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2. Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study

Author

Kemper, Johann, Kohaupt, Lena, Witzler, Jette, Tuzhikov, Michael, Roth, Sebastian, Stroda, Alexandra, M’Pembele, René, Tenge, Theresa, Schultze, Cornelia, Verbarg, Nele, Gehrke, Christian, Klemann, Anna Katharina, Hagebölling, Friederike, Albrecht, Svenja, Stroeder, Jakob, Schubert, Ann-Kristin, Espeter, Florian, Russe, Benedikt, Weigand, Markus A., Bergmann, Lars, Unterberg, Matthias, Bischoff, Petra, Pirzer, Raphael, Rach, Patric Rene, Ott, Klaus, Zarbock, Alexander, Kowark, Ana, Neumann, Claudia, Marchand, Bahareh, Sponholz, Christoph, Rueffert, Henrik, Kramer, Mira, Zacharowski, Kai, Meybohm, Patrick, Lindau, Simone, Carollo, Melissa, Novazzi, Cecilia, Toso, Fiorenza, Bacuzzi, Alessandro, Ragazzi, Riccardo, Volta, Carlo Alberto, De Giorgi, Francesco, Bacer, Barbara, Federico, Antonio, Chiumello, Davide, Vetrugno, Luigi, Castella, Alberto, Tesoro, Simonetta, Cotoia, Antonella, Bignami, Elena, Bellissima, Agrippino, Cortegiani, Andrea, Crisman, Marco, Toninelli, Arturo, Piazza, Ornella, Mirabella, Lucia, Bossolasco, Matteo, Bona, Francesco, Perdomo, Juan Manuel, Coca-Martinez, Miquel, Carramiñana, Albert, Servén, Marta Giné, González, Astrid Batalla, Gil Sánchez, José Maria, Becerra-Bolaños, Ángel, Rodríguez-Pérez, Aurelio, Soler, Anna Artigas, Basso, Morena, Font, Anna Peig, Vernetta, Diana, Santos, Julia Hernando, Muñoz, Enrique Alday, Olivares, Mercedes Cabellos, Marco, Gregorio, Lopez, Maria Bermudez, Barrio, Javier, Forés, María Isabel, Boix, Estefanía, Ayuso, Mercedes, Petre, Bogdan Sorel, Oprea, Ioana Sorina, Latiș, Mihai Dan, Margarit, Simona, Vasian, Horatiu, Tomescu, Dana, Cîndea, Iulia, Dirzu, Dan Sebastian, Copotoiu, Sanda-Maria, Moise, Alida, Bubenek-Turconi, Serban, Valeanu, Liana, Wanner, Patrick Mark, Djurdjevic, Mirjana, Nuth, Sandra, Seeberger, Esther, Goettel, Nicolai, Kamber, Firmin, Ganter, Michael Thomas, Gerber, Thomas Jan, Schneebeli, Daniela, Pregernig, Andreas, Grape, Sina, Tomala, Simon, Pinto, Bernardo Bollen, Żukowski, Maciej, Zegan-Barańska, Małgorzata, Karolak, Igor, Krzych, Lukasz, Czajka, Szymon, Studzińska, Dorota, Kluzik, Anna, Koszel, Tomasz, Pabjańczyk, Izabela, Gajdosz, Anna, Erkoc, Suheyla Karadag, Meco, Basak Ceyda, Koltka, Ahmet Kemalettin, Dincer, Muserref Beril, Ekmekçi, Perihan, Saracoglu, Kemal Tolga, Solmaz, Filiz Alkaya, Ozcelik, Menekse, Arun, Oguzhan, Dilmen, Ozlem Korkmaz, Preckel, Benedikt, Hollmann, Markus W., Hazen, Yannick, Donald de Boer, Hans, Epema, Anne, Koopman, Seppe, Van Lier, Felix, Pinto, Rita, Carrão, André, Ribeiro, Daniel, Mourão, Joana, Coelho, Miguel, Losa, Nuno, Santos, Nuno, Cabral, Luis, Afonso, Diana, Zenha, Sérgio, Ramos, Cristina, Hipólito, Carla, Vasilaki, Maria, Andreeva, Antonia, Zaimi, Donika, Chalkias, Athanasios, Spyraki, Maria, Rekatsina, Martina, Tsaousi, Georgia, Short, Anthony, Meier, Sonja, Madhuri, Thumuluru Kavitha, Latham, Scott, Knock, James, Drummond, Andrew, Ramsden, Fiona, Kubisz-Pudelko, Agnieszka, Walker, James, Moppett, Iain, White, Louise, Jackson, Matthew, Reschreiter, Henrik, Innes, Richard, Chew, Michelle, Kalman, Sigridur, Wallden, Jakob, Schening, Anna, Jonikaite, Lina, Enlund, Anna, De Baerdemaeker, Luc, Morrison, Stuart, Rex, Steffen, Alexis, Alexandros, Khoronenko, Viktoria E., Ovezov, Alexey, Belskii, Vladislav, Kaznacheeva, Kseniya, Gritsan, Alexey, Kuzmanovska, Biljana, Malinovska-Nikolovska, Liljana, Barisin, Stjepan, Poredos, Peter, Arabadzhieva, Daniela, Unic-Stojanovic, Dragana, Golubović, Mladjan, Fleischmann, Edith, Kotzinger, Oskar, Des Deserts, Marc Danguy, Ducrocq, Nicolas, Buggy, Donal J., Bonnet, Jean François, Cusack, Barbara, Calleja, Paul, Hasani, Antigona, Nallbani, Rajmonda, Mauermann, Eckhard, Ionescu, Daniela, Szczeklik, Wojciech, De Hert, Stefan, Filipovic, Miodrag, Beck Schimmer, Beatrice, Spadaro, Savino, Matute, Purificación, Ganter, Michael T., Turhan, Sanem C., van Waes, Judith, Lagarto, Filipa, Theodoraki, Kassiani, Gupta, Anil, Gillmann, Hans-Jörg, Guzzetti, Luca, Kotfis, Katarzyna, Larmann, Jan, Corneci, Dan, Howell, Simon J., and Lurati Buse, Giovanna

