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36 results on '"Meybohm, P"'

1. 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

Author

Stoppe, Christian, Patel, Jayshil J., Zarbock, Alex, Lee, Zheng-Yii, Rice, Todd W., Mafrici, Bruno, Wehner, Rebecca, Chan, Man Hung Manuel, Lai, Peter Chi Keung, MacEachern, Kristen, Myrianthefs, Pavlos, Tsigou, Evdoxia, Ortiz-Reyes, Luis, Jiang, Xuran, Day, Andrew G., Hasan, M. Shahnaz, Meybohm, Patrick, Ke, Lu, and Heyland, Daren K.

Published
2023
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3. Mechanical power of ventilation and driving pressure: two undervalued parameters for pre extracorporeal membrane oxygenation ventilation and during daily management?

Author

K. Hoppe, E. Khan, P. Meybohm, and T. Riese

Subjects
ARDS, Ventilation, ECMO indication, Mechanical power, Driving pressure, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract The current ARDS guidelines highly recommend lung protective ventilation which include plateau pressure (P plat 5 cm H2O) and tidal volume (V t of 6 ml/kg) of predicted body weight. In contrast, the ELSO guidelines suggest the evaluation of an indication of veno-venous extracorporeal membrane oxygenation (ECMO) due to hypoxemic or hypercapnic respiratory failure or as bridge to lung transplantation. Finally, these recommendations remain a wide range of scope of interpretation. However, particularly patients with moderate-severe to severe ARDS might benefit from strict adherence to lung protective ventilation strategies. Subsequently, we discuss whether extended physiological ventilation parameter analysis might be relevant for indication of ECMO support and can be implemented during the daily routine evaluation of ARDS patients. Particularly, this viewpoint focus on driving pressure and mechanical power.

Published
2023
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4. Administration of vitamin D and its metabolites in critically ill adult patients: an updated systematic review with meta-analysis of randomized controlled trials

Author

Johannes Menger, Zheng-Yii Lee, Quirin Notz, Julia Wallqvist, M. Shahnaz Hasan, Gunnar Elke, Martin Dworschak, Patrick Meybohm, Daren K. Heyland, and Christian Stoppe

Subjects
Vitamin D, Critically ill, Nutrition, Meta-analysis, Mortality, Mechanical ventilator weaning, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The clinical significance of vitamin D administration in critically ill patients remains inconclusive. The purpose of this systematic review with meta-analysis was to investigate the effect of vitamin D and its metabolites on major clinical outcomes in critically ill patients, including a subgroup analysis based on vitamin D status and route of vitamin D administration. Methods Major databases were searched through February 9, 2022. Randomized controlled trials of adult critically ill patients with an intervention group receiving vitamin D or its metabolites were included. Random-effect meta-analyses were performed to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes). Risk of bias assessment included the Cochrane tool for assessing risk of bias in randomized trials. Results Sixteen randomized clinical trials with 2449 patients were included. Vitamin D administration was associated with lower overall mortality (16 studies: risk ratio 0.78, 95% confidence interval 0.62–0.97, p = 0.03; I 2 = 30%), reduced intensive care unit length of stay (12 studies: mean difference − 3.13 days, 95% CI − 5.36 to − 0.89, n = 1250, p = 0.006; I 2 = 70%), and shorter duration of mechanical ventilation (9 studies: mean difference − 5.07 days, 95% CI − 7.42 to − 2.73, n = 572, p

Published
2022
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5. Intravenous IgM-enriched immunoglobulins in critical COVID-19: a multicentre propensity-weighted cohort study

Author

Tim Rahmel, Felix Kraft, Helge Haberl, Ute Achtzehn, Timo Brandenburger, Holger Neb, Dominik Jarczak, Maximilian Dietrich, Harry Magunia, Frieda Zimmer, Jale Basten, Claudia Landgraf, Thea Koch, Kai Zacharowski, Markus A. Weigand, Peter Rosenberger, Roman Ullrich, Patrick Meybohm, Axel Nierhaus, Detlef Kindgen-Milles, Nina Timmesfeld, and Michael Adamzik

Subjects
Immunoglobulins, Immunoglobulin M, COVID-19, Coronavirus disease, SARS-CoV-2, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background A profound inflammation-mediated lung injury with long-term acute respiratory distress and high mortality is one of the major complications of critical COVID-19. Immunoglobulin M (IgM)-enriched immunoglobulins seem especially capable of mitigating the inflicted inflammatory harm. However, the efficacy of intravenous IgM-enriched preparations in critically ill patients with COVID-19 is largely unclear. Methods In this retrospective multicentric cohort study, 316 patients with laboratory-confirmed critical COVID-19 were treated in ten German and Austrian ICUs between May 2020 and April 2021. The primary outcome was 30-day mortality. Analysis was performed by Cox regression models. Covariate adjustment was performed by propensity score weighting using machine learning-based SuperLearner to overcome the selection bias due to missing randomization. In addition, a subgroup analysis focusing on different treatment regimens and patient characteristics was performed. Results Of the 316 ICU patients, 146 received IgM-enriched immunoglobulins and 170 cases did not, which served as controls. There was no survival difference between the two groups in terms of mortality at 30 days in the overall cohort (HRadj: 0.83; 95% CI: 0.55 to 1.25; p = 0.374). An improved 30-day survival in patients without mechanical ventilation at the time of the immunoglobulin treatment did not reach statistical significance (HRadj: 0.23; 95% CI: 0.05 to 1.08; p = 0.063). Also, no statistically significant difference was observed in the subgroup when a daily dose of ≥ 15 g and a duration of ≥ 3 days of IgM-enriched immunoglobulins were applied (HRadj: 0.65; 95% CI: 0.41 to 1.03; p = 0.068). Conclusions Although we cannot prove a statistically reliable effect of intravenous IgM-enriched immunoglobulins, the confidence intervals may suggest a clinically relevant effect in certain subgroups. Here, an early administration (i.e. in critically ill but not yet mechanically ventilated COVID-19 patients) and a dose of ≥ 15 g for at least 3 days may confer beneficial effects without concerning safety issues. However, these findings need to be validated in upcoming randomized clinical trials. Trial registration DRKS00025794 , German Clinical Trials Register, https://www.drks.de . Registered 6 July 2021.

