Publications by authors named "Florian Piekarski"

28 Publications

  • Page 1 of 1

[Evaluation of Characteristics and Management of Influenza Patients in Relation to the STIKO Vaccination Recommendation During the 2017/2018 Season].

Gesundheitswesen 2021 Oct 8. Epub 2021 Oct 8.

Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Goethe Universität, Frankfurt, Frankfurt am Main, Deutschland.

Background: Every year a large number of patients is suffering from influenza infection with often severe outcome. The influenza season 2017/2018 was characterized by a high number of cases (in Germany>346,000 laboratory-confirmed cases), but also by a high rate of hospitalizations with sometimes severe clinical outcome - also in the group of patients under 60 years.

Aim: The aim of the present study was to find out whether patients not fullfilling the STIKO vaccination recommendation in the 2017/18 season were suffering from a worse outcome.

Materials And Methods: All laboratory-confirmed influenza patients at Frankfurt University Hospital were retrospectively analyzed for disease severity with respect to the primary endpoint. Secondary endpoints were defined as demographic data, length of hospital stay, previous illnesses, intensive care therapy and its duration, drug therapy, and mortality.

Results: Fifty-one of 303 patients (16.8%) required intensive care treatments. Of these 51, 46 patients (90.2%) belonged to the group that should have been vaccinated according to the vaccination recommendations according to STIKO, 5 patients (9.8%) did not belong to this group (p=0.434). Of the 51 ICU patients, 16 (31.4%) died. All deceased were from the group with vaccination recommendation (p=0.120).

Conclusions: Based on these data, it appears that severe disease progression occurs in both the group of patients with and without STIKO vaccination recommendation, but deaths occur only in the group of patients with recommendation.
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http://dx.doi.org/10.1055/a-1633-3748DOI Listing
October 2021

Physician's Subjective Increase in Awareness towards Perioperative Anaemia, Patient's Blood Resource, and Transfusion after the Implementation of Patient Blood Management: A Nationwide Multicentre Survey.

Acta Haematol 2021 Aug 31:1-8. Epub 2021 Aug 31.

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.

Introduction: Patient blood management (PBM) is a clinical and multidisciplinary, 3-pillar concept. The aim of this study was to detect the subjective increase in physician's awareness towards perioperative anaemia, patient's blood resource, and transfusion after the implementation of PBM in German hospitals.

Material And Methods: A survey among 56 hospitals from the German PBM Network group was conducted from October 27 to December 19, 2020. An electronic questionnaire with 28 questions was sent to the local PBM coordinator for the distribution at the hospital level. For assessment of the physician's subjective increase in awareness, numeric rating scales (0 [no increase] - 10 [maximum increase]) were used.

Results: In total, 404 clinicians from 56 hospitals completed the survey. The mean (±standard deviation) time of an existing PBM program was 4.8 (±2.2) years. The physician's subjective increase in awareness towards anaemia (8.2 [±2.0]), patient's blood resource (7.6 [±2.5]), and transfusion (8.1 [±1.9]) was the highest in physicians from hospitals with ≥21 implemented PBM measures. In addition, a subjective increase in awareness towards anaemia (6.6 [±3.3]), patient's blood resource (7.0 [±3.3]), and transfusion (6.6 [±3.4]) was the highest in physicians with daily PBM contact.

Conclusion: Results suggest that physician's awareness towards perioperative anaemia, patient's blood resource, and transfusion has increased, depending on the hospital's number of implemented PBM measures and physician's PBM contact in everyday clinical practice.
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http://dx.doi.org/10.1159/000517607DOI Listing
August 2021

Voice alerting as a medical alarm modality for next-generation patient monitoring: a randomised international multicentre trial.

Br J Anaesth 2021 Nov 26;127(5):769-777. Epub 2021 Aug 26.

Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.

Background: Acoustic alarms in medical devices are vital for patient safety. State-of-the-art patient monitoring alarms are indistinguishable and contribute to alarm fatigue. There are two promising new sound modalities for vital sign alarms. Auditory icons convey alarms as brief metaphorical sounds, and voice alerts transmit information using a clear-spoken language. We compared how reliably healthcare professionals identified alarms using these two modalities.

Methods: This investigator-initiated computer-based multicentre simulation study included 28 anaesthesia providers who were asked to identify vital sign alarms in randomised order, once with voice alerts and once with auditory icons. We further assessed time to decision, diagnostic confidence, and perceived helpfulness. We analysed the results using mixed models, adjusted for possible confounders.

Results: We assessed 14 alarms for each modality, resulting in 392 comparisons across all participants. Compared with auditory icons, healthcare providers had 58 times higher odds of correctly identifying alarms using voice alerts (odds ratio 58.0; 95% confidence interval [CI]: 25.1-133.6; P<0.001), made their decisions about 14 s faster (coefficient -13.9; 95% CI: -15.8 to -12.1 s; P<0.001), perceived higher diagnostic confidence (100% [392 of 392] vs 43% [169 of 392; P<0.001]), and rated voice alerts as more helpful (odds ratio 138.2; 95% CI: 64.9-294.1; P<0.001). The participants were able to identify significantly higher proportions of alarms with voice alerts (98.5%; P<0.001) and auditory icons (54.1%; P<0.001) compared with state-of-the-art alarms (17.9%).

Conclusions: Voice alerts were superior to auditory icons, and both were superior to current state-of-the-art auditory alarms. These findings demonstrate the potential that voice alerts hold for patient monitoring.
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http://dx.doi.org/10.1016/j.bja.2021.07.015DOI Listing
November 2021

The Reticulocyte Hemoglobin Equivalent as a Screening Marker for Iron Deficiency and Iron Deficiency Anemia in Children.

J Clin Med 2021 Aug 9;10(16). Epub 2021 Aug 9.

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany.

Background: Iron deficiency (ID) is one of the most common nutritional deficiencies in children worldwide and may result in iron deficiency anemia (IDA). The reticulocyte hemoglobin equivalent (Ret-He) provides information about the current availability of iron in erythropoiesis. This study aims to examine the validation of Ret-He as a screening marker for ID and IDA in children.

