40 results on '"Steiger, Peter"'
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2. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study
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Lorusso, Roberto, De Piero, Maria Elena, Mariani, Silvia, Di Mauro, Michele, Folliguet, Thierry, Taccone, Fabio Silvio, Camporota, Luigi, Swol, Justyna, Wiedemann, Dominik, Belliato, Mirko, Broman, Lars Mikael, Vuylsteke, Alain, Kassif, Yigal, Scandroglio, Anna Mara, Fanelli, Vito, Gaudard, Philippe, Ledot, Stephane, Barker, Julian, Boeken, Udo, Maier, Sven, Kersten, Alexander, Meyns, Bart, Pozzi, Matteo, Pedersen, Finn M, Schellongowski, Peter, Kirali, Kaan, Barrett, Nicholas, Riera, Jordi, Mueller, Thomas, Belohlavek, Jan, Lo Coco, Valeria, Van der Horst, Iwan C C, Van Bussel, Bas C T, Schnabel, Ronny M, Delnoij, Thijs, Bolotin, Gil, Lorini, Luca, Schmiady, Martin O, Schibilsky, David, Kowalewski, Mariusz, Pinto, Luis F, Silva, Pedro E, Kornilov, Igor, Blandino Ortiz, Aaron, Vercaemst, Leen, Finney, Simon, Roeleveld, Peter P, Di Nardo, Matteo, Hennig, Felix, Antonini, Marta Velia, Davidson, Mark, Jones, Tim J, Staudinger, Thomas, Mair, Peter, Kilo, Juliane, Krapf, Christoph, Erbert, Kathrin, Peer, Andreas, Bonaros, Nikolaos, Kotheletner, Florian, Krenner Mag, Niklas, Shestakova, Liana, Hermans, Greet, Dauwe, Dieter, Meersseman, Philippe, Stockman, Bernard, Nobile, Leda, Lhereux, Olivier, Nrasseurs, Alexandre, Creuter, Jacques, De Backer, Daniel, Giglioli, Simone, Michiels, Gregoire, Foulon, Pierre, Raes, Matthias, Rodrigus, Inez, Allegaert, Matthias, Jorens, Philippe, Debeucklare, Gerd, Piagnerelli, Michael, Biston, Patrick, Peperstraete, Harlinde, Vandewiele, Komeel, Germay, Olivier, Vandeweghe, Dimitri, Havrin, Sven, Bourgeois, Marc, Lagny, Marc-Gilbert, Alois, Genette, Lavios, Nathalie, Misset, Benoit, Courcelle, Romain, Timmermans, Philippe J, Yilmaz, Alaaddin, Vantomout, Michiel, Lehaen, Jerone, Jassen, Ame, Guterman, Herbert, Strauven, Maarten, Lormans, Piet, Verhamme, Bruno, Vandewaeter, catherine, Bonte, Frederik, Vionne, Dominique, Balik, Martin, Blàha, Jan, Lips, Michal, Othal, Michal, Bursa, Filip, Spacek, Radim, Christensen, Steffen, Jorgensen, Vibeke, Sorensen, Marc, Madsen, Soren A, Puss, Severin, Beljantsev, Aleksandr, Saiydoun, gabriel, Fiore, Antonio, Colson, Pascal, Bazalgette, Florian, Capdevila, Xavier, Kollen, Sebastien, Muller, Laurent, Obadia, Jean-Francois, Dubien, Pierre-Yves, Ajrhourh, Lucrezia, Guinot, Pierre G, Zarka, Jonathan, Besserve, Patricia, Malfertheiner, Maximilian V, Dreier, Esther, Heinze, Birgit, Akhyari, Payam, Lichtenberg, Artur, Aubin, Hug, Assman, Alexander, Saeed, Diyar, Thiele, Holger, Baumgaertel, Matthias, Schmitto, Jan D, Ruslan, Natanov, Haverich, Axel, Thielmann, Matthias, Brenner, Thorsten, Ruhpawar, Arjang, Benk, Christoph, Czerny, Martin, Staudacher, Dawid L, Beyersdorf, Fridhelm, Kalbhenn, Johannes, Henn, Philipp, Popov, Aron-Frederik, Iuliu, Torje, Muellenbach, Ralf, Reyher, Christian, Rolfes, Caroline, Lotz, Gosta, Sonntagbauer, Michael, Winkels, Helen, Fichte, Julia, Stohr, Robert, Kalverkamp, Sebastian, Karagiannidis, Christian, Schafer, Simone, Svetlitchny, Alexei, Hopf, Hans-Bernd, Jarczak, Dominik, Groesdonk, Heinirich, Rommer, Magdalena, Hirsch, Jan, Kaehny, Christian, Soufleris, Dimitros, Gavriilidis, Georgios, Pontikis, Kostantinos, Kyriakopoulou, Magdalini, Kyriakoudi, Anna, O'Brien, Serena, Conrick-Martin, Ian, Carton, Edmund, Makhoul, Maged, Ben-Ari, Josef, Hadash, Amir, Kogan, Alexander, Kassif Lerner, Reut, Abu-Shakra, Anas, Matan, Moshe, Balawona, Ahmad, Kachel, Erez, Altshuler, Roman, Galante, Ori, Fuchs, Lior, Almog, Yaniv, Ishay, Yaron S, Lichter, Yael, Gal-oz, Amir, Carmi, Uri, Nini, Asaph, Soroksky, Arie, Dekel, Hagi, Rozman, Ziv, Tayem, Emad, Ilgiyaev, Eduard, Hochman, Yuval, Miltau, daniel, Rapoport, Avigal, Eden, Arieh, Kompanietz, Dmitry, Yousif, Michael, Golos, Miri, Grazioli, Lorenzo, Ghitti, Davide, Loforte, Antonio, Di Luca, Daniela, Baiocchi, Massimo, Pacini, Davide, Cappai, Antioco, Meani, Paolo, Mondino, Michele, Russo, Claudio F, Ranucci, Marco, Fina, Dario, Cotza, Marco, Ballotta, Andrea, Landoni, Giovanni, Nardelli, Pasquale, Fominski, Eygeny V, Brazzi, Luca, Montrucchio, Giorgia, Sales, Gabriele, Simonetti, Umberto, Livigni, Sergio, Silengo, Daniela, Arena, Giulia, Sovatzis, Stefania S, Degani, Antonella, Riccardi, Mariachiara, Milanesi, Elisa, Raffa, Giuseppe, Martucci, Gennaro, Arcadipane, Antonio, Panarello, Giovanna, Chiarini, Giovanni, Cattaneo, Sergio, Puglia, Carmine, Benussi, Stefano, Foti, Giuseppe, Giani, Marco, Bombino, Michela, Costa, Maria Cristina, Rona, Roberto, Avalli, Leonello, Donati, Abele, Carozza, Roberto, Gasparri, Francesco, Carsetti, Andrea, Picichè, Marco, Marinello, Anna, Danzi, Vinicio, Zanin, Anita, Condello, Ignazio, Fiore, Flavio, Moscarelli, Marco, Nasso, Giuseppe, Speziale, Giuseppe, Sandrelli, Luca, Montalto, Andrea, Musumeci, Francesco, Circelli, Alessandro, Russo, Emanuele, Agnoletti, Vanni, Rociola, Ruggero, Milano, Aldo D, Pilato, Emanuele, Comentale, Giuseppe, Montisci, Andrea, Alessandri, Francesco, Tosi, Antonella, Pugliese, Francesco, Giordano, Giovanni, Carelli, Simone, Grieco, Domenico L, Dell'Anna, Antonio M, Antonelli, Massimo, Ramoni, Enrico, Zulueta, Josè, Del Giglio, Mauro, Petracca, Sebastiano, Bertini, Pietro, Guarracino, Fabio, De Simone, Luigi, Angeletti, Paolo M, Forfori, Francesco, Taraschi, Francesco, Quintiliani, Veronica N, Samalavicius, Robertas, Jankuviene, Agne, Scupakova, Nadezda, Urbonas, Karolis, Kapturauskas, Juozas, Soerensen, Gro, Suwalski, Piotr, Linhares Santos, Luis, Marques, Ana, Miranda, Marisa, Teixeira, Sonia, Salgueiro, Andrea, Pereira, Filipe, Ketskalo, Michail, Tsarenko, Sergey, Shilova, Alexandra, Afukov, Ivan, Popugaev, Konstantin, Minin, Sergei, Shelukhin, Daniil, Malceva, Olga, Gleb, Moroz, Skopets, Alexander, Kornelyuk, Roman, Kulikov, Alexandr, Okhrimchuk, Vadim, Turchaninov, Alexandr, Petrushin, Maxim, Sheck, Anastasia, Mekulov, Akhmed, Ciryateva, Svetlana, Urusov, Dmitry, Gorjup, Vojka, Golicnik, Alenka, Goslar, Tomaz, Ferrer, Ricard, Martinez-Martinez, Maria, Argudo, Eduard, Palmer, Neiser, De Pablo Sanchez, Raul, Juan Higuera, Lucas, Arnau Blasco, Lucas, Marquez, Josè A, Sbraga, Fabrizio, Fuset, Mari Paz, De Gopegui, Pablo Ruiz, Claraco, Luis M, De Ayala, Josè A, Peiro, Maranta, Ricart, Pilar, Martinez, Sergio, Chavez, Fernando, Fabra, Marc, Sandoval, elena, Toapanta, David, Carraminana, Albert, Tellez, Adrian, Ososio, Jeysson, Milan, Pablo, Rodriguez, Jorge, Andoni, Garcia, Gutierrez, Carola, Perez de la Sota, Enrique, Eixeres-Esteve, Andrea, Garcia-Maellas, Maria Teresa, Gutierrez-Gutierrez, Judit, Arboleda-Salazar, Rafael, Santa Teresa, Patricia, Jaspe, Alexis, Garrido, Alberto, Castaneda, Galo, Alcantara, Sara, Martinez, Nuria, Perez, Marina, Villanueva, Hector, Vidal