Jouke Regt - Academia.edu (original) (raw)
Papers by Jouke Regt
CMIG Extra: Cases, 2004
A case of severe COPD patient complicated by pneumomediastinum due to spontaneous tracheal perfor... more A case of severe COPD patient complicated by pneumomediastinum due to spontaneous tracheal perforation related to post-influenza vaccination is presented. The virtual bronchoscopy was superior to fiberoptic bronchoscopy and classic multi-slice CT in diagnosing the tracheal perforation. The use of virtual bronchoscopy should be considered as a reliable diagnostic tool in cases of pneumomediastinum especially due to the ability to explore the airways in both antegrade and retrograde navigation.
Intensive Care Medicine Experimental, 2016
Journal of Translational Internal Medicine, 2014
The role of corticosteroids in critically ill patients has always been discussed by researchers a... more The role of corticosteroids in critically ill patients has always been discussed by researchers and clinicians dedicated in the related field. Despite several decades of clinical studies exploring their role in both sepsis and treatment of acute respiratory distress syndrome (ARDS), their use remains controversial. This short review highlights current knowledge and opinions.
pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and fut... more pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and future developments
R e v I e w open access to scientific and medical research Open Access Full Text Article
51 This issue of the Journal of Translational Internal Medicine contains a comprehensive and upda... more 51 This issue of the Journal of Translational Internal Medicine contains a comprehensive and updated overview of steroid treatment in a wide array of pathologic conditions. Within this scope, we take the opportunity to draw attention to an often neglected, yet very important aspect of steroid metabolism: Steroid pharmacokinetics (PK). The knowledge on PK behavior of steroid drugs such as prednisolone or prednisone has indeed been expanding at a rather slow pace. First, convenient, rapid, and specific determination of plasma levels of these steroids was largely indebted to the breakthrough of high performance liquid chromatography (HPLC). Second, prednisolone is nonlinearly proteinbound. Since unbound prednisolone is the biologically active compound, only the measurement of this free fraction in plasma is relevant. Third, the short half-life of prednisolone precludes to reach steady-state levels and requires determination of the area under the concentration-time curve. Fourth, predni...
Journal of Translational Internal Medicine, 2018
Statins essentially are cholesterol-lowering drugs that are extensively prescribed for primary an... more Statins essentially are cholesterol-lowering drugs that are extensively prescribed for primary and secondary prevention of cardiovascular disease. Compelling evidence suggests that the beneficial effects of statins may not only be due to its ability to control cholesterol levels but also due to a pleiotropic cholesterol-independent anti-inflammatory, antioxidant, endothelial-protective and plaque-stabilizing activity. Along this line, statins may also exert acute and long-term effects on renal function. We present a narrative literature review that summarizes arguments in favor of or against the preventive and/or therapeutic use of statins in kidney-related diseases or complications. We also highlight the ongoing controversy regarding statin therapy in chronic and end-stage kidney disease.
Journal of thoracic disease, 2017
A beneficial adjuvant role of chest physiotherapy (CPT) to promote airway clearance, alveolar rec... more A beneficial adjuvant role of chest physiotherapy (CPT) to promote airway clearance, alveolar recruitment, and ventilation/perfusion matching in mechanically ventilated (MV) patients with pneumonia or relapsing lung atelectasis is commonly accepted. However, doubt prevails regarding the usefulness of applying routine CPT in MV subjects with no such lung diseases. In-depth narrative review based on a literature search for prospective randomized trials comparing CPT with a non-CPT strategy in adult patients ventilated for at least 48 h. Six relevant studies were identified. Sample size was small. Various CPT modalities were used including body positioning, manual chest manipulation (mobilization, percussion, vibration, and compression), and specific techniques such as lung hyperinflation and intrapulmonary percussion. Control subjects mostly received general nursing care and tracheal suction. In general, CPT was safe and supportive, yet had debatable or no significant impact on any re...
