Search

Your search keyword '"Schaller, Stefan J."' showing total 489 results
Start Over Author "Schaller, Stefan J."
489 results on '"Schaller, Stefan J."'

101. Effect of midodrine versus placebo on time to vasopressor discontinuation in patients with persistent hypotension in the intensive care unit (MIDAS): an international randomised clinical trial

Author

Santer, Peter, Anstey, Matthew H., Patrocínio, Maria D., Wibrow, Bradley, Teja, Bijan, Shay, Denys, Shaefi, Shahzad, Parsons, Charles S., Houle, Timothy T., Eikermann, Matthias, Ho, Kwok M., Schaller, Stefan J., Thevathasan, Tharusan, Albrecht, Lea, Grabitz, Stephanie, Chhangani, Khushi, Ng, Pauline Y., Levine, Alexander, DiBiasio, Alan, Palmer, Robert, Myers, Erina, Rauniyar, Rashmi, Sarge, Todd, Scheffenbichler, Flora, and Gupta, Alok

Subjects
medicine.medical_specialty, business.industry, Standard treatment, Midodrine, Medizin, 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, Placebo, Intensive care unit, Article, Discontinuation, law.invention, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Randomized controlled trial, law, Anesthesia, Anesthesiology, Medicine, business, medicine.drug
Abstract

PURPOSE: ICU discharge is often delayed by a requirement for intravenous vasopressor medications to maintain normotension. We hypothesised that the administration of midodrine, an oral α(1)-adrenergic agonist, as adjunct to standard treatment shortens the duration of intravenous vasopressor requirement. METHODS: In this multicentre, randomised, controlled trial including three tertiary referral hospitals in the US and Australia, we enrolled adult patients with hypotension requiring a single-agent intravenous vasopressor for ≥24 hours. Subjects received oral midodrine (20 mg) or placebo every 8 hours in addition to standard care until cessation of intravenous vasopressors, ICU discharge, or occurrence of adverse events. The primary outcome was time to vasopressor discontinuation. Secondary outcomes included time to ICU discharge readiness, ICU and hospital lengths of stay, and ICU readmission rates. RESULTS: Between October 2012 and June 2019, 136 participants were randomised, of whom 132 received the allocated intervention and were included in the analysis (modified intention-to-treat approach). Time to vasopressor discontinuation was not different between midodrine and placebo groups (median [IQR], 23.5 [10.0–54.0] vs 22.5 [10.4–40.0] hours; difference, 1.0 hour; 95% CI, −10.4 to 12.3 hours; p=0.62). No differences in secondary endpoints were observed. Bradycardia occurred more often after midodrine administration (5 [7.6%] vs 0 [0%], p=0.02). CONCLUSION: Midodrine did not accelerate liberation from intravenous vasopressors and was not effective for the treatment of hypotension in critically ill patients. TRIAL REGISTRATION: NCT01531959, registered on February 13, 2012

Published
2020
Full Text
View/download PDF

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

Author

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

Abstract

Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.

Published
2022

103. Detection of delirium by family members in the intensive care unit: Translation, Cross-Cultural adaptation and validation of the Family Confusion Assessment Method for the German-Speaking area

Author

Greindl, Stephanie; https://orcid.org/0000-0001-5930-2802, Weiss, Björn; https://orcid.org/0000-0003-3139-595X, Magnolini, Raphael, Lingg, Charlotte, Mayer, Hanna; https://orcid.org/0000-0002-7206-9432, Schaller, Stefan J; https://orcid.org/0000-0002-6683-9584, Greindl, Stephanie; https://orcid.org/0000-0001-5930-2802, Weiss, Björn; https://orcid.org/0000-0003-3139-595X, Magnolini, Raphael, Lingg, Charlotte, Mayer, Hanna; https://orcid.org/0000-0002-7206-9432, and Schaller, Stefan J; https://orcid.org/0000-0002-6683-9584

Abstract

Aim: The aim of this study was the translation, cross-cultural adaptation and validation of the Family Confusion Assessment Method in critically ill patients. Background: Delirium is a frequently unrecognized disorder in critically ill patients. Visiting family members might be the first to notice subtle changes in a patient's cognition and behaviour. The Family Confusion Assessment Method was developed to detect delirium by family members, but has not been available for the German-speaking area yet. Design: A prospective validation study was conducted between January 2020 and October 2020. Methods: The Family Confusion Assessment Method was translated into German according to the Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes. Subsequently, we compared the Family Confusion Assessment Method with the Confusion Assessment Method for the Intensive Care Unit in critically ill patients and their family members in a medical intensive care unit in Germany. Results: We included 50 dyads of critically ill patients and their family members. The prevalence of delirium measured by Confusion Assessment Method for the Intensive Care Unit was 44%. Cohen's kappa coefficient was 0.84. The German Family Confusion Assessment Method had a high sensitivity of 95.5% and specificity of 89.3%. The positive predictive value and negative predictive value were 87.5% and 96.2% respectively. Conclusions: These findings suggest that the German Family Confusion Assessment Method is an accurate assessment tool for delirium detection in the intensive care unit by family members. Furthermore, the results indicate that family members may identify delirium by the Family Confusion Assessment Method without prior training. Impact: Collaborating medical staff with patients' family members to detect delirium in the intensive care unit may lead to early recognition of delirium. Keywords: Family Confusion Assessment Method; delirium; family mem

Published
2022

104. Assessment and technical monitoring of nutritional status of patients in intensive and intermediate care units

Author

Weimann, Arved, primary, Hartl, Wolfgang H., additional, Adolph, Michael, additional, Angstwurm, Matthias, additional, Brunkhorst, Frank M., additional, Edel, Andreas, additional, de Heer, Geraldine, additional, Felbinger, Thomas W., additional, Goeters, Christiane, additional, Hill, Aileen, additional, Kreymann, K. Georg, additional, Mayer, Konstantin, additional, Ockenga, Johann, additional, Petros, Sirak, additional, Rümelin, Andreas, additional, Schaller, Stefan J., additional, Schneider, Andrea, additional, Stoppe, Christian, additional, and Elke, Gunnar, additional

Published
2022
Full Text
View/download PDF

105. Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome-assessor blinded trial

Author

Schaller, Stefan J, primary, Kiselev, Jörn, additional, Loidl, Verena, additional, Quentin, Wilm, additional, Schmidt, Katrin, additional, Mörgeli, Rudolf, additional, Rombey, Tanja, additional, Busse, Reinhard, additional, Mansmann, Ulrich, additional, and Spies, Claudia, additional

Published
2022
Full Text
View/download PDF

107. Additional file 4 of Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome assessor-blinded trial

Author

Schaller, Stefan J., Kiselev, Jörn, Loidl, Verena, Quentin, Wilm, Schmidt, Katrin, Mörgeli, Rudolf, Rombey, Tanja, Busse, Reinhard, Mansmann, Ulrich, and Spies, Claudia

Subjects
Data_FILES, GeneralLiterature_MISCELLANEOUS
Abstract

Additional file 4. Spirit Figure.

Published
2022
Full Text
View/download PDF

108. Additional file 5 of Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome assessor-blinded trial

Author

Schaller, Stefan J., Kiselev, Jörn, Loidl, Verena, Quentin, Wilm, Schmidt, Katrin, Mörgeli, Rudolf, Rombey, Tanja, Busse, Reinhard, Mansmann, Ulrich, and Spies, Claudia

Subjects
ComputerSystemsOrganization_COMPUTER-COMMUNICATIONNETWORKS, Data_FILES
Abstract

Additional file 5. Study protocol.

Published
2022
Full Text
View/download PDF

109. Additional file 7 of Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome assessor-blinded trial

Author

Schaller, Stefan J., Kiselev, Jörn, Loidl, Verena, Quentin, Wilm, Schmidt, Katrin, Mörgeli, Rudolf, Rombey, Tanja, Busse, Reinhard, Mansmann, Ulrich, and Spies, Claudia

Subjects
ComputingMilieux_THECOMPUTINGPROFESSION, Data_FILES, ComputingMilieux_COMPUTERSANDSOCIETY, ComputingMilieux_LEGALASPECTSOFCOMPUTING
Abstract

Additional file 7. Ethical vote.

Published
2022
Full Text
View/download PDF

110. sj-docx-1-jic-10.1177_08850666221132246 - Supplemental material for Comparison of Different Ultrasound Methods to Assess Changes in Muscle Mass in Critically ill Patients

Author

Fuest, Kristina E., Lanz, Hugo, Schulz, Jana, Ulm, Bernhard, Bennett, Victoria A., Grunow, Julius J., Weiss, Björn, Blobner, Manfred, and Schaller, Stefan J.

Subjects
110203 Respiratory Diseases, FOS: Clinical medicine, 111702 Aged Health Care, FOS: Health sciences, 110305 Emergency Medicine
Abstract

Supplemental material, sj-docx-1-jic-10.1177_08850666221132246 for Comparison of Different Ultrasound Methods to Assess Changes in Muscle Mass in Critically ill Patients by Kristina E. Fuest, Hugo Lanz, Jana Schulz, Bernhard Ulm, Victoria A. Bennett, Julius J. Grunow, Björn Weiss, Manfred Blobner and Stefan J. Schaller in Journal of Intensive Care Medicine

Published
2022
Full Text
View/download PDF

112. Additional file 1 of Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study

Author

Lindholz, Maximilian, Schellenberg, Clara M., Grunow, Julius J., Kagerbauer, Simone, Milnik, Annette, Zickler, Daniel, Angermair, Stefan, Reißhauer, Anett, Witzenrath, Martin, Menk, Mario, Boie, Sebastian, Balzer, Felix, and Schaller, Stefan J.

Abstract

Additional file 1. Table S1. Individual elements of the Elixhauser index. Table S2. All Admission diagnoses with n > 50.

Published
2022
Full Text
View/download PDF

117. The Functional Trajectory in Frail Compared With Non-frail Critically Ill Patients During the Hospital Stay

Author

Fuest, K. E., primary, Lorenz, Marco, additional, Grunow, Julius J., additional, Weiss, Björn, additional, Mörgeli, Rudolf, additional, Finkenzeller, Sebastian, additional, Bogdanski, Ralph, additional, Heim, Markus, additional, Kapfer, Barbara, additional, Kriescher, Silja, additional, Lingg, Charlotte, additional, Martin, Jan, additional, Ulm, Bernhard, additional, Jungwirth, Bettina, additional, Blobner, Manfred, additional, and Schaller, Stefan J., additional

