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1. Weaning from mechanical ventilation with high flow oxygen therapy via tracheal cannula

Author: Kristijan Skok, Jerneja Golub, Damjana Kunej, Andreja Sinkovič, and Andrej Markota
Subjects: intensive care medicine, ventilator weaning, high-flow oxygen therapy, tracheal cannula, nasal cannula, Medicine
Abstract: Introduction: Application of oxygen at high flows via nasal cannula can be used in patients with hypoxemic respiratory failure and to prevent reintubation. It is well tolerated by the patients and has been associated with lower mortality. However, there is very little data on the use of oxygen at high flows connected to tracheal cannula (HFOTC). Case presentation: We present two patients in whom weaning from mechanical ventilation was difficult and we decided to use HFOTC for weaning. Weaning from mechanical ventilation with HFOTC was successful in both patients and they tolerated long term (4 and 2 days, respectively) ventilatory support with HFOTC without adverse effects. Conclusions: HFOTC might be used during weaning from mechanical ventilation, however, more data is needed to determine the optimal use of this treatment option.
Published: 2021
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2. Point-of-care lactate testing in emergency room

Author: Darinka Purg, Andrej Markota, and Matej Berhardt
Subjects: point-of-care testing, triage, lactate, critically ill, Medicine
Abstract: Lactate is a product of anaerobic metabolism, which can be used to detect the critically ill. Rapid recognition, early appropriate treatment and control of treatment success are paramount in that population. Lactate levels need to be available as soon as possible if they are to be of assistance at the bedside. Point-of-care analyzers enable rapid determination of lactate. The role of point-of-care lactate analyzers in the treatment of the critically ill, different analysis techniques and limitations of point-of-care lactate analyzers are presented. The use of point-of-care lactate analyzers is demonstrated in two cases of patients with sepsis. The first patient is a 73-year-old female, where point-of-care lactate was determined immediately. Septic shock with multi-organ failure developed. She was successfully treated and discharged after 14 days to home care. The second patient is a 62-year old male, where elevated lactate was detected after three hours. The patient died after a total of 5 months of treatment in the intensive care unit. Lactate can be an important tool in early recognition and treatment of the critically ill.
Published: 2014

3. Comparison of point-of-care and laboratory troponin I assays

Author: Andrej Markota, Matej Bernhardt, and Miroslav Palfy
Subjects: Medicine
Abstract: BACKGROUND In recent years a number of pointof- care troponin assays have emerged. There have been reports of discrepancies between the results of point-of-care and laboratory assays. We sought to compare the results of point-ofcare and laboratory troponin I assays in patients with suspected acute coronary syndromes. METHODS A retrospective study was performed comparing the results of point-of-care (i-STAT cardiac troponin I test, Abbott Point of Care) and laboratory troponin I analysis in patients with suspected acute coronary syndrome treated in the Internal Medicine Emergency Department, University Medical Centre Maribor, between 23 November and 21 December 2010, who had blood samples drawn simultaneously for pointof- care and laboratory troponin I analysis. RESULTS 112 patients were included in the analysis. There was an agreement between the results of point-of-care and laboratory troponin analysis in 105 (93.8 %) patients. If we consider the laboratory results as »gold standard« (diagnosis was based on laboratory troponin results), then 6 (5.4 %) false negative results and 1 (0.9 %) false positive result were found (sensitivity 81.2 %, specificity 98.7 %). However, there was no statistically significant difference between point-of-care and laboratory troponin I analysis (p = 0.125). CONCLUSIONS We detected lower sensitivity of point-of-care assay, but there was no statistically significant difference between point-of-care and laboratory troponin I analysis. We adopted a strategy of using point-of-care troponin assay primarily in patients at high-risk for acute coronary syndrome without ST elevation.
Published: 2011

4. The Role of Environmental PM2.5 in Admission Acute Heart Failure in ST-Elevation Myocardial Infarction patients - An Observational Retrospective Study

Author: Manja Krasevec, Martin Marinšek, David Suran, Andreja Sinkovič, and Andrej Markota
Subjects: medicine.medical_specialty, Resuscitation, biology, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, International Journal of General Medicine, Retrospective cohort study, General Medicine, medicine.disease, Troponin, Internal medicine, Diabetes mellitus, Heart failure, biology.protein, medicine, Cardiology, Observational study, Myocardial infarction, business
Abstract: Andreja Sinkovic,1 Andrej Markota,1 Manja Krasevec,2 David Suran,3 Martin Marinsek1 1Department of Medical Intensive Care, University Clinical Centre Maribor, Maribor, Slovenia; 2Medical Faculty of University Maribor, Maribor, Slovenia; 3Department of Cardiology, University Clinical Centre Maribor, Maribor, SloveniaCorrespondence: Andreja SinkovicDepartment of Medical Intensive Care, University Clinical Centre Maribor, Ljubljanska 5, Maribor, 2000, SloveniaTel +38641337822Email andreja.sinkovic@guest.arnes.siBackground: Air pollution with increased concentrations of fine (< 2.5 Î¼m) particulate matter (PM2.5) increases the risk of cardiovascular morbidity and mortality. Even short-term increase of PM2.5 may help trigger ST-elevation myocardial infarction (STEMI) and heart failure (HF) in susceptible individuals, even in areas with good air quality.Purpose: To evaluate the role of PM2.5 levels â¥ 20 Î¼g/m3 in admission acute HF in STEMI patients.Materials and Methods: In 290 STEMI patients with the leading reperfusion strategy primary percutaneous coronary intervention (PPCI), we retrospectively studied independent predictors of admission acute HF and included admission demographic and clinical data as well as ambient PM2.5 levels â¥ 20 Î¼g/m3. We defined admission acute HF in STEMI patients as classes IIâIV by Killip Kimball classification.Results: Acute admission HF was observed in 34.5% of STEMI patients. PPCI was performed in 87.1% of acute admission HF patients and in 94.7% non-HF patients (p= 0.037). Significant independent predictors of acute admission HF were prior diabetes (OR 2.440, 95% CI 1.100 to 5.400, p=0.028), admission LBBB (OR 10.190, 95% CI 1.160 to 89.360, p=0.036), prior resuscitation (OR 2.530, 95% CI 1.010 to 6.340, p=0.048), admission troponin Iâ¥ 5Î¼g/l (OR 3.390, 95% CI 1.740 to 6.620, p< 0.001), admission eGFR levels (0.61, 95% CI 0.52 to 0.72, p < 0.001), and levels of PM2.5 â¥ 20 Î¼g/m3 (OR 2.140, 95% CI 1.005 to 4.560, p=0.049) one day before admission.Conclusion: Temporary short-term increase in PM2.5 levels (â¥ 20 Î¼g/m3) one day prior to admission in an area with mainly good air quality was among significant independent predictors of acute admission HF in STEMI patients.Keywords: admission acute heart failure, ST-elevation myocardial infarction, air pollution, PM2.5
Published: 2021
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5. Weaning from mechanical ventilation with high flow oxygen therapy via tracheal cannula

Author: Andreja Sinkovič, Kristijan Skok, Andrej Markota, Jerneja Golub, and Damjana Kunej
Subjects: Mechanical ventilation, high-flow oxygen therapy, business.industry, medicine.medical_treatment, lcsh:R, lcsh:Medicine, High flow oxygen, intensive care medicine, Cannula, nasal cannula, Anesthesia, medicine, ventilator weaning, Weaning, tracheal cannula, business
Abstract: Introduction: Application of oxygen at high flows via nasal cannula can be used in patients with hypoxemic respiratory failure and to prevent reintubation. It is well tolerated by the patients and has been associated with lower mortality. However, there is very little data on the use of oxygen at high flows connected to tracheal cannula (HFOTC). Case presentation: We present two patients in whom weaning from mechanical ventilation was difficult and we decided to use HFOTC for weaning. Weaning from mechanical ventilation with HFOTC was successful in both patients and they tolerated long term (4 and 2 days, respectively) ventilatory support with HFOTC without adverse effects. Conclusions: HFOTC might be used during weaning from mechanical ventilation, however, more data is needed to determine the optimal use of this treatment option.
Published: 2021
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6. Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study

Author: Peter Wright, Johan Herlitz, Leo Bossaert, Jan Wnent, Violetta Raffay, Vitor H Correia, Hajriz Alihodžić, Joséphine Escutnaire, Nikolaos I. Nikolaou, Scott J. Booth, Roman Burkart, Ari Salo, Jan-Thorsten Gräsner, Pierre Mols, Anatolij Truhlář, Grzegorz Cebula, Anneli Strömsöe, Siobhán Masterson, Mads Wissenberg, Diana Cimpoesu, Ingvild Tjelmeland, Irzal Hadžibegović, Bergthor Steinn Jonsson, Bernd W. Böttiger, Stefan Trenkler, Carlo Clarens, Gavin D. Perkins, Federico Semeraro, Rudolph W. Koster, Andrej Markota, Holger Maurer, Endre Nagy, Rolf Lefering, Marios Ioannides, Fernando Rossell-Ortiz, Maximilian Moertl, Steffie Beesems, Cardiology, ACS - Amsterdam Cardiovascular Sciences, and ACS - Heart failure & arrhythmias
Subjects: Emergency Medical Services, medicine.medical_specialty, Resuscitation, 030204 cardiovascular system & hematology, Emergency Nursing, Return of spontaneous circulation, Out of hospital cardiac arrest, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, Humans, Prospective Studies, Registries, Out-of-hospital cardiac arrest, Portugal, business.industry, Incidence (epidemiology), Public health, Bystander CPR, Outcome after OHCA, 030208 emergency & critical care medicine, medicine.disease, European registry of cardiac arrest, Cardiopulmonary Resuscitation, 3. Good health, Europe, Ventricular fibrillation, Emergency medicine, Emergency Medicine, Bystander cpr, Human medicine, Cardiology and Cardiovascular Medicine, business
Abstract: Background The epidemiology and outcome after out-of-hospital cardiac arrest (OHCA) varies across Europe. Following on from EuReCa ONE, the aim of this study was to further explore the incidence of and outcomes from OHCA in Europe and to improve understanding of the role of the bystander. Methods This prospective, multicentre study involved the collection of registry-based data over a three-month period (1st October 2017 to 31st December 2017). The core study dataset complied with the Utstein-style. Primary outcomes were return of spontaneous circulation (ROSC) and survival to hospital admission. Secondary outcome was survival to hospital discharge. Results All 28 countries provided data, covering a total population of 178,879,118. A total of 37,054 OHCA were confirmed, with CPR being started in 25,171 cases. The bystander cardiopulmonary resuscitation (CPR) rate ranged from 13% to 82% between countries (average: 58%). In one third of cases (33%) ROSC was achieved and 8% of patients were discharged from hospital alive. Survival to hospital discharge was higher in patients when a bystander performed CPR with ventilations, compared to compression-only CPR (14% vs. 8% respectively). Conclusion In addition to increasing our understanding of the role of bystander CPR within Europe, EuReCa TWO has confirmed large variation in OHCA incidence, characteristics and outcome, and highlighted the extent to which OHCA is a public health burden across Europe. Unexplained variation remains and the EuReCa network has a continuing role to play in improving the quality management of resuscitation. info:eu-repo/semantics/publishedVersion
Published: 2020
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7. Non-SARS-CoV-2 Coronavirus severe acute respiratory failure

Author: Andrej Markota and Ziga Kalamar
Subjects: Respiratory Distress Syndrome, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19, medicine.disease_cause, Virology, Anesthesiology and Pain Medicine, Humans, Medicine, Acute respiratory failure, Respiratory Insufficiency, business, Coronavirus
Published: 2022
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8. The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

Author: Alexei Birkun, Diana Cimpoesu, Enrico Baldi, Olympia Nikolaidou, Violetta Raffay, Julian Ganter, Martin Quinn, Remy Stieglis, Hajriz Alihodžić, Giuseppe Ristagno, Anneli Strömsöe, Ingvild Tjelmeland, Simone Savastano, Jan Wnent, Ari Salo, Fernando Rosell Ortiz, Bernd W. Böttiger, Carlo Clarens, Niccolò Grieco, Stefan Trenkler, Pierre Mols, Valentine Canon, Jan Thorsten Gräsner, Andrej Markota, Ruggero Cresta, HUS Emergency Medicine and Services, Anestesiologian yksikkö, Cardiology, Graduate School, ACS - Heart failure & arrhythmias, and ACS - Amsterdam Cardiovascular Sciences
Subjects: IMPACT, Population, Settore MED/41 - Anestesiologia, Legislation, 030204 cardiovascular system & hematology, legislation, Article, first responders, 03 medical and health sciences, 0302 clinical medicine, DISPATCH, out-of-hospital cardiac arrest (OHCA), medicine, PUBLIC-ACCESS DEFIBRILLATION, Cardiac and Cardiovascular Systems, education, Automated external defibrillator, education.field_of_study, OUTCOMES, Kardiologi, business.industry, HOSPITAL CARDIAC-ARREST, 030208 emergency & critical care medicine, General Medicine, Limiting, medicine.disease, Certificate, LAYPERSONS, COVERAGE, 3. Good health, Mapping system, 3121 General medicine, internal medicine and other clinical medicine, automated external defibrillator (AED) system, SURVIVAL, Medicine, RESUSCITATION COUNCIL GUIDELINES, Medical emergency, business, SYSTEM
Abstract: Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries. Methods: We performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival.
Published: 2021