Published
2022
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7. Intravenous IgM-enriched immunoglobulins in critical COVID-19: a multicentre propensity-weighted cohort study

Author

Rahmel, Tim, Kraft, Felix, Haberl, Helge, Achtzehn, Ute, Brandenburger, Timo, Neb, Holger, Jarczak, Dominik, Dietrich, Maximilian, Magunia, Harry, Zimmer, Frieda, Basten, Jale, Landgraf, Claudia, Koch, Thea, Zacharowski, Kai, Weigand, Markus A., Rosenberger, Peter, Ullrich, Roman, Meybohm, Patrick, Nierhaus, Axel, Kindgen-Milles, Detlef, Timmesfeld, Nina, and Adamzik, Michael

Published
2022
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8. Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation

Author

Herrmann, Johannes, Lotz, Christopher, Karagiannidis, Christian, Weber-Carstens, Steffen, Kluge, Stefan, Putensen, Christian, Wehrfritz, Andreas, Schmidt, Karsten, Ellerkmann, Richard K., Oswald, Daniel, Lotz, Gösta, Zotzmann, Viviane, Moerer, Onnen, Kühn, Christian, Kochanek, Matthias, Muellenbach, Ralf, Gaertner, Matthias, Fichtner, Falk, Brettner, Florian, Findeisen, Michael, Heim, Markus, Lahmer, Tobias, Rosenow, Felix, Haake, Nils, Lepper, Philipp M., Rosenberger, Peter, Braune, Stephan, Kohls, Mirjam, Heuschmann, Peter, and Meybohm, Patrick

Published
2022
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11. Fibrin-derived peptide Bβ15-42 (FX06) as salvage treatment in critically ill patients with COVID-19-associated acute respiratory distress syndrome

Author

Elisabeth H. Adam, Benedikt Schmid, Michael Sonntagbauer, Peter Kranke, Kai Zacharowski, and Patrick Meybohm

Subjects
Critical care, Respiratory distress syndrome, adult, COVID-19, Therapies, investigational, Pulmonary edema, Immunomodulatory agents, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published
2020
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12. Machine learning identifies ICU outcome predictors in a multicenter COVID-19 cohort

Author

Magunia, Harry, Lederer, Simone, Verbuecheln, Raphael, Gilot, Bryant Joseph, Koeppen, Michael, Haeberle, Helene A., Mirakaj, Valbona, Hofmann, Pascal, Marx, Gernot, Bickenbach, Johannes, Nohe, Boris, Lay, Michael, Spies, Claudia, Edel, Andreas, Schiefenhövel, Fridtjof, Rahmel, Tim, Putensen, Christian, Sellmann, Timur, Koch, Thea, Brandenburger, Timo, Kindgen-Milles, Detlef, Brenner, Thorsten, Berger, Marc, Zacharowski, Kai, Adam, Elisabeth, Posch, Matthias, Moerer, Onnen, Scheer, Christian S., Sedding, Daniel, Weigand, Markus A., Fichtner, Falk, Nau, Carla, Prätsch, Florian, Wiesmann, Thomas, Koch, Christian, Schneider, Gerhard, Lahmer, Tobias, Straub, Andreas, Meiser, Andreas, Weiss, Manfred, Jungwirth, Bettina, Wappler, Frank, Meybohm, Patrick, Herrmann, Johannes, Malek, Nisar, Kohlbacher, Oliver, Biergans, Stephanie, and Rosenberger, Peter

Published
2021
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16. Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery

Author

Christian Stoppe, Andreas Goetzenich, Glenn Whitman, Rika Ohkuma, Trish Brown, Roupen Hatzakorzian, Arnold Kristof, Patrick Meybohm, Jefferey Mechanick, Adam Evans, Daniel Yeh, Bernard McDonald, Michael Chourdakis, Philip Jones, Richard Barton, Ravi Tripathi, Gunnar Elke, Oliver Liakopoulos, Ravi Agarwala, Vladimir Lomivorotov, Ekaterina Nesterova, Gernot Marx, Carina Benstoem, Margot Lemieux, and Daren K. Heyland

Subjects
High-risk cardiac surgery, Cardiopulmonary bypass, Systemic inflammatory response, Organ dysfunctions, Nutrition risk stratification, Underfeeding, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Nutrition support is a necessary therapy for critically ill cardiac surgery patients. However, conclusive evidence for this population, consisting of well-conducted clinical trials is lacking. To clarify optimal strategies to improve outcomes, an international multidisciplinary group of 25 experts from different clinical specialties from Germany, Canada, Greece, USA and Russia discussed potential approaches to identify patients who may benefit from nutrition support, when best to initiate nutrition support, and the potential use of pharmaco-nutrition to modulate the inflammatory response to cardiopulmonary bypass. Despite conspicuous knowledge and evidence gaps, a rational nutritional support therapy is presented to benefit patients undergoing cardiac surgery.

Published
2017
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22. 37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3)

