المؤلفون: Kai Hennemann, Annegret Kamp, Ralf Michael Muellenbach, Frederik Seiler, Philipp M. Lepper, Franziska C. Trudzinski, Hendrik Haake, Robert Bals, Christian Schmoll, Tom Niermeyer

مصطلحات موضوعية: Adult, Male, Extracorporeal Circulation, medicine.medical_treatment, Biomedical Engineering, Biophysics, Bioengineering, Air embolism, Biomaterials, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, ventilatory failure, medicine, Extracorporeal membrane oxygenation, Intubation, Humans, 030212 general & internal medicine, Oxygenator, Aged, Retrospective Studies, Respiratory Distress Syndrome, Lung, business.industry, 030208 emergency & critical care medicine, hypercapnia, General Medicine, Carbon Dioxide, Middle Aged, medicine.disease, Cannula, medicine.anatomical_structure, Anesthesia, ECCO2 R, Female, business, Complication, Respiratory Insufficiency, Central venous catheter

الوصف: Extracorporeal carbon dioxide removal (ECCO2R) is increasingly considered a viable therapeutic approach in the management of hypercapnic lung failure to avoid intubation or to allow lung-protective ventilator settings. This study aimed to analyze efficacy and safety of a minimal-invasive ECCO2R device, the Homburg lung. The Homburg lung is a pump-driven system for veno-venous ECCO2R with ¼″ tubing and a 0.8 m surface oxygenator. Vascular access is usually established via a 19F/21 cm bilumen cannula in the right internal jugular vein. For this work, we screened patient registries from two German centers for patients who underwent ECCO2R with the Homburg lung because of hypercapnic lung failure since 2013. Patients who underwent extracorporeal membrane oxygenation before ECCO2R were excluded. Patients who underwent ECCO2R more than one time were only included once. In total, 24 patients (aged 53.86 ± 12.49 years; 62.5% male) were included in the retrospective data analysis. Ventilatory failure occurred because of chronic obstructive pulmonary disease (50%), cystic fibrosis (16.7%), acute respiratory distress syndrome (12.5%), and other origins (20.8%). The system generated a blood flow of 1.18 ± 0.23 liters per minute (lpm). Sweep gas flow was 3.87 ± 2.97 lpm. Within 4 hours, paCO2 could be reduced significantly from 82.05 ± 15.57 mm Hg to 59.68 ± 12.27 mm Hg, thereby, increasing pH from 7.23 ± 0.10 to 7.36 ± 0.09. Cannulation-associated complications were transient arrhythmia (1/24 patients) and air embolism (1/24). Fatal complications did not occur. In conclusion, the Homburg lung provides effective carbon dioxide removal in hypercapnic lung failure. The cannulation is a safe procedure, with complication rates comparable to those in central venous catheter implantation.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::04c40facb70fe144fb2733e1f7d4b9d9Test

المؤلفون: Ralf Michael Muellenbach, Frederik Seiler, Markus Kredel, Hendrik Haake, Annegret Kamp, Monika Flaig, Robert Bals, Mohammad Alqudrah, Philipp M. Lepper, Carlos Metz, Sabrina I. Hörsch, Franziska C. Trudzinski, Holger Wehrfritz

المصدر: Journal of Artificial Organs. 21:300-307

مصطلحات موضوعية: Adult, Male, Patient Transfer, Nephrology, medicine.medical_specialty, ARDS, medicine.medical_treatment, Biomedical Engineering, Medicine (miscellaneous), Weaning, Respiratory failure, 030204 cardiovascular system & hematology, Lung injury, Hospitals, Special, Biomaterials, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Internal medicine, Extracorporeal membrane oxygenation, Humans, Medicine, Lung transplantation, Lung failure, Retrospective Studies, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, medicine.disease, Cardiac surgery, surgical procedures, operative, Anesthesia, Preoperative Period, Female, ECMO, Respiratory Insufficiency, Cardiology and Cardiovascular Medicine, business, Lung transplant, Lung Transplantation

