Publications by authors named "Thijs C D Rettig"

16 Publications

  • Page 1 of 1

Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome.

Crit Care Explor 2021 Oct 14;3(10):e0555. Epub 2021 Oct 14.

Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.

Objectives: As coronavirus disease 2019 is a novel disease, treatment strategies continue to be debated. This provides the intensive care community with a unique opportunity as the population of coronavirus disease 2019 patients requiring invasive mechanical ventilation is relatively homogeneous compared with other ICU populations. We hypothesize that the novelty of coronavirus disease 2019 and the uncertainty over its similarity with noncoronavirus disease 2019 acute respiratory distress syndrome resulted in substantial practice variation between hospitals during the first and second waves of coronavirus disease 2019 patients.

Design: Multicenter retrospective cohort study.

Setting: Twenty-five hospitals in the Netherlands from February 2020 to July 2020, and 14 hospitals from August 2020 to December 2020.

Patients: One thousand two hundred ninety-four critically ill intubated adult ICU patients with coronavirus disease 2019 were selected from the Dutch Data Warehouse. Patients intubated for less than 24 hours, transferred patients, and patients still admitted at the time of data extraction were excluded.

Measurements And Main Results: We aimed to estimate between-ICU practice variation in selected ventilation parameters (positive end-expiratory pressure, Fio, set respiratory rate, tidal volume, minute volume, and percentage of time spent in a prone position) on days 1, 2, 3, and 7 of intubation, adjusted for patient characteristics as well as severity of illness based on Pao/Fio ratio, pH, ventilatory ratio, and dynamic respiratory system compliance during controlled ventilation. Using multilevel linear mixed-effects modeling, we found significant ( ≤ 0.001) variation between ICUs in all ventilation parameters on days 1, 2, 3, and 7 of intubation for both waves.

Conclusions: This is the first study to clearly demonstrate significant practice variation between ICUs related to mechanical ventilation parameters that are under direct control by intensivists. Their effect on clinical outcomes for both coronavirus disease 2019 and other critically ill mechanically ventilated patients could have widespread implications for the practice of intensive care medicine and should be investigated further by causal inference models and clinical trials.
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http://dx.doi.org/10.1097/CCE.0000000000000555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522869PMC
October 2021

Rapid Evaluation of Coronavirus Illness Severity (RECOILS) in intensive care: Development and validation of a prognostic tool for in-hospital mortality.

Acta Anaesthesiol Scand 2021 Oct 8. Epub 2021 Oct 8.

Intensive Care, Reinier de Graaf Gasthuis, Delft, The Netherlands.

Background: The prediction of in-hospital mortality for ICU patients with COVID-19 is fundamental to treatment and resource allocation. The main purpose was to develop an easily implemented score for such prediction.

Methods: This was an observational, multicenter, development, and validation study on a national critical care dataset of COVID-19 patients. A systematic literature review was performed to determine variables possibly important for COVID-19 mortality prediction. Using a logistic multivariable model with a LASSO penalty, we developed the Rapid Evaluation of Coronavirus Illness Severity (RECOILS) score and compared its performance against published scores.

Results: Our development (validation) cohort consisted of 1480 (937) adult patients from 14 (11) Dutch ICUs admitted between March 2020 and April 2021. Median age was 65 (65) years, 31% (26%) died in hospital, 74% (72%) were males, average length of ICU stay was 7.83 (10.25) days and average length of hospital stay was 15.90 (19.92) days. Age, platelets, PaO2/FiO2 ratio, pH, blood urea nitrogen, temperature, PaCO2, Glasgow Coma Scale (GCS) score measured within +/-24 h of ICU admission were used to develop the score. The AUROC of RECOILS score was 0.75 (CI 0.71-0.78) which was higher than that of any previously reported predictive scores (0.68 [CI 0.64-0.71], 0.61 [CI 0.58-0.66], 0.67 [CI 0.63-0.70], 0.70 [CI 0.67-0.74] for ISARIC 4C Mortality Score, SOFA, SAPS-III, and age, respectively).