Methods: Blood samples were retrospectively obtained from medical records. Anemia was defined according to the definition provided by the World Health Organization (WHO) for children. ID was defined by transferrin saturation (TSAT) < 20% and ferritin < 100 ng/mL. Children were classified into four groups: IDA, non-anemia iron deficiency (NAID), control and others.

Results: Out of 970 children, 332 (34.2%) had NAID and 278 (28.7%) presented with IDA. Analysis revealed that Ret-He significantly correlates with ferritin (rho = 0.41; < 0.001), TSAT (rho = 0.66; < 0.001) and soluble transferrin receptor (sTfR) (rho = -0.72; < 0.001). For ROC analysis, the area under the curve (AUC) was 0.771 for Ret-He detecting ID and 0.845 for detecting IDA. The cut-off value for Ret-He to diagnose ID was 33.5 pg (sensitivity 90.7%; specificity 35.8%) and 31.6 pg (sensitivity 90.6%; specificity 50.4%) to diagnose IDA.

Conclusions: The present study demonstrates Ret-He to be a screening marker for ID and IDA in children. Furthermore, Ret-He can be used as a single screening parameter for ID and IDA in children without considering other iron parameters. Economically, the use of Ret-He is highly relevant, as it can save one blood tube per patient and additional costs.
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http://dx.doi.org/10.3390/jcm10163506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397001PMC
August 2021

Independent Risk Factors for RBC Transfusion in Children Undergoing Surgery. Analysis of 14,248 Cases at a German University Hospital.

Children (Basel) 2021 Jul 25;8(8). Epub 2021 Jul 25.

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt, Germany.

Background: paediatric patients are vulnerable to blood loss and even a small loss of blood can be associated with severe shock. In emergency situations, a red blood cell (RBC) transfusion may become unavoidable, although it is associated with various risks. The aim of this trial was to identify independent risk factors for perioperative RBC transfusion in children undergoing surgery.

Methods: to identify independent risk factors for perioperative RBC transfusion in children undergoing surgery and to access RBC transfusion rates and in-hospital outcomes (e.g., length of stay, mortality, and typical postoperative complication rates), a monocentric, retrospective, and observational study was conducted. Descriptive, univariate, and multivariate analyses were performed.

Results: between 1 January 2010 and 31 December 2019, data from = 14,248 cases were identified at the centre. Analysis revealed an RBC transfusion rate of 10.1% ( = 1439) in the entire cohort. The independent predictors of RBC transfusion were the presence of preoperative anaemia ( < 0.001; OR = 15.10 with preoperative anaemia and OR = 2.40 without preoperative anaemia), younger age ( < 0.001; ORs between 0.14 and 0.28 for children older than 0 years), female gender ( = 0.036; OR = 1.19 compared to male gender), certain types of surgery (e.g., neuro surgery ( < 0.001; OR = 10.14), vascular surgery ( < 0.001; OR = 9.93), cardiac surgery ( < 0.001; OR = 4.79), gynaecology ( = 0.014; OR = 3.64), visceral surgery ( < 0.001; OR = 2.48), and the presence of postoperative complications (e.g., sepsis ( < 0.001; OR = 10.16), respiratory dysfunction ( < 0.001; OR = 7.56), cardiovascular dysfunction ( < 0.001; OR = 4.68), neurological dysfunction ( = 0.029; OR = 1.77), and renal dysfunction ( < 0.001; OR = 16.17)).

Conclusion: preoperative anaemia, younger age, female gender, certain types of surgery, and postoperative complications are independent predictors for RBC transfusion in children undergoing surgery. Future prospective studies are urgently required to identify, in detail, the potential risk factors and impact of RBC transfusion in children.
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http://dx.doi.org/10.3390/children8080634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8394932PMC
July 2021

Clinical Outcome and Risk Factors of Red Blood Cell Transfusion in Patients Undergoing Elective Primary Meningioma Resection.

Cancers (Basel) 2021 Jul 18;13(14). Epub 2021 Jul 18.

Department of Neurosurgery, University Hospital, Goethe University Frankfurt, 60528 Frankfurt am Main, Germany.

Transfusion of red blood cells (RBC) in patients undergoing major elective cranial surgery is associated with increased morbidity, mortality and prolonged hospital length of stay (LOS). This retrospective single center study aims to identify the clinical outcome of RBC transfusions on skull base and non-skull base meningioma patients including the identification of risk factors for RBC transfusion. Between October 2009 and October 2016, 423 patients underwent primary meningioma resection. Of these, 68 (16.1%) received RBC transfusion and 355 (83.9%) did not receive RBC units. Preoperative anaemia rate was significantly higher in transfused patients (17.7%) compared to patients without RBC transfusion (6.2%; = 0.0015). In transfused patients, postoperative complications as well as hospital LOS was significantly higher ( < 0.0001) compared to non-transfused patients. After multivariate analyses, risk factors for RBC transfusion were preoperative American Society of Anaesthesiologists (ASA) physical status score ( = 0.0247), tumor size ( = 0.0006), surgical time ( = 0.0018) and intraoperative blood loss ( < 0.0001). Kaplan-Meier curves revealed significant influence on overall survival by preoperative anaemia, RBC transfusion, smoking, cardiovascular disease, preoperative KPS ≤ 60% and age (elderly ≥ 75 years). We concluded that blood loss due to large tumors or localization near large vessels are the main triggers for RBC transfusion in meningioma patients paired with a potential preselection that masks the effect of preoperative anaemia in multivariate analysis. Further studies evaluating the impact of preoperative anaemia management for reduction of RBC transfusion are needed to improve the clinical outcome of meningioma patients.
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http://dx.doi.org/10.3390/cancers13143601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307823PMC
July 2021

Role of POC INR in the early stage of diagnosis of coagulopathy.

Pract Lab Med 2021 Aug 23;26:e00238. Epub 2021 May 23.

Department of Anaesthesiology, Intensive Care Medicine and Emergency Medicine, Asklepios Clinics Hamburg, AK Wandsbek, Alphonsstraße 14, 22043, Hamburg, Germany.

Background: Acute bleeding requires fast and targeted therapy. Therefore, knowledge of the patient's potential to form a clot is crucial. Point-of-care testing (POCT) provides fast and reliable information on coagulation. Structural circumstances, such as person-bound sample transport, can prolong the reporting of the results. The aim of the present study was to investigate the diagnostic quality and accuracy between POCT INR diagnostics and standard laboratory analysis (SLA) as well as the time advantage between a pneumatic tube and a personal-based transport system.