الوصف: Veno-venous extracorporeal membrane oxygenation (vvECMO) is increasingly used as rescue therapy in severe respiratory failure. In patients with pre-existent lung diseases or persistent lung injury weaning from vvECMO can be challenging. This study sought to investigate outcomes of patients transferred to a specialized ECMO center after prolonged ECMO therapy. We performed a retrospective analysis of all patients admitted to our medical intensive care unit (ICU) between 01/2013 and 12/2016 who were transferred from an external ICU after > 8 days on vvECMO. 12 patients on ECMO for > 8 days were identified. Prior to transfer, patients underwent ECMO therapy for 18 ± 9.5 days. Total time on ECMO was 60 ± 46.6 days. 11/12 patients could be successfully weaned from ECMO, 7/12 in the first 28 days after transfer (8 ± 8.8 ECMO-free days at day 28). In 7 patients, ECMO could be terminated after at least partial lung recovery, in 4 patients after salvage lung transplant. No patient died or needed re-initiation of ECMO therapy at day 28. In summary, weaning from vvECMO was feasible even after prolonged ECMO courses and salvage lung transplant could be avoided in most cases. Patients may benefit from transfer to a specialized ECMO center.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::21464d236c9ca721417f599c787ff77bTest
https://doi.org/10.1007/s10047-018-1046-1Test

المؤلفون: Heinrich V. Groesdonk, Andreas Meiser, Philipp M. Lepper, Hagen Bomberg, Thomas Volk, Franziska C. Trudzinski

المصدر: Anesthesia & Analgesia. 125:1235-1239

مصطلحات موضوعية: Adult, Male, Sedation, medicine.medical_treatment, Acute respiratory distress, Anaconda, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, 030202 anesthesiology, Tidal Volume, Extracorporeal membrane oxygenation, Humans, Hypnotics and Sedatives, Medicine, Tidal volume, Aged, Retrospective Studies, Respiratory Distress Syndrome, Isoflurane, biology, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, biology.organism_classification, Anesthesiology and Pain Medicine, Anesthesia, Anesthetics, Inhalation, Breathing, Feasibility Studies, Female, Blood Gas Analysis, medicine.symptom, business, medicine.drug

الوصف: Six patients suffering from acute respiratory distress syndrome with the need for extracorporeal membrane oxygenation (ECMO) therapy in deep sedation were included. Isoflurane sedation with the AnaConDa system was initiated within 24 hours after initiation of ECMO therapy and resulted in a satisfactory sedation (Richmond Agitation-Sedation Scale -4 to -5). Despite deep sedation, spontaneous breathing was possible in 6 of 6 patients. We observed a reduced need for vasopressor therapy and improved lung function (PaO2, PaCO2, delta P, and tidal volume) during isoflurane sedation. Opioid consumption could be reduced, and only very low doses of isoflurane were needed (1-3 mL/h). This small case series supports the feasibility of sedation using inhaled anesthetics concurrently with venovenous ECMO.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c20190e1508607a24f4a115df13cfc11Test
https://doi.org/10.1213/ane.0000000000001915Test

المؤلفون: Hans-Joachim Schäfers, Heinrike Wilkens, Frederik Seiler, Sebastian Fähndrich, Hendrik Haake, Franziska C. Trudzinski, Frank Langer, Oliver Linn, Robert Bals, Philip Böhmer, Philipp M. Lepper, Franziska Kaestner, Ralf Kaiser

المصدر: American Journal of Respiratory and Critical Care Medicine. 193:527-533

مصطلحات موضوعية: Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, Intensive care, medicine, Extracorporeal membrane oxygenation, Acute respiratory failure, Diffuse alveolar damage, Mechanical ventilation, Lung, business.industry, Interstitial lung disease, medicine.disease, Intensive care unit, surgical procedures, operative, medicine.anatomical_structure, 030228 respiratory system, Anesthesia, Cardiology, business

