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Ard Struijs

ErasmusMC Rotterdam, Intensive Care Adults, Post-Doc

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I am a specialist in intensive care and internal medicine with more than 20 years of experience in cardiac and lungtransplant and cardiac assist devices. I am working for more than 7 years on research application and registration of bacteriophages in clinical settings.

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Raul CHAVARRO BUSTOS

University of Kufa - Iraq

Jacqueline Center

Kürşat Gündoğan

Nipith Charoenngam

Journal of Clinical Practice and Research

Erciyes University

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Papers by Ard Struijs

Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis

Critical Care, Dec 1, 2014

Introduction: In Europe, vitamin D deficiency is highly prevalent varying between 40% and 60% in ... more Introduction: In Europe, vitamin D deficiency is highly prevalent varying between 40% and 60% in the healthy general adult population. The consequences of vitamin D deficiency for sepsis and outcome in critically ill patients remain controversial. We therefore systematically reviewed observational cohort studies on vitamin D deficiency in the intensive care unit. Methods: Fourteen observational reports published from January 2000 to March 2014, retrieved from Pubmed and Embase, involving 9,715 critically ill patients and serum 25-hydroxyvitamin D 3 (25 (OH)-D) concentrations, were meta-analysed. Results: Levels of 25 (OH)-D less than 50 nmol/L were associated with increased rates of infection (risk ratio (RR) 1.49, 95% (confidence interval (CI) 1.12 to 1.99), P = 0.007), sepsis (RR 1.46, 95% (CI 1.27 to 1.68), P <0.001), 30-day mortality (RR 1.42, 95% (CI 1.00 to 2.02), P = 0.05), and in-hospital mortality (RR 1.79, 95% (CI 1.49 to 2.16), P <0.001). In a subgroup analysis of adjusted data including vitamin D deficiency as a risk factor for 30-day mortality the pooled RR was 1.76 (95% CI 1.37 to 2.26, P <0.001). Conclusions: This meta-analysis suggests that vitamin D deficiency increases susceptibility for severe infections and mortality of the critically ill.

Corticosteroid-Induced Osteoporosis in Daily Practice: Pathophysiology, Clinical Importance, Prevention and Intervention Strategies

Single-stage surgical repair of benign laryngotracheal stenosis in adults

Head & neck, 2004

Background. Benign laryngotracheal stenosis causes considerable morbidity. In a retrospective stu... more Background. Benign laryngotracheal stenosis causes considerable morbidity. In a retrospective study, we describe the results of our surgical treatment. Methods. Between June 1999 and June 2002, 14 adults with laryngotracheal stenosis were referred to our hospital. Stenosis resulted from mechanical ventilation in 11 patients, from Wegener's granulomatosis in 2 patients, and from strangulation in 1 patient. Eleven patients had a tracheotomy. One patient was found unfit for surgery. Nine patients underwent cricotracheal resection (CTR) with end-to-end anastomosis, and four patients underwent single-stage laryngotracheoplasty (SS-LTP) without stenting. Results. There were no perioperative deaths. Patients were extubated after mean of 3 days (range, 0-10 days; CTR 2.3 days vs SS-LTP 3.5 days, p = .45). There were in-hospital complications in five patients. Mean hospital stay was 19 days (range, 8-53 days; after CTR 24 days vs SS-LTP 9 days, p = .015). With regard to airway patency and voice recovery, 10 patients (77%) had good results, including 1 patient with two readmissions, and 3 (23%) had satisfactory results, including 1 patient with 11 additional nonsurgical interventions. Conclusions. Benign laryngotracheal stenosis in the adult patient can be repaired successfully using a strategy of two single-stage surgical procedures. All patients had good or satisfactory functional results. A multidisciplinary approach was essential to achieve these good results.

