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1. Quality indicators in intensive care medicine for Germany – fourth edition 2022

Author

Kumpf, Oliver, Assenheimer, Markus, Bloos, Frank, Brauchle, Maria, Braun, Jan-Peter, Brinkmann, Alexander, Czorlich, Patrick, Dame, Christof, Dubb, Rolf, Gahn, Georg, Greim, Clemens-A., Gruber, Bernd, Habermehl, Hilmar, Herting, Egbert, Kaltwasser, Arnold, Krotsetis, Sabine, Kruger, Bastian, Markewitz, Andreas, Marx, Gernot, Muhl, Elke, Nydahl, Peter, Pelz, Sabrina, Sasse, Michael, Schaller, Stefan J., Schäfer, Andreas, Schürholz, Tobias, Ufelmann, Marina, Waydhas, Christian, Weimann, Jörg, Wildenauer, René, Wöbker, Gabriele, Wrigge, Hermann, and Riessen, Reimer

Subjects
quality management, intensive care medicine, quality indicators, peer review, Medicine
Abstract

The measurement of quality indicators supports quality improvement initiatives. The German Interdisciplinary Society of Intensive Care Medicine (DIVI) has published quality indicators for intensive care medicine for the fourth time now. After a scheduled evaluation after three years, changes in several indicators were made. Other indicators were not changed or only minimally. The focus remained strongly on relevant treatment processes like management of analgesia and sedation, mechanical ventilation and weaning, and infections in the ICU. Another focus was communication inside the ICU. The number of 1ndicators remained the same. The development method was more structured and transparency was increased by adding new features like evidence levels or author contribution and potential conflicts of interest. These quality indicators should be used in the peer review in intensive care, a method endorsed by the DIVI. Other forms of measurement and evaluation are also reasonable, for example in quality management. This fourth edition of the quality indicators will be updated in the future to reflect the recently published recommendations on the structure of intensive care units by the DIVI.

Published
2023
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3. The impact of the massive open online course C19_SPACE during the COVID-19 pandemic on clinical knowledge enhancement: a study among medical doctors and nurses

Author

Cecconi, Maurizio, Barth, Anita, Szőllősi, Gergő József, Istrate, Gizella Melania, Alexandre, Joel, Duska, Frantisek, Schaller, Stefan J., Boulanger, Carole, Mellinghoff, Johannes, Waldauf, Peter, Girbes, Armand R. J., Derde, Lennie, De Waele, Jan J., Azoulay, Elie, and Kesecioglu, Jozef

Published
2024
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4. Continuous chest compressions with a simultaneous triggered ventilator in the Munich Emergency Medical Services: a case series

Author

Schaller, Stefan J., Altmann, Sonja, Unsworth, Annalise, Schneider, Gerhard, Bogner-Flatz, Viktoria, Paul, Thomas, Hoppmann, Petra, and Kanz, Karl-Georg

Subjects
cardiopulmonary resuscitation, emergency therapy, ventilation, ventilators, emergency medical services, Medicine
Abstract

Background: Mechanical chest compression devices are commonly used providing a constant force and frequency of chest compression during cardiopulmonary resuscitation. However, there are currently no recommendations on ventilation during cardiopulmonary resuscitation with a mechanical chest compression device using continuous mode. An effective method for ventilation in such scenarios might be a triggered oxygen-powered resuscitator.Methods: We report seven cardiopulmonary resuscitation cases from the Munich Emergency Medical Service where mechanical chest compression devices in continuous mode were used with an oxygen-powered resuscitator. In each case, the resuscitator (Oxylator) was running in automatic mode delivering a breath during the decompression phase of the chest compressions at a frequency of 100 per minute. End-tidal carbon dioxide and pulse oximetry were measured. Additional data was collected from the resuscitation protocol of each patient.Results: End-tidal carbon dioxide was available in all cases while oxygen saturation only in four. Five patients had a return of spontaneous circulation. Based on the end-tidal carbon dioxide values of each of the cases, the resuscitator did not seem to cause hyperventilation and suggests that good-quality cardiopulmonary resuscitation was delivered.Conclusions: Continuous chest compressions using a mechanical chest compression device and simultaneous synchronized ventilation using an oxygen-powered resuscitator in an automatic triggering mode might be feasible during cardiopulmonary resuscitation.