9. To ventilate or not to ventilate during bystander CPR — A EuReCa TWO analysis

Author: Jan Wnent, Ingvild Tjelmeland, Rolf Lefering, Rudolph W. Koster, Holger Maurer, Siobhán Masterson, Johan Herlitz, Bernd W. Böttiger, Fernando Rosell Ortiz, Gavin D. Perkins, Leo Bossaert, Maximilian Moertl, Pierre Mols, Irzal Hadžibegović, Anatolij Truhlář, Ari Salo, Valentine Baert, Eniko Nagy, Grzegorz Cebula, Violetta Raffay, Stefan Trenkler, Andrej Markota, Anneli Strömsöe, Jan-Thorsten Gräsner, Hajriz Alihodžić, Marios Ioannides, Mads Wissenberg, Josephine Escutnaire, Nikolaos Nikolaou, Bergthor Steinn Jonsson, Peter Wright, Federico Semeraro, Carlo Clarens, Steffie Beesems, Vitor H. Correia, Diana Cimpoesu, Roman Burkart, Scott Booth, Michael Baubin, Adolf Schinnerl, Gerhard Prause, Thomas Tschoellitsch, Helmut Trimmel, Rene Belz, Wolfgang Fleischmann, Magali Bartiaux, Koenraad Monsieurs, Stephan Wilmin, Mathias Faniel, Marie Vanhove, Pascale Lievens, Dominique Biarent, Marc Van Nuffelen, Ives Hubloue, Jean-Marie Jacques, Michèle Yerna, Robert Leach, Mathieu Jeanmaire, Paule Denoël, Frank Van Trimpont, Francis Desmet, Louise Delhaye, Vincent Van Belleghem, Ken Dewitte, Musa Abbasi, Simon Scheyltjens, Olivier Vermylen, Diane de Longueville, Stéphane Debaize, Silvija Hunyadi Antičević, Slobodanka Keleuva, Milan Lazarević, Radmila Majhen Ujević, Gordana Antić Šego, Branka Bardak, Domagoj Mišković, Monika Praunová, Ondřej Franěk, Jaroslav Kratochvíl, Jan Přikryl, Roman Sýkora, Tomáš Vaňatka, Marek Vašák, Petr Jaššo, Petr Šmejkal, Otomar Kušička, Robin Šín, Eva Smržová, Dorián Pfeifer, Heini Harve-Rytsälä, Pamela Hiltunen, Peter Holmström, Timo Iirola, Katja Jokela, Hetti Kirves, Pekka Korvenoja, Markku Kuisma, Jukka Laine, Markus Lyyra, Sami Länkimäki, Petra Portaankorva, Lasse Raatiniemi, Marko Sainio, Piritta Setälä, Tuukka Toivonen, Jan Uotinen, Jukka Vaahersalo, Taneli Väyrynen, David Hamdan, Jean-Marc Agostinucci, Fabienne Branche, François Revaux, Sébastien Jonquet, Richard Loubert, Marion Boursier, Bruno Simonnet, Jean-Charles Morel, Steven Lagadec, Aurélie Avondo, Emilie Gelin, Emanuel Morel-Maréchal, Cécile Ursat, Laurent Villain-Coquet, Marc Fournier, Romain Tabary, Philippe Le Pimpec, Delphine Hugenschmitt, Diego Abarrategui, Romain Blondet, Aurélie Arnaud, Sonia Sadoune, Julien Segard, Sophie Narcisse, Mélanie Laot, Thomas Pernot, Hubert Courcoux, Coralie Chassin, Benoît Jardel, Jeanne Picart, Franck Garden Brèche, Pierre-Alban Guenier, Renaud Getti, Alexandre Jeziorny, Antoine Leroy, Carine Vanderstraeten, Sébastien Dussoulier, Attila Haja, Dániel Németh, Andrea Válint, Gábor Csató, Gerda Lóczi, Péter Vörös, Zsuzsanna Németh, Ferenc Molnár, Ferenc Nagy, Henrietta Kádár, Julia Duda, Justyna Tęczar, Sylwia Dul, Grażyna Świtacz, Andrzej Raczynski, Zlatko Fiser, Zlatko Babic, Aleksandra Opacic, Kornelija Jaksic Horvat, Snezana Vukelic, Jelena Tijanic, Dusan Milenkovic, Sasa Milic, Deze Babinski, Cedomir Boskovic, Jovanka Koprivica, Erika Terek, Goran Provci, Dragana Jovic Zvijer, Ľubica Bajerovská, Miroslav Chabroň, Danka Pražienková, Renáta Kratochvílová, Radoslav Burian, Martin Dobrík, Juraj Patráš, Vladimír Šteflík, Peter Androvič, František Mičáň, Božena Horáňová, Július Pavčo, Monika Grochová, Táňa Bulíková, Rok Maček, Matej Rubelli Furman, Samo Podhostnik, Miha Oman, Klemen Lipovšek, Špela Baznik, Jurica Ferenčina, Matej Strnad, Edith Žižek, Miha Kodela, Alenka Antolinc Košat, Nina Lotrič, Jonny Lindqvist, Remy Stieglis, Anja Radstok, Cardiology, ACS - Heart failure & arrhythmias, Graduate School, ACS - Amsterdam Cardiovascular Sciences, EuReCa TWO, Supporting clinical sciences, and Emergency Medicine
Subjects: Emergency Medical Services, Resuscitation, medicine.medical_specialty, Chest-compression only CPR, medicine.medical_treatment, EuReCa, Subgroup analysis, 030204 cardiovascular system & hematology, Emergency Nursing, Return of spontaneous circulation, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Full CPR, medicine, Humans, Registries, Cardiopulmonary resuscitation, Survival rate, Out-of-hospital cardiac arrest, business.industry, Bystander CPR, 030208 emergency & critical care medicine, Odds ratio, Cardiopulmonary Resuscitation, Ventilation, Confidence interval, 3. Good health, Survival Rate, Emergency medicine, Emergency Medicine, Bystander cpr, Human medicine, Cardiology and Cardiovascular Medicine, business
Abstract: Background Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR). Method In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed. Results A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17–1.83). Conclusion In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both.
Published: 2021

10. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Author: Labeau, Sonia O, Afonso, Elsa, Benbenishty, Julie, Blackwood, Bronagh, Boulanger, Carole, Brett, Stephen J, Calvino-Gunther, Silvia, Chaboyer, Wendy, Coyer, Fiona, Deschepper, Mieke, François, Guy, Honore, Patrick M, Jankovic, Radmilo, Khanna, Ashish K, Llaurado-Serra, Mireia, Lin, Frances, Rose, Louise, Rubulotta, Francesca, Saager, Leif, Williams, Ged, Blot, Stijn I, Dritan, Muzha, Antoni Margarit Ribas, Fernando, Lipovesty, Cecilia, Loudet, Fiona, Coyer, Philipp, Eller, Nafseen, Mostafa, Patrick, M Honoré, Vanesa Mercado Telleria, Jasmina, Smajic, Paula Cristina Nogueira, Khalid Mahmood Khan Nafees, Romuald, Hentchoya, Louise, Rose, Javiera, Soledad, Frances, Lin, Yenny, Cardenas, Amylkar Garay Reyes, Alan, Sustic, Meropi, Mpouzika, Tamas, Vymazal, Hanne Irene Jensen, Hernan, Aguirre-Bermeo, Liivi, Maddison, Maija, Valta, Silvia, Calvino-Gunther, Frank, Bloos, Faustina Excel Adipa, Vasilios, Koulouras, Judy, Enamorado, Zsuzsann, Ágoston, Hrönn, Birgisdóttir, Amit, Gupta, Mohan, Gurjar, Bram, Kilapong, Seyed Mohammadreza Hashemian, Ignacio, Martin-Loeches, Julie, Benbenishty, Andrea, Cortegiani, Kelly, Fletcher, Yoshiro, Hayashi, Wangari, Waweru-Siika, Khalid, Abidi, Sang-Min, Lee, Burhan, Hadri, Mihails, Dolgusevs, Fayez François Abillama, Tomas, Jovaisa, Cyril, Thix, Muhammed, Elhadi, Basri Mat Nor, Shanti, Ratnam, Mohd Zulfakar Mazlan, Sundaresan, Maiyalagan, Luis, Sánchez-Hurtado, Adrian, Belii, Mendsaikhan, Naranpurev, Prabha, Gautam, Dylan De Lange, Rachael, Parke, Rose Ekama Ilesanmi, Mirjana, Shosholcheva, Antonija, Petosic, Ranveig, Lind, Madiha Hashmi Ffarcsi, Javier, Bogarin, Aaron Mark Hernandez, Malgorzata, Mikaszewska-Sokolewicz, Bruno, Sousa, Dana, Tomescu, Dorel, Sandesc, Theogene, Twagirumugabe, Vitaly, Gusarov, Maie, Ebaid, Radmilo, Jankovic, Gari, Slobodianiuk, Andrea, Martonova, Rihard, Knafelj, Mervyn, Mer, Emilio, Maseda, Bernardo, Panka, Joerg, C Schefold, Eva, Joelsson-Alm, Konlawij, Trongtrakul, Lorna, Merritt-Charles, Lamia Ouanes Besbes, Yalım, Dikmen, Lesia, Zgrzheblovska, Mark, Fielding, Francesca, Rubulotta, Ashish, K Khanna, Leif, Saager, Ingrid von der Osten, Alban, Greca, Alma, Cani, Nordian, Xhindi, Genci, Hyska, Antonio Margarit Ribas, Susana, Pinto, Paulo, Alves, Romina, Esposito, Emanuel, Valgolio, John Thomas Sanchez Minope, Antonio, Abdala, Maria, Ayala, Silvina, Bravo, Ana, Bantar, Patricia, Delgado, Gustavo, Badariotti, Fernando, Lipovestky, Ana, Diaz, Pablo, Saul, Mariano, Setten, Alejandra, Aucapina, Ysica, Acosta, Victor, Gonzalez, Luis, Camputaro, Fernando, Baccaro, Robert, Villa, Marcela, Mastantuono, Emiliano, Dean, Oscar Fernández Rostello, Patricia, Brizuela, Julio Ricardo Bartoli, Matias, Guereschi, Cristian, Quiroga, Sofia, Putruele, Paula, Villegas, Veronica, Curilen, Ruben, Fernandez, Mariangeles Gabriela Nocheretti, Rosana Gabriela Escalante, Cecilia Inés Loudet, Silvia, Fernandez, Ana Laura Gonzalez, Gustavo Andres Alvarez, Federico, Iglesias, Silvia, Chaparro, Graciela, Zakalik, Gonzalo, Pagella, Matías, Baini, Pierina Arias Campos, Ignacio, Sabbag, Armando, Schmukler, Imelda Perdomo Fonseca, Gonzalo Martín Alvarez, Mario, Ramirez, Fernando, Tapia, Carlos Alejandro Bascary, Graciela Del Valle Gimenez, Fernando Pablo Bertoletti, Esteban, Milioto, Pablo Julio Maldonaldo Bonsignore, Maria Alejandra Fernandez, Julie, Smith, Tim, Chimunda, Lorraine, Thompson, Teena, Maguire, Wendy, Chaboyer, Stacey, Watts, Marion, Mitchell, Madeleine, Powell, India, Lye, Leanne, Parsons, Nerilee, Baker, Claire, Reynolds, Amy, Thompson, Kristy, Masters, Kellie, Sosnowski, Lynette, Morrison, Gavin, D Leslie, Ramanathan, Lakshmanan, Alexis, Tabah, Wendy, Brown, Sharon, McDowell-Skaines, Andrea, Mclucas, Chris, Smith, Mandy, Tallot, Sarah, Jones, Michelle, Barakat-Johnson, Thomas, Leong, Rand, Butcher, Kerrie, Martin, Philipp, Douschan, Dirk von Lewinski, René, Schmutz, Uta, Kolussi, Fatema, Salman, Zainab, Ateya, Koen De Decker, Niels Van Regenmortel, Anita, Jans, Patricia, Wijnands, Stefano, Coremans, Patrick, M Honore, David De Bels, Tanja, Depuydt, Caroline, Paillet, Luc-Marie, Jacquet, Walter, Swinnen, Francis, Hannes, Matthia, Mergeay, Stijn Van de Velde, Silvie, Allaert, Pieter, Hoste, Christophe, Borin, Sandrine, Balon, Vincent, Fraipont, Patrick, Biston, Nicolas De Schryver, Thierry, Dugernier, Ilse Van Cotthem, Angelica Olivetto de Almeida, Silvia Angelica Jorge, Delmiro, Becker, Raysa Cristina Schmidt, Evellyn, Oliveira, Aline, Ramalho, Eliane, Mazocoli, Audrey, Fioretti, Elaine, Barros, Leticia, Serpa, Suzana, Bianchini, Ticiane, Campanili, Taís, Pantaleao, Paulo Carlos Garcia, Ana Lucia Vitti Ronchini, Rayanne, Santos, Nurulhuda Binti, A Manap, Sean, Bagshaw, Dominic, Carney, Jon, Davidow, Ella, Rokosh, Andréa Maria Laizner, Samantha, Smith, Megan, Mcquirter, Betty Star Kampayana, René, Favre, Martin, Sills, Julie, Dallaire, Cathy, Becker, Sherissa, Microys, Bonnie, Bowes, Jennifer, Lajeunesse, Rishi, Ghosh, Jacqueline, Baptiste-Savoie, Rose, Raizman, Gabriel, Suen, Noushin, Taghavi, Orla, Smith, Clare, Fielding, Julieta, Canales, Pia, Molina, Javiera, Chaparro, Maria Idalia Sepulveda, Matias Jesús Flamm Zamorano, Pamela, Rocha, Ximena, Villanueva, Paola, Araya, Meneses, Dayan, Fernando, Avalos, Xiaohan, Li, Liu, Yu, Xinxia, Li, Xiaoyan, Chen, Zhixia, Jiang, Jing, Yang, Jingfang, Chen, Lei, Yang, Kefang, Wang, Jie, Gao, Xiuhua, Fang, Ronghua, Zhao, Xinhua, Xia, Hongmei, Liu, Jing, Li, Haiyan, Wang, Gen, Meng, Yanhong, Di, Damei, Wang, Rong Hua Zhao, Li Ping Hu, Peipei, Xu, Qing Feng Jiao, Hai Yun Wang, Chun Jie Xia, Yan, Liu, Mei, Ye, Yan, Wan, Wenmei, Wang, Yajun, Ding, Aiua, Ren, Yan, Gao, Qi, Li, Guifang, Du, Yanling, Shen, Yanming, Ding, Ning, Li, Cui, Yuan, Lei, Tan, Qiang, Lin, Hailing, Guo, Howe, Yan, Xiao, Xu, Wei, Zhang, Jinxian, Liang, Libing, Zhang, Eryun, Tian, Qian, Zhao, Lin, Insu, Jingwen, Dong, Yanmei, Gu, Ying, Liu, Lina, Zhao, Wei, Wang, Hongmei, Qiao, Lili, Tuo, Mengmeng, Lv, Jin Yu Zhu, Jifen, Zhu, Ying, 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Slobodianiuk, Daria, Rabarova, Danca, Lančaričová, Janko, Vlaovic, Matjaž, Groznik, Milica, Lukic, Janja, Perme, Maja, Sostaric, Nejc, Umek, Tomislav, Mirkovic, Simon, Dolenc, Misa, Fister, Nika, Zorko, Andrej, Markota, Nomhle Princess Yeni, Phumele, Jali, Shelley, Schmollgruber, Muhommed Ridwaan Syed, Nivisha, Parag, Robert, Wise, Maria, Galiana, José Alejandro Navarro, Ana María De Pablo, Patricia, Albert, Pilar, Martinez, Yolanda, Mendiara, Barbara, Garcia, Ana Alabart Llinas, Marilyn, Riveiro, Elisabet, Gallart, Alba, Riera, Miquel, Sanz, Swagotika, Salo, Miguel Angel Gimenez Lajara, Montserrat Venturas Nieto, Rosa, Garcia, José Manuel Garcia Pena, Maria Carmen Gorgolas, Maria Aranzazu Isasi, Rafael, Sierra, Federico, Gordo, Isabel, Conejo, Vicent, Salvà-Costa, Carolina, Garzón-Tovar, Sara, Lospitao, Rafael, Gonzalez, Pedro, Gutierrez, Mercè, Girona, Jordi, Adamuz, Pablo Garcia Olivares, José Peral Gutierrez de Ceballos, Celia, Tirado, Irene De Wit, Ana Belén Curto Polo, Maria Del 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A.S., Goller, S., Afonso, E., Larina, E., Labeau, Sonia O. 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P., Hughes J., Balasubramanian M., Salberg A., Saha R., Holmquist D., Derbyshire C., Smith N., Stones E., Ademokun J., Legorburo M.S., North S., Brett C., Jaundoo H., Craig J., Whiteley S., Howcroft C., Wilby L., Delve P., Shaw D., Williams K., Welters I.D., McMullen J., Brett S., Flores L., Trueman-Dawkins T., Templeton M., Adams J., Prowle J., Byers H., McDonnell A., Rose B.O., Reece-Anthony R., Mendes L., Vizcaychipi M., Bull R., Lacaden G., Santiago E., Delgado C.C., Farnell-Ward S., Thorpe E., Somerville J., Williams A., Cummings D., Derrick H., Brumwell S., Randell C., McCann N., Aves E., Berry G., Szakmany T., Gunter U., Pulak P., Sarkar N., Wright K., Gomes V., Jones J., Palfrey R., Camsooksai J., Lewis A., Eneas A., Tridente A., Barr L., Thomas B., Parkin E., Horner D., Frey C., Bench S., Baumber R., Broadhurst P., Jackson M., Williams L., Clark M., Paddle J., Bean S., Buckley S., Palfreeman C., Liu S., Allison N., Attwood B., Parsons P., Houghton V., Turner S.J., Higgins D., Bielskute E., Horrigan N., Jacob R., Habgood K., Zaki A., Collins A., Lord J., Ramiro C., Kubisz-Pudelko A., Kotze M., Williams H., Iovenko I., Tsarev A., Briva A., Mendez G., Napolitano L., Teig M., Rodriguez G.E., Ben-Jacob T., Potestio C., Eng T., Mahanes D., Khanna A., Duggal A., Nananmori M., Lois M., Karamchandani K., Bealer C., Barefield C., Terry D., Fivecoat P., Idowu O., Cata J., Clesi T., Peterson J., Hatton K., Dhaliwal J., Mueller D., Tao J., Eltorai A.S., Pastores S.M., Remor N., Salazar J., Barkas D., Joffe A., Barnes C., Sona C., Schallom M., Short J., Lorenzo J., Von Der Osten I., Borkowska M., Demarre L., Pleitinckx V., Xing C., Debue A.-S., Goller S., Larina E., Labeau, S. O., Blackwood, B., Brett, S. J., Deschepper, M., Francois, G., Honore, P. M., Khanna, A. K., Williams, G., Blot, S. I., Ribas, A. M., Telleria, V. M., Nogueira, P. C., Nafees, K. M. K., Reyes, A. G., Jensen, H. I., Adipa, F. E., Agoston, Z., Hashemian, S. M., Lee, S. -M., Abillama, F. F., Nor, B. M., Mazlan, M. Z., Sanchez-Hurtado, L., De lange, D., Ilesanmi, R. E., Ffarcsi, M. H., Hernandez, A. M., Schefold, J. C., Besbes, L. O., Minope, J. T. S., Rostello, O. F., Bartoli, J. R., Nocheretti, M. G., Escalante, R. G., Loudet, C. I., Gonzalez, A. L., Alvarez, G. A., Campos, P. A., Fonseca, I. P., Alvarez, G. M., Bascary, C. A., del Valle Gimenez, G., Bertoletti, F. P., Bonsignore, P. J. M., Fernandez, M. A., Leslie, G. D., Mclucas, A., Jacquet, L. -M., de Almeida, A. O., Jorge, S. A., Schmidt, R. C., Garcia, P. C., Ronchini, A. L. V., Manap, N. B. A., Laizner, A. M., Mcquirter, M., Kampayana, B. S., Sepulveda, M. I., Zamorano, M. J. F., Zhao, R. H., Hu, L. P., Jiao, Q. F., Wang, H. Y., Xia, C. J., Insu, L., Zhu, J. Y., Zhu, J. F., Huang, R. F., Wang, L. L., Song, J. H., Liu, X. M., Li, Z. S., Li, L. C., Zeng, J. M., Hu, X. C., Wang, R. X., Tak, P. S., Ho, S. W., Jiang, Q. X., Huang, L. P., Liu, X. L., Jiang, J. H., Gong, Y. Y., Lei, D. H., Bi, A. P., Zhao, H. M., Cao, Z. Q., Wu, S. F., Tian, X. F., Feng, Z. X., Liu, X. Z., Jiang, Z. X., Wang, G. X., Hu, R. L., Li, X. Q., Yu, Z. J., Yang, Y. X., Gama, L. M. S., Hernandez, J. S., Ochoa, M. -E., Reyes, A. J. G., Filipovic-Grcic, I., Vukovic, A., Pecenkovic, S., Suput, A., Radivojevic, R. C., Culjak, H., Adam, V. N., Pedersen, K. R., Kjaergard, I. E., Kodal, A. M., Hansen, T. C. B., Pedersen, A. S. B., Thomsen, T. D., Frandsen, T. M., Bliksted, I. A., Tamayo, L. M., Tutillo, D. R. M., Hurtado, C. V., Garcia, M. F., Kutimets, M., Lofqvist, C., Sakki, J. -K., Valta, M. A., Plantefeve, G., Deserts, M. D., Gunther, S. C., Timsit, J. -F., Farkas, J. -C., Bosl, K., Schuppel, S., Stubner, A., Osei, I. P., Kusi-Appiah, A. -C., Yakubu, Y. H., Patsiou, E. -C., Stalika, K. M. M., Enamorado, J. E., Jonasdottir, R. J., Lestari, M. I., Finn, D. O. C. R., Mcpherson, S., Ghioldi, D. M., Bruno, A. V., Maggiore, S. M., Volta, C. A., Taibi, M. R., Tranello, F. P., Giusti, G. D., Martin, M. A., Correia, M. C., Kim, J. H., Kim, K. C., Bae, J. -M., Park, S. Y., Park, T. S., Lee, H. B., Kim, S. C., Chee, H. K., Huh, J. W., Sim, Y. S., Ahn, J. -J., Kang, B. J., Lee, W. -Y., Lee, S. J., Feghaly, M. E., Belkhair, W. A., Tababa, O. W. E., Alkhumsi, S. I. R., Alshrif, A. I., Aboufray, A. A., Triki, A. R., Zahra, H. B., Al-Alawi, M. M. S., Ghula, M. A. A., Bahrin, L. K. K., Deva, S. R., Rahim, A. H. A., Hassan, W. N. W., Ismail, W. N. W., Ali, M. N., Khoo, T. M., Samat, N. M., Tong, J. M. G., Adib, N. A. N., Nor, M. B. M., Sulaiman, S. R., Foong, K. W., Hua, N. P., Zermeno, J. M., Nava, C. L. L., Nandyelly, S. J. R., Sanchez-Hurtado, L. A., Nava, L. P. A., Herrera, J. G., de Anda, G. F. V., Namendys-Silva, S. A., Romero-Gonzalez, J. P., Sosa, M. A., de Molina Serrano, J. I. R., Iburrigarro, S. R., Padilla, N. R. C., Pineda, A. A. V., Villafuerte, M. V. E., Herrera, M. O. G., Subedi, N. B., Pathak, S. D., Vermeijden, J. W., Gerritsen, R. T., Fijen, J. -W., Adejumo, P. O., Sankey, B. J., Olsen, B. F., Jensen, K. D., Johansen, B. F., Finnstrom, I. J., Skorstad, E. M., Lunde, G. A., Akselsen, G. R., Monstad, K. R., Hogvall, L., Malmin, S. K., Andersen, M. H., Hargott, R. F., de Jesus Ortiz, A., Cabral, D. M. B., Rivas, J. C., Moreira, M. L., Ellazar, C. G., Cerezo, F. D., Palo, J. E., Aperocho, C. A. J., Figueiredo, M. F., Pinheiro, C. M., Rita, C. S., Feranandes, A. M., Pinto, V. M. V., Bispo, B. M., Lima, A., Alsheikhly, A. S., Guran, C. T., Filipescu, D. C., Scutariu, M. A., Ebaid, M. S., Velickovic, D., Rajkovic, M., Stanojevic, M., Turcan, A., Lancaricova, D., Yeni, N. P., Syed, M. R., Navarro, J. A., De Pablo, A. M., Llinas, A. A., Lajara, M. A. G., Nieto, M. V., Pena, J. M. G., Gorgolas, M. C., Isasi, M. A., Salva-Costa, V., Garzon-Tovar, C., Olivares, P. G., de Ceballos, J. P. G., Polo, A. B. C., del Mar Diaz Salcedo, M., Alvarez, J. D., Arcas, M. L. B., Gonzalez, J. I. T., de la Ventana, A. B. S., Calleja, P. L. -A., Alvarez, R. G., Zamora, P. S., Guerrero, A. O., Barreiro, E. M., Sanchez, L. C., Diaz, M. G., Muriel, D. S., Alonso, H. F., Fernandez, A. W., Pinan, I. S., Albaiceta, G. M., Fernandez, M. C. I., Abos, F. J. S., Chueca, R. M., Aguirre, L. G., Manosa, S. C., Luque, C. P., Losilla, M. R., Fores, M. T., del Rosario Villar Redondo, M., Arteta Arteta, D. S., Sanchez, M. A. H., Espinosa, C. P., Reyes, L. M., Domenech, L. C., Guillen, C. V., Alvarez, J. T., del Cotillo, M., Barrueco-Francioni, J. E., Conde, B. B., Blanco, M. P. S., Blasco, M. L., Clement, A. I., Sanz, L. C., Gonzalez, I. A., Cano, A. E., Nunez, C. R., Fernadez, I. L., Fernandez, A. A. M., Boedjawan, N. N., Jansson, E. B., Malvemyr, A. -S., Lof, G., Spangfors, M., Lagerhall, C., Akerman, E., Hellkvist, V. H., Larsson, I. -M., Jong, M. L., Hsu, M. Y., Chang, S. C., Mebazaa, M. S., Elhechmi, Y. Z., Kuscu, O. O., Dal, H. C., Calili, D. K., Izdes, S., Gumus, A., Tasdemir, B., Kagnici, A., Ay, S. A., Balbay, A. O., Ozserezli, B., Senturk, E., Serin, S. O., Gul, F., Cinel, I., Undar, H. N., Bayraktar, Y. S., Celik, J. B., Tokur, M. E., Aydin, D. T., Yildiz, I., Ozcan, B., Akdag, D., Unlu, N., Reyes, P. E., Ahmad, F. K. E., Smiley, K. A., Miller, M. T., Antonio, M. G. S., Qawasmeh, K. A., Shawish, S. A., Groba, C. B., Raj, A. S., Ei, P. P., Legorburo, M. S., Welters, I. D., Mcmullen, J., Mcdonnell, A., Rose, B. O., Delgado, C. C., Mccann, N., Turner, S. J., Rodriguez, G. E., Eltorai, A. S., Pastores, S. M., Demarre, L., and Debue, A. -S.
Subjects: Male, Original, medicine.medical_treatment, artificial, Critical Care and Intensive Care Medicine, Medical and Health Sciences, Pressure ulcer, law.invention, Decubitus epidemiology, ICU, Morbidity, Mortality, Outcome, Pressure injury, Risk factors, Adult, Aged, Hospital Mortality, Humans, Patient Discharge, Prevalence, Risk Factors, Intensive Care Units, Respiration, Artificial, 0302 clinical medicine, decubitus epidemiology, pressure injury, pressure ulcer, outcome, risk factors, morbidity, mortality, law, Medicine and Health Sciences, adults, Medicine, Simplified Acute Physiology Score, icu, ziekenhuissterfte, Immunodeficiency, intensive care, European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators, mannen, volwassenen, COST, Intensive care unit, STATE, ULCERS, Underweight, medicine.symptom, Life Sciences & Biomedicine, Human, medicine.medical_specialty, risicofactoren, Decubitus epidemiology, ICU, Pressure injury, Pressure ulcer, Outcome, Risk factors, Morbidity, Mortality, pressure injuries, Intensive Care Unit, prevalentie, NO, 1117 Public Health and Health Services, DecubICUs Study Team, 03 medical and health sciences, Critical Care Medicine, Anesthesiology, General & Internal Medicine, Health Sciences, ouderen, Mechanical ventilation, Science & Technology, business.industry, decubitus, Risk Factor, 030208 emergency & critical care medicine, 1103 Clinical Sciences, Odds ratio, medicine.disease, Emergency & Critical Care Medicine, Confidence interval, 030228 respiratory system, Emergency medicine, kunstmatige ademhaling, RISK-FACTORS, business, respiration
Abstract: Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347, Funder: Flemish Society for Critical Care Nurses, Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.
Published: 2021
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11. Inhaled isoflurane via the anaesthetic conserving device versus propofol for sedation of invasively ventilated patients in intensive care units in Germany and Slovenia: an open-label, phase 3, randomised controlled, non-inferiority trial