Methods: Two groups of haemorrhagic patients (EG: emergency department; OG: delivery room; each n = 12) were examined in the context of bleeding emergencies using POCT and SLA. Samples were transported via a pneumatic tube system or by a personal transport service.

Results: INR results between POCT and SLA showed a high and significant correlation (EG: p < 0.001; OG: p < 0.001). POCT results were reported significantly more quickly (EG: 1.1 vs. 39.6 min; OG: 2.0 vs. 75.0 min; p < 0.001) and required less time for analysis (EG: 0.3 vs. 24.0 min; OG: 0.5 vs. 45.0 min; p < 0.001) compared to SLA. The time for transportation with the pneumatic tube was significantly shorter (8.0 vs. 18.5 min; p < 0.001) than with the personal-based transport system.

Conclusion: The results of the present study suggest that POCT may be a suitable method for the emergency diagnosis and may be used as prognostic diagnostic elements in haemotherapy algorithms to initiate targeted haemotherapy at an early point in time.
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http://dx.doi.org/10.1016/j.plabm.2021.e00238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167296PMC
August 2021

The impact of timing of intravenous iron supplementation on preoperative haemoglobin in patients scheduled for major surgery.

Blood Transfus 2021 May 26. Epub 2021 May 26.

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Germany.

Background: Anaemia is frequent and an independent risk factor for morbidity and mortality in patients undergoing surgery. Iron deficiency (ID) is the main cause for anaemia and can be corrected by intravenous (IV) iron. The aim of this study was to investigate the timing of preoperative IV iron supplementation on preoperative haemoglobin (Hb) level.

Materials And Methods: Surgical patients were screened for the presence of anaemia and ID from November 2015 to January 2020. In case of ID or iron deficiency anaemia (IDA), patients received IV iron supplementation. The timing of IV iron supplementation on preoperative Hb level was analysed by days and time frames clustered by 5 days before surgery.

Results: In total, 404 patients with IV iron supplementation were analysed. In all patients, IV iron was administered with a median (interquartile range [IQR]) of 3.0 (1.0; 9.0) days before surgery. Preoperative Hb level increased steadily starting from 6 days (0.13 [±1.2] g/dL) until 16 days before surgery (1.75 [±1.1] g/dL). Group comparison revealed a median preoperative Hb change of -0.2 (-0.5; 0.2) g/dL for days 1-5, 0.2 (0.0; 0.7) g/dL for days 6-10, 0.7 (0.2; 1.1) g/dL for days 11-15, 0.7 (0.2; 1.8) g/dL for days 16-20, 0.9 (0.3; 1.7) g/dL for days 21-25, 1.5 (0.4; 2.6) g/dL for days 26-30, and 0.6 (0.0; 1.7) g/dL for >31 days. Three patients received multiple administrations of IV iron which resulted in an increase in Hb of >4 g/dL.

Discussion: Supplementation of IV iron to increase Hb concentration preoperatively may be most effective if administered at least ten days before surgery.
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http://dx.doi.org/10.2450/2021.0058-21DOI Listing
May 2021

The multisystem inflammatory syndrome in children and its association to SARS-CoV-2.

Curr Opin Anaesthesiol 2021 Aug;34(4):521-529

Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.

Purpose Of Review: Multisystem inflammatory syndrome in children (MIS-C)/pediatric inflammatory multisystem syndrome (PIMS) is a new and serious disease that occurs in temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We describe the clinical presentation, diagnosis, and treatment recommendations.

Recent Finding: To date, no randomized prospective studies have been published; recommendations are based on some observational studies, case reports, and expert opinions. The article provides an overview of the most important publications, presents the current results of the German Registry for PIMS and expert recommendations for treatment.

Summary: MIS-C PIMS is a new syndrome that is associated with a variety of virus infections, and also with SARS-CoV-2. The main characteristics are fever, multiple organ dysfunction due to a hyper-inflammatory state. In particular, cardiac dysfunction and severe shock. A high proportion of patients require intensive medical care, but the absolute number of children with SARS-CoV-2 MIS-C is low. Medical therapy is based on pathophysiologic considerations and is not evidence-based. Immunoglobulins, steroids and biologics are used and lead to effective treatment. Therefore, the mortality rate is very low. Patients usually recover within days, sequelae are reported only in a minority of cases.
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http://dx.doi.org/10.1097/ACO.0000000000001024DOI Listing
August 2021

Current concepts in the evaluation and management of preoperative anemia.

Curr Opin Anaesthesiol 2021 Jun;34(3):352-356

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt.

Purpose Of Review: In the past years, patient blood management (PBM) has evolved to improve patient's care and safety. Anemia is one of the most common medical diseases in the world and is an independent risk factor for morbidity and mortality. Iron deficiency is the main cause for anemia and constitutes a potentially preventable condition with a great impact on surgical outcome. However, preoperative anemia management is not yet established in most hospitals. Changing workflows and re-thinking is challenging. Numerous published studies confirmed the positive effect of preoperative anemia diagnosis and treatment recently.

Recent Findings: Iron supplementation in iron-deficient anemic (IDA) patients reduce the need for allogenic blood transfusion thereby improving perioperative outcome.

Summary: Since the introduction of PBM programs, important movements towards early detection and therapy of preoperative anemia have been observed. However, preoperative anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Preoperative anemia management, particularly iron supplementation in IDA patients, has proven to be highly effective and has a tremendous effect on patient safety and outcome.
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http://dx.doi.org/10.1097/ACO.0000000000000979DOI Listing
June 2021

Effects of an Animated Blood Clot Technology (Visual Clot) on the Decision-Making of Users Inexperienced in Viscoelastic Testing: Multicenter Trial.

J Med Internet Res 2021 05 3;23(5):e27124. Epub 2021 May 3.

Institute of Anesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Background: Viscoelastic test-guided coagulation management has become increasingly important in assessing hemostasis. We developed Visual Clot, an animated, 3D blood clot that illustrates raw rotational thromboelastometry (ROTEM) parameters in a user-centered and situation awareness-oriented method.