Cyclical edidronate reverses bone loss of the spine and proximal femur in patients with established corticosteroid-induced osteoporosis

The American Journal of Medicine, Sep 1, 1995

PURPOSE: To compare the bone-mass effects of calcium supplementation and intermittent cyclic etid... more PURPOSE: To compare the bone-mass effects of calcium supplementation and intermittent cyclic etidronate in patients with established cotticosteroid-induced osteoporosis. PATIENTS AND METHODS: Eighteen male and 21 female patients who had established corticosteroid-induced osteoporosis and were receiving chronic prednisone therapy (210 mg/d) were enrolled in a prospective 18month, open-label study. In addition to continuing prednisone therapy, patients received continuous calcium supplementation 500 mg/d (n = 20) or four cycles of intermittent cyclic etidronate therapy consisting of etidronate 400 mg/d for 14 days followed by calcium 500 mg/d for 76 days (n = 19). Bone mineral density (BMD) of the spine (Ll through L4) and proximal femur (total hip, femoral neck, trochanter, Ward's triangle) was measured by dual-energy x-ray absorptiometry at baseline, 6 months, and 12 months by staff blinded to the treatment. Serum calcium, phosphorus, and alkaline phosphatase were also measured at these times. RESULTS: Treatment with intermittent cyclic etidronate for 12 months resulted in significant increases of 5.7% and 6.8% in BMD of the spine and proximal femur (total hip), respectively (P co.02 versus baseline; P co.001 versus calcium group). Calcium supplementation alone did not prevent significant losses of 3.4% and 4.1% in BMD at the respective sites (P co.02 versus baseline). At the end of the study Z scores reflected significant increases in BMD of the spine and proximal femur (all regions) in the etidronate group (P cO.Ol), and significant decreases at the spine, proximal femur, and trochanter in the calcium group (P eO.01). After 12 months, the difference between the groups was 9.1% (P ~0.01;

Intermittent Cyclical Etidronate in the Prevention of Corticosteroid-Induced Bone Loss

Rheumatology, 1994

We conducted a prospective study of etidronate&#39;s effects on corticosteroid-induced bone l... more We conducted a prospective study of etidronate&#39;s effects on corticosteroid-induced bone loss in postmenopausal women with temporal arteritis for whom high-dose prednisone therapy was indicated. Group A (n = 10) received etidronate (400 mg/day for 2 weeks, then 11 weeks off etidronate; four cycles total) and prednisone: Group B (n = 10) received only prednisone. Vertebral bone mineral density (BMD) was measured blinded by dual X-ray absorptiometry. At 3, 6 and 12 months, vertebral BMD was significantly (P &lt; 0.01) increased in Group A and decreased in Group B, based on mean actual and percent changes in BMD and mean changes in BMD Z-score from baseline. Between-group comparisons were also significant (P &lt; 0.002) at each time point. No adverse events related to etidronate treatment were reported. Our results suggest that corticosteroid-induced bone loss may be prevented by instituting intermittent cyclical etidronate therapy when high-dose prednisone therapy is begun. Further research into bisphosphonate use in corticosteroid-induced bone loss (with larger patient populations, longer follow-up and fracture assessment) is warranted.

Treatment of post-menopausal osteoporosis and low serum magnesium with intermittent cyclical EHDP and magnesium

Osteoporosis International, 1996

Open lung ventilation improves functional residual capacity after extubation in cardiac surgery*

Critical Care Medicine, Oct 1, 2005

After cardiac surgery, functional residual capacity (FRC) after extubation is reduced significant... more After cardiac surgery, functional residual capacity (FRC) after extubation is reduced significantly. We hypothesized that ventilation according to the open lung concept (OLC) attenuates FRC reduction after extubation. Design: A prospective, single-center, randomized, controlled clinical study. Setting: Cardiothoracic operating room and intensive care unit of a university hospital. Patients: Sixty-nine patients scheduled for elective coronary artery bypass graft and/or valve surgery with cardiopulmonary bypass. Interventions: Before surgery, patients were randomly assigned to three groups: (1) conventional ventilation (CV); (2) OLC, started after arrival in the intensive care unit (late open lung); and (3) OLC, started directly after intubation (early open lung). In both OLC groups, recruitment maneuvers were applied until PaO 2 /FIO 2 was >375 Torr (50 kPa). No recruitment maneuvers were applied in the CV group. Measurements and Main Results: FRC was measured preop

Case Report: Early Identification of Subclinical Cardiac Tamponade in a Patient With a Left Ventricular Assist Device by the Use of Sublingual Microcirculatory Imaging: A New Diagnostic Imaging Tool?