Published
2024
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4. Early sevoflurane sedation in severe COVID-19-related lung injury patients. A pilot randomized controlled trial.

Author

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

Subjects
*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]

Published
2024
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6. Association between self-reported functional capacity and general postoperative complications: analysis of predefined outcomes of the MET-REPAIR international cohort study

Author

Roth, Sebastian, M'Pembele, René, Nienhaus, Johannes, Kemper, Johann, Kohaupt, Lena, Witzler, Jette, Tuzhikov, Michael, Stroda, Alexandra, Tenge, Theresa, Huhn, Ragnar, Schultze, Cornelia, Verbarg, Nele, Gehrke, Christian, Klemann, Anna Katharina, Hagebölling, Friederike, Albrecht, Svenja, Stroeder, Jakob, Schubert, Ann-Kristin, Espeter, Florian, Russe, Benedikt, Weigand, Markus A., Bergmann, Lars, Unterberg, Matthias, Bischoff, Petra, Pirzer, Raphael, Rach, Patric Rene, Ott, Klaus, Zarbock, Alexander, Kowark, Ana, Neumann, Claudia, Marchand, Bahareh, Sponholz, Christoph, Rueffert, Henrik, Kramer, Mira, Piekarski, Florian, Carollo, Melissa, Novazzi, Cecilia, Toso, Fiorenza, Bacuzzi, Alessandro, Ragazzi, Riccardo, Volta, Carlo Alberto, De Giorgi, Francesco, Bacer, Barbara, Federico, Antonio, Chiumello, Davide, Vetrugno, Luigi, Castella, Alberto, Tesoro, Simonetta, Cotoia, Antonella, Bignami, Elena, Bellissima, Agrippino, Cortegiani, Andrea, Crisman, Marco, Toninelli, Arturo, Piazza, Ornella, Mirabella, Lucia, Bossolasco, Matteo, Bona, Francesco, Perdomo, Juan Manuel, Coca-Martinez, Miquel, Carramiñana, Albert, Servén, Marta Giné, González, Astrid Batalla, Gil Sánchez, José Maria, Becerra-Bolaños, Ángel, Rodríguez-Pérez, Aurelio, Soler, Anna Artigas, Basso, Morena, Font, Anna Peig, Vernetta, Diana, Santos, Julia Hernando, Muñoz, Enrique Alday, Olivares, Mercedes Cabellos, Marco, Gregorio, Lopez, Maria Bermudez, Barrio, Javier, Forés, María Isabel, Boix, Estefanía, Ayuso, Mercedes, Petre, Bogdan Sorel, Oprea, Ioana Sorina, Latiș, Mihai Dan, Margarit, Simona, Vasian, Horatiu, Tomescu, Dana, Cîndea, Iulia, Dirzu, Dan Sebastian, Copotoiu, Sanda-Maria, Moise, Alida, Bubenek-Turconi, Serban, Valeanu, Liana, Wanner, Patrick