Objective: This study aimed to evaluate the applicability of Visual Clot by examining its effects on users that are novices in viscoelastic-guided resuscitation.

Methods: We conducted an investigator-initiated, international, multicenter study between September 16, 2020, and October 6, 2020, in 5 tertiary care hospitals in central Europe. We randomly recruited medical students and inexperienced resident physicians without significant prior exposure to viscoelastic testing. The 7 participants per center managed 9 different ROTEM outputs twice, once as standard ROTEM tracings and once as the corresponding Visual Clot. We randomly presented the 18 viscoelastic cases and asked the participants for their therapeutic decisions. We assessed the performance, diagnostic confidence, and perceived workload in managing the tasks using mixed statistical models and adjusted for possible confounding factors.

Results: Analyzing a total of 630 results, we found that the participants solved more cases correctly (odds ratio [OR] 33.66, 95% CI 21.13-53.64; P<.001), exhibited more diagnostic confidence (OR 206.2, 95% CI 93.5-454.75; P<.001), and perceived less workload (coefficient -41.63; 95% CI -43.91 to -39.36; P<.001) using Visual Clot compared to using standard ROTEM tracings.

Conclusions: This study emphasizes the practical benefit of presenting viscoelastic test results in a user-centered way. Visual Clot may allow inexperienced users to be involved in the decision-making process to treat bleeding-associated coagulopathy. The increased diagnostic confidence, diagnostic certainty, reduced workload, and positive user feedback associated with this visualization may promote the further adoption of viscoelastic methods in diverse health care settings.
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http://dx.doi.org/10.2196/27124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129883PMC
May 2021

The visually estimated blood volume in scaled canisters based on a simulation study.

BMC Anesthesiol 2021 02 16;21(1):54. Epub 2021 Feb 16.

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.

Background: The most common technique used worldwide to quantify blood loss during an operation is the visual assessment by the attending intervention team. In every operating room you will find scaled suction canisters that collect fluids from the surgical field. This scaling is commonly used by clinicians for visual assessment of intraoperative blood loss. While many studies have been conducted to quantify and improve the inaccuracy of the visual estimation method, research has focused on the estimation of blood volume in surgical drapes. The question whether and how scaling of canisters correlates with actual blood loss and how accurately clinicians estimate blood loss in scaled canisters has not been the focus of research to date.

Methods: A simulation study with four "bleeding" scenarios was conducted using expired whole blood donations. After diluting the blood donations with full electrolyte solution, the sample blood loss volume (SBL) was transferred into suction canisters. The study participants then had to estimate the blood loss in all four scenarios. The difference to the reference blood loss (RBL) per scenario was analyzed.

Results: Fifty-three anesthetists participated in the study. The median estimated blood loss was 500 ml (IQR 300/1150) compared to the RBL median of 281.5 ml (IQR 210.0/1022.0). Overestimations up to 1233 ml were detected. Underestimations were also observed in the range of 138 ml. The visual estimate for canisters correlated moderately with RBL (Spearman's rho: 0.818; p < 0.001). Results from univariate nonparametric confirmation statistics regarding visual estimation of canisters show that the deviation of the visual estimate of blood loss is significant (z = - 10.95, p < 0.001, n = 220). Participants' experience level had no significant influence on VEBL (p = 0.402).

Conclusion: The discrepancies between the visual estimate of canisters and the actual blood loss are enormous despite the given scales. Therefore, we do not recommend estimating the blood loss visually in scaled suction canisters. Colorimetric blood loss estimation could be a more accurate option.
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http://dx.doi.org/10.1186/s12871-021-01265-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885508PMC
February 2021

Insight into ECMO, mortality and ARDS: a nationwide analysis of 45,647 ECMO runs.

Crit Care 2021 01 28;25(1):38. Epub 2021 Jan 28.

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.

Background: Extracorporeal life support (ECLS) has become an integral part of modern intensive therapy. The choice of support mode depends largely on the indication. Patients with respiratory failure are predominantly treated with a venovenous (VV) approach. We hypothesized that mortality in Germany in ECLS therapy did not differ from previously reported literature METHODS: Inpatient data from Germany from 2007 to 2018 provided by the Federal Statistical Office of Germany were analysed. The international statistical classification of diseases and related health problems codes (ICD) and process keys (OPS) for extracorporeal membrane oxygenation (ECMO) types, acute respiratory distress syndrome (ARDS) and hospital mortality were used.

Results: In total, 45,647 hospitalized patients treated with ECLS were analysed. In Germany, 231 hospitals provided ECLS therapy, with a median of 4 VV-ECMO and 9 VA-ECMO in 2018. Overall hospital mortality remained higher than predicted in comparison to the values reported in the literature. The number of VV-ECMO cases increased by 236% from 825 in 2007 to 2768 in 2018. ARDS was the main indication for VV-ECMO in only 33% of the patients in the past, but that proportion increased to 60% in 2018. VA-ECMO support is of minor importance in the treatment of ARDS in Germany. The age distribution of patients undergoing ECLS has shifted towards an older population. In 2018, the hospital mortality decreased in VV-ECMO patients and VV-ECMO patients with ARDS to 53.9% (n = 1493) and 54.4% (n = 926), respectively.

Conclusions: ARDS is a severe disease with a high mortality rate despite ECLS therapy. Although endpoints and timing of the evaluations differed from those of the CESAR and EOLIA studies and the Extracorporeal Life Support Organization (ELSO) Registry, the reported mortality in these studies was lower than in the present analysis. Further prospective analyses are necessary to evaluate outcomes in ECMO therapy at the centre volume level.
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http://dx.doi.org/10.1186/s13054-021-03463-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841040PMC
January 2021

Audit of international intraoperative hemotherapy and blood loss documentation on anesthetic records.

Minerva Anestesiol 2021 03 15;87(3):312-318. Epub 2020 Dec 15.

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

Background: Anesthetic records facilitate information transmission to the next healthcare professional and should contain all relevant information of perioperative care. While most anesthesia societies provide guidelines for record content, important topics like hemotherapy and hemostatic therapy are not well represented. We considered the quality of anesthetic records with regard to the documentation options for hemotherapy and hemostatic therapy. A secondary objective was to examine guidelines for appropriate recommendations.