Published
2021
Full Text
View/download PDF

119. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

Author

Flaatten, Hans, De Lange, Dylan W., Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Bertolini, Guido, Boumendil, Ariane, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agwald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Zaferidis, Tilemachos, Guidet, Bertrand, Schmutz, René, Wimmer, Franz, Eller, Philipp, Zotter, Klemens, Swinnen, Walter, De Buysscher, Pieter, De Neve, Nikolaas, Abraham, Paul, Fleury, Yvan, Schefold, Joerg C., Biskup, Ewelina, Taliadoros, Ioannis, Piza, Petr, Lauten, Alexander, Sacher, Anna Lena, Brenner, Thorsten, Franz, Marcus, Bloos, Frank, Ebelt, Henning, Schaller, Stefan J., Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobias, Nia, Amir M., Janosi, Rolf Alexander, Meybohm, Patrick, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Dey, Nilanjan, Sølling, Christoffer, Rasmussen, Bodil Steen, Rodriguez, Enver, Rebollo, Sergio, Aguilar, Gerardo, Masdeu, Gaspar, Jaimes, Marián Irazábal, Prado Mira, Ángela, Bodi, Maria A., Barea Mendoza, Jesus A., López-Cuenca, Sonia, Homez Guzman, Marcela, Rico-Feijoo, Jesús, Ibarz, Mercedes, Trenado-Alvarez, Josep, Forceville, Xavier, Besch, Guillaume, Mentec, Herve, Michel, Philippe, Mateu, Philippe, Vettoretti, Lucie, Bourenne, Jeremy, Marin, Nathalie, Guillot, Max, Aissaoui, Naida, Goulenok, Cyril, Thieulot-Rolin, Nathalie, Messika, Jonathan, Lamhaut, Lionel, Charron, Cyril, Dempsey, Ged, Mathew, Shiju J., Raj, Ashok S., Grecu, Irina, Cupitt, Jason, Lawton, Tom, Clark, Richard, Popescu, Monica, Spittle, Nick, Faulkner, Maria, Cowton, Amanda, Elloway, Esme, Williams, Patricia, Reay, Michael, Chukkambotla, Srikanth, Kumar, Ravi, Al-Subaie, Nawaf, Kent, Linda, Tamm, Tiina, Kajtor, Istvan, Burns, Karen, Pugh, Richard, Ostermann, Marlies, Kam, Elisa, Bowyer, Helen, Smith, Neil, Templeton, Maie, Henning, Jeremy, Goffin, Kelly, Kapoor, Ritoo, Laha, Shondipon, Chilton, Phil, Khaliq, Waqas, Crayford, Alison, Coetzee, Samantha, Tait, Moira, Boultoukas, Evangelos, Stoker, Wendy, Gimenez, Marc, Pope, Alan, Camsooksai, Julie, Pogson, David, Quigley, Kate, Ritzema, Jenny, Hormis, Anil, Boulanger, Carole, Balasubramaniam, M., Vamplew, Luke, Burt, Karen, Martin, Daniel, Craig, Jayne, Prowle, John, Doyle, Nanci, Shelton, Jonathon, Scott, Carmen, Donnison, Phil, Shelton, Sarah, Frey, Christian, Ryan, Christine, Spray, Dominic, Barnes, Veronica, Barnes, Kerry, Furneval, Julie, Ridgway, Stephanie, Saha, Rajnish, Clark, Thomas, Wood, James, Bolger, Clare, Bassford, Christopher, Lewandowski, john, Zhao, Xiaobei, Humphreys, Sally, Dowling, Susan, Richardson, Neil, Burtenshaw, Andrew, Stevenson, Carl, Wilcock, Danielle, Aidoni, Zoi, Aloizos, Stavros, Tasioudis, Polychronis, Lampiri, Kleri, Zisopoulou, Vasiliki, Ifigenia, Ravani, Eymorfia, Pagaki, Angela, Anttoniou, Katsoulas, Theodoros A., Kyparissi, Aikaterini, Aikaterini, Kounougeri, Marinakis, George, Tsimpoukas, Fotios, Spyropoulou, Anastasia, Zygoulis, Paris, Hayes, Ivan, Kelly, Yvelynne, Westbrook, Andrew, Fitzpatrick, Gerry, Maheshwari, Darshana, Motherway, Catherine, Gupta, Manish, Gurjar, Mohan, Maji, Ismail M, Negri, Giovanni, Spadaro, Savino, Nattino, Giuseppe, Pedeferri, Matteo, Boscolo, Annalisa, Rossi, Simona, Rossi, Maurizio, Calicchio, Giuseppe, Cubattoli, Lucia, Di Lascio, Gabriella, Barbagallo, Maria, Berruto, Francesco, Codazzi, Daniela, Bottazzi, Andrea, Fumagalli, Paolo, Negro, Giancarlo, Lupi, Giuseppe, Savelli, Flavia, Vulcano, Giuseppe A., Fumagalli, Roberto, Marudi, Andrea, Lefons, Ugo, Lembo, Rita, Babini, Maria, Paggioro, Alessandra, Parrini, Vieri, Zaccaria, Maria, Clementi, Stefano, Gigliuto, Carmelo, Facondini, Francesca, Pastorini, Simonetta, Munaron, Susanna, Calamai, Italo, Bocchi, Anna, Brizio, Elisabetta, Adorni, Adele, Bocci, Maria Grazia, Cortegiani, Andrea, Casalicchio, Tiziana, Mellea, Serena, Graziani, Elia, Barattini, Massimo, van Dijk, I., van Lelyveld-Haas, L. E. M., Ramnarain, D., Jansen, Tim, Nooteboom, Fleur, van der Voort, Peter H. J., Dieperink, Willem, de Waard, Monique C., Bormans, Laura, Hahn, Michael, Kemmerer, Nicolai, Strietzel, Hans Frank, Fehrle, Lutz, Dybwik, Knut, Legernaes, Terje, Klepstad, Pål, Olaussen, Even Braut, Olsen, Knut Inge, Børresen, Ole Marius, Bjørsvik, Geir, Maini, Sameer, Czuczwar, Miroslaw, Krawczyk, Pawel, Ziętkiewicz, Mirosław, Nowak, Łukasz R., Kotfis, Katarzyna, Cwyl, Katarzyna, Gajdosz, Ryszard, Biernawska, Jowita, Grudzień, Paweł, Nasiłowski, Paweł, Popek, Natalia, Cyrankiewicz, Waldemar, Wnuk, Marek, Maciejewski, Dariusz, Studzińska, Dorota, Zukowski, Maciej, Bernas, Szymon, Serwa, Marta, Stefaniak, Jan, Pawel, Maciejewski, Szymkowiak, Malgorzata, Adamik, Barbara, Catorze, Nuno, Castelo Branco, Miguel, Barros, Inês, Barros, Nelson, Krystopchuk, Andriy, Honrado, Teresa, Sousa, Cristina, Munoz, Francisco, Rebelo, Marta, Gomes, Rui, Nunes, Jorge, Dias, Celeste, Fernandes, Ana Margarida, Petrisor, Cristina, Constantin, Bodolea, Belskiy, Vladislav, Boskholov, Boris, Kawati, Rafael, Sivik, Joakim, Nauska, Jessica, Smole, Daniel, Parenmark, Fredric, Lyrén, Johanna, Rockstroh, Katalin, Rydén, Sara, Spångfors, Martin, Strinnholm, Morten, Walther, Sten, De Geer, Lina, Nordlund, Peter, Pålsson, Staffan, Zetterquist, Harald, Nilsson, Annika, Thiringer, Karin, Jungner, Mårten, Bark, Björn, Nordling, Berit, Sköld, Hans, Brorsson, Camilla, Persson, Stefan, Bergström, Anna, Berkius, Johan, Holmström, Johanna, Yapici, Nihan, University of Bergen (UiB), Haukeland University Hospital, University Medical Center [Utrecht], CIBER de Epidemiología y Salud Pública (CIBERESP), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), St George’s University Hospitals, Aarhus University Hospital, Mater Misericordiae University Hospital (The Mater Hospital), NOVA Medical School - Faculdade de Ciências Médicas (NMS), Universidade Nova de Lisboa = NOVA University Lisbon (NOVA), Ghent University Hospital, Karolinska University Hospital [Stockholm], Hôpitaux Universitaires de Genève (HUG), Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Réanimation Médicale [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Gestionnaire, Hal Sorbonne Université, Flaatten, H, De Lange, D, Morandi, A, Andersen, F, Artigas, A, Bertolini, G, Boumendil, A, Cecconi, M, Christensen, S, Faraldi, L, Fjolner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Ohman, C, Pinto, B, Soliman, I, Szczeklik, W, Valentin, A, Watson, X, Zaferidis, T, Guidet, B, Schmutz, R, Wimmer, F, Eller, P, Zotter, K, Swinnen, W, De Buysscher, P, De Neve, N, Abraham, P, Fleury, Y, Schefold, J, Biskup, E, Taliadoros, I, Piza, P, Lauten, A, Sacher, A, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, S, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, A, Janosi, R, Meybohm, P, Simon, P, Utzolino, S, Rahmel, T, Barth, E, Schuster, M, Dey, N, Solling, C, Rasmussen, B, Rodriguez, E, Rebollo, S, Aguilar, G, Masdeu, G, Jaimes, M, Prado Mira, A, Bodi, M, Barea Mendoza, J, Lopez-Cuenca, S, Homez Guzman, M, Rico-Feijoo, J, Ibarz, M, Trenado-Alvarez, J, Forceville, X, Besch, G, Mentec, H, Michel, P, Mateu, P, Vettoretti, L, Bourenne, J, Marin, N, Guillot, M, Aissaoui, N, Goulenok, C, Thieulot-Rolin, N, Messika, J, Lamhaut, L, Charron, C, Dempsey, G, Mathew, S, Raj, A, Grecu, I, Cupitt, J, Lawton, T, Clark, R, Popescu, M, Spittle, N, Faulkner, M, Cowton, A, Elloway, E, Williams, P, Reay, M, Chukkambotla, S, Kumar, R, Al-Subaie, N, Kent, L, Tamm, T, Kajtor, I, Burns, K, Pugh, R, Ostermann, M, Kam, E, Bowyer, H, Smith, N, Templeton, M, Henning, J, Goffin, K, Kapoor, R, Laha, S, Chilton, P, Khaliq, W, Crayford, A, Coetzee, S, Tait, M, Boultoukas, E, Stoker, W, Gimenez, M, Pope, A, Camsooksai, J, Pogson, D, Quigley, K, Ritzema, J, Hormis, A, Boulanger, C, Balasubramaniam, M, Vamplew, L, Burt, K, Martin, D, Craig, J, Prowle, J, Doyle, N, Shelton, J, Scott, C, Donnison, P, Shelton, S, Frey, C, Ryan, C, Spray, D, Barnes, V, Barnes, K, Furneval, J, Ridgway, S, Saha, R, Clark, T, Wood, J, Bolger, C, Bassford, C, Lewandowski, J, Zhao, X, Humphreys, S, Dowling, S, Richardson, N, Burtenshaw, A, Stevenson, C, Wilcock, D, Aidoni, Z, Aloizos, S, Tasioudis, P, Lampiri, K, Zisopoulou, V, Ifigenia, R, Eymorfia, P, Angela, A, Katsoulas, T, Kyparissi, A, Aikaterini, K, Marinakis, G, Tsimpoukas, F, Spyropoulou, A, Zygoulis, P, Hayes, I, Kelly, Y, Westbrook, A, Fitzpatrick, G, Maheshwari, D, Motherway, C, Gupta, M, Gurjar, M, Maji, I, Negri, G, Spadaro, S, Nattino, G, Pedeferri, M, Boscolo, A, Rossi, S, Rossi, M, Calicchio, G, Cubattoli, L, Di Lascio, G, Barbagallo, M, Berruto, F, Codazzi, D, Bottazzi, A, Fumagalli, P, Negro, G, Lupi, G, Savelli, F, Vulcano, G, Fumagalli, R, Marudi, A, Lefons, U, Lembo, R, Babini, M, Paggioro, A, Parrini, V, Zaccaria, M, Clementi, S, Gigliuto, C, Facondini, F, Pastorini, S, Munaron, S, Calamai, I, Bocchi, A, Brizio, E, Adorni, A, Bocci, M, Cortegiani, A, Casalicchio, T, Mellea, S, Graziani, E, Barattini, M, van Dijk, I, van Lelyveld-Haas, L, Ramnarain, D, Jansen, T, Nooteboom, F, van der Voort, P, Dieperink, W, de Waard, M, Bormans, L, Hahn, M, Kemmerer, N, Strietzel, H, Fehrle, L, Dybwik, K, Legernaes, T, Klepstad, P, Olaussen, E, Olsen, K, Borresen, O, Bjorsvik, G, Maini, S, Czuczwar, M, Krawczyk, P, Zietkiewicz, M, Nowak, L, Kotfis, K, Cwyl, K, Gajdosz, R, Biernawska, J, Grudzien, P, Nasilowski, P, Popek, N, Cyrankiewicz, W, Wnuk, M, Maciejewski, D, Studzinska, D, Zukowski, M, Bernas, S, Serwa, M, Stefaniak, J, Pawel, M, Szymkowiak, M, Adamik, B, Catorze, N, Castelo Branco, M, Barros, I, Barros, N, Krystopchuk, A, Honrado, T, Sousa, C, Munoz, F, Rebelo, M, Gomes, R, Nunes, J, Dias, C, Fernandes, A, Petrisor, C, Constantin, B, Belskiy, V, Boskholov, B, Kawati, R, Sivik, J, Nauska, J, Smole, D, Parenmark, F, Lyren, J, Rockstroh, K, Ryden, S, Spangfors, M, Strinnholm, M, Walther, S, De Geer, L, Nordlund, P, Palsson, S, Zetterquist, H, Nilsson, A, Thiringer, K, Jungner, M, Bark, B, Nordling, B, Skold, H, Brorsson, C, Persson, S, Bergstrom, A, Berkius, J, Holmstrom, J, Yapici, N, Flaatten, Han, De Lange, Dylan W., Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Bertolini, Guido, Boumendil, Ariane, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjølner, Jesper, Jung, Christian, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agwald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andrea, Watson, Ximena, Zaferidis, Tilemacho, Guidet, Bertrand, Schmutz, René, Wimmer, Franz, Eller, Philipp, Zotter, Klemen, Swinnen, Walter, De Buysscher, Pieter, De Neve, Nikolaa, Abraham, Paul, Fleury, Yvan, Schefold, Joerg C., Biskup, Ewelina, Taliadoros, Ioanni, Piza, Petr, Lauten, Alexander, Sacher, Anna Lena, Brenner, Thorsten, Franz, Marcu, Bloos, Frank, Ebelt, Henning, Schaller, Stefan J., Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobia, Nia, Amir M., Janosi, Rolf Alexander, Meybohm, Patrick, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Dey, Nilanjan, Sølling, Christoffer, Rasmussen, Bodil Steen, Rodriguez, Enver, Rebollo, Sergio, Aguilar, Gerardo, Masdeu, Gaspar, Jaimes, Marián Irazábal, Prado Mira, Ángela, Bodi, Maria A., Barea Mendoza, Jesus A., López-Cuenca, Sonia, Homez Guzman, Marcela, Rico-Feijoo, Jesú, Ibarz, Mercede, Trenado-Alvarez, Josep, Forceville, Xavier, Besch, Guillaume, Mentec, Herve, Michel, Philippe, Mateu, Philippe, Vettoretti, Lucie, Bourenne, Jeremy, Marin, Nathalie, Guillot, Max, Aissaoui, Naida, Goulenok, Cyril, Thieulot-Rolin, Nathalie, Messika, Jonathan, Lamhaut, Lionel, Charron, Cyril, Dempsey, Ged, Mathew, Shiju J., Raj, Ashok S., Grecu, Irina, Cupitt, Jason, Lawton, Tom, Clark, Richard, Popescu, Monica, Spittle, Nick, Faulkner, Maria, Cowton, Amanda, Elloway, Esme, Williams, Patricia, Reay, Michael, Chukkambotla, Srikanth, Kumar, Ravi, Al-Subaie, Nawaf, Kent, Linda, Tamm, Tiina, Kajtor, Istvan, Burns, Karen, Pugh, Richard, Ostermann, Marlie, Kam, Elisa, Bowyer, Helen, Smith, Neil, Templeton, Maie, Henning, Jeremy, Goffin, Kelly, Kapoor, Ritoo, Laha, Shondipon, Chilton, Phil, Khaliq, Waqa, Crayford, Alison, Coetzee, Samantha, Tait, Moira, Boultoukas, Evangelo, Stoker, Wendy, Gimenez, Marc, Pope, Alan, Camsooksai, Julie, Pogson, David, Quigley, Kate, Ritzema, Jenny, Hormis, Anil, Boulanger, Carole, Balasubramaniam, M., Vamplew, Luke, Burt, Karen, Martin, Daniel, Craig, Jayne, Prowle, John, Doyle, Nanci, Shelton, Jonathon, Scott, Carmen, Donnison, Phil, Shelton, Sarah, Frey, Christian, Ryan, Christine, Spray, Dominic, Barnes, Veronica, Barnes, Kerry, Furneval, Julie, Ridgway, Stephanie, Saha, Rajnish, Clark, Thoma, Wood, Jame, Bolger, Clare, Bassford, Christopher, Lewandowski, john, Zhao, Xiaobei, Humphreys, Sally, Dowling, Susan, Richardson, Neil, Burtenshaw, Andrew, Stevenson, Carl, Wilcock, Danielle, Aidoni, Zoi, Aloizos, Stavro, Tasioudis, Polychroni, Lampiri, Kleri, Zisopoulou, Vasiliki, Ifigenia, Ravani, Eymorfia, Pagaki, Angela, Anttoniou, Katsoulas, Theodoros A., Kyparissi, Aikaterini, Aikaterini, Kounougeri, Marinakis, George, Tsimpoukas, Fotio, Spyropoulou, Anastasia, Zygoulis, Pari, Hayes, Ivan, Kelly, Yvelynne, Westbrook, Andrew, Fitzpatrick, Gerry, Maheshwari, Darshana, Motherway, Catherine, Gupta, Manish, Gurjar, Mohan, Maji, Ismail M, Negri, Giovanni, Spadaro, Savino, Nattino, Giuseppe, Pedeferri, Matteo, Boscolo, Annalisa, Rossi, Simona, Rossi, Maurizio, Calicchio, Giuseppe, Cubattoli, Lucia, Di Lascio, Gabriella, Barbagallo, Maria, Berruto, Francesco, Codazzi, Daniela, Bottazzi, Andrea, Fumagalli, Paolo, Negro, Giancarlo, Lupi, Giuseppe, Savelli, Flavia, Vulcano, Giuseppe A., Fumagalli, Roberto, Marudi, Andrea, Lefons, Ugo, Lembo, Rita, Babini, Maria, Paggioro, Alessandra, Parrini, Vieri, Zaccaria, Maria, Clementi, Stefano, Gigliuto, Carmelo, Facondini, Francesca, Pastorini, Simonetta, Munaron, Susanna, Calamai, Italo, Bocchi, Anna, Brizio, Elisabetta, Adorni, Adele, Bocci, Maria Grazia, Cortegiani, Andrea, Casalicchio, Tiziana, Mellea, Serena, Graziani, Elia, Barattini, Massimo, van Dijk, I., van Lelyveld-Haas, L.E.M., Ramnarain, D., Jansen, Tim, Nooteboom, Fleur, van der Voort, Peter H.J., Dieperink, Willem, de Waard, Monique C., Bormans, Laura, Hahn, Michael, Kemmerer, Nicolai, Strietzel, Hans Frank, Fehrle, Lutz, Dybwik, Knut, Legernaes, Terje, Klepstad, Pål, Olaussen, Even Braut, Olsen, Knut Inge, Børresen, Ole Mariu, Bjørsvik, Geir, Maini, Sameer, Czuczwar, Miroslaw, Krawczyk, Pawel, Ziętkiewicz, Mirosław, Nowak, Łukasz R., Kotfis, Katarzyna, Cwyl, Katarzyna, Gajdosz, Ryszard, Biernawska, Jowita, Grudzień, Paweł, Nasiłowski, Paweł, Popek, Natalia, Cyrankiewicz, Waldemar, Wnuk, Marek, Maciejewski, Dariusz, Studzińska, Dorota, Zukowski, Maciej, Bernas, Szymon, Serwa, Marta, Stefaniak, Jan, Pawel, Maciejewski, Szymkowiak, Malgorzata, Adamik, Barbara, Catorze, Nuno, Castelo Branco, Miguel, Barros, Inê, Barros, Nelson, Krystopchuk, Andriy, Honrado, Teresa, Sousa, Cristina, Munoz, Francisco, Rebelo, Marta, Gomes, Rui, Nunes, Jorge, Dias, Celeste, Fernandes, Ana Margarida, Petrisor, Cristina, Constantin, Bodolea, Belskiy, Vladislav, Boskholov, Bori, Kawati, Rafael, Sivik, Joakim, Nauska, Jessica, Smole, Daniel, Parenmark, Fredric, Lyrén, Johanna, Rockstroh, Katalin, Rydén, Sara, Spångfors, Martin, Strinnholm, Morten, Walther, Sten, De Geer, Lina, Nordlund, Peter, Pålsson, Staffan, Zetterquist, Harald, Nilsson, Annika, Thiringer, Karin, Jungner, Mårten, Bark, Björn, Nordling, Berit, Sköld, Han, Brorsson, Camilla, Persson, Stefan, Bergström, Anna, Berkius, Johan, Holmström, Johanna, and Yapici, Nihan