Author: Andreas Meiser, Thomas Volk, Jan Wallenborn, Ulf Guenther, Tobias Becher, Hendrik Bracht, Konrad Schwarzkopf, Rihard Knafelj, Andreas Faltlhauser, Serge C Thal, Jens Soukup, Patrick Kellner, Matthias Drüner, Heike Vogelsang, Martin Bellgardt, Peter Sackey, Eberhard Barth, Berthold Bein, Paul Biever, Ralph Bogdanski, Sebastian Brandt, Anreas Faltlhauser, Arnim Geise, Adrian Iustin Georgevici, Philipp Gude, Uwe Hamsen, Christian Hönemann, Kerstin Kellner, Azzeddine Kermad, Klaus Kogelmann, Rainer Kram, Andrej Markota, Werner Meermeier, Matej Podbregar, Patrick Schramm, Matthias Schroeder, Christian Waydhas, Norbert Weiler, and Richard Wetzold
Subjects: Pulmonary and Respiratory Medicine, Adult, Sedation, Population, Slovenia, law.invention, law, Intensive care, Germany, Clinical endpoint, Medicine, Humans, Hypnotics and Sedatives, Prospective Studies, education, Prospective cohort study, Propofol, Anesthetics, education.field_of_study, Isoflurane, business.industry, Intensive care unit, Respiration, Artificial, Intensive Care Units, Anesthesia, medicine.symptom, business, medicine.drug
Abstract: Summary Background Previous studies indicate that isoflurane could be useful for the sedation of patients in the intensive care unit (ICU), but prospective studies evaluating isoflurane's efficacy have been small. The aim of this study was to test whether the sedation with isoflurane was non-inferior to sedation with propofol. Methods This phase 3, randomised, controlled, open-label non-inferiority trial evaluated the efficacy and safety of up to 54 h of isoflurane compared with propofol in adults (aged ≥18 years) who were invasively ventilated in ICUs in Germany (21 sites) and Slovenia (three sites). Patients were randomly assigned (1:1) to isoflurane inhalation via the Sedaconda anaesthetic conserving device (ACD; Sedana Medical AB, Danderyd, Sweden; ACD-L [dead space 100 mL] or ACD-S [dead space 50 mL]) or intravenous propofol infusion (20 mg/mL) for 48 h (range 42–54) using permuted block randomisation with a centralised electronic randomisation system. The primary endpoint was percentage of time in Richmond Agitation–Sedation Scale (RASS) range –1 to –4, assessed in eligible participants with at least 12 h sedation (the per-protocol population), five or more RASS measurements, and no major protocol violations, with a non-inferiority margin of 15%. Key secondary endpoints were opioid requirements, spontaneous breathing, time to wake-up and extubation, and adverse events. Safety was assessed in all patients who received at least one dose. The trial is complete and registered with EudraCT, 2016–004551–67. Findings Between July 2, 2017, and Jan 12, 2020, 338 patients were enrolled and 301 (89%) were randomly assigned to isoflurane (n=150) or propofol (n=151). 146 patients (97%) in each group completed the 24-h follow-up. 146 (97%) patients in the isoflurane group and 148 (98%) of patients in the propofol group were included in the per-protocol analysis of the primary endpoint. Least-squares mean percentage of time in RASS target range was 90·7% (95% CI 86·8–94·6) for isoflurane and 91·1% (87·2–95·1) for propofol. With isoflurane sedation, opioid dose intensity was 29% lower than with propofol for the overall sedation period (0·22 [0·12–0·34] vs 0·32 [0·21–0·42] mg/kg per h morphine equivalent dose, p=0·0036) and spontaneous breathing was more frequent on day 1 (odds ratio [OR] 1·72 [1·12–2·64], generalised mixed linear model p=0·013, with estimated rates of 50% of observations with isoflurane vs 37% with propofol). Extubation times were short and median wake-up was significantly faster after isoflurane on day 2 (20 min [IQR 10–30] vs 30 min [11–120]; Cox regression p=0·0011). The most common adverse events by treatment group (isoflurane vs propofol) were: hypertension (ten [7%] of 150 vs two [1%] of 151), delirium (eight [5%] vs seven [5%]), oliguria (seven [5%] vs six [4%]), and atrial fibrillation (five [3%] vs four [3%]). Interpretation These results support the use of isoflurane in invasively ventilated patients who have a clinical need for sedation. Funding Sedana Medical AB.
Published: 2021

12. Temperature management and its role in cardiac arrest patients—a review

Author: Kristijan Skok, Maja Duh, Andrej Markota, and Marko Gosak
Subjects: medicine.medical_specialty, Resuscitation, business.industry, medicine.medical_treatment, Targeted temperature management, Thermoregulation, Hypothermia, Out of hospital cardiac arrest, Thermoregulatory system, Temperature homeostasis, medicine, medicine.symptom, Intensive care medicine, business, Pathological
Abstract: Thermoregulation constitutes one of the most important homeostatic systems of the human body. The human thermoregulatory system is highly complex and intertwined with other regulatory homeostatic systems. Different evolutionary adaptations have evolved to ensure a well-regulated body temperature, encompassing simple behavioural (e.g., seeking shelter, going underground) as well as physiological changes (e.g., vasodilatation, sweating). However, when the heat, cold or other stimuli cause a disruption in the thermoregulatory state and our adaptations can no longer cope with the additional stress, the body enters a pathological state. In such instances other measures must be undertaken. In medicine there are several pathological states associated with disruptions in temperature homeostasis. Consequently, these patients have to be, in broad terms, thermoregulated. Speaking specifically, the most common application of thermoregulation is therapeutic temperature management. A prominent example is the utilisation of this technique in post-cardiac arrest patients, who remain comatose after resuscitation. This technique has been in use for almost 20 years since the first major reports on its benefits in improving out-of-hospital cardiac arrest and in-hospital cardiac arrest survival as well as improving neurological outcome. Recently, the findings from one of the biggest targeted temperature international and multicentre trials to date have been published (TTM2 trial; https://ttm2trial.org/). The study surprisingly showed no difference in mortality between patients after out of hospital cardiac arrest, who underwent normo- or hypothermia. Consequently, we might need to re-evaluate certain guidelines, recommendations, and perspectives. The aim of the current review is to present an overview of targeted temperature management in the field of intensive care medicine and cardiac arrest.
Published: 2021
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13. Tissue adhesives for peripheral intravenous catheter securement: A prospective randomized controlled pilot trial

Author: Andrej Markota, Sandi Žumer, Urška Fekonja, Marko Majhenič, Matevž Toplak, Žarko Mišanović, Anja Podstenšek, Mario Gorenjak, Amadeus Lešnik, and Valerija Zorčič
Subjects: Male, medicine.medical_specialty, Randomization, Peripheral intravenous, Pilot Projects, Tertiary Care Centers, 03 medical and health sciences, 0302 clinical medicine, Catheters, Indwelling, Catheterization, Peripheral, medicine, Humans, Prospective Studies, Aged, business.industry, Tissue adhesives, Pilot trial, 030208 emergency & critical care medicine, General Medicine, Emergency department, Cannula, Bandages, Surgery, Occlusive dressing, Catheter, Emergency Medicine, Female, Tissue Adhesives, business, Emergency Service, Hospital
Abstract: Background In some patients securing the peripheral intravenous cannula (PIVC) with a standard adhesive dressing can be difficult because of sweat or other body fluids. The aim of our study was to evaluate the use of tissue adhesives alone as a means to secure PIVCs inserted in the emergency department. Methods We performed a prospective interventional pilot study from November 2019 to May 2020 in a medical emergency department of an urban tertiary hospital. Patients were randomized to two groups: tissue adhesives (TA) or adhesive dressing (AD) group. After randomization we followed them until day 4. Results There were no significant differences between TA and AD groups in the rate of unplanned removal of PIVCs in the first 72 h (57.1% vs. 45.8%, p = 0.29), the rate of unplanned removal of PIVCs in the ED (0% vs. 2.1%, p = 1.00), the rate of unplanned removal of PIVC in the first 24 h (42.8% vs. 35.4%, p = 0.52), as well as in the rate of phlebitis (7.1% vs. 14.6%, p = 0.34) and the rate of any blood-stream infection (0% vs. 0%, p = 1.00). Conclusion We did not observe any significant differences when PIVCs inserted in the emergency department were secured with tissue adhesives alone, compared to standard adhesive dressings. We observed a high rate of unplanned removal of PIVCs, necessitating further research to determine more reliable ways of securing PIVCs.
Published: 2020

14. Thermoregulation: A journey from physiology to computational models and the intensive care unit

Author: Marko Gosak, Andrej Markota, Kristijan Skok, Maja Duh, and Andraž Stožer
Subjects: 0303 health sciences, Computational model, medicine.medical_specialty, business.industry, medicine.medical_treatment, Targeted temperature management, Thermoregulation, Intensive care unit, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Medicine, business, Intensive care medicine, 030217 neurology & neurosurgery, 030304 developmental biology
Abstract: Thermoregulation plays a vital role in homeostasis. Many species of animals as well as humans have evolved various physiological mechanisms for body temperature control, which are characteristically flexible and enable a fine-tuned spatial and temporal regulation of body temperature in different environmental conditions and circumstances. Human beings normally maintain a core body temperature at around 37°C, and maintenance of this relatively high temperature is critical for survival. Therefore, principles of thermoregulatory control have also important clinical implications. Infections can cause the body temperature to rise internally and several diseases can cause a dysfunction of thermoregulatory mechanisms. Moreover, the utilization of thermotherapies in treating various diseases has been known for thousands of years with a recent resurgence of interest. An increasing amount of research suggests that targeted temperature management is of paramount importance to patient outcomes in certain clinical scenarios. We provide a concise summary of the basic concepts of thermoregulation. Emphasis is given to the principles of thermoregulation in humans in basic pathological states and to targeted temperature management strategies in the clinical environment, with special attention on therapeutic hypothermia in postcardiac arrest patients. Finally, the discussion is focused on the potential offered by computational thermophysiological models for predicting thermal responses of patients in various clinical circumstances, for proposing new perspectives in the design of novel thermal therapies, and to optimize targeted temperature management strategies. This article is categorized under: Cardiovascular Diseases > Cardiovascular Diseases>Computational Models Cardiovascular Diseases > Cardiovascular Diseases>Environmental Factors Cardiovascular Diseases > Cardiovascular Diseases>Biomedical Engineering.
Published: 2020

15. Retrospective Analysis of Esophageal Heat Transfer for Active Temperature Management in Post-cardiac Arrest, Refractory Fever, and Burn Patients

Author: Erik Kulstad, Andrej Markota, Ahmed F. Hegazy, Melissa Naiman, and John Dingley
Subjects: medicine.medical_specialty, Time Factors, Fever, post-cardiac arrest, medicine.medical_treatment, therapeutic hypothermia, Targeted temperature management, targeted temperature management, burns, 03 medical and health sciences, Esophagus, 0302 clinical medicine, Refractory, Intensive care, refractory fever, medicine, Retrospective analysis, Humans, Post cardiac arrest, Adverse effect, Retrospective Studies, business.industry, Public Health, Environmental and Occupational Health, Thermal Conductivity, 030208 emergency & critical care medicine, General Medicine, Hypothermia, Heart Arrest, critical care, Heat transfer, Emergency medicine, Supplement Article, medicine.symptom, business, 030217 neurology & neurosurgery, Body Temperature Regulation
Abstract: Core temperature management is an important aspect of critical care; preventing unintentional hypothermia, reducing fever, and inducing therapeutic hypothermia when appropriate are each tied to positive health outcomes. The purpose of this study is to evaluate the performance of a new temperature management device that uses the esophageal environment to conduct heat transfer. De-identified patient data were aggregated from three clinical sites where an esophageal heat transfer device (EHTD) was used to provide temperature management. The device was evaluated against temperature management guidelines and best practice recommendations, including performance during induction, maintenance, and cessation of therapy. Across all active cooling protocols, the average time-to-target was 2.37 h and the average maintenance phase was 22.4 h. Patients spent 94.9% of the maintenance phase within ±1.0°C and 67.2% within ±0.5°C (574 and 407 measurements, respectively, out of 605 total). For warming protocols, all of the patient temperature readings remained above 36°C throughout the surgical procedure (average 4.66 h). The esophageal heat transfer device met performance expectations across a range of temperature management applications in intensive care and burn units. Patients met and maintained temperature goals without any reported adverse events.
Published: 2018
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16. GPIIb-IIIa Receptor Inhibitors in Acute Coronary Syndrome Patients Presenting With Cardiogenic Shock and/or After Cardiopulmonary Resuscitation

Author: Vojko Kanic, Zlatka Kanic, Meta Penko, Gregor Kompara, Maja Vollrath, and Andrej Markota
Subjects: Male, Pulmonary and Respiratory Medicine, Ticagrelor, medicine.medical_specialty, Acute coronary syndrome, Adenosine, Ticlopidine, Time Factors, Slovenia, Shock, Cardiogenic, Platelet Glycoprotein GPIIb-IIIa Complex, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Cause of Death, Internal medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, Survival rate, Aged, Retrospective Studies, business.industry, Cardiogenic shock, Middle Aged, medicine.disease, Cardiopulmonary Resuscitation, Clopidogrel, Survival Rate, Conventional PCI, Purinergic P2Y Receptor Antagonists, Cardiology, Platelet aggregation inhibitor, Drug Therapy, Combination, Female, Cardiology and Cardiovascular Medicine, business, Prasugrel Hydrochloride, Platelet Aggregation Inhibitors, TIMI, Follow-Up Studies, medicine.drug
Abstract: Background Data on the use of GPIIb-IIIa receptor inhibitors (GPI) in acute coronary syndrome (ACS) patients presenting with cardiogenic shock and/or after cardiopulmonary resuscitation is sparse. The aim of the study was to establish the possible influence of the adjunctive use of GPI on 30-day and 1-year mortality in these high-risk patients. Methods Acute coronary syndrome patients (261), who presented with cardiogenic shock and/or were cardiopulmonary resuscitated on admission, were analysed. Groups receiving (170 patients) and not receiving (91 patients) GPI were compared regarding 30-day and 1-year mortality. Results The unadjusted all-cause 30-day and 1-year mortality were similar in patients receiving GPI and those not receiving GPI [79 patients (46.5%) vs 50 patients (54.9%) at 30 days; ns, 91 patients (53.5%) vs. 55 (61.1%) at 1 year; ns]. After the adjustment for baseline and clinical characteristics, the adjunctive usage of GPI was identified as an independent prognostic factor in lower 30-day mortality (adjusted OR: 0.41; 95%CI: 0.20 to 0.84; p=0.015) and 1-year mortality (HR 0.62; 95%CI 0.39–0.97; p=0.037). Age, left main PCI and major bleeding , were also identified as independent prognostic factors in worse 30-day and 1-year mortality. In addition, Thrombolysis in Myocardial Infarction (TIMI) flow 0/1 pre-percutaneous coronary intervention (PCI) predicted a worse 1-year outcome. Novel oral P2Y12 receptor antagonists predicted better 30-day and 1-year survival. Conclusion Our study suggests that the adjunctive usage of GPI may be beneficial in this high-risk group of patients in whom a delayed onset of action of oral antiplatelet therapy would be expected.
Published: 2018
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17. Comparison between arterial and peripheral-venous blood gases analysis in patients with dyspnoea and/or suspected acute respiratory failure

Author: Mario Gorenjak, Amadeus Lešnik, Eva Žuran Pilinger, Jerneja Golub, and Andrej Markota
Subjects: medicine.medical_specialty, business.industry, Arteries, Venous blood, Carbon Dioxide, Peripheral, Dyspnea, Internal medicine, Internal Medicine, Cardiology, medicine, Humans, Acute respiratory failure, In patient, Gases, Blood Gas Analysis, Respiratory Insufficiency, business
Published: 2020
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18. EuReCa ONE⿿27 Nations, ONE Europe, ONE Registry