الوصف: Rationale: Patients with interstitial lung disease and acute respiratory failure have a poor prognosis especially if mechanical ventilation is required.Objectives: To investigate the outcome of patients with acute respiratory failure in interstitial lung disease undergoing extracorporeal membrane oxygenation (ECMO) as a bridge to recovery or transplantation.Methods: This was a retrospective analysis of all patients with interstitial lung disease and acute respiratory failure treated with or without ECMO from March 2012 to August 2015.Measurements and Main Results: Forty patients with interstitial lung disease referred to our intensive care unit for acute respiratory failure were included in the analysis. Twenty-one were treated with ECMO. Eight patients were transferred by air from other hospitals within a range of 320 km (linear distance) for extended intensive care including the option of lung transplant. In total, 13 patients were evaluated, and eight were finally found to be suitable for lung transpla...

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::0f0a3db8c28532dd9c6b0d28cb814be3Test
https://doi.org/10.1164/rccm.201508-1701ocTest

المؤلفون: Robert Bals, Carlos Metz, Frederik Seiler, Annegret Kamp, Holger Wehrfritz, Ralf Michael Muellenbach, Hendrik Haake, Mohammad Alqudrah, Philipp M. Lepper, Franziska C. Trudzinski, Sabrina I. Hörsch

المصدر: Acute Critical Care.

مصطلحات موضوعية: Lung, business.industry, medicine.medical_treatment, Lung injury, surgical procedures, operative, medicine.anatomical_structure, Respiratory failure, Medical intensive care unit, Rescue therapy, Anesthesia, Extracorporeal membrane oxygenation, medicine, Weaning, In patient, business

الوصف: Background: Veno-venous extracorporeal membrane oxygenation (vV-ECMO) is increasingly used as a rescue therapy in severe respiratory failure. In patients with pre-existent lung diseases or persistent lung injury weaning from vV-ECMO can be challenging. This study sought to investigate outcomes of patients transferred to a specialized ECMO center after prolonged ECMO therapy. Methods: We performed a retrospective analysis of all patients treated at our medical intensive care unit (ICU) between 01/2013 and 07/2016 who were transferred from an external ICU after > 8 days on vV-ECMO. Results: We identified 10 patients on ECMO for > 8 days. Prior to transfer, patients underwent ECMO therapy for 18 (9 – 34) ± 9.5 days. Total time on ECMO was 46 (16 – 135) ± 33 days. 9/10 patients were weaned from ECMO in the first 28 days after transfer, 7 after at least partial lung recovery, 2 after salvage lung transplant (10 ± 8.3 ECMO-free days at day 28). No patient died or needed re-initiation of ECMO therapy at day 28. Conclusion: Weaning from vV-ECMO was feasible even after prolonged ECMO courses and salvage lung transplant could be avoided in most cases. Patients may benefit from transfer to a specialized ECMO center.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::03350acf4cdc59c8429546da7f665979Test
https://doi.org/10.1183/1393003.congress-2017.pa2122Test

المؤلفون: Annaelle Zietz, Frederik Seiler, Robert Bals, Philipp M. Lepper, Franziska C. Trudzinski, Annegret Kamp

المصدر: Acute Critical Care.

مصطلحات موضوعية: 0301 basic medicine, Mechanical ventilation, business.industry, medicine.medical_treatment, Blood flow, 030105 genetics & heredity, Lung injury, pCO2, 03 medical and health sciences, Plateau pressure, surgical procedures, operative, 0302 clinical medicine, Respiratory failure, Anesthesia, medicine, Extracorporeal membrane oxygenation, Breathing, business, 030217 neurology & neurosurgery