Conclusions: Using a large dataset from multiple Dutch ICUs, we developed a predictive score for mortality of COVID-19 patients admitted to ICU, which outperformed other predictive scores reported so far.
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http://dx.doi.org/10.1111/aas.13991DOI Listing
October 2021

The Dutch Data Warehouse, a multicenter and full-admission electronic health records database for critically ill COVID-19 patients.

Crit Care 2021 08 23;25(1):304. Epub 2021 Aug 23.

Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands.

Background: The Coronavirus disease 2019 (COVID-19) pandemic has underlined the urgent need for reliable, multicenter, and full-admission intensive care data to advance our understanding of the course of the disease and investigate potential treatment strategies. In this study, we present the Dutch Data Warehouse (DDW), the first multicenter electronic health record (EHR) database with full-admission data from critically ill COVID-19 patients.

Methods: A nation-wide data sharing collaboration was launched at the beginning of the pandemic in March 2020. All hospitals in the Netherlands were asked to participate and share pseudonymized EHR data from adult critically ill COVID-19 patients. Data included patient demographics, clinical observations, administered medication, laboratory determinations, and data from vital sign monitors and life support devices. Data sharing agreements were signed with participating hospitals before any data transfers took place. Data were extracted from the local EHRs with prespecified queries and combined into a staging dataset through an extract-transform-load (ETL) pipeline. In the consecutive processing pipeline, data were mapped to a common concept vocabulary and enriched with derived concepts. Data validation was a continuous process throughout the project. All participating hospitals have access to the DDW. Within legal and ethical boundaries, data are available to clinicians and researchers.

Results: Out of the 81 intensive care units in the Netherlands, 66 participated in the collaboration, 47 have signed the data sharing agreement, and 35 have shared their data. Data from 25 hospitals have passed through the ETL and processing pipeline. Currently, 3464 patients are included in the DDW, both from wave 1 and wave 2 in the Netherlands. More than 200 million clinical data points are available. Overall ICU mortality was 24.4%. Respiratory and hemodynamic parameters were most frequently measured throughout a patient's stay. For each patient, all administered medication and their daily fluid balance were available. Missing data are reported for each descriptive.

Conclusions: In this study, we show that EHR data from critically ill COVID-19 patients may be lawfully collected and can be combined into a data warehouse. These initiatives are indispensable to advance medical data science in the field of intensive care medicine.
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http://dx.doi.org/10.1186/s13054-021-03733-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381710PMC
August 2021

Early high-dose vitamin C in post-cardiac arrest syndrome (VITaCCA): study protocol for a randomized, double-blind, multi-center, placebo-controlled trial.

Trials 2021 Aug 18;22(1):546. Epub 2021 Aug 18.

Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.

Background: High-dose intravenous vitamin C directly scavenges and decreases the production of harmful reactive oxygen species (ROS) generated during ischemia/reperfusion after a cardiac arrest. The aim of this study is to investigate whether short-term treatment with a supplementary or very high-dose intravenous vitamin C reduces organ failure in post-cardiac arrest patients.

Methods: This is a double-blind, multi-center, randomized placebo-controlled trial conducted in 7 intensive care units (ICUs) in The Netherlands. A total of 270 patients with cardiac arrest and return of spontaneous circulation will be randomly assigned to three groups of 90 patients (1:1:1 ratio, stratified by site and age). Patients will intravenously receive a placebo, a supplementation dose of 3 g of vitamin C or a pharmacological dose of 10 g of vitamin C per day for 96 h. The primary endpoint is organ failure at 96 h as measured by the Resuscitation-Sequential Organ Failure Assessment (R-SOFA) score at 96 h minus the baseline score (delta R-SOFA). Secondary endpoints are a neurological outcome, mortality, length of ICU and hospital stay, myocardial injury, vasopressor support, lung injury score, ventilator-free days, renal function, ICU-acquired weakness, delirium, oxidative stress parameters, and plasma vitamin C concentrations.