Author

Rob, D., primary, Špunda, R., additional, Lindner, J., additional, Šmalcová, J., additional, Šmíd, O., additional, Kovárník, T., additional, Linhart, A., additional, Bìlohlávek, J., additional, Marinoni, M. M., additional, Cianchi, G., additional, Trapani, S., additional, Migliaccio, M. L., additional, Gucci, L., additional, Bonizzoli, M., additional, Cramaro, A., additional, Cozzolino, M., additional, Valente, S., additional, Peris, A., additional, Grins, E., additional, Kort, E., additional, Weiland, M., additional, Shresta, N. Manandhar, additional, Davidson, P., additional, Algotsson, L., additional, Fitch, S., additional, Marco, G., additional, Sturgill, J., additional, Lee, S., additional, Dickinson, M., additional, Boeve, T., additional, Khaghani, A., additional, Wilton, P., additional, Jovinge, S., additional, Ahmad, A. N., additional, Loveridge, R., additional, Vlachos, S., additional, Patel, S., additional, Gelandt, E., additional, Morgan, L., additional, Butt, S., additional, Whitehorne, M., additional, Kakar, V., additional, Park, C., additional, Hayes, M., additional, Willars, C., additional, Hurst, T., additional, Best, T., additional, Vercueil, A., additional, Auzinger, G., additional, Adibelli, B., additional, Akovali, N., additional, Torgay, A., additional, Zeyneloglu, P., additional, Pirat, A., additional, Kayhan, Z., additional, Schmidbauer, S. S., additional, Herlitz, J., additional, Karlsson, T., additional, Friberg, H., additional, Knafelj, R., additional, Radsel, P., additional, Duprez, F., additional, Bonus, T., additional, Cuvelier, G., additional, Mashayekhi, S., additional, Maka, M., additional, Ollieuz, S., additional, Reychler, G., additional, Mosaddegh, R., additional, Abbasi, S., additional, Talaee, S., additional, Zotzmann, V. Z., additional, Staudacher, D. S., additional, Wengenmayer, T. W., additional, Dürschmied, D. D., additional, Bode, C. B., additional, Nelskylä, A., additional, Nurmi, J., additional, Jousi, M., additional, Schramko, A., additional, Mervaala, E., additional, Ristagno, G., additional, Skrifvars, M., additional, Ozsoy, G., additional, Kendirli, T., additional, Azapagasi, E., additional, Perk, O., additional, Gadirova, U., additional, Ozcinar, E., additional, Cakici, M., additional, Baran, C., additional, Durdu, S., additional, Uysalel, A., additional, Dogan, M., additional, Ramoglu, M., additional, Ucar, T., additional, Tutar, E., additional, Atalay, S., additional, Akar, R., additional, Kamps, M., additional, Leeuwerink, G., additional, Hofmeijer, J., additional, Hoiting, O., additional, Van der Hoeven, J., additional, Hoedemaekers, C., additional, Konkayev, A., additional, Kuklin, V., additional, Kondratyev, T., additional, Konkayeva, M., additional, Akhatov, N., additional, Sovershaev, M., additional, Tveita, T., additional, Dahl, V., additional, Wihersaari, L., additional, Skrifvars, M. B., additional, Bendel, S., additional, Kaukonen, K. M., additional, Vaahersalo, J., additional, Romppanen, J., additional, Pettilä, V., additional, Reinikainen, M., additional, Lybeck, A., additional, Cronberg, T., additional, Nielsen, N., additional, Rauber, M., additional, Steblovnik, K., additional, Jazbec, A., additional, Noc, M., additional, Kalasbail, P., additional, Garrett, F., additional, Kulstad, E., additional, Bergström, D. J., additional, Olsson, H. R., additional, Schmidbauer, S., additional, Mandel, I., additional, Mikheev, S., additional, Podoxenov, Y., additional, Suhodolo, I., additional, Podoxenov, A., additional, Svirko, J., additional, Sementsov, A., additional, Maslov, L., additional, Shipulin, V., additional, Vammen, L. V., additional, Rahbek, S. R., additional, Secher, N. S., additional, Povlsen, J. P., additional, Jessen, N. J., additional, Løfgren, B. L., additional, Granfeldt, A. G., additional, Grossestreuer, A., additional, Perman, S., additional, Patel, P., additional, Ganley, S., additional, Portmann, J., additional, Cocchi, M., additional, Donnino, M., additional, Nassar, Y., additional, Fathy, S., additional, Gaber, A., additional, Mokhtar, S., additional, Chia, Y. C., additional, Lewis-Cuthbertson, R., additional, Mustafa, K., additional, Sabra, A., additional, Evans, A., additional, Bennett, P., additional, Eertmans, W., additional, Genbrugge, C., additional, Boer, W., additional, Dens, J., additional, De Deyne, C., additional, Jans, F., additional, Skorko, A., additional, Thomas, M., additional, Casadio, M., additional, Coppo, A., additional, Vargiolu, A., additional, Villa, J., additional, Rota, M., additional, Avalli, L., additional, Citerio, G., additional, Moon, J. B., additional, Cho, J. H., additional, Park, C. W., additional, Ohk, T. G., additional, Shin, M. C., additional, Won, M. H., additional, Papamichalis, P., additional, Zisopoulou, V., additional, Dardiotis, E., additional, Karagiannis, S., additional, Papadopoulos, D., additional, Zafeiridis, T., additional, Babalis, D., additional, Skoura, A., additional, Staikos, I., additional, Komnos, A., additional, Passos, S. Silva, additional, Maeda, F., additional, Souza, L. Silva, additional, Filho, A. Amato, additional, Granjeia, T. Araújo Guerra, additional, Schweller, M., additional, Franci, D., additional, De Carvalho Filho, M., additional, Santos, T. Martins, additional, De Azevedo, P., additional, Wall, R., additional, Welters, I., additional, Tansuwannarat, P., additional, Sanguanwit, P., additional, Langer, T., additional, Carbonara, M., additional, Caccioppola, A., additional, Fusarini, C. Ferraris, additional, Carlesso, E., additional, Paradiso, E., additional, Battistini, M., additional, Cattaneo, E., additional, Zadek, F., additional, Maiavacca, R., additional, Stocchetti, N., additional, Pesenti, A., additional, Ramos, A., additional, Acharta, F., additional, Toledo, J., additional, Perezlindo, M., additional, Lovesio, L., additional, Dogliotti, A., additional, Lovesio, C., additional, Schroten, N., additional, Van der Veen, B., additional, De Vries, M. C., additional, Veenstra, J., additional, Abulhasan, Y. B., additional, Rachel, S., additional, Châtillon-Angle, M., additional, Alabdulraheem, N., additional, Schiller, I., additional, Dendukuri, N., additional, Angle, M., additional, Frenette, C., additional, Lahiri, S., additional, Schlick, K., additional, Mayer, S. A., additional, Lyden, P., additional, Akatsuka, M., additional, Arakawa, J., additional, Yamakage, M., additional, Rubio, J., additional, Mateo-Sidron, J. A. Rubio, additional, Sierra, R., additional, Celaya, M., additional, Benitez, L., additional, Alvarez-Ossorio, S., additional, Fernandez, A., additional, Gonzalez, O., additional, Engquist, H., additional, Rostami, E., additional, Enblad, P., additional, Canullo, L., additional, Nallino, J., additional, Perreault, M., additional, Talic, J., additional, Frenette, A. J., additional, Burry, L., additional, Bernard, F., additional, Williamson, D. R., additional, Adukauskiene, D., additional, Cyziute, J., additional, Adukauskaite, A., additional, Malciene, L., additional, Luca, L., additional, Rogobete, A., additional, Bedreag, O., additional, Papurica, M., additional, Sarandan, M., additional, Cradigati, C., additional, Popovici, S., additional, Vernic, C., additional, Sandesc, D., additional, Avakov, V., additional, Shakhova, I., additional, Trimmel, H., additional, Majdan, M., additional, Herzer, G. H., additional, Sokoloff, C. S., additional, Albert, M., additional, Williamson, D., additional, Odier, C., additional, Giguère, J., additional, Charbonney, E., additional, Husti, Z., additional, Kaptás, T., additional, Fülep, Z., additional, Gaál, Z., additional, Tusa, M., additional, Donnelly, J., additional, Aries, M., additional, Czosnyka, M., additional, Robba, C., additional, Liu, M., additional, Ercole, A., additional, Menon, D., additional, Hutchinson, P., additional, Smielewski, P., additional, López, R., additional, Graf, J., additional, Montes, J. M., additional, Kenawi, M., additional, Kandil, A., additional, Husein, K., additional, Samir, A., additional, Heijneman, J., additional, Huijben, J., additional, Abid-Ali, F., additional, Stolk, M., additional, Van