Gonzalez, Anxela, Paez, Juan, Santon, Arnoldo, Perez, Cesar, Lopez, Marta, Rubio Lopez, Maria Isabel, Gordillo, Antonio, Naranjo-Izurieta, Jose, Munoz, Javier, Alcalde, Immaculada, Onieva, Fernando, Gimeno Costa, Ricardo, Perez, Francisco, Madrid, Isabel, Gordon, Monica, Albacete Moreno, Carlos L, Perez, Daniel, Lopez, Nayara, Martinenz, Domingo, Blanco-Schweizer, Pablo, Diez, Cristina, Perez, David, Prieto, Ana, Renedo, Gloria, Bustamante, Elena, Cicuendez, Ramon, Citores, Rafael, Boado, Victoria, Garcia, Katherine, Voces, Roberto, Domezain, Monica, Nunez Martinez, Jose Maria, Vicente, Raimundo, Martin, David, Andreu, Antonio, Gomez Casal, Vanesa, Chico, Ignacio, Menor, Eva Maria, Vara, Sabela, Gamacho, Jose, Perez-Chomon, Helen, Javier Gonzales, Francisco, Barrero, Irene, Martin-Villen, Luis, Fernandez, Esperanza, Mendoza, Maria, Navarro, Joaquin, Colomina Climent, Joaquin, Gonzales-Perez, Alfredo, Muniz-Albaceita, Guillermo, Amado, Laura, Rodriguez, Raquel, Ruiz, Emilio, Eiras, Maria, Grins, Edgars, Magnus, Rosen, Kanetoft, Mikael, Eidevald, Marcus, Watson, Pia, Vogt, Paul R, Steiger, Peter, Aigner, Tobias, Weber, Alberto, Grunefelder, Jurg, Kunz, Martin, Grapow, Martin, Aymard, Thierry, Reser, Diana, Agus, Gianluca, Consiglio, Jolanda, Haenggi, Matthias, Hansjoerg, Jenni, Iten, Manuela, Doeble, Thomas, Zenklusen, Urs, Bechtold, Xavier, Faedda, Giovanni, Iafrate, Manuel, Rohjer, Amanda, Bergamaschi, Layla, Maessen, Jos, Reis Miranda, Dinis, Endeman, H, Gommers, D, Meuwese, C, Maas, Jacinta, Van Gijlswijk, MJ, Van Berg, RN, Candura, Dario, Van der Linden, Marcel, Kant, Merijin, Van der Heijden, JJ, Scholten, Eric, Van Belle-van Haren, Nicole, Lagrand, WK, Vlaar, Alexander P, De Jong, Syste, Cander, Basar, Sargin, Murat, Ugur, Murat, Kaygin, Mehmet A, Daly, Kathleen, Agnew, Nicola, Head, Laura, Kelly, Laura, Anoma, Gunawardena, Russell, Clare, Aquino, Verna, Scott, Ian, Flemming, Lucy, Gillon, Stuart, Moore, Olivia, Gelandt, Elton, Auzinger, George, Patel, Sameer, and Loveridge, Robert
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- 2023
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3. Early sevoflurane sedation in severe COVID-19-related lung injury patients. A pilot randomized controlled trial.
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Beck-Schimmer, Beatrice, Schadde, Erik, Pietsch, Urs, Filipovic, Miodrag, Dübendorfer-Dalbert, Seraina, Fodor, Patricia, Hübner, Tobias, Schuepbach, Reto, Steiger, Peter, David, Sascha, Krüger, Bernard D., Neff, Thomas A., and Schläpfer, Martin
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LUNG disease treatment ,VASCULAR endothelial growth factors ,PEARSON correlation (Statistics) ,SEVOFLURANE ,EARLY medical intervention ,RESEARCH funding ,CRITICALLY ill ,PATIENTS ,THERAPEUTICS ,RENAL replacement therapy ,CREATININE ,INFLAMMATORY mediators ,T-test (Statistics) ,CYTOKINE release syndrome ,MULTIPLE organ failure ,PILOT projects ,STATISTICAL sampling ,SEX distribution ,SEVERITY of illness index ,RANDOMIZED controlled trials ,TERTIARY care ,HOSPITAL mortality ,DESCRIPTIVE statistics ,ACUTE kidney failure ,CALCITONIN ,CHI-squared test ,MANN Whitney U Test ,TREATMENT duration ,OPERATIVE surgery ,LUNG diseases ,ARTIFICIAL respiration ,DRUG efficacy ,RESEARCH ,INTRAVENOUS anesthesia ,INTENSIVE care units ,UREA ,ONE-way analysis of variance ,COMPARATIVE studies ,VASOCONSTRICTORS ,LENGTH of stay in hospitals ,ADVERSE health care events ,ANESTHESIA ,COVID-19 ,INTERLEUKINS ,C-reactive protein ,CELL receptors ,DISEASE incidence ,EVALUATION ,BLOOD - Abstract
Background: This study aimed to assess a potential organ protective effect of volatile sedation in a scenario of severe inflammation with an early cytokine storm (in particular IL-6 elevation) in patients suffering from COVID-19-related lung injury with invasive mechanical ventilation and sedation. Methods: This is a small-scale pilot multicenter randomized controlled trial from four tertiary hospitals in Switzerland, conducted between April 2020 and May 2021. 60 patients requiring mechanical ventilation due to severe COVID-19-related lung injury were included and randomized to 48-hour sedation with sevoflurane vs. continuous intravenous sedation (= control) within 24 h after intubation. The primary composite outcome was determined as mortality or persistent organ dysfunction (POD), defined as the need for mechanical ventilation, vasopressors, or renal replacement therapy at day 28. Secondary outcomes were the length of ICU and hospital stay, adverse events, routine laboratory parameters (creatinine, urea), and plasma inflammatory mediators. Results: 28 patients were randomized to sevoflurane, 32 to the control arm. The intention-to-treat analysis revealed no difference in the primary endpoint with 11 (39%) sevoflurane and 13 (41%) control patients (p = 0.916) reaching the primary outcome. Five patients died within 28 days in each group (16% vs. 18%, p = 0.817). Of the 28-day survivors, 6 (26%) and 8 (30%) presented with POD (p = 0.781). There was a significant difference regarding the need for vasopressors (1 (4%) patient in the sevoflurane arm, 7 (26%) in the control one (p = 0.028)). Length of ICU stay, hospital stay, and registered adverse events within 28 days were comparable, except for acute kidney injury (AKI), with 11 (39%) sevoflurane vs. 2 (6%) control patients (p = 0.001). The blood levels of IL-6 in the first few days after the onset of the lung injury were less distinctly elevated than expected. Conclusions: No evident benefits were observed with short sevoflurane sedation on mortality and POD. Unexpectedly low blood levels of IL-6 might indicate a moderate injury with therefore limited improvement options of sevoflurane. Acute renal issues suggest caution in using sevoflurane for sedation in COVID-19. Trial registration: The trial was registered on ClinicalTrials.gov (NCT04355962) on 2020/04/21. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Pancreatic Stone Protein Predicts Sepsis in Severely Burned Patients Irrespective of Trauma Severity: A Monocentric Observational Study
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Klein, Holger Jan, Niggemann, Pia, Buehler, Philipp Karl, Lehner, Fabienne, Schweizer, Riccardo, Rittirsch, Daniel, Fuchs, Nina, Waldner, Matthias, Steiger, Peter, Giovanoli, Pietro, Reding, Theresia, Graf, Rolf, and Plock, Jan Alexander
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- 2021
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5. Large and Small Cerebral Vessel Involvement in Severe COVID-19: Detailed Clinical Workup of a Case Series
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Keller, Emanuela, Brandi, Giovanna, Winklhofer, Sebastian, Imbach, Lukas L., Kirschenbaum, Daniel, Frontzek, Karl, Steiger, Peter, Dietler, Sabeth, Haeberlin, Marcellina, Willms, Jan, Porta, Francesca, Waeckerlin, Adrian, Huber, Michael, Abela, Irene A., Lutterotti, Andreas, Stippich, Christoph, Globas, Christoph, Varga, Zsuzsanna, and Jelcic, Ilijas