Annals of Intensive Care, 2012
Because of its still rising incidence and high mortality rate in intensive care unit (ICU) patien... more Because of its still rising incidence and high mortality rate in intensive care unit (ICU) patients, early recognition of acute kidney injury (AKI) remains a critical issue. Surprisingly, effective biomarkers for early detection and hence appropriate and timely therapy of AKI have not yet entered the clinical arena. We performed a systematic search of the literature published between 1999 and 2011 on potential early biomarkers for acute renal failure/kidney injury in an at-risk adult and pediatric population following the Quorum Guidelines. Based on this review, recommendations for the clinical use of these biomarkers were proposed. In general, kidney biomarkers may aid to direct early aggressive treatment strategies for AKI thereby decreasing the associated high mortality. To date, however, sensitivity and specificity of individual biomarker assays are low and do not sustain their routine clinical use. "Kits" containing a combination of established biomarkers, in conjunction with measured glomerular filtration rate, may enhance diagnostic and prognostic accuracy in the future.
Blood Purification, 2014
perience, we postulate that patients undergoing CRRT may receive substantially higher doses of co... more perience, we postulate that patients undergoing CRRT may receive substantially higher doses of colistin (i.e. a high loading dose, followed by a maintenance dose of up to 4.5 million IU t.i.d.). Treatment can be continued for a prolonged time period without increasing toxicity. CRRT counteracts colistin accumulation because the drug is continuously filtered and also significantly adsorbed in the bulk of the dialysis membrane. Implementing such a 'CRRT rescue' therapy does require the strict use of highly adsorptive dialysis membranes in association with citrate anticoagulation to increase membrane performance.
Annals of Intensive Care, 2011
Evidence is accumulating showing that septic acute kidney injury (AKI) is different from non-sept... more Evidence is accumulating showing that septic acute kidney injury (AKI) is different from non-septic AKI. Specifically, a large body of research points to apoptotic processes underlying septic AKI. Unravelling the complex and intertwined apoptotic and immuno-inflammatory pathways at the cellular level will undoubtedly create new and exciting perspectives for the future development (e.g., caspase inhibition) or refinement (specific vasopressor use) of therapeutic strategies. Shock complicating sepsis may cause more AKI but also will render treatment of this condition in an hemodynamically unstable patient more difficult. Expert opinion, along with the aggregated results of two recent large randomized trials, favors continuous renal replacement therapy (CRRT) as preferential treatment for septic AKI (hemodynamically unstable). It is suggested that this approach might decrease the need for subsequent chronic dialysis. Large-scale introduction of citrate as an anticoagulant most likely will change CRRT management in intensive care units (ICU), because it not only significantly increases filter lifespan but also better preserves filter porosity. A possible role of citrate in reducing mortality and morbidity, mainly in surgical ICU patients, remains to be proven. Also, citrate administration in the predilution mode appears to be safe and exempt of relevant side effects, yet still requires rigorous monitoring. Current consensus exists about using a CRRT dose of 25 ml/kg/h in non-septic AKI. However, because patients should not be undertreated, this implies that doses as high as 30 to 35 ml/kg/h must be prescribed to account for eventual treatment interruptions. Awaiting results from large, ongoing trials, 35 ml/kg/h should remain the standard dose in septic AKI, particularly when shock is present. To date, exact timing of CRRT is not well defined. A widely accepted composite definition of timing is needed before an appropriate study challenging this major issue can be launched.
International Journal of Nephrology and Renovascular Disease, 2013
The Lancet Diabetes & Endocrinology, 2015
International Journal of Nephrology and Renovascular Disease, 2013
Acute phosphate nephropathy or nephrocalcinosis is a tubulointerstitial nephropathy characterized... more Acute phosphate nephropathy or nephrocalcinosis is a tubulointerstitial nephropathy characterized by tubular calcium phosphate deposition-crystal nephropathy-and slowly progressive renal insufficiency during or following treatment with preparations containing sodium phosphate. We report a patient who developed nephrocalcinosis (crystal induced acute kidney injury) following the administration of a combination of oral and rectal sodium phosphate for treatment of postoperative constipation. A timely renal replacement therapy procedure may reverse the process of crystallization and the irreversible slope towards chronic dialysis.