Frontiers in Cardiovascular Medicine, 2022

Clinical diagnosis of cardiac tamponade can be difficult in patients with continuous flow left ve... more Clinical diagnosis of cardiac tamponade can be difficult in patients with continuous flow left ventricle assist devices (cf-LVADs). This is even more so because of the lack of adequate bedside echocardiographic windows. Previous studies on monitoring sublingual microcirculation showed deterioration of end-organ perfusion in patient with cardiogenic shock. In this paper we report alterations in the sublingual microcirculation in a cf-LVAD patient prior to clinical manifestation of tamponade. Our case report suggests that such real-time monitoring of the microcirculation may provide a new diagnostic modality for early recognition of cardiac tamponade.

ESICM LIVES 2016: part three : Milan, Italy. 1-5 October 2016

Intensive care medicine experimental, 2016

Introduction: Critically ill children in the pediatric intensive care unit (PICU) are at high ris... more Introduction: Critically ill children in the pediatric intensive care unit (PICU) are at high risk for developing nutritional deficiencies and undernutrition is known to be a risk factor for morbidity and mortality. Malnutrition represents a continuous spectrum ranging from marginal nutrient status to severe metabolic and functional alterations and this in turn, affects clinical outcome. Objectives: The aim of the study was to assess nutritional status of critically ill children admitted to the PICU and its association to clinical outcomes. Methods: Critically ill children age 6 months to 18 years were prospectively enrolled on PICU admission. Nutritional status was assessed by weight for age (WFA: underweight), weight for height (WFH: wasting), height for age (HFA: stunting) z-scores and mid upper arm circumference (MUAC: wasting) according to the WHO. (1,2) Malnutrition was defined as mild, moderate, and severe if z-scores were > −1, > − 2, and > −3, respectively. Hospital and PICU length of stay (LOS), duration of mechanical ventilation (MV), and risk of mortality (ROM) by the Pediatric Index of Mortality 2 (PIM2) were obtained. Sensitivity and specificity of the MUAC to identify children with wasting (WFH) were calculated. Results: Two hundred and fifty children (136 males), aged 81 months (23-167; median (25-75 th IQR)), were prospectively included in the study. The hospital LOS was 8 (4-16) days; PICU LOS: 2 (1-4) days; duration of MV, 0 (0-1.5) days;

P5122A novel method for early identification of cardiac tamponade in patients with continuous flow left ventricular assist devices by use of sublingual microcirculatory imaging

European Heart Journal, Aug 1, 2018

differences in haemodynamic response to active leg raise test between LVAD and CHF patients (p>0.... more differences in haemodynamic response to active leg raise test between LVAD and CHF patients (p>0.05 for all variables of interests). Peak O2 consumption in LVAD and CHF patients was 12.2±4.8 and 11.0±3.5 ml/kg/min respectively, p=0.54. There was a positive moderate relationship between cardiac index and peak O2 consumption in LVAD (r=0.68, p=0.06) and CHF patients (r=0.66, p<0.04), Figure 1. Conclusion: There is a significant positive relationship between cardiac index response to physiological stress and peak O2 consumption. This suggests that haemodynamic response to stress can be used to predict functional capacity and potentially indicate cardiac reverse remodelling and recovery during mechanical circulatory support. P5122 A novel method for early identification of cardiac tamponade in patients with continuous flow left ventricular assist devices by use of sublingual microcirculatory imaging

A novel mortality risk score predicting intensive care mortality in cardiogenic shock patients treated with veno-arterial extracorporeal membrane oxygenation

Journal of Critical Care, Feb 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Intravascular versus surface cooling speed and stability after cardiopulmonary resuscitation

