Publications by authors named "Jan F Heuer"

4 Publications

  • Page 1 of 1

Can breathing circuit filters help prevent the spread of influenza A (H1N1) virus from intubated patients?

GMS Hyg Infect Control 2013 29;8(1):Doc09. Epub 2013 Apr 29.

Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Centre Göttingen, Göttingen, Germany.

Introduction: In March 2010, more than 213 countries worldwide reported laboratory confirmed cases of influenza H1N1 infections with at least 16,813 deaths. In some countries, roughly 10 to 30% of the hospitalized patients were admitted to the ICU and up to 70% of those required mechanical ventilation. The question now arises whether breathing system filters can prevent virus particles from an infected patient from entering the breathing system and passing through the ventilator into the ambient air. We tested the filters routinely used in our institution for their removal efficacy and efficiency for the influenza virus A H1N1 (A/PR/8/34).

Methods: Laboratory investigation of three filters (PALL Ultipor(®) 25, Ultipor(®) 100 and Pall BB50T Breathing Circuit Filter, manufactured by Pall Life Sciences) using a monodispersed aerosol of human influenza A (H1N1) virus in an air stream model with virus particles quantified as cytopathic effects in cultured canine kidney cells (MDCK).

Results: The initial viral load of 7.74±0.27 log10 was reduced to a viral load of ≤2.43 log10, behind the filter. This represents a viral filtration efficiency of ≥99.9995%.

Conclusion: The three tested filters retained the virus input, indicating that their use in the breathing systems of intubated and mechanically ventilated patients can reduce the risk of spreading the virus to the breathing system and the ambient air.
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http://dx.doi.org/10.3205/dgkh000209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746606PMC
August 2013

Incidence of difficult intubation in intensive care patients: analysis of contributing factors.

Anaesth Intensive Care 2012 Jan;40(1):120-7

Department of Anesthesiology, University of Göttingen Medical School, Göttingen, Germany.

Difficulties in endotracheal intubation increase morbidity and mortality in intensive care patients. We studied the problem in surgical intensive care patients with the aim of risk reduction. Patients intubated in the intensive care unit were evaluated. The intubations were performed or supervised by anaesthetists following the algorithm valid at the time of the study. Fifty percent of the 198 intubations were performed by specialist anaesthetists, 41.5% by anaesthesia trainees and 8.5% by surgical trainees. The initial attempt was by direct laryngoscopy (n=173), flexible fibrescope (n=8) or blind nasal technique (n=17). When direct laryngoscopy failed (n=7), intubation was accomplished with an intubating laryngeal mask airway (n=5), Frova stylet (n=1) or fibrescope (n=1). Thirty percent were rated as easy, 47% as moderately easy and 23% as difficult. Difficult intubations were associated with a higher incidence of anatomic anomalies, difficult bag-mask ventilation and severe oxygen desaturation. Every intubation in the ICU setting should be considered potentially difficult. The existing algorithm should be modified to incorporate the American Society of Anesthesiologists difficult airway algorithm adapted to the needs of the intensive care unit. A training program for alternative methods of airway management for difficult intubations should be established.
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http://dx.doi.org/10.1177/0310057X1204000113DOI Listing
January 2012

Characteristics and outcome of prehospital paediatric tracheal intubation attended by anaesthesia-trained emergency physicians.

Resuscitation 2009 Dec 4;80(12):1371-7. Epub 2009 Oct 4.

Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Centre, 37075 Göttingen, Germany.

Aim: To collect data regarding prehospital paediatric tracheal intubation by emergency physicians skilled in advanced airway management.

Methods: A prospective 8-year observational study of a single emergency physician-staffed emergency medical service. Self-reporting by emergency physicians of all children aged 0-14 years who had prehospital tracheal intubation and were attended by either anaesthesia-trained emergency physicians (group 1) or by a mixture of anaesthesia and non-anaesthesia-trained emergency physicians (group 2).

Results: Eighty-two out of 2040 children (4.0%) had prehospital tracheal intubation (58 in group 1). The most common diagnoses were trauma (50%; in school children, 73.0%), convulsions (13.4%) and SIDS (12.2%; in infants, 58.8%). The overall tracheal intubation success rate was 57 out of 58 attempts (98.3%). Compared to older children, infants had a higher number of Cormack-Lehane scores of 3 or 4, "difficult to intubate" status (both 3 out of 13; 23.1%) and a lower first attempt success rate for tracheal intubation (p=0.04). Among all 82 children 71 (86.6%) survived to hospital admission and 63 (76.8%) to discharge. Of the 63 survivors, 54 (85.7%) demonstrated a favourable or unchanged neurological outcome (PCPC 1-3). The survival and neurological outcomes of infants were inferior compared to older children (p<0.001). On average an emergency physician performed one prehospital tracheal intubation in 3 years in a child and one in 13 years in an infant.

Conclusions: Anaesthesia-trained emergency physicians working in our system report high success rates for prehospital tracheal intubation in children. Survival and neurological outcomes were considerably better than reported in previous studies.
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http://dx.doi.org/10.1016/j.resuscitation.2009.09.004DOI Listing
December 2009

Characteristics of out-of-hospital paediatric emergencies attended by ambulance- and helicopter-based emergency physicians.

Resuscitation 2009 Aug 10;80(8):888-92. Epub 2009 Jun 10.

Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Centre Göttingen, 37075 Gottingen, Germany.

Background: In Germany, as in many other countries, for the vast majority of cases, critical out-of-hospital (OOH) paediatric emergencies are attended by non-specialised emergency physicians (EPs). As it is assumed that this may lead to deficient service we aimed to gather robust data on the characteristics of OOH paediatric emergencies.

Methods: We retrospectively evaluated all OOH paediatric emergencies (0-14 years) within a 9-year period and attended by physician-staffed ground- or helicopter-based emergency medical service (EMS or HEMS) teams from our centre.

Results: We identified 2271 paediatric emergencies, making up 6.3% of all cases (HEMS 8.5%). NACA scores IV-VII were assigned in 27.3% (HEMS 32.0%). The leading diagnosis groups were age dependent: respiratory disorders (infants 34.5%, toddlers 21.8%, school children 15.0%), convulsions (17.2%, 43.2%, and 16.0%, respectively), and trauma (16.0%, 19.5%, and 44.4%, respectively). Endotracheal intubation was performed in 4.2% (HEMS 7.6%) and intraosseous canulation in 0.7% (HEMS 1.0%) of children. Cardiopulmonary resuscitation (CPR) was commenced in 2.3% (HEMS 3.4%). Thoracocentesis, chest drain insertion and defibrillation were rarities. HEMS physicians attended a particularly high fraction of drowning (80.0%), head injury (73.9%) and SIDS (60.0%) cases, whereas 75.6% of all respiratory emergencies were attended by ground-based EPs.

Conclusions: Our data suggest that EPs need to be particularly confident with the care of children suffering respiratory disorders, convulsions, and trauma. The incidence of severe paediatric OOH emergencies requiring advanced interventions is higher in HEMS-attended cases. However, well-developed skills in airway management, CPR, and intraosseous canulation in children are essential for all EPs.
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http://dx.doi.org/10.1016/j.resuscitation.2009.05.008DOI Listing
August 2009