Author: Jan-Thorsten Gräsner, Rolf Lefering, Rudolph W. Koster, Siobhán Masterson, Bernd W. Böttiger, Johan Herlitz, Jan Wnent, Ingvild B.M. Tjelmeland, Fernando Rosell Ortiz, Holger Maurer, Michael Baubin, Pierre Mols, Irzal HadžibegoviĿ, Marios Ioannides, Roman Škulec, Mads Wissenberg, Ari Salo, Hervé Hubert, Nikolaos I. Nikolaou, Gerda Lóczi, Hildigunnur Svavarsdóttir, Federico Semeraro, Peter J. Wright, Carlo Clarens, Ruud Pijls, Grzegorz Cebula, Vitor Gouveia Correia, Diana Cimpoesu, Violetta Raffay, Stefan Trenkler, Andrej Markota, Anneli Strömsöe, Roman Burkart, Gavin D. Perkins, Leo L. Bossaert, Marc Kaufmann, Markus Thaler, Martin Maier, Gerhard Prause, Helmut Trimmel, Diane de Longueville, Thierry Preseau, Dominique Biarent, Christian Melot, Nicolas Mpotos, Koen Monsieurs, Patrick Van de Voorde, Marie Vanhove, Pascale Lievens, Mathias Faniel, Slobodanka Keleuva, Milan Lazarevic, Radmila Majhen Ujevic, Mato Devcic, Branka Bardak, Fabijan Barisic, Silvija Hunyadi Anticevic, Marios Georgiou, Anatolij Truhláſ, Jiſí Knor, Eva Smržová, Roman Sviták, Robin Šín, Petr Mokrejš, Freddy K. Lippert, Juhana Hallikainen, Marko Hoikka, Timo Iirola, Timo Jama, Helena Jäntti, Raimo Jokisalo, Milla Jousi, Hetti Kirves, Markku Kuisma, Jukka Laine, Sami Länkimäki, Petri Loikas, Vesa Lund, Teuvo Määttä, Heini Nal, Heimo Niemelä, Petra Portaankorva, Marko Pylkkänen, Marko Sainio, Piritta Setälä, Jerry Tervo, Taneli Väyrynen, Davy Murgue, Anne Champenois, Marc Fournier, Daniel Meyran, Romain Tabary, Aurélie Avondo, Gelin Gelin, Bruno Simonnet, Marc Joly, Isabelle Megy-Michoux, Xavier Paringaux, Yves Duffait, Michael Vial, Julien Segard, Sophie Narcisse, David Hamban, Jonathan Hennache, Sylvain Thiriez, Mathieu Doukhan, Carine Vanderstraeten, Jean-Charles Morel, Gilles Majour, Corinne Michenet, Laurent Tritsch, Marc Dubesset, Olivier Peguet, David Pinero, Fréderic Guillaumee, Patrick Fuster, Jean-François Ciacala, Benoît Jardel, Jean-Yves Letarnec, Frank Goes, Pierre Gosset, Muriel Vergne, Christian Bar, Fabienne Branche, Stevens Prineau, Steven Lagadec, Carole Cornaglia, Cécile Ursat, Philippe Bertrand, Jean-Marc Agostinucci, Pierre Nadiras, Géraldine Gonzales de Linares, Line Jacob, François Revaux, Thomas Pernot, Nathalie Roudiak, Agnès Ricard-Hibon, Laurent Villain-Coquet, Stefan Beckers, Thomas Hanff, Bernd Strickmann, Nicolai Wiegand, Petra Wilke, Harald Sues, Stefan Bogatzki, Wolfgang Baumeier, Kai Pohl, Bert Werner, Hans Fischer, Torsten Zeng, Erik Popp, Andreas Günther, Andreas Hochberg, Alex Lechleuthner, Jens-Christian Schewe, Hans Lemke, Erich Wranze-Bielefeld, Andreas Bohn, Markus Roessler, Frank Naujoks, Frank Sensen, Torben Esser, Matthias Fischer, Martin Messelken, Christopher Rose, Gabriele Schlüter, Wolfgang Lotz, Michael Corzilius, Claus-Martin Muth, Christian Diepenseifen, Björn Tauchmann, Torsten Birkholz, Andreas Flemming, Stefanie Herrmann, Uwe Kreimeier, Clemens Kill, Frank Marx, Ralph Schröder, Wolfgang Lenz, Glykeria Botini, Barakos Grigorios, Nikolaos Giannakoudakis, Michail Zervopoulos, Dimitrios Papangelis, Sofia Petropoulou-Papanastasiou, Themistoklis Liaskos, Spyridon Papanikolaou, Andreas Karabinis, Attila Zentay, Hólmgeir ÿorsteinsson, Anna Gilsdóttir, Svavar A. Birgisson, Fjölnir Freyr Guðmundsson, Hallgrímur Hreiðarsson, Björgvin ÿrnason, Hermann Hermannsson, Gísli Björnsson, Brynjar ÿór Friðriksson, Gunnar Baldursson, ÿrmann Höskuldsson, Jórunn Valgarðsdottir, Matthildur ÿsmundardóttir, Guðmundur Guðmundsson, Hjörtur Kristjánsson, Eyþór Rúnar ÿórarinsson, Jón Guðlaugsson, Sigurður Skarphéðinsson, Alberto Peratoner, Andrea Santarelli, Cesare Sabetta, Giovanni Gordini, Giovanni Sesana, Riccardo Giudici, Simone Savastano, Tommaso Pellis, Jean Beissel, Jean Uhrig, Tom Manderscheid, Marco Klop, Pascal Stammet, Marc Koch, Philippe Welter, Robert Schuman, Wendy Bruins, Hesam Amin, Nina Braa, Staale Bratland, Eirik Alnes Buanes, Tomas Draegni, Knut Roar Johnsen, Wenche Torunn Mathisen, Terje Oedegaarden, Marie Oppedal, Alf Stolt-Nielsen Reksten, Mats Eirik Roedsand, Jon Erik Steen-Hansen, Marta Dyrda, Anna Frejlich, Sſawomir MaciĿg, Sonia Osadnik, Ireneusz Weryk, Eugénio Mendonça, Carlos Freitas, Pinto Cruz, Carmo Caldeira, José Barros, Luis Vale, António Brazão, Nuno Jardim, Fernanda Rocha, Ricardo Duarte, Nicodemos Fernandes, Pedro Ramos, Margarida Jardim, Miguel Reis, Romulo Ribeiro, Sérgio Zenha, Jorge Fernandes, Juan Francisco, David Assis, Fernanda Abreu, Dinarte Freitas, Leonardo Ribeiro, Paulo Azevedo, Débora Calafatinho, Rui Jardim, Aleixo Pestana, Rui Faria, Bogdan Oprita, Alis Grasu, Paul Nedelea, Sorina Sovar, Florin Agapi, Aleksandar KliĿkoviĿ, Aleksandra LaziĿ, Bogdan NikoliĿ, Bogdan Zivanovic, Branislav MartinoviĿ, Dušan MilenkoviĿ, HuseinoviĿ Damir, Jovanka Koprivica, Kornelija Horvat JakšiĿ, Margit Pajor, Saša MiliĿ, Mirko VidoviĿ, Radojka Petrovic Glamoclija, Sladjana Andjelic, Vlajovic Sladjana, Zlatko BabiĿ, Zlatko Fišer, Peter Androvic, Lubica Bajerovska, Miroslav Chabron, Viliam Dobias, Eva Havlikova, Bozena Horanova, Renata Kratochvilova, Dana Kubova, Jan Murgas, Juraj Patras, Ladislav Simak, Vladimir Snarskij, Zuzana Zaviaticova, Marcela Zuffova, Francesc Escalada Roig, Luis Sánchez Santos, Alfredo Echarri Sucunza, Juan A. Cordero Torres, Guadalupe Inza Muñoz, Marta Martínez del Valle, Isabel Ceniceros Rozalen, Enrique Martín Sánchez, María Victoria Raúl Canabal Berlanga, Karlos Ibarguren Olalde, José I. Ruiz Azpiazu, María José García-Ochoa, Rafael Zoyo López-Navarro, José M. Adsuar Quesada, José A. Cortés Ramas, Francisco J. Mellado Vergel, Juan B. López Messa, Patricia Fernández del Valle, Luciano Anselmi, Breganzona Claudio Benvenuti, Nigel Batey, Yorkshire Ambulance, Scott Booth, Patricia Bucher, Charles D. Deakin, Jay Duckett, Chen Ji, Nancy Loughlin, Jenny Lumley-Holmes, Jessica Lynde, Frank Mersom, Carly Ramsey, Clare Robinson, Robert Spaight, Sukhdeep Dosanjh, Gurkamal Virdi, and Andrew Whittington
Subjects: medicine.medical_specialty, resuscitation outcomes, resuscitation, united-states, education, cardiac arrest, 030204 cardiovascular system & hematology, Emergency Nursing, survival, Out of hospital cardiac arrest, resuscitation registry, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, cpr, success, business.industry, sweden, Incidence (epidemiology), association, emergency medicine, europe, 030208 emergency & critical care medicine, defibrillation, 3. Good health, quality, Emergency, Emergency medicine, Emergency Medicine, epidemiology, Cardiology and Cardiovascular Medicine, business, management
Abstract: INTRODUCTION: The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.METHODS: This was an international, pr ...
Published: 2016
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19. Surface Body Temperature and Thermoregulation After Cardiac Arrest

Author: Sandra Burja, Jernej Mori, Andrej Markota, and Kristijan Skok
Subjects: Adult, Male, medicine.medical_specialty, business.industry, Thermoregulation, Critical Care and Intensive Care Medicine, Body Temperature, Heart Arrest, Anesthesiology and Pain Medicine, Hypothermia, Induced, Internal medicine, Cardiology, Medicine, Humans, Female, Prospective Studies, Coma, Rewarming, business, Surface cooling, Body Temperature Regulation
Abstract: The purpose of our study was to measure surface body temperatures (SBT) and to determine rewarming patterns after surface cooling in adult comatose survivors of cardiac arrest. We performed a prospective study in two phases from April to May 2016 and from December 2017 to March 2018. In the first phase we measured SBT as soon as possible after admission (t0) and 10 minutes later (t10). In the second phase we measured SBT and changes of SBT after local cooling of different regions in the maintenance phase of targeted temperature management. We included six patients to each phase of the study. In the first phase, we observed lower SBT compared with core body temperature (CBT) at t0 and t10, with nonsignificant differences in head and axillary region at t0 (35.2°C ± 1.3°C vs. 36°C ± 0.6°C
Published: 2018

20. Correction to: Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients

Author: Sébastien Champion, Christoph Adler, Tahar Chouihed, Batric Popovic, Andrej Markota, Dagmar M. Ouweneel, Mir B Basir, Valentine Léopold, Antoine Kimmoun, Alexandre Mebazaa, Tuukka Tarvasmäki, Gregor Simonis, José P.S. Henriques, Hannes Reuter, Bruno Levy, Faiez Zannad, Johan Lassus, Philippe Gaudard, Romain Pirracchio, Etienne Gayat, Veli-Pekka Harjola, Jindrich Spinar, Horng-Ruey Chua, Rinaldo Bellomo, Philip Urban, Serafina Valente, and Jiri Parenica
Subjects: medicine.medical_specialty, business.industry, Cardiogenic shock, 030208 emergency & critical care medicine, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Epinephrine, Meta-analysis, Internal medicine, Anesthesiology, Cohort, Short term survival, Individual data, medicine, Cardiology, business, medicine.drug
Abstract: Because of a technical error, the code corresponding to the outcome for the Basir et al. cohort was mis-implemented in the original version of our article. Characteristics of the cohort are in fact the followings.
Published: 2018

21. Successful use of combined blood purification techniques in splenectomised patient with septic shock in streptococcus pneumoniae infection – a case report

Author: Andreja Sinkovič, Andrej Markota, and Barbara Kit
Subjects: medicine.medical_specialty, medicine.medical_treatment, Splenectomy, Case Report, Hemodiafiltration, medicine.disease_cause, Pneumococcal Infections, lcsh:Infectious and parasitic diseases, Proinflammatory cytokine, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Septic shock, Internal medicine, Streptococcus pneumoniae, medicine, Humans, lcsh:RC109-216, Chemotherapy, business.industry, Heart, 030208 emergency & critical care medicine, Combined blood purification techniques, Middle Aged, medicine.disease, Combined Modality Therapy, Shock, Septic, Pneumococcal infections, Treatment Outcome, Infectious Diseases, Septic cardiomyopathy, 030220 oncology & carcinogenesis, Cardiology, Cytokines, Female, Adsorption, Inflammation Mediators, Cardiomyopathies, Cytokine storm, business
Abstract: Background Septic cardiomyopathy represents cardiac impairment in sepsis and is a part of systemic involvement in sepsis. Cytokine storm is responsible for septic shock and for myocardial dysfunction of potentially reversible septic cardiomyopathy. Several case reports and case series demonstrated successful removal of circulating cytokines by combined blood purification techniques. In this way, septic shock and survival of septic patients improved. However, the evidences for reversal of myocardial dysfunction are rare. Case presentation We present a patient with a history of chemotherapy for coat cell lymphoma, splenectomy and autologous bone marrow transplantation, who suffered severe pneumococcal sepsis, septic shock and septic cardiomyopathy, resistant to pharmacological therapy. Combined blood purification techniques 36 h after the start of treatment successfully decreased Interleukin-6 level, lactacidosis, the need for vasopressors to maintain normotension, improved systolic function of the left ventricle and clinical outcome. Conclusions Our case suggests that combined blood purification techniques initiated even 36 h after the start of treatment successfully removed inflammatory cytokines, reversed circulatory failure and improved left ventricular systolic function in pneumococcal sepsis.
Published: 2018
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22. Mortality, intensive care treatment, and cost evaluation: Role of a polymerase chain reaction assay in patients with sepsis

Author: Andreja Sinkovič and Andrej Markota
Subjects: Male, Research Report, Medicine (General), polymerase chain reaction, Bacteremia, Biochemistry, Gastroenterology, intensive care unit, Procalcitonin, law.invention, 0302 clinical medicine, law, cost, Vasoconstrictor Agents, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, biology, treatment, Standard treatment, General Medicine, Middle Aged, Intensive care unit, Anti-Bacterial Agents, Intensive Care Units, C-Reactive Protein, Female, Calcitonin, DNA, Bacterial, medicine.medical_specialty, Sepsis, 03 medical and health sciences, R5-920, Internal medicine, medicine, Humans, Aged, business.industry, Septic shock, Biochemistry (medical), C-reactive protein, 030208 emergency & critical care medicine, Cell Biology, Length of Stay, medicine.disease, Survival Analysis, mortality, Surgery, biology.protein, business
Abstract: Objective We examined whether patients with a positive SeptiFast (SF) assay (LightCycler SeptiFast; Roche Diagnostics, Basel, Switzerland) developed higher long-term mortality, a more difficult course of treatment, and a higher antimicrobial treatment cost than patients with a negative SF assay. Methods We performed a post-hoc analysis of data collected in a 1-year prospective interventional study of adults with severe sepsis and septic shock. In addition to the standard treatment, an additional 5 ml of blood was obtained for an SF assay, and the antimicrobial treatment was changed according to the SF results. Results We included 57 patients, and the SF assay was positive (SF+) in 10 (17.5%) and negative (SF−) in 47 (82.5%) patients. A trend toward a higher 6-month, 1-year, and 2-year mortality rate was observed in the SF+ group. In the SF+ group, we observed a significantly greater need for second-line vasopressor therapy, a higher initial procalcitonin concentration, and higher maximum C-reactive protein and lactate concentrations. We found no significant differences in cost of antimicrobial treatment between the SF+ and SF− groups. Conclusions We observed a trend toward higher long-term mortality and a more difficult course of treatment but no difference in the cost of antimicrobial treatment.
Published: 2018