Mark, Djurdjevic, Mirjana, Nuth, Sandra, Seeberger, Esther, Goettel, Nicolai, Kamber, Firmin, Ganter, Michael Thomas, Gerber, Thomas Jan, Schneebeli, Daniela, Pregernig, Andreas, Grape, Sina, Tomala, Simon, Pinto, Bernardo Bollen, Żukowski, Maciej, Zegan-Barańska, Małgorzata, Karolak, Igor, Krzych, Lukasz, Czajka, Szymon, Studzińska, Dorota, Kluzik, Anna, Koszel, Tomasz, Pabjańczyk, Izabela, Gajdosz, Anna, Erkoc, Suheyla Karadag, Meco, Basak Ceyda, Koltka, Ahmet Kemalettin, Dincer, Muserref Beril, Ekmekçi, Perihan, Saracoglu, Kemal Tolga, Solmaz, Filiz Alkaya, Ozcelik, Menekse, Arun, Oguzhan, Dilmen, Ozlem Korkmaz, Preckel, Benedikt, Hollmann, Markus W., Hazen, Yannick, Donald de Boer, Hans, Epema, Anne, Koopman, Seppe, Van Lier, Felix, Pinto, Rita, Carrão, André, Ribeiro, Daniel, Mourão, Joana, Coelho, Miguel, Santos, Nuno, Cabral, Luis, Afonso, Diana, Zenha, Sérgio, Ramos, Cristina, Hipólito, Carla, Vasilaki, Maria, Andreeva, Antonia, Zaimi, Donika, Chalkias, Athanasios, Spyraki, Maria, Rekatsina, Martina, Tsaousi, Georgia, Short, Anthony, Meier, Sonja, Madhuri, Thumuluru Kavitha, Latham, Scott, Knock, James, Drummond, Andrew, Ramsden, Fiona, Kubisz-Pudelko, Agnieszka, Walker, James, Moppett, Iain, White, Louise, Jackson, Matthew, Reschreiter, Henrik, Innes, Richard, Chew, Michelle, Kalman, Sigridur, Wallden, Jakob, Schening, Anna, Jonikaite, Lina, Enlund, Anna, De Baerdemaeker, Luc, Morrison, Stuart, Rex, Steffen, Alexis, Alexandros, Khoronenko, Viktoria E., Ovezov, Alexey, Belskii, Vladislav, Kaznacheeva, Kseniya, Gritsan, Alexey, Kuzmanovska, Biljana, Malinovska-Nikolovska, Liljana, Barisin, Stjepan, Poredos, Peter, Arabadzhieva, Daniela, Unic-Stojanovic, Dragana, Golubović, Mladjan, Fleischmann, Edith, Kotzinger, Oskar, Des Deserts, Marc Danguy, Ducrocq, Nicolas, Buggy, Donal J., Bonnet, Jean François, Cusack, Barbara, Calleja, Paul, Hasani, Antigona, Nallbani, Rajmonda, Mauermann, Eckhard, Ionescu, Daniela, Szczeklik, Wojciech, De Hert, Stefan, Filipovic, Miodrag, Beck-Schimmer, Beatrice, Spadaro, Savino, Matute, Purificación, Bolliger, Daniel, Turhan, Sanem C., van Waes, Judith, Lagarto, Filipa, Theodoraki, Kassiani, Gupta, Anil, Gillmann, Hans-Jörg, Guzzetti, Luca, Kotfis, Katarzyna, Wulf, Hinnerk, Larmann, Jan, Corneci, Dan, Chammartin, Frédérique, Howell, Simon J., and Lurati Buse, Giovanna