Methods: Anesthetic records of international anesthesiology departments were evaluated for the presence of 20 defined fields associated with hemotherapy, hemostatic and fluid therapy as well as intraoperative diagnostics and monitoring. International guidelines were reviewed for appropriate recommendations.

Results: A total of 98 anesthetic records from eight countries and guidelines of six anesthesia societies were analyzed. Data fields for red blood cell transfusion have been found in 29.3% (95% CI 0.20 to 0.38), ABO-testing in 6.1% (95% CI 0.01 to 0.11) and indication for transfusion in 2.0% (CI 0.00 to 0.05) of records. Most records contain fields for blood loss (94.4%; 95% CI 0.91 to 0.99) and diuresis (87.9%; 95% CI 0.81 to 0.94). International guidelines that were analyzed do not cover the topic of transfusion, but most give recommendations on basic monitoring, blood loss and fluid management documentation.

Conclusions: Most of the evaluated anesthetic records did not contain fields for relevant aspects of perioperative hemotherapy, hemostatic therapy and diagnostics. Guidelines and protocols for anesthetic documentation should include these topics to ensure information transfer and patient safety.
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http://dx.doi.org/10.23736/S0375-9393.20.14828-4DOI Listing
March 2021

Implementation of an anaemia walk-in clinic: Feasibility and preliminary data from the Orthopedic University Hospital.

Transfus Med 2020 Dec 25;30(6):467-474. Epub 2020 Nov 25.

Department of Special Orthopedics, Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt, Germany.

Background: Approximately one in three patients suffers from preoperative anaemia. Even though haemoglobin is measured before surgery, anaemia management is not implemented in every hospital.

Objective: Here, we demonstrate the implementation of an anaemia walk-in clinic at an Orthopedic University Hospital. To improve the diagnosis of iron deficiency (ID), we examined whether reticulocyte haemoglobin (Ret-He) could be a useful additional parameter.

Material And Methods: In August 2019, an anaemia walk-in clinic was established. Between September and December 2019, major orthopaedic surgical patients were screened for preoperative anaemia. The primary endpoint was the incidence of preoperative anaemia. Secondary endpoints included Ret-He level, red blood cell (RBC) transfusion rate, in-hospital length of stay and anaemia at hospital discharge.

Results: A total of 104 patients were screened for anaemia. Preoperative anaemia rate was 20.6%. Intravenous iron was supplemented in 23 patients. Transfusion of RBC units per patient (1.7 ± 1.2 vs. 0.2 ± 0.9; p = 0.004) and hospital length of stay (13.1 ± 4.8 days vs. 10.6 ± 5.1 days; p = 0.068) was increased in anaemic patients compared to non-anaemic patients. Ret-He values were significantly lower in patients with ID anaemia (33.3 pg [28.6-40.2 pg]) compared to patients with ID (35.3 pg [28.9-38.6 pg]; p = 0.015) or patients without anaemia (35.4 pg [30.2-39.4 pg]; p = 0.001).

Conclusion: Preoperative anaemia is common in orthopaedic patients. Our results proved the feasibility of an anaemia walk-in clinic to manage preoperative anaemia. Furthermore, our analysis supports the use of Ret-He as an additional parameter for the diagnosis of ID in surgical patients.
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http://dx.doi.org/10.1111/tme.12740DOI Listing
December 2020

Changes in Transfusion Practice in Children and Adolescents over Time.

Transfus Med Hemother 2020 Oct 16;47(5):379-384. Epub 2020 Sep 16.

Department of Anaesthesia and Critical Care, University Hospitals of Würzburg, University of Würzburg, Würzburg, Germany.

Introduction: In recent years, resource-saving handling of allogeneic blood products and a reduction of transfusion rates in adults has been observed. However, comparable published national data for transfusion practices in pediatric patients are currently not available. In this study, the transfusion rates for children and adolescents were analyzed based on data from the Federal Statistical Office of Germany during the past 2 decades.

Methods: Data were queried via the database of the Federal Statistical Office (Destasis). The period covered was from 2005 to 2018, and those in the sample group were children and adolescents aged 0-17 years receiving inpatient care. Operation and procedure codes (OPS) for transfusions, procedures, or interventions with increased transfusion risk were queried and evaluated in detail.

Results: In Germany, 0.9% of the children and adolescents treated in hospital received a transfusion in 2018. A reduction in transfusion rates from 1.02% (2005) to 0.9% (2018) was observed for the total collective of children and adolescents receiving inpatient care. Increases in transfusion rates were recorded for 1- to 4- (1.41-1.45%) and 5- to 10-year-olds (1.24-1.33%). Children under 1 year of age were most frequently transfused (in 2018, 40.2% of the children were cared for in hospital). Transfusion-associated procedures such as chemotherapy or machine ventilation and respiratory support for newborns and infants are on the rise.

Conclusion: Transfusion rates are declining in children and adolescents, but the reasons for increases in transfusion rates in other groups are unclear. Prospective studies to evaluate transfusion rates and triggers in children are urgently needed.
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http://dx.doi.org/10.1159/000511231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588733PMC
October 2020

Airway management in a prehospital setting during the SARS-CoV-2 pandemic.

Anaesthesiol Intensive Ther 2020 ;52(4):341-343

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

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http://dx.doi.org/10.5114/ait.2020.100536DOI Listing
November 2020

Factors influencing the bias between blood gas analysis versus central laboratory hemoglobin testing. A secondary analysis of a randomized controlled trial.

PLoS One 2020 30;15(10):e0240721. Epub 2020 Oct 30.

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany.

Background: Anemia is the most important complication during major surgery and transfusion of red blood cells is the mainstay to compensate for life threating blood loss. Therefore, accurate measurement of hemoglobin (Hb) concentration should be provided in real-time. Blood Gas Analysis (BGA) provides rapid point-of-care assessment using smaller sampling tubes compared to central laboratory (CL) services.

Objective: This study aimed to investigate the accuracy of BGA hemoglobin testing as compared to CL services.