Subjects
Male, Time Factors, Outcome Assessment, Frail Elderly/statistics & numerical data, [SDV]Life Sciences [q-bio], HSJ UCI, Passive, Critical Care and Intensive Care Medicine, Frailty/classification/diagnosis/mortality/therapy, Severity of Illness Index, Severity of illne, Elderly, 0302 clinical medicine, Quality of life, Frailty, ICU, Mortality, Octogenarians, Severity of illness, Aged, 80 and over, Critical Illness, Europe, Euthanasia, Passive, Female, Frail Elderly, Geriatric Assessment, Humans, Intensive Care Units, Length of Stay, Outcome Assessment, Health Care, Proportional Hazards Models, Prospective Studies, Quality of Life, Hospital Mortality, 80 and over, 030212 general & internal medicine, Prospective cohort study, education.field_of_study, ddc:617, Mortality rate, [SDV] Life Sciences [q-bio], Length of Stay/statistics & numerical data, Cohort, Intensive Care Units/statistics & numerical data, Critical Illne, SOFA score, Human, medicine.medical_specialty, Time Factor, Intensive Care Unit, Population, INTENSIVE-CARE, Europe/epidemiology, Outcome Assessment (Health Care), 03 medical and health sciences, Octogenarian, Intensive care, Journal Article, medicine, COHORT, Octogenarinans, Intensive care medicine, education, Aged, OLDER, Euthanasia, business.industry, 030208 emergency & critical care medicine, Health Care, Prospective Studie, Critical Illness/mortality, UNIT, Emergency medicine, Proportional Hazards Model, business
Abstract

Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥80years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30days. Results: A total of 5021 patients with a median age of 84years (IQR 81–86years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38–1.73) for frail versus non-frail. Conclusions: Among very old patients (≥80years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group. Trial registration: ClinicalTrials.gov (ID: NCT03134807).