Emergency Medicine Journal, Dec 19, 2014

Mild therapeutic hypothermia (MTH) is used to limit neurological injury and improve survival afte... more Mild therapeutic hypothermia (MTH) is used to limit neurological injury and improve survival after cardiac arrest (CA) and cardiopulmonary resuscitation, but the optimal mode of cooling is controversial. We therefore compared the effectiveness of MTH using invasive intravascular or non-invasive surface cooling with temperature feedback control. This retrospective study in post-CA patients studied the effects of intravascular cooling (CoolGard, Zoll, n=97), applied on the intensive care unit (ICU) in one university hospital compared with those of surface cooling (Medi-Therm, Gaymar, n=76) applied in another university hospital. Time to reach target temperature and cooling speeds did not differ between groups. During the maintenance phase, mean core temperature was 33.1°C (range 32.7-33.7°C) versus 32.5°C (range 31.7-33.4°C) at targets of 33.0 and 32.5°C in intravascularly versus surface cooled patients, respectively. The variation coefficient for temperature during maintenance was higher in the surface than the intravascular cooling group (mean 0.85% vs 0.35%, p&amp;amp;amp;amp;lt;0.0001). ICU survival was 60% and 50% in the intravascularly and surface cooled groups, respectively (NS). Lower age (OR 0.95; 95% CI 0.93 to 0.98; p&amp;amp;amp;amp;lt;0.0001), ventricular fibrillation/ventricular tachycardia as presenting rhythm (OR 7.6; 95% CI 1.8 to 8.9; p&amp;amp;amp;amp;lt;0.0001) and lower mean temperature during the maintenance phase (OR 0.52; 95% CI 0.25 to 1.08; p=0.081) might be independent determinants of ICU survival, while cooling technique and temperature variability did not contribute. In post-CA patients, intravascular cooling systems result in equal cooling speed, but less variation in temperature during the maintenance phase, as surface cooling. This may not affect the outcome.

The open lung concept: effects on right ventricular afterload after cardiac surgery

BJA: British Journal of Anaesthesia, Sep 1, 2004

Background. The open lung concept (OLC) is a method of ventilation intended to maintain endexpira... more Background. The open lung concept (OLC) is a method of ventilation intended to maintain endexpiratory lung volume by increased airway pressure. Since this could increase right ventricular afterload, we studied the effect of this method on right ventricular afterload in patients after cardiac surgery. Methods. We studied 24 stable patients after coronary artery surgery and=or valve surgery with cardiopulmonary bypass. Patients were randomly assigned to OLC or conventional mechanical ventilation (CMV). In the OLC group, recruitment manoeuvres were applied until Pa O 2 =FI O 2 was greater than 50 kPa (reflecting an open lung). This value was maintained by sufficient positive airway pressure. In the CMV group, volume-controlled ventilation was used with a PEEP of 5 cm H 2 O. Cardiac index, right ventricular preload, contractility and afterload were measured with a pulmonary artery thermodilution catheter during the 3-h observation period. Blood gases were monitored continuously. Results. To achieve Pa O 2 =FI O 2 > 50 kPa, 5.3 (3) (mean, SD) recruitment attempts were performed with a peak pressure of 45.5 (2) cm H 2 O. To keep the lung open, PEEP of 17.0 (3) cm H 2 O was required. Compared with baseline, pulmonary vascular resistance and right ventricular ejection fraction did not change significantly during the observation period in either group. Conclusion. No evidence was found that ventilation according to the OLC affects right ventricular afterload.

Open lung ventilation does not increase right ventricular outflow impedance: An echo-Doppler study*

Critical Care Medicine, Oct 1, 2006

Additional file 6: of Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock

Clip 2 shows movie of a patient with non-successful weaning attempt. Microcirculatory image clips... more

Additional file 1: Table S1. of Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock

Shows technical overview of the SDF and IDF devices (adapted with permission from van Elteren et ... more

Additional file 3: of Microcirculatory assessment of patients under VA-ECMO

Cardiac output ROC curve 5. (TIFF 1521 kb)

Additional file 6: Table S4. of Microcirculatory assessment of patients under VA-ECMO

Sensitivity, specificity, positive predictive value, and negative predictive value for PVD all ve... more

Additional file 2: Table S6. of Microcirculatory assessment of patients under VA-ECMO

The median values of administered drugs, blood transfusions, and laboratory parameters at VA-ECMO... more

Goksel Guven & Milos Brankovic et al Preoperative RHH HTx AKI

Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis

Critical Care, Dec 1, 2014

Introduction: In Europe, vitamin D deficiency is highly prevalent varying between 40% and 60% in ... more Introduction: In Europe, vitamin D deficiency is highly prevalent varying between 40% and 60% in the healthy general adult population. The consequences of vitamin D deficiency for sepsis and outcome in critically ill patients remain controversial. We therefore systematically reviewed observational cohort studies on vitamin D deficiency in the intensive care unit. Methods: Fourteen observational reports published from January 2000 to March 2014, retrieved from Pubmed and Embase, involving 9,715 critically ill patients and serum 25-hydroxyvitamin D 3 (25 (OH)-D) concentrations, were meta-analysed. Results: Levels of 25 (OH)-D less than 50 nmol/L were associated with increased rates of infection (risk ratio (RR) 1.49, 95% (confidence interval (CI) 1.12 to 1.99), P = 0.007), sepsis (RR 1.46, 95% (CI 1.27 to 1.68), P <0.001), 30-day mortality (RR 1.42, 95% (CI 1.00 to 2.02), P = 0.05), and in-hospital mortality (RR 1.79, 95% (CI 1.49 to 2.16), P <0.001). In a subgroup analysis of adjusted data including vitamin D deficiency as a risk factor for 30-day mortality the pooled RR was 1.76 (95% CI 1.37 to 2.26, P <0.001). Conclusions: This meta-analysis suggests that vitamin D deficiency increases susceptibility for severe infections and mortality of the critically ill.

Corticosteroid-Induced Osteoporosis in Daily Practice: Pathophysiology, Clinical Importance, Prevention and Intervention Strategies

Single-stage surgical repair of benign laryngotracheal stenosis in adults

Head & neck, 2004

Background. Benign laryngotracheal stenosis causes considerable morbidity. In a retrospective stu... more Background. Benign laryngotracheal stenosis causes considerable morbidity. In a retrospective study, we describe the results of our surgical treatment. Methods. Between June 1999 and June 2002, 14 adults with laryngotracheal stenosis were referred to our hospital. Stenosis resulted from mechanical ventilation in 11 patients, from Wegener's granulomatosis in 2 patients, and from strangulation in 1 patient. Eleven patients had a tracheotomy. One patient was found unfit for surgery. Nine patients underwent cricotracheal resection (CTR) with end-to-end anastomosis, and four patients underwent single-stage laryngotracheoplasty (SS-LTP) without stenting. Results. There were no perioperative deaths. Patients were extubated after mean of 3 days (range, 0-10 days; CTR 2.3 days vs SS-LTP 3.5 days, p = .45). There were in-hospital complications in five patients. Mean hospital stay was 19 days (range, 8-53 days; after CTR 24 days vs SS-LTP 9 days, p = .015). With regard to airway patency and voice recovery, 10 patients (77%) had good results, including 1 patient with two readmissions, and 3 (23%) had satisfactory results, including 1 patient with 11 additional nonsurgical interventions. Conclusions. Benign laryngotracheal stenosis in the adult patient can be repaired successfully using a strategy of two single-stage surgical procedures. All patients had good or satisfactory functional results. A multidisciplinary approach was essential to achieve these good results.