Methods: Data of the ongoing LIBERAL-Trial (Liberal transfusion strategy to prevent mortality and anemia-associated ischemic events in elderly non-cardiac surgical patients, LIBERAL) was used to assess the bias for Hb level measured by BGA devices (ABL800 Flex analyzer®, GEM series® and RapidPoint 500®) and CL as the reference method. For that, we analyzed pairs of Hb level measured by CL and BGA within two hours. Furthermore, the impact of various confounding factors including age, gender, BMI, smoker status, transfusion of RBC, intraoperative hemodilution, and co-medication was elucidated. In order to ensure adequate statistical analysis, only data of participating centers providing more than 200 Hb pairs were used.

Results: In total, three centers including 963 patients with 1,814 pairs of Hb measurements were analyzed. Mean bias was comparable between ABL800 Flex analyzer® and GEM series®: - 0.38 ± 0.15 g/dl whereas RapidPoint 500® showed a smaller bias (-0.09 g/dl) but greater median absolute deviation (± 0.45 g/dl). In order to avoid interference with different standard deviations caused by the different analytic devices, we focused on two centers using the same BGA technique (309 patients and 1,570 Hb pairs). A Bland-Altman analysis and LOWESS curve showed that bias decreased with smaller Hb values in absolute numbers but increased relatively. The smoker status showed the greatest reduction in bias (0.1 g/dl, p<0.001) whereas BMI (0.07 g/dl, p = 0.0178), RBC transfusion (0.06 g/dl, p<0.001), statins (0.04 g/dl, p<0.05) and beta blocker (0.03 g/dl, p = 0.02) showed a slight effect on bias. Intraoperative substitution of volume and other co-medications did not influence the bias significantly.

Conclusion: Many interventions like substitution of fluids, coagulating factors or RBC units rely on the accuracy of laboratory measurement devices. Although BGA Hb testing showed a consistently stable difference to CL, our data confirm that BGA devices are associated with different bias. Therefore, we suggest that hospitals assess their individual bias before implementing BGA as valid and stable supplement to CL. However, based on the finding that bias decreased with smaller Hb values, which in turn are used for transfusion decision, we expect no unnecessary or delayed RBC transfusion, and no major impact on the LIBERAL trial performance.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240721PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598475PMC
December 2020

Safety considerations for the use of Point-Of-Care diagnostics during SARS-CoV-2 pandemic.

J Clin Lab Anal 2021 Jan 22;35(1):e23631. Epub 2020 Oct 22.

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

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http://dx.doi.org/10.1002/jcla.23631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645901PMC
January 2021

Do we visually estimate intra-operative blood loss better with white or green sponges and is the deviation from the real blood loss clinically acceptable? Results from a simulated scenario study.

PLoS One 2020 21;15(10):e0240808. Epub 2020 Oct 21.

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

Background: The intraoperative blood loss is estimated daily in the operating room and is mainly done by visual techniques. Due to local standards, the surgical sponge colours can vary (e.g. white in US, green in Germany). The influence of sponge colour on accuracy of estimation has not been in the focus of research yet.

Material And Methods: A blood loss simulation study containing four "bleeding" scenarios each per sponge colour were created by using expired whole blood donation samples. The blood donations were applied to white and green surgical sponges after dilution with full electrolyte solution. Study participants had to estimate the absorbed blood loss in sponges in all scenarios. The difference to the reference blood loss was analysed. Multivariate linear regression analysis was performed to investigate other influence factors such as staff experience and sponge colour.

Results: A total of 53 anaesthesists participated in the study. Visual estimation correlated moderately with reference blood loss in white (Spearman's rho: 0.521; p = 3.748*10-16) and green sponges (Spearman's rho: 0.452; p = 4.683*10-12). The median visually estimated blood loss was higher in white sponges (250ml IRQ 150-412.5ml) than in green sponges (150ml IQR 100-300ml), compared to reference blood loss (103ml IQR 86-162.8). For both colour types of sponges, major under- and overestimation was observed. The multivariate statistics demonstrates that fabric colours have a significant influence on estimation (p = 3.04*10-10), as well as clinician's qualification level (p = 2.20*10-10, p = 1.54*10-08) and amount of RBL to be estimated (p < 2*10-16).

Conclusion: The deviation of correct blood loss estimation was smaller with white surgical sponges compared to green sponges. In general, deviations were so severe for both types of sponges, that it appears to be advisable to refrain from visually estimating blood loss whenever possible and instead to use other techniques such as e.g. colorimetric estimation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240808PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577479PMC
December 2020

Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis.

J Clin Monit Comput 2021 Apr 19;35(2):245-258. Epub 2020 Aug 19.

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.

Estimating intraoperative blood loss is one of the daily challenges for clinicians. Despite the knowledge of the inaccuracy of visual estimation by anaesthetists and surgeons, this is still the mainstay to estimate surgical blood loss. This review aims at highlighting the strengths and weaknesses of currently used measurement methods. A systematic review of studies on estimation of blood loss was carried out. Studies were included investigating the accuracy of techniques for quantifying blood loss in vivo and in vitro. We excluded nonhuman trials and studies using only monitoring parameters to estimate blood loss. A meta-analysis was performed to evaluate systematic measurement errors of the different methods. Only studies that were compared with a validated reference e.g. Haemoglobin extraction assay were included. 90 studies met the inclusion criteria for systematic review and were analyzed. Six studies were included in the meta-analysis, as only these were conducted with a validated reference. The mixed effect meta-analysis showed the highest correlation to the reference for colorimetric methods (0.93 95% CI 0.91-0.96), followed by gravimetric (0.77 95% CI 0.61-0.93) and finally visual methods (0.61 95% CI 0.40-0.82). The bias for estimated blood loss (ml) was lowest for colorimetric methods (57.59 95% CI 23.88-91.3) compared to the reference, followed by gravimetric (326.36 95% CI 201.65-450.86) and visual methods (456.51 95% CI 395.19-517.83). Of the many studies included, only a few were compared with a validated reference. The majority of the studies chose known imprecise procedures as the method of comparison. Colorimetric methods offer the highest degree of accuracy in blood loss estimation. Systems that use colorimetric techniques have a significant advantage in the real-time assessment of blood loss.
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http://dx.doi.org/10.1007/s10877-020-00579-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943515PMC
April 2021

Total Intravenous Anesthesia in Joubert Syndrome Patient for Otorhinolaryngology Surgery: A Case Report and Mini Review of the Literature.

Am J Case Rep 2020 Aug 7;21:e923018. Epub 2020 Aug 7.