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- 2020
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6. Pancreatic Stone Protein Predicts Sepsis in Severely Burned Patients Irrespective of Trauma Severity: A Monocentric Observational Study
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Klein, Holger Jan, Niggemann, Pia, Buehler, Philipp Karl, Lehner, Fabienne, Schweizer, Riccardo, Rittirsch, Daniel, Fuchs, Nina, Waldner, Matthias, Steiger, Peter, Giovanoli, Pietro, Reding, Theresia, Graf, Rolf, and Plock, Jan Alexander
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- 2020
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7. Coagulation side effects of enzymatic debridement in burned patients
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Pfister, Pablo, Wendel Garcia, Pedro David, Kim, Bong-Sung, Schuepbach, Reto A, Steiger, Peter, Camen, Giovanni, Buehler, Philipp Karl, and University of Zurich
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Emergency Medicine ,610 Medicine & health ,Surgery ,General Medicine ,10023 Institute of Intensive Care Medicine ,10266 Clinic for Reconstructive Surgery ,Critical Care and Intensive Care Medicine - Abstract
Bromelain-based enzymatic debridement has emerged as a valuable option to the standard surgical intervention for debridement in burn injuries. Adverse effects on coagulation parameters after enzymatic debridement have been described. The purpose of this study was to compare the effect of enzymatic and surgical debridement on coagulation.Between 03/2017 and 02/2021 patients with burn injuries with a total body surface area (TBSA) ≥ 1% were included in the study. Patients were categorized into two groups: the surgically debrided group and the enzymatically debrided group. Coagulation parameters were assessed daily for the first seven days of hospitalization.In total 132 patients with a mean TBSA of 17% were included in this study, of which 66 received enzymatic debridement and 66 received regular surgical-debridement. Patients receiving enzymatic debridement presented significantly higher factor-V concentration values over the first seven days after admission (p = 0.01). Regarding coagulation parameters, we found no difference in INR-, aPTT-, fibrinogen-, factor-XIII- and thrombocyte-concentrations over the first seven days (p = 0.05).Enzymatic debridement in burned patients does not appear to increase the risk of coagulation abnormalities compared with the regular surgical approach.
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- 2022
8. Cerebral metabolism is not affected by moderate hyperventilation in patients with traumatic brain injury
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Brandi, Giovanna, Stocchetti, Nino, Pagnamenta, Alberto, Stretti, Federica, Steiger, Peter, and Klinzing, Stephanie
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- 2019
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9. Low Level of Vegetative State After Traumatic Brain Injury in a Swiss Academic Hospital
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Stretti, Federica, Klinzing, Stephanie, Ehlers, Ulrike, Steiger, Peter, Schuepbach, Reto, Krones, Tanja, and Brandi, Giovanna
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- 2018
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10. Neurologic Injury With Severe Adult Respiratory Distress Syndrome in Patients Undergoing Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Analysis
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Klinzing, Stephanie, Wenger, Urs, Stretti, Federica, Steiger, Peter, Rushing, Elisabeth J., Schwarz, Urs, and Maggiorini, Marco
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- 2017
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11. In memoriam – Harry K Genant, MD
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Engelke, Klaus, Fuerst, Thomas, Glüer, Claus-C., Glüer, Maren G., Hans, Didier, Majumdar, Sharmila, Peterfy, Charles, and Steiger, Peter
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- 2022
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12. Correction: Early sevoflurane sedation in severe COVID19-related lung injury patients. A pilot randomized controlled trial.
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Beck-Schimmer, Beatrice, Schadde, Erik, Pietsch, Urs, Filipovic, Miodrag, Dübendorfer-Dalbert, Seraina, Fodor, Patricia, Hübner, Tobias, Schuepbach, Reto, Steiger, Peter, David, Sascha, Krüger, Bernard D., Neff, Thomas A., and Schläpfer, Martin
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SEVOFLURANE ,LUNG injuries ,SEVERITY of illness index ,ANESTHESIA ,COVID-19 - Published
- 2024
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13. Benralizumab for severe DRESS in two COVID-19 patients
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Schmid-Grendelmeier, Peter, Steiger, Peter, Naegeli, Mirjam C., Kolm, Isabel, Lang, Claudia Cécile Valérie, Maverakis, Emanual, and Brüggen, Marie-Charlotte
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- 2021
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14. External validation of scores proposed for estimation of survival probability of patients with severe adult respiratory distress syndrome undergoing extracorporeal membrane oxygenation therapy: a retrospective study
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Klinzing, Stephanie, Wenger, Urs, Steiger, Peter, Starck, Christoph Thomas, Wilhelm, Markus, Schuepbach, Reto A, and Maggiorini, Marco
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- 2015
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15. Pancreatic stone protein predicts sepsis in severely burned patients irrespective of trauma severity
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Klein, Holger Jan, Niggemann, Pia, Buehler, Philipp Karl, Lehner, Fabienne, Schweizer, Riccardo, Rittirsch, Daniel, Fuchs, Nina, Waldner, Matthias, Steiger, Peter, Giovanoli, Pietro, Reding, Theresia, Graf, Rolf, Plock, Jan Alexander, and University of Zurich
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610 Medicine & health ,Surgery ,10023 Institute of Intensive Care Medicine ,10266 Clinic for Reconstructive Surgery - Published
- 2021
16. Myocardial edema in COVID-19 on cardiac MRI
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Manka, Robert, Karolyi, Mihaly, Polacin, Malgorzata, Holy, Erik W., Nemeth, Johannes, Steiger, Peter, Schuepbach, Reto A., Zinkernagel, Annelies S., Alkadhi, Hatem, Mehra, Mandeep R., and Ruschitzka, Frank
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- 2020
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17. Key Factors in Decision Making for ECLS: A Binational Factorial Survey.