Bommel, J., additional, Lingsma, H., additional, Van der Jagt, M., additional, Cihlar, R. C., additional, Mancino, G., additional, Bertini, P., additional, Forfori, F., additional, Guarracino, F., additional, Pavelescu, D., additional, Grintescu, I., additional, Mirea, L., additional, Alamri, S., additional, Tharwat, M., additional, Kono, N., additional, Okamoto, H., additional, Uchino, H., additional, Ikegami, T., additional, Fukuoka, T., additional, Simoes, M., additional, Trigo, E., additional, Coutinho, P., additional, Pimentel, J., additional, Franci, A., additional, Basagni, D., additional, Boddi, M., additional, Anichini, V., additional, Cecchi, A., additional, Markopoulou, D., additional, Venetsanou, K., additional, Papanikolaou, I., additional, Barkouri, T., additional, Chroni, D., additional, Alamanos, I., additional, Cingolani, E., additional, Bocci, M. G., additional, Pisapia, L., additional, Tersali, A., additional, Cutuli, S. L., additional, Fiore, V., additional, Palma, A., additional, Nardi, G., additional, Antonelli, M., additional, Coke, R., additional, Kwong, A., additional, Dwivedi, D. J., additional, Xu, M., additional, McDonald, E., additional, Marshall, J. C., additional, Fox-Robichaud, A. E., additional, Liaw, P. C., additional, Kuchynska, I., additional, Malysh, I. R., additional, Zgrzheblovska, L. V., additional, Mestdagh, L., additional, Verhoeven, E. F., additional, Hubloue, I., additional, Ruel-laliberte, J., additional, Zarychanski, R., additional, Lauzier, F., additional, Bonaventure, P. Lessard, additional, Green, R., additional, Griesdale, D., additional, Fowler, R., additional, Kramer, A., additional, Zygun, D., additional, Walsh, T., additional, Stanworth, S., additional, Léger, C., additional, Turgeon, A. F., additional, Baron, D. M., additional, Baron-Stefaniak, J., additional, Leitner, G. C., additional, Ullrich, R., additional, Tarabrin, O., additional, Mazurenko, A., additional, Potapchuk, Y., additional, Sazhyn, D., additional, Tarabrin, P., additional, Pérez, A. González, additional, Silva, J., additional, Artemenko, V., additional, Bugaev, A., additional, Tokar, I., additional, Konashevskaya, S., additional, Kolesnikova, I. M., additional, Roitman, E. V., additional, Kiss, T. Rengeiné, additional, Máthé, Z., additional, Piros, L., additional, Dinya, E., additional, Tihanyi, E., additional, Smudla, A., additional, Fazakas, J., additional, Ubbink, R., additional, Boekhorst te, P., additional, Mik, E., additional, Caneva, L., additional, Ticozzelli, G., additional, Pirrelli, S., additional, Passador, D., additional, Riccardi, F., additional, Ferrari, F., additional, Roldi, E. M., additional, Di Matteo, M., additional, Bianchi, I., additional, Iotti, G. A., additional, Zurauskaite, G., additional, Voegeli, A., additional, Meier, M., additional, Koch, D., additional, Haubitz, S., additional, Kutz, A., additional, Bargetzi, M., additional, Mueller, B., additional, Schuetz, P., additional, Von Meijenfeldt, G., additional, Van der Laan, M., additional, Zeebregts, C., additional, Christopher, K. B., additional, Vernikos, P., additional, Melissopoulou, T., additional, Kanellopoulou, G., additional, Panoutsopoulou, M., additional, Xanthis, D., additional, Kolovou, K., additional, Kypraiou, T., additional, Floros, J., additional, Broady, H., additional, Pritchett, C., additional, Marshman, M., additional, Jannaway, N., additional, Ralph, C., additional, Lehane, C. L., additional, Keyl, C. K., additional, Zimmer, E. Z., additional, Trenk, D. T., additional, Ducloy-Bouthors, A. S., additional, Jonard, M. J., additional, Fourrier, F., additional, Piza, F., additional, Correa, T., additional, Marra, A., additional, Guerra, J., additional, Rodrigues, R., additional, Vilarinho, A., additional, Aranda, V., additional, Shiramizo, S., additional, Lima, M. R., additional, Kallas, E., additional, Cavalcanti, A. B., additional, Donoso, M., additional, Vargas, P., additional, McCartney, J., additional, Ramsay, S., additional, McDowall, K., additional, Novitzky-Basso, I., additional, Wright, C., additional, Medic, M Grgic, additional, Bielen, L, additional, Radonic, V, additional, Zlopasa, O, additional, Vrdoljak, N Gubarev, additional, Gasparovic, V, additional, Radonic, R, additional, Narváez, G., additional, Cabestrero, D., additional, Rey, L., additional, Aroca, M., additional, Gallego, S., additional, Higuera, J., additional, De Pablo, R., additional, González, L. Rey, additional, Chávez, G. Narváez, additional, Lucas, J. Higuera, additional, Alonso, D. Cabestrero, additional, Ruiz, M. Aroca, additional, Valarezo, L. Jaramillo, additional, De Pablo Sánchez, R., additional, Real, A. Quinza, additional, Wigmore, T. W., additional, Bendavid, I., additional, Cohen, J., additional, Avisar, I., additional, Serov, I., additional, Kagan, I., additional, Singer, P., additional, Hanison, J, additional, Mirza, U, additional, Conway, D, additional, Takasu, A., additional, Tanaka, H., additional, Otani, N., additional, Ohde, S., additional, Ishimatsu, S., additional, Coffey, F, additional, Dissmann, P, additional, Mirza, K, additional, Lomax, M, additional, Dissmann, P., additional, Coffey, F., additional, Mirza, K., additional, Lomax, M., additional, Miner, JR, additional, Leto, R, additional, Markota, AM, additional, Gradišek, PG, additional, Aleksejev, VA, additional, Sinkovič, AS, additional, Romagnoli, S., additional, Chelazzi, C., additional, Zagli, G., additional, Benvenuti, F., additional, Mancinelli, P., additional, Boninsegni, P., additional, Paparella, L., additional, Bos, A. T., additional, Thomas, O., additional, Goslar, T., additional, Martone, A., additional, Sandu, P. R., additional, Rosu, V. A., additional, Capilnean, A., additional, Murgoi, P., additional, Lecavalier, A., additional, Jayaraman, D., additional, Rico, P., additional, Bellemare, P., additional, Gelinas, C., additional, Nishida, T., additional, Kinoshita, T., additional, Iwata, N., additional, Yamakawa, K., additional, Fujimi, S., additional, Maggi, L., additional, Sposato, F., additional, Citterio, G., additional, Bonarrigo, C., additional, Rocco, M., additional, Zani, V., additional, De Blasi, R. A., additional, Alcorn, D, additional, Barry, L, additional, Riedijk, M. A., additional, Milstein, D. M., additional, Caldas, J., additional, Panerai, R., additional, Camara, L., additional, Ferreira, G., additional, Bor-Seng-Shu, E., additional, Lima, M., additional, Galas, F., additional, Mian, N., additional, Nogueira, R., additional, de Oliveira, G. Queiroz, additional, Almeida, J., additional, Jardim, J., additional, Robinson, T. G., additional, Gaioto, F., additional, Hajjar, L. A., additional, Zabolotskikh, I., additional, Musaeva, T., additional, Saasouh, W., additional, Freeman, J., additional, Turan, A., additional, Saseedharan, S., additional, Pathrose, E., additional, Poojary, S., additional, Messika, J., additional, Martin, Y., additional, Maquigneau, N., additional, Henry-Lagarrigue, M., additional, Puechberty, C., additional, Stoclin, A., additional, Martin-Lefevre, L., additional, Blot, F., additional, Dreyfuss, D., additional, Dechanet, A., additional, Hajage, D., additional, Ricard, J., additional, Almeida, E., additional, Landoni, G., additional, Fukushima, J., additional, Fominskiy, E., additional, De Brito, C., additional, Cavichio, L., additional, Almeida, L., additional, Ribeiro, U., additional, Osawa, E., additional, Boltes, R., additional, Battistella, L., additional, Hajjar, L., additional, Fontela, P., additional, Lisboa, T., additional, Junior, L. Forgiarini, additional, Friedman, G. F., additional, Abruzzi, F., additional, Primo, J. 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2017
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23. 37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3)