Discussion: Vitamin C supplementation is safe and preclinical studies have shown beneficial effects of high-dose IV vitamin C in cardiac arrest models. This is the first RCT to assess the clinical effect of intravenous vitamin C on organ dysfunction in critically ill patients after cardiac arrest.

Trial Registration: ClinicalTrials.gov NCT03509662. Registered on April 26, 2018. https://clinicaltrials.gov/ct2/show/NCT03509662 European Clinical Trials Database (EudraCT): 2017-004318-25. Registered on June 8, 2018. https://www.clinicaltrialsregister.eu/ctr-search/trial/2017-004318-25/NL.
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http://dx.doi.org/10.1186/s13063-021-05483-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8371424PMC
August 2021

[Adenotonsillectomy with or without intubation? Safety of the adenotonsillectomy without endotracheal tube in children].

Ned Tijdschr Geneeskd 2021 05 19;165. Epub 2021 May 19.

Amphia Ziekenhuis, afd. Anesthesiologie, Intensive Care en Pijngeneeskunde,Breda.

Objective: To determine the safety of the non-intubated and intubated adenotonsillectomy by the Sluder method in children DESIGN: Retrospective database study METHOD: We compared the data of adenotonsillectomy by the Sluder method in children until thirteen years of two teaching hospitals from 2014 until 2017. In the Amphia Hospital the procedure was performed without endotracheal tube placement and without perioperative opioids, in the Haga Hospital the patients were intubated and received perioperative opioids. Primary outcome was reoperation for postoperative haemorrhage. Secondary outcomes included desaturation (saturation ≤ 90% > 1 min), severe hypoxemia (saturation ≤ 85% for ≥ 5 min), airway complications, bradycardia, total postoperative haemorrhages, use of rescue medication, hospital readmission and 30-day mortality.

Results: A total of 1370 patients were analysed: 1267 adenotonsillectomies and 103 tonsillectomies. Median operation time was 7 minutes in the non-intubated group versus 12 minutes in the intubated group. The primary outcome occurred in thirteen patients in the group without intubation (2.2%) and eleven times in the group with intubation (1.4%). There was one case of severe hypoxemia in the group without intubation. Desaturation occurred mostly in the group without intubation (26.4%) for a short time (median 0 min, interquartile range 0-1). Bradycardia was seen more in the group with intubation (4.1% vs 2.2%).

Conclusion: The incidence of postoperative haemorrhage and severe airway complications after adenotonsillectomy by the Sluder method with and without endotracheal tube placement in both groups was comparable.
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May 2021

Late histopathologic characteristics of critically ill COVID-19 patients: Different phenotypes without evidence of invasive aspergillosis, a case series.

J Crit Care 2020 10 8;59:149-155. Epub 2020 Jul 8.

Department of Pulmonology, Amphia Hospital, Breda, the Netherlands; Department of Intensive Care, Amphia Hospital, Breda, the Netherlands.

Purpose: Pathological data of critical ill COVID-19 patients is essential in the search for optimal treatment options.

Material And Methods: We performed postmortem needle core lung biopsies in seven patients with COVID-19 related ARDS. Clinical, radiological and microbiological characteristics are reported together with histopathological findings.

Measurement And Main Results: Patients age ranged from 58 to 83 years, five males and two females were included. Time from hospital admission to death ranged from 12 to 36 days, with a mean of 20 ventilated days. ICU stay was complicated by pulmonary embolism in five patients and positive galactomannan on bronchoalveolar lavage fluid in six patients, suggesting COVID-19 associated pulmonary aspergillosis. Chest CT in all patients showed ground glass opacities, commonly progressing to nondependent consolidations. We observed four distinct histopathological patterns: acute fibrinous and organizing pneumonia, diffuse alveolar damage, fibrosis and, in four out of seven patients an organizing pneumonia. None of the biopsy specimens showed any signs of invasive aspergillosis.