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Drewniak, Daniel, Brandi, Giovanna, Buehler, Philipp Karl, Steiger, Peter, Hagenbuch, Niels, Stamm-Balderjahn, Sabine, Schenk, Liane, Rosca, Ana, and Krones, Tanja
- Abstract
Background: Extracorporeal life support (ECLS) provides support to patients with cardiopulmonary failure refractory to conventional therapy. While ECLS is potentially life-saving, it is associated with severe complications; decision making to initiate ECLS must, therefore, carefully consider which patients ECLS potentially benefits despite its consequences. Objective: To answer 2 questions: First, which medically relevant patient factors influence decisions to initiate ECLS? Second, what are factors relevant to decisions to withdraw a running ECLS treatment? Methods: We conducted a factorial survey among 420 physicians from 111 hospitals in Switzerland and Germany. The study included 2 scenarios: 1 explored willingness to initiate ECLS, and 1 explored willingness to withdraw a running ECLS treatment. Each participant responded to 5 different vignettes for each scenario. Vignettes were analyzed using mixed-effects regression models with random intercepts. Results: Factors in the vignettes such as patients' age, treatment costs, therapeutic goal, comorbidities, and neurological outcome significantly influenced the decision to initiate ECLS. When it came to the decision to withdraw ECLS, patients' age, days on ECLS, criteria for discontinuation, condition of the patient, comorbidities, and neurological outcome were significant factors. In both scenarios, patients' age and neurological outcome were the most influential factors. Conclusions: This study provided insights into physicians' decision making processes about ECLS initiation and withdrawal. Patients' age and neurological status were the strongest factors influencing decisions regarding initiation of ECLS as well as for ECLS withdrawal. The findings may contribute to a more refined understanding of complex decision making for ECLS. [ABSTRACT FROM AUTHOR]
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- 2022
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18. Cutaneous and systemic hyperinflammation drives maculopapular drug exanthema in severely ill COVID‐19 patients.
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Mitamura, Yasutaka, Schulz, Daniel, Oro, Saskia, Li, Nick, Kolm, Isabel, Lang, Claudia, Ziadlou, Reihane, Tan, Ge, Bodenmiller, Bernd, Steiger, Peter, Marzano, Angelo, de Prost, Nicolas, Caudin, Olivier, Levesque, Mitchell, Stoffel, Corinne, Schmid‐Grendelmeier, Peter, Maverakis, Emanual, Akdis, Cezmi A., and Brüggen, Marie‐Charlotte
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COVID-19 ,DRESS syndrome ,CORONAVIRUS diseases ,CYTOTOXIC T cells ,INFLAMMATION ,EXANTHEMA - Abstract
Background: Coronavirus disease‐2019 (COVID‐19) has been associated with cutaneous findings, some being the result of drug hypersensitivity reactions such as maculopapular drug rashes (MDR). The aim of this study was to investigate whether COVID‐19 may impact the development of the MDR. Methods: Blood and skin samples from COVID‐19 patients (based on a positive nasopharyngeal PCR) suffering from MDR (COVID‐MDR), healthy controls, non‐COVID‐19—related patients with drug rash with eosinophilia and systemic symptoms (DRESS), and MDR were analyzed. We utilized imaging mass cytometry (IMC) to characterize the cellular infiltrate in skin biopsies. Furthermore, RNA sequencing transcriptome of skin biopsy samples and high‐throughput multiplexed proteomic profiling of serum were performed. Results: IMC revealed by clustering analyses a more prominent, phenotypically shifted cytotoxic CD8+ T cell population and highly activated monocyte/macrophage (Mo/Mac) clusters in COVID‐MDR. The RNA sequencing transcriptome demonstrated a more robust cytotoxic response in COVID‐MDR skin. However, severe acute respiratory syndrome coronavirus 2 was not detected in skin biopsies at the time point of MDR diagnosis. Serum proteomic profiling of COVID‐MDR patients revealed upregulation of various inflammatory mediators (IL‐4, IL‐5, IL‐6, TNF, and IFN‐γ), eosinophil and Mo/Mac ‐attracting chemokines (MCP‐2, MCP‐3, MCP‐4 and CCL11). Proteomics analyses demonstrated a massive systemic cytokine storm in COVID‐MDR compared with the relatively milder cytokine storm observed in DRESS, while MDR did not exhibit such features. Conclusion: A systemic cytokine storm may promote activation of Mo/Mac and cytotoxic CD8+ T cells in severe COVID‐19 patients, which in turn may impact the development of MDR. [ABSTRACT FROM AUTHOR]
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- 2022
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19. Autopsy-Based Pulmonary and Vascular Pathology: Pulmonary Endotheliitis and Multi-Organ Involvement in COVID-19 Associated Deaths.
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Haberecker, Martina, Schwarz, Esther Irene, Steiger, Peter, Frontzek, Karl, Scholkmann, Felix, Zeng, Xiankun, Höller, Sylvia, Moch, Holger, and Varga, Zsuzsanna
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CAUSES of death ,ENDOTHELIUM ,COVID-19 ,RESPIRATORY insufficiency ,CHEST X rays ,AUTOPSY ,LUNG diseases ,MULTIPLE organ failure ,RETROSPECTIVE studies ,MANN Whitney U Test ,THROMBOEMBOLISM ,STATISTICAL correlation - Abstract
Background: Findings from autopsies have provided evidence on systemic microvascular damage as one of the underlying mechanisms of Coronavirus disease 2019 (CO-VID-19). The aim of this study was to correlate autopsy-based cause of death in SARS-CoV-2, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive patients with chest imaging and severity grade of pulmonary and systemic morphological vascular pathology. Methods: Fifteen SARS-CoV-2 positive autopsies with clinically distinct presentations (age 22–89 years) were retrospectively analyzed with focus on vascular, thromboembolic, and ischemic changes in pulmonary and in extrapulmonary sites. Eight patients died due to COVID-19 associated respiratory failure with diffuse alveolar damage in various stages and/or multi-organ failure, whereas other reasons such as cardiac decompensation, complication of malignant tumors, or septic shock were the cause of death in 7 further patients. The severity of gross and histopathological changes was semi-quantitatively scored as 0 (absent), 1 (mild), and 3 (severe). Severity scores between the 2 groups were correlated with selected clinical parameters, initial chest imaging, autopsy-based cause of death, and compared using Pearson χ
2 and Mann-Whitney U tests. Results: Severe pulmonary endotheliitis (p = 0.031, p = 0.029) and multi-organ involvement (p = 0.026, p = 0.006) correlated significantly with COVID-19 associated death. Pulmonary microthrombi showed limited statistical correlation, while tissue necrosis, gross pulmonary embolism, and bacterial superinfection did not differentiate the 2 study groups. Chest imaging at hospital admission did not differ either. Conclusions: Extensive pulmonary endotheliitis and multi-organ involvement are characteristic autopsy features in fatal CO-VID-19 associated deaths. Thromboembolic and ischemic events and bacterial superinfections occur frequently in SARS-CoV-2 infection independently of outcome. [ABSTRACT FROM AUTHOR]- Published
- 2022
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20. Implementation of a multiprofessional, multicomponent delirium management guideline in two intensive care units, and its effect on patient outcomes and nurse workload: a pre-post design retrospective cohort study
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Schubert, Maria, Bettex, Dominique, Steiger, Peter, Schürch, Roger, Haller, Alois, Bogdanovic, Jasmina, Garcia Nuñez, David, Schwarz, Urs, and Siegemund, Martin
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postoperative delirium ,delirium management ,mortality rates ,mental disorders ,critically ill patients ,before and after design ,nursing hours - Abstract
AIM OF THE STUDY: Delirium is a frequent intensive care unit (ICU) complication, affecting 26% to 80% of ICU patients, often with serious consequences. This study aimed to evaluate the effectiveness, costs and benefits of following a standardised multiprofessional, multicomponent delirium guideline on eight outcomes: delirium prevalence and duration, lengths of stay in ICU and hospital, in-hospital mortality, duration of mechanical ventilation, and cost and nursing hours per case. It also aimed to explore the associations of delirium with length of ICU stay, length of hospital stay and duration of mechanical ventilation. METHODS: This retrospective cohort study used a pre-post design. ICU patients in an historical control group (n = 1608) who received standard ICU care were compared with a postintervention group (n = 1684) who received standardised delirium management - delirium risk identification, preventive measures, screening and treatment - with regard to eight outcomes. The delirium management guideline was developed and implemented in 2012 by a group of experts from the study hospital. As appropriate, descriptive statistics and multivariate, multilevel models were used to compare the two groups and to explore the association between delirium occurrence and the selected outcomes. RESULTS: Twelve percent of the 1608 historical controls and 20% of the 1684 postintervention patients were diagnosed with delirium according to the ICD-10 delirium diagnosis codes. Patients being treated for heart disease, and those with septic shock, ARDS, renal insufficiency (acute or chronic), older age and higher numbers of comorbidities were significantly more likely to develop delirium during their stay. Multivariate models comparing the historical controls with the post intervention group indicated significant differences in delirium period prevalence (odds ratio 1.68, 95% confidence interval [CI] 1.38-2.06; p < 0.001), length of stay in the ICU (time ratio [TR] 0.94, CI 0.89-1.00; p = 0.048), cost per case (median difference 3.83, CI 0.54-7.11; p = 0.023) and duration of mechanical ventilation (TR 0.84, CI 0.77-0.92; p < 0.001). The observed differences in the other four outcomes - in-hospital mortality, delirium duration, length of stay in the hospital, and nursing hours per case - were not significant. Delirium was a significant predictor for prolonged duration of mechanical ventilation and for both ICU and hospital stay. CONCLUSION: Standardised delirium management, specifically delirium screening, supports timely detection of delirium in ICU patients. Increased awareness of delirium after the implementation of standardised multiprofessional, multicomponent management leads to increased therapeutic attention, a prolongation of ICU stay and increased costs, but with no influence on mortality. Gottfried und Julia Bangerter-Rhyner Foundation; Swiss Academy of Medical Sciences (SAMS) [842/HEGDSV] This study was funded by Gottfried und Julia Bangerter-Rhyner Foundation, the Swiss Academy of Medical Sciences (SAMS) (842/HEGDSV), in the context of a five-year Health Service Research (HSR) funding programme (2012-2016). Grant recipients: Prof. Rebecca Spirig, Prof. Maria Schubert, University Hospital Zurich. The study also received hospital funds in the form of the human resources and time (working hours) allocated for this project.