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

BACKGROUND Joubert syndrome is a rare autosomal recessive disorder first described in 1969, with an estimated prevalence of 1 in 100 000. Joubert syndrome is characterized by partial or complete agenesis of the cerebellar vermis - the structure that connects both parts of the cerebellum. This results in the main clinical symptoms, such as muscular hypotonia, ataxia, mental retardation, abnormal eye movements, and a central apnea breathing pattern. Joubert syndrome can combine neurological signs with variable multi-organ involvement, mainly of the retina, kidneys, liver, and musculoskeletal system. CASE REPORT A 13-year-old boy presenting with recurrent otitis media, fever, respiratory infections, and tonsillar hyperplasia needed surgery. At the otorhinolaryngology outpatient clinic, the indication for surgical paracentesis, adenoidectomy, and tonsillectomy under general anesthesia (first in his life) was set. We performed a total intravenous anesthesia (TIVA) using propofol (described as safe) and remifentanil (organ-independent metabolism) without any side-effects. For postoperative pain therapy we used metamizole instead of paracetamol in order to avoid liver injury. CONCLUSIONS Due to the possible facial dysmorphism we recommend a critical evaluation of the airway to assess a potential difficult airway preoperatively. Our case underlines that TIVA, with the medications used in this case, is safe. We refrained from premedication in order not to trigger central apnea. For safety reasons, all preparatory procedures were carried out in the recovery room under monitor surveillance and with audio-visual distraction for the patient in order to reduce the stress level. For postoperative pain therapy, we recommend the use of metamizole.
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http://dx.doi.org/10.12659/AJCR.923018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440750PMC
August 2020

Quantification of Intraoperative Blood Loss in a Simulated Scenario Using a Novel Device.

Shock 2021 06;55(6):759-765

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

Background: Particularly for protracted bleeding situations, the realization of a relevant blood loss is necessary for early initiation of therapy to avoid hemodynamic instability and shock. The frequently used visual assessment of blood loss is known to be incorrect. An innovative option to address this problem is a mobile application using colorimetric image correction and analysis.

Methods: The objective of this study was to evaluate the clinical applicability and accuracy of a novel mobile device application using colorimetric image correction and analysis for blood loss estimation. Scenarios of blood-filled surgical sponges were created to evaluate the accuracy of colorimetric-based blood loss estimation and visual and gravimetric blood loss estimation.

Results: Fifty-three anesthesiologists ran through the scenarios. The estimated blood loss correlated the least with the reference blood loss in the visual technique (Rho: 0.52; P < 3.7×10-16), followed by the gravimetric technique (Rho: 0.73; P = 2.8×10-05). The best correlation was found in the colorimetric blood loss measurement (Rho: 0.77; P = 3.53×10-06). A median overestimation per scenario of 133.0 mL (interquartile range [IQR] 33.0 mL-283.0 mL) was observed when using the visual method, whereas 32.5 mL (IQR 10.8 mL-44.0 mL) was overestimated with the gravimetric method and 31 mL (IQR 17.0 mL-42.8 mL) with the colorimetric method. Especially in the case of blood loss underestimation, the application has the least deviation from the reference.

Conclusion: The blood loss measured in the sponges correlated strong with the reference blood loss, showing the smallest median overestimation and the smallest deviation in underestimation. The visual estimation shows serious errors, where the gravimetric method is prone to errors, especially in dilution. The colorimetric method offers an easily implementable possibility to monitor blood loss in real time and to initiate early diagnostic and therapeutic measures in case of persistent blood loss. The influence of real-time estimation of colorimetric blood loss on transfusion decisions should be the subject of future studies.
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http://dx.doi.org/10.1097/SHK.0000000000001615DOI Listing
June 2021

Changes in transfusion and fluid therapy practices in severely injured children: an analysis of 5118 children from the TraumaRegister DGU®.

Eur J Trauma Emerg Surg 2020 Jun 29. Epub 2020 Jun 29.

Department of Anaesthesia and Critical Care, University Hospital Würzburg, Würzburg, Germany.

Purpose: Trauma is the leading cause of death in children. In adults, blood transfusion and fluid resuscitation protocols changed resulting in a decrease of morbidity and mortality over the past 2 decades. Here, transfusion and fluid resuscitation practices were analysed in severe injured children in Germany.

Methods: Severely injured children (maximum Abbreviated Injury Scale (AIS) ≥ 3) admitted to a certified trauma-centre (TraumaZentrum DGU®) between 2002 and 2017 and registered at the TraumaRegister DGU® were included and assessed regarding blood transfusion rates and fluid therapy.

Results: 5,118 children (aged 1-15 years) with a mean ISS 22 were analysed. Blood transfusion rates administered until ICU admission decreased from 18% (2002-2005) to 7% (2014-2017). Children who are transfused are increasingly seriously injured. ISS has increased for transfused children aged 1-15 years (2002-2005: mean 27.7-34.4 in 2014-2017). ISS in non-transfused children has decreased in children aged 1-15 years (2002-2005: mean 19.6 to mean 17.6 in 2014-2017). Mean prehospital fluid administration decreased from 980 to 549 ml without affecting hemodynamic instability.

Conclusion: Blood transfusion rates and amount of fluid resuscitation decreased in severe injured children over a 16-year period in Germany. Restrictive blood transfusion and fluid management has become common practice in severe injured children. A prehospital restrictive fluid management strategy in severely injured children is not associated with a worsened hemodynamic state, abnormal coagulation or base excess but leads to higher hemoglobin levels.
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http://dx.doi.org/10.1007/s00068-020-01423-zDOI Listing
June 2020

Hemostatis Analyzer-Supported Hemotherapy Algorithm in Cardiac Surgery: Protocol for a Randomized Controlled Monocentric Trial.

JMIR Res Protoc 2020 Apr 21;9(4):e17206. Epub 2020 Apr 21.

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.

Background: Point of care devices for performing targeted coagulation substitution in patients who are bleeding have become increasingly important in recent years. New on the market is the Quantra. It is a device that uses sonorheometry, a sonic estimation of elasticity via resonance, which is a novel ultrasound-based technology that measures viscoelastic properties of whole blood. Several studies have already shown the comparability of the Quantra with devices already established on the market, such as the rotational thromboelastometry (ROTEM) device.

Objective: In contrast to existing studies, this study is the first prospective interventional study using this new system in a cardiac surgical patient cohort. We will investigate the noninferiority between an already existing coagulation algorithm based on the ROTEM/Multiplate system and a new algorithm based on the Quantra system for the treatment of coagulopathic cardiac surgical patients.

Methods: The study is divided into two phases. In an initial observation phase, whole blood samples of 20 patients obtained at three defined time points (prior to surgery, after completion of cardiopulmonary bypass, and on arrival in the intensive care unit) will be analyzed using both the ROTEM/Multiplate and Quantra systems. The obtained threshold values will be used to develop a novel algorithm for hemotherapy. In a second intervention phase, the new algorithm will be tested for noninferiority against an algorithm used routinely for years in our department.

Results: The main objective of the examination is the cumulative loss of blood within 24 hours after surgery. Statistical calculations based on the literature and in-house data suggest that the new algorithm is not inferior if the difference in cumulative blood loss is <150 mL/24 hours.

Conclusions: Because of the comparability of the Quantra sonorheometry system with the ROTEM measurement methods, the existing hemotherapy treatment algorithm can be adapted to the Quantra device with proof of noninferiority.

Trial Registration: ClinicalTrials.gov NCT03902275; https://clinicaltrials.gov/ct2/show/NCT03902275.

International Registered Report Identifier (irrid): DERR1-10.2196/17206.
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http://dx.doi.org/10.2196/17206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201313PMC
April 2020

Influence of temperature on volume, weight and density changes of i-gel masks.

Anaesthesiol Intensive Ther 2020 ;52(2):119-125

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.

Background: The i-gel mask is a second-generation, single-use supraglottic airway device which does not have an inflatable cuff. The cuff consists of a thermoplastic elastomer and its mechanism of sealing still remains unclear. Various theories such as temperature-dependent changes in hardness and volume expansion as well as fluid absorption have been discussed. The aim of the present study is to investigate changes in volume, weight and density caused by temperature changes.

Material And Methods: Three i-gel masks (sizes 3, 4 and 5) were heated in a water bath from 10°C to 50°C in 5°C steps. The changes in weight, volume, and density were measured at each temperature step. In a second study, the identical parameters of masks (n = 5 of sizes 3, 4 and 5) used in patients were investigated. Results of volume and density between benchtop and patient measurements were examined for correlation.

Results: All masks investigated, regardless of the size, showed a significant linear temperature-dependent volume expansion (sizes 3, 4 and 5: P < 0.001), a weight increase (sizes 3: P = 0.018; 4: P = 0.027; and 5: P = 0.006) and a linear decrease in density (sizes 3, 4 and 5: P < 0.001). There was a very strong correlation between the results of benchtop and patient measurements (volume: P < 0.001; density: P < 0.001).

Conclusions: We observed significant changes in all three properties investigated. Thus, a temperature-dependent volume expansion and weight increasement was observed, which can be considered as a further explanation for improved sealing after insertion.
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http://dx.doi.org/10.5114/ait.2020.93416DOI Listing
July 2021

Continuous lateral rotational therapy in trauma-A systematic review and meta-analysis.

J Trauma Acute Care Surg 2017 11;83(5):926-933

From the University Witten/Herdecke, Medical Centre Cologne-Merheim, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany.

Background: The purpose of this study was to evaluate the impact of continuous lateral rotational therapy (CLRT) on respiratory complications and mortality in patients suffering from trauma.

Methods: The literature databases PubMed®/Medline® and the Cochrane Library® were systematically searched for prospective controlled trials comparing continuous lateral rotational therapy to conventional manual positioning in trauma patients.

Results: A total of 8 publications (n= 422 patients) with comparable age and injury severity were included in the meta-analysis. A significant reduction in the incidence of nosocomial pneumonia (OR: 0.33, [95%CI: 0.17, 0.65], p=0.001) was observed in patients treated prophylactically with continuous lateral rotational therapy. When used with therapeutic intention, CLRT had no impact on the incidence of pneumonia. There were no significant differences in mortality, duration of mechanical ventilation, or ICU length of stay.

Conclusions: Analogous to studies evaluating CLRT in medical or mixed patient collectives, CLRT reduced the rates of nosocomial pneumonia in trauma patients. This, however, had no impact on overall mortality. The level of evidence of the studies included was limited by several factors. An adequately powered, well-designed multi-centre randomised controlled trial is required, to validly assess the utility of CLRT for the prevention and treatment of pulmonary complications in patients suffering from trauma.

Level Of Evidence: Systematic review and meta-analysis, level III.
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http://dx.doi.org/10.1097/TA.0000000000001572DOI Listing
November 2017

Quality of handover in a pediatric postanesthesia care unit.

Paediatr Anaesth 2015 Jul 2;25(7):746-52. Epub 2015 Apr 2.

Department of Pediatric Anesthesiology, Children's Hospital of Cologne, Köln/Cologne, Germany.

Background: The quality of anesthetic handovers to postanesthesia care units (PACU) is known to be poor in adults, and only very limited reports are available regarding the quality of handovers in pediatric anesthesia. In particular, it is not known which and in what quality information is communicated. This current study investigated, therefore, the presence of any handover component as well as its consistency in a pediatric postanesthesia care unit.

Methods: This prospective observational study evaluated postoperative anesthetic handovers to a pediatric PACU using a detailed checklist, comprising 55 possible items. The main outcome measure was the proportion of information verbally transmitted in relation to the written documentation within the anesthesia record.

Results: Four hundred and forty-three handovers were observed with two handovers excluded due to missing data. Type of surgery (93% [95% CI 91-95]) and any intra-operative regional anesthesia (89% [95% CI 85-94]) were most frequently communicated. Items such as ASA-PS (3% [95% CI 2-5]) and fluid management (4% of cases [95% CI 2-6]) were rarely handed over. Eleven of the 55 items contained within the checklist were communicated in more than 70% of patients.

Conclusions: The observed handovers to PACU staff were incomplete and missing important information. However, omission of essential information potentially compromises patient safety. A standardized universal mandatory handover protocol following pediatric anesthesia is required.
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http://dx.doi.org/10.1111/pan.12646DOI Listing
July 2015
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