Published
2017
Full Text
View/download PDF

120. Management and outcomes in critically ill nonagenarian versus octogenarian patients

Author

Bruno, Raphael Romano, Wernly, Bernhard, Kelm, Malte, Boumendil, Ariane, Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Finazzi, Stefano, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Lichtenauer, Michael, Muessig, Johanna M., Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Öhman, Christina Agvald, Pinto, Bernardo Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Leaver, Susannah, Boulanger, Carole, Walther, Sten, Schefold, Joerg C., Joannidis, Michael, Nalapko, Yuriy, Elhadi, Muhammed, Fjølner, Jesper, Zafeiridis, Tilemachos, De Lange, Dylan W., Guidet, Bertrand, Flaatten, Hans, Jung, Christian, Eller, Philipp, Helbok, Raimund, Schmutz, René, Nollet, Joke, de Neve, Nikolaas, Buysscher, Pieter De, Swinnen, Walter, Mikačić, Marijana, Bastiansen, Anders, Husted, Andreas, Dahle, Bård E. S., Cramer, Christine, Sølling, Christoffer, Ørsnes, Dorthe, Thomsen, Jakob Edelberg, Pedersen, Jonas Juul, Enevoldsen, Mathilde Hummelmose, Elkmann, Thomas, Kubisz-Pudelko, Agnieszka, Pope, Alan, Collins, Amy, Raj, Ashok S., Frey, Christian, Hart, Ciaran, Bolger, Clare, Spray, Dominic, Randell, Georgina, Filipe, Helder, Welters, Ingeborg D., Grecu, Irina, Evans, Jane, Cupitt, Jason, Lord, Jenny, Henning, Jeremy, Jones, Joanne, Ball, Jonathan, North, Julie, Salaunkey, Kiran, De Gordoa, Laura Ortiz-Ruiz, Bell, Louise, Balasubramaniam, Madhu, Vizcaychipi, Marcela, Faulkner, Maria, Mupudzi, Mc Donald, Lea-Hagerty, Megan, Reay, Michael, Spivey, Michael, Love, Nicholas, Spittle, Nick Spittle Nick, White, Nigel, Williams, Patricia, Morgan, Patrick, Wakefield, Phillipa, Savine, Rachel, Jacob, Reni, Innes, Richard, Kapoor, Ritoo, Humphreys, Sally, Rose, Steve, Dowling, Susan, Mane, Tarkeshwari, Lawton, Tom, Ogbeide, Vongayi, Khaliq, Waqas, Baird, Yolanda, Romen, Antoine, Galbois, Arnaud, Vinsonneau, Christophe, Charron, Cyril, Thevenin, Didier, Guerot, Emmanuel, Besch, Guillaume, Savary, Guillaume, Mentec, Hervé, Chagnon, Jean-Luc, Rigaud, Jean-Philippe, Quenot, Jean-Pierre, Castanera, Jeremy, Rosman, Jérémy, Maizel, Julien, Tiercelet, Kelly, Vettoretti, Lucie, Hovaere, Maud Mousset, Messika, Messika, Djibré, Michel, Rolin, Nathalie, Burtin, Philippe, Garcon, Pierre, Nseir, Saad, Valette, Xavier, Rabe, Christian, Barth, Eberhard, Ebelt, Henning, Fuest, Kristina, Franz, Marcus, Horacek, Michael, Schuster, Michael, Meybohm, Patrick, Allgäuer, Sebastian, Dubler, Simon, Schaller, Stefan J., Schering, Stefan, Steiner, Stephan, Dieck, Thorben, Rahmel, Tim, Graf, Tobias, Koutsikou, Anastasia, Vakalos, Aristeidis, Raitsiou, Bogdan, Flioni, Elli Niki, Neou, Evangelia, Tsimpoukas, Fotios, Papathanakos, Georgios, Marinakis, Giorgos, Koutsodimitropoulos, Ioannis, Aikaterini, Kounougeri, Rovina, Nikoletta, Kourelea, Stylliani, Tasioudis, Polychronis, Zidianakis, Vasiiios, Konstantinia, Vryza, Aidoni, Zoi, Motherway, Catherine, Read, Chris, Martin-Loeches, Ignacio, Cracchiolo, Andrea Neville, Morigi, Aristide, Calamai, Italo, Brusa, Stefania, Elhadi, Ahmed, Tarek, Ahmed, Khaled, Ala, Ahmed, Hazem, Belkhair, Wesal Ali, Cornet, Alexander D., Gommers, Diederik, van Boven, Eva, Haringman, Jasper, Haas, Lenneke, van den Berg, Lettie, Hoiting, Oscar, de Jager, Peter, Gerritsen, Rik T., Dormans, Tom, Dieperink, Willem, Breidablik, Alena Breidablik Alena, Slapgard, Anita, Rime, Anne-Karin, Jannestad, Bente, Sjøbøe, Britt, Rice, Eva, Strietzel, Hans Frank, Jensen, Jan Peter, Langørgen, Jørund, Tøien, Kirsti, Strand, Kristian, Hahn, Michael, Klepstad, Pål, Biernacka, Aleksandra, Kluzik, Anna, Kudlinski, Bartosz, Maciejewski, Dariusz, Studzińska, Dorota, Hymczak, Hubert, Stefaniak, Jan, Solek-Pastuszka, Joanna, Zorska, Joanna, Cwyl, Katarzyna, Krzych, Lukasz J., Zukowski, Maciej, Lipińska-Gediga, Małgorzata, Pietruszko, Marek, Piechota, Mariusz, Serwa, Marta, Czuczwar, Miroslaw, Ziętkiewicz, Mirosław, Kozera, Natalia, Nasiłowski, Paweł, Sendur, Paweł, Zatorski, Paweł, Galkin, Piotr, Gawda, Ryszard, Kościuczuk, Urszula, Cyrankiewicz, Waldemar, Gola, Wojciech, Fernandes Pinto, Alexandre, Fernandes, Ana Margarida, Santos, Ana Rita, Sousa, Cristina, Barros, Inês, Ferreira, Isabel Amorim, Blanco, Jacobo Bacariza, Carvalho, João Teles, Maia, Jose, Candeias, Nuno, Catorze, Nuno, Belskiy, Vladislav, Lores, Africa, Mira, Angela Prado, Cilloniz, Catia, Perez-Torres, David, Maseda, Emilio, Rodriguez, Enver, Prol-Silva, Estefania, Eixarch, Gaspar, Gomà, Gemma, Aguilar, Gerardo, Velasco, Gonzalo Navarro, Jaimes, Marián Irazábal, Villamayor, Mercedes Ibarz, Fernández, Noemí Llamas, Cubero, Patricia Jimeno, López-Cuenca, Sonia, Tomasa, Teresa, Sjöqvist, Anders, Brorsson, Camilla, Schiöler, Fredrik, Westberg, Henrik, Nauska, Jessica, Sivik, Joakim, Berkius, Johan, Thiringer, Karin Kleiven, De Geer, Lina, Boroli, Filippo, Hergafi, Leila, Eckert, Philippe, Yıldız, Ismail, Yovenko, Ihor, Pugh, Richard, and on behalf of the VIP2 study group, [missing]

Subjects
Octogenarians, INTENSIVE-CARE-UNIT, Frailty, PREDICTION, SURGERY, MORTALITY, Nonagenarians, ICU, Medicine and Health Sciences, OLD PATIENTS, SHORT-TERM, Intensive care medicine, Geriatrics and Gerontology, ELDERLY-PATIENTS, Outcome
Abstract

Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (>= 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 +/- 5 vs. 7 +/- 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions.

Published
2021

121. Adverse events during and after early mobilisation: A post hoc analysis of the TEAM trial

Author

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

Abstract

The Treatment of Mechanically Ventilated Adults with Early Activity and Mobilisation (TEAM) trial reported a higher occurrence of adverse events with greater mobilisation. However, their timing and nature remained unexplored. We conducted an in-depth exploration of such events.

Published
2025
Full Text
View/download PDF

122. The Functional Trajectory in Frail Compared With Non-frail Critically Ill Patients During the Hospital Stay

Author

Fuest, K. E., Lorenz, Marco, Grunow, Julius J., Weiss, Björn, Mörgeli, Rudolf, Finkenzeller, Sebastian, Bogdanski, Ralph, Heim, Markus, Kapfer, Barbara, Kriescher, Silja, Lingg, Charlotte, Martin, Jan, Ulm, Bernhard, Jungwirth, Bettina, Blobner, Manfred, and Schaller, Stefan J.

Subjects
Medicine, frailty, critical illness, outcome assessment, ICU, morbidity, ddc
Published
2020

125. Hypophosphataemia in Critically Ill Adults and Children – A Systematic Review

Author

Blaser, Annika Reintam, primary, Gunst, Jan, additional, Ichai, Carole, additional, Casaer, Michael, additional, Benstoem, Carina, additional, Besch, Guillaume, additional, Dauger, Stephane, additional, Fruhwald, Sonja M, additional, Hiesmayr, Michael, additional, Joannes-Boyau, Olivier, additional, Malbrain, Manu LNG, additional, Perez, Maria-Helena, additional, Schaller, Stefan J, additional, Man, Angelique de, additional, Starkopf, Joel, additional, Tamme, Kadri, additional, Wernerman, Jan, additional, and Berger, Mette M, additional

Published
2020
Full Text
View/download PDF

126. Meeting nutritional targets of critically ill patients by combined enteral and parenteral nutrition: review and rationale for the EFFORTcombo trial

Author

Hill, Aileen, primary, Heyland, Daren K., additional, Elke, Gunnar, additional, Schaller, Stefan J., additional, Stocker, Reto, additional, Haberthür, Christoph, additional, von Loeffelholz, Christian, additional, Suchner, Ulrich, additional, Puthucheary, Zudin A., additional, Bear, Danielle E., additional, Ney, Julia, additional, Clasen, Kai C., additional, Meybohm, Patrick, additional, Lindau, Simone, additional, Laurentius, Thea, additional, and Stoppe, Christian, additional

Published
2020
Full Text
View/download PDF

127. Additional file 1 of Substitution of perioperative albumin deficiency disorders (SuperAdd) in adults undergoing vascular, abdominal, trauma, or orthopedic surgery: protocol for a randomized controlled trial

Author

Schaller, Stefan J., Fuest, Kristina, Ulm, Bernhard, Schmid, Sebastian, Bubb, Catherina, Eisenhart-Rothe, Rüdiger Von, Friess, Helmut, Chlodwig Kirchhoff, Stadlbauer, Thomas, Luppa, Peter, Blobner, Manfred, and Jungwirth, Bettina

Abstract

Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents.

Published
2020
Full Text
View/download PDF

128. Additional file 2 of Substitution of perioperative albumin deficiency disorders (SuperAdd) in adults undergoing vascular, abdominal, trauma, or orthopedic surgery: protocol for a randomized controlled trial

Author

Schaller, Stefan J., Fuest, Kristina, Ulm, Bernhard, Schmid, Sebastian, Bubb, Catherina, Eisenhart-Rothe, Rüdiger Von, Friess, Helmut, Chlodwig Kirchhoff, Stadlbauer, Thomas, Luppa, Peter, Blobner, Manfred, and Jungwirth, Bettina

Subjects
Data_FILES
Abstract

Additional file 2.

Published
2020
Full Text
View/download PDF

129. Substitution of perioperative albumin deficiency disorders (SuperAdd) in adults undergoing vascular, abdominal, trauma, or orthopedic surgery: protocol for a randomized controlled trial

Author

Schaller, Stefan J., Fuest, Kristina, Ulm, Bernhard, Schmid, Sebastian, Bubb, Catherina, von Eisenhart-Rothe, Rüdiger, Friess, Helmut, Kirchhoff, Chlodwig, Stadlbauer, Thomas, Luppa, Peter, Blobner, Manfred, and Jungwirth, Bettina

Subjects
Study Protocol, Serum albumin, Perioperative care, Postoperative care, Hypalbuminemia, Postoperative complications, ddc
Published
2019

131. Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

Author

Bus, Liesbet De, Depuydt, Pieter, Steen, Johan, Dhaese, Sofie, Smet, Ken De, Tabah, Alexis, Akova, Murat, Cotta, Menino Osbert, Pascale, Gennaro De, Dimopoulos, George, Fujitani, Shigeki, Garnacho-Montero, Jose, Leone, Marc, Lipman, Jeffrey, Ostermann, Marlies, Paiva, José-Artur, Schouten, Jeroen, Sjövall, Fredrik, Timsit, Jean-François, Roberts, Jason A., Zahar, Jean-Ralph, Zand, Farid, Zirpe, Kapil, Waele, Jan J. De, Rios, Fernando, Vazquez, Alejandro Risso, Vidal, Maria Gabriela, Zakalik, Graciela, Attokaran, Antony George, Banakh, Iouri, Dey-Chatterjee, Smita, Ewan, Julie, Ferrier, Janet, Forbes, Loretta, Fourie, Cheryl, Leditschke, Anne, Murray, Lauren, Eller, Philipp, Biston, Patrick, Bracke, Stephanie, Crop, Luc De, Schryver, Nicolas De, Frans, Eric, Spapen, Herbert, Malderen, Claire Van, Vansteelandt, Stijn, Vermeiren, Daisy, Arévalo, Elias Pablo, Crespo, Mónica, Flores, Roberto Zelaya, Píza, Petr, Tutillo, Diego Morocho, Elme, Andreas, Kallaste, Anne, Starkopf, Joel, Bourenne, Jeremy, Calypso, Mathieu, Cohen, Yves, Dahyot-Fizelier, Claire, Depret, François, Guillot, Max, Imzi, Nadia, Jochmans, Sebastien, Kouatchet, Achille, Lepape, Alain, Martin, Olivier, Heim, Markus, Schaller, Stefan J, Arvaniti, Kostoula, Bekridelis, Anestis, Ioannidis, Panagiotis, Mitrakos, Cornelia, Papanikolaou, Metaxia N., Pouriki, Sofia, Vemvetsou, Anna, Abraham, Babu, Bhattacharya, Pradip Kumar, Budugu, Anusha, Dixit, Subhal, Gurav, Sushma, Kandanuri, Padmaja, Prabhu, Dattatray Arun, Rathod, Darshana, Savaru, Kavitha, Udupa, Ashwin Neelavar, Varghese, Sunitha Binu, Bakhodaei, Hossein Haddad, Dabiri, Gholamreza, Fallahi, Mohammad Javad, Feiz, Farnia, Firoozifar, Mohammad, Khaloo, Vahid, Maghsudi, Behzad, Masjedi, Mansoor, Nikandish, Reza, Sabetian, Golnar, Marsh, Brian, Martin-Loeches, Ignacio, Steiner, Jan, Barbagallo, Maria, Caricato, Anselmo, Cortegiani, Andrea, D’Andrea, Rocco, Deana, Cristian, Donati, Abele, Girardis, Massimo, Mandalà, Giuliana, Panarello, Giovanna, Pasero, Daniela, Pelagalli, Lorella, Soave, Paolo Maurizio, Spadaro, Savino, Fujita, Yoshihito, Fujiwara, Shinsuke, Hara, Yuya, Hashi, Hideki, Hashimoto, Satoru, Hashimoto, Hideki, Hayakawa, Katsura, Inoue, Masash, Isokawa, Shutaro, Kameda, Shinya, Kamohara, Hidenobu, Kanamoto, Masafumi, Katayama, Shinshu, Kawagishi, Toshiomi, Kawano, Yasumasa, Kida, Yoshiko, Kita, Mami, Kobayashi, Atsuko, Kuriyama, Akira, Naito, Takaki, Nashiki, Hiroshi, Nishiyama, Kei, Shindo, Shunsuke, Suzuki, Taketo, Takaba, Akihiro, Tanaka, Chie, Tetsuya, Komuro, Tomioka, Yoshihiro, Yanagawa, Youichi, Yoshida, Hideki, Adnan, Syamhanin, Hasan, Mohd Shahnaz, Sulaiman, Helmi, Lopez, Gilberto A. Gasca, Hernández-Cárdenas, Carmen M., Ñamendys-Silva, Silvio A., Bethlehem, Carina, Lange, Dylan de, Hunfeld, Nicole, Numan, Sandra, Leeuwen, Henk van, Owens, Daniel, Almeida, Mónica, Fragoso, Elsa, Leonor, Tiago, Pereira, José-Manuel, Filipescu, Daniela, Grigoras, Ioana, Popescu, Mihai, Tomescu, Dana, Alshahrani, Mohammed S., Alvarez-Gonzalez, Manuel, Barrero-García, Irene, Blasco-Navalpotro, Miguel Angel, Claverias, Laura, Estella, Ángel, Espina, Lorena Forcelledo, Garmendia, Jose Luis Garcia, Prieto, Emilio García, Gómez-Prieto, Gracia, Conde, Carlos Jiménez, Sagasti, Fernando Martinez, Cantero, Alicia Muñoz, Orejas-Gallego, Alberto, Papiol, Elisabeth, Pérez-Civantos, Demetrio, Laderas, Juan Carlos Pozo, Álvarez, Josep Trenado, Vera-Artázcoz, Paula, Cortés, Pablo Vidal, Oldner, Anders, Spångfors, Martin, Alp, Emine, Köksal, Iftihar, Korten, Volkan, Özveren, Arife, Hall, Anna, Hatton, Kevin W., Laudanski, Krzysztof, other, and, Bus, Liesbet De, Depuydt, Pieter, Steen, Johan, Dhaese, Sofie, Smet, Ken De, Tabah, Alexis, Akova, Murat, Cotta, Menino Osbert, Pascale, Gennaro De, Dimopoulos, George, Fujitani, Shigeki, Garnacho-Montero, Jose, Leone, Marc, Lipman, Jeffrey, Ostermann, Marlies, Paiva, José-Artur, Schouten, Jeroen, Sjövall, Fredrik, Timsit, Jean-François, Roberts, Jason A., Zahar, Jean-Ralph, Zand, Farid, Zirpe, Kapil, Waele, Jan J. De, Rios, Fernando, Vazquez, Alejandro Risso, Vidal, Maria Gabriela, Zakalik, Graciela, Attokaran, Antony George, Banakh, Iouri, Dey-Chatterjee, Smita, Ewan, Julie, Ferrier, Janet, Forbes, Loretta, Fourie, Cheryl, Leditschke, Anne, Murray, Lauren, Eller, Philipp, Biston, Patrick, Bracke, Stephanie, Crop, Luc De, Schryver, Nicolas De, Frans, Eric, Spapen, Herbert, Malderen, Claire Van, Vansteelandt, Stijn, Vermeiren, Daisy, Arévalo, Elias Pablo, Crespo, Mónica, Flores, Roberto Zelaya, Píza, Petr, Tutillo, Diego Morocho, Elme, Andreas, Kallaste, Anne, Starkopf, Joel, Bourenne, Jeremy, Calypso, Mathieu, Cohen, Yves, Dahyot-Fizelier, Claire, Depret, François, Guillot, Max, Imzi, Nadia, Jochmans, Sebastien, Kouatchet, Achille, Lepape, Alain, Martin, Olivier, Heim, Markus, Schaller, Stefan J, Arvaniti, Kostoula, Bekridelis, Anestis, Ioannidis, Panagiotis, Mitrakos, Cornelia, Papanikolaou, Metaxia N., Pouriki, Sofia, Vemvetsou, Anna, Abraham, Babu, Bhattacharya, Pradip Kumar, Budugu, Anusha, Dixit, Subhal, Gurav, Sushma, Kandanuri, Padmaja, Prabhu, Dattatray Arun, Rathod, Darshana, Savaru, Kavitha, Udupa, Ashwin Neelavar, Varghese, Sunitha Binu, Bakhodaei, Hossein Haddad, Dabiri, Gholamreza, Fallahi, Mohammad Javad, Feiz, Farnia, Firoozifar, Mohammad, Khaloo, Vahid, Maghsudi, Behzad, Masjedi, Mansoor, Nikandish, Reza, Sabetian, Golnar, Marsh, Brian, Martin-Loeches, Ignacio, Steiner, Jan, Barbagallo, Maria, Caricato, Anselmo, Cortegiani, Andrea, D’Andrea, Rocco, Deana, Cristian, Donati, Abele, Girardis, Massimo, Mandalà, Giuliana, Panarello, Giovanna, Pasero, Daniela, Pelagalli, Lorella, Soave, Paolo Maurizio, Spadaro, Savino, Fujita, Yoshihito, Fujiwara, Shinsuke, Hara, Yuya, Hashi, Hideki, Hashimoto, Satoru, Hashimoto, Hideki, Hayakawa, Katsura, Inoue, Masash, Isokawa, Shutaro, Kameda, Shinya, Kamohara, Hidenobu, Kanamoto, Masafumi, Katayama, Shinshu, Kawagishi, Toshiomi, Kawano, Yasumasa, Kida, Yoshiko, Kita, Mami, Kobayashi, Atsuko, Kuriyama, Akira, Naito, Takaki, Nashiki, Hiroshi, Nishiyama, Kei, Shindo, Shunsuke, Suzuki, Taketo, Takaba, Akihiro, Tanaka, Chie, Tetsuya, Komuro, Tomioka, Yoshihiro, Yanagawa, Youichi, Yoshida, Hideki, Adnan, Syamhanin, Hasan, Mohd Shahnaz, Sulaiman, Helmi, Lopez, Gilberto A. Gasca, Hernández-Cárdenas, Carmen M., Ñamendys-Silva, Silvio A., Bethlehem, Carina, Lange, Dylan de, Hunfeld, Nicole, Numan, Sandra, Leeuwen, Henk van, Owens, Daniel, Almeida, Mónica, Fragoso, Elsa, Leonor, Tiago, Pereira, José-Manuel, Filipescu, Daniela, Grigoras, Ioana, Popescu, Mihai, Tomescu, Dana, Alshahrani, Mohammed S., Alvarez-Gonzalez, Manuel, Barrero-García, Irene, Blasco-Navalpotro, Miguel Angel, Claverias, Laura, Estella, Ángel, Espina, Lorena Forcelledo, Garmendia, Jose Luis Garcia, Prieto, Emilio García, Gómez-Prieto, Gracia, Conde, Carlos Jiménez, Sagasti, Fernando Martinez, Cantero, Alicia Muñoz, Orejas-Gallego, Alberto, Papiol, Elisabeth, Pérez-Civantos, Demetrio, Laderas, Juan Carlos Pozo, Álvarez, Josep Trenado, Vera-Artázcoz, Paula, Cortés, Pablo Vidal, Oldner, Anders, Spångfors, Martin, Alp, Emine, Köksal, Iftihar, Korten, Volkan, Özveren, Arife, Hall, Anna, Hatton, Kevin W., Laudanski, Krzysztof, and other, and

Abstract

Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60–1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14–1.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.

Published
2020

132. Substitution of perioperative albumin deficiency disorders (SuperAdd) in adults undergoing vascular, abdominal, trauma, or orthopedic surgery: protocol for a randomized controlled trial

Author

Schaller, Stefan J, Fuest, Kristina, Ulm, Bernhard, Schmid, Sebastian, Bubb, Catherina, von Eisenhart-Rothe, Rüdiger, Friess, Helmut, Kirchhoff, Chlodwig, Stadlbauer, Thomas, Luppa, Peter, Blobner, Manfred; https://orcid.org/0000-0002-0370-5247, Jungwirth, Bettina, Schaller, Stefan J, Fuest, Kristina, Ulm, Bernhard, Schmid, Sebastian, Bubb, Catherina, von Eisenhart-Rothe, Rüdiger, Friess, Helmut, Kirchhoff, Chlodwig, Stadlbauer, Thomas, Luppa, Peter, Blobner, Manfred; https://orcid.org/0000-0002-0370-5247, and Jungwirth, Bettina

Abstract

Background: Hypalbuminemia is associated with numerous postoperative complications, so a perioperative albumin substitution is often considered. The objective of SuperAdd is to investigate whether substitution of human albumin, aiming to maintain a serum concentration > 30 g/l, can reduce postoperative complications in normovolemic surgical patients in comparison with standard care. Methods/design: SuperAdd is a single-center, prospective, randomized, outcome-assessor blinded, patient blinded controlled trial. The primary outcome is the frequency of postoperative complications identified using the Postoperative Morbidity Survey graded ≥ 2 according to the Clavien-Dindo Score. Adult patients at risk to develop hypalbuminemia, i.e., ASA III or IV or high-risk surgery, are recruited after written informed consent was obtained. The albumin concentration is assessed before the induction of anesthesia and every 3 h until admission to the postanesthesia care unit. If albumin concentrations drop below 30 g/l, patients are randomly allocated to the control or the treatment group. The study intervention is a goal-directed human albumin substitution aimed at a concentration > 30 g/l during surgery and postanesthesia care unit stay. The patients in the control group are treated according to standard clinical care. Postoperative visits are to be performed on days 1, 3, 5, 8, and 15, as well as by telephone 6 months after surgery. Discussion: SuperAdd is the first clinical trial in a surgical population investigating the effect of a goal-directed albumin substitution aiming at a serum level > 30 g/l. The nonrestrictive selection of patients guarantees that the patients without albumin screening will most likely not develop hypalbuminemia, thus ensuring generalizability of the study results. Trial registration: EudraCT 2016-001313-24. Registered on 5 September 2016. Clinical Trials NCT03167645. Registered on 18 October 2016 and has the Universal Trial Number (UTN) U1111-1181-2625.