- Published
- 2020
21. Factors associated with death and limitation of life-sustaining therapies in patients with traumatic brain injury
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Brandi, Giovanna, Stretti, Federica, Schüpbach, Reto, Krones, Tanja, Bühler, Philipp K, Steiger, Peter, and University of Zurich
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610 Medicine & health ,10023 Institute of Intensive Care Medicine - Published
- 2019
22. Safety of enzymatic debridement in extensive burns larger than 15% total body surface area.
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Hofmaenner, Daniel A., Steiger, Peter, Schuepbach, Reto A., Klinzing, Stephanie, Waldner, Mathias, Klein, Holger, Enthofer, Katharina, Giovanoli, Pietro, Mannil, Lijo, Buehler, Philipp Karl, and Plock, Jan A.
- Subjects
- *
BODY surface area , *DEBRIDEMENT , *ADVERSE health care events , *PATIENT safety , *BURN care units , *LEUKOCYTE count , *BLOOD pressure - Abstract
Objectives: Bromelain-based enzymatic debridement has emerged as an alternative to surgical eschar removal. Indications include partial thickness, mixed pattern, and full-thickness burns. Enzymatic debridement has been approved by the European Medicines Agency for treating burn wounds affecting <15% total body surface area (TBSA). Data and evidence for the treatment of areas >15% TBSA in one session is scarce. The aim of this retrospective study was to retrospectively analyze off-label use of enzymatic debridement in a single burn center for large TBSA burns.Methods: Between 01/2017 and 12/2018, 59 patients with partial- to full-thickness burns underwent enzymatic debridement in a single center study. Patients were categorized into two groups: the regular use group with a treated area less than 15% TBSA and the off-label group (OG) with larger TBSA debrided in one session. Treatment was evaluated for systemic inflammatory reaction, bleeding, hemodynamic instability and electrolyte shifts.Results: In total, 49 patients were treated in the regular use group with a median application area of 6% (IQR 2.5-9.5) and 10 patients were treated in the off-label group with a median application area of 18% (IQR 15-19) TBSA. We found no significant differences regarding blood pressure, body temperature or hemodynamic stability during and after enzymatic debridement. No treatment-related serious adverse events were observed in either group. Catecholamine use was similar in both groups. No differences in leukocyte counts, CRP, PCT and lactate prior to application and during the following three days were observed. Sodium, potassium, chloride and phosphate levels did not differ. We found no evidence of an electrolyte shift. Survival was 49 of 49 patients (100%) in the RG and 7 of 10 patients (70%) in the OG (p = 0.004).Conclusion: Enzymatic debridement did not result in any expected or unexpected side effects in the patient groups investigated. These preliminary results indicate the potential safety of bromelain-based enzymatic debridementin the treatment of burns greater than 15% TBSA. [ABSTRACT FROM AUTHOR]- Published
- 2021
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23. Intracerebral endotheliitis and microbleeds are neuropathological features of COVID‐19.
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Kirschenbaum, Daniel, Imbach, Lukas L., Rushing, Elisabeth J., Frauenknecht, Katrin B. M., Gascho, Dominic, Ineichen, Benjamin V., Keller, Emanuela, Kohler, Sibylle, Lichtblau, Mona, Reimann, Regina R., Schreib, Katharina, Ulrich, Silvia, Steiger, Peter, Aguzzi, Adriano, and Frontzek, Karl
- Subjects
COVID-19 ,COVID-19 pandemic ,CEREBRAL amyloid angiopathy ,SARS-CoV-2 ,CENTRAL nervous system ,AUTOPSY ,BRAIN stem - Abstract
Coronavirus disease 19 (COVID‐19) is a rapidly evolving pandemic caused by the coronavirus Sars‐CoV‐2. Clinically manifest central nervous system symptoms have been described in COVID‐19 patients and could be the consequence of commonly associated vascular pathology, but the detailed neuropathological sequelae remain largely unknown. A total of six cases, all positive for Sars‐CoV‐2, showed evidence of cerebral petechial hemorrhages and microthrombi at autopsy. Two out of six patients showed an elevated risk for disseminated intravascular coagulopathy according to current criteria and were excluded from further analysis. In the remaining four patients, the hemorrhages were most prominent at the grey and white matter junction of the neocortex, but were also found in the brainstem, deep grey matter structures and cerebellum. Two patients showed vascular intramural inflammatory infiltrates, consistent with Sars‐CoV‐2‐associated endotheliitis, which was associated by elevated levels of the Sars‐CoV‐2 receptor ACE2 in the brain vasculature. Distribution and morphology of patchy brain microbleeds was clearly distinct from hypertension‐related hemorrhage, critical illness‐associated microbleeds and cerebral amyloid angiopathy, which was ruled out by immunohistochemistry. Cerebral microhemorrhages in COVID‐19 patients could be a consequence of Sars‐ CoV‐2‐induced endotheliitis and more general vasculopathic changes and may correlate with an increased risk of vascular encephalopathy. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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24. Prevalence and outcome of silent hypoxemia in COVID-19.
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BUSANA, Mattia, GASPERETTI, Alessio, GIOSA, Lorenzo, FORLEO, Giovanni B., SCHIAVONE, Marco, MITACCHIONE, Gianfranco, BONINO, Cecilia, VILLA, Paolo, GALLI, Massimo, TONDO, Claudio, SAGUNER, Ardan, STEIGER, Peter, CURNIS, Antonio, DELLO RUSSO, Antonio, PUGLIESE, Francesco, MANCONE, Massimo, MARINI, John J., and GATTINONI, Luciano
- Published
- 2021
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25. Maternal effects on reproduction in the precocial European hare (Lepus europaeus).