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Rob, D., Špunda, R., Lindner, J., Šmalcová, J., Šmíd, O., Kovárník, T., Linhart, A., Bìlohlávek, J., Marinoni, M. M., Cianchi, G., Trapani, S., Migliaccio, M. L., Gucci, L., Bonizzoli, M., Cramaro, A., Cozzolino, M., Valente, S., Peris, A., Grins, E., Kort, E., Weiland, M., Shresta, N. Manandhar, Davidson, P., Algotsson, L., Fitch, S., Marco, G., Sturgill, J., Lee, S., Dickinson, M., Boeve, T., Khaghani, A., Wilton, P., Jovinge, S., Ahmad, A. N., Loveridge, R., Vlachos, S., Patel, S., Gelandt, E., Morgan, L., Butt, S., Whitehorne, M., Kakar, V., Park, C., Hayes, M., Willars, C., Hurst, T., Best, T., Vercueil, A., Auzinger, G., Adibelli, B., Akovali, N., Torgay, A., Zeyneloglu, P., Pirat, A., Kayhan, Z., Schmidbauer, S. S., Herlitz, J., Karlsson, T., Friberg, H., Knafelj, R., Radsel, P., Duprez, F., Bonus, T., Cuvelier, G., Mashayekhi, S., Maka, M., Ollieuz, S., Reychler, G., Mosaddegh, R., Abbasi, S., Talaee, S., Zotzmann, V. Z., Staudacher, D. S., Wengenmayer, T. W., Dürschmied, D. D., Bode, C. B., Nelskylä, A., Nurmi, J., Jousi, M., Schramko, A., Mervaala, E., Ristagno, G., Skrifvars, M., Ozsoy, G., Kendirli, T., Azapagasi, E., Perk, O., Gadirova, U., Ozcinar, E., Cakici, M., Baran, C., Durdu, S., Uysalel, A., Dogan, M., Ramoglu, M., Ucar, T., Tutar, E., Atalay, S., Akar, R., Kamps, M., Leeuwerink, G., Hofmeijer, J., Hoiting, O., Van der Hoeven, J., Hoedemaekers, C., Konkayev, A., Kuklin, V., Kondratyev, T., Konkayeva, M., Akhatov, N., Sovershaev, M., Tveita, T., Dahl, V., Wihersaari, L., Skrifvars, M. B., Bendel, S., Kaukonen, K. M., Vaahersalo, J., Romppanen, J., Pettilä, V., Reinikainen, M., Lybeck, A., Cronberg, T., Nielsen, N., Rauber, M., Steblovnik, K., Jazbec, A., Noc, M., Kalasbail, P., Garrett, F., Kulstad, E., Bergström, D. J., Olsson, H. R., Schmidbauer, S., Mandel, I., Mikheev, S., Podoxenov, Y., Suhodolo, I., Podoxenov, A., Svirko, J., Sementsov, A., Maslov, L., Shipulin, V., Vammen, L. V., Rahbek, S. R., Secher, N. S., Povlsen, J. P., Jessen, N. 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Tadini, Cecci, L., Lindskog, J., Rowland, K., Sturgess, P., Ankuli, A., Rosa, R, Tonietto, T, Ascoli, A, Madeira, L, Rutzen, W, Falavigna, M, Robinson, C, Salluh, J, Cavalcanti, A, Azevedo, L, Cremonese, R, Da Silva, D, Dornelles, A, Skrobik, Y, Teles, J, Ribeiro, T, Eugênio, C, Teixeira, C, Zarei, M., Hashemizadeh, H., Eriksson, M., Strandberg, G., Lipcsey, M., Larsson, A., Lignos, M., Crissanthopoulou, E., Flevari, K., Dimopoulos, P., Armaganidis, A., Golub, JG, Stožer, AS, Rüddel, H., Ehrlich, C., Burghold, C. M., Hohenstein, C., Winning, J., Sellami, W., Hajjej, Z., Bousselmi, M., Gharsallah, H., Labbene, I., Ferjani, M., Sattler, J., Steinbrunner, D., Poppert, H., Schneider, G., Blobner, M., Kanz, K. G., Schaller, S. J., Apap, K., Xuereb, G., Massa, L., Delvau, N., Penaloza, A, Liistro, G, Thys, F, Delattre, I. K., Hantson, P., Roy, P. M., Gianello, P., Hadîrcă, L, Ghidirimschi, A, Catanoi, N, Scurtov, N, Bagrinovschi, M, Sohn, Y. S., Cho, Y. C., Golovin, B., Creciun, O., Ghidirimschi, A., Bagrinovschi, M., Tabbara, R., Whitgift, J. Z., Ishimaru, A., Yaguchi, A., Akiduki, N., Namiki, M., Takeda, M., Tamminen, J. N., Uusaro, A., Taylor, C. G., Mills, E. D., Mackay, A. D., Ponzoni, C., Rabello, R., Serpa, A., Assunção, M., Pardini, A., Shettino, G., Corrêa, T., Vidal-Cortés, P. V., Álvarez-Rocha, L., Fernández-Ugidos, P., Virgós-Pedreira, A., Pérez-Veloso, M. A., Suárez-Paul, I. M., Del Río-Carbajo, L., Fernández, S. Pita, Castro-Iglesias, A., Butt, A., Alghabban, A. A., Khurshid, S. K., Ali, Z. A., Nizami, I. N., Salahuddin, N. S., Alshahrani, M., Alsubaie, A. W., Alshamsy, A. S., Alkhiliwi, B. A., Alshammari, H. K., Alshammari, M. B., Telmesani, N. K., Alshammari, R. B., Asonto, L. P., Damiani, L. P., Bozza, F, El Khattate, A., Bizrane, M., Madani, N., Belayachi, J., Abouqal, R., Ramnarain, D., Gouw-Donders, B., Benstoem, C., Moza, A., Meybohm, P., Stoppe, C., Autschbach, R., Devane, D., Goetzenich, A., Taniguchi, L. U., Araujo, L., Salgado, G., Vieira, J. M., Viana, J., Ziviani, N., Pessach, I., Lipsky, A., Nimrod, A., O´Connor, M., Matot, I., Segal, E., Kluzik, A., Gradys, A., Smuszkiewicz, P., Trojanowska, I., Cybulski, M., De Jong, A., Sebbane, M., Chanques, G., Jaber, S., Rosa, R., Robinson, C., Bessel, M., Cavalheiro, L., Madeira, L., Rutzen, W., Oliveira, R., Maccari, J., Falavigna, M., Sanchez, E., Dutra, F., Dietrich, C., Balzano, P., Rezende, J., Teixeira, C., Sinha, S., Majhi, K., Gorlicki, J. G., Pousset, F. P., Kelly, J., Aron, J., Gilbert, A. Crerar, Urankar, N. Prevec, Irazabal, M., Bosque, M., Manciño, J., Kotsopoulos, A., Jansen, N., Abdo, W., Casey, Ú. M., O’Brien, B., Plant, R., and Doyle, B.