Published
2020

133. International variation in the management of severe COVID-19 patients

Author

Medische Staf Intensive Care, Brain, Infection & Immunity, Azoulay, Elie, de Waele, Jan, Ferrer, Ricard, Staudinger, Thomas, Borkowska, Marta, Povoa, Pedro, Iliopoulou, Katerina, Artigas, Antonio, Schaller, Stefan J, Shankar-Hari, Manu, Pellegrini, Mariangela, Darmon, Michael, Kesecioglu, Jozef, Cecconi, Maurizio, Medische Staf Intensive Care, Brain, Infection & Immunity, Azoulay, Elie, de Waele, Jan, Ferrer, Ricard, Staudinger, Thomas, Borkowska, Marta, Povoa, Pedro, Iliopoulou, Katerina, Artigas, Antonio, Schaller, Stefan J, Shankar-Hari, Manu, Pellegrini, Mariangela, Darmon, Michael, Kesecioglu, Jozef, and Cecconi, Maurizio

Published
2020

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

Author

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

Published
2020

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

Author

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

Published
2021
Full Text
View/download PDF

136. A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

Author

Jung, Christian, Wernly, Bernhard, Muessig, Johanna M., Kelm, Malte, Boumendil, Ariane, Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Bertolini, Guido, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjolner, Jesper, Lichtenauer, Michael, Bruno, Raphael Romano, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Ohman, Christina Agvald, Pinto, Bernadro Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Zafeiridis, Tilemachos, De Lange, Dylan W., Guidet, Bertrand, Flaatten, Hans, Schmutz, Rene, Wimmer, Franz, Eller, Philipp, Joannidis, Michael, De Buysscher, Pieter, De Neve, Nikolaas, Swinnen, Walter, Abraham, Paul, Hergafi, Leila, Schefold, Joerg C., Biskup, Ewelina, Piza, Petr, Taliadoros, Ioannis, Dey, Nilanjan, Solling, Christoffer, Rasmussen, Bodil Steen, Forceville, Xavier, Besch, Guillaume, Mentec, Herve, Michel, Philippe, Mateu, Philippe, Vettoretti, Lucie, Bourenne, Jeremy, Marin, Nathalie, Guillot, Max, Aissaoui, Naida, Goulenok, Cyril, Thieulot-Rolin, Nathalie, Messika, Jonathan, Lamhaut, Lionel, Charron, Cyril, Lauten, Alexander, Sacher, Anna Lena, Brenner, Thorsten, Franz, Marcus, Bloos, Frank, Ebelt, Henning, Schaller, Stefan J., Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobias, Nia, Amir M., Janosi, Rolf Alexander, Meybohm, Patrick, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Aidoni, Zoi, Aloizos, Stavros, Tasioudis, Polychronis, Lampiri, Kleri, Zisopoulou, Vasiliki, Ravani, Ifigenia, Pagaki, Eumorfia, Antoniou, Angela, Katsoulas, Theodoros A., Kounougeri, Aikaterini, Marinakis, George, Tsimpoukas, Fotios, Spyropoulou, Anastasia, Zygoulis, Paris, Kyparissi, Aikaterini, Gupta, Manish, Gurjar, Mohan, Maji, Ismail M., Hayes, Ivan, Kelly, Yvelynne, Westbrook, Andrew, Fitzpatrick, Gerry, Maheshwari, Darshana, Motherway, Catherine, Negri, Giovanni, Spadaro, Savino, Nattino, Giuseppe, Pedeferri, Matteo, Boscolo, Annalisa, Rossi, Simona, Calicchio, Giuseppe, Cubattoli, Lucia, Di Lascio, Gabriella, Barbagallo, Maria, Berruto, Francesco, Codazzi, Daniela, Bottazzi, Andrea, Fumagalli, Paolo, Negro, Giancarlo, Lupi, Giuseppe, Savelli, Flavia, Vulcano, Giuseppe A., Fumagalli, Roberto, Marudi, Andrea, Lefons, Ugo, Lembo, Rita, Babini, Maria, Paggioro, Alessandra, Parrini, Vieri, Zaccaria, Maria, Clementi, Stefano, Gigliuto, Carmelo, Facondini, Francesca, Pastorini, Simonetta, Munaron, Susanna, Calamai, Italo, Bocchi, Anna, Adorni, Adele, Bocci, Maria Grazia, Cortegiani, Andrea, Casalicchio, Tiziana, Mellea, Serena, Graziani, Elia, Barattini, Massimo, Brizio, Elisabetta, Rossi, Maurizio, Hahn, Michael, Kemmerer, Nicolai, Strietzel, Hans Frank, Dybwik, Knut, Legernaes, Terje, Klepstad, Pal, Olaussen, Even Braut, Olsen, Knut Inge, Brresen, Ole Marius, Bjorsvik, Geir, Maini, Sameer, Fehrle, Lutz, Czuczwar, Miroslaw, Krawczyk, Pawel, Zietkiewicz, Miroslaw, Nowak, Lukasz R., Kotfis, Katarzyna, Cwyl, Katarzyna, Gajdosz, Ryszard, Biernawska, Jowita, Bohatyrewicz, Romuald, Gawda, Ryszard, Grudzien, Pawel, Nasilowski, Pawel, Popek, Natalia, Cyrankiewicz, Waldemar, Wawrzyniak, Katarzyna, Wnuk, Marek, Maciejewski, Dariusz, Studzinska, Dorota, Zukowski, Maciej, Bernas, Szymon, Piechota, Mariusz, Nowak, Ilona, Fronczek, Jakub, Serwa, Marta, Machala, Waldemar, Stefaniak, Jan, Wujtewicz, Maria, Maciejewski, Pawel, Szymkowiak, Malgorzata, Adamik, Barbara, Catorze, Nuno, Branco, Miguel Castelo, Barros, Ines, Barros, Nelson, Krystopchuk, Andriy, Honrado, Teresa, Sousa, Cristina, Munoz, Francisco, Rebelo, Marta, Gomes, Rui, Nunes, Jorge, Dias, Celeste, Fernandes, Ana Margarida, Petrisor, Cristina, Constantin, Bodolea, Belskiy, Vladislav, Boskholov, Boris, Rodriguez, Enver, Rebollo, Sergio, Aguilar, Gerardo, Masdeu, Gaspar, Irazabal Jaimes, Marian, Prado Mira, Angela, Bodi, Maria A., Barea Mendoza, Jesus A., Lopez-Cuenca, Sonia, Homez Guzman, Marcela, Rico-Feijoo, Jesus, Ibarz, Mercedes, Trenado Alvarez, Josep, Kawati, Rafael, Sivik, Joakim, Nauska, Jessica, Smole, Daniel, Parenmark, Fredric, Lyren, Johanna, Rockstroh, Katalin, Ryden, Sara, Spangfors, Martin, Strinnholm, Morten, Walther, Sten, De Geer, Lina, Nordlund, Peter, Palsson, Staffan, Zetterquist, Harald, Nilsson, Annika, Thiringer, Karin, Jungner, Marten, Bark, Bjorn, Nordling, Berit, Skold, Hans, Brorsson, Camilla, Persson, Stefan, Bergstrom, Anna, Berkius, Johan, Holmstrom, Johanna, van Dijk, I, van Lelyveld-Haas, L. E. M., Ramnarain, D., Jansen, Tim, Nooteboom, Fleur, van der Voort, Peter H. J., de Lange, Dylan, Dieperink, Willem, de Waard, Monique C., de Smet, Annemarie G. E., Bormans, Laura, Dormans, Tom, Dempsey, Ged, Mathew, Shiju J., Raj, Ashok S., Grecu, Irina, Cupitt, Jason, Lawton, Tom, Clark, Richard, Popescu, Monica, Spittle, Nick, Faulkner, Maria, Cowton, Amanda, Elloway, Esme, Williams, Patricia, Reay, Michael, Chukkambotla, Srikanth, Kumar, Ravi, Al-Subaie, Nawaf, Kent, Linda, Tamm, Tiina, Kajtor, Istvan, Burns, Karen, Pugh, Richard, Ostermann, Marlies, Kam, Elisa, Bowyer, Helen, Smith, Neil, Templeton, Maie, Henning, Jeremy, Goffin, Kelly, Kapoor, Ritoo, Laha, Shondipon, Chilton, Phil, Khaliq, Waqas, Crayford, Alison, Coetzee, Samantha, Tait, Moira, Stoker, Wendy, Gimenez, Marc, Pope, Alan, Camsooksai, Julie, Pogson, David, Quigley, Kate, Ritzema, Jenny, Hormis, Anil, Boulanger, Carole, Balasubramaniam, M., Vamplew, Luke, Burt, Karen, Martin, Daniel, Craig, Jayne, Prowle, John, Doyle, Nanci, Shelton, Jonathon, Scott, Carmen, Donnison, Phil, Shelton, Sarah, Frey, Christian, Ryan, Christine, Spray, Dominic, Barnes, Veronica, Barnes, Kerry, Ridgway, Stephanie, Saha, Rajnish, Clark, Thomas, Wood, James, Bolger, Clare, Bassford, Christopher, Lewandowski, John, Zhao, Xiaobei, Humphreys, Sally, Dowling, Susan, Richardson, Neil, Burtenshaw, Andrew, Stevenson, Carl, Wilcock, Danielle, Nalapko, Yuiry, Jung, Christian, Wernly, Bernhard, Muessig, Johanna M., Kelm, Malte, Boumendil, Ariane, Morandi, Alessandro, Andersen, Finn H., Artigas, Antonio, Bertolini, Guido, Cecconi, Maurizio, Christensen, Steffen, Faraldi, Loredana, Fjolner, Jesper, Lichtenauer, Michael, Bruno, Raphael Romano, Marsh, Brian, Moreno, Rui, Oeyen, Sandra, Ohman, Christina Agvald, Pinto, Bernadro Bollen, Soliman, Ivo W., Szczeklik, Wojciech, Valentin, Andreas, Watson, Ximena, Zafeiridis, Tilemachos, De Lange, Dylan W., Guidet, Bertrand, Flaatten, Hans, Schmutz, Rene, Wimmer, Franz, Eller, Philipp, Joannidis, Michael, De Buysscher, Pieter, De Neve, Nikolaas, Swinnen, Walter, Abraham, Paul, Hergafi, Leila, Schefold, Joerg C., Biskup, Ewelina, Piza, Petr, Taliadoros, Ioannis, Dey, Nilanjan, Solling, Christoffer, Rasmussen, Bodil Steen, Forceville, Xavier, Besch, Guillaume, Mentec, Herve, Michel, Philippe, Mateu, Philippe, Vettoretti, Lucie, Bourenne, Jeremy, Marin, Nathalie, Guillot, Max, Aissaoui, Naida, Goulenok, Cyril, Thieulot-Rolin, Nathalie, Messika, Jonathan, Lamhaut, Lionel, Charron, Cyril, Lauten, Alexander, Sacher, Anna Lena, Brenner, Thorsten, Franz, Marcus, Bloos, Frank, Ebelt, Henning, Schaller, Stefan J., Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobias, Nia, Amir M., Janosi, Rolf Alexander, Meybohm, Patrick, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Aidoni, Zoi, Aloizos, Stavros, Tasioudis, Polychronis, Lampiri, Kleri, Zisopoulou, Vasiliki, Ravani, Ifigenia, Pagaki, Eumorfia, Antoniou, Angela, Katsoulas, Theodoros A., Kounougeri, Aikaterini, Marinakis, George, Tsimpoukas, Fotios, Spyropoulou, Anastasia, Zygoulis, Paris, Kyparissi, Aikaterini, Gupta, Manish, Gurjar, Mohan, Maji, Ismail M., Hayes, Ivan, Kelly, Yvelynne, Westbrook, Andrew, Fitzpatrick, Gerry, Maheshwari, Darshana, Motherway, Catherine, Negri, Giovanni, Spadaro, Savino, Nattino, Giuseppe, Pedeferri, Matteo, Boscolo, Annalisa, Rossi, Simona, Calicchio, Giuseppe, Cubattoli, Lucia, Di Lascio, Gabriella, Barbagallo, Maria, Berruto, Francesco, Codazzi, Daniela, Bottazzi, Andrea, Fumagalli, Paolo, Negro, Giancarlo, Lupi, Giuseppe, Savelli, Flavia, Vulcano, Giuseppe A., Fumagalli, Roberto, Marudi, Andrea, Lefons, Ugo, Lembo, Rita, Babini, Maria, Paggioro, Alessandra, Parrini, Vieri, Zaccaria, Maria, Clementi, Stefano, Gigliuto, Carmelo, Facondini, Francesca, Pastorini, Simonetta, Munaron, Susanna, Calamai, Italo, Bocchi, Anna, Adorni, Adele, Bocci, Maria Grazia, Cortegiani, Andrea, Casalicchio, Tiziana, Mellea, Serena, Graziani, Elia, Barattini, Massimo, Brizio, Elisabetta, Rossi, Maurizio, Hahn, Michael, Kemmerer, Nicolai, Strietzel, Hans Frank, Dybwik, Knut, Legernaes, Terje, Klepstad, Pal, Olaussen, Even Braut, Olsen, Knut Inge, Brresen, Ole Marius, Bjorsvik, Geir, Maini, Sameer, Fehrle, Lutz, Czuczwar, Miroslaw, Krawczyk, Pawel, Zietkiewicz, Miroslaw, Nowak, Lukasz R., Kotfis, Katarzyna, Cwyl, Katarzyna, Gajdosz, Ryszard, Biernawska, Jowita, Bohatyrewicz, Romuald, Gawda, Ryszard, Grudzien, Pawel, Nasilowski, Pawel, Popek, Natalia, Cyrankiewicz, Waldemar, Wawrzyniak, Katarzyna, Wnuk, Marek, Maciejewski, Dariusz, Studzinska, Dorota, Zukowski, Maciej, Bernas, Szymon, Piechota, Mariusz, Nowak, Ilona, Fronczek, Jakub, Serwa, Marta, Machala, Waldemar, Stefaniak, Jan, Wujtewicz, Maria, Maciejewski, Pawel, Szymkowiak, Malgorzata, Adamik, Barbara, Catorze, Nuno, Branco, Miguel Castelo, Barros, Ines, Barros, Nelson, Krystopchuk, Andriy, Honrado, Teresa, Sousa, Cristina, Munoz, Francisco, Rebelo, Marta, Gomes, Rui, Nunes, Jorge, Dias, Celeste, Fernandes, Ana Margarida, Petrisor, Cristina, Constantin, Bodolea, Belskiy, Vladislav, Boskholov, Boris, Rodriguez, Enver, Rebollo, Sergio, Aguilar, Gerardo, Masdeu, Gaspar, Irazabal Jaimes, Marian, Prado Mira, Angela, Bodi, Maria A., Barea Mendoza, Jesus A., Lopez-Cuenca, Sonia, Homez Guzman, Marcela, Rico-Feijoo, Jesus, Ibarz, Mercedes, Trenado Alvarez, Josep, Kawati, Rafael, Sivik, Joakim, Nauska, Jessica, Smole, Daniel, Parenmark, Fredric, Lyren, Johanna, Rockstroh, Katalin, Ryden, Sara, Spangfors, Martin, Strinnholm, Morten, Walther, Sten, De Geer, Lina, Nordlund, Peter, Palsson, Staffan, Zetterquist, Harald, Nilsson, Annika, Thiringer, Karin, Jungner, Marten, Bark, Bjorn, Nordling, Berit, Skold, Hans, Brorsson, Camilla, Persson, Stefan, Bergstrom, Anna, Berkius, Johan, Holmstrom, Johanna, van Dijk, I, van Lelyveld-Haas, L. E. M., Ramnarain, D., Jansen, Tim, Nooteboom, Fleur, van der Voort, Peter H. J., de Lange, Dylan, Dieperink, Willem, de Waard, Monique C., de Smet, Annemarie G. E., Bormans, Laura, Dormans, Tom, Dempsey, Ged, Mathew, Shiju J., Raj, Ashok S., Grecu, Irina, Cupitt, Jason, Lawton, Tom, Clark, Richard, Popescu, Monica, Spittle, Nick, Faulkner, Maria, Cowton, Amanda, Elloway, Esme, Williams, Patricia, Reay, Michael, Chukkambotla, Srikanth, Kumar, Ravi, Al-Subaie, Nawaf, Kent, Linda, Tamm, Tiina, Kajtor, Istvan, Burns, Karen, Pugh, Richard, Ostermann, Marlies, Kam, Elisa, Bowyer, Helen, Smith, Neil, Templeton, Maie, Henning, Jeremy, Goffin, Kelly, Kapoor, Ritoo, Laha, Shondipon, Chilton, Phil, Khaliq, Waqas, Crayford, Alison, Coetzee, Samantha, Tait, Moira, Stoker, Wendy, Gimenez, Marc, Pope, Alan, Camsooksai, Julie, Pogson, David, Quigley, Kate, Ritzema, Jenny, Hormis, Anil, Boulanger, Carole, Balasubramaniam, M., Vamplew, Luke, Burt, Karen, Martin, Daniel, Craig, Jayne, Prowle, John, Doyle, Nanci, Shelton, Jonathon, Scott, Carmen, Donnison, Phil, Shelton, Sarah, Frey, Christian, Ryan, Christine, Spray, Dominic, Barnes, Veronica, Barnes, Kerry, Ridgway, Stephanie, Saha, Rajnish, Clark, Thomas, Wood, James, Bolger, Clare, Bassford, Christopher, Lewandowski, John, Zhao, Xiaobei, Humphreys, Sally, Dowling, Susan, Richardson, Neil, Burtenshaw, Andrew, Stevenson, Carl, Wilcock, Danielle, and Nalapko, Yuiry