Published
2024
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7. Erratum to ‘Association between self-reported functional capacity and general postoperative complications: analysis of predefined outcomes of the MET-REPAIR international cohort study’ (Br J Anaesth 2024; 132: 811–4)

Author

Roth, Sebastian, M'Pembele, René, Nienhaus, Johannes, Mauermann, Eckhard, Ionescu, Daniela, Szczeklik, Wojciech, De Hert, Stefan, Filipovic, Miodrag, Beck-Schimmer, Beatrice, Spadaro, Savino, Matute, Purificación, Bolliger, Daniel, Turhan, Sanem C., van Waes, Judith, Lagarto, Filipa, Theodoraki, Kassiani, Gupta, Anil, Gillmann, Hans-Jörg, Guzzetti, Luca, Kotfis, Katarzyna, Wulf, Hinnerk, Larmann, Jan, Corneci, Dan, Chammartin, Frédérique, Howell, Simon J., and Buse, Giovanna L.

Published
2024
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8. Correction: Early sevoflurane sedation in severe COVID19-related lung injury patients. A pilot randomized controlled trial.

Author

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

Subjects
*SEVOFLURANE, *LUNG injuries, *SEVERITY of illness index, *ANESTHESIA, *COVID-19
Published
2024
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9. Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study.

Author

Stroda, Alexandra, Mauermann, Eckhard, Ionescu, Daniela, Szczeklik, Wojciech, De Hert, Stefan, Filipovic, Miodrag, Beck Schimmer, Beatrice, Spadaro, Savino, Matute, Purificación, Ganter, Michael T., Ovezov, Alexey, Turhan, Sanem C., van Waes, Judith, Lagarto, Filipa, Theodoraki, Kassiani, Gupta, Anil, Gillmann, Hans-Jörg, Guzzetti, Luca, Kotfis, Katarzyna, and Larmann, Jan

Subjects
*MAJOR adverse cardiovascular events, *MONTE Carlo method, *COHORT analysis, *STRESS echocardiography, *VENTRICULAR ejection fraction
Abstract

In 2022, the European Society of Cardiology updated guidelines for preoperative evaluation. The aims of this study were to quantify: (1) the impact of the updated recommendations on the yield of pathological findings compared with the previous guidelines published in 2014; (2) the impact of preoperative B-type natriuretic peptide (NT-proBNP) use for risk estimation on the yield of pathological findings; and (3) the association between 2022 guideline adherence and outcomes. This was a secondary analysis of MET-REPAIR, an international, prospective observational cohort study (NCT03016936). Primary endpoints were reduced ejection fraction (EF<40%), stress-induced ischaemia, and major adverse cardiovascular events (MACE). The explanatory variables were class of recommendations for transthoracic echocardiography (TTE), stress imaging, and guideline adherence. We conducted second-order Monte Carlo simulations and multivariable regression. In total, 15,529 patients (39% female, median age 72 [inter-quartile range: 67–78 ] yr) were included. The 2022 update changed the recommendation for preoperative TTE in 39.7% patients, and for preoperative stress imaging in 12.9% patients. The update resulted in missing 1 EF <40% every 3 fewer conducted TTE, and in 4 additional stress imaging per 1 additionally detected ischaemia events. For cardiac stress testing, four more investigations were performed for every 1 additionally detected ischaemia episodes. Use of NT-proBNP did not improve the yield of pathological findings. Multivariable regression analysis failed to find an association between adherence to the updated guidelines and MACE. The 2022 update for preoperative cardiac testing resulted in a relevant increase in tests receiving a stronger recommendation. The updated recommendations for TTE did not improve the yield of pathological cardiac testing. [ABSTRACT FROM AUTHOR]

Published
2024
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10. Factors affecting adherence to recommendations on pre-operative cardiac testing: A cohort study.

