TY - JOUR A1 - Döhler, Ida A1 - Röder, Daniel A1 - Schlesinger, Tobias A1 - Nassen, Christian Alexander A1 - Germer, Christoph-Thomas A1 - Wiegering, Armin A1 - Lock, Johan Friso T1 - Risk-adjusted perioperative bridging anticoagulation reduces bleeding complications without increasing thromboembolic events in general and visceral surgery JF - BMC Anesthesiology N2 - Background Perioperative bridging of oral anticoagulation increases the risk of bleeding complications after elective general and visceral surgery. The aim of this study was to explore, whether an individual risk-adjusted bridging regimen can reduce bleeding events, while still protecting against thromboembolic events. Methods We performed a quality improvement study comparing bridging parameters and postoperative outcomes before (period 1) and after implementation (period 2) of a new risk-adjusted bridging regimen. The primary endpoint of the study was overall incidence of postoperative bleeding complications during 30 days postoperatively. Secondary endpoints were major postoperative bleeding, minor bleeding, thromboembolic events, postoperative red blood cell transfusion, perioperative length-of-stay (LOS) and in-hospital mortality. Results A total of 263 patients during period 1 and 271 patients during period 2 were compared. The included elective operations covered the entire field of general and visceral surgery. The overall incidence of bleeding complications declined from 22.1% during period 1 to 10.3% in period 2 (p < 0.001). This reduction affected both major as well as minor bleeding events (8.4% vs. 4.1%; p = 0.039; 13.7% vs. 6.3%; p = 0.004). The incidence of thromboembolic events remained low (0.8% vs. 1.1%). No changes in mortality or length-of-stay were observed. Conclusion It is important to balance the individual thromboembolic and bleeding risks in perioperative bridging management. The risk adjusted bridging regimen reduces bleeding events in general and visceral surgery while the risk of thromboembolism remains comparably low. KW - low-molecular heparin KW - atrial fibrillation KW - postoperative bleeding KW - thromboembolism KW - anticoagulation KW - bridging Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357305 VL - 23 ER - TY - THES A1 - Schlesinger, Tobias T1 - Autolog zellbesiedelte Matrix zum Verschluss gastraler Inzisionen: Eine Machbarkeitsstudie im Schweinemodell T1 - Autologous seeded matrix for gastrotomy closure: A proof of concept in a porcine model N2 - Einleitung: Strukturelle Defekte der gastrointestinalen Hohlorgane stellen ein allgegen-wärtiges Problem im klinischen Alltag dar. Sie entstehen meist auf dem Boden einer ent-zündlichen oder tumorösen Grunderkrankung und können außerdem traumatisch sowie durch medizinische Eingriffe hervorgerufen werden. In der Folge kommt es zur Kontami-nation des umliegenden Gewebes mit Magen- bzw. Darminhalt, wodurch deletäre Folgen wie eine systemische Infektion, also eine Sepsis mit Multiorganversagen drohen können. Vor diesem Hintergrund sind gastrointestinale Defekte immer als potenziell lebensbedroh-lich für den Patienten zu betrachten. Die adäquate und kausale Behandlung erfolgt je nach Ätiologie und Zustand des Patienten durch eine Operation oder eine endoskopische Inter-vention. Hierzu stehen zahlreiche etablierte, operative und interventionelle Therapieme-thoden zur Verfügung. In manchen Fällen stoßen die etablierten Techniken jedoch an ihre Grenzen. Bei Patienten mit schwerwiegenden Komorbiditäten oder im Rahmen neuer me-dizinischer Verfahren sind Innovationen gefragt. Die Grundidee der vorliegenden Arbeit ist die Entwicklung einer biotechnologischen Therapieoption zur Versorgung gastrointesti-naler Hohlorganperforationen. Methoden: Zur Durchführung einer Machbarkeitsstudie wurden zehn Göttinger Mi-nischweine in zwei Gruppen mit jeweils 5 Tieren aufgeteilt. Den Tieren der Experimental-gruppe wurden Hautbiopsien entnommen und daraus Fibroblasten isoliert, welche vo-rübergehend konserviert wurden. Unter Verwendung von azellularisiertem Schweinedarm erfolgte die Herstellung von Implantaten nach den