23. Epinephrine and short-term survival in cardiogenic shock: an individual data meta-analysis of 2583 patients

Author: Sébastien Champion, Andrej Markota, Mir B Basir, Etienne Gayat, Bruno Levy, Tahar Chouihed, José P.S. Henriques, Christoph Adler, Batric Popovic, Philippe Gaudard, Romain Pirracchio, Valentine Léopold, Dagmar M. Ouweneel, Philip Urban, Tuukka Tarvasmäki, Alexandre Mebazaa, Antoine Kimmoun, Gregor Simonis, Veli-Pekka Harjola, Hannes Reuter, Johan Lassus, Horng-Ruey Chua, Jindrich Spinar, Rinaldo Bellomo, Serafina Valente, Jiri Parenica, Faiez Zannad, GAUDARD, Philippe, Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Biomarqueurs CArdioNeuroVASCulaires (BioCANVAS), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Anesthésie et Soins Intensifs [HEGP], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), University Hospital Brno, Masaryk University [Brno] (MUNI), Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Helsinki University Eye Hospital, Heart and Lung Center [Helsinki], Helsingin yliopisto = Helsingfors universitet = University of Helsinki-Helsinki University Eye Hospital, Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion], Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Azienda Ospedaliero-Universitaria Careggi [Firenze] (AOUC), Hôpital de la Tour, Austin Hospital [Melbourne], Austin Health, Australian and New Zealand Intensive Care Research Centre (ANZIC RC ), School of Public Health and Preventive Medicine [Monash University-Melbourne], Monash University [Melbourne]-Monash University [Melbourne], School of Medicine [University of Melbourne], University of Melbourne, The Royal Melbourne Hospital, University Medicine Cluster (UMC), Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), AMC Heart Center, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA)-University of Amsterdam [Amsterdam] (UvA), Technische Universität Dresden = Dresden University of Technology (TU Dresden), Praxisklinik Herz und Gefaesse, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de Soins Intensifs [CHRU Nancy], Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Henry Ford Hospital, University medical centre Maribor (UKC Maribor), Universität zu Köln = University of Cologne, Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Service d’Accueil des urgences [CHRU Nancy], Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Hôpital Lariboisière, Biomarqueurs CArdioNeuroVASCulaires ( BioCANVAS ), Université Paris Diderot - Paris 7 ( UPD7 ) -Université Paris 13 ( UP13 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Masaryk University, University of Helsinki [Helsinki], University of Helsinki [Helsinki]-Helsinki University Eye Hospital, Centre hospitalier Felix Guyon (Saint-Denis), Centre d'investigation clinique plurithématique Pierre Drouin ( CIC-P ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lorraine ( UL ), Azienda Ospedaliero-Universitaria Careggi ( AOU Careggi ), Austin Hospital, Australian and New Zealand Intensive Care Research Centre ( ANZIC RC ), University Medicine Cluster ( UMC ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Academic Medical Center [Amsterdam] ( AMC ), University of Amsterdam [Amsterdam] ( UvA ) -University of Amsterdam [Amsterdam] ( UvA ), Technische Universität Dresden ( TUD ), Défaillance Cardiovasculaire Aiguë et Chronique ( DCAC ), Université de Lorraine ( UL ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] ( PhyMedExp ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Montpellier ( UM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), University medical centre Maribor, Universität zu Köln, Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] ( INI-CRCT ), University of Helsinki, University of Helsinki-Helsinki University Eye Hospital, Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Azienda Ospedaliero-Universitaria Careggi (AOU Careggi), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Clinicum, HUS Heart and Lung Center, Department of Diagnostics and Therapeutics, Department of Medicine, Kardiologian yksikkö, and HUS Emergency Medicine and Services
Subjects: Male, CONTEMPORARY MANAGEMENT, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 0302 clinical medicine, CARDIAC-ARREST, Vasoconstrictor Agents, Myocardial infarction, PREDICTORS, 10. No inequality, ComputingMilieux_MISCELLANEOUS, Aged, 80 and over, Cardiogenic shock, Mortality rate, Incidence (epidemiology), INTRAAORTIC BALLOON PUMP, MECHANICAL CIRCULATORY SUPPORT, [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Middle Aged, Prognosis, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Epinephrine, Shock (circulatory), Cohort, TRIAL, REVASCULARIZATION, Female, medicine.symptom, medicine.drug, Adult, ACUTE MYOCARDIAL-INFARCTION, medicine.medical_specialty, Shock, Cardiogenic, 03 medical and health sciences, Percutaneous Coronary Intervention, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, Propensity Score, Aged, business.industry, 030208 emergency & critical care medicine, medicine.disease, Meta-analysis, CARDIOPULMONARY-RESUSCITATION, REGISTRY, 3121 General medicine, internal medicine and other clinical medicine, Propensity score matching, business
Abstract: Correction Volume: 44 Issue: 11 Pages: 2022-2023 DOI: 10.1007/s00134-018-5372-9 Catecholamines have been the mainstay of pharmacological treatment of cardiogenic shock (CS). Recently, use of epinephrine has been associated with detrimental outcomes. In the present study we aimed to evaluate the association between epinephrine use and short-term mortality in all-cause CS patients. We performed a meta-analysis of individual data with prespecified inclusion criteria: (1) patients in non-surgical CS treated with inotropes and/or vasopressors and (2) at least 15% of patients treated with epinephrine administrated alone or in association with other inotropes/vasopressors. The primary outcome was short-term mortality. Fourteen published cohorts and two unpublished data sets were included. We studied 2583 patients. Across all cohorts of patients, the incidence of epinephrine use was 37% (17-76%) and short-term mortality rate was 49% (21-69%). A positive correlation was found between percentages of epinephrine use and short-term mortality in the CS cohort. The risk of death was higher in epinephrine-treated CS patients (OR [CI] = 3.3 [2.8-3.9]) compared to patients treated with other drug regimens. Adjusted mortality risk remained striking in epinephrine-treated patients (n = 1227) (adjusted OR = 4.7 [3.4-6.4]). After propensity score matching, two sets of 338 matched patients were identified and epinephrine use remained associated with a strong detrimental impact on short-term mortality (OR = 4.2 [3.0-6.0]). In this very large cohort, epinephrine use for hemodynamic management of CS patients is associated with a threefold increase of risk of death.
Published: 2018
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24. Higher post-resuscitation hemoglobin, lower pO2 and lower lactate are associated with survival after cardiac arrest

Author: Ana Keršič, Doroteja Meško, Andrej Markota, Sandra Burja, and Jernej Mori
Subjects: business.industry, Anesthesia, Emergency Medicine, Post resuscitation, Medicine, Hemoglobin, Emergency Nursing, Cardiology and Cardiovascular Medicine, business
Published: 2019
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25. Difference Between Bladder and Esophageal Temperatures in Mild Induced Hypothermia

Author: Andraž Stožer, Miroslav Palfy, Andreja Sinkovič, and Andrej Markota
Subjects: Male, Mild hypothermia, Time Factors, Saline infusion, Urinary Bladder, Induction Phase, Sodium Chloride, Body Temperature, Esophagus, Hypothermia, Induced, medicine, Humans, Prospective Studies, Coma, Prospective cohort study, Aged, Aged, 80 and over, Urinary bladder, business.industry, Middle Aged, Hypothermia, Heart Arrest, Cold Temperature, medicine.anatomical_structure, Fluid infusion, Anesthesia, Emergency Medicine, Female, medicine.symptom, business
Abstract: Mild induced hypothermia is an established treatment strategy for comatose survivors of cardiac arrest. The goal of the induction phase of mild induced hypothermia is to cool the patient's core body temperature to 32°-34°C.The main goal of this study was to compare temperature changes measured in the esophagus and urinary bladder in survivors of cardiac arrest undergoing mild induced hypothermia using cold saline infusion.We performed a prospective study in a 12-bed adult medical intensive care unit at a tertiary level hospital in comatose adult survivors of nontraumatic cardiac arrest admitted from January to April 2012. Paired temperature readings from bladder and esophageal probes were recorded every 5 min for 95 min (20 readings). Cold fluid infusion was terminated when the measured temperature from either of the probes reached 33.9°C. Factorial repeated-measures analysis of variance was used to determine the effect of time and site of measurement on temperature readings.Measurements were performed in 8 patients. Target temperature was achieved in 33 ± 15 min in the esophagus and in 63 ± 15 min in the bladder (p = 0.006). We discovered a significant interaction effect (p0.001) between time and site of measurement, indicating that temperature changes differently depending on the site of measurement, with esophageal temperatures decreasing faster than temperatures measured in urinary bladder.Our results indicate that esophageal temperature measurements show a faster response rate compared to temperature measured in the bladder when cold saline infusion is used to induce mild hypothermia.
Published: 2015
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26. Gender-related differences in patients with ST-elevation myocardial infarction

Author: Andrej Markota, Andreja Sinkovič, Matevž Privšek, and Nejc Piko
Subjects: Male, medicine.medical_specialty, Prasugrel, medicine.medical_treatment, Slovenia, Population, Myocardial Infarction, Percutaneous Coronary Intervention, Postoperative Complications, Risk Factors, Internal medicine, medicine, Humans, Bivalirudin, Hospital Mortality, cardiovascular diseases, Myocardial infarction, Sex Distribution, education, Retrospective Studies, education.field_of_study, business.industry, Incidence (epidemiology), Percutaneous coronary intervention, General Medicine, Length of Stay, Middle Aged, medicine.disease, Clopidogrel, Survival Rate, Treatment Outcome, Cardiology, Female, business, Ticagrelor, medicine.drug
Abstract: A decade ago women with ST-elevation myocardial infarction (STEMI) were significantly older than men, with more comorbidities, less likely treated by primary percutaneous coronary intervention (PPCI) and their prognosis was worse. The progress in treatment led to increased survival after STEMI. Our aim was to evaluate the possible current differences between the genders in treatments, mortality and the changes in women over time in STEMI population. We retrospectively evaluated 307 STEMI patients (224 men, 83 women), admitted between October 1, 2011 and December 31, 2012 and a historic group of 523 STEMI patients from 2008 to 2009 (361 men, 162 women). Reperfusion strategy was PPCI, combined with aspirin and clopidogrel or prasugrel or ticagrelor and a heparin with glycoprotein receptor IIb/IIIa antagonist or bivalirudin. Between the genders and in women over time we compared clinical data, the use and time to PPCI, in-hospital complications, 30-day and 6-month mortality. STEMI patients in recent years were treated by PPCI in 94.5 %. Their 30-day mortality was 10.4 % and 6-month mortality 14.7 %. Between the genders we observed mostly nonsignificant differences (age, comorbidities, treatments, in-hospital complications, 30-day and 6-month mortality). Over the last years in women mean age significantly decreased, the use of PPCI significantly increased, the incidence of heart failure and bleedings decreased significantly, but mortalities nonsignificantly. Women still account for 1/4 of STEMI population, but the gap between the genders in presentation, treatments and outcome in STEMI population is decreasing.
Published: 2015
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27. Intra-arrest percutaneous coronary intervention: a case series

Author: Andreja Sinkovič, Matej Bernhardt, Darinka Purg, Andrej Markota, Igor Balevski, Matej Strnad, and Vojko Kanic
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Slovenia, Population, Comorbidity, Return of spontaneous circulation, Percutaneous Coronary Intervention, Postoperative Complications, Refractory, Risk Factors, Internal medicine, medicine, Humans, Cardiopulmonary resuscitation, education, Retrospective Studies, education.field_of_study, business.industry, Percutaneous coronary intervention, General Medicine, Middle Aged, medicine.disease, Heart Arrest, Causality, Survival Rate, Treatment Outcome, Coronary Occlusion, Coronary occlusion, Life support, Ventricular fibrillation, Cardiology, Female, business
Abstract: In patients with refractory cardiac arrest presumably from acute coronary occlusion, primary percutaneous coronary intervention (PPCI) may provide an opportunity for revascularisation and, subsequently, return of spontaneous circulation. We present our experience from a 24/7 primary percutaneous coronary intervention centre serving a population of approximately 800,000 individuals. A retrospective analysis was performed in patients with cardiac arrest treated from July 2011 to January 2014. Inclusion criteria were cardiac arrest and emergency coronary angiography performed during on-going external cardiopulmonary resuscitation (CPR). Course of treatment was analysed to outline the reasons for poor survival. Eight patients met the inclusion criteria; six (75 %) were male, and the mean age was 63 ± 16 years. Revascularisation under continuous cardiopulmonary resuscitation was achieved in all eight patients. Sustained return of spontaneous circulation was achieved in two patients (25 %). Both patients had poor neurological outcome (cerebral performance category 4), and both died within 3 months. We identified total duration of cardiopulmonary resuscitation (90.5 ± 33.3 min), lack of prehospital mechanical cardiopulmonary resuscitation devices and lack of extra-corporeal life support devices as the most likely reasons contributing to poor survival.
Published: 2015
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28. Efficacy of a bundle approach in preventing the incidence of ventilator associated pneumonia (VAP)

Author: Jernej Mori, Andreja Sinkovič, Andrej Markota, Nika Bizjak, Tina Belec, and Sandra Burja
Subjects: Male, medicine.medical_treatment, primary prevention, 030501 epidemiology, law.invention, 0302 clinical medicine, law, Epidemiology, Intubation, primarna preventiva, Hospital Mortality, Aged, 80 and over, lcsh:R5-920, Incidence, Incidence (epidemiology), Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, General Medicine, Middle Aged, Combined Modality Therapy, Intensive care unit, ventilatorska pljučnica, Anesthesia, Female, epidemiology, lcsh:Medicine (General), 0305 other medical science, medicine.medical_specialty, Critical Care, Short Communication, epidemiologija, medicinski pripomočki, medical devices, 03 medical and health sciences, ventilator-associated pneumonia, Intubation, Intratracheal, medicine, Humans, Aged, Retrospective Studies, Mechanical ventilation, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, Length of Stay, udc:616.24-002, intratrahealna intubacija, medicine.disease, bacterial infections and mycoses, Respiration, Artificial, intratracheal intubation, respiratory tract diseases, Pneumonia, VAP, business, bundle
Abstract: Ventilator-associated pneumonia (VAP) is a potentially preventable iatrogenic illness that may develop following mechanical ventilation. A bundle for the prevention of VAP consists of different measures which may vary between institutions, and may include: elevation of the head of the bed, oral care with chlorhexidine, subglottic suctioning, daily assessment for extubation and the need for proton-pump inhibitors, use of closed suction systems, and maintaining endotracheal cuff pressure at 25 cmH2O. Our aim was to determine the efficacy of a VAP prevention bundle, consisting of the above-mentioned measures, by evaluating the incidence of VAP before (no-VAP-B group) and after (VAP-B group) the introduction of the bundle. We retrospectively evaluated the data for patients who were mechanically ventilated with an endotracheal tube, in the period between 1 September and 31 December 2014 (no-VAP-B group, n = 55, 54.5% males, mean age 67.8 ± 14.5 years) and between 1 January to 30 April 2015 (VAP-B group, n = 74, 62.1% males, mean age 64.8 ± 13.7 years). There were no statistically significant differences between no-VAP-B and VAP-B groups in demographic data, intensive care unit (ICU) mortality, hospital mortality, duration of ICU treatment, and duration of mechanical ventilation. No significant differences in the rates of VAP and early VAP (onset ≤7 days after intubation) were found between no-VAP-B and VAP-B groups (41.8% versus 25.7%, p = 0.06 and 10.9% versus 12.2%, p > 0.99, respectively). However, a significant decrease in the late VAP (onset >8 days after intubation) was found in VAP-B group compared to no-VAP-B group (13.5% versus 30.9%, p = 0.027). Overall, our results support the use of VAP prevention bundle in clinical practice.
Published: 2017

29. Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management

Author: Maria Gray, Neeraj Badjatia, Andrej Markota, Joseph Haymore, Melissa Naiman, Ahmed F. Hegazy, and Erik Kulstad
Subjects: Hyperthermia, Adult, Male, medicine.medical_specialty, Burn injury, medicine.medical_treatment, General Chemical Engineering, cardiac arrest, 030204 cardiovascular system & hematology, Targeted temperature management, General Biochemistry, Genetics and Molecular Biology, Body Temperature, 03 medical and health sciences, 0302 clinical medicine, Esophagus, Hypothermia, Induced, medicine, Humans, Meningitis, Stroke, neurogenic fever, normothermia, fever, Temperature control, General Immunology and Microbiology, business.industry, General Neuroscience, 030208 emergency & critical care medicine, Perioperative, Hypothermia, Middle Aged, medicine.disease, Surgery, Heart Arrest, Anesthesia, Shivering, Medicine, Issue 129, Female, medicine.symptom, business, hypothermia, Burns, burn injury
Abstract: Controlling patient temperature is important for a wide variety of clinical conditions. Cooling to normal or below normal body temperature is often performed for neuroprotection after ischemic insult (e.g. hemorrhagic stroke, subarachnoid hemorrhage, cardiac arrest, or other hypoxic injury). Cooling from febrile states treats fever and reduces the negative effects of hyperthermia on injured neurons. Patients are warmed in the operating room to prevent inadvertent perioperative hypothermia, which is known to cause increased blood loss, wound infections, and myocardial injury, while also prolonging recovery time. There are many reported approaches for temperature management, including improvised methods that repurpose standard supplies (e.g., ice, chilled saline, fans, blankets) but more sophisticated technologies designed for temperature management are typically more successful in delivering an optimized protocol. Over the last decade, advanced technologies have developed around two heat transfer methods: surface devices (water blankets, forced-air warmers) or intravascular devices (sterile catheters requiring vascular placement). Recently, a novel device became available that is placed in the esophagus, analogous to a standard orogastric tube, that provides efficient heat transfer through the patient's core. The device connects to existing heat exchange units to allow automatic patient temperature management via a servo mechanism, using patient temperature from standard temperature sensors (rectal, Foley, or other core temperature sensors) as the input variable. This approach eliminates vascular placement complications (deep venous thrombosis, central line associated bloodstream infection), reduces obstruction to patient access, and causes less shivering when compared to surface approaches. Published data have also shown a high degree of accuracy and maintenance of target temperature using the esophageal approach to temperature management. Therefore, the purpose of this method is to provide a low-risk alternative method for controlling patient temperature in critical care settings.
Published: 2017

30. Rewarming After Severe Accidental Hypothermia Using the Esophageal Heat Transfer Device: A Case Report

Author: Andreja Sinkovič, Franci Svenšek, Katarina Katja Primožič, and Andrej Markota
Subjects: Male, medicine.medical_specialty, Fatal outcome, Accidental hypothermia, medicine.medical_treatment, Vascular access, macromolecular substances, Hypothermia, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Fatal Outcome, medicine, Humans, Renal replacement therapy, Esophagus, Rewarming, business.industry, 030208 emergency & critical care medicine, Middle Aged, Surgery, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Anesthesia, Accidental, medicine.symptom, business
Abstract: Patients with severe accidental hypothermia require active rewarming. External rewarming may not be successful in severe hypothermia, and use of invasive techniques is limited to regional centers and is associated with vascular access site and other complications. We present a patient with severe accidental hypothermia who was successfuly rewarmed using a novel esophageal heat transfer device. A 55-year-old male (175 cm, 71 kg) was admitted with the first recorded temperature 23.3°C. Rewarming using renal replacement therapy circuit was unsuccessful because of severe hypotension. We inserted the esophageal heat transfer device and rewarmed him successfully to target temperature 35–36°C. After rewarming, we maintained his body temperature in the range 35–36°C until accidental removal of the device. We observed no major adverse effects. To conclude, rewarming from severe accidental hypothermia was possible using the esophageal heat transfer device.
Published: 2017

31. Rectal Instillation of Cold Fluids for Targeted Temperature Management After Cardiac Arrest: A Case Report

Author: Jure Fluher, Andrej Markota, and Andreja Sinkovič
Subjects: Male, Medical device, medicine.medical_treatment, 030204 cardiovascular system & hematology, Targeted temperature management, Sodium Chloride, Critical Care and Intensive Care Medicine, Hypothermia induced, 03 medical and health sciences, 0302 clinical medicine, Administration, Rectal, Hypothermia, Induced, medicine, Humans, Saline, Aged, medicine.diagnostic_test, business.industry, 030208 emergency & critical care medicine, Arterial catheter, Hypothermia, Heart Arrest, Anesthesiology and Pain Medicine, Anesthesia, medicine.symptom, business, Electrocardiography
Abstract: The optimal method of temperature management after cardiac arrest remains unknown. Methods that are most effective are usually invasive and expensive. Noninvasive methods are not as effective and obstruct access to the patient. Temperature management via rectal cooling offers some potential advantages in survivors of cardiac arrest, namely, relatively large volumes of temperature-controlled fluids can be instilled, access to the patient is not obstructed, and fluid overload can be ameliorated by removal of a fraction of instilled fluid. We used rectal cooling in a 72-year-old male comatose survivor of cardiac arrest with an initial body temperature of 36.8°C. We instilled 3000 mL of normal saline at 4°C in 75 minutes, and ∼2000 mL of effluent fluid was removed via gravity at 105 minutes after instillation. At 135 minutes, temperature decreased to a minimum of 35.2°C. No leakage was observed. Standard procedures (insertion of central venous and arterial catheters, electrocardiography, echocardiography, chest radiography) were performed with a rectal catheter in situ. At 210 minutes after instillation, the catheter was removed and there were no clinical signs of rectal injury after removal. To conclude, rectal instillation of cold fluids resulted in a significant decrease of body temperature and we observed no major side effects. Fluid overloading was avoided by removing effluent fluid. Additional studies are needed if this technique is to gain more widespread use.
Published: 2017

32. Changes of surface body temperatures after local cooling in survivors of cardiac arrest during the maintenance phase of TTM

Author: Andrej Markota, Andreja Sinkovič, Kristijan Skok, Jernej Mori, and Sandra Burja
Subjects: medicine.medical_specialty, business.industry, Internal medicine, Emergency Medicine, medicine, Cardiology, Maintenance phase, Emergency Nursing, Cardiology and Cardiovascular Medicine, business
Published: 2018
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33. Association of arterial carbon dioxide and pH with hospital mortality after cardiac arrest

Author: Andrej Markota, Sandra Burja, Jernej Mori, Ana Keršič, and Doroteja Meško
Subjects: medicine.medical_specialty, chemistry.chemical_compound, chemistry, business.industry, Emergency medicine, Carbon dioxide, Emergency Medicine, medicine, Hospital mortality, Emergency Nursing, Cardiology and Cardiovascular Medicine, business
Published: 2019
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34. Comparison of time within target range and complications related to temperature management between esophageal temperature management device and surface cooling

Author: Andrej Markota, Jernej Mori, and Sandra Burja
Subjects: Esophageal temperature, business.industry, Emergency Medicine, Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine, Target range, business, Surface cooling, Biomedical engineering
Published: 2019
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35. Corrigendum to 'EuReCa ONE-27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe' [Resuscitation 105 (2016) 188-195]

Author: Grzegorz Cebula, Peter Wright, Anneli Strömsöe, Vitor Gouveia Correia, Ari Salo, Pierre Mols, Fernando Rosell Ortiz, Violetta Raffay, Diana Cimpoesu, Irzal Hadžibegović, Rudolph W. Koster, Marios Ioannides, Gerda Lóczi, Ingvild B.M. Tjelmeland, Roman Skulec, Siobhán Masterson, Hervé Hubert, Gavin D. Perkins, Federico Semeraro, Nikolaos I. Nikolaou, Michael Baubin, Jan Wnent, Hildigunnur Svavarsdóttir, Stefan Trenkler, Johan Herlitz, Holger Maurer, Mads Wissenberg, Bernd W. Böttiger, Carlo Clarens, Andrej Markota, Roman Burkart, Rolf Lefering, Jan-Thorsten Gräsner, Ruud Pijls, and Leo Bossaert
Subjects: medicine.medical_specialty, education.field_of_study, Resuscitation, business.industry, Public health, Incidence (epidemiology), Population, MEDLINE, 030208 emergency & critical care medicine, 030204 cardiovascular system & hematology, Emergency Nursing, medicine.disease, Out of hospital cardiac arrest, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Health care, Emergency Medicine, medicine, Hospital discharge, Medical emergency, Cardiology and Cardiovascular Medicine, business, education
Abstract: Introduction The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe. Methods This was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries. Results Data on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge. Conclusion The results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe. EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events.
Published: 2016

36. Absence of lung sliding is not a reliable sign of pneumothorax in patients with high positive end-expiratory pressure

Author: Jure Fluher, Andraž Stožer, Jerneja Golub, Gregor Prosen, Andrej Markota, Andrej Bergauer, Andreja Sinkovič, and Franci Svenšek
Subjects: Male, medicine.medical_specialty, Positive-Pressure Respiration, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Humans, In patient, Prospective Studies, Lung, Positive end-expiratory pressure, Aged, Ultrasonography, business.industry, Pneumothorax, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Surgery, medicine.anatomical_structure, 030228 respiratory system, Point-of-Care Testing, Emergency Medicine, Cardiology, Female, business, Tomography, X-Ray Computed, Sign (mathematics)
Published: 2016

37. Low-dose intravenous lipid emulsion for the treatment of severe quetiapine and citalopram poisoning

Author: Andreja Sinkovič, Damjan Grenc, Darinka Purg, and Andrej Markota
Subjects: Fat Emulsions, Intravenous, medicine.medical_treatment, education.educational_degree, Slovenia, Psychiatric rehabilitation, Suicide, Attempted, Citalopram, Toxicology, Ventricular tachycardia, 03 medical and health sciences, Quetiapine Fumarate, Young Adult, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, education, Bromazepam, Mechanical ventilation, business.industry, Public Health, Environmental and Occupational Health, 030208 emergency & critical care medicine, medicine.disease, Gastric lavage, Treatment Outcome, Anesthesia, Quetiapine, Antidepressive Agents, Second-Generation, Female, Drug Overdose, business, medicine.drug, Antipsychotic Agents
Abstract: The treatment of quetiapine and/or citalopram poisoning is mainly supportive and involves gastric lavage, activated charcoal, intubation, and mechanical ventilation. Recently, however, there were reports of successful treatment with intravenous lipid emulsion. Here we report a case of a 19-year-old Caucasian girl who ingested approximately 6000 mg of quetiapine, 400 mg of citalopram, and 45 mg of bromazepam in a suicide attempt. The patient developed ventricular tachycardia and epileptic seizures 12 h after admission to the hospital. As the patient’s condition deteriorated, we combined standard therapy (intubation, mechanical ventilation, and vasopressors) with low-dose intravenous lipid emulsion (ILE) (a total of 300 mL of 20 % lipid emulsion) and normalised her heart rhythm and stopped the seizures. She was discharged to the psychiatric ward after 48 h and home after a prolonged (2-month) psychiatric rehabilitation. Intravenous lipid emulsion turned out to be effective even in the lower dose range than previously reported for quetiapine poisoning in patients presenting with seizure and ventricular arrhythmia. To our knowledge, there are no case reports describing the use of ILE in treating citalopram poisoning.
Published: 2016

38. Impact of the New P2Y12 Receptor Inhibitors on Mortality in STElevation Myocardial Infarction Patients with Cardiogenic Shock and / or After Cardiopulmonary Resuscitation Undergoing Percutaneous Coronary Intervention

Author: Maja Vollrath, Andrej Markota, Franjo Naji, Vojko Kanic, and Andreja Sinkovič
Subjects: medicine.medical_specialty, Prasugrel, business.industry, Cardiogenic shock, medicine.medical_treatment, Percutaneous coronary intervention, General Medicine, Clopidogrel, medicine.disease, Surgery, P2Y12, Internal medicine, medicine, Cardiology, cardiovascular diseases, Myocardial infarction, Cardiopulmonary resuscitation, business, Ticagrelor, medicine.drug
Abstract: Background: Little is known about clinical efficacy of newer P2Y12 receptor inhibitors in ST-elevation myocardial infarction patients presenting with cardiogenic shock or after cardiopulmonary resuscitation. The aim of our study was to establish the possible role of newer P2Y12 receptor inhibitors prasugrel and ticagrelor on survival in comparison to clopidogrel administration in ST-elevation myocardial infarction patients presenting with cardiogenic shock and / or after cardiopulmonary resuscitation. Method: The present study was an analysis of 187 patients with ST-elevation myocardial infarction presenting with cardiogenic shock and / or after cardiopulmonary resuscitation. Groups with newer P2Y12 receptor inhibitors (107 patients) and with clopidogrel (80 patients) were compared and followed for median 160 days (25th, 75th percentile: 6,841). Mortality at 14 days, 30 days and one year were compared between the groups. Results: Mortality at 14 days was similar in both groups. A strong trend towards a lower mortality at 30 days was noticed in the newer P2Y12 receptor inhibitors group [39 (48.8%) patients in clopidogrel group died versus 38 (35.5%) in the newer P2Y12 group receptor inhibitors; p = 0.07]. All-cause mortality at one year was significantly higher in the group with clopidogrel administration [47 (58.8%) patients in clopidogrel group died versus 46 (43.0%) in the newer P2Y12 receptor inhibitors group; p = 0.039]. Conclusion: In ST-elevation myocardial infarction patients presenting with cardiogenic shock and/or after cardiopulmonary resuscitation, the administration of newer P2Y12 receptor inhibitors reduced the one-year mortality in comparison to clopidogrel. The use of newer P2Y12 receptor inhibitors may be advocated in this very high risk group of patients.
Published: 2016
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39. A Novel Esophageal Heat Transfer Device for Temperature Management in an Adult Patient with Severe Meningitis