Author

Stroda A, Sulot T, Roth S, M'Pembele R, Mauermann E, Ionescu D, Szczeklik W, De Hert S, Filipovic M, Beck Schimmer B, Spadaro S, Matute P, Turhan SC, van Waes J, Lagarto F, Theodoraki K, Gupta A, Gillmann HJ, Guzzetti L, Kotfis K, Larmann J, Corneci D, Howell SJ, and Lurati Buse G

Abstract

Background: Cardiac risk evaluation prior to noncardiac surgery is fundamental to tailor peri-operative management to patient's estimated risk. Data on the degree of adherence to guidelines in patients at cardiovascular risk in Europe and factors influencing adherence are underexplored., Objectives: The aim of this analysis was to describe the degree of adherence to [2014 European Society of Cardiology (ESC)/European Society of Anaesthesiology (ESA) guidelines] recommendations on rest echocardiography [transthoracic echocardiography (TTE)] and to stress imaging prior to noncardiac surgery in a large European sample and to assess factors potentially affecting adherence., Design: Secondary analysis of a multicentre, international, prospective cohort study (MET-REPAIR)., Setting: Twenty-five European centres of all levels of care that enrolled patients between 2017 and 2020., Patients: With elevated cardiovascular risk undergoing in-hospital elective, noncardiac surgery., Main Outcome Measures: (Non)adherence to each pre-operative TTE and stress imaging recommendations classified as guideline-adherent, overuse and underuse. We performed descriptive analysis. To explore the impact of patients' sex, age, geographical region, and hospital teaching status, we conducted multivariate multinominal regression analysis., Results: Out of 15 983 patients, 15 529 were analysed (61% men, mean age 72 ± 8 years). Overuse (conduction in spite of class III) and underuse (nonconduction in spite of class I recommendation) for pre-operative TTE amounted to 16.6% (2542/15 344) and 6.6% (1015/15 344), respectively. Stress imaging overuse and underuse amounted to 1.7% (241/14 202) and 0.4% (52/14 202) respectively. Male sex, some age categories and some geographical regions were significantly associated with TTE overuse. Male sex and some regions were also associated with TTE underuse. Age and regions were associated with overuse of stress imaging. Male sex, age, and some regions were associated with stress imaging underuse., Conclusion: Adherence to pre-operative stress imaging recommendation was high. In contrast, adherence to TTE recommendations was moderate. Both patients' and geographical factors affected adherence to joint ESC/ESA guidelines., Trial Registration: Clinicaltrials.gov identifier: NCT03016936., (Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.)

Published
2024
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11. Functionalized magnetic nanoparticles remove donor-specific antibodies (DSA) from patient blood in a first ex vivo proof of principle study.

Author

Lauener F, Schläpfer M, Mueller TF, Von Moos S, Janker S, Doswald S, Stark WJ, and Beck-Schimmer B

Subjects
Humans, Kidney Transplantation, Tissue Donors, Female, Proof of Concept Study, Male, Antibodies immunology, Magnetite Nanoparticles chemistry, Isoantibodies immunology, Isoantibodies blood
Abstract

The presence of donor-specific antibodies (DSA) such as antibodies directed against donor class I human leucocyte antigen (e.g., HLA-A) is a major barrier to kidney transplant success. As a proof of concept, functionalized magnetic nanoparticles have been designed to eliminate DSA from saline, blood and plasma of healthy donors and sensitized patients. Specific HLA-A1 protein was covalently bound to functionalized cobalt nanoparticles (fNP), human serum albumin (HSA) as control. fNP were added to anti-HLA class I-spiked saline, spiked volunteers' whole blood, and to whole blood and plasma of sensitized patients ex vivo. Anti-HLA-A1 antibody levels were determined with Luminex technology. Antibodies' median fluorescent intensity (MFI) was defined as the primary outcome. Furthermore, the impact of fNP treatment on blood coagulation and cellular uptake was determined. Treatment with fNP reduced MFI by 97 ± 2% and by 94 ± 4% (p < 0.001 and p = 0.001) in spiked saline and whole blood, respectively. In six known sensitized anti-HLA-A1 positive patients, a reduction of 65 ± 26% (p = 0.002) in plasma and 65 ± 33% (p = 0.012) in whole blood was achieved. No impact on coagulation was observed. A minimal number of nanoparticles was detected in peripheral mononuclear blood cells. The study demonstrates-in a first step-the feasibility of anti-HLA antibody removal using fNP. These pilot data might pave the way for a new personalized DSA removal technology in the future., (© 2024. The Author(s).)

Published
2024
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