Prinzipien des Tissue Engineerings. Die Tiere beider Gruppen wurden einer Minilaparotomie und einer ca. 3cm-Inzision der Ma-genvorderwand unterzogen. Die anschließende Versorgung wurde in der Experimental-gruppe durch Implantation der neuartigen Konstrukte erzielt. In der Kontrollgruppe wur-de im Sinne des Goldstandards eine konventionelle Naht durchgeführt. Anschließend wurden die Tiere für vier Wochen beobachtet. Eine bzw. zwei Wochen nach dem pri-mären Eingriff wurde bei allen Tieren beider Gruppen eine Laparoskopie bzw. Gastrosko-pie durchgeführt. Am Ende der klinischen Observationsphase wurden die Versuchstiere getötet und die entsprechenden Magenareale zur histologischen Untersuchung explantiert. Ergebnisse: Die Herstellung der Implantate konnte auf der Basis standardisierter zellbio-logischer Methoden problemlos etabliert werden. Alle Tiere beider Gruppen überlebten den Primäreingriff sowie das vierwöchige Nachbeobachtungsintervall und zeigten dabei keine klinischen Zeichen möglicher Komplikationen. Die durchgeführten Laparoskopien und Gastroskopien ergaben bei keinem der Tiere Hinweise auf Leckagen oder lokale Infek-tionsprozesse. Die histologische Aufarbeitung zeigte im Bereich des ursprünglichen De-fekts eine bindegewebige Überbrückung sowie ein beginnendes Remodeling der Magen-schleimhaut in beiden Gruppen. Schlussfolgerungen: Durch die Verknüpfung von Einzelprozessen der Zellkultur und dem Großtier-OP konnte ein neues Verfahren zum Verschluss gastrointestinaler Defekt erfolgreich demonstriert und etabliert werden. Das Projekt konnte reibungslos durchge-führt werden und lieferte Ergebnisse, die dem Goldstandard nicht unterlegen waren. Auf-grund der kleinen Fallzahl und weiterer methodischer Limitationen sind jedoch nur einge-schränkt Schlussfolgerungen möglich, weshalb die Durchführung größerer und gut geplan-ter Studien notwendig ist. Die Erkenntnisse dieser Pilotstudie liefern eine solide Basis für die Planung weiterführender Untersuchungen. N2 - Introduction: Structural defects of the gastrointestinal hollow organs are a common problem in clinical routine. They mostly arise from inflammatory or malignant patholo-gies as well as trauma or medical procedures. Contamination of adjacent tissue with fae-ces is a consequence of this, which can lead to systemic infection e.g. sepsis with multiple organ failure. Bearing this in mind gastrointestinal defects are always potentially life-threatening for the patient. Considering the aethiology and the patient’s general condition an appropriate therapy namely operation or endoscopic intervention will be performed. Though, these techniques have limitations in certain cases. For example there are patients with severe comorbidities or history of previous operations. And there are also new sur-gical procedures emerging. Therefore, innovations are needed in this field. The main purpose of the present study is the fabrication of a new biotechnological method for therapy of gastrointestinal hollow organ perforation. Methods: A feasibility study with Göttinger Minipigs was perforemd. Ten animals were randomly split up in two groups regarding closure technique . Skin biopsies were ob-tained from the animals of the experimental group (n=5) in order to obtain dermal fibro-blasts. Using acellularised porcine small intestine seeded with the autologous dermal fi-broblasts implants were manufactured following the principles to tissue engineering. All animals underwent laparotomy and a 3cm gastrical incision. Subsequently, animals of the experimental group received a novel implant in order to close the defect. Animals of the control group received a conventional suture as a gold standard technique. All animals were observed for four weeks. One and two weeks after primary surgery all animals un-derwent laparoscopy and gastroscopy respectively. Observation was completed after four weeks and all animals were euthanized. Relevant specimens of the gastric wall were ex-planted for histological examination. Results: Fabrication of the implants was based on well-established cell cultural methods. All animals survived