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Kompass Neumología
Actualmente se discute si la hiperoxia – es decir, la ventilación con altas concentraciones de O2... more Actualmente se discute si la hiperoxia – es decir, la ventilación con altas concentraciones de O2 inspirado (FIO2) – y la hiperoxemia resultante – o sea, la existencia de tensiones arteriales de O2 (PaO2) suprafisiológicas – tienen utilidad durante el manejo agudo del choque circulatorio. Este concepto se basa en la evidencia experimental de que la hiperoxemia podría contribuir a compensar el desbalance entre la provisión y los requerimientos de O2. Sin embargo, a pesar de que aún es una práctica común, su uso se ve limitado debido a la posible toxicidad del oxígeno debido a una mayor formación de especies reactivas de oxígeno (ROS), especialmente bajo condiciones de isquemia/reperfusión. Varios estudios han reportado que existe una relación con forma de U entre la PaO2 y la mortalidad/morbilidad en pacientes en la UCI. Es interesante que estos estudios, retrospectivos en su mayor parte, encontraron que la mortalidad más baja coincide con una PaO2 ∼150 mmHg durante las primeras 24 h...
Annals of Intensive Care
There is an ongoing discussion whether hyperoxia, i.e. ventilation with high inspiratory O2 conce... more There is an ongoing discussion whether hyperoxia, i.e. ventilation with high inspiratory O2 concentrations (FIO2), and the consecutive hyperoxaemia, i.e. supraphysiological arterial O2 tensions (PaO2), have a place during the acute management of circulatory shock. This concept is based on experimental evidence that hyperoxaemia may contribute to the compensation of the imbalance between O2 supply and requirements. However, despite still being common practice, its use is limited due to possible oxygen toxicity resulting from the increased formation of reactive oxygen species (ROS) limits, especially under conditions of ischaemia/reperfusion. Several studies have reported that there is a U-shaped relation between PaO2 and mortality/morbidity in ICU patients. Interestingly, these mostly retrospective studies found that the lowest mortality coincided with PaO2 ~ 150 mmHg during the first 24 h of ICU stay, i.e. supraphysiological PaO2 levels. Most of the recent large-scale retrospective ...
Intensive Care Medicine Experimental
Background 3,4-Methylenedioxymethamphetamine intoxication can result in potentially lethal multi-... more Background 3,4-Methylenedioxymethamphetamine intoxication can result in potentially lethal multi-organ failure, for which the current treatment is largely supportive. Recently, a report of the use of the CytoSorb device as a part of the successful treatment of a patient with 3,4-methylenedioxymethamphetamine intoxication and multi-organ failure has been described. Main body While 3,4-methylenedioxymethamphetamine was very effectively removed by CytoSorb in vitro, the degree of removal in the clinical setting described may have been minimal. Indeed, the therapy was started relatively late in this case, and, as the therapy is concentration dependent, the removal of 3,4-methylenedioxymethamphetamine is likely to have been limited. On the other hand, in this case, CytoSorb hemoadsorption was very effective to treat rhabdomyolysis and hyperinflammation. Conclusion The in vitro experimentation demonstrates that 3,4-methylenedioxymethamphetamine is effectively removed by CytoSorb. However,...
Intensive Care Medicine Experimental
This review addresses the plausibility of hydrogen sulfide (H2S) therapy for acute lung injury (A... more This review addresses the plausibility of hydrogen sulfide (H2S) therapy for acute lung injury (ALI) and circulatory shock, by contrasting the promising preclinical results to the present clinical reality. The review discusses how the narrow therapeutic window and width, and potentially toxic effects, the route, dosing, and timing of administration all have to be balanced out very carefully. The development of standardized methods to determine in vitro and in vivo H2S concentrations, and the pharmacokinetics and pharmacodynamics of H2S-releasing compounds is a necessity to facilitate the safety of H2S-based therapies. We suggest the potential of exploiting already clinically approved compounds, which are known or unknown H2S donors, as a surrogate strategy.