الوصف: Background: Veno-venous extracorporeal membrane oxygenation (ECMO) is considered an established rescue therapy in severe respiratory failure. Current knowledge on the optimal ventilation strategy during ECMO is sparse. In recent years, the concept of ultra-protective ventilation has been emerging, aiming to reduce ventilator-induced lung injury. This study sought to investigate ventilator settings used in patients on ECMO and their impact on mortality. Methods: Retrospective Analysis of patients undergoing invasive mechanical ventilation and simultaneous ECMO between 01/2009 and 06/2016. Patients on non-invasive ventilation, veno-arterial ECMO, or low-flow ECMO for carbon dioxide removal were excluded. Results: 62 patients were included (age 49.45 ±17.79 a, 59.7% male). ECMO was administered using a blood flow of 3.55 ± 0.93 lpm and a sweep-gas flow of 3.37 ±1.51 lpm. Upon ECMO initiation, tidal volumes could be reduced from 6.25 ±2.63 to 4.13 ±2.10 ml/kg PBW. Changes were due to reduction of the inspiratory plateau pressure (29.2 ±5.85 vs. 22.7 ±3.84 cmH2O), thus reducing driving pressure (19.25 ±6.35 vs. 12.25 ±3.48 cmH2O). Positive end-expiratory pressure remained constant (9.82 ±3.81 vs. 10.59 ±3.70 cmH2O). Despite ultra-protective ventilation, gas exchange during ECMO was sufficient (pO2 79.60 ±19.60 mmHg, pCO2 46.66 ±9.19 mmHg). 33 patients (53.2%) died. There were no significant differences in ventilator parameters between survivors and non-survivors. Conclusion: Our data show that ultra-protective ventilation during ECMO therapy can be feasibly applied under real-world conditions. However, a positive prognostic effect could not be detected.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::026a4dd33bbd6bd7e83908f316b8ae4eTest
https://doi.org/10.1183/1393003.congress-2017.pa2123Test

المؤلفون: Mathias Herrmann, Annegret Kamp, Heinrike Wilkens, Uwe Schlotthauer, Udo Reischl, Sören L. Becker, Ralf Michael Muellenbach, Kai Hennemann, Robert Bals, Barbara Gärtner, Philipp M. Lepper, Franziska C. Trudzinski

المصدر: Eurosurveillance

مصطلحات موضوعية: diagnosis, Epidemiology, medicine.medical_treatment, 030501 epidemiology, law.invention, 0302 clinical medicine, heater-cooler unit, law, extracorporeal membrane oxygenation (ECMO), Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Cross Infection, biology, Nontuberculous Mycobacteria, Middle Aged, Intensive care unit, Cardiac surgery, surgical procedures, operative, Anesthesia, Water Microbiology, 0305 other medical science, Body Temperature Regulation, Research Article, Adult, medicine.medical_specialty, Mycobacterium Infections, Nontuberculous, Opportunistic Infections, Mycobacterium, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, Virology, medicine, Extracorporeal membrane oxygenation, Humans, Mycobacterium chimaera, Clinical significance, Intensive care medicine, Aged, Retrospective Studies, atypical mycobacteria, business.industry, Public Health, Environmental and Occupational Health, Retrospective cohort study, biology.organism_classification, infection, Equipment Contamination, Nontuberculous mycobacteria, business

الوصف: Mycobacterium chimaera, a non-tuberculous mycobacterium, was recently identified as causative agent of deep-seated infections in patients who had previously undergone open-chest cardiac surgery. Outbreak investigations suggested an aerosol-borne pathogen transmission originating from water contained in heater-cooler units (HCUs) used during cardiac surgery. Similar thermoregulatory devices are used for extracorporeal membrane oxygenation (ECMO) and M. chimaera might also be detectable in ECMO treatment settings. We performed a prospective microbiological study investigating the occurrence of M. chimaera in water from ECMO systems and in environmental samples, and a retrospective clinical review of possible ECMO-related mycobacterial infections among patients in a pneumological intensive care unit. We detected M. chimaera in 9 of 18 water samples from 10 different thermoregulatory ECMO devices; no mycobacteria were found in the nine room air samples and other environmental samples. Among 118 ECMO patients, 76 had bronchial specimens analysed for mycobacteria and M. chimaera was found in three individuals without signs of mycobacterial infection at the time of sampling. We conclude that M. chimaera can be detected in water samples from ECMO-associated thermoregulatory devices and might potentially pose patients at risk of infection. Further research is warranted to elucidate the clinical significance of M. chimaera in ECMO treatment settings.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e2028f465c39fab5cb7b69316d66e0b1Test
https://doi.org/10.2807/1560-7917.es.2016.21.46.30398Test