Cyclical edidronate reverses bone loss of the spine and proximal femur in patients with established corticosteroid-induced osteoporosis

The American Journal of Medicine, Sep 1, 1995

PURPOSE: To compare the bone-mass effects of calcium supplementation and intermittent cyclic etid... more PURPOSE: To compare the bone-mass effects of calcium supplementation and intermittent cyclic etidronate in patients with established cotticosteroid-induced osteoporosis. PATIENTS AND METHODS: Eighteen male and 21 female patients who had established corticosteroid-induced osteoporosis and were receiving chronic prednisone therapy (210 mg/d) were enrolled in a prospective 18month, open-label study. In addition to continuing prednisone therapy, patients received continuous calcium supplementation 500 mg/d (n = 20) or four cycles of intermittent cyclic etidronate therapy consisting of etidronate 400 mg/d for 14 days followed by calcium 500 mg/d for 76 days (n = 19). Bone mineral density (BMD) of the spine (Ll through L4) and proximal femur (total hip, femoral neck, trochanter, Ward's triangle) was measured by dual-energy x-ray absorptiometry at baseline, 6 months, and 12 months by staff blinded to the treatment. Serum calcium, phosphorus, and alkaline phosphatase were also measured at these times. RESULTS: Treatment with intermittent cyclic etidronate for 12 months resulted in significant increases of 5.7% and 6.8% in BMD of the spine and proximal femur (total hip), respectively (P co.02 versus baseline; P co.001 versus calcium group). Calcium supplementation alone did not prevent significant losses of 3.4% and 4.1% in BMD at the respective sites (P co.02 versus baseline). At the end of the study Z scores reflected significant increases in BMD of the spine and proximal femur (all regions) in the etidronate group (P cO.Ol), and significant decreases at the spine, proximal femur, and trochanter in the calcium group (P eO.01). After 12 months, the difference between the groups was 9.1% (P ~0.01;

Intermittent Cyclical Etidronate in the Prevention of Corticosteroid-Induced Bone Loss

Rheumatology, 1994

We conducted a prospective study of etidronate&#39;s effects on corticosteroid-induced bone l... more We conducted a prospective study of etidronate&#39;s effects on corticosteroid-induced bone loss in postmenopausal women with temporal arteritis for whom high-dose prednisone therapy was indicated. Group A (n = 10) received etidronate (400 mg/day for 2 weeks, then 11 weeks off etidronate; four cycles total) and prednisone: Group B (n = 10) received only prednisone. Vertebral bone mineral density (BMD) was measured blinded by dual X-ray absorptiometry. At 3, 6 and 12 months, vertebral BMD was significantly (P &lt; 0.01) increased in Group A and decreased in Group B, based on mean actual and percent changes in BMD and mean changes in BMD Z-score from baseline. Between-group comparisons were also significant (P &lt; 0.002) at each time point. No adverse events related to etidronate treatment were reported. Our results suggest that corticosteroid-induced bone loss may be prevented by instituting intermittent cyclical etidronate therapy when high-dose prednisone therapy is begun. Further research into bisphosphonate use in corticosteroid-induced bone loss (with larger patient populations, longer follow-up and fracture assessment) is warranted.

Treatment of post-menopausal osteoporosis and low serum magnesium with intermittent cyclical EHDP and magnesium

Osteoporosis International, 1996

Open lung ventilation improves functional residual capacity after extubation in cardiac surgery*

Critical Care Medicine, Oct 1, 2005

After cardiac surgery, functional residual capacity (FRC) after extubation is reduced significant... more After cardiac surgery, functional residual capacity (FRC) after extubation is reduced significantly. We hypothesized that ventilation according to the open lung concept (OLC) attenuates FRC reduction after extubation. Design: A prospective, single-center, randomized, controlled clinical study. Setting: Cardiothoracic operating room and intensive care unit of a university hospital. Patients: Sixty-nine patients scheduled for elective coronary artery bypass graft and/or valve surgery with cardiopulmonary bypass. Interventions: Before surgery, patients were randomly assigned to three groups: (1) conventional ventilation (CV); (2) OLC, started after arrival in the intensive care unit (late open lung); and (3) OLC, started directly after intubation (early open lung). In both OLC groups, recruitment maneuvers were applied until PaO 2 /FIO 2 was >375 Torr (50 kPa). No recruitment maneuvers were applied in the CV group. Measurements and Main Results: FRC was measured preop

Case Report: Early Identification of Subclinical Cardiac Tamponade in a Patient With a Left Ventricular Assist Device by the Use of Sublingual Microcirculatory Imaging: A New Diagnostic Imaging Tool?

Frontiers in Cardiovascular Medicine, 2022

Clinical diagnosis of cardiac tamponade can be difficult in patients with continuous flow left ve... more Clinical diagnosis of cardiac tamponade can be difficult in patients with continuous flow left ventricle assist devices (cf-LVADs). This is even more so because of the lack of adequate bedside echocardiographic windows. Previous studies on monitoring sublingual microcirculation showed deterioration of end-organ perfusion in patient with cardiogenic shock. In this paper we report alterations in the sublingual microcirculation in a cf-LVAD patient prior to clinical manifestation of tamponade. Our case report suggests that such real-time monitoring of the microcirculation may provide a new diagnostic modality for early recognition of cardiac tamponade.

ESICM LIVES 2016: part three : Milan, Italy. 1-5 October 2016

Intensive care medicine experimental, 2016

Introduction: Critically ill children in the pediatric intensive care unit (PICU) are at high ris... more Introduction: Critically ill children in the pediatric intensive care unit (PICU) are at high risk for developing nutritional deficiencies and undernutrition is known to be a risk factor for morbidity and mortality. Malnutrition represents a continuous spectrum ranging from marginal nutrient status to severe metabolic and functional alterations and this in turn, affects clinical outcome. Objectives: The aim of the study was to assess nutritional status of critically ill children admitted to the PICU and its association to clinical outcomes. Methods: Critically ill children age 6 months to 18 years were prospectively enrolled on PICU admission. Nutritional status was assessed by weight for age (WFA: underweight), weight for height (WFH: wasting), height for age (HFA: stunting) z-scores and mid upper arm circumference (MUAC: wasting) according to the WHO. (1,2) Malnutrition was defined as mild, moderate, and severe if z-scores were > −1, > − 2, and > −3, respectively. Hospital and PICU length of stay (LOS), duration of mechanical ventilation (MV), and risk of mortality (ROM) by the Pediatric Index of Mortality 2 (PIM2) were obtained. Sensitivity and specificity of the MUAC to identify children with wasting (WFH) were calculated. Results: Two hundred and fifty children (136 males), aged 81 months (23-167; median (25-75 th IQR)), were prospectively included in the study. The hospital LOS was 8 (4-16) days; PICU LOS: 2 (1-4) days; duration of MV, 0 (0-1.5) days;

P5122A novel method for early identification of cardiac tamponade in patients with continuous flow left ventricular assist devices by use of sublingual microcirculatory imaging

European Heart Journal, Aug 1, 2018

differences in haemodynamic response to active leg raise test between LVAD and CHF patients (p>0.... more differences in haemodynamic response to active leg raise test between LVAD and CHF patients (p>0.05 for all variables of interests). Peak O2 consumption in LVAD and CHF patients was 12.2±4.8 and 11.0±3.5 ml/kg/min respectively, p=0.54. There was a positive moderate relationship between cardiac index and peak O2 consumption in LVAD (r=0.68, p=0.06) and CHF patients (r=0.66, p<0.04), Figure 1. Conclusion: There is a significant positive relationship between cardiac index response to physiological stress and peak O2 consumption. This suggests that haemodynamic response to stress can be used to predict functional capacity and potentially indicate cardiac reverse remodelling and recovery during mechanical circulatory support. P5122 A novel method for early identification of cardiac tamponade in patients with continuous flow left ventricular assist devices by use of sublingual microcirculatory imaging

A novel mortality risk score predicting intensive care mortality in cardiogenic shock patients treated with veno-arterial extracorporeal membrane oxygenation

Journal of Critical Care, Feb 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Intravascular versus surface cooling speed and stability after cardiopulmonary resuscitation