Journal of Translational Internal Medicine, 2014
51 This issue of the Journal of Translational Internal Medicine contains a comprehensive and upda... more 51 This issue of the Journal of Translational Internal Medicine contains a comprehensive and updated overview of steroid treatment in a wide array of pathologic conditions. Within this scope, we take the opportunity to draw attention to an often neglected, yet very important aspect of steroid metabolism: Steroid pharmacokinetics (PK). The knowledge on PK behavior of steroid drugs such as prednisolone or prednisone has indeed been expanding at a rather slow pace. First, convenient, rapid, and specific determination of plasma levels of these steroids was largely indebted to the breakthrough of high performance liquid chromatography (HPLC). Second, prednisolone is nonlinearly proteinbound. Since unbound prednisolone is the biologically active compound, only the measurement of this free fraction in plasma is relevant. Third, the short half-life of prednisolone precludes to reach steady-state levels and requires determination of the area under the concentration-time curve. Fourth, prednisolone and prednisone are mutually convertible. Intravenous prednisolone, however, is administered as a prodrug ester, which renders comparison and interpretation of reported PK data of both agents unreliable. Finally, total body clearance of prednisolone, and to a lesser extent, only the unbound fraction directly correlates with increasing concentrations of prednisolone. To be valid, steroid PK studies should therefore at least aim at standardization of drug dose, profile and hydrosolubility.
Journal of Anesthesia
Microaspiration of bacteriologically contaminated oropharyngeal secretions alongside the cuff of ... more Microaspiration of bacteriologically contaminated oropharyngeal secretions alongside the cuff of an endotracheal tube (ETT) is a key mechanism for development of ventilator-associated pneumonia. We have constructed a prototype double-cuffed ETT equipped with a supplemental port in-between the cuffs through which continuous positive airway pressure (CPAP) is delivered. Pressure in the intercuff space propels secretions upwards and produces 100% tracheal sealing in an in vitro model. We conducted a 24 h study to investigate the sealing effect of this ETT in 12 critically ill mechanically ventilated patients. Methylene blue, instilled through a bronchoscope on top of the proximal cuff, was used as leakage tracer. Fiberoptic visualisation of the trachea was performed 1 h and 24 h thereafter. Leakage was confirmed if blue dye was detected on the tracheal mucosa beyond the tip of the ETT. In no patient, dye passed by the cuffs during the study period. Presence of the ETT did not interfere with ventilator settings, patient mobilization, physiotherapy, and technical acts. Overall, pressures in the intercuff space remained between 10 and 15 cmH 2 O. Excessive pressure swings were swiftly corrected by the CPAP system. A double-cuffed ETT, offering "pressurized sealing" of the trachea, safely and effectively prevented leakage during 24 h mechanical ventilation.
International Journal of Nephrology and Renovascular Disease, 2016
CMIG Extra: Cases, 2004
A case of severe COPD patient complicated by pneumomediastinum due to spontaneous tracheal perfor... more A case of severe COPD patient complicated by pneumomediastinum due to spontaneous tracheal perforation related to post-influenza vaccination is presented. The virtual bronchoscopy was superior to fiberoptic bronchoscopy and classic multi-slice CT in diagnosing the tracheal perforation. The use of virtual bronchoscopy should be considered as a reliable diagnostic tool in cases of pneumomediastinum especially due to the ability to explore the airways in both antegrade and retrograde navigation.
Intensive Care Medicine Experimental, 2016
Journal of Translational Internal Medicine, 2014
The role of corticosteroids in critically ill patients has always been discussed by researchers a... more The role of corticosteroids in critically ill patients has always been discussed by researchers and clinicians dedicated in the related field. Despite several decades of clinical studies exploring their role in both sepsis and treatment of acute respiratory distress syndrome (ARDS), their use remains controversial. This short review highlights current knowledge and opinions.
pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and fut... more pathophysiology, and treatment type, dosing, and timing: a comprehensive review of recent and future developments
R e v I e w open access to scientific and medical research Open Access Full Text Article
51 This issue of the Journal of Translational Internal Medicine contains a comprehensive and upda... more 51 This issue of the Journal of Translational Internal Medicine contains a comprehensive and updated overview of steroid treatment in a wide array of pathologic conditions. Within this scope, we take the opportunity to draw attention to an often neglected, yet very important aspect of steroid metabolism: Steroid pharmacokinetics (PK). The knowledge on PK behavior of steroid drugs such as prednisolone or prednisone has indeed been expanding at a rather slow pace. First, convenient, rapid, and specific determination of plasma levels of these steroids was largely indebted to the breakthrough of high performance liquid chromatography (HPLC). Second, prednisolone is nonlinearly proteinbound. Since unbound prednisolone is the biologically active compound, only the measurement of this free fraction in plasma is relevant. Third, the short half-life of prednisolone precludes to reach steady-state levels and requires determination of the area under the concentration-time curve. Fourth, predni...
Journal of Translational Internal Medicine, 2018
Statins essentially are cholesterol-lowering drugs that are extensively prescribed for primary an... more Statins essentially are cholesterol-lowering drugs that are extensively prescribed for primary and secondary prevention of cardiovascular disease. Compelling evidence suggests that the beneficial effects of statins may not only be due to its ability to control cholesterol levels but also due to a pleiotropic cholesterol-independent anti-inflammatory, antioxidant, endothelial-protective and plaque-stabilizing activity. Along this line, statins may also exert acute and long-term effects on renal function. We present a narrative literature review that summarizes arguments in favor of or against the preventive and/or therapeutic use of statins in kidney-related diseases or complications. We also highlight the ongoing controversy regarding statin therapy in chronic and end-stage kidney disease.
Journal of thoracic disease, 2017
A beneficial adjuvant role of chest physiotherapy (CPT) to promote airway clearance, alveolar rec... more A beneficial adjuvant role of chest physiotherapy (CPT) to promote airway clearance, alveolar recruitment, and ventilation/perfusion matching in mechanically ventilated (MV) patients with pneumonia or relapsing lung atelectasis is commonly accepted. However, doubt prevails regarding the usefulness of applying routine CPT in MV subjects with no such lung diseases. In-depth narrative review based on a literature search for prospective randomized trials comparing CPT with a non-CPT strategy in adult patients ventilated for at least 48 h. Six relevant studies were identified. Sample size was small. Various CPT modalities were used including body positioning, manual chest manipulation (mobilization, percussion, vibration, and compression), and specific techniques such as lung hyperinflation and intrapulmonary percussion. Control subjects mostly received general nursing care and tracheal suction. In general, CPT was safe and supportive, yet had debatable or no significant impact on any re...
Annals of Intensive Care, 2012
Because of its still rising incidence and high mortality rate in intensive care unit (ICU) patien... more Because of its still rising incidence and high mortality rate in intensive care unit (ICU) patients, early recognition of acute kidney injury (AKI) remains a critical issue. Surprisingly, effective biomarkers for early detection and hence appropriate and timely therapy of AKI have not yet entered the clinical arena. We performed a systematic search of the literature published between 1999 and 2011 on potential early biomarkers for acute renal failure/kidney injury in an at-risk adult and pediatric population following the Quorum Guidelines. Based on this review, recommendations for the clinical use of these biomarkers were proposed. In general, kidney biomarkers may aid to direct early aggressive treatment strategies for AKI thereby decreasing the associated high mortality. To date, however, sensitivity and specificity of individual biomarker assays are low and do not sustain their routine clinical use. "Kits" containing a combination of established biomarkers, in conjunction with measured glomerular filtration rate, may enhance diagnostic and prognostic accuracy in the future.
Blood Purification, 2014
perience, we postulate that patients undergoing CRRT may receive substantially higher doses of co... more perience, we postulate that patients undergoing CRRT may receive substantially higher doses of colistin (i.e. a high loading dose, followed by a maintenance dose of up to 4.5 million IU t.i.d.). Treatment can be continued for a prolonged time period without increasing toxicity. CRRT counteracts colistin accumulation because the drug is continuously filtered and also significantly adsorbed in the bulk of the dialysis membrane. Implementing such a 'CRRT rescue' therapy does require the strict use of highly adsorptive dialysis membranes in association with citrate anticoagulation to increase membrane performance.
Annals of Intensive Care, 2011
Evidence is accumulating showing that septic acute kidney injury (AKI) is different from non-sept... more Evidence is accumulating showing that septic acute kidney injury (AKI) is different from non-septic AKI. Specifically, a large body of research points to apoptotic processes underlying septic AKI. Unravelling the complex and intertwined apoptotic and immuno-inflammatory pathways at the cellular level will undoubtedly create new and exciting perspectives for the future development (e.g., caspase inhibition) or refinement (specific vasopressor use) of therapeutic strategies. Shock complicating sepsis may cause more AKI but also will render treatment of this condition in an hemodynamically unstable patient more difficult. Expert opinion, along with the aggregated results of two recent large randomized trials, favors continuous renal replacement therapy (CRRT) as preferential treatment for septic AKI (hemodynamically unstable). It is suggested that this approach might decrease the need for subsequent chronic dialysis. Large-scale introduction of citrate as an anticoagulant most likely will change CRRT management in intensive care units (ICU), because it not only significantly increases filter lifespan but also better preserves filter porosity. A possible role of citrate in reducing mortality and morbidity, mainly in surgical ICU patients, remains to be proven. Also, citrate administration in the predilution mode appears to be safe and exempt of relevant side effects, yet still requires rigorous monitoring. Current consensus exists about using a CRRT dose of 25 ml/kg/h in non-septic AKI. However, because patients should not be undertreated, this implies that doses as high as 30 to 35 ml/kg/h must be prescribed to account for eventual treatment interruptions. Awaiting results from large, ongoing trials, 35 ml/kg/h should remain the standard dose in septic AKI, particularly when shock is present. To date, exact timing of CRRT is not well defined. A widely accepted composite definition of timing is needed before an appropriate study challenging this major issue can be launched.