المؤلفون: Franziska C. Trudzinski, Konstantinos Tsitouras, Frederik Seiler, Oliver Linn, Robert Bals, Philipp M. Lepper, Ralf Kaiser, Carlos Metz, Heinrike Wilkens, Philip Böhmer, Sebastian Fähndrich, Annegret Kamp, Hendrik Haake

المصدر: 2.1 Acute Critical Care.

مصطلحات موضوعية: COPD, medicine.medical_specialty, Lung, business.industry, medicine.medical_treatment, medicine.disease, Air embolism, Cannula, Extracorporeal, Surgery, medicine.anatomical_structure, Pneumothorax, Anesthesia, medicine, Intubation, business, Central venous catheter

الوصف: Introduction: Extracorporeal CO 2 removal (ECCO 2 R) is increasingly used as a therapeutic strategy in hypercapnic lung failure in order to avoid intubation, to allow lung protective ventilator settings, or to facilitate weaning from invasive ventilation. Here, we report on the Homburg Lung, a novel minimal-invasive mid-flow ECCO 2 R system which was established and successfully used at our ICU. The Homburg Lung is a pump-driven (Maquet Rotaflow) system for veno-venous ECCO 2 R with ¼” tubing and a 0.8 m 2 surface oxygenator (Maquet Quadrox-I pediatric). Vascular access is usually established via a 19F/21cm bilumen cannula in the right internal jugular vein. Methods: To analyse efficacy and safety of the Homburg Lung, we screened our patient registry for ECCO 2 R procedures since 2013. Patients who underwent ECMO prior to ECCO 2 R were excluded. Patients who underwent ECCO 2 R more than one time since 2013 were only included once. Results: A total of 19 patients (age 52.3 ± 12.86 years, 42.1% female) was analysed. Ventilatory failure occurred due to COPD (47.4%), cystic fibrosis (21 %), and other origins (31.6%). The system generated a blood flow of 1.23 ± 0.29 lpm. Gas flow was 5.37 ± 2.98 lpm. Within 4 h, pCO 2 could be reduced from 74.03 ± 17.51 mmHg to 55.53 ± 10.85 mmHg. Cannulation-associated complications were transient arrhythmia (1/19 patients), pneumothorax (1/19), and air embolism (1/19). Fatal complications were not registered. Conclusion: The Homburg Lung provides effective CO 2 removal in hypercapnic lung failure. The cannulation is a safe procedure with complication rates comparable to those in central venous catheter implantation.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::a2ca1335ed329f71343eafcc9860acf1Test
https://doi.org/10.1183/13993003.congress-2016.pa3571Test

المؤلفون: Tom Wolf, Sebastian Fähndrich, Christian Lensch, Ralf Michael Muellenbach, Frederik Seiler, Robert Bals, Franziska C. Trudzinski, Philipp M. Lepper, Franziska Kaestner, Monika Flaig

المصدر: 2.1 Acute Critical Care.

مصطلحات موضوعية: medicine.medical_specialty, business.industry, medicine.medical_treatment, Factor XIII, Single Center, Fibrinogen, Surgery, Coagulation, Anesthesia, medicine, Factor XIII Measurement, Lung transplantation, Platelet, business, Coagulation Disorder, medicine.drug