within four weeks after primary surgery and showed no signs for possible complications. Neither laparoscopy nor gastroscopy revealed leakage or local infection in both groups. Histological examinations showed connective tissue in the de-fect-area predominantly but also initial remodeling of gastric mucosa. Conclusions: In this trial, a novel method based on cell culture methods and surgery were combined creating a new technique for closure of gastrointestinal defect. The pro-ject was carried out smoothly and results showed non-inferiority compared with the gold standard. Though, evidence generated from this study is limited due to the small scaled design and methodological issues. Thus, further investigations with larger animal groups and proper planning are required. Nevertheless, this pilot study will contribute to im-provement of trial designs in the future. KW - Magenkrankheit KW - NOTES KW - Tissue Engineering KW - Fibroblast KW - Magenchirurgie KW - Fibroblasts KW - small intestinal submucosa KW - Anastomoseninsuffizienz KW - Gastrointestinaltrakt KW - Magen KW - Perforation Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-305832 ER - TY - JOUR A1 - Sitter, Magdalena A1 - Schlesinger, Tobias A1 - Reinhold, Ann-Kristin A1 - Scholler, Axel A1 - Heymann, Christian von A1 - Welfle, Sabine A1 - Bartmann, Catharina A1 - Wöckel, Achim A1 - Kleinschmidt, Stefan A1 - Schneider, Sven A1 - Gottschalk, André A1 - Greve, Susanne A1 - Wermelt, Julius Z. A1 - Wiener, Roland A1 - Schulz, Frank A1 - Chappell, Daniel A1 - Brunner, Maya A1 - Neumann, Claudia A1 - Meybohm, Patrick A1 - Kranke, Peter T1 - COVID-19 in der geburtshilflichen Anästhesie: Prospektive Erfassung von SARS-CoV-2-Infektionen zum Zeitpunkt der Geburt sowie des peripartalen Verlaufs SARS-CoV-2-positiver Schwangerer JF - Der Anaesthesist N2 - Hintergrund Im Rahmen der Pandemie des SARS-CoV-2-Virus erlangte das Patientenkollektiv der Schwangeren früh Aufmerksamkeit. Initial wurde angesichts sich früh abzeichnender Krankheitsfälle bei jüngeren Patienten mit einem erheblichen Aufkommen peripartal zu betreuender, COVID-19-positiver Schwangerer gerechnet. Ziel der Arbeit Diese Arbeit vermittelt einen Einblick in die SARS-CoV-2-Infektionszahlen im Rahmen der geburtshilflichen Anästhesie zu Beginn der Pandemie sowie während der zweiten Infektionswelle in Deutschland. Methoden Über das COALA-Register (COVID-19 related Obstetric Anaesthesia Longitudinal Assessment-Registry) wurden sowohl von März bis Mai 2020 als auch von Oktober 2020 bis Februar 2021 in Deutschland und der Schweiz wöchentlich prospektiv Daten zu Verdachts- und bestätigten SARS-CoV-2-Fällen bei Schwangeren zum Zeitpunkt der Geburt erhoben. Betrachtet wurden die Verteilung dieser auf die Anzahl der Geburten, Zentren und Erhebungswochen sowie mütterliche Charakteristika und Krankheitsverläufe. Ergebnisse Neun Zentren haben im Verlauf 44 SARS-CoV-2-positive Schwangere zum Zeitpunkt der Geburt bei 7167 Geburten (0,6 %) gemeldet (3 Fälle auf 2270 Geburten (0,4 %) und 41 Fälle auf 4897 Geburten (0,8 %)). Berichtet wurden 2 schwere COVID-19-Verläufe (n = 1 mit Todesfolge nach ECMO, n = 1 mit ECMO überlebt). Bei 28 (68 %) Patientinnen verlief die Infektion asymptomatisch. Ein Neugeborenes wurde im Verlauf positiv auf SARS-CoV‑2 getestet. Schlussfolgerung Mithilfe des Registers konnte das Auftreten von Fällen zu Beginn der Pandemie zeitnah eingeschätzt werden. Es traten sporadisch Verdachtsfälle bzw. bestätigte Fälle auf. Aufgrund fehlender flächendeckender Testung muss aber von einer Dunkelziffer asymptomatischer Fälle ausgegangen werden. Während der zweiten Infektionswelle wurden 68 % asymptomatische Fälle gemeldet. Jedoch kann es bei jungen, gesunden Patientinnen ohne das Vorliegen typischer Risikofaktoren zu schwerwiegenden Verläufen kommen. KW - ECMO-Therapie KW - Geburtshilfe KW - Geburtshilfliche Intensivmedizin KW - COVID-19-Pademie KW - Infektionswellen Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-264878 SN - 1432-055X VL - 71 IS - 6 ER - TY - JOUR A1 - Hottenrott, Sebastian A1 - Schlesinger, Tobias A1 - Helmer, Philipp A1 - Meybohm, Patrick A1 - Alkatout, Ibrahim A1 - Kranke, Peter T1 - Do small incisions need only minimal anesthesia? — anesthetic management in laparoscopic and robotic surgery JF - Journal of Clinical Medicine N2 - Laparoscopic techniques have established themselves as a major part of modern surgery. Their implementation in every surgical discipline has played a vital part in the reduction of perioperative morbidity and mortality. Precise robotic surgery, as an evolution of this, is shaping the present and future operating theatre that an anesthetist is facing. While incisions get smaller and the impact on the organism seems to dwindle, challenges for anesthetists do not lessen and could even become more demanding than in open procedures. This review focuses on the pathophysiological effects of contemporary laparoscopic and robotic procedures and summarizes anesthetic challenges and strategies for perioperative management. KW - general anesthesia KW - anesthetics KW - perioperative care KW - minimally invasive surgery KW - laparoscopic surgery KW - robotic surgery Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-220039 SN - 2077-0383 VL - 9 IS - 12 ER - TY - JOUR A1 - Riemer, Manuel A1 - Kranke, Peter A1 - Helf, Antonia A1 - Mayer, Debora A1 - Popp, Maria A1 - Schlesinger, Tobias A1 - Meybohm, Patrick A1 - Weibel, Stephanie T1 - Trial registration and selective outcome reporting in 585 clinical trials investigating drugs for prevention of postoperative nausea and vomiting JF - BMC Anesthesiology N2 - Background: Selective outcome reporting in clinical trials introduces bias in the body of evidence distorting clinical decision making. Trial registration aims to prevent this bias and is suggested by the International Committee of Medical Journal Editors (ICMJE) since 2004. Methods: The 585 randomized controlled trials (RCTs) published between 1965 and 2017 that were included in a recently published Cochrane review on antiemetic drugs for prevention of postoperative nausea and vomiting were selected. In a retrospective study, we assessed trial registration and selective outcome reporting by comparing study publications with their registered protocols according to the ‘Cochrane Risk of bias’ assessment tool 1.0. Results: In the Cochrane review, the first study which referred to a registered trial protocol was published in 2004. Of all 585 trials included in the Cochrane review, 334 RCTs were published in 2004 or later, of which only 22% (75/334) were registered. Among the registered trials, 36% (27/75) were pro- and 64% (48/75) were retrospectively registered. 41% (11/27) of the prospectively registered trials were free of selective outcome reporting bias, 22% (6/27) were incompletely registered and assessed as unclear risk, and 37% (10/27) were assessed as high risk. Major outcome discrepancies between registered and published high risk trials were a change from the registered primary to a published secondary outcome (32%), a new primary outcome (26%), and different outcome assessment times (26%). Among trials with high risk of selective outcome reporting 80% favoured at least one statistically significant result. Registered trials were assessed more often as ‘overall low risk of bias’ compared to non-registered trials (64% vs 28%). Conclusions: In 2017, 13 years after the ICMJE declared prospective protocol registration a necessity for reliable clinical studies, the frequency and quality of trial registration in the field of PONV is very poor. Selective outcome reporting reduces trustworthiness in findings of clinical trials. Investigators and clinicians should be aware that only following a properly registered protocol and transparently reporting of predefined outcomes, regardless of the direction and significance of the result, will ultimately strengthen the body of evidence in the field of PONV research in the future. KW - clinical trial KW - postoperative nausea and vomiting KW - selective outcome reporting KW - systematic review KW - trial registration Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265518 VL - 21 ER - TY - JOUR A1 - Weibel, Stephanie A1 - Pace, Nathan L. A1 - Schaefer, Maximilian S. A1 - Raj, Diana A1 - Schlesinger, Tobias A1 - Meybohm, Patrick A1 - Kienbaum, Peter A1 - Eberhart, Leopold H. J. A1 - Kranke, Peter T1 - Drugs for preventing postoperative nausea and vomiting in adults after general anesthesia: An abridged Cochrane network meta-analysis JF - Journal of Evidence-Based Medicine N2 - Objective In this abridged version of the recently published Cochrane review on antiemetic drugs, we summarize its most important findings and discuss the challenges and the time needed to prepare what is now the largest Cochrane review with network meta-analysis in terms of the number of included studies and pages in its full printed form. Methods We conducted a systematic review with network meta-analyses to compare and rank single antiemetic drugs and their combinations belonging to 5HT₃-, D₂-, NK₁-receptor antagonists, corticosteroids, antihistamines, and anticholinergics used to prevent postoperative nausea and vomiting in adults after general anesthesia. Results 585 studies (97 516 participants) testing 44 single drugs and 51 drug combinations were included. The studies’ overall risk of bias was assessed as low in only 27% of the studies. In 282 studies, 29 out of 36 drug combinations and 10 out of 28 single drugs lowered the risk of vomiting at least 20% compared to placebo. In the ranking of treatments, combinations of drugs were generally more effective than single drugs. Single NK1 receptor antagonists were as effective as other drug combinations. Of the 10 effective single drugs, certainty of evidence was high for aprepitant, ramosetron, granisetron, dexamethasone, and ondansetron, while moderate for fosaprepitant and droperidol. For serious adverse events (SAEs), any adverse event (AE), and drug-class specific side effects evidence for intervention effects was mostly not convincing. Conclusions There is high or moderate evidence for at least seven single drugs preventing postoperative vomiting. However, there is still considerable lack of evidence regarding safety aspects that does warrant investigation. KW - systematic review, KW - antiemetics KW - network meta-analysis KW - postoperative nausea and vomiting KW - vomiting Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259470 VL - 14 IS - 3 ER - TY - JOUR A1 - Schlesinger, Tobias A1 - Weibel, Stephanie A1 - Steinfeldt, Thorsten A1 - Sitter, Magdalena A1 - Meybohm, Patrick A1 - Kranke, Peter T1 - Intraoperative management of combined general anesthesia and thoracic epidural analgesia: A survey among German anesthetists JF - Acta Anaesthesiologica Scandinavica N2 - Background Evidence concerning combined general anesthesia (GA) and thoracic epidural analgesia (EA) is controversial and the procedure appears heterogeneous in clinical implementation. We aimed to gain an overview of different approaches and to unveil a suspected heterogeneity concerning the intraoperative management of combined GA and EA. Methods This was an anonymous survey among Members of the Scientific working group for regional anesthesia within the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) conducted from February 2020 to August 2020. Results The response rate was 38%. The majority of participants were experienced anesthetists with high expertise for the specific regimen of combined GA and EA. Most participants establish EA in the sitting position (94%), prefer early epidural initiation (prior to skin incision: 80%; intraoperative: 14%) and administer ropivacaine (89%) in rather low concentrations (0.2%: 45%; 0.375%: 30%; 0.75%: 15%) mostly with an opioid (84%) in a bolus-based mode (95%). The majority reduce systemic opioid doses intraoperatively if EA works sufficiently (minimal systemic opioids: 58%; analgesia exclusively via EA: 34%). About 85% manage intraoperative EA insufficiency with systemic opioids, 52% try to escalate EA, and only 25% use non-opioids, e.g. intravenous ketamine or lidocaine. Conclusions Although, consensus seems to be present for several aspects (patient's position during epidural puncture, main