Conclusions: In this case series common late histopathology in critically ill COVID patients is not classic DAD but heterogeneous with predominant pattern of organizing pneumonia. Postmortem biopsy investigations in critically COVID-19 patients with probable COVID-19 associated pulmonary aspergillosis obtained no evidence for invasive aspergillosis.
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http://dx.doi.org/10.1016/j.jcrc.2020.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340597PMC
October 2020

A 0.6-protamine/heparin ratio in cardiac surgery is associated with decreased transfusion of blood products.

Interact Cardiovasc Thorac Surg 2020 09;31(3):391-397

Department of Anaesthesiology and Intensive Care, Amphia Hospital, Breda, Netherlands.

Objectives: In cardiac surgery, adequate heparinization is necessary to prevent thrombus formation in the cardiopulmonary bypass (CPB). To counteract the heparin effect after weaning from CPB, protamine is administered. The optimal protamine/heparin ratio is still unknown.

Methods: In this before-after study, we evaluated the effect of a 0.6/1-protamine/heparin ratio implementation as of May 2017 versus a 0.8/1-protamine/heparin ratio on the 12-h postoperative blood loss and the amount of blood and blood component transfusions (fresh frozen plasma, packed red blood cells, fibrinogen concentrate, platelet concentrate and prothrombin complex concentrate) after cardiac surgery. A total of 2051 patients who underwent cardiac surgery requiring CPB between May 2016 and May 2018 were included.

Results: In the 0.6/1-protamine/heparin ratio group, only 28.8% of the patients received blood component transfusion, compared to 37.9% of the patients in the 0.8/1-ratio group (P < 0.001). The median 12-h postoperative blood loss was 230 ml (interquartile range 140-320) in the 0.6/1-ratio group versus 260 ml (interquartile range 155-365) in the 0.8/1-ratio group (P < 0.001).

Conclusions: A 0.6/1-protamine/heparin ratio after weaning from CPB is associated with a significantly reduced 12-h postoperative blood loss and blood components transfusion.
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http://dx.doi.org/10.1093/icvts/ivaa109DOI Listing
September 2020

Maintaining endotracheal tube cuff pressure at 20 mmHg during anterior cervical spine surgery to prevent dysphagia: a double-blind randomized controlled trial.

Eur Spine J 2019 02 25;28(2):353-361. Epub 2018 Oct 25.

Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.

Purpose: Anterior cervical spine surgery is associated with postoperative dysphagia, sore throat and dysphonia. It is unclear, whether this is caused by increased endotracheal tube (ETT) cuff pressure after retractor placement. This study aims to assess the effect of ETT cuff pressure adjustment on postoperative dysphagia, sore throat and dysphonia.

Methods: In this, single-centre, observer and patient-blinded randomized controlled trial patients treated with anterior cervical spine surgery were randomized to adjustment of the ETT cuff pressure to 20 mmHg after placement of the retractor versus no adjustment. Primary outcome was the incidence and severity of postoperative dysphagia. Secondary outcomes were sore throat and dysphonia. Outcomes were evaluated on day one and 2 months after the operation.

Results: Of 177 enrolled patients, 162 patients (92.5%) could be evaluated. The incidence of dysphagia was 75.9% on day one and 34.6% 2 months after surgery. Dysphagia in the intervention and control group was present in 77.8% versus 74.1% of patients on day one (odds ratio (OR) 1.2, 95% confidence interval (CI) (0.6-2.5)) and 28.4% versus 40.7% of patients after 2 months (OR 0.6, 95% CI 0.3-1.1), respectively. Severity of dysphagia, sore throat and dysphonia was similar in both groups.