Integrative Food, Nutrition and Metabolism
Administration of nutrients during critical illness is depicted in current guidelines, e.g. in th... more Administration of nutrients during critical illness is depicted in current guidelines, e.g. in the guidelines of the American Society for Parenteral and Enteral Nutrition (ASPEN) [1] or in the European Society for clinical Nutrition and Metabolism (ESPEN) [2]. Special recommendations for critically ill children requiring continuous renal replacement therapy (CRRT) also exist [3]. The prescription of micronutrients like vitamins and trace elements is of moderate evidence especially for renal dysfunction and during CRRT and solid data of adequate micronutrient administration during critical illness are lacking. The dynamic of critical illness should be kept in mind which can have a relevant impact for vitamin or trace element requirement.
The International Journal of Artificial Organs
Introduction: Extracorporeal life support is an increasingly used technique for respiratory and c... more Introduction: Extracorporeal life support is an increasingly used technique for respiratory and cardiocirculatory support. Besides primary organ dysfunction, an excessive systemic hyperinflammatory response can be the underlying cause for acute organ failure necessitating extracorporeal life support therapy, or it may be associated with the extracorporeal life support itself. Controlling this overwhelming inflammatory response using CytoSorb® hemoadsorption has been shown to be associated with improved hemodynamics and restored metabolic balance resulting in preserved organ functions. Methods: In this retrospective case series, we describe 23 patients undergoing extracorporeal life support therapy and CytoSorb hemoadsorption. Cytokine levels were monitored, hemodynamic and metabolic variables were recorded, and outcome measures such as duration of organ support, intensive care unit mortality, and hospital mortality were noted. Results: CytoSorb treatment was associated with a trend ...
Journal of Neurosurgery
OBJECTIVEAcute subdural hematoma (ASDH) is a leading entity in brain injury. Rodent models mostly... more OBJECTIVEAcute subdural hematoma (ASDH) is a leading entity in brain injury. Rodent models mostly lack standard intensive care, while large animal models frequently are only short term. Therefore, the authors developed a long-term, resuscitated porcine model of ASDH-induced brain injury and report their findings.METHODSAnesthetized, mechanically ventilated, and instrumented pigs with human-like coagulation underwent subdural injection of 20 mL of autologous blood and subsequent observation for 54 hours. Continuous bilateral multimodal brain monitoring (intracranial pressure [ICP], cerebral perfusion pressure [CPP], partial pressure of oxygen in brain tissue [PbtO2], and brain temperature) was combined with intermittent neurological assessment (veterinary modified Glasgow Coma Scale [MGCS]), microdialysis, and measurement of plasma protein S100β, GFAP, neuron-specific enolase [NSE], nitrite+nitrate, and isoprostanes. Fluid resuscitation and continuous intravenous norepinephrine were ...
Journal of Thoracic Disease
International Urology and Nephrology
Journal of Thoracic Disease
Extracorporeal membrane oxygenation (ECMO) is an increasingly used technology for mechanical supp... more Extracorporeal membrane oxygenation (ECMO) is an increasingly used technology for mechanical support of respiratory and cardio-circulatory failure. Excessive systemic inflammatory response is observed during sepsis and after cardiopulmonary bypass (CPB) with similar clinical features. The overwhelming inflammatory response is characterized by highly elevated pro-and anti-inflammatory cytokine levels. The excessive cytokine release during the overwhelming inflammatory response may result in multiple organ damage and failure. During ECMO therapy activation of complement and contact systems occur which may be followed by cytokine release. Controlling excessively increased cytokines may be considered as a valuable treatment option. Hemoadsorption therapy may be used to decrease cytokine levels in case of excessive inflammatory response and due to its unspecific adsorptive characteristics also substances like myoglobin, free hemoglobin or bilirubin. Controlling pro-inflammatory response with hemoadsorption may have positive impact on the endothelial glycocalix and also may be advantageous for maintenance of the vascular barrier function which plays a pivotal role in the development of tissue edema and oxygen mismatch. Hemoadsorption therapy seems to offer a promising new option for the treatment of patients with overwhelming inflammatory response leading to faster hemodynamic and metabolic stabilization finally resulting in preserved organ functions.
Kompass Neumología
Actualmente se discute si la hiperoxia – es decir, la ventilación con altas concentraciones de O2... more Actualmente se discute si la hiperoxia – es decir, la ventilación con altas concentraciones de O2 inspirado (FIO2) – y la hiperoxemia resultante – o sea, la existencia de tensiones arteriales de O2 (PaO2) suprafisiológicas – tienen utilidad durante el manejo agudo del choque circulatorio. Este concepto se basa en la evidencia experimental de que la hiperoxemia podría contribuir a compensar el desbalance entre la provisión y los requerimientos de O2. Sin embargo, a pesar de que aún es una práctica común, su uso se ve limitado debido a la posible toxicidad del oxígeno debido a una mayor formación de especies reactivas de oxígeno (ROS), especialmente bajo condiciones de isquemia/reperfusión. Varios estudios han reportado que existe una relación con forma de U entre la PaO2 y la mortalidad/morbilidad en pacientes en la UCI. Es interesante que estos estudios, retrospectivos en su mayor parte, encontraron que la mortalidad más baja coincide con una PaO2 ∼150 mmHg durante las primeras 24 h...
Annals of Intensive Care
There is an ongoing discussion whether hyperoxia, i.e. ventilation with high inspiratory O2 conce... more There is an ongoing discussion whether hyperoxia, i.e. ventilation with high inspiratory O2 concentrations (FIO2), and the consecutive hyperoxaemia, i.e. supraphysiological arterial O2 tensions (PaO2), have a place during the acute management of circulatory shock. This concept is based on experimental evidence that hyperoxaemia may contribute to the compensation of the imbalance between O2 supply and requirements. However, despite still being common practice, its use is limited due to possible oxygen toxicity resulting from the increased formation of reactive oxygen species (ROS) limits, especially under conditions of ischaemia/reperfusion. Several studies have reported that there is a U-shaped relation between PaO2 and mortality/morbidity in ICU patients. Interestingly, these mostly retrospective studies found that the lowest mortality coincided with PaO2 ~ 150 mmHg during the first 24 h of ICU stay, i.e. supraphysiological PaO2 levels. Most of the recent large-scale retrospective ...
Intensive Care Medicine Experimental
Background 3,4-Methylenedioxymethamphetamine intoxication can result in potentially lethal multi-... more Background 3,4-Methylenedioxymethamphetamine intoxication can result in potentially lethal multi-organ failure, for which the current treatment is largely supportive. Recently, a report of the use of the CytoSorb device as a part of the successful treatment of a patient with 3,4-methylenedioxymethamphetamine intoxication and multi-organ failure has been described. Main body While 3,4-methylenedioxymethamphetamine was very effectively removed by CytoSorb in vitro, the degree of removal in the clinical setting described may have been minimal. Indeed, the therapy was started relatively late in this case, and, as the therapy is concentration dependent, the removal of 3,4-methylenedioxymethamphetamine is likely to have been limited. On the other hand, in this case, CytoSorb hemoadsorption was very effective to treat rhabdomyolysis and hyperinflammation. Conclusion The in vitro experimentation demonstrates that 3,4-methylenedioxymethamphetamine is effectively removed by CytoSorb. However,...
Intensive Care Medicine Experimental
This review addresses the plausibility of hydrogen sulfide (H2S) therapy for acute lung injury (A... more This review addresses the plausibility of hydrogen sulfide (H2S) therapy for acute lung injury (ALI) and circulatory shock, by contrasting the promising preclinical results to the present clinical reality. The review discusses how the narrow therapeutic window and width, and potentially toxic effects, the route, dosing, and timing of administration all have to be balanced out very carefully. The development of standardized methods to determine in vitro and in vivo H2S concentrations, and the pharmacokinetics and pharmacodynamics of H2S-releasing compounds is a necessity to facilitate the safety of H2S-based therapies. We suggest the potential of exploiting already clinically approved compounds, which are known or unknown H2S donors, as a surrogate strategy.
