TY  - JOUR
A1  - Hanke, Kathrin
A1  - Rausch, Tanja K.
A1  - Sosnowski, Runa
A1  - Paul, Pia
A1  - Spiegler, Juliane
A1  - Müller, Mirja
A1  - König, Inke R.
A1  - Göpel, Wolfgang
A1  - Herting, Egbert
A1  - Härtel, Christoph
T1  - Early skin-to-skin contact does not affect cerebral tissue oxygenation in preterm infants <32 weeks of gestation
JF  - Children
N2  - Aim: It was the aim of our study to determine the regional cerebral tissue oxygenation saturation (rcSO\(_2\)) as an additional monitoring parameter during early skin-to-skin contact (SSC) in preterm infants with a gestational age of <32 gestational weeks. Methods: We conducted two observational convenience sample studies using additional monitoring with near-infrared spectroscopy (NIRS) in the first 120 h of life: (a) NIRS 1 (gestational age of 26 0/7 to 31 6/7 weeks) and (b) NIRS 2 (gestational age of 24 0/7 to 28 6/7 weeks). The rcSO\(_2\) values were compared between resting time in the incubator (period I), SSC (period II) and handling nursing care (period III). For the comparison, we separated the sequential effects by including a “wash-out phase” of 1 h between each period. Results: During the first 120 h of life 38/53 infants in NIRS 1 and 15/23 infants in NIRS 2 received SSC, respectively. We found no remarkable differences for rcSO\(_2\) values of NIRS 1 patients between SSC time and period I (95% confidence interval (CI) for the difference in %: SSC vs. period I [1; 3]). In NIRS 2, rcSO\(_2\) values during SSC were only 2% lower compared with period I [median [1. quartile; 3. quartile] in %; 78 [73; 82] vs. 80 [74; 85]] but were similar to period III [78 [72; 83]]. In a combined analysis, a small difference in rcSO\(_2\) values between SSC and resting times was found using a generalized linear mixed model that included gender and gestational age (OR 95% CI; 1.178 [1.103; 1.253], p < 0.0001). Episodes below the cut-off for “hypoxia”; e.g., <55%, were comparable during SSC and periods I and III (0.3–2.1%). No FiO\(_2\) adjustment was required in the vast majority of SSC episodes. Conclusions: Our observational data indicate that rcSO\(_2\) values of infants during SSC were comparable to rcSO\(_2\) values during incubator care and resting time. This additional monitoring supports a safe implementation of early SSC in extremely preterm infants in NICUs.
KW  - regional cerebral oxygenation saturation
KW  - near infrared spectroscopy
KW  - skin-to-skin contact
KW  - preterm infants
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262290
SN  - 2227-9067
VL  - 9
IS  - 2
ER  - 
TY  - JOUR
A1  - Jobs, Alexander
A1  - Vonthein, Reinhard
A1  - König, Inke R.
A1  - Schäfer, Jane
A1  - Nauck, Matthias
A1  - Haag, Svenja
A1  - Fichera, Carlo Federico
A1  - Stiermaier, Thomas
A1  - Ledwoch, Jakob
A1  - Schneider, Alisa
A1  - Valentova, Miroslava
A1  - von Haehling, Stephan
A1  - Störk, Stefan
A1  - Westermann, Dirk
A1  - Lenz, Tobias
A1  - Arnold, Natalie
A1  - Edelmann, Frank
A1  - Seppelt, Philipp
A1  - Felix, Stephan
A1  - Lutz, Matthias
A1  - Hedwig, Felix
A1  - Borggrefe, Martin
A1  - Scherer, Clemens
A1  - Desch, Steffen
A1  - Thiele, Holger
T1  - Inferior vena cava ultrasound in acute decompensated heart failure: design rationale of the CAVA‐ADHF‐DZHK10 trial
JF  - ESC Heart Failure
N2  - Aims
Treating patients with acute decompensated heart failure (ADHF) presenting with volume overload is a common task. However, optimal guidance of decongesting therapy and treatment targets are not well defined. The inferior vena cava (IVC) diameter and its collapsibility can be used to estimate right atrial pressure, which is a measure of right‐sided haemodynamic congestion. The CAVA‐ADHF‐DZHK10 trial is designed to test the hypothesis that ultrasound assessment of the IVC in addition to clinical assessment improves decongestion as compared with clinical assessment alone.

Methods and results
CAVA‐ADHF‐DZHK10 is a randomized, controlled, patient‐blinded, multicentre, parallel‐group trial randomly assigning 388 patients with ADHF to either decongesting therapy guided by ultrasound assessment of the IVC in addition to clinical assessment or clinical assessment alone. IVC ultrasound will be performed daily between baseline and hospital discharge in all patients. However, ultrasound results will only be reported to treating physicians in the intervention group. Treatment target is relief of congestion‐related signs and symptoms in both groups with the additional goal to reduce the IVC diameter ≤21 mm and increase IVC collapsibility >50% in the intervention group. The primary endpoint is change in N‐terminal pro‐brain natriuretic peptide from baseline to hospital discharge. Secondary endpoints evaluate feasibility, efficacy of decongestion on other scales, and the impact of the intervention on clinical endpoints.

Conclusions
CAVA‐ADHF‐DZHK10 will investigate whether IVC ultrasound supplementing clinical assessment improves decongestion in patients admitted for ADHF.
KW  - acute decompensated heart failure
KW  - inferior vena cava
KW  - congestion
KW  - NT‐proBNP
KW  - ultrasound
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-212692
VL  - 7
IS  - 3
SP  - 973
EP  - 983
ER  -