Conclusions: Anterior cervical spine surgery is accompanied by a high incidence of postoperative dysphagia, lasting until at least 2 months after surgery in over a third of our patients. Adjusting ETT cuff pressure to 20 mmHg after retractor placement, as compared to controls, did not lower the risk for both short- and long-term dysphagia. Netherlands National Trial Registry Number: NTR 3542. These slides can be retrieved under electronic supplementary material.
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http://dx.doi.org/10.1007/s00586-018-5798-3DOI Listing
February 2019

Systemic Inflammation after Transcatheter Aortic Valve Implantation: A Prospective Exploratory Study.

J Cardiothorac Vasc Anesth 2018 08 30;32(4):e77-e82. Epub 2017 Dec 30.

Department of Anesthesiology Intensive Care and Pain Medicine, St. Antonius Hospital Nieuwegein, The Netherlands.

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http://dx.doi.org/10.1053/j.jvca.2017.12.051DOI Listing
August 2018

Intraoperative hypotension and change in estimated glomerular filtration rate after major abdominal surgery: A prospective observational study.

Eur J Anaesthesiol 2017 04;34(4):243-246

From the Department of Anaesthesiology, Intensive Care and Pain Medicine (TCDR, EV, PGN), Department of Clinical Chemistry (IMD) and Department of Clinical Pharmacy (EMWG), St. Antonius Hospital, Nieuwegein; Department of Anaesthesiology, Intensive Care and Emergency Medicine (WAK, LMP); Department of Epidemiology, Julius Center for Health Sciences and Primary Care (LMP), University Medical Center Utrecht, Utrecht, The Netherlands.

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http://dx.doi.org/10.1097/EJA.0000000000000540DOI Listing
April 2017

Impact of Intraoperative Hypotension During Cardiopulmonary Bypass on Acute Kidney Injury After Coronary Artery Bypass Grafting.

J Cardiothorac Vasc Anesth 2017 Apr 30;31(2):522-528. Epub 2016 Jul 30.

Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands. Electronic address:

Objective: The aim of this study was to investigate whether acute kidney injury (AKI) after coronary artery bypass grafting can be attributed to intraoperative hypotension during cardiopulmonary bypass (IOH-CPB).

Design: Retrospective analysis.

Setting: Tertiary-care hospital.

Participants: Patients undergoing on-pump coronary artery bypass grafting from June 2011 to January 2014.

Interventions: None.

Measurements And Main Results: IOH-CPB was defined as blood pressure below several absolute and relative mean arterial pressure (MAP) thresholds and as the area under the curve for absolute MAP thresholds. AKI was defined as an absolute increase in serum creatinine of≥26 µmol/L within 48 hours or an increase to 150% or more within 7 days of surgery. Poisson regression with robust standard errors both before and after adjustment for confounders was used. Of the 1,891 patients included, 386 (20%) developed AKI. In univariable analysis, all IOH-CPB thresholds defined as a MAP of 50 mmHg or less and as a decrease in MAP of 60% from baseline were associated with a 1.07-to-1.11 times increased risk of AKI per 10 minutes of IOH-CPB (p<0.01). After adjustment for potential confounders, IOH-CPB, irrespective of the definition chosen, was not associated with an increased risk of AKI.

Conclusions: In the authors' study population, univariable analysis showed an association of IOH-CPB with AKI in patients undergoing isolated CABG, but this relationship disappeared after correction for well-known risk factors for AKI.
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http://dx.doi.org/10.1053/j.jvca.2016.07.040DOI Listing
April 2017

Letter in Response to "No Cytokine is an Island: IL-6 Alone is Not Enough to Predict the Morbidity After Major Abdominal Surgery".

Ann Surg 2018 02;267(2):e32-e33

Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.

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http://dx.doi.org/10.1097/SLA.0000000000001981DOI Listing
February 2018

Biomarkers Capable to Early Predict Postoperative Complications: The Grail.

Ann Surg 2017 12;266(6):e92

Departments of Anesthesiology, Intensive Care and Pain Medicine, Nieuwegein, The Netherlands Departments of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands Departