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1,887 results on '"Van den Berghe, Greet"'

4. Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial

Author

Zeilmaker-Roest, Gerdien, de Vries-Rink, Christine, van Rosmalen, Joost, van Dijk, Monique, de Wildt, Saskia N., Knibbe, Catherijne A. J., Koomen, Erik, Jansen, Nicolaas J. G., Kneyber, Martin C. J., Maebe, Sofie, Van den Berghe, Greet, Haghedooren, Renata, Vlasselaers, Dirk, Bogers, Ad J. J. C., Tibboel, Dick, and Wildschut, Enno D.

Published
2024
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14. Modulation of thromboinflammation in hospitalized COVID‐19 patients with aprotinin, low molecular weight heparin, and anakinra: The DAWn‐Antico study

Author

Engelen, Matthias M., Van Thillo, Quentin, Betrains, Albrecht, Gyselinck, Iwein, Martens, Caroline P., Spalart, Valérie, Ockerman, Anna, Devooght, Caroline, Wauters, Joost, Gunst, Jan, Wouters, Carine, Vandenbriele, Christophe, Rex, Steffen, Liesenborghs, Laurens, Wilmer, Alexander, Meersseman, Philippe, Van den Berghe, Greet, Dauwe, Dieter, Belmans, Ann, Thomeer, Michiel, Fivez, Tom, Mesotten, Dieter, Ruttens, David, Heytens, Luc, Dapper, Ilse, Tuyls, Sebastiaan, De Tavernier, Brecht, Verhamme, Peter, Vanassche, Thomas, Van Wijngaerden, Eric, Janssens, Wim, Meyfroidt, Geert, Vos, Robin, Devos, Timothy, De Munter, Paul, Neyts, Johan, Dupont, Lieven, Spriet, Isabel, Verbeke, Geert, Claes, Kathleen, Robberecht, Wim, Van Geet, Chris, Debaveye, Barbara, Ceunen, Helga, Servaes, Veerle, Cludts, Katrien, Vanheule, Kristine, Jacobs, Cato, Roebroek, Daimy, Dreesen, Paulien, Smet, Nele, Dolhain, Jan, Hoppenbrouwers, Mieke, Wens, Kathleen, Daems, Kristel, and D’hondt, Monique

Published
2022
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16. Impact of duration of critical illness and level of systemic glucocorticoid availability on tissue-specific glucocorticoid receptor expression and actions: A prospective, observational, cross-sectional human and two translational mouse studies

Author

Téblick, Arno, Van Dyck, Lisa, Van Aerde, Nathalie, Van der Perre, Sarah, Pauwels, Lies, Derese, Inge, Debaveye, Yves, Wouters, Pieter J., Vanhorebeek, Ilse, Langouche, Lies, and Van den Berghe, Greet

Published
2022
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17. Leukocyte telomere length in paediatric critical illness: effect of early parenteral nutrition.

Author

Verstraete, Sören, Vanhorebeek, Ilse, van Puffelen, Esther, Derese, Inge, Ingels, Catherine, Verbruggen, Sascha, Wouters, Pieter, Joosten, Koen, Hanot, Jan, Guerra, Gonzalo, Vlasselaers, Dirk, Lin, Jue, and Van den Berghe, Greet

Subjects
Children, Critical care, Critical illness, Intensive care, Nutrition, PICU, Paediatric, Telomere length, Telomeres, Adolescent, Child, Child, Preschool, Critical Illness, Female, Humans, Infant, Intensive Care Units, Pediatric, Leukocytes, Male, Parenteral Nutrition, Pediatrics, Propensity Score, Survival Analysis, Telomere, Time Factors
Abstract

BACKGROUND: Children who have suffered from critical illnesses that required treatment in a paediatric intensive care unit (PICU) have long-term physical and neurodevelopmental impairments. The mechanisms underlying this legacy remain largely unknown. In patients suffering from chronic diseases hallmarked by inflammation and oxidative stress, poor long-term outcome has been associated with shorter telomeres. Shortened telomeres have also been reported to result from excessive food consumption and/or unhealthy nutrition. We investigated whether critically ill children admitted to the PICU have shorter-than-normal telomeres, and whether early parenteral nutrition (PN) independently affects telomere length when adjusting for known determinants of telomere length. METHODS: Telomere length was quantified in leukocyte DNA from 342 healthy children and from 1148 patients who had been enrolled in the multicenter, randomised controlled trial (RCT), PEPaNIC. These patients were randomly allocated to initiation of PN within 24 h (early PN) or to withholding PN for one week in PICU (late PN). The impact of early PN versus late PN on the change in telomere length from the first to last PICU-day was investigated with multivariable linear regression analyses. RESULTS: Leukocyte telomeres were 6% shorter than normal upon PICU admission (median 1.625 (IQR 1.446-1.825) telomere/single-copy-gene ratio (T/S) units vs. 1.727 (1.547-1.915) T/S-units in healthy children (P

Published
2018

22. Adrenal function/dysfunction in critically ill patients: a concise narrative review of recent novel insights

Author

Van den Berghe, Greet

Subjects
Medical research, Medicine, Experimental, Corticosteroids, Intermedin, ACTH, Hospital patients, Health
Abstract

The 'fight or flight' response to critical illness relies on increased cortisol availability, traditionally attributed to several-fold-increased cortisol production via hypothalamus-pituitary-adrenal-axis activation. Recent studies provided evidence against this concept with clinical implications. First, high cortisol availability during critical illness is driven by suppressed cortisol binding and reduced cortisol breakdown rather than increased cortisol production. This implies reduction of hydrocortisone doses when prescribed in ICU. Second, plasma ACTH is low, explained by feedback inhibition by peripherally driven high free cortisol and/or other central glucocorticoid-receptor ligands. Third, ICU patients have elevated plasma concentrations of the ACTH-precursor hormone, pro-opiomelanocortin, because of impaired pituitary processing into ACTH, and pro-opiomelanocortin could drive some adrenocortical cortisol production in face of low ACTH. Fourth, in prolonged critically ill patients, endogenously suppressed ACTH, aggravated by exogenous corticosteroids, associates with poor outcome. In long-stay ICU patients, central adrenal insufficiency may occur due to lack of trophic ACTH signaling. Finally, the Cosyntropin test is not suitable to assess adrenocortical reserve in ICU patients as the test is confounded by increased cortisol distribution volume. These insights necessitate further research focusing on the need, if any, of treating ICU patients with corticosteroids, and timing thereof, outside indications for pharmacological anti-inflammatory drugs., Author(s): Greet Van den Berghe [sup.1] Author Affiliations: (1) grid.5596.f, 0000 0001 0668 7884, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven [...]

Published
2021
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25. Recovery after critical illness: putting the puzzle together-a consensus of 29.

Author

Azoulay, Elie, Vincent, Jean-Louis, Angus, Derek C, Arabi, Yaseen M, Brochard, Laurent, Brett, Stephen J, Citerio, Giuseppe, Cook, Deborah J, Curtis, Jared Randall, Dos Santos, Claudia C, Ely, E Wesley, Hall, Jesse, Halpern, Scott D, Hart, Nicholas, Hopkins, Ramona O, Iwashyna, Theodore J, Jaber, Samir, Latronico, Nicola, Mehta, Sangeeta, Needham, Dale M, Nelson, Judith, Puntillo, Kathleen, Quintel, Michael, Rowan, Kathy, Rubenfeld, Gordon, Van den Berghe, Greet, Van der Hoeven, Johannes, Wunsch, Hannah, and Herridge, Margaret

Subjects
Humans, Delirium, Critical Illness, Respiration, Artificial, Length of Stay, Consensus, Time Factors, Intensive Care Units, Deep Sedation, Pain Management, Long Term Adverse Effects, Cognitive dysfunction, Depression, Intensive care, Mechanical ventilation, Muscular disorder, Sedation, Traumatic stress, Weakness, Respiration, Artificial, Medical and Health Sciences, Emergency & Critical Care Medicine
Abstract

In this review, we seek to highlight how critical illness and critical care affect longer-term outcomes, to underline the contribution of ICU delirium to cognitive dysfunction several months after ICU discharge, to give new insights into ICU acquired weakness, to emphasize the importance of value-based healthcare, and to delineate the elements of family-centered care. This consensus of 29 also provides a perspective and a research agenda about post-ICU recovery.

Published
2017

28. Endocrinopathy of the Critically Ill

Author

Van Aerde, Nathalie, Van Dyck, Lisa, Vanhorebeek, Ilse, Van den Berghe, Greet, Cecconi, Maurizio, Series Editor, De Backer, Daniel, Series Editor, Preiser, Jean-Charles, editor, Herridge, Margaret, editor, and Azoulay, Elie, editor

Published
2020
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31. Effect of early parenteral nutrition during paediatric critical illness on DNA methylation as a potential mediator of impaired neurocognitive development: a pre-planned secondary analysis of the PEPaNIC international randomised controlled trial

Author

Güiza, Fabian, Vanhorebeek, Ilse, Verstraete, Sören, Verlinden, Ines, Derese, Inge, Ingels, Catherine, Dulfer, Karolijn, Verbruggen, Sascha C, Garcia Guerra, Gonzalo, Joosten, Koen F, Wouters, Pieter J, and Van den Berghe, Greet

Published
2020
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34. Designing phase 3 sepsis trials: application of learned experiences from critical care trials in acute heart failure

Author

Mebazaa, Alexandre, Laterre, Pierre François, Russell, James A, Bergmann, Andreas, Gattinoni, Luciano, Gayat, Etienne, Harhay, Michael O, Hartmann, Oliver, Hein, Frauke, Kjolbye, Anne Louise, Legrand, Matthieu, Lewis, Roger J, Marshall, John C, Marx, Gernot, Radermacher, Peter, Schroedter, Mathias, Scigalla, Paul, Stough, Wendy Gattis, Struck, Joachim, Van den Berghe, Greet, Yilmaz, Mehmet Birhan, and Angus, Derek C

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Trials and Supportive Activities, Hematology, Heart Disease, Patient Safety, Sepsis, Clinical Research, Cardiovascular, Infectious Diseases, Inflammatory and immune system, Infection, Good Health and Well Being, Clinical trials as topic, Heart failure, Mortality, Multiple organ failure, Clinical sciences
Abstract

Substantial attention and resources have been directed to improving outcomes of patients with critical illnesses, in particular sepsis, but all recent clinical trials testing various interventions or strategies have failed to detect a robust benefit on mortality. Acute heart failure is also a critical illness, and although the underlying etiologies differ, acute heart failure and sepsis are critical care illnesses that have a high mortality in which clinical trials have been difficult to conduct and have not yielded effective treatments. Both conditions represent a syndrome that is often difficult to define with a wide variation in patient characteristics, presentation, and standard management across institutions. Referring to past experiences and lessons learned in acute heart failure may be informative and help frame research in the area of sepsis. Academic heart failure investigators and industry have worked closely with regulators for many years to transition acute heart failure trials away from relying on dyspnea assessments and all-cause mortality as the primary measures of efficacy, and recent trials have been designed to assess novel clinical composite endpoints assessing organ dysfunction and mortality while still assessing all-cause mortality as a separate measure of safety. Applying the lessons learned in acute heart failure trials to severe sepsis and septic shock trials might be useful to advance the field. Novel endpoints beyond all-cause mortality should be considered for future sepsis trials.

Published
2016

36. ICU-acquired weakness

Author

Vanhorebeek, Ilse, Latronico, Nicola, and Van den Berghe, Greet

Subjects
Hospital patients -- Analysis -- Usage, Health care industry
Abstract

Critically ill patients often acquire neuropathy and/or myopathy labeled ICU-acquired weakness. The current insights into incidence, pathophysiology, diagnostic tools, risk factors, short- and long-term consequences and management of ICU-acquired weakness are narratively reviewed. PubMed was searched for combinations of 'neuropathy', 'myopathy', 'neuromyopathy', or 'weakness' with 'critical illness', 'critically ill', 'ICU', 'PICU', 'sepsis' or 'burn'. ICU-acquired weakness affects limb and respiratory muscles with a widely varying prevalence depending on the study population. Pathophysiology remains incompletely understood but comprises complex structural/functional alterations within myofibers and neurons. Clinical and electrophysiological tools are used for diagnosis, each with advantages and limitations. Risk factors include age, weight, comorbidities, illness severity, organ failure, exposure to drugs negatively affecting myofibers and neurons, immobility and other intensive care-related factors. ICU-acquired weakness increases risk of in-ICU, in-hospital and long-term mortality, duration of mechanical ventilation and of hospitalization and augments healthcare-related costs, increases likelihood of prolonged care in rehabilitation centers and reduces physical function and quality of life in the long term. RCTs have shown preventive impact of avoiding hyperglycemia, of omitting early parenteral nutrition use and of minimizing sedation. Results of studies investigating the impact of early mobilization, neuromuscular electrical stimulation and of pharmacological interventions were inconsistent, with recent systematic reviews/meta-analyses revealing no or only low-quality evidence for benefit. ICU-acquired weakness predisposes to adverse short- and long-term outcomes. Only a few preventive, but no therapeutic, strategies exist. Further mechanistic research is needed to identify new targets for interventions to be tested in adequately powered RCTs., Author(s): Ilse Vanhorebeek [sup.1], Nicola Latronico [sup.2] [sup.3], Greet Van den Berghe [sup.1] Author Affiliations: (1) grid.5596.f, 0000 0001 0668 7884, Clinical Division and Laboratory of Intensive Care Medicine, Department [...]

Published
2020
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38. Pro-opiomelanocortin and ACTH–cortisol dissociation during pediatric cardiac surgery

Author

Téblick, Arno, Vanhorebeek, Ilse, Derese, Inge, Jacobs, An, Haghedooren, Renata, Maebe, Sofie, Zeilmaker-Roest, Gerdien A., Wildschut, Enno D., Langouche, Lies, Van den Berghe, Greet, Téblick, Arno, Vanhorebeek, Ilse, Derese, Inge, Jacobs, An, Haghedooren, Renata, Maebe, Sofie, Zeilmaker-Roest, Gerdien A., Wildschut, Enno D., Langouche, Lies, and Van den Berghe, Greet

Abstract

In critically ill adults, high plasma cortisol in the face of low ACTH coincides with high pro-opiomelanocortin (POMC) levels. Glucocorticoids further lower ACTH without affecting POMC. We hypothesized that in pediatric cardiac surgery-induced critical illness, plasma POMC is elevated, plasma ACTH transiently rises intraoperatively but becomes suppressed post-operatively, and glucocorticoid administration amplifies this phenotype. From 53 patients (0–36 months), plasma was obtained pre-operatively, intraoperatively, and on post-operative days 1 and 2. Plasma was also collected from 24 healthy children. In patients, POMC was supra-normal pre-operatively (P < 0.0001) but no longer thereafter (P > 0.05). ACTH was never high in patients. While in glucocorticoid-naive patients ACTH became suppressed by post-operative day 1 (P < 0.0001), glucocorticoid-treated patients had already suppressed ACTH intraoperatively (P ≤ 0.0001). Pre-operatively high POMC, not accompanied by increased plasma ACTH, suggests a centrally activated HPA axis with reduced pituitary processing of POMC into ACTH. Increasing systemic glucocorticoid availability with glucocorticoid treatment accelerated the suppression of plasma ACTH. Significance statement Glucocorticoids are often administered during pediatric cardiac surgery. In critically ill children, endogenous systemic glucocorticoid availability is elevated already upon ICU admission while ACTH levels are normal. This hormonal constellation suggests the presence of active feedback inhibition of ACTH. In this study, we have documented that intraoperative administration of glucocorticoids accelerates the suppression of ACTH, resulting in low plasma ACTH already upon ICU admission. Pre-operative plasma POMC, the ACTH precursor, but not ACTH, was increased. This is compatible with a centrally activated HPA axis prior to surgery in young children but reduced processing of POMC into ACTH within the pituitary. These findings suggest that

Published
2024

39. Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial

Author

Intensive care patientenzorg, Cluster A, Zeilmaker-Roest, Gerdien, de Vries-Rink, Christine, van Rosmalen, Joost, van Dijk, Monique, de Wildt, Saskia N., Knibbe, Catherijne A.J., Koomen, Erik, Jansen, Nicolaas J.G., Kneyber, Martin C.J., Maebe, Sofie, Van den Berghe, Greet, Haghedooren, Renata, Vlasselaers, Dirk, Bogers, Ad J.J.C., Tibboel, Dick, Wildschut, Enno D., Intensive care patientenzorg, Cluster A, Zeilmaker-Roest, Gerdien, de Vries-Rink, Christine, van Rosmalen, Joost, van Dijk, Monique, de Wildt, Saskia N., Knibbe, Catherijne A.J., Koomen, Erik, Jansen, Nicolaas J.G., Kneyber, Martin C.J., Maebe, Sofie, Van den Berghe, Greet, Haghedooren, Renata, Vlasselaers, Dirk, Bogers, Ad J.J.C., Tibboel, Dick, and Wildschut, Enno D.

Published
2024

40. Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery:a multi-center randomized controlled trial

Author

Zeilmaker-Roest, Gerdien, de Vries-Rink, Christine, van Rosmalen, Joost, van Dijk, Monique, de Wildt, Saskia N., Knibbe, Catherijne A.J., Koomen, Erik, Jansen, Nicolaas J.G., Kneyber, Martin C.J., Maebe, Sofie, Van den Berghe, Greet, Haghedooren, Renata, Vlasselaers, Dirk, Bogers, Ad J.J.C., Tibboel, Dick, Wildschut, Enno D., Zeilmaker-Roest, Gerdien, de Vries-Rink, Christine, van Rosmalen, Joost, van Dijk, Monique, de Wildt, Saskia N., Knibbe, Catherijne A.J., Koomen, Erik, Jansen, Nicolaas J.G., Kneyber, Martin C.J., Maebe, Sofie, Van den Berghe, Greet, Haghedooren, Renata, Vlasselaers, Dirk, Bogers, Ad J.J.C., Tibboel, Dick, and Wildschut, Enno D.

Abstract

Background: To determine whether intermittent intravenous (IV) paracetamol as primary analgesic would significantly reduce morphine consumption in children aged 0–3 years after cardiac surgery with cardiopulmonary bypass. Methods: Multi-center, randomized, double-blinded, controlled trial in four level-3 Pediatric Intensive Care Units (PICU) in the Netherlands and Belgium. Inclusion period; March 2016–July 2020. Children aged 0–3 years, undergoing cardiac surgery with cardiopulmonary bypass were eligible. Patients were randomized to continuous morphine or intermittent IV paracetamol as primary analgesic after a loading dose of 100 mcg/kg morphine was administered at the end of surgery. Rescue morphine was given if numeric rating scale (NRS) pain scores exceeded predetermined cutoff values. Primary outcome was median weight-adjusted cumulative morphine dose in mcg/kg in the first 48 h postoperative. For the comparison of the primary outcome between groups, the nonparametric Van Elteren test with stratification by center was used. For comparison of the proportion of patients with one or more NRS pain scores of 4 and higher between the two groups, a non-inferiority analysis was performed using a non-inferiority margin of 20%. Results:In total, 828 were screened and finally 208 patients were included; parents of 315 patients did not give consent and 305 were excluded for various reasons. Fourteen of the enrolled 208 children were withdrawn from the study before start of study medication leaving 194 patients for final analysis. One hundred and two patients received intermittent IV paracetamol, 106 received continuous morphine. The median weight-adjusted cumulative morphine consumption in the first 48 h postoperative in the IV paracetamol group was 5 times lower (79%) than that in the morphine group (median, 145.0 (IQR, 115.0–432.5) mcg/kg vs 692.6 (IQR, 532.7–856.1) mcg/kg; P < 0.001). The rescue morphine cons

Published
2024

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