TY  - JOUR
A1  - Stetter, Christian
A1  - Weidner, Franziska
A1  - Lilla, Nadine
A1  - Weiland, Judith
A1  - Kunze, Ekkehard
A1  - Ernestus, Ralf-Ingo
A1  - Muellenbach, Ralf Michael
A1  - Westermaier, Thomas
T1  - Therapeutic hypercapnia for prevention of secondary ischemia after severe subarachnoid hemorrhage: physiological responses to continuous hypercapnia
JF  - Scientific Reports
N2  - Temporary hypercapnia has been shown to increase cerebral blood flow (CBF) and might be used as a therapeutical tool in patients with severe subarachnoid hemorrhage (SAH). It was the aim of this study was to investigate the optimum duration of hypercapnia. This point is assumed to be the time at which buffer systems become active, cause an adaptation to changes of the arterial partial pressure of carbon dioxide (PaCO2) and annihilate a possible therapeutic effect. In this prospective interventional study in a neurosurgical ICU the arterial partial pressure of carbon dioxide (PaCO\(_2\)) was increased to a target range of 55 mmHg for 120 min by modification of the respiratory minute volume (RMV) one time a day between day 4 and 14 in 12 mechanically ventilated poor-grade SAH-patients. Arterial blood gases were measured every 15 min. CBF and brain tissue oxygen saturation (StiO\(_2\)) were the primary and secondary end points. Intracranial pressure (ICP) was controlled by an external ventricular drainage. Under continuous hypercapnia (PaCO\(_2\) of 53.17 ± 5.07), CBF was significantly elevated between 15 and 120 min after the start of hypercapnia. During the course of the trial intervention, cardiac output also increased significantly. To assess the direct effect of hypercapnia on brain perfusion, the increase of CBF was corrected by the parallel increase of cardiac output. The maximum direct CBF enhancing effect of hypercapnia of 32% was noted at 45 min after the start of hypercapnia. Thereafter, the CBF enhancing slowly declined. No relevant adverse effects were observed. CBF and StiO\(_2\) reproducibly increased by controlled hypercapnia in all patients. After 45 min, the curve of CBF enhancement showed an inflection point when corrected by cardiac output. It is concluded that 45 min might be the optimum duration for a therapeutic use and may provide an optimal balance between the benefits of hypercapnia and risks of a negative rebound effect after return to normal ventilation parameters.
KW  - cerebrovascular disorders
KW  - clinical trials
KW  - neurology
KW  - neurovascular disorders
KW  - Phase II trials
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260779
VL  - 11
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  -