Published
2019
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5. Core outcome set of daily monitoring of gastrointestinal function in adult critically ill patients: a modified Delphi consensus process (COSMOGI)

Author

Bachmann, Kaspar F., Jenkins, Bethan, Asrani, Varsha, Bear, Danielle E., Bolondi, Giuliano, Boraso, Sabrina, Casaer, Michael P., Chang, Zhigang, Coopersmith, Craig M., Cotoia, Antonella, Davies, Thomas, De Man, Angelique, Elke, Gunnar, Gundogan, Kursat, Gunst, Jan, Kvolik, Slavica, Laube, Marcus, Lindner, Matthias, Lopez-Delgado, Juan Carlos, Loudet, Cecilia, Matsa, Ram, Pardo, Emmanuel, Piva, Simone, Puthucheary, Zudin, Rice, Todd W., Ruiz-Santana, Sergio, Schaller, Stefan J., Starkopf, Joel, Stoppe, Christian, Van Zanten, Arthur, and Reintam Blaser, Annika

Published
2024
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11. Protocol and statistical analysis plan for the phase 3 randomised controlled Treatment of Invasively Ventilated Adults with Early Activity and Mobilisation (TEAM III) trial

Author

Presneill, Jeffrey J, Bellomo, Rinaldo, Brickell, Kathy, Buhr, Heidi, Gabbe, Belinda J, Gould, Doug W, Harrold, Meg, Higgins, Alisa M, Hurford, Sally, Iwashyna, Theodore, Neto, Ary Serpa, Nichol, Alistair, Schaller, Stefan J, Sivasuthan, Janani, Tipping, Claire, Webb, Steven, Young, Paul, and Hodgson, Carol L

Published
2021

15. Contemporary assessment of short- and functional 90-days outcome in old intensive care patients suffering from COVID-19

Author

Bruno, Raphael Romano, Wernly, Bernhard, Artigas, Antonio, Fuest, Kristina, Schaller, Stefan J., Dannenberg, Lisa, Kindgen-Milles, Detlef, Kelm, Malte, Beil, Michael, Sviri, Sigal, Elhadi, Muhammed, Joannidis, Michael, Oeyen, Sandra, Kondili, Eumorfia, Moreno, Rui, Leaver, Susannah, Guidet, Bertrand, De Lange, Dylan W., Flaatten, Hans, Szczeklik, Wojciech, and Jung, Christian

Published
2025
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24. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

Author

Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R. J., Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J., Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J., and Cecconi, Maurizio

Published
2022
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25. Handlungsalgorithmus: Bauchpositionierung bei kritisch kranken Patienten.

Author

Hermes, Carsten, Krüger, Lars, Ochmann, Tobias, Erbes, Vanessa, Eggers, Detlef, Kany, Anke, Klimpel, Ricardo, König, Victoria, Ansorge, Marcel, Henck, Anett, Wittler, Tobias, Bein, Thomas, and Schaller, Stefan J

Subjects
PATIENT positioning, CRITICALLY ill, LUNG injuries, CONFLICT of interests, OXYGEN in the blood
Abstract

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2024
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26. Education to save lives: C19SPACE, the COVID19 Skills PrepAration CoursE

Author

Schaller, Stefan J., Mellinghoff, Johannes, Cecconi, Maurizio, Maurizio, Cecconi, Kesecioglu, Jozef, Azoulay, Elie, and Forni, Lui

Subjects
Hospital patients -- Training, Health care industry, European Union -- Training, European Union. European Commission -- Training
Abstract

Author(s): Stefan J. Schaller [sup.1] [sup.2] [sup.3], Johannes Mellinghoff [sup.1] [sup.4], Maurizio Cecconi [sup.1] [sup.5] [sup.6], Cecconi Maurizio, Jozef Kesecioglu, Elie Azoulay, Lui Forni, Jean-Louis Teboul, Armand R. J. Girbes, [...]

Published
2022
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32. Prevalence of hypophosphatemia in the ICU – Results of an international one-day point prevalence survey

Author

Abel, Arroyo, Erna, Alberts, Berger Mette, M., Guillaume, Besch, Costel, Besançon Bodolea, Michael, Casaer, Pérez, Cheng Meisy, Jean-Michel, Constantin, Swarna, Deepak, de Man Angelique, M.E., Frantisek, Duska, Patricia, Fodor, Kristina, Fuest, Thierry, Fumeaux, Hubert, Grand, Gundogan, K., Jan, Gunst, Mohan, Gurjar, Laurent, Heyer, Shihan, Huq, Carole, Ichai, Motiul, Islam, Samir, Jaber, Nikilesh, Jain, Matthieu, Jamme, Ib, Jammer, Olivier, Joannes-Boyau, Veronika, Jung, Inga, Karu, Kamal Habeeb, Keryakos Hesham, Gian-Reto, Kleger, Tim, Krol, Friedrich, Kuhn Karl, Marcus, Laube, Yoann, Launey, Manu, Malbrain, Manrique Ezequiel, Julien, Marrel, Roberto, Martinez-Alejos, Mongardon, Nicolas, Conway, Morris Andrew, Madhu, Pahuja, Fernando, Pereira, Gema, Pérez, Marie-Helene, Perez, Carmen, Pfortmuller, Annika, Reintam Blaser, Ricardo, Rosenfeld, Noryani, Samat, Schaller Stefan, J., Shannon, Simpson, Kelly, Straka, Tamas, Szakmany, Kadri, Tamme, Arthur, Van Zanten, Verçoza, Viana Marina, Berger, M.M., Appelberg, O., Reintam-Blaser, A., Ichai, C., Joannes-Boyau, O., Casaer, M., Schaller, S.J., Gunst, J., and Starkopf, J.

Published
2021
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34. Impact of High-Dose Early Mobilization on Outcomes for Patients with Diabetes: A Secondary Analysis of the TEAM Trial.

Author

Serpa Neto, Ary, Bailey, Michael, Seller, Daniel, Agli, Alicia, Bellomo, Rinaldo, Brickell, Kathy, Broadley, Tessa, Buhr, Heidi, Gabbe, Belinda J., Gould, Doug W., Harrold, Meg, Higgins, Alisa M., Hurford, Sally, Iwashyna, Theodore J., Nichol, Alistair D., Presneill, Jeffrey J., Schaller, Stefan J., Sivasuthan, Janani, Tipping, Claire J., and Poole, Alex

Subjects
PEOPLE with diabetes, ODDS ratio, ARTIFICIAL respiration, LOGISTIC regression analysis, SECONDARY analysis
Abstract

Rationale: Patients with diabetes represent almost 20% of all ICU admissions and might respond differently to high-dose early active mobilization. Objectives: To assess whether diabetes modified the relationship between the dose of early mobilization on clinical outcomes in the TEAM trial. Methods: All TEAM trial patients were included. The primary outcome was days alive and out of the hospital at Day 180. Secondary outcomes included 180-day mortality and long-term functional outcomes at Day 180. Logistic and median regression models were used to explore the effect of high-dose early mobilization on outcomes by diabetes status. Measurements and Main Results: All 741 patients from the original trial were included. Of these, 159 patients (21.4%) had diabetes. Patients with diabetes had fewer days alive and out of the hospital at Day 180 (124 [0–153] vs. 147 [82–164]; P = 0.013) and higher 180-day mortality (30% vs. 18%; P = 0.044). In patients receiving high-dose early mobilization, the number of days alive and out of the hospital at Day 180 was 73.0 (0.0–144.5) in patients with diabetes and 146.5 (95.8–163.0) in patients without diabetes (P value for interaction = 0.108). However, in patients with diabetes, high-dose early mobilization increased the odds of mortality at 180 days (adjusted odds ratio, 3.47; 95% confidence interval, 1.67–7.61; P value for interaction = 0.001). Conclusions: In this secondary analysis of the TEAM trial, in patients with diabetes, a high-dose early mobilization strategy did not significantly decrease the number of days alive and out of the hospital at Day 180, but it increased 180-day mortality. [ABSTRACT FROM AUTHOR]

Published
2024
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36. Guideline on positioning and early mobilisation in the critically ill by an expert panel.

Author

Schaller, Stefan J., Scheffenbichler, Flora T., Bein, Thomas, Blobner, Manfred, Grunow, Julius J., Hamsen, Uwe, Hermes, Carsten, Kaltwasser, Arnold, Lewald, Heidrun, Nydahl, Peter, Reißhauer, Anett, Renzewitz, Leonie, Siemon, Karsten, Staudinger, Thomas, Ullrich, Roman, Weber-Carstens, Steffen, Wrigge, Hermann, Zergiebel, Dominik, and Coldewey, Sina M.

Subjects
*ELECTRIC stimulation, *MEDICAL societies, *EVIDENCE gaps, *PATIENT positioning, *CRITICAL care medicine
Abstract

A scientific panel was created consisting of 23 interdisciplinary and interprofessional experts in intensive care medicine, physiotherapy, nursing care, surgery, rehabilitative medicine, and pneumology delegated from scientific societies together with a patient representative and a delegate from the Association of the Scientific Medical Societies who advised methodological implementation. The guideline was created according to the German Association of the Scientific Medical Societies (AWMF), based on The Appraisal of Guidelines for Research and Evaluation (AGREE) II. The topics of (early) mobilisation, neuromuscular electrical stimulation, assist devices for mobilisation, and positioning, including prone positioning, were identified as areas to be addressed and assigned to specialist expert groups, taking conflicts of interest into account. The panel formulated PICO questions (addressing the population, intervention, comparison or control group as well as the resulting outcomes), conducted a systematic literature review with abstract screening and full-text analysis and created summary tables. This was followed by grading the evidence according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence and a risk of bias assessment. The recommendations were finalized according to GRADE and voted using an online Delphi process followed by a final hybrid consensus conference. The German long version of the guideline was approved by the professional associations. For this English version an update of the systematic review was conducted until April 2024 and recommendation adapted based on new evidence in systematic reviews and randomized controlled trials. In total, 46 recommendations were developed and research gaps addressed. [ABSTRACT FROM AUTHOR]

Published
2024
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39. Therapy limitation in octogenarians in German intensive care units is associated with a longer length of stay and increased 30 days mortality: A prospective multicenter study

Author

Bruno, Raphael Romano, Wernly, Bernhard, Beil, Michael, Muessig, Johanna M., Rahmel, Tim, Graf, Tobias, Meybohm, Patrick, Schaller, Stefan J., Allgäuer, Sebastian, Franz, Marcus, Westphal, Julian Georg, Barth, Eberhard, Ebelt, Henning, Fuest, Kristina, Horacek, Michael, Schuster, Michael, Dubler, Simon, Schering, Stefan, Wolff, Georg, Steiner, Stephan, Rabe, Christian, Dieck, Thorben, Lauten, Alexander, Sacher, Anne Lena, Brenner, Thorsten, Bloos, Frank, Jánosi, Rolf A., Simon, Philipp, Utzolino, Stefan, Kelm, Malte, De Lange, Dylan W., Guidet, Bertrand, Flaatten, Hans, and Jung, Christian

Published
2020
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43. Influence of the initial level of consciousness on early, goal-directed mobilization: a post hoc analysis

Author

Schaller, Stefan J., Scheffenbichler, Flora T., Bose, Somnath, Mazwi, Nicole, Deng, Hao, Krebs, Franziska, and Seifert, Christian L.