Subjects
Critical Care and Intensive Care Medicine, Meeting Abstracts
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24. Cardiopulmonary resuscitation traumatic cardiac arrest--there are survivors. An analysis of two national emergency registries.

Author

Gräsner JT, Wnent J, Seewald S, Meybohm P, Fischer M, Paffrath T, Wafaisade A, Bein B, Lefering R, German Resuscitation Registry Working Group, Trauma Registry of the German Society for Trauma Surgery (DGU), Gräsner, Jan-Thorsten, Wnent, Jan, Seewald, Stephan, Meybohm, Patrick, Fischer, Matthias, Paffrath, Thomas, Wafaisade, Arasch, Bein, Berthold, and Lefering, Rolf

Abstract

Introduction: Cardiac arrest following trauma occurs infrequently compared with cardiac aetiology. Within the German Resuscitation Registry a traumatic cause is documented in about 3% of cardiac arrest patients. Regarding the national Trauma Registry, only a few of these trauma patients with cardiac arrest survive. The aim of the present study was to analyze the outcome of cardiopulmonary resuscitation (CPR) after traumatic cardiac arrest by combining data from two different large national registries in Germany.Methods: This study includes 368 trauma patients (2.8%) out of 13,329 cardiac arrest patients registered within the Resuscitation Registry, whereby 3,673 patients with a cardiac cause and successful CPR served as a cardiac control group. We further analyzed a second group of 1,535 trauma patients with cardiac arrest and early CPR registered within the Trauma Registry, whereby a total of 25,366 trauma patients without any CPR attempts served as a trauma control group. The relative frequencies from each database were used to calculate relative percentages for patients with traumatic cardiac arrest in whom resuscitation was attempted.Results: Within the Resuscitation Registry, cardiac arrest was present in 331 patients (89.9%) when the EMS personal arrived at the scene and in 37 patients (10.1%) when cardiac arrest occurred after arrival. Spontaneous circulation could be achieved in 107 patients (29.1%). A total of 101 (27.4%) were transferred to hospital, 95 of whom (25.8%) had return of spontaneous circulation (ROSC) on admission. According to the Trauma Registry, the overall hospital mortality rate for cardiac arrest patients following trauma was 73% (n = 593 of 814). About half of the patients who were admitted alive to hospital died within 24 hours, resulting in 13% survivors within 24 hours. 7% of the patients survived until hospital discharge, and only 2% of the patients had good neurological outcome.Conclusions: Our present study encourages CPR attempts in cardiac arrest patients following severe trauma. When a manageable number of patients is present, the decision on whether to start CPR or not should be done liberally, using comparable criteria as in patients with cardiac etiology. In this respect, trauma management programs that restrict CPR attempts should not be encouraged. [ABSTRACT FROM AUTHOR]

Published
2011
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25. Pharmacological postconditioning with sevoflurane after cardiopulmonary resuscitation reduces myocardial dysfunction.

Author

Meybohm P, Gruenewald M, Albrecht M, Müller C, Zitta K, Foesel N, Maracke M, Tacke S, Schrezenmeir J, Scholz J, Bein B, Meybohm, Patrick, Gruenewald, Matthias, Albrecht, Martin, Müller, Christina, Zitta, Karina, Foesel, Nikola, Maracke, Moritz, Tacke, Sabine, and Schrezenmeir, Jürgen

Abstract

Introduction: In this study, we sought to examine whether pharmacological postconditioning with sevoflurane (SEVO) is neuro- and cardioprotective in a pig model of cardiopulmonary resuscitation.Methods: Twenty-two pigs were subjected to cardiac arrest. After 8 minutes of ventricular fibrillation and 2 minutes of basic life support, advanced cardiac life support was started. After successful return of spontaneous circulation (N = 16), animals were randomized to either (1) propofol (CONTROL) anesthesia or (2) SEVO anesthesia for 4 hours. Neurological function was assessed 24 hours after return of spontaneous circulation. The effects on myocardial and cerebral damage, especially on inflammation, apoptosis and tissue remodeling, were studied using cellular and molecular approaches.Results: Animals treated with SEVO had lower peak troponin T levels (median [IQR]) (CONTROL vs SEVO = 0.31 pg/mL [0.2 to 0.65] vs 0.14 pg/mL [0.09 to 0.25]; P < 0.05) and improved left ventricular systolic and diastolic function compared to the CONTROL group (P < 0.05). SEVO was associated with a reduction in myocardial IL-1β protein concentrations (0.16 pg/μg total protein [0.14 to 0.17] vs 0.12 pg/μg total protein [0.11 to 0.14]; P < 0.01), a reduction in apoptosis (increased procaspase-3 protein levels (0.94 arbitrary units [0.86 to 1.04] vs 1.18 arbitrary units [1.03 to 1.28]; P < 0.05), increased hypoxia-inducible factor (HIF)-1α protein expression (P < 0.05) and increased activity of matrix metalloproteinase 9 (P < 0.05). SEVO did not, however, affect neurological deficit score or cerebral cellular and molecular pathways.Conclusions: SEVO reduced myocardial damage and dysfunction after cardiopulmonary resuscitation in the early postresuscitation period. The reduction was associated with a reduced rate of myocardial proinflammatory cytokine expression, apoptosis, increased HIF-1α expression and increased activity of matrix metalloproteinase 9. Early administration of SEVO may not, however, improve neurological recovery. [ABSTRACT FROM AUTHOR]

Published
2011
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26. Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation

Author

Johannes Herrmann, Christopher Lotz, Christian Karagiannidis, Steffen Weber-Carstens, Stefan Kluge, Christian Putensen, Andreas Wehrfritz, Karsten Schmidt, Richard K. Ellerkmann, Daniel Oswald, Gösta Lotz, Viviane Zotzmann, Onnen Moerer, Christian Kühn, Matthias Kochanek, Ralf Muellenbach, Matthias Gaertner, Falk Fichtner, Florian Brettner, Michael Findeisen, Markus Heim, Tobias Lahmer, Felix Rosenow, Nils Haake, Philipp M. Lepper, Peter Rosenberger, Stephan Braune, Mirjam Kohls, Peter Heuschmann, Patrick Meybohm, and for the German ECMO COVID Study Group

Subjects
COVID-19, Acute respiratory distress syndrome (ARDS), Intensive care, Extracorporeal life support, Case-volume relationship, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Severe COVID-19 induced acute respiratory distress syndrome (ARDS) often requires extracorporeal membrane oxygenation (ECMO). Recent German health insurance data revealed low ICU survival rates. Patient characteristics and experience of the ECMO center may determine intensive care unit (ICU) survival. The current study aimed to identify factors affecting ICU survival of COVID-19 ECMO patients. Methods 673 COVID-19 ARDS ECMO patients treated in 26 centers between January 1st 2020 and March 22nd 2021 were included. Data on clinical characteristics, adjunct therapies, complications, and outcome were documented. Block wise logistic regression analysis was applied to identify variables associated with ICU-survival. Results Most patients were between 50 and 70 years of age. PaO2/FiO2 ratio prior to ECMO was 72 mmHg (IQR: 58–99). ICU survival was 31.4%. Survival was significantly lower during the 2nd wave of the COVID-19 pandemic. A subgroup of 284 (42%) patients fulfilling modified EOLIA criteria had a higher survival (38%) (p = 0.0014, OR 0.64 (CI 0.41–0.99)). Survival differed between low, intermediate, and high-volume centers with 20%, 30%, and 38%, respectively (p = 0.0024). Treatment in high volume centers resulted in an odds ratio of 0.55 (CI 0.28–1.02) compared to low volume centers. Additional factors associated with survival were younger age, shorter time between intubation and ECMO initiation, BMI > 35 (compared to

Published
2022
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27. Mild hypothermia alone or in combination with anesthetic post-conditioning reduces expression of inflammatory cytokines in the cerebral cortex of pigs after cardiopulmonary resuscitation

Author

Meybohm, Patrick, Gruenewald, Matthias, Zacharowski, Kai, Albrecht, Martin, Lucius, Ralph, Fösel, Nikola, Hensler, Johannes, Zitta, Karina, and Bein, Berthold

Abstract

Hypothermia improves survival and neurological recovery after cardiac arrest. Pro-inflammatory cytokines have been implicated in focal cerebral ischemia/reperfusion injury. It is unknown whether cardiac arrest also triggers the release of cerebral inflammatory molecules, and whether therapeutic hypothermia alters this inflammatory response. This study sought to examine whether hypothermia or the combination of hypothermia with anesthetic post-conditioning with sevoflurane affect cerebral inflammatory response after cardiopulmonary resuscitation.

