TY  - JOUR
A1  - Hill, Aileen
A1  - Dossow, Vera von
A1  - Heyland, Daren K.
A1  - Rossaint, Rolf
A1  - Meybohm, Patrick
A1  - Fox, Henrik
A1  - Morshuis, Michiel
A1  - Elke, Gunnar
A1  - Panholzer, Bernd
A1  - Haneya, Assad
A1  - Böning, Andreas
A1  - Niemann, Bernd
A1  - Zayat, Rashad
A1  - Moza, Ajay
A1  - Stoppe, Christian
T1  - Preoperative nutritional optimization and physical exercise for patients scheduled for elective implantation for a left-ventricular assist device — The PROPER-LVAD study
JF  - Surgeries
N2  - 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.
KW  - prehabilitation
KW  - medical nutrition therapy
KW  - in-bed cycling
KW  - left-ventricular assist device
KW  - trial protocol
KW  - clinical trial
KW  - oral nutrition supplements
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288317
SN  - 2673-4095
N1  - Funding: This investigator-initiated trial is supported by a grant from Fresenius Kabi Deutschland (Fresenius Kabi Deutschland GmbH, Else-Kröner-Straße 1, 61352 Bad Homburg). The oral nutrition supplements (Fresubin PRO®) are provided by Fresenius Kabi Germany.
VL  - 3
IS  - 4
SP  - 284
EP  - 296
ER  - 
TY  - JOUR
A1  - Hill, Aileen
A1  - Heyland, Daren K.
A1  - Rossaint, Rolf
A1  - Arora, Rakesh C.
A1  - Engelman, Daniel T.
A1  - Day, Andrew G.
A1  - Stoppe, Christian
T1  - Longitudinal outcomes in octogenarian critically ill patients with a focus on frailty and cardiac surgery
JF  - Journal of Clinical Medicine
N2  - Cardiac surgery (CSX) can be lifesaving in elderly patients (age ≥ 80 years) but may still be associated with complications and functional decline. Frailty represents a determinant to outcomes in critically ill patients, but little is known about its influence on elderly CSX-patients. This is a secondary exploratory analysis of a multi-center, prospective observational cohort study of 610 elderly patients admitted to the ICU and followed for one year to document long-term outcomes. CSX-ICU-patients (n = 49) were compared to surgical ICU patients (n = 184) with regard to demographics, frailty, and outcomes. Of all surgical patients, 102 (43%) were considered vulnerable or frail. The subdistribution hazard ratio (SHR) of time to discharge home (TTDH) for vulnerable/frail vs. fit/well patients was 0.54 (95% confidence interval (CI), 0.34, 0.86, p = 0.007). The p-value for effect modification between surgery group (CSX vs. surgical ICU patients) and Clinical Frailty Scale (CFS) group was not significant (p = 0.37) suggesting that the observed difference in the CFS effect between the CSX and surgical ICU patients is consistent with random error. A further subgroup analysis shows that among surgical ICU patients, the SHR of time to discharge home (TTDH) for vulnerable/frail vs. fit/well patients was 0.49 (95% CI, 0.29, 0.83) while the corresponding SHR for CSX patients was 0.77 (0.32–1.88). In conclusion, preoperative frailty reduced the rate of discharge to home in both surgical and CSX patients, but a larger sample of CSX patients is needed to adequately address this question in this patient group.
KW  - population characteristics
KW  - demography
KW  - aged 80 and over
KW  - critical illness
KW  - cardiac surgery
KW  - critical care
KW  - frailty
KW  - prospective studies
KW  - nutrition therapy
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-220064
SN  - 2077-0383
VL  - 10
IS  - 1
ER  -