Abstract

Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed. Methods: In total, 5063 VIPs were induded in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality. Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 +/- 5 vs 7 +/- 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02). Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.

Published
2019
Full Text
View/download PDF

138. Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak.

Author

Azoulay, Elie, De Waele, Jan, Ferrer, Ricard, Staudinger, Thomas, Borkowska, Marta, Povoa, Pedro, Iliopoulou, Katerina, Artigas, Antonio, Schaller, Stefan J., Hari, Manu Shankar, Pellegrini, Mariangela, Darmon, Michael, Kesecioglu, Jozef, and Cecconi, Maurizio

Subjects
COVID-19 pandemic, INTENSIVE care units, MEDICAL care surveys, SYMPTOMS, MEDICAL personnel, PSYCHOLOGICAL distress
Abstract

Background: The COVID-19 pandemic has resulted in an unprecedented healthcare crisis with a high prevalence of psychological distress in healthcare providers. We sought to document the prevalence of burnout syndrome amongst intensivists facing the COVID-19 outbreak. Methods: Cross-sectional survey among intensivists part of the European Society of Intensive Care Medicine. Symptoms of severe burnout, anxiety and depression were collected. Factors independently associated with severe burnout were assessed using Cox model. Results: Response rate was 20% (1001 completed questionnaires were returned, 45 years [39–53], 34% women, from 85 countries, 12 regions, 50% university-affiliated hospitals). The prevalence of symptoms of anxiety and depression or severe burnout was 46.5%, 30.2%, and 51%, respectively, and varied significantly across regions. Rating of the relationship between intensivists and other ICU stakeholders differed significantly according to the presence of anxiety, depression, or burnout. Similar figures were reported for their rating of the ethical climate or the quality of the decision-making. Factors independently associated with anxiety were female gender (HR 1.85 [1.33–2.55]), working in a university-affiliated hospital (HR 0.58 [0.42–0.80]), living in a city of > 1 million inhabitants (HR 1.40 [1.01–1.94]), and clinician's rating of the ethical climate (HR 0.83 [0.77–0.90]). Independent determinants of depression included female gender (HR 1.63 [1.15–2.31]) and clinician's rating of the ethical climate (HR 0.84 [0.78–0.92]). Factors independently associated with symptoms of severe burnout included age (HR 0.98/year [0.97–0.99]) and clinician's rating of the ethical climate (HR 0.76 [0.69–0.82]). Conclusions: The COVID-19 pandemic has had an overwhelming psychological impact on intensivists. Follow-up, and management are warranted to assess long-term psychological outcomes and alleviate the psychological burden of the pandemic on frontline personnel. [ABSTRACT FROM AUTHOR]

Published
2020
Full Text
View/download PDF

140. Early mobilisation within 72 hours after admission of critically ill patients in the intensive care unit: A systematic review with network meta-analysis.

Author

Daum, Nils, Drewniok, Nils, Bald, Annika, Ulm, Bernhard, Buyukli, Alyona, Grunow, Julius J., and Schaller, Stefan J.

Abstract

Early mobilisation within 72 hours of intensive care unit admission counteracts complications caused by critical illness. The effect of different interventions on intensive care unit length of stay and other outcomes is unclear. We aimed to investigate the effectiveness of various early mobilisation interventions within 72 hours of admission to the intensive care unit on length of stay and other outcomes. A systematic review and (network) meta-analysis examining the effect of early mobilisation on length of stay in the intensive care unit and other outcomes, conducting searches in four databases. Randomised controlled trials were included from inception to 10/08/2022. Early mobilisation was defined as interventions that initiates and/or supports passive/active range-of-motion exercises within 72 hours of admission. In multi-arm studies, interventions used in other studies were declared as early intervention and were included in subgroup meta-analysis. Risk-of-bias was assessed using RoB2. Of 29,680 studies screened, 18 studies with 1923 patients (three high, eleven some, four low risk-of-bias) and seven discriminable interventions of early mobilisation met inclusion criteria. Early mobilisation alone (WMD 0.78 days, 95 %CI [−1.38;-0.18], 11 studies, n = 1124) and early mobilisation with early nutrition (WMD −1.19 days, 95 %CI [−2.34;-0.03], 1 study, n = 100) were able to significantly shorten length of stay. Early mobilisation alone could also substantially shorten hospital length of stay (WMD -1.05 days, 95 %CI [−1.74;-0.36], 8 studies, n = 977). This effect in hospital length of stay was furthermore seen in the early intervention group compared with standard care (WMD −1.71 days, 95 %CI [−2.99;-0.43], 14 studies, n = 1587). Also, functionality and quality of life could significantly be improved by an early start of mobilisation. In the network meta-analysis, early mobilisation alone and early mobilisation with early nutrition demonstrated a significant effect on intensive care length of stay. Early mobilisation could also reduce hospital length of stay and positively influence functionality and quality of life. Early mobilisation and early mobilisation with early nutrition seemed to be beneficial compared to other interventions like cycling on intensive care length of stay. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

141. Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs : a multicentre prospective cohort study

Author

Müssig, Johanna Maria, Nia, Amir M., Masyuk, Maryna, Lauten, Alexander, Sacher, Anne Lena, Brenner, Thorsten, Franz, Marcus, Bloos, Frank, Ebelt, Henning, Schaller, Stefan J., Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobias, Jánosi, Rolf Alexander, Meybohm, Patrick, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Kelm, Malte, Jung, Christian, Müssig, Johanna Maria, Nia, Amir M., Masyuk, Maryna, Lauten, Alexander, Sacher, Anne Lena, Brenner, Thorsten, Franz, Marcus, Bloos, Frank, Ebelt, Henning, Schaller, Stefan J., Fuest, Kristina, Rabe, Christian, Dieck, Thorben, Steiner, Stephan, Graf, Tobias, Jánosi, Rolf Alexander, Meybohm, Patrick, Simon, Philipp, Utzolino, Stefan, Rahmel, Tim, Barth, Eberhard, Schuster, Michael, Kelm, Malte, and Jung, Christian

Abstract

Background: In intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making. Due to increased mortality and a reduced quality of life in this high-risk population, medical decision-making a fortiori requires an optimum of risk stratification. Recently, the VIP-1 trial prospectively observed that the clinical frailty scale (CFS) performed well in ICU patients in overall-survival and short-term outcome prediction. However, it is known that healthcare systems differ in the 21 countries contributing to the VIP-1 trial. Hence, our main focus was to investigate whether the CFS is usable for risk stratification in octogenarians admitted to diversified and high tech German ICUs. Methods: This multicentre prospective cohort study analyses very old patients admitted to 20 German ICUs as a sub-analysis of the VIP-1 trial. Three hundred and eight patients of 80 years of age or older admitted consecutively to participating ICUs. CFS, cause of admission, APACHE II, SAPS II and SOFA scores, use of ICU resources and ICU- and 30-day mortality were recorded. Multivariate logistic regression analysis was used to identify factors associated with 30-day mortality. Results: Patients had a median age of 84 [IQR 82–87] years and a mean CFS of 4.75 (± 1.6 standard-deviation) points. More than half of the patients (53.6%) were classified as frail (CFS ≥ 5). ICU-mortality was 17.3% and 30-day mortality was 31.2%. The cause of admission (planned vs. unplanned), (OR 5.74) and the CFS (OR 1.44 per point increase) were independent predictors of 30-day survival. Conclusions: The CFS is an easy determinable valuable tool for prediction of 30-day ICU survival in octogenarians, thus, it may facilitate decision-making for intensive care givers in Germany. Trial registration: The VIP-1 study was retrospectively registered on ClinicalTrials.gov (ID: NCT03134807) on May 1, 2017.