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Schai-Braun, Stéphanie C., Steiger, Peter, Ruf, Thomas, Arnold, Walter, and Hackländer, Klaus
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- *
HARES , *MAMMAL mortality , *BIRTH intervals , *FOOD supply , *LACTATION , *REPRODUCTION - Abstract
In female mammals, reproduction, and in particular lactation, is the energetically most exigent life-history phase. Reproduction is strongly controlled by body reserves and food availability, so females with better body condition or food supply are believed to have higher reproductive output. Additionally, the growth and mortality of young mammals depends on their postnatal development. Therefore, the degree of precociality affects energetic demands for both mothers and young. To study the reproductive performance of the precocial European hare (Lepus europaeus), we analysed relationships between six predictor variables describing maternal and environmental effects and nine response variables relating to reproduction from 217 captive females. We compared the data with those of precocial and altricial mammal species from an extensive literature search. For hares, we found: (1) Heavier females had heavier litters at birth. (2) In summer and spring, total litter mass was larger than in winter. (3) At the end of lactation, the litters of multiparous females were heavier than those of primiparous females. (4) Both older females and females giving birth for the first time had relatively high leveret mortality during lactation. Comparing our results with the literature for other mammals revealed that the body condition (i.e., body mass) of females before birth is predictive of reproductive parameters in both precocial and altricial species. In the precocial hare, female body condition is no longer predictive of reproductive parameters at the end of lactation, whereas in altricial species, female body condition remains predictive of reproduction (litter mass at the end of lactation, offspring mortality) until the end of lactation. We conclude that these effects are caused by precocial offspring feeding on solid food soon after birth and, thus, being less dependent on the mother's body condition during lactation than altricial offspring. In line with this, precociality might have evolved as a way of buffering offspring against maternal effects. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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26. Indications and contraindications for extracorporeal life support for severe heart or lung failure: a systematic review.
- Author
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BRANDI, Giovanna, DREWNIAK, Daniel, BUEHLER, Philipp K., BUDILIVSCHI, Ana, STEIGER, Peter, and KRONES, Tanja
- Published
- 2021
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27. Methods and reliability of radiographic vertebral fracture detection in older men: The osteoporotic fractures in men study
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Cawthon, Peggy M., Haslam, Jane, Fullman, Robin, Peters, Katherine W., Black, Dennis, Ensrud, Kristine E., Cummings, Steven R., Orwoll, Eric S., Barrett-Connor, Elizabeth, Marshall, Lynn, Steiger, Peter, and Schousboe, John T.
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- 2014
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28. The impact of mild induced hypothermia on the rate of transfusion and the mortality in severely injured patients: a retrospective multi-centre study.
- Author
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Jensen, Kai Oliver, Held, Leonhard, Kraus, Andrea, Hildebrand, Frank, Mommsen, Philipp, Mica, Ladislav, Wanner, Guido A., Steiger, Peter, Moos, Rudolf M., Simmen, Hans-Peter, and Sprengel, Kai
- Subjects
BLOOD transfusion reaction ,HYPOTHERMIA ,CARDIAC arrest - Abstract
Background: Although under discussion, induced hypothermia (IH) is an established therapy for patients with cardiac arrest or traumatic brain injuries. The influences on coagulopathy and bleeding tendency in severely injured patients (SIP) with concomitant traumatic brain injury are most widely unclear. Therefore, the aim of this study was to quantify the effect of mild IH in SIP with concomitant severe traumatic brain injuries on transfusion rate and mortality. Methods: In this retrospective multi-centre study, SIP from three European level-1 trauma centres with an ISS ≥16 between 2009 and 2011 were included. At hospital A, patients qualified for IH with age ≤70 years and a severe head injury with an abbreviated injury scale (AIS
Head ) of ≥3. IH was defined as target core body temperature of 35 °C. Hypo-thermic patients were matched with two patients, one from hospital B and one from hospital C using age and AISHead . The effect of IH on the transfusion rate, complications and mortality was quantified with 95 % confidence intervals (CI). Patients not treated with IH in hospital A and those from hospital B and C, who were not matched, were used to adjust the CI for the effect of inter-hospital therapy protocol differences. Results: Mean age of patients in the IH-group (n = 43) was 35.7 years, mean ISS 30 points and sex distribution showed 83.7 % male. Mean age of matched patients in the normotherm-group (n = 86) was 36.7 years, mean ISS 33 points and there were 75.6 % males. For the hypothermic patients, we pointed out an estimate of mean difference for the number of transfused units of packed red blood cells as well as for mortality which does not indicate a decrease in the benefit gained by hypothermia. It is suggested that hypothermic patients tend to a higher rate of lung failure and thromboembolisms. Conclusion: Though tending to an increased rate of complications, there is no evidence for a difference in both; rate of transfusion and mortality in SIP. Mild IH as an option for severe head injuries seems as well-being practicable in the presence of multiple severe injuries. Further, clinical studies regarding the side effects are necessary. [ABSTRACT FROM AUTHOR]- Published
- 2016
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- View/download PDF
29. Response to BONE-D-14-00884
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Cawthon, Peggy M., Haslam, Jane, Fullman, Robin, Peters, Katherine W., Black, Dennis, Ensrud, Kristine E., Cummings, Steven R., Orwoll, Eric S., Barrett-Connor, Elizabeth, Marshall, Lynn, Steiger, Peter, and Schousboe, John T.
- Published
- 2015
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30. Effect of diagnosis related groups implementation on the intensive care unit of a Swiss tertiary hospital: a cohort study.
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Chok, Lionel, Bachli, Esther B., Steiger, Peter, Bettex, Dominique, Cottini, Silvia R., Keller, Emanuela, Maggiorini, Marco, and Schuepbach, Reto A.
- Subjects
DIAGNOSIS related groups ,INTENSIVE care units ,HOSPITAL care ,HOSPITAL admission & discharge ,EPIDEMIOLOGY ,PUBLIC health - Abstract
Background: In 2013 the Swiss Diagnosis Related Groups ((Swiss)-DRG) was implemented in Intensive Care Units (ICU). Its impact on hospitalizations has not yet been examined. We compared the number of ICU admissions, according to clinical severity and referring institution, and screened whether implementation of Swiss-DRG affected admission policy, ICU length-of-stay (ICU-LOS) or ICU mortality.Methods: Retrospective, single centre, cohort study conducted at the University Hospital Zurich, Switzerland between January 2009 and end of September 2013. Demographic and clinical data was retrieved from a quality assurance database.Results: Admissions (n = 17,231) before the introduction of Swiss-DRG were used to model expected admissions after DRG, and then compared to the observed admissions. Forecasting matched observations in patients with a high clinical severity admitted from internal units and external hospitals (admitted / predicted: 709 / 703, [95% Confidence Interval (CI), 658-748] and 302 / 332, [95% CI, 269-365] respectively). In patients with low severity of disease, in-house admissions became more frequent than expected and external admission were less frequent (admitted / predicted: 1972 / 1910, [95% CI, 1898-1940] and 436 / 518, [95% CI, 482-554] respectively). Various mechanisms related to Swiss-DRG may have led to these changes. DRG could not be linked to significant changes in regard to ICU-LOS and ICU mortality.Conclusions: DRG introduction had not affected ICU admissions policy, except for an increase of in-house patients with a low clinical severity of disease. DRG had neither affected ICU mortality nor ICU-LOS. [ABSTRACT FROM AUTHOR]- Published
- 2018
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31. Perioperative targeted temperature management of severely burned patients by means of an oesophageal temperature probe.