Subjects
Medical colleges -- Analysis, Health care industry
Abstract

Purpose Early mobilization within 72 h of intensive care unit (ICU) admission improves functional status at hospital discharge. We aimed to assess the effectiveness of early, goal-directed mobilization in critically ill patients across a broad spectrum of initial consciousness levels. Methods Post hoc analysis of the international, randomized, controlled, outcome-assessor blinded SOMS trial conducted 2011-2015. Randomization was stratified according to the immediate post-injury Glasgow Coma Scale (GCS) ([less than or equal to] 8 or > 8). Patients received either SOMS-guided mobility treatment with a facilitator or standard care. We used general linear models to test the hypothesis that immediate post-randomization GCS modulates the intervention effects on functional independence at hospital discharge. Results Two hundred patients were included in the intention-to-treat analysis. The significant effect of early, goal-directed mobilization was consistent across levels of GCS without evidence of effect modification, for the primary outcome functional independence at hospital discharge (p = 0.53 for interaction), as well as average achieved mobility level during ICU stay (mean achieved SOMS level) and functional status at hospital discharge measured with the functional independence measure. In patients with low GCS, delay to first mobilization therapy was longer (0.7 ± 0.2 days vs. 0.2 ± 0.1 days, p = 0.008), but early, goal-directed mobilization compared with standard care significantly increased functional independence at hospital discharge in this subgroup of patients with immediate post-randomization GCS [less than or equal to] 8 (OR 3.67; 95% CI 1.02-13.14; p = 0.046). Conclusion This post hoc analysis of a randomized controlled trial suggests that early, goal-directed mobilization in patients with an impaired initial conscious state (GCS [less than or equal to] 8) is not harmful but effective., Author(s): Stefan J. Schaller [sup.1], Flora T. Scheffenbichler [sup.2], Somnath Bose [sup.3], Nicole Mazwi [sup.4], Hao Deng [sup.2], Franziska Krebs [sup.1], Christian L. Seifert [sup.5], George Kasotakis [sup.6], Stephanie D. [...]

Published
2019
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50. Phrenic nerve stimulation to prevent diaphragmatic dysfunction and ventilator-induced lung injury.

Author

Panelli, Alessandro, Verfuß, Michael A., Dres, Martin, Brochard, Laurent, and Schaller, Stefan J.

Subjects
PHRENIC nerve, NEURAL stimulation, LUNG volume measurements, LUNG injuries, RESPIRATORY muscles
Abstract

Side effects of mechanical ventilation, such as ventilator-induced diaphragmatic dysfunction (VIDD) and ventilator-induced lung injury (VILI), occur frequently in critically ill patients. Phrenic nerve stimulation (PNS) has been a valuable tool for diagnosing VIDD by assessing respiratory muscle strength in response to magnetic PNS. The detection of pathophysiologically reduced respiratory muscle strength is correlated with weaning failure, longer mechanical ventilation time, and mortality. Non-invasive electromagnetic PNS designed for diagnostic use is a reference technique that allows clinicians to measure transdiaphragm pressure as a surrogate parameter for diaphragm strength and functionality. This helps to identify diaphragm-related issues that may impact weaning readiness and respiratory support requirements, although lack of lung volume measurement poses a challenge to interpretation. In recent years, therapeutic PNS has been demonstrated as feasible and safe in lung-healthy and critically ill patients. Effects on critically ill patients' VIDD or diaphragm atrophy outcomes are the subject of ongoing research. The currently investigated application forms are diverse and vary from invasive to non-invasive and from electrical to (electro)magnetic PNS, with most data available for electrical stimulation. Increased inspiratory muscle strength and improved diaphragm activity (e.g., excursion, thickening fraction, and thickness) indicate the potential of the technique for beneficial effects on clinical outcomes as it has been successfully used in spinal cord injured patients. Concerning the potential for electrophrenic respiration, the data obtained with non-invasive electromagnetic PNS suggest that the induced diaphragmatic contractions result in airway pressure swings and tidal volumes remaining within the thresholds of lung-protective mechanical ventilation. PNS holds significant promise as a therapeutic intervention in the critical care setting, with potential applications for ameliorating VIDD and the ability for diaphragm training in a safe lung-protective spectrum, thereby possibly reducing the risk of VILI indirectly. Outcomes of such diaphragm training have not been sufficiently explored to date but offer the perspective for enhanced patient care and reducing weaning failure. Future research might focus on using PNS in combination with invasive and non-invasive assisted ventilation with automatic synchronisation and the modulation of PNS with spontaneous breathing efforts. Explorative approaches may investigate the feasibility of long-term electrophrenic ventilation as an alternative to positive pressure-based ventilation. [ABSTRACT FROM AUTHOR]

Published
2023
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