الوصف: Introduction: Bleeding and transfusion requirements are frequent complications under veno-venous extracorporeal carbon dioxide removal (ECCO 2 R). Data concerning coagulation in ECCO 2 R patients are few. We therefore aimed to analyze hemostatic changes during extracorporeal carbon dioxide removal. Methods: Single center analysis. 20 Patients undergoing pump-driven ECCO 2 R between 03/13 and 10/15 were included. According our protocol, platelet count and fibrinogen testing were performed on a daily base; factor XIII analysis was done before ECCO 2 R and twice a week. Results: Results: 19 Patients, 11 male, mean age 50.2 ± 13.2 were finally analyzed. ECCO 2 R was initiated due to AECOPD in 12 cases (60%), to chronic respiratory failure in patients waiting for lung transplantation in 7 cases (35%), to ARDS in 2 Cases (%) and to refractory status asthmaticus in one case (5%). Mean ECCO 2 R runtime was 9.6 ± 7.6 days. Within the first 7 days platelet count decreased from 265.2 ± 78.2 (N=17) to 131 ± 48.18 (N=15) platelets/µl (P = 0.003). HIT-II Elisa was performed in 11 cases (57.9%) and was positive in one of them (9.1%). Fibrinogen decreased from 483.1 ± 142.8 (N=18) at baseline to 364.8 ± 95.8 mg/dl (N=15) on day 7 (P =0.002). Factor XIII measurement showed an acquired deficiency under support dropping from 84.5 ± 14.8 (N=14) before ECCO2R to 69.9 ± 11.7 % on day 2-5 (N= 8) (P=0.018). Four Patients received purified concentrate of blood coagulation factor XIII. Conclusion: Patients on ECCO2R develop coagulation disorders analog High-flow ECMO patients. The impact on bleeding complications and thromboembolic events needs further investigation.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::95a7ee2abe0a27663ff73a4e8e633461Test
https://doi.org/10.1183/13993003.congress-2016.pa3574Test

المؤلفون: Philipp M. Lepper, Sebastian Fähndrich, Dominik Ballek, Robert Bals, Franziska C. Trudzinski, Franziska Kaestner

المصدر: 1.4 Interventional Pulmonology.

مصطلحات موضوعية: Lung volume reduction, business.industry, medicine.medical_treatment, Atelectasis, Respiratory physiology, medicine.disease, Hypercapnic respiratory failure, Chest tube, Pneumothorax, Anesthesia, medicine, In patient, Prospective cohort study, business

الوصف: Even though eLVR with EBV is an established therapy option for patients with severe emphysema, patients with hypercapnic respiratory failure are usually excluded from treatment. We retrospectively evaluated all patients treated in our department. Hypercapnic respiratory failure was defined as CO 2 ≥ 50mmHg and/or NIV therapy. All patients underwent V/Q-Scan and were evaluated for collateral ventilation (Chartis) to determine the target lobe. CO 2 was analyzed at 3 time points (TP), before, 2-4 days after, and 1-3 months after eLVR. We treated 13 patients (6 bilaterally); (age 61.8 ± 7.6 years). Mean (± SD) FEV 1 before EBV implantation was 0.53 ± 0.15 L (19.8 ± 3.8 % pred.); mean residual volume (RV) was 6.24 ± 1.6 L (287 ± 69.5 % pred.). Left upper lobe was treated 4-times, left lower lobe was treated 7-times, right upper lobe was treated 2-times, right lower lobe 6-times. Patients developed atelectasis in 10/19 (52.6%) cases. Overall, CO 2 was 55.1 ± 9.5 mmHg before and 50.2 ± 12.6 mmHg after 1-3 months (p 2 in patients who developed atelectasis was 57.3 ± 7.74 mmHg before, 53.10 ± 10.6 mmHg at TP2 and 48.7 ± 5.8 mmHg (p 2 levels. The overall pneumothorax rate was 21.1% (4/19 procedures.); all pneumothoraces were treatable by chest tube only. The results of this retrospective analysis show that EBV treatment in patients with hypercapnic respiratory failure is feasible and safe. Successful eLVR may lead to a decrease of CO 2 levels due to improvement in respiratory mechanics. A prospective study has to elucidate the benefit of eLVR in hypercapnic patients.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::38f485b843087edad0d9251ae8aaac8fTest
https://doi.org/10.1183/13993003.congress-2015.pa797Test