- Author
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Furrer, Florian, Wendel-Garcia, Pedro David, Pfister, Pablo, Hofmaenner, Daniel Andrea, Franco, Carlos, Sachs, Alexandra, Fleischer, Juliane, Both, Christian, Kim, Bong Sun, Schuepbach, Reto A., Steiger, Peter, Camen, Giovanni, and Buehler, Philipp Karl
- Subjects
- *
BODY surface area , *INDUCED hypothermia , *HEAT exchangers , *BURN patients , *TEMPERATURE , *HEAT transfer - Abstract
Hypothermia in severely burned patients is associated with a significant increase in morbidity and mortality. The use of an oesophageal heat exchanger tube (EHT) can improve perioperative body temperatures in severely burned patients. The aim of this study was to investigate the intraoperative warming effect of oesophageal heat transfer in severe burn patients. Single-centre retrospective study performed at the Burns Centre of the University Hospital Zurich. Between January 2020 and May 2021 perioperative temperature management with EHT was explored in burned patients with a total body surface area (TBSA) larger than 30%. Data from patients, who received perioperative temperature management by EHT, were compared to data from the same patients during interventions performed under standard temperature management matching for length and type of intervention. A total of 30 interventions (15 with and 15 without EHT) in 10 patients were analysed. Patient were 38 [26−48] years of age, presented with severe burns covering a median of 50 [42−64] % TBSA and were characterized by an ABSI of 10 [8−12] points. When receiving EHT management patients experienced warming at 0.07 °C per minute (4.2 °C/h) compared to a temperature loss of − 0.03 °C per minute (1.8 °C/h) when only receiving standard temperature management (p < 0.0001). No adverse or serious adverse events were reported. The use of an oesophageal heat transfer device was effective and safe in providing perioperative warming to severely burned patients when compared to a standard temperature management protocol. By employing an EHT as primary temperature management device perioperative hypothermia in severely burned patients can possibly be averted, potentially leading to reduced hypothermia-associated complications. • EHT was associated with intraoperative warming as opposed to standard temperature management. • This study shows that the use of an EHT was effective and safe. • EHT can potentially leading to reduced hypothermia-associated complications. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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- View/download PDF
32. Endothelial cell infection and endotheliitis in COVID-19.
- Author
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Varga, Zsuzsanna, Flammer, Andreas J, Steiger, Peter, Haberecker, Martina, Andermatt, Rea, Zinkernagel, Annelies S, Mehra, Mandeep R, Schuepbach, Reto A, Ruschitzka, Frank, and Moch, Holger
- Abstract
Cardiovascular complications are rapidly emerging as a key threat in coronavirus disease 2019 (COVID-19) in addition to respiratory disease. Intriguingly, SARS-CoV-2 can directly infect engineered human blood vessel organoids in vitro.[4] Here we demonstrate endothelial cell involvement across vascular beds of different organs in a series of patients with COVID-19 (further case details are provided in the appendix). She developed progressive respiratory failure due to COVID-19 and subsequently developed multi-organ failure and needed renal replacement therapy. [Extracted from the article]
- Published
- 2020
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- View/download PDF
33. Impact of allogeneic blood transfusions on clinical outcomes in severely burned patients.
- Author
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Kaserer, Alexander, Rössler, Julian, Slankamenac, Ksenija, Arvanitakis, Michael, Spahn, Donat R., Giovanoli, Pietro, Steiger, Peter, and Plock, Jan A.
- Subjects
- *
BODY surface area , *BLOOD platelet transfusion , *RED blood cell transfusion , *BLOOD transfusion , *SYSTEMIC inflammatory response syndrome , *BLOOD transfusion reaction , *SURGICAL intensive care , *BURN care units - Abstract
Background: Allogeneic blood transfusions are common in the treatment of severely burned patients as surgery may lead to major blood loss. However, transfusions are associated with a number of adverse events. Therefore, the purpose of our study was to investigate the impact of allogeneic blood transfusions on clinical outcomes in severely burned patients.Methods: This retrospective study included all adult patients admitted to the burn center of the University Hospital Zurich between January 2004 and December 2014, with burn injuries greater than 10% of total body surface area and receiving both surgical and intensive care treatment. Primary Endpoints were infectious or thromboembolic complications and mortality and secondary endpoints were length of hospital and ICU stay. Simple and multivariable logistic and linear regression models, adjusted for injury severity and confounders, were applied.Results: 413 patients met inclusion criteria of which 212 patients (51%) received allogenic blood products. After adjustment for injury severity and confounders, red blood cell transfusion was independently associated with wound infection (OR 13.5, 95% CI 1.7-107, p = 0.014), sepsis (OR 8.3, 4.2-16.3; p < 0.001), pneumonia (OR 4.7, 2.2-10.0; p < 0.001), thrombosis (OR 3.0, 1.2-7.4; p = 0.015), central line infection (OR 34.7, 4.6-260; p = 0.001) and a longer ICU and hospital stay (difference 17.7, CI 12.1-23.4, p < 0.001 and 22.0, 15.8-28.2, p < 0.001, respectively). Fresh frozen plasma transfusion was independently associated with a longer ICU and hospital stay (difference 13.7, 95% CI 5.5-21.8, p = 0.001 and 13.5, 4.6-22.5, p = 0.003, respectively). Platelet transfusion was independently associated with systemic inflammatory response syndrome (OR 4.5, 1.3-15.5; p = 0.018) and mortality (OR 5.8, 2.1-16.0; p = 0.001).Conclusion: Transfusion of allogeneic blood products is associated with an increased infection rate and thromboembolic morbidity and a longer hospital stay in severely burned patients. [ABSTRACT FROM AUTHOR]- Published
- 2020
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34. Electron microscopy of SARS-CoV-2: a challenging task - Authors' reply.
- Author
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Varga, Zsuzsanna, Flammer, Andreas J, Steiger, Peter, Haberecker, Martina, Andermatt, Rea, Zinkernagel, Annelies, Mehra, Mandeep R, Scholkmann, Felix, Schüpbach, Reto, Ruschitzka, Frank, and Moch, Holger
- Abstract
We thank Cynthia Goldsmith and colleagues for their interest in our recent Correspondence.[1] We described autopsy findings from patients who had died from COVID-19 and showed a systemic endotheliitis with evidence of loss of integrity of the endothelial monolayer.[1] The framework of endotheliitis provides an explanation for the unique predilection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in those individuals with hypertension, diabetes, or established cardiovascular disease, a group known to have pre-existing endothelial dysfunction. In another recent study,[6] virus-like particles in patients with confirmed SARS-CoV-2 infection were 70-110 nm in diameter. This notwithstanding, these observed particles in patients with COVID-19 should be best designated as virus-like particles because definitive assignment of these structures as SARS-CoV-2 virions requires immuno-EM. [Extracted from the article]
- Published
- 2020
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35. Intracerebral endotheliitis and microbleeds are neuropathological features of COVID‐19
- Author
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Elisabeth J. Rushing, Sibylle Kohler, Peter Steiger, Mona Lichtblau, Karl Frontzek, R T Dominic Gascho, Benjamin V. Ineichen, Katrin Frauenknecht, Katharina Schreib, Silvia Ulrich, Emanuela Keller, Adriano Aguzzi, Lukas L. Imbach, Regina Reimann, Daniel Kirschenbaum, University of Zurich, Steiger, Peter, Aguzzi, Adriano, and Frontzek, Karl
- Subjects
0301 basic medicine ,Male ,Pathology ,Neurology ,COVID19 ,ACE2 ,medicine.disease_cause ,2722 Histology ,Covid ,2737 Physiology (medical) ,0302 clinical medicine ,Coronavirus ,Aged, 80 and over ,Sars‐CoV‐2 ,10218 Institute of Legal Medicine ,endotheliitis ,2728 Neurology (clinical) ,Female ,10023 Institute of Intensive Care Medicine ,10178 Clinic for Pneumology ,medicine.symptom ,Meningitis ,Encephalitis ,Scientific Correspondence ,medicine.medical_specialty ,Histology ,10208 Institute of Neuropathology ,Clinical Neurology ,610 Medicine & health ,Neuropathology ,Asymptomatic ,Pathology and Forensic Medicine ,10180 Clinic for Neurosurgery ,03 medical and health sciences ,10043 Clinic for Neuroradiology ,Physiology (medical) ,medicine ,Humans ,Vasculitis, Central Nervous System ,Endotheliitis ,Aged ,Cerebral Hemorrhage ,Retrospective Studies ,business.industry ,SARS-CoV-2 ,COVID-19 ,Endothelial Cells ,medicine.disease ,2734 Pathology and Forensic Medicine ,Pneumonia ,030104 developmental biology ,2808 Neurology ,570 Life sciences ,biology ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Coronavirus disease 19 (COVID‐19) is a rapidly evolving pandemic caused by the coronavirus Sars‐CoV‐2. Clinically manifest central nervous system symptoms have been described in COVID‐19 patients and could be the consequence of commonly associated vascular pathology, but the detailed neuropathological sequelae remain largely unknown. A total of six cases, all positive for Sars‐CoV‐2, showed evidence of cerebral petechial hemorrhages and microthrombi at autopsy. Two out of six patients showed an elevated risk for disseminated intravascular coagulopathy according to current criteria and were excluded from further analysis. In the remaining four patients, the hemorrhages were most prominent at the grey and white matter junction of the neocortex, but were also found in the brainstem, deep grey matter structures and cerebellum. Two patients showed vascular intramural inflammatory infiltrates, consistent with Sars‐CoV‐2‐associated endotheliitis, which was associated by elevated levels of the Sars‐CoV‐2 receptor ACE2 in the brain vasculature. Distribution and morphology of patchy brain microbleeds was clearly distinct from hypertension‐related hemorrhage, critical illness‐associated microbleeds and cerebral amyloid angiopathy, which was ruled out by immunohistochemistry. Cerebral microhemorrhages in COVID‐19 patients could be a consequence of Sars‐ CoV‐2‐induced endotheliitis and more general vasculopathic changes and may correlate with an increased risk of vascular encephalopathy., Clinically manifest central nervous system symptoms are common in COVID‐19 patients but their causes are still unknown. We present here four patients who tested positive for Sars‐CoV‐2 with cerebral haemorrhages which were most prominent at the grey and white matter junction of the neocortex and the brainstem. We present evidence of intracerebral endotheliitis in COVID‐19 patients which could predispose to more general vasculopathic changes and may correlate with an increased risk of vascular encephalopathy.