Emergency Medicine Journal, Dec 19, 2014

Mild therapeutic hypothermia (MTH) is used to limit neurological injury and improve survival afte... more Mild therapeutic hypothermia (MTH) is used to limit neurological injury and improve survival after cardiac arrest (CA) and cardiopulmonary resuscitation, but the optimal mode of cooling is controversial. We therefore compared the effectiveness of MTH using invasive intravascular or non-invasive surface cooling with temperature feedback control. This retrospective study in post-CA patients studied the effects of intravascular cooling (CoolGard, Zoll, n=97), applied on the intensive care unit (ICU) in one university hospital compared with those of surface cooling (Medi-Therm, Gaymar, n=76) applied in another university hospital. Time to reach target temperature and cooling speeds did not differ between groups. During the maintenance phase, mean core temperature was 33.1°C (range 32.7-33.7°C) versus 32.5°C (range 31.7-33.4°C) at targets of 33.0 and 32.5°C in intravascularly versus surface cooled patients, respectively. The variation coefficient for temperature during maintenance was higher in the surface than the intravascular cooling group (mean 0.85% vs 0.35%, p&amp;amp;amp;amp;lt;0.0001). ICU survival was 60% and 50% in the intravascularly and surface cooled groups, respectively (NS). Lower age (OR 0.95; 95% CI 0.93 to 0.98; p&amp;amp;amp;amp;lt;0.0001), ventricular fibrillation/ventricular tachycardia as presenting rhythm (OR 7.6; 95% CI 1.8 to 8.9; p&amp;amp;amp;amp;lt;0.0001) and lower mean temperature during the maintenance phase (OR 0.52; 95% CI 0.25 to 1.08; p=0.081) might be independent determinants of ICU survival, while cooling technique and temperature variability did not contribute. In post-CA patients, intravascular cooling systems result in equal cooling speed, but less variation in temperature during the maintenance phase, as surface cooling. This may not affect the outcome.

The open lung concept: effects on right ventricular afterload after cardiac surgery

BJA: British Journal of Anaesthesia, Sep 1, 2004

Background. The open lung concept (OLC) is a method of ventilation intended to maintain endexpira... more Background. The open lung concept (OLC) is a method of ventilation intended to maintain endexpiratory lung volume by increased airway pressure. Since this could increase right ventricular afterload, we studied the effect of this method on right ventricular afterload in patients after cardiac surgery. Methods. We studied 24 stable patients after coronary artery surgery and=or valve surgery with cardiopulmonary bypass. Patients were randomly assigned to OLC or conventional mechanical ventilation (CMV). In the OLC group, recruitment manoeuvres were applied until Pa O 2 =FI O 2 was greater than 50 kPa (reflecting an open lung). This value was maintained by sufficient positive airway pressure. In the CMV group, volume-controlled ventilation was used with a PEEP of 5 cm H 2 O. Cardiac index, right ventricular preload, contractility and afterload were measured with a pulmonary artery thermodilution catheter during the 3-h observation period. Blood gases were monitored continuously. Results. To achieve Pa O 2 =FI O 2 > 50 kPa, 5.3 (3) (mean, SD) recruitment attempts were performed with a peak pressure of 45.5 (2) cm H 2 O. To keep the lung open, PEEP of 17.0 (3) cm H 2 O was required. Compared with baseline, pulmonary vascular resistance and right ventricular ejection fraction did not change significantly during the observation period in either group. Conclusion. No evidence was found that ventilation according to the OLC affects right ventricular afterload.

Open lung ventilation does not increase right ventricular outflow impedance: An echo-Doppler study*

Critical Care Medicine, Oct 1, 2006

Additional file 6: of Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock

Clip 2 shows movie of a patient with non-successful weaning attempt. Microcirculatory image clips... more

Additional file 1: Table S1. of Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock

Shows technical overview of the SDF and IDF devices (adapted with permission from van Elteren et ... more

Additional file 3: of Microcirculatory assessment of patients under VA-ECMO

Cardiac output ROC curve 5. (TIFF 1521 kb)

Additional file 6: Table S4. of Microcirculatory assessment of patients under VA-ECMO

Sensitivity, specificity, positive predictive value, and negative predictive value for PVD all ve... more

Additional file 2: Table S6. of Microcirculatory assessment of patients under VA-ECMO

The median values of administered drugs, blood transfusions, and laboratory parameters at VA-ECMO... more

Goksel Guven & Milos Brankovic et al Preoperative RHH HTx AKI