epidural substance, application mode), there is considerable heterogeneity regarding systemic opioids, rescue strategies for insufficient EA, and hemodynamic management, which might explain inconsistent results of previous trials and meta-analyses. KW - analgesics KW - enhanced recovery after surgery KW - multimodal treatments KW - perioperative care KW - epidural analgesia Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258286 VL - 65 IS - 10 ER - TY - JOUR A1 - Herrmann, Johannes A1 - Notz, Quirin A1 - Schlesinger, Tobias A1 - Stumpner, Jan A1 - Kredel, Markus A1 - Sitter, Magdalena A1 - Schmid, Benedikt A1 - Kranke, Peter A1 - Schulze, Harald A1 - Meybohm, Patrick A1 - Lotz, Christopher T1 - Point of care diagnostic of hypercoagulability and platelet function in COVID-19 induced acute respiratory distress syndrome: a retrospective observational study JF - Thrombosis Journal N2 - Background Coronavirus disease 2019 (COVID-19) associated coagulopathy (CAC) leads to thromboembolic events in a high number of critically ill COVID-19 patients. However, specific diagnostic or therapeutic algorithms for CAC have not been established. In the current study, we analyzed coagulation abnormalities with point-of-care testing (POCT) and their relation to hemostatic complications in patients suffering from COVID-19 induced Acute Respiratory Distress Syndrome (ARDS). Our hypothesis was that specific diagnostic patterns can be identified in patients with COVID-19 induced ARDS at risk of thromboembolic complications utilizing POCT. Methods This is a single-center, retrospective observational study. Longitudinal data from 247 rotational thromboelastometries (Rotem®) and 165 impedance aggregometries (Multiplate®) were analysed in 18 patients consecutively admitted to the ICU with a COVID-19 induced ARDS between March 12th to June 30th, 2020. Results Median age was 61 years (IQR: 51–69). Median PaO2/FiO2 on admission was 122 mmHg (IQR: 87–189), indicating moderate to severe ARDS. Any form of hemostatic complication occurred in 78 % of the patients with deep vein/arm thrombosis in 39 %, pulmonary embolism in 22 %, and major bleeding in 17 %. In Rotem® elevated A10 and maximum clot firmness (MCF) indicated higher clot strength. The delta between EXTEM A10 minus FIBTEM A10 (ΔA10) > 30 mm, depicting the sole platelet-part of clot firmness, was associated with a higher risk of thromboembolic events (OD: 3.7; 95 %CI 1.3–10.3; p = 0.02). Multiplate® aggregometry showed hypoactive platelet function. There was no correlation between single Rotem® and Multiplate® parameters at intensive care unit (ICU) admission and thromboembolic or bleeding complications. Conclusions Rotem® and Multiplate® results indicate hypercoagulability and hypoactive platelet dysfunction in COVID-19 induced ARDS but were all in all poorly related to hemostatic complications.. KW - COVID-19 KW - acute Respiratory Distress Syndrome KW - point of care testing KW - thromboelastometry KW - impedance aggregometry; WHOLE-BLOOD THROMBOELASTOMETRY; DEFINITION; DISEASE Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260739 VL - 19 IS - 1 ER - TY - JOUR A1 - Herrmann, Johannes A1 - Adam, Elisabeth Hannah A1 - Notz, Quirin A1 - Helmer, Philipp A1 - Sonntagbauer, Michael A1 - Ungemach-Papenberg, Peter A1 - Sanns, Andreas A1 - Zausig, York A1 - Steinfeldt, Thorsten A1 - Torje, Iuliu A1 - Schmid, Benedikt A1 - Schlesinger, Tobias A1 - Rolfes, Caroline A1 - Reyher, Christian A1 - Kredel, Markus A1 - Stumpner, Jan A1 - Brack, Alexander A1 - Wurmb, Thomas A1 - Gill-Schuster, Daniel A1 - Kranke, Peter A1 - Weismann, Dirk A1 - Klinker, Hartwig A1 - Heuschmann, Peter A1 - Rücker, Viktoria A1 - Frantz, Stefan A1 - Ertl, Georg A1 - Muellenbach, Ralf Michael A1 - Mutlak, Haitham A1 - Meybohm, Patrick A1 - Zacharowski, Kai A1 - Lotz, Christopher T1 - COVID-19 Induced Acute Respiratory Distress Syndrome — A Multicenter Observational Study JF - Frontiers in Medicine N2 - Background: Proportions of patients dying from the coronavirus disease-19 (COVID-19) vary between different countries. We report the