International Journal of Nephrology and Renovascular Disease, 2013
The Lancet Diabetes & Endocrinology, 2015
International Journal of Nephrology and Renovascular Disease, 2013
Acute phosphate nephropathy or nephrocalcinosis is a tubulointerstitial nephropathy characterized... more Acute phosphate nephropathy or nephrocalcinosis is a tubulointerstitial nephropathy characterized by tubular calcium phosphate deposition-crystal nephropathy-and slowly progressive renal insufficiency during or following treatment with preparations containing sodium phosphate. We report a patient who developed nephrocalcinosis (crystal induced acute kidney injury) following the administration of a combination of oral and rectal sodium phosphate for treatment of postoperative constipation. A timely renal replacement therapy procedure may reverse the process of crystallization and the irreversible slope towards chronic dialysis.
Journal of Translational Internal Medicine, 2014
51 This issue of the Journal of Translational Internal Medicine contains a comprehensive and upda... more 51 This issue of the Journal of Translational Internal Medicine contains a comprehensive and updated overview of steroid treatment in a wide array of pathologic conditions. Within this scope, we take the opportunity to draw attention to an often neglected, yet very important aspect of steroid metabolism: Steroid pharmacokinetics (PK). The knowledge on PK behavior of steroid drugs such as prednisolone or prednisone has indeed been expanding at a rather slow pace. First, convenient, rapid, and specific determination of plasma levels of these steroids was largely indebted to the breakthrough of high performance liquid chromatography (HPLC). Second, prednisolone is nonlinearly proteinbound. Since unbound prednisolone is the biologically active compound, only the measurement of this free fraction in plasma is relevant. Third, the short half-life of prednisolone precludes to reach steady-state levels and requires determination of the area under the concentration-time curve. Fourth, prednisolone and prednisone are mutually convertible. Intravenous prednisolone, however, is administered as a prodrug ester, which renders comparison and interpretation of reported PK data of both agents unreliable. Finally, total body clearance of prednisolone, and to a lesser extent, only the unbound fraction directly correlates with increasing concentrations of prednisolone. To be valid, steroid PK studies should therefore at least aim at standardization of drug dose, profile and hydrosolubility.
Journal of Anesthesia
Microaspiration of bacteriologically contaminated oropharyngeal secretions alongside the cuff of ... more Microaspiration of bacteriologically contaminated oropharyngeal secretions alongside the cuff of an endotracheal tube (ETT) is a key mechanism for development of ventilator-associated pneumonia. We have constructed a prototype double-cuffed ETT equipped with a supplemental port in-between the cuffs through which continuous positive airway pressure (CPAP) is delivered. Pressure in the intercuff space propels secretions upwards and produces 100% tracheal sealing in an in vitro model. We conducted a 24 h study to investigate the sealing effect of this ETT in 12 critically ill mechanically ventilated patients. Methylene blue, instilled through a bronchoscope on top of the proximal cuff, was used as leakage tracer. Fiberoptic visualisation of the trachea was performed 1 h and 24 h thereafter. Leakage was confirmed if blue dye was detected on the tracheal mucosa beyond the tip of the ETT. In no patient, dye passed by the cuffs during the study period. Presence of the ETT did not interfere with ventilator settings, patient mobilization, physiotherapy, and technical acts. Overall, pressures in the intercuff space remained between 10 and 15 cmH 2 O. Excessive pressure swings were swiftly corrected by the CPAP system. A double-cuffed ETT, offering "pressurized sealing" of the trachea, safely and effectively prevented leakage during 24 h mechanical ventilation.
International Journal of Nephrology and Renovascular Disease, 2016