Author: Petra Balažič, Andrej Markota, Iris Živko, Alenka Strdin Košir, and Andreja Sinkovič
Subjects: medicine.medical_specialty, Brain edema, business.industry, MEDLINE, 030208 emergency & critical care medicine, medicine.disease, medicine.disease_cause, Surgery, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Streptococcus pyogenes, Emergency Medicine, medicine, Esophagus, business, Meningitis, 030217 neurology & neurosurgery, Intracranial pressure
Published: 2017
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40. Optimization of induction of mild therapeutic hypothermia with cold saline infusion: A laboratory experiment

Author: Andrej Markota, Jure Fluher, Andreja Sinkovič, and Andraž Stožer
Subjects: medicine.medical_specialty, Mild hypothermia, Saline infusion, Induction Phase, therapeutic hypothermia, Sodium Chloride, Intravenous cannula, Hypothermia, Induced, medicine, Volume of fluid method, Humans, Fluid temperature, intravenous infusion, Infusions, Intravenous, lcsh:R5-920, business.industry, Temperature, Hypothermia, Cardiac arrest, Surgery, Heart Arrest, Cold Temperature, Anesthesia, Laboratory experiment, medicine.symptom, business, lcsh:Medicine (General), Research Article
Abstract: Cold fluid infusions can be used to induce mild therapeutic hypothermia after cardiac arrest. Fluid temperature higher than 4°C can increase the volume of fluid needed, prolong the induction phase of hypothermia and thus contribute to complications. We performed a laboratory experiment with two objectives. The first objective was to analyze the effect of wrapping fluid bags in ice packs on the increase of fluid temperature with time in bags exposed to ambient conditions. The second objective was to quantify the effect of insulating venous tubing and adjusting flow rate on fluid temperature increase from bag to the level of an intravenous cannula during a simulated infusion. The temperature of fluid in bags wrapped in ice packs was significantly lower compared to controls at all time points during the 120 minutes observation. The temperature increase from the bag to the level of intravenous cannula was significantly lower for insulated tubing at all infusion rates (median temperature differences between bag and intravenous cannula were: 8.9, 4.8, 4.0, and 3.1°C, for non-insulated and 5.9, 3.05, 1.1, and 0.3°C, for insulated tubing, at infusion rates 10, 30, 60, and 100 mL/minute, respectively). The results from this study could potentially be used to decrease the volume of fluid infused when inducing mild hypothermia with an infusion of cold fluids.
Published: 2015

41. An evaluation of esophageal temperature management in cases longer than 72 h

Author: Andrej Markota, Neeraj Badjatia, Ahmed F. Hegazy, Erik Kulstad, Joseph Haymore, and Melissa Naiman
Subjects: medicine.medical_specialty, Esophageal temperature, business.industry, Emergency Medicine, medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine, business, Surgery
Published: 2017
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42. Therapeutic hypothermia and inhalation anesthesia in a patient with severe pneumococcal meningitis and secondary cardiac arrest

Author: Janez Rebol, Tomaž Velnar, Andreja Sinkovič, Nejc Bukovnik, and Andrej Markota
Subjects: Methyl Ethers, medicine.medical_specialty, Intracranial Pressure, Sedation, Respiratory arrest, 030204 cardiovascular system & hematology, Return of spontaneous circulation, Severity of Illness Index, Sevoflurane, 03 medical and health sciences, 0302 clinical medicine, Adrenal Cortex Hormones, Hypothermia, Induced, Humans, Medicine, Monitoring, Physiologic, Intracranial pressure, Meningitis, Pneumococcal, business.industry, 030208 emergency & critical care medicine, General Medicine, Middle Aged, Hypothermia, medicine.disease, Anti-Bacterial Agents, Heart Arrest, Surgery, Anesthesia, Anesthetics, Inhalation, Emergency Medicine, Drainage, Intracranial pressure monitoring, Female, medicine.symptom, Anesthesia, Inhalation, business, Meningitis, medicine.drug
Abstract: Therapeutic hypothermia was associated with increased mortality in patients with severe bacterial meningitis in a large randomized trial. It still remains a treatment strategy for comatose survivors of cardiac arrest. There are several potential advantages of inhalational anesthetics as long-term sedation agents compared to intravenous sedation, however, uncontrollable increases of intracranial pressure were observed in neurocritical patients. Here we present a patient with severe bacterial meningitis and secondary cardiac arrest where therapeutic hypothermia and inhalational anesthesia were successfully used. A 59-year old female with a history of a vestibular Schwannoma surgery on the left side was admitted with signs of meningitis. Within minutes after admission, she further deteriorated with respiratory arrest, followed by cardiac arrest. She remained comatose after return of spontaneous circulation. The standard treatment of severe meningitis (steroids, antibiotics, insertion of intracranial pressure probe and external ventricular drainage) along with therapeutic hypothermia and inhalational anesthesia were implemented. Intracranial pressure remained stable and daily neurological examination was possible without being confounded by concurrent sedation. She was discharged home without neurological sequelae after 27 days. In selected patients with meningitis, therapeutic hypothermia may still present a treatment option, and the long-term use of inhalational anesthetics could be appropriate with concomitant intracranial pressure monitoring.
Published: 2017
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43. Surgical tracheotomy performed with and without dual antiplatelet therapy

Author: Bogdan Čizmarević, Andrej Markota, and Andreja Sinkovič
Subjects: medicine.medical_specialty, Blood transfusion, complications, medicine.medical_treatment, Surgical Revision, intensive care unit, antiplatelet therapy, law.invention, Tracheotomy, Bronchoscopy, law, Medicine, medicine.diagnostic_test, business.industry, Mean age, General Medicine, bleeding, Intensive care unit, Surgery, tracheotomy, Anesthesia, business, Complication, Research Article
Abstract: Some patients who need dual antiplatelet therapy sometimes require tracheotomy. Aim of this study was to compare the rate of complications during and after surgical tracheotomy between patients requiring dual antiplatelet therapy and those without dual antiplatelet therapy. We retrospectively included 79 patients (62% men, mean age 64 ± 14 years) in the period 2007- 2011. The following complications were analyzed: need for surgical revision within 24 hours after tracheotomy, need for bronchoscopy within 24 hour after tracheotomy, need for blood transfusion within 24 hours after tracheotomy, death attributed to tracheotomy and any complication attributed to tracheotomy. We compared patients where tracheotomy was performed while receiving dual antiplatelet therapy (n=27, 34%) to patients where tracheotomy was performed without dual antiplatelet therapy (n=52, 66%). Nonsignificant differences between the two groups were observed general characteristics. There were no statistically significant differences in complications after tracheotomy (surgical revision after tracheotomy p=0.63, bronchoscopy after tracheotomy p=0.74, blood transfusion after tracheotomy p=0.59, death attributed to tracheotomy p=1.00 and any complication attributed to tracheotomy p=1.00). The study shows that tracheotomy is safe in cardiac patients on dual antiplatelet therapy.
Published: 2014
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44. Cool enough to induce hypothermia?

Author: Andrej Markota, Andreja Sinkovič, Andraž Stožer, and Jure Fluher
Subjects: business.industry, Anesthesia, Medicine, Hypothermia, medicine.symptom, business
Abstract: Background Infusion of cold fluids can be used to induce hypothermia after cardiac arrest. Fluid temperature higher than 4C could increase the volume needed, prolong the induction phase and/or contribute to complications. In this study, we analyzed the effect of flow rate and venous tubing insulation on the fluid temperature at the level of the intravenous (iv.) cannula, when infusing cold saline. We also analyzed the warming rate of 0.5 L bags of normal saline wrapped in ice packs and without ice packs. Methods All measurements were performed at ambient temperature 23C, constant humidity of 40 % and without exposure to direct sunlight. 0.5L bags containing normal saline were stored in refrigerated conditions for at least 24 hours prior to usage, mean initial temperature in the bags was 3.96 0.17C. For measurements of temperature at the level of the venous cannula during an infusion, 0.5 L bags of normal saline were connected to venous tubing and iv. cannulas. 10 measurements of fluid temperature in the cannula and in the bag were performed (with one digital filament thermometers inserted in the bag and one in the cannula) at flow rates 10, 30, 60 and 100 ml/min. Measurements were repeated with just the venous tubing wrapped in aluminum foil for thermal insulation. 3 sets of measurements with 0.5 L bags of normal saline wrapped in ice packs and 3 sets without ice packs were made for the analysis of the rate of warming. Temperature of the fluid in the bag was recorded at 5 min intervals for 120 min with a digital filament thermometer inserted in the fluid. Results With non-insulated tubing, we observed significantly higher temperatures in the cannula compared to temperatures in the bag at all flow rates (all p
Published: 2014
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45. Use of an oesophageal heat transfer device in therapeutic hypothermia

Author: Andreja Sinkovič, Andrej Markota, Barbara Kit, and Jure Fluher
Subjects: business.industry, Anesthesia, Heat transfer, Emergency Medicine, Medicine, Emergency Nursing, Hypothermia, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Published: 2015
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46. Identification of regions with maximal body surface-to-environment temperature differences in survivors of out-of-hospital cardiac arrest using an infrared camera

Author: Andraž Stožer, Andrej Markota, Jure Fluher, Andreja Sinkovič, and Milan Brumen
Subjects: medicine.medical_specialty, Identification (information), business.industry, Internal medicine, Body surface, Emergency Medicine, medicine, Cardiology, Emergency Nursing, Cardiology and Cardiovascular Medicine, business, Out of hospital cardiac arrest, Surgery
Published: 2016
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47. Central venous to arterial pCO2 difference in cardiogenic shock

Author: Andreja Sinkovič and Andrej Markota
Subjects: Inotrope, Male, medicine.medical_specialty, medicine.medical_treatment, Slovenia, Shock, Cardiogenic, Risk Assessment, Sensitivity and Specificity, Veins, Internal medicine, Heart rate, medicine, Humans, Cardiopulmonary resuscitation, Myocardial infarction, Aged, Mechanical ventilation, business.industry, Cardiogenic shock, Incidence, Reproducibility of Results, General Medicine, Arteries, Carbon Dioxide, medicine.disease, Survival Analysis, respiratory tract diseases, Survival Rate, Mean blood pressure, Shock (circulatory), Cardiology, Female, medicine.symptom, Blood Gas Analysis, business
Abstract: In normal circumstances central venous to arterial pCO(2) difference is approximately 1 kPa (7.5 mmHg). In shock states it is usually increased. We sought to evaluate the agreement between admission central venous to arterial pCO(2) difference and mortality in patients with acute myocardial infarction and cardiogenic shock. We hypothesized that patients with higher central venous to arterial pCO(2) difference on admission would have higher mortality. We retrospectively included 30 patients with acute myocardial infarction and cardiogenic shock (mean age 67 ± 10 years, 73 % men), of which 20 (67 %) died. Nonsignificant differences between survivors and nonsurvivors were observed in age, gender, admission mean blood pressure, heart rate, lactate, hemoglobin, peak troponin I, cardiopulmonary resuscitation, use of therapeutic hypothermia, vasopressors, inotropes, intraaortic balloon pump, and mechanical ventilation. A significant difference between survivors and nonsurvivors was observed in admission central venous to arterial pCO(2) difference (1.35 ± 0.49 kPa vs. 0.83 ± 0.36 kPa, p = 0.003). In patients with admission central venous oxygen saturation over 70 %, we observed a significant difference in central venous to arterial pCO(2) difference between survivors and nonsurvivors (1.33 ± 0.51 kPa vs. 0.7 ± 0.3 kPa, p = 0.003) and a nonsignificant difference between survivors and nonsurvivors in patients with admission central venous oxygen saturation under 70 % (1.38 ± 0.53 kPa vs. 1.25 ± 0.33 kPa, p = 0.37). Patients with decreased central venous to arterial pCO(2) difference on admission seem to be at increased risk of dying even with admission central venous oxygen saturation over 70 %.
Published: 2012

48. Therapeutic hypothermia with esophageal heat transfer device

Author: Jure Fluher, Petra Balazic, Andreja Sinkovič, Barbara Kit, and Andrej Markota
Subjects: business.industry, medicine.medical_treatment, Cardiogenic shock, Cooling therapy, Emergency Nursing, Hypothermia, medicine.disease, Multiorgan failure, Anesthesia, Emergency Medicine, medicine, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Saline
Abstract: Purpose of the study: To evaluate the performance of esophageal heat transfer device (EHTD) in inducing, maintaining, and reversing therapeutic hypothermia in adult survivors of cardiac arrest. Materials and methods: We performed a prospective, interventional study from March to May 2015. EHTD (Esophageal Cooling Device, Advanced Cooling Therapy, Chicago, IL, USA) was inserted after admission and connected to chiller (CritiCool, MTRE, Rehovot, Israel). Study protocol was to achieve target temperature (32–34 ◦C in urinary bladder) within 1h after admission, maintain it until 24h after admission and rewarm to 36 ◦C at a rate 0.25–0.5 ◦C/h. Iced saline infusionduring induction (1000ml for initial temperature 34.1–35 ◦C and 20ml/kg if ≥35.1 ◦C) and external cooling/rewarming during maintenance and rewarming (for temperature outside the desired range for ≥2h) were allowed. Minor fluctuations were defined as
Published: 2015
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49. Absence of lung sliding is not a reliable indicator of pneumothorax in patients who require high PEEP

Author: Gregor Prosen, Andrej Markota, Andraž Stožer, Franci Svenšek, Andrej Bergauer, Jerneja Golub, and Andreja Sinkovič
Subjects: medicine.medical_specialty, High peep, Lung, business.industry, respiratory system, Critical Care and Intensive Care Medicine, medicine.disease, respiratory tract diseases, surgical procedures, operative, medicine.anatomical_structure, Pneumothorax, Poster Presentation, medicine, In patient, Intensive care medicine, business, therapeutics, circulatory and respiratory physiology
Abstract: The objective of our study was to estimate correlation between PEEP and disappearance of lung sliding (LS) due to lung overdistension in the absence of pneumothorax.
Published: 2015

50. Use of sevoflurane in the medical ICU: 2-year experience, patient and safety profile

Author: Andrej Markota, Franci Svenšek, Andreja Sinkovič, and A Koroša
Subjects: medicine.medical_specialty, Safety profile, Medical icu, business.industry, health care facilities, manpower, and services, Poster Presentation, medicine, Intravenous sedation, Critical Care and Intensive Care Medicine, Intensive care medicine, business, Sevoflurane, medicine.drug
Abstract: The aim of this study is to present our experience with sevoflurane in the ICU, outline which patients were sedated with sevoflurane and present the safety profile. Sevoflurane has some potential advantages over intravenous sedation: rapid elimination and few interactions. The optimal role of sevoflurane in ICU is not known.
Published: 2015

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