characteristics; clinical course and outcome of patients requiring intensive care due to COVID-19 induced acute respiratory distress syndrome (ARDS). Methods: This is a retrospective, observational multicentre study in five German secondary or tertiary care hospitals. All patients consecutively admitted to the intensive care unit (ICU) in any of the participating hospitals between March 12 and May 4, 2020 with a COVID-19 induced ARDS were included. Results: A total of 106 ICU patients were treated for COVID-19 induced ARDS, whereas severe ARDS was present in the majority of cases. Survival of ICU treatment was 65.0%. Median duration of ICU treatment was 11 days; median duration of mechanical ventilation was 9 days. The majority of ICU treated patients (75.5%) did not receive any antiviral or anti-inflammatory therapies. Venovenous (vv) ECMO was utilized in 16.3%. ICU triage with population-level decision making was not necessary at any time. Univariate analysis associated older age, diabetes mellitus or a higher SOFA score on admission with non-survival during ICU stay. Conclusions: A high level of care adhering to standard ARDS treatments lead to a good outcome in critically ill COVID-19 patients. KW - COVID-19 KW - ARDS (acute respiratory distress syndrome) KW - intensive care medicine KW - pandemia KW - Germany Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219834 SN - 2296-858X VL - 7 ER - TY - JOUR A1 - Notz, Quirin A1 - Herrmann, Johannes A1 - Schlesinger, Tobias A1 - Helmer, Philipp A1 - Sudowe, Stephan A1 - Sun, Qian A1 - Hackler, Julian A1 - Roeder, Daniel A1 - Lotz, Christopher A1 - Meybohm, Patrick A1 - Kranke, Peter A1 - Schomburg, Lutz A1 - Stoppe, Christian T1 - Clinical Significance of Micronutrient Supplementation in Critically Ill COVID-19 Patients with Severe ARDS JF - Nutrients N2 - The interplay between inflammation and oxidative stress is a vicious circle, potentially resulting in organ damage. Essential micronutrients such as selenium (Se) and zinc (Zn) support anti-oxidative defense systems and are commonly depleted in severe disease. This single-center retrospective study investigated micronutrient levels under Se and Zn supplementation in critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) and explored potential relationships with immunological and clinical parameters. According to intensive care unit (ICU) standard operating procedures, patients received 1.0 mg of intravenous Se daily on top of artificial nutrition, which contained various amounts of Se and Zn. Micronutrients, inflammatory cytokines, lymphocyte subsets and clinical data were extracted from the patient data management system on admission and after 10 to 14 days of treatment. Forty-six patients were screened for eligibility and 22 patients were included in the study. Twenty-one patients (95%) suffered from severe ARDS and 14 patients (64%) survived to ICU discharge. On admission, the majority of patients had low Se status biomarkers and Zn levels, along with elevated inflammatory parameters. Se supplementation significantly elevated Se (p = 0.027) and selenoprotein P levels (SELENOP; p = 0.016) to normal range. Accordingly, glutathione peroxidase 3 (GPx3) activity increased over time (p = 0.021). Se biomarkers, most notably SELENOP, were inversely correlated with CRP (r\(_s\) = −0.495), PCT (r\(_s\) = −0.413), IL-6 (r\(_s\) = −0.429), IL-1β (r\(_s\) = −0.440) and IL-10 (r\(_s\) = −0.461). Positive associations were found for CD8\(^+\) T cells (r(_s\) = 0.636), NK cells (r\(_s\) = 0.772), total IgG (r\(_s\) = 0.493) and PaO\(_2\)/FiO\(_2\) ratios (r\(_s\) = 0.504). In addition, survivors tended to have higher Se levels after 10 to 14 days compared to non-survivors (p = 0.075). Sufficient Se and Zn levels may potentially be of clinical significance for an adequate immune response in critically ill patients with severe COVID-19 ARDS. KW - acute respiratory distress syndrome KW - selen KW - zinc KW - critical care KW - oxidative stress KW - nutrient supplementation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-241112 SN - 2072-6643 VL - 13 IS - 6 ER -