- Published
- 2020
36. Inflammatory olfactory neuropathy in two patients with COVID-19.
- Author
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Kirschenbaum, Daniel, Imbach, Lukas L, Ulrich, Silvia, Rushing, Elisabeth J, Keller, Emanuela, Reimann, Regina R, Frauenknecht, Katrin B M, Lichtblau, Mona, Witt, Martin, Hummel, Thomas, Steiger, Peter, Aguzzi, Adriano, and Frontzek, Karl
- Subjects
- *
COVID-19 , *SMELL disorders , *CENTRAL nervous system viral diseases , *POLYNEUROPATHIES - Published
- 2020
- Full Text
- View/download PDF
37. Radiomics and Artificial Intelligence: From Academia to Clinical Practice.
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Steiger P
- Subjects
- Humans, Artificial Intelligence, Benchmarking
- Published
- 2022
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38. Implementation of a multiprofessional, multicomponent delirium management guideline in two intensive care units, and its effect on patient outcomes and nurse workload: a pre-post design retrospective cohort study.
- Author
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Schubert M, Bettex D, Steiger P, Schürch R, Haller A, Bogdanovic J, Garcia Nuñez D, Schwarz U, and Siegemund M
- Subjects
- Aged, Aged, 80 and over, Cohort Studies, Comorbidity, Cost-Benefit Analysis, Female, Hospital Mortality, Humans, Intensive Care Units, Male, Middle Aged, Patient Care Team, Practice Guidelines as Topic, Retrospective Studies, Risk Factors, Switzerland epidemiology, Treatment Outcome, Delirium diagnosis, Delirium economics, Delirium epidemiology, Delirium therapy, Length of Stay economics, Length of Stay statistics & numerical data, Nursing Staff, Hospital economics, Nursing Staff, Hospital statistics & numerical data, Respiration, Artificial economics, Respiration, Artificial statistics & numerical data, Workload economics, Workload statistics & numerical data
- Abstract
Aim of the Study: Delirium is a frequent intensive care unit (ICU) complication, affecting 26% to 80% of ICU patients, often with serious consequences. This study aimed to evaluate the effectiveness, costs and benefits of following a standardised multiprofessional, multicomponent delirium guideline on eight outcomes: delirium prevalence and duration, lengths of stay in ICU and hospital, in-hospital mortality, duration of mechanical ventilation, and cost and nursing hours per case. It also aimed to explore the associations of delirium with length of ICU stay, length of hospital stay and duration of mechanical ventilation., Methods: This retrospective cohort study used a pre-post design. ICU patients in an historical control group (n = 1608) who received standard ICU care were compared with a postintervention group (n = 1684) who received standardised delirium management – delirium risk identification, preventive measures, screening and treatment – with regard to eight outcomes. The delirium management guideline was developed and implemented in 2012 by a group of experts from the study hospital. As appropriate, descriptive statistics and multivariate, multilevel models were used to compare the two groups and to explore the association between delirium occurrence and the selected outcomes., Results: Twelve percent of the 1608 historical controls and 20% of the 1684 postintervention patients were diagnosed with delirium according to the ICD-10 delirium diagnosis codes. Patients being treated for heart disease, and those with septic shock, ARDS, renal insufficiency (acute or chronic), older age and higher numbers of comorbidities were significantly more likely to develop delirium during their stay. Multivariate models comparing the historical controls with the post intervention group indicated significant differences in delirium period prevalence (odds ratio 1.68, 95% confidence interval [CI] 1.38–2.06; p <0.001), length of stay in the ICU (time ratio [TR] 0.94, CI 0.89–1.00; p = 0.048), cost per case (median difference 3.83, CI 0.54–7.11; p = 0.023) and duration of mechanical ventilation (TR 0.84, CI 0.77–0.92; p <0.001). The observed differences in the other four outcomes – in-hospital mortality, delirium duration, length of stay in the hospital, and nursing hours per case – were not significant. Delirium was a significant predictor for prolonged duration of mechanical ventilation and for both ICU and hospital stay., Conclusion: Standardised delirium management, specifically delirium screening, supports timely detection of delirium in ICU patients. Increased awareness of delirium after the implementation of standardised multiprofessional, multicomponent management leads to increased therapeutic attention, a prolongation of ICU stay and increased costs, but with no influence on mortality.
- Published
- 2020
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39. How Can Radiomics Be Consistently Applied across Imagers and Institutions?
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Steiger P and Sood R
- Subjects
- Tomography, X-Ray Computed
- Published
- 2019
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40. Age-related outcome of patients after traumatic brain injury: a single-center observation.
- Author
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Erlebach R, Pagnamenta A, Klinzing S, Stretti F, Cottini S, Schüpbach R, Steiger P, and Brandi G
- Subjects
- Adolescent, Adult, Age Factors, Aged, Brain Injuries, Traumatic etiology, Cohort Studies, Female, Humans, Injury Severity Score, Male, Middle Aged, Prognosis, Retrospective Studies, Time Factors, Young Adult, Brain Injuries, Traumatic therapy
- Abstract
Background: The purpose of the present study was to analyze clinical features of patients with traumatic brain injury (TBI), their age-related outcomes and determinants of long-term outcome., Methods: This retrospective cohort study was conducted in a level I University Swiss trauma center. Consecutive patients with moderate to severe TBI admitted for more than 48 hours to the Intensive Care Unit (ICU) were included. Patients' and trauma characteristics, management during ICU stay, prognostic scores and long-term outcomes were analyzed., Results: Hundred-seventy-four patients (72% males, mean age 49 years) were divided in three age groups: young (≤39 years, N.=69, 39.7%), middle aged (40-64 years, N.=55, 31.6%), and elderly (≥65 years, N.=50, 28.7%). In elderly patients, falls (62%) were the most common cause of TBI. Overall ICU mortality was 15% with no difference among age groups. Within six-months after TBI, 80% of elderly patients presented unfavorable outcomes. Age, pre-existing cardiovascular disease, use of anticoagulants and/or antiplatelet agents, abnormal pupillary reactivity, a high score in Marshall CT classification, and a higher glucose level were associated with unfavorable outcomes in a univariable logistic regression. In a multivariable logistic regression, age and abnormal pupillary reactivity were identified as independent risk factors for unfavorable outcomes, while presence of epidural hematoma and higher hemoglobin levels were predictors for favorable outcomes., Conclusions: Older patients are at higher risk for long-term unfavorable outcomes than younger patients. Use of anticoagulants and/or antiplatelet agents and lower hemoglobin levels during rescue phase are associated with unfavorable long-term outcomes. Fall prevention in the elderly should be a key target of intervention programs.
- Published
- 2017
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