Published
2018

142. Surgeons assign lower pain score to prehospital emergency patients than anaesthetists

Author

Schaller, Stefan J

Abstract

Background and Goal of StudyPain is the main indication for alerting the prehospital doctor staffed emergency service in Germany. Furthermore treatment of pain is an important marker of quality in health care supply nowadays. In a previous study we could demonstrate that surgeons and anaesthetists use pain medication similarly. One exception, however, was the use of opioids. Surgeons used opioids significantly less than anaesthetists (OR 0.55). We conducted this retrospective analysis to study differences in assessment of pain of these specialities.Materials and MethodsAfter IRB approval, all protocols of 2014 from our prehospital emergency service at the fire department 10 in Munich, Germany were analysed. This service is staffed by surgeons and anaesthetists. Statistical calculation was done using Mann-Whitney-U tests or logistic regression where appropriate with STATA14 (College Station, TX, USA).Results and DiscussionWe assessed 3024 protocols. Of these, 155 incorrect alarms and 122 alarms carried out by one specialist of internal medicine were excluded. Consequently, 2747 protocols were analyzed, including 320 acute coronary syndromes (ACS) and 542 trauma cases. Overall, surgeons documented a significant lower numerical rating score (NRS) (p < 0.001). This was also the case in the subcategory ACS (p = 0.002) but not in trauma (p > 0.05) or if opioids were given (p > 0.05). In 33% (anaesthesists) and 25% (surgeons) of cases with opioid administration no NRS was documented. Although this missing documentation might be a risk of bias, our results might explains why surgeons administer less opioids as we have shown before: They assign lower NRS scores in their non-traumatic patients (e.g. ACS). However, if the surgeons administers an opioid the NRS scores do not differ significantly from anaesthetists (Figure 2 and 3).ConclusionAlthough NRS is a patient based score, surgeons assign a lower NRS score to prehospital emergency service patients compared to anaesthetists. However, documentation compliance was low, even if an opioid was administered; perhaps electronic documentation with mandatory fields in different scenario might improve documentation and further research. Reference: Hossfeld, B. et al. Pru00e4hospitale Analgesie beim Erwachsenen. Notf.med. up2date 10, 269-284 (2015)

Published
2017

145. Facilitators and barriers to the implementation of prehabilitation for frail patients into routine health care: a realist review.

Author

Sontag, Anna Frederike, Kiselev, Jörn, Schaller, Stefan J, Spies, Claudia, and Rombey, Tanja

Abstract

Background: Despite evidence supporting the effectiveness of prehabilitation as a new preoperative care pathway to optimise perioperative outcomes, its implementation into routine health care is widely pending. Frail patients might particularly benefit from prehabilitation interventions, but facilitating and hindering factors need to be considered in the implementation process. Thus, our aim was to derive a programme theory on what prehabilitation programmes work for frail patients in what circumstances and why. Methods: Following Pawson's realist review approach, preliminary programme theories on facilitators and barriers were established. General and topic-specific databases were searched systematically for facilitators and barriers to the implementation of prehabilitation for frail patients. Articles were included if they dealt with multimodal prehabilitation programmes prior to surgery in a frail population and if they contained information on facilitators and barriers during the implementation process in the full text. Based on these articles, refined programme theories were generated. Results: From 2,609 unique titles, 34 were retained for the realist synthesis. Facilitating factors included the individualisation of prehabilitation programmes to meet the patients' needs and abilities, multimodality, adaption to the local setting and health care system, endorsement by an ambassador and sharing of responsibilities among a multidisciplinary team. Central barriers for frail patients were transportation, lack of social support, and inadequate, overwhelming information provision. Conclusions: Implementing prehabilitation as a new care pathway for frail patients requires organisational readiness and adaptability to the local setting. On an individual level, a clear understanding of responsibilities and of the intervention's goal among patients and providers are necessary. Added attention must be paid to the individualisation to fit the needs and restrictions of frail patients. This makes prehabilitation a resource-intense, but promising intervention for frail surgery patients. Trial registration: PROSPERO (CRD42022335282). [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

146. Neuromuscular blockade improves surgical conditions (NISCO)

Author

Blobner, Manfred, primary, Frick, Christiane G., additional, Stäuble, Roland B., additional, Feussner, Hubertus, additional, Schaller, Stefan J., additional, Unterbuchner, Christoph, additional, Lingg, Charlotte, additional, Geisler, Martina, additional, and Fink, Heidrun, additional

Published
2014
Full Text
View/download PDF

147. Pharmacokinetics cannot explain the increased effective dose requirement for morphine and midazolam in rats during their extended administration alone or in combination.

Author

Schaller, Stefan J., Alam, Saad M., Mao, Jianren, Zhao, Yanli, Blobner, Manfred, Greenblatt, David J., and Martyn, J.A. Jeevendra

Subjects
*MIDAZOLAM, *MORPHINE, *PHARMACOKINETICS, *MASS spectrometry, *RATS
Abstract

Objectives Chronic administration of morphine and midazolam, alone or in combination, can induce tolerance to their effects. Data showed that co-administration of morphine and midazolam increased effective dose requirement of morphine, exceeding that observed with morphine alone. Methods To elucidate the pharmacokinetic component to the tolerance, we administered midazolam (2 mg/kg) and morphine (10 mg/kg) alone or their combination daily to rats for 12 days followed by a pharmacokinetic study on day 13. On the study day, each animal received a single bolus dose of 5 mg/kg morphine, and 2 mg/kg of midazolam 30 s later. Multiple blood samples were obtained for 6 h. Plasma drug concentrations were assayed by mass spectrometry optimized for small samples. Key findings Mean morphine clearance was as follows: 22.2, 27.2, 26.0 and 23.4 l/h per kg in the saline-saline, saline-midazolam, saline-morphine and midazolam-morphine groups, respectively. Corresponding midazolam clearances were 32.8, 23.0, 22.2 and 31.1 l/h per kg. ANOVA indicated no significant differences among the four groups in the clearances, half-lives, and volumes of distribution. Morphine and midazolam clearances were significantly correlated ( R2 = 0.48, P < 0.001). Conclusions This animal model suggests that altered pharmacokinetics cannot explain tolerance evidenced as increased dose requirement for morphine or midazolam, when administered alone or combination, for extended periods. [ABSTRACT FROM AUTHOR]

Published
2017
Full Text
View/download PDF

149. Functional outcome after interdisciplinary, acute rehabilitation in COVID-19 patients: a retrospective study.

Author

Elmer, Nancy, Reißhauer, Anett, Brehm, Katharina, Drebinger, Daniel, Schaller, Stefan J., Schwedtke, Christine, and Liebl, Max E.

Subjects
*POST-acute COVID-19 syndrome, *MEDICAL rehabilitation, *PHYSICAL mobility, *ACTIVITIES of daily living, *COVID-19
Abstract

Background: Survivors of severe COVID-19 often exhibit a variety of sequelae including loss of mobility and ADL (activities of daily living) capacity. Acute rehabilitation (AR) is an interdisciplinary rehabilitation intervention applied early while still in a hospital setting. The goal of AR is to improve functional limitations and to increase functional independence at discharge. It is established in the treatment of patients with other severe diseases such as sepsis, polytrauma, or stroke. Data concerning AR in COVID-19 are sparse. Aim: To evaluate the changes in physical function during AR in patients after severe COVID-19. Methods: This monocentric, retrospective observational study examined the functional outcomes of a sample of COVID-19-patients who received interdisciplinary AR at a university hospital. Inclusion criteria were a positive SARS-CoV-2 test in 05/2020–01/2022 and transfer to AR after intensive care treatment. 87 patients were elegible for evaluation, 3 of whom were excluded because of death during AR. Data were extracted from the hospital information system. In a pre-post analysis, mobility (Charité Mobility Index), ADL (Barthel Index), and oxygen demand were assessed. In addition, discharge location after AR, factors associated with AR unit length of stay, and functional improvements were analyzed. Results: Data of 84 patients were analyzed. Mobility increased significantly from a median of 4 [1.25-6] CHARMI points at admission to a median of 9 [8.25-9] at discharge (p < 0.001). ADL increased significantly from a median of 52.5 [35.0-68.75] Barthel Index points at admission to a median of 92.5 [85–95] at discharge (p < 0.001). Oxygen demand decreased from 80.7 to 30.5% of patients. The majority (55.9%) of patients were discharged home, while 36.9% received direct follow-up rehabilitation. Older age correlated significantly with lower scores on the discharge assessment for mobility (Spearman's ϱ = -0.285, p = 0.009) and ADL (Spearman's ϱ = -0.297, p = 0.006). Conclusion: Acute rehabilitation is a viable option for COVID-19 patients with severe functional deficits after ICU treatment to achieve functional progress in mobility and ADL, reduce oxygen requirements and enable follow-up rehabilitation. Trial registration number and date of registration for prospectively registered trials: Trial registration number: DRKS00025239. Date of registration: 08 Sep 2021. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

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

Author

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

Subjects
*COVID-19 pandemic, *MEDICAL personnel, *PHYSICIANS, *MASSIVE open online courses, *COVID-19
Abstract

Purpose: During the initial phase of the pandemic, healthcare professionals faced difficulties due to the limited availability of comprehensive learning resources on managing patients affected with coronavirus disease 2019 (COVID-19). The COVID-19 Skills Preparation Course (C19_SPACE) was tailored to meet the overwhelming demand for specialized training. The primary objective of this study was to assess the efficacy and impact of this program on enhancing clinical knowledge and to identify factors affecting this improvement. Methods: As part of the project, data were collected prospectively to measure the baseline knowledge. After the descriptive statistics, multiple and multivariate logistic regression models were executed to identify the factors associated with knowledge increase. Results: The final sample included 3140 medical doctors (MDs) and 3090 nurses (RNs). For the primary analysis, the mean value of the baseline knowledge test score of MDs was 62.41 (standard deviation, SD = 13.48), and it significantly (p < 0.001) increased to 84.65 (SD = 11.95). Factors influencing overall knowledge scores were female sex (AOR = 1.34 [1.04–1.73]), being a specialist qualified for intensive care medicine (adjusted odds ratio, AOR = 0.56, [0.33–0.96]), and performance on the pre-test (AOR = 0.91, [0.90–0.92]). As for the RNs, the mean value of the total knowledge score was 63.25 (SD = 13.53), which significantly (p < 0.001) increased to 81.51 (SD = 14.21). Factor associated with knowledge was performance on the pre-test (AOR = 0.92 [0.92–0.93]). Conclusions: C19_SPACE effectively increased the clinical knowledge of doctors and nurses. The effect was more pronounced in the program's target group of healthcare workers with less experience in the intensive care unit (ICU). Other factors associated with knowledge enhancement were sex and being a specialist in intensive care. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results