Published
2010
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28. Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report

Author

Saskia von Stillfried, Roman David Bülow, Rainer Röhrig, Patrick Meybohm, Peter Boor, and for the German Registry of COVID-19 Autopsies (DeRegCOVID), DeRegCOVID Collaborators#

Subjects
Autopsy, Registry, COVID-19, ECMO, Intracranial bleeding, Bleeding events, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background In severe cases, SARS-CoV-2 infection leads to acute respiratory distress syndrome (ARDS), often treated by extracorporeal membrane oxygenation (ECMO). During ECMO therapy, anticoagulation is crucial to prevent device-associated thrombosis and device failure, however, it is associated with bleeding complications. In COVID-19, additional pathologies, such as endotheliitis, may further increase the risk of bleeding complications. To assess the frequency of bleeding events, we analyzed data from the German COVID-19 autopsy registry (DeRegCOVID). Methods The electronic registry uses a web-based electronic case report form. In November 2021, the registry included N = 1129 confirmed COVID-19 autopsy cases, with data on 63 ECMO autopsy cases and 1066 non-ECMO autopsy cases, contributed from 29 German sites. Findings The registry data showed that ECMO was used in younger male patients and bleeding events occurred much more frequently in ECMO cases compared to non-ECMO cases (56% and 9%, respectively). Similarly, intracranial bleeding (ICB) was documented in 21% of ECMO cases and 3% of non-ECMO cases and was classified as the immediate or underlying cause of death in 78% of ECMO cases and 37% of non-ECMO cases. In ECMO cases, the three most common immediate causes of death were multi-organ failure, ARDS and ICB, and in non-ECMO cases ARDS, multi-organ failure and pulmonary bacterial ± fungal superinfection, ordered by descending frequency. Interpretation Our study suggests the potential value of autopsies and a joint interdisciplinary multicenter (national) approach in addressing fatal complications in COVID-19.

Published
2022
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29. Reliability of continuous cardiac output measurement during intra-abdominal hypertension relies on repeated calibrations: an experimental animal study

Author

Gruenewald, Matthias, Renner, Jochen, Meybohm, Patrick, Höcker, Jan, Scholz, Jens, and Bein, Berthold

Abstract

Monitoring cardiac output (CO) may allow early detection of haemodynamic instability, aiming to reduce morbidity and mortality in critically ill patients. Continuous cardiac output (CCO) monitoring is recommended in septic or postoperative patients with high incidences of intra-abdominal hypertension (IAH). The aim of the present study was to compare the agreement between three CCO methods and a bolus thermodilution CO technique during acute IAH and volume loading.

Published
2008
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31. A comparison of transcranial Doppler with near infrared spectroscopy and indocyanine green during hemorrhagic shock: a prospective experimental study

Author

Bein, Berthold, Meybohm, Patrick, Cavus, Erol, Tonner, Peter, Steinfath, Markus, Scholz, Jens, and Doerges, Volker

Abstract

Introduction The present study was designed to compare cerebral hemodynamics assessed using the blood flow index (BFI) derived from the kinetics of the tracer dye indocyanine green (ICG) with transcranial Doppler ultrasound (TCD) in an established model of hemorrhagic shock.Methods After approval from the Animal Investigational Committee, 20 healthy pigs underwent a simulated penetrating liver trauma. Following hemodynamic decompensation, all animals received a hypertonic-isooncotic hydroxyethyl starch solution and either arginine vasopressin or norepinephrine, and bleeding was subsequently controlled. ICG passage through the brain was monitored by near infrared spectroscopy. BFI was calculated by dividing maximal ICG absorption change by rise time. Mean blood flow velocity (FVmean) of the right middle cerebral artery was recorded by TCD. FVmean and BFI were assessed at baseline (BL), at hemodynamic decompensation, and repeatedly after control of bleeding.Results At hemodynamic decompensation, cerebral perfusion pressure (CPP), FVmean and BFI dropped compared to BL (mean ± standard deviation; CPP 16 ± 5 mmHg versus 70 ± 16 mmHg; FVmean 4 ± 5 cm·s-1 versus 28 ± 9 cm·s-1; BFI 0.008 ± 0.004 versus 0.02 ± 0.006; p < 0.001). After pharmacological intervention and control of bleeding, FVmean and BFI increased close to baseline values (FVmean 23 ± 9 cm·s-1; BFI 0.02 ± 0.01), respectively. FVmean and BFI were significantly correlated (r = 0.62, p < 0.0001).Conclusion FVmean and BFI both reflected the large variations in cerebral perfusion during hemorrhage and after resuscitation and were significantly correlated. BFI is a promising tool to monitor cerebral hemodynamics at the bedside.

Published
2005

32. Omega-6 sparing effects of parenteral lipid emulsions—an updated systematic review and meta-analysis on clinical outcomes in critically ill patients

Author

Quirin Notz, Zheng-Yii Lee, Johannes Menger, Gunnar Elke, Aileen Hill, Peter Kranke, Daniel Roeder, Christopher Lotz, Patrick Meybohm, Daren K. Heyland, and Christian Stoppe

Subjects
Omega-6 fatty acid, Fish oil, Omega-3 fatty acid, Immunonutrition, Critical illness, Parenteral nutrition, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critically ill patients. Methods A systematic search of MEDLINE, EMBASE, CINAHL and CENTRAL was conducted to identify all randomized controlled trials in critically ill patients published from inception to June 2021, which investigated clinical omega-6 sparing effects. Two independent reviewers extracted bias risk, treatment details, patient characteristics and clinical outcomes. Random effect meta-analysis was performed. Results 1054 studies were identified in our electronic search, 136 trials were assessed for eligibility and 26 trials with 1733 critically ill patients were included. The median methodologic score was 9 out of 14 points (95% confidence interval [CI] 7, 10). Omega-6 FA sparing PN in comparison with traditional lipid emulsions did not decrease overall mortality (20 studies; risk ratio [RR] 0.91; 95% CI 0.76, 1.10; p = 0.34) but hospital length of stay was substantially reduced (6 studies; weighted mean difference [WMD] − 6.88; 95% CI − 11.27, − 2.49; p = 0.002). Among the different lipid emulsions, fish oil (FO) containing PN reduced the length of intensive care (8 studies; WMD − 3.53; 95% CI − 6.16, − 0.90; p = 0.009) and rate of infectious complications (4 studies; RR 0.65; 95% CI 0.44, 0.95; p = 0.03). When FO was administered as a stand-alone medication outside PN, potential mortality benefits were observed compared to standard care. Conclusion Overall, these findings highlight distinctive omega-6 sparing effects attributed to PN. Among the different lipid emulsions, FO in combination with PN or as a stand-alone treatment may have the greatest clinical impact. Trial registration PROSPERO international prospective database of systematic reviews (CRD42021259238). Graphical abstract

Published
2022
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33. Machine learning identifies ICU outcome predictors in a multicenter COVID-19 cohort

