Ulrike Holzinger - Academia.edu (original) (raw)

Papers by Ulrike Holzinger

Research paper thumbnail of Einführung in die Aufgaben der Intensivmedizin

Lehrbuch Tertiale Notfall- und Intensivmedizin, 2012

ABSTRACT Die Rettung fi ndet in der Wohnung einen komatösen Patienten vor, der sich als bekannter... more ABSTRACT Die Rettung fi ndet in der Wohnung einen komatösen Patienten vor, der sich als bekannter Diabetiker laut Angaben der Angehörigen in suizidaler Absicht mehrere Ampullen Insulin verabreicht hat. Der Patient atmet spontan, der GCS beträgt 3 und der Blutdruck liegt bei 80/50 mmHg. Der Blutzuckerwert ist so niedrig, dass ihn das Messgerät nicht anzeigen kann. Trotz mehrerer hochprozentiger Glukoseinfusionen bessert sich der Zustand des Patienten nicht. Er wird daraufh in intubiert und zur weiteren Betreuung mit Voranmeldung auf eine Intensivstation transportiert. Dort wird der Patient weiter überwacht und er erhält noch zahlreiche weitere Glukoseinfusionen, bis sich der Zustand nach mehreren Stunden stabilisiert. Der Patient kann wenig später extubiert und die psychiatrische Therapie begonnen werden.

Research paper thumbnail of Glukosemonitoring beim Intensivpatienten

Wiener klinisches Magazin, 2012

Research paper thumbnail of Glukosemonitoring beim Intensivpatienten

Wiener Klinisches Magazin, Oct 1, 2012

Research paper thumbnail of Jejunal tube placement in critically ill patients: A prospective, randomized trial comparing the endoscopic technique with the electromagnetically visualized method

Critical Care Medicine, 2011

This prospective, randomized study was investigator initiated and investigator driven. No financi... more This prospective, randomized study was investigator initiated and investigator driven. No financial support was used for this study. Study equipment (50 CORFLO enteral feeding tubes and 50 CORFLO nasogastric tubes) was donated by Eumedics,

Research paper thumbnail of Continuous lateral rotation therapy to prevent ventilator-associated pneumonia*

Critical Care Medicine, Feb 1, 2010

To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence o... more To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients. Prospective, randomized, clinical study. Three medical intensive care units of an university tertiary care hospital. Patients were randomized to continuous lateral rotation therapy or standard care if they were mechanically ventilated for <48 hrs and free from pneumonia. Primary study end point was development of ventilator-associated pneumonia. Ventilator-associated pneumonia was defined as infiltrate on the chest radiograph plus newly developed purulent tracheal secretion plus increasing signs of inflammation. The diagnosis had to be confirmed microbiologically and required the growth of a pathogen >10(4) colony-forming units/mL in bronchoalveolar lavage. Radiologists were blinded to randomization whereas clinical outcome assessors were not. Rotation therapy was performed continuously in a specially designed bed over an arc of 90 degrees. Additional measures to prevent ventilator-associated pneumonia were equally standardized in both groups including semirecumbent position. Ventilator-associated pneumonia frequency during the intensive care unit stay was 11% in the rotation group and 23% in the control group (p = .048), respectively. Duration of ventilation (8 +/- 5 vs. 14 +/- 23 days, p = .02) and length of stay (25 +/- 22 days vs. 39 +/- 45 days, p = .01) were significantly shorter in the rotation group. In a forward stepwise logistic regression model including the continuous lateral rotation therapy, gender, Lung Injury Score, and Simplified Acute Physiology Score II, continuous lateral rotation therapy just failed to reach statistical significance with respect to development of ventilator-associated pneumonia (p = .08). Intolerance to continuous lateral rotation therapy during the weaning phase was observed in 29 patients (39%). Mortality was comparable in both groups. Ventilator-associated pneumonia prevalence was significantly reduced by continuous lateral rotation therapy. Continuous lateral rotation therapy led to shorter ventilation time and length of stay. Continuous lateral rotation therapy should be considered in ventilated patients at risk for ventilator-associated pneumonia as a feasible method exerting additive effects to other preventive measures.

Research paper thumbnail of Pharmacokinetics and pharmacodynamics of esomeprazole and ranitidine during continuous venovenous hemodiafiltration

Critical Care, Mar 19, 2013

Research paper thumbnail of Pharmacokinetics of ranitidine during hemodiafiltration

Critical Care, 2008

Introduction In order to find out the frequency rates of domestic and wild animal bites as well a... more Introduction In order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration between

Research paper thumbnail of 462 Hypoxic Hepatitis – Underlying Conditions and Risk Factors for Mortality in Critically Ill Patients

Journal of Hepatology, Apr 1, 2009

Research paper thumbnail of Single-dose application of antithrombin III as alternative anticoagulation during extracorporeal therapy in critically ill patients with advanced liver cirrhosis: a retrospective data analysis

Critical Care, Feb 1, 2011

Research paper thumbnail of Resting energy expenditure and substrate oxidation rates correlate to temperature and outcome after cardiac arrest - a prospective observational cohort study

Critical Care, Dec 1, 2015

Introduction: Targeted temperature management improves outcome after cardiopulmonary resuscitatio... more Introduction: Targeted temperature management improves outcome after cardiopulmonary resuscitation. Reduction of resting energy expenditure might be one mode of action. The aim of this study was to correlate resting energy expenditure and substrate oxidation rates with targeted temperature management at 33°C and outcome in patients after cardiac arrest. Methods: This prospective, observational cohort study was performed at the department of emergency medicine and a medical intensive care unit of a university hospital. Patients after successful cardiopulmonary resuscitation undergoing targeted temperature management at 33°C for 24 hours with subsequent rewarming to 36°C and standardized sedation, analgesic and paralytic medication were included. Indirect calorimetry was performed five times within 48 h after cardiac arrest. Measurements were correlated to outcome with repeated measures ANOVA, linear and logistic regression analysis. Results: In 25 patients resting energy expenditure decreased 20 (18 to 27) % at 33°C compared to 36°C without differences between outcome groups (favourable vs. unfavourable: 25 (21 to 26) vs. 21 (16 to 26); P = 0.5). In contrast to protein oxidation rate (favourable vs. unfavourable: 35 (11 to 68) g/day vs. 39 (7 to 75) g/day, P = 0.8) patients with favourable outcome had a significantly higher fat oxidation rate (139 (104 to 171) g/day vs. 117 (70 to 139) g/day, P <0.05) and a significantly lower glucose oxidation rate (30 (−34 to 88) g/day vs. 77 (19 to 138) g/day; P < 0.05) as compared to patients with unfavourable neurological outcome. Conclusions: Targeted temperature management at 33°C after cardiac arrest reduces resting energy expenditure by 20% compared to 36°C. Glucose and fat oxidation rates differ significantly between patients with favourable and unfavourable neurological outcome. Trial registration: Clinicaltrials.gov NCT00500825. Registered 11 July 2007.

Research paper thumbnail of Correlation of calculated indices of insulin resistance (QUICKI and HOMA) with the euglycaemic hyperinsulinaemic clamp technique for evaluating insulin resistance in critically ill patients

European Journal of Anaesthesiology, Nov 1, 2007

Insulin resistance is frequently observed in critical illness. It can be quantified by the expens... more Insulin resistance is frequently observed in critical illness. It can be quantified by the expensive and time-consuming euglycaemic hyperinsulinaemic clamp technique (M-value) and calculated indices of insulin resistance (Quantitative Insulin Sensitivity Check Index; QUICKI and Homeostasis Model Assessment; HOMA) with lower costs and efforts. We performed an observational study to assess the reliability of QUICKI and HOMA to evaluate insulin resistance in critically ill patients compared with the current gold standard method, the euglycaemic hyperinsulinaemic clamp technique. Insulin resistance was measured in 30 critically ill medical patients by the euglycaemic hyperinsulinaemic clamp technique (M-value) as well as calculated using QUICKI and HOMA. Correlations between the M-values as well as QUICKI and HOMA were assessed by means of the Pearson&#39;s correlation coefficient. M-value, QUICKI and HOMA indicated insulin resistance in all 30 patients. However, both indices QUICKI and HOMA did not correlate with the M-values in our patients (r2 = 0.008 and 0.0005, respectively). A significant negative correlation was found between the M-value and the severity of illness assessed by the APACHE (Acute Physiology and Chronic Health Evaluation) III score (r2 = 0.16; P &lt; 0.05). In contrast, neither HOMA nor QUICKI correlated with the APACHE III score (r2 = 0.034 and 0.033, respectively). Although QUICKI and HOMA indicated insulin resistance in the critically ill medical patients, both indices did not correlate with the M-value. Therefore, the euglycaemic hyperinsulinaemic clamp technique remains the gold standard for estimating insulin resistance in critically ill patients.

Research paper thumbnail of Statin therapy is associated with reduced incidence of hypoxic hepatitis in critically ill patients

Journal of Hepatology, Jun 1, 2014

Background & Aims: Hypoxic hepatitis (HH) is a frequent and life-threatening complication associa... more Background & Aims: Hypoxic hepatitis (HH) is a frequent and life-threatening complication associated with states of oxygen depletion in critically ill patients. Ischemia and reperfusion contribute to liver injury in HH. Experimental data suggest beneficial effects of statins in hepatic ischemia/reperfusion injury. This study was conducted to investigate whether statin treatment prior to intensive care unit (ICU) admission affects incidence rates and severity of HH. Methods: Eight hundred fifty-one patients admitted consecutively to three medical ICUs between December 2008 and December 2009 were prospectively screened for new occurrence of HH within 48 h following ICU admission. Statin treatment prior to ICU admission was assessed. 28-day-, 90-day-, and 1-year-survival as well as new-onset of complications in HH patients were prospectively documented. Results: Eighty-seven patients (10%) developed HH. Statin treatment prior to ICU admission was significantly associated with decreased incidence of HH within 48 h after ICU admission in the multivariate analysis (adjusted OR = 0.42 (95% CI 0.19-0.95); p <0.05). Cardiogenic shock (p <0.001), septic shock (p <0.001) and active alcohol consumption (p <0.01) were identified as independent risk factors for development of HH. 28-day-, 90-day-, and 1-year-mortality rates in HH were 58%, 67%, and 74%, respectively. Statins were associated with improved 28-day-survival in the total study cohort (p <0.05), but did not affect 90-day-and 1-year-mortality, respectively. Conclusions: Cardiogenic shock, septic shock, and active alcohol consumption were independent factors predisposing patients to new onset of HH. Statin treatment prior to ICU admission was the only protective factor regarding the new occurrence of HH in critically ill patients.

Research paper thumbnail of Acid?base disturbances in critically ill patients with cirrhosis

Liver International, Sep 1, 2007

Background/Aims: The equilibrium of offsetting metabolic acid-base disorders in stable cirrhosis ... more Background/Aims: The equilibrium of offsetting metabolic acid-base disorders in stable cirrhosis might be lost during episodes of hepatic decompensation, haemorrhage or sepsis. The purpose of this study was to determine whether the acid-base state is destabilized in critically ill patients with cirrhosis and whether this is associated with mortality. Patients and Method: One-hundred and eightyone consecutive patients with cirrhosis were investigated in a prospective observational cohort study on admission to a medical intensive care unit (ICU) of a university hospital. Arterial acid-base state was assessed according to the Gilfix methodology. Clinical data, ICU mortality and hospital mortality were recorded. Main Results: Patients had net metabolic acidosis owing to unmeasured anions and owing to hyperchloraemic, dilutional and lactic acidosis. Lactic acidosis, acidemia and acute renal failure on ICU admission were associated with increased mortality. Lactate and pH discriminated survivors from non-survivors. The presence of lactic acidosis could not always be recognized by customary acid-base parameters. Conclusion: The stable equilibrium of acid-base disorders is lost when patients with cirrhosis become critically ill. Lactic acidosis and acidaemia are associated with increased ICU mortality caused by severe underlying organ dysfunction.

Research paper thumbnail of Stress-Hyperglyk�mie � Einfluss auf Morbidit�t und Mortalit�t beim Akutpatienten

Wien Klin Wochenschr, 2008

Research paper thumbnail of Continuous glucose control in the ICU: report of a 2013 round table meeting

Critical care (London, England), Jan 13, 2014

Achieving adequate glucose control in critically ill patients is a complex but important part of ... more Achieving adequate glucose control in critically ill patients is a complex but important part of optimal patient management. Until relatively recently, intermittent measurements of blood glucose have been the only means of monitoring blood glucose levels. With growing interest in the possible beneficial effects of continuous over intermittent monitoring and the development of several continuous glucose monitoring (CGM) systems, a round table conference was convened to discuss and, where possible, reach consensus on the various aspects related to glucose monitoring and management using these systems. In this report, we discuss the advantages and limitations of the different types of devices available, the potential advantages of continuous over intermittent testing, the relative importance of trend and point accuracy, the standards necessary for reporting results in clinical trials and for recognition by official bodies, and the changes that may be needed in current glucose managemen...

Research paper thumbnail of Treatment of adult patients with sepsis‐induced coagulopathy and purpura fulminans using a plasma‐derived protein C concentrate (Ceprotin®)

Vox Sanguinis, 2006

Background and Objectives The aim of this study was to document the effects of supplementation w... more Background and Objectives The aim of this study was to document the effects of supplementation with a plasma‐derived protein C concentrate in adult patients with infectious purpura fulminans.Materials and Methods We report the effect of the administration of a human protein C concentrate (Ceprotin®, Baxter, Vienna, Austria) in eight adult patients with purpura fulminans. Five patients received the concentrate as level‐adjusted continuous infusion (10 U/kg/h, target protein C activity 100%) and three patients received the concentrate as bolus infusions (100 U/kg every 6 h) in addition to standard sepsis therapy. Heparin, fresh‐frozen plasma, antithrombin‐ and fibrinogen concentrates, low‐dose rtPA, and platelet transfusions were given when appropriate.Results Six patients had overt disseminated intravascular coagulation: platelets, 19 g/l; fibrinogen, 60 mg/dl; antithrombin, 47%; prothrombin time, 32%; activated partial thromboplastin time (APTT), 88 s; d‐dimer, 66 µg/ml; protein ...

Research paper thumbnail of Acid–base disturbances in critically ill patients with cirrhosis

Liver International, 2007

Background/Aims: The equilibrium of offsetting metabolic acid–base disorders in stable cirrhosis ... more Background/Aims: The equilibrium of offsetting metabolic acid–base disorders in stable cirrhosis might be lost during episodes of hepatic decompensation, haemorrhage or sepsis. The purpose of this study was to determine whether the acid–base state is destabilized in critically ill patients with cirrhosis and whether this is associated with mortality.Patients and Method: One‐hundred and eighty‐one consecutive patients with cirrhosis were investigated in a prospective observational cohort study on admission to a medical intensive care unit (ICU) of a university hospital. Arterial acid–base state was assessed according to the Gilfix methodology. Clinical data, ICU mortality and hospital mortality were recorded.Main Results: Patients had net metabolic acidosis owing to unmeasured anions and owing to hyperchloraemic, dilutional and lactic acidosis. Lactic acidosis, acidemia and acute renal failure on ICU admission were associated with increased mortality. Lactate and pH discriminated sur...

Research paper thumbnail of 462 Hypoxic Hepatitis – Underlying Conditions and Risk Factors for Mortality in Critically Ill Patients

Journal of Hepatology, 2009

Research paper thumbnail of Statin therapy is associated with reduced incidence of hypoxic hepatitis in critically ill patients

Journal of Hepatology, 2014

Background & Aims: Hypoxic hepatitis (HH) is a frequent and life-threatening complication associa... more Background & Aims: Hypoxic hepatitis (HH) is a frequent and life-threatening complication associated with states of oxygen depletion in critically ill patients. Ischemia and reperfusion contribute to liver injury in HH. Experimental data suggest beneficial effects of statins in hepatic ischemia/reperfusion injury. This study was conducted to investigate whether statin treatment prior to intensive care unit (ICU) admission affects incidence rates and severity of HH. Methods: Eight hundred fifty-one patients admitted consecutively to three medical ICUs between December 2008 and December 2009 were prospectively screened for new occurrence of HH within 48 h following ICU admission. Statin treatment prior to ICU admission was assessed. 28-day-, 90-day-, and 1-year-survival as well as new-onset of complications in HH patients were prospectively documented. Results: Eighty-seven patients (10%) developed HH. Statin treatment prior to ICU admission was significantly associated with decreased incidence of HH within 48 h after ICU admission in the multivariate analysis (adjusted OR = 0.42 (95% CI 0.19-0.95); p <0.05). Cardiogenic shock (p <0.001), septic shock (p <0.001) and active alcohol consumption (p <0.01) were identified as independent risk factors for development of HH. 28-day-, 90-day-, and 1-year-mortality rates in HH were 58%, 67%, and 74%, respectively. Statins were associated with improved 28-day-survival in the total study cohort (p <0.05), but did not affect 90-day-and 1-year-mortality, respectively. Conclusions: Cardiogenic shock, septic shock, and active alcohol consumption were independent factors predisposing patients to new onset of HH. Statin treatment prior to ICU admission was the only protective factor regarding the new occurrence of HH in critically ill patients.

Research paper thumbnail of Impact of shock requiring norepinephrine on the accuracy and reliability of subcutaneous continuous glucose monitoring

Intensive Care Medicine, 2009

To evaluate the impact of circulatory shock requiring norepinephrine therapy on the accuracy and ... more To evaluate the impact of circulatory shock requiring norepinephrine therapy on the accuracy and reliability of a subcutaneous continuous glucose monitoring system (CGMS) in critically ill patients. A prospective, validation study of a medical intensive care unit at a university hospital was carried out. Continuous glucose monitoring was performed subcutaneously in 50 consecutive patients on intensive insulin therapy (IIT), who were assessed according to the a priori strata of circulatory shock requiring norepinephrine therapy or not. A total of 736 pairs of sensor glucose (SG)/blood glucose (BG) values were analysed (502 without and 234 with norepinephrine therapy). For all values, repeated measures Bland-Altman analysis showed a mean difference of 0.08 mmol/l (limits of agreement: -1.26 and 1.43 mmol/l). Circulatory shock requiring norepinephrine therapy did not influence the relation of arterial BG with SG in a multivariable random effects linear regression analysis. The covariates norepinephrine dose, body mass index (BMI), glucose level and severity of illness also had no influence. Insulin titration grid analysis showed that 98.6% of the data points were in the acceptable treatment zone. No data were in the life-threatening zone. Circulatory shock requiring norepinephrine therapy, as well as other covariates, had no influence on the accuracy and reliability of the CGMS in critically ill patients.

Research paper thumbnail of Einführung in die Aufgaben der Intensivmedizin

Lehrbuch Tertiale Notfall- und Intensivmedizin, 2012

ABSTRACT Die Rettung fi ndet in der Wohnung einen komatösen Patienten vor, der sich als bekannter... more ABSTRACT Die Rettung fi ndet in der Wohnung einen komatösen Patienten vor, der sich als bekannter Diabetiker laut Angaben der Angehörigen in suizidaler Absicht mehrere Ampullen Insulin verabreicht hat. Der Patient atmet spontan, der GCS beträgt 3 und der Blutdruck liegt bei 80/50 mmHg. Der Blutzuckerwert ist so niedrig, dass ihn das Messgerät nicht anzeigen kann. Trotz mehrerer hochprozentiger Glukoseinfusionen bessert sich der Zustand des Patienten nicht. Er wird daraufh in intubiert und zur weiteren Betreuung mit Voranmeldung auf eine Intensivstation transportiert. Dort wird der Patient weiter überwacht und er erhält noch zahlreiche weitere Glukoseinfusionen, bis sich der Zustand nach mehreren Stunden stabilisiert. Der Patient kann wenig später extubiert und die psychiatrische Therapie begonnen werden.

Research paper thumbnail of Glukosemonitoring beim Intensivpatienten

Wiener klinisches Magazin, 2012

Research paper thumbnail of Glukosemonitoring beim Intensivpatienten

Wiener Klinisches Magazin, Oct 1, 2012

Research paper thumbnail of Jejunal tube placement in critically ill patients: A prospective, randomized trial comparing the endoscopic technique with the electromagnetically visualized method

Critical Care Medicine, 2011

This prospective, randomized study was investigator initiated and investigator driven. No financi... more This prospective, randomized study was investigator initiated and investigator driven. No financial support was used for this study. Study equipment (50 CORFLO enteral feeding tubes and 50 CORFLO nasogastric tubes) was donated by Eumedics,

Research paper thumbnail of Continuous lateral rotation therapy to prevent ventilator-associated pneumonia*

Critical Care Medicine, Feb 1, 2010

To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence o... more To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients. Prospective, randomized, clinical study. Three medical intensive care units of an university tertiary care hospital. Patients were randomized to continuous lateral rotation therapy or standard care if they were mechanically ventilated for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;48 hrs and free from pneumonia. Primary study end point was development of ventilator-associated pneumonia. Ventilator-associated pneumonia was defined as infiltrate on the chest radiograph plus newly developed purulent tracheal secretion plus increasing signs of inflammation. The diagnosis had to be confirmed microbiologically and required the growth of a pathogen &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10(4) colony-forming units/mL in bronchoalveolar lavage. Radiologists were blinded to randomization whereas clinical outcome assessors were not. Rotation therapy was performed continuously in a specially designed bed over an arc of 90 degrees. Additional measures to prevent ventilator-associated pneumonia were equally standardized in both groups including semirecumbent position. Ventilator-associated pneumonia frequency during the intensive care unit stay was 11% in the rotation group and 23% in the control group (p = .048), respectively. Duration of ventilation (8 +/- 5 vs. 14 +/- 23 days, p = .02) and length of stay (25 +/- 22 days vs. 39 +/- 45 days, p = .01) were significantly shorter in the rotation group. In a forward stepwise logistic regression model including the continuous lateral rotation therapy, gender, Lung Injury Score, and Simplified Acute Physiology Score II, continuous lateral rotation therapy just failed to reach statistical significance with respect to development of ventilator-associated pneumonia (p = .08). Intolerance to continuous lateral rotation therapy during the weaning phase was observed in 29 patients (39%). Mortality was comparable in both groups. Ventilator-associated pneumonia prevalence was significantly reduced by continuous lateral rotation therapy. Continuous lateral rotation therapy led to shorter ventilation time and length of stay. Continuous lateral rotation therapy should be considered in ventilated patients at risk for ventilator-associated pneumonia as a feasible method exerting additive effects to other preventive measures.

Research paper thumbnail of Pharmacokinetics and pharmacodynamics of esomeprazole and ranitidine during continuous venovenous hemodiafiltration

Critical Care, Mar 19, 2013

Research paper thumbnail of Pharmacokinetics of ranitidine during hemodiafiltration

Critical Care, 2008

Introduction In order to find out the frequency rates of domestic and wild animal bites as well a... more Introduction In order to find out the frequency rates of domestic and wild animal bites as well as the evaluation of the prevalence rates of rabies disease in the human population in the Province of Kerman, a retrospective study was designed to analyze statistically the collected recorded data related to this project. Methods This study was conducted within the framework of MPVM student research projects by means of collaboration between

Research paper thumbnail of 462 Hypoxic Hepatitis – Underlying Conditions and Risk Factors for Mortality in Critically Ill Patients

Journal of Hepatology, Apr 1, 2009

Research paper thumbnail of Single-dose application of antithrombin III as alternative anticoagulation during extracorporeal therapy in critically ill patients with advanced liver cirrhosis: a retrospective data analysis

Critical Care, Feb 1, 2011

Research paper thumbnail of Resting energy expenditure and substrate oxidation rates correlate to temperature and outcome after cardiac arrest - a prospective observational cohort study

Critical Care, Dec 1, 2015

Introduction: Targeted temperature management improves outcome after cardiopulmonary resuscitatio... more Introduction: Targeted temperature management improves outcome after cardiopulmonary resuscitation. Reduction of resting energy expenditure might be one mode of action. The aim of this study was to correlate resting energy expenditure and substrate oxidation rates with targeted temperature management at 33°C and outcome in patients after cardiac arrest. Methods: This prospective, observational cohort study was performed at the department of emergency medicine and a medical intensive care unit of a university hospital. Patients after successful cardiopulmonary resuscitation undergoing targeted temperature management at 33°C for 24 hours with subsequent rewarming to 36°C and standardized sedation, analgesic and paralytic medication were included. Indirect calorimetry was performed five times within 48 h after cardiac arrest. Measurements were correlated to outcome with repeated measures ANOVA, linear and logistic regression analysis. Results: In 25 patients resting energy expenditure decreased 20 (18 to 27) % at 33°C compared to 36°C without differences between outcome groups (favourable vs. unfavourable: 25 (21 to 26) vs. 21 (16 to 26); P = 0.5). In contrast to protein oxidation rate (favourable vs. unfavourable: 35 (11 to 68) g/day vs. 39 (7 to 75) g/day, P = 0.8) patients with favourable outcome had a significantly higher fat oxidation rate (139 (104 to 171) g/day vs. 117 (70 to 139) g/day, P <0.05) and a significantly lower glucose oxidation rate (30 (−34 to 88) g/day vs. 77 (19 to 138) g/day; P < 0.05) as compared to patients with unfavourable neurological outcome. Conclusions: Targeted temperature management at 33°C after cardiac arrest reduces resting energy expenditure by 20% compared to 36°C. Glucose and fat oxidation rates differ significantly between patients with favourable and unfavourable neurological outcome. Trial registration: Clinicaltrials.gov NCT00500825. Registered 11 July 2007.

Research paper thumbnail of Correlation of calculated indices of insulin resistance (QUICKI and HOMA) with the euglycaemic hyperinsulinaemic clamp technique for evaluating insulin resistance in critically ill patients

European Journal of Anaesthesiology, Nov 1, 2007

Insulin resistance is frequently observed in critical illness. It can be quantified by the expens... more Insulin resistance is frequently observed in critical illness. It can be quantified by the expensive and time-consuming euglycaemic hyperinsulinaemic clamp technique (M-value) and calculated indices of insulin resistance (Quantitative Insulin Sensitivity Check Index; QUICKI and Homeostasis Model Assessment; HOMA) with lower costs and efforts. We performed an observational study to assess the reliability of QUICKI and HOMA to evaluate insulin resistance in critically ill patients compared with the current gold standard method, the euglycaemic hyperinsulinaemic clamp technique. Insulin resistance was measured in 30 critically ill medical patients by the euglycaemic hyperinsulinaemic clamp technique (M-value) as well as calculated using QUICKI and HOMA. Correlations between the M-values as well as QUICKI and HOMA were assessed by means of the Pearson&#39;s correlation coefficient. M-value, QUICKI and HOMA indicated insulin resistance in all 30 patients. However, both indices QUICKI and HOMA did not correlate with the M-values in our patients (r2 = 0.008 and 0.0005, respectively). A significant negative correlation was found between the M-value and the severity of illness assessed by the APACHE (Acute Physiology and Chronic Health Evaluation) III score (r2 = 0.16; P &lt; 0.05). In contrast, neither HOMA nor QUICKI correlated with the APACHE III score (r2 = 0.034 and 0.033, respectively). Although QUICKI and HOMA indicated insulin resistance in the critically ill medical patients, both indices did not correlate with the M-value. Therefore, the euglycaemic hyperinsulinaemic clamp technique remains the gold standard for estimating insulin resistance in critically ill patients.

Research paper thumbnail of Statin therapy is associated with reduced incidence of hypoxic hepatitis in critically ill patients

Journal of Hepatology, Jun 1, 2014

Background & Aims: Hypoxic hepatitis (HH) is a frequent and life-threatening complication associa... more Background & Aims: Hypoxic hepatitis (HH) is a frequent and life-threatening complication associated with states of oxygen depletion in critically ill patients. Ischemia and reperfusion contribute to liver injury in HH. Experimental data suggest beneficial effects of statins in hepatic ischemia/reperfusion injury. This study was conducted to investigate whether statin treatment prior to intensive care unit (ICU) admission affects incidence rates and severity of HH. Methods: Eight hundred fifty-one patients admitted consecutively to three medical ICUs between December 2008 and December 2009 were prospectively screened for new occurrence of HH within 48 h following ICU admission. Statin treatment prior to ICU admission was assessed. 28-day-, 90-day-, and 1-year-survival as well as new-onset of complications in HH patients were prospectively documented. Results: Eighty-seven patients (10%) developed HH. Statin treatment prior to ICU admission was significantly associated with decreased incidence of HH within 48 h after ICU admission in the multivariate analysis (adjusted OR = 0.42 (95% CI 0.19-0.95); p <0.05). Cardiogenic shock (p <0.001), septic shock (p <0.001) and active alcohol consumption (p <0.01) were identified as independent risk factors for development of HH. 28-day-, 90-day-, and 1-year-mortality rates in HH were 58%, 67%, and 74%, respectively. Statins were associated with improved 28-day-survival in the total study cohort (p <0.05), but did not affect 90-day-and 1-year-mortality, respectively. Conclusions: Cardiogenic shock, septic shock, and active alcohol consumption were independent factors predisposing patients to new onset of HH. Statin treatment prior to ICU admission was the only protective factor regarding the new occurrence of HH in critically ill patients.

Research paper thumbnail of Acid?base disturbances in critically ill patients with cirrhosis

Liver International, Sep 1, 2007

Background/Aims: The equilibrium of offsetting metabolic acid-base disorders in stable cirrhosis ... more Background/Aims: The equilibrium of offsetting metabolic acid-base disorders in stable cirrhosis might be lost during episodes of hepatic decompensation, haemorrhage or sepsis. The purpose of this study was to determine whether the acid-base state is destabilized in critically ill patients with cirrhosis and whether this is associated with mortality. Patients and Method: One-hundred and eightyone consecutive patients with cirrhosis were investigated in a prospective observational cohort study on admission to a medical intensive care unit (ICU) of a university hospital. Arterial acid-base state was assessed according to the Gilfix methodology. Clinical data, ICU mortality and hospital mortality were recorded. Main Results: Patients had net metabolic acidosis owing to unmeasured anions and owing to hyperchloraemic, dilutional and lactic acidosis. Lactic acidosis, acidemia and acute renal failure on ICU admission were associated with increased mortality. Lactate and pH discriminated survivors from non-survivors. The presence of lactic acidosis could not always be recognized by customary acid-base parameters. Conclusion: The stable equilibrium of acid-base disorders is lost when patients with cirrhosis become critically ill. Lactic acidosis and acidaemia are associated with increased ICU mortality caused by severe underlying organ dysfunction.

Research paper thumbnail of Stress-Hyperglyk�mie � Einfluss auf Morbidit�t und Mortalit�t beim Akutpatienten

Wien Klin Wochenschr, 2008

Research paper thumbnail of Continuous glucose control in the ICU: report of a 2013 round table meeting

Critical care (London, England), Jan 13, 2014

Achieving adequate glucose control in critically ill patients is a complex but important part of ... more Achieving adequate glucose control in critically ill patients is a complex but important part of optimal patient management. Until relatively recently, intermittent measurements of blood glucose have been the only means of monitoring blood glucose levels. With growing interest in the possible beneficial effects of continuous over intermittent monitoring and the development of several continuous glucose monitoring (CGM) systems, a round table conference was convened to discuss and, where possible, reach consensus on the various aspects related to glucose monitoring and management using these systems. In this report, we discuss the advantages and limitations of the different types of devices available, the potential advantages of continuous over intermittent testing, the relative importance of trend and point accuracy, the standards necessary for reporting results in clinical trials and for recognition by official bodies, and the changes that may be needed in current glucose managemen...

Research paper thumbnail of Treatment of adult patients with sepsis‐induced coagulopathy and purpura fulminans using a plasma‐derived protein C concentrate (Ceprotin®)

Vox Sanguinis, 2006

Background and Objectives The aim of this study was to document the effects of supplementation w... more Background and Objectives The aim of this study was to document the effects of supplementation with a plasma‐derived protein C concentrate in adult patients with infectious purpura fulminans.Materials and Methods We report the effect of the administration of a human protein C concentrate (Ceprotin®, Baxter, Vienna, Austria) in eight adult patients with purpura fulminans. Five patients received the concentrate as level‐adjusted continuous infusion (10 U/kg/h, target protein C activity 100%) and three patients received the concentrate as bolus infusions (100 U/kg every 6 h) in addition to standard sepsis therapy. Heparin, fresh‐frozen plasma, antithrombin‐ and fibrinogen concentrates, low‐dose rtPA, and platelet transfusions were given when appropriate.Results Six patients had overt disseminated intravascular coagulation: platelets, 19 g/l; fibrinogen, 60 mg/dl; antithrombin, 47%; prothrombin time, 32%; activated partial thromboplastin time (APTT), 88 s; d‐dimer, 66 µg/ml; protein ...

Research paper thumbnail of Acid–base disturbances in critically ill patients with cirrhosis

Liver International, 2007

Background/Aims: The equilibrium of offsetting metabolic acid–base disorders in stable cirrhosis ... more Background/Aims: The equilibrium of offsetting metabolic acid–base disorders in stable cirrhosis might be lost during episodes of hepatic decompensation, haemorrhage or sepsis. The purpose of this study was to determine whether the acid–base state is destabilized in critically ill patients with cirrhosis and whether this is associated with mortality.Patients and Method: One‐hundred and eighty‐one consecutive patients with cirrhosis were investigated in a prospective observational cohort study on admission to a medical intensive care unit (ICU) of a university hospital. Arterial acid–base state was assessed according to the Gilfix methodology. Clinical data, ICU mortality and hospital mortality were recorded.Main Results: Patients had net metabolic acidosis owing to unmeasured anions and owing to hyperchloraemic, dilutional and lactic acidosis. Lactic acidosis, acidemia and acute renal failure on ICU admission were associated with increased mortality. Lactate and pH discriminated sur...

Research paper thumbnail of 462 Hypoxic Hepatitis – Underlying Conditions and Risk Factors for Mortality in Critically Ill Patients

Journal of Hepatology, 2009

Research paper thumbnail of Statin therapy is associated with reduced incidence of hypoxic hepatitis in critically ill patients

Journal of Hepatology, 2014

Background & Aims: Hypoxic hepatitis (HH) is a frequent and life-threatening complication associa... more Background & Aims: Hypoxic hepatitis (HH) is a frequent and life-threatening complication associated with states of oxygen depletion in critically ill patients. Ischemia and reperfusion contribute to liver injury in HH. Experimental data suggest beneficial effects of statins in hepatic ischemia/reperfusion injury. This study was conducted to investigate whether statin treatment prior to intensive care unit (ICU) admission affects incidence rates and severity of HH. Methods: Eight hundred fifty-one patients admitted consecutively to three medical ICUs between December 2008 and December 2009 were prospectively screened for new occurrence of HH within 48 h following ICU admission. Statin treatment prior to ICU admission was assessed. 28-day-, 90-day-, and 1-year-survival as well as new-onset of complications in HH patients were prospectively documented. Results: Eighty-seven patients (10%) developed HH. Statin treatment prior to ICU admission was significantly associated with decreased incidence of HH within 48 h after ICU admission in the multivariate analysis (adjusted OR = 0.42 (95% CI 0.19-0.95); p <0.05). Cardiogenic shock (p <0.001), septic shock (p <0.001) and active alcohol consumption (p <0.01) were identified as independent risk factors for development of HH. 28-day-, 90-day-, and 1-year-mortality rates in HH were 58%, 67%, and 74%, respectively. Statins were associated with improved 28-day-survival in the total study cohort (p <0.05), but did not affect 90-day-and 1-year-mortality, respectively. Conclusions: Cardiogenic shock, septic shock, and active alcohol consumption were independent factors predisposing patients to new onset of HH. Statin treatment prior to ICU admission was the only protective factor regarding the new occurrence of HH in critically ill patients.

Research paper thumbnail of Impact of shock requiring norepinephrine on the accuracy and reliability of subcutaneous continuous glucose monitoring

Intensive Care Medicine, 2009

To evaluate the impact of circulatory shock requiring norepinephrine therapy on the accuracy and ... more To evaluate the impact of circulatory shock requiring norepinephrine therapy on the accuracy and reliability of a subcutaneous continuous glucose monitoring system (CGMS) in critically ill patients. A prospective, validation study of a medical intensive care unit at a university hospital was carried out. Continuous glucose monitoring was performed subcutaneously in 50 consecutive patients on intensive insulin therapy (IIT), who were assessed according to the a priori strata of circulatory shock requiring norepinephrine therapy or not. A total of 736 pairs of sensor glucose (SG)/blood glucose (BG) values were analysed (502 without and 234 with norepinephrine therapy). For all values, repeated measures Bland-Altman analysis showed a mean difference of 0.08 mmol/l (limits of agreement: -1.26 and 1.43 mmol/l). Circulatory shock requiring norepinephrine therapy did not influence the relation of arterial BG with SG in a multivariable random effects linear regression analysis. The covariates norepinephrine dose, body mass index (BMI), glucose level and severity of illness also had no influence. Insulin titration grid analysis showed that 98.6% of the data points were in the acceptable treatment zone. No data were in the life-threatening zone. Circulatory shock requiring norepinephrine therapy, as well as other covariates, had no influence on the accuracy and reliability of the CGMS in critically ill patients.