilities (including memory and learning), and is correlated with an increase in the expression of the neurotrophic factors and markers of synaptic plasticity as well as a reduction in the inflammatory factors. Studies published so far show that the energy challenge caused by physical exercise can affect the CNS by improving cellular bioenergetics, stimulating the processes responsible for the removal of damaged organelles and molecules, and attenuating inflammation processes. Regular physical activity brings another important benefit: increased stress robustness. The evidence from animal studies is that a sedentary lifestyle is associated with stress vulnerability, whereas a physically active lifestyle is associated with stress resilience. Here, we have performed a comprehensive PubMed Search Strategy for accomplishing an exhaustive literature review. In this review, we discuss the findings from experimental studies on the molecular and neurobiological mechanisms underlying the impact of exercise on brain resilience. A thorough understanding of the mechanisms underlying the neuroprotective potential of preconditioning exercise and of the role of exercise in stress resilience, among other things, may open further options for prevention and therapy in the treatment of CNS diseases.}, language = {en} } @article{HillDossowHeylandetal.2022, author = {Hill, Aileen and Dossow, Vera von and Heyland, Daren K. and Rossaint, Rolf and Meybohm, Patrick and Fox, Henrik and Morshuis, Michiel and Elke, Gunnar and Panholzer, Bernd and Haneya, Assad and B{\"o}ning, Andreas and Niemann, Bernd and Zayat, Rashad and Moza, Ajay and Stoppe, Christian}, title = {Preoperative nutritional optimization and physical exercise for patients scheduled for elective implantation for a left-ventricular assist device — The PROPER-LVAD study}, series = {Surgeries}, volume = {3}, journal = {Surgeries}, number = {4}, issn = {2673-4095}, doi = {10.3390/surgeries3040031}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-288317}, pages = {284 -- 296}, year = {2022}, abstract = {Background: Prehabilitation is gaining increasing interest and shows promising effects on short- and long-term outcomes among patients undergoing major surgery. The effect of multimodal, interdisciplinary prehabilitation has not yet been studied in patients with severe heart failure scheduled for the implantation of a left-ventricular assist device (LVAD). Methods: This randomized controlled multi-center study evaluates the effect of preoperative combined optimization of nutritional and functional status. Patients in the intervention group are prescribed daily in-bed cycling and oral nutrition supplements (ONS) from study inclusion until the day before LVAD-implantation. Patients in the control group receive standard of care treatment. The primary outcomes for the pilot study that involves 48 patients are safety (occurrence of adverse events), efficacy (group separation regarding the intake of macronutrients), feasibility of the trial protocol (compliance (percentage of received interventions) and confirmation of recruitment rates. Secondary outcomes include longitudinal measurements of muscle mass, muscle strength, physical function and quality of life, next to traditional clinical outcomes (30-day mortality, hospital and ICU length of stay, duration of mechanical ventilation and number of complications and infections). If the pilot study is successful, a larger confirmatory, international multicenter study is warranted.}, language = {en} }