Integrative Food, Nutrition and Metabolism
Administration of nutrients during critical illness is depicted in current guidelines, e.g. in th... more Administration of nutrients during critical illness is depicted in current guidelines, e.g. in the guidelines of the American Society for Parenteral and Enteral Nutrition (ASPEN) [1] or in the European Society for clinical Nutrition and Metabolism (ESPEN) [2]. Special recommendations for critically ill children requiring continuous renal replacement therapy (CRRT) also exist [3]. The prescription of micronutrients like vitamins and trace elements is of moderate evidence especially for renal dysfunction and during CRRT and solid data of adequate micronutrient administration during critical illness are lacking. The dynamic of critical illness should be kept in mind which can have a relevant impact for vitamin or trace element requirement.
The International Journal of Artificial Organs
Introduction: Extracorporeal life support is an increasingly used technique for respiratory and c... more Introduction: Extracorporeal life support is an increasingly used technique for respiratory and cardiocirculatory support. Besides primary organ dysfunction, an excessive systemic hyperinflammatory response can be the underlying cause for acute organ failure necessitating extracorporeal life support therapy, or it may be associated with the extracorporeal life support itself. Controlling this overwhelming inflammatory response using CytoSorb® hemoadsorption has been shown to be associated with improved hemodynamics and restored metabolic balance resulting in preserved organ functions. Methods: In this retrospective case series, we describe 23 patients undergoing extracorporeal life support therapy and CytoSorb hemoadsorption. Cytokine levels were monitored, hemodynamic and metabolic variables were recorded, and outcome measures such as duration of organ support, intensive care unit mortality, and hospital mortality were noted. Results: CytoSorb treatment was associated with a trend ...
Journal of Neurosurgery
OBJECTIVEAcute subdural hematoma (ASDH) is a leading entity in brain injury. Rodent models mostly... more OBJECTIVEAcute subdural hematoma (ASDH) is a leading entity in brain injury. Rodent models mostly lack standard intensive care, while large animal models frequently are only short term. Therefore, the authors developed a long-term, resuscitated porcine model of ASDH-induced brain injury and report their findings.METHODSAnesthetized, mechanically ventilated, and instrumented pigs with human-like coagulation underwent subdural injection of 20 mL of autologous blood and subsequent observation for 54 hours. Continuous bilateral multimodal brain monitoring (intracranial pressure [ICP], cerebral perfusion pressure [CPP], partial pressure of oxygen in brain tissue [PbtO2], and brain temperature) was combined with intermittent neurological assessment (veterinary modified Glasgow Coma Scale [MGCS]), microdialysis, and measurement of plasma protein S100β, GFAP, neuron-specific enolase [NSE], nitrite+nitrate, and isoprostanes. Fluid resuscitation and continuous intravenous norepinephrine were ...
Journal of Thoracic Disease
International Urology and Nephrology
Journal of Thoracic Disease
Extracorporeal membrane oxygenation (ECMO) is an increasingly used technology for mechanical supp... more Extracorporeal membrane oxygenation (ECMO) is an increasingly used technology for mechanical support of respiratory and cardio-circulatory failure. Excessive systemic inflammatory response is observed during sepsis and after cardiopulmonary bypass (CPB) with similar clinical features. The overwhelming inflammatory response is characterized by highly elevated pro-and anti-inflammatory cytokine levels. The excessive cytokine release during the overwhelming inflammatory response may result in multiple organ damage and failure. During ECMO therapy activation of complement and contact systems occur which may be followed by cytokine release. Controlling excessively increased cytokines may be considered as a valuable treatment option. Hemoadsorption therapy may be used to decrease cytokine levels in case of excessive inflammatory response and due to its unspecific adsorptive characteristics also substances like myoglobin, free hemoglobin or bilirubin. Controlling pro-inflammatory response with hemoadsorption may have positive impact on the endothelial glycocalix and also may be advantageous for maintenance of the vascular barrier function which plays a pivotal role in the development of tissue edema and oxygen mismatch. Hemoadsorption therapy seems to offer a promising new option for the treatment of patients with overwhelming inflammatory response leading to faster hemodynamic and metabolic stabilization finally resulting in preserved organ functions.