Author

Harry Magunia, Simone Lederer, Raphael Verbuecheln, Bryant Joseph Gilot, Michael Koeppen, Helene A. Haeberle, Valbona Mirakaj, Pascal Hofmann, Gernot Marx, Johannes Bickenbach, Boris Nohe, Michael Lay, Claudia Spies, Andreas Edel, Fridtjof Schiefenhövel, Tim Rahmel, Christian Putensen, Timur Sellmann, Thea Koch, Timo Brandenburger, Detlef Kindgen-Milles, Thorsten Brenner, Marc Berger, Kai Zacharowski, Elisabeth Adam, Matthias Posch, Onnen Moerer, Christian S. Scheer, Daniel Sedding, Markus A. Weigand, Falk Fichtner, Carla Nau, Florian Prätsch, Thomas Wiesmann, Christian Koch, Gerhard Schneider, Tobias Lahmer, Andreas Straub, Andreas Meiser, Manfred Weiss, Bettina Jungwirth, Frank Wappler, Patrick Meybohm, Johannes Herrmann, Nisar Malek, Oliver Kohlbacher, Stephanie Biergans, and Peter Rosenberger

Subjects
COVID-19, Critical care, ARDS, Outcome, Prognostic models, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Intensive Care Resources are heavily utilized during the COVID-19 pandemic. However, risk stratification and prediction of SARS-CoV-2 patient clinical outcomes upon ICU admission remain inadequate. This study aimed to develop a machine learning model, based on retrospective & prospective clinical data, to stratify patient risk and predict ICU survival and outcomes. Methods A Germany-wide electronic registry was established to pseudonymously collect admission, therapeutic and discharge information of SARS-CoV-2 ICU patients retrospectively and prospectively. Machine learning approaches were evaluated for the accuracy and interpretability of predictions. The Explainable Boosting Machine approach was selected as the most suitable method. Individual, non-linear shape functions for predictive parameters and parameter interactions are reported. Results 1039 patients were included in the Explainable Boosting Machine model, 596 patients retrospectively collected, and 443 patients prospectively collected. The model for prediction of general ICU outcome was shown to be more reliable to predict “survival”. Age, inflammatory and thrombotic activity, and severity of ARDS at ICU admission were shown to be predictive of ICU survival. Patients’ age, pulmonary dysfunction and transfer from an external institution were predictors for ECMO therapy. The interaction of patient age with D-dimer levels on admission and creatinine levels with SOFA score without GCS were predictors for renal replacement therapy. Conclusions Using Explainable Boosting Machine analysis, we confirmed and weighed previously reported and identified novel predictors for outcome in critically ill COVID-19 patients. Using this strategy, predictive modeling of COVID-19 ICU patient outcomes can be performed overcoming the limitations of linear regression models. Trial registration “ClinicalTrials” (clinicaltrials.gov) under NCT04455451.

Published
2021
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34. In-line filtration of intravenous infusion may reduce organ dysfunction of adult critical patients

Author

Elke Schmitt, Patrick Meybohm, Eva Herrmann, Karin Ammersbach, Raphaela Endres, Simone Lindau, Philipp Helmer, Kai Zacharowski, and Holger Neb

Subjects
Intensive care, Infusion management, In-line filtration, Particles, Organ dysfunction, Inflammation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The potential harmful effects of particle-contaminated infusions for critically ill adult patients are yet unclear. So far, only significant improved outcome in critically ill children and new-borns was demonstrated when using in-line filters, but for adult patients, evidence is still missing. Methods This single-centre, retrospective controlled cohort study assessed the effect of in-line filtration of intravenous fluids with finer 0.2 or 1.2 μm vs 5.0 μm filters in critically ill adult patients. From a total of n = 3215 adult patients, n = 3012 patients were selected by propensity score matching (adjusting for sex, age, and surgery group) and assigned to either a fine filter cohort (with 0.2/1.2 μm filters, n = 1506, time period from February 2013 to January 2014) or a control filter cohort (with 5.0 μm filters, n = 1506, time period from April 2014 to March 2015). The cohorts were compared regarding the occurrence of severe vasoplegia, organ dysfunctions (lung, kidney, and brain), inflammation, in-hospital complications (myocardial infarction, ischemic stroke, pneumonia, and sepsis), in-hospital mortality, and length of ICU and hospital stay. Results Comparing fine filter vs control filter cohort, respiratory dysfunction (Horowitz index 206 (119–290) vs 191 (104.75–280); P = 0.04), pneumonia (11.4% vs 14.4%; P = 0.02), sepsis (9.6% vs 12.2%; P = 0.03), interleukin-6 (471.5 (258.8–1062.8) ng/l vs 540.5 (284.5–1147.5) ng/l; P = 0.01), and length of ICU (1.2 (0.6–4.9) vs 1.7 (0.8–6.9) days; P 0.20) and acute kidney injury (11.8% vs 13.7%; P = 0.11) was not significantly different between the cohorts. Conclusions In-line filtration with finer 0.2 and 1.2 μm filters may be associated with less organ dysfunction and less inflammation in critically ill adult patients. Trial registration The study was registered at ClinicalTrials.gov (number: NCT02281604).

Published
2019
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35. The use of mid-regional proadrenomedullin to identify disease severity and treatment response to sepsis - a secondary analysis of a large randomised controlled trial

Author

Gunnar Elke, Frank Bloos, Darius Cameron Wilson, Frank Martin Brunkhorst, Josef Briegel, Konrad Reinhart, Markus Loeffler, Stefan Kluge, Axel Nierhaus, Ulrich Jaschinski, Onnen Moerer, Andreas Weyland, Patrick Meybohm, and the SepNet Critical Care Trials Group

Subjects
MR-proADM, Biomarkers, Sepsis, Mortality, SOFA, Septic shock, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background This study assessed the ability of mid-regional proadrenomedullin (MR-proADM) in comparison to conventional biomarkers (procalcitonin (PCT), lactate, C-reactive protein) and clinical scores to identify disease severity in patients with sepsis. Methods This is a secondary analysis of a randomised controlled trial in patients with severe sepsis or septic shock across 33 German intensive care units. The association between biomarkers and clinical scores with mortality was assessed by Cox regression analysis, area under the receiver operating characteristic and Kaplan-Meier curves. Patients were stratified into three severity groups (low, intermediate, high) for all biomarkers and scores based on cutoffs with either a 90% sensitivity or specificity. Results 1089 patients with a 28-day mortality rate of 26.9% were analysed. According to the Sepsis-3 definition, 41.2% and 58.8% fulfilled the criteria for sepsis and septic shock, with respective mortality rates of 20.0% and 32.1%. MR-proADM had the strongest association with mortality across all Sepsis-1 and Sepsis-3 subgroups and could facilitate a more accurate classification of low (e.g. MR-proADM vs. SOFA: N = 265 vs. 232; 9.8% vs. 13.8% mortality) and high (e.g. MR-proADM vs. SOFA: N = 161 vs. 155; 55.9% vs. 41.3% mortality) disease severity. Patients with decreasing PCT concentrations of either ≥ 20% (baseline to day 1) or ≥ 50% (baseline to day 4) but continuously high MR-proADM concentrations had a significantly increased mortality risk (HR (95% CI): 19.1 (8.0–45.9) and 43.1 (10.1–184.0)). Conclusions MR-proADM identifies disease severity and treatment response more accurately than established biomarkers and scores, adding additional information to facilitate rapid clinical decision-making and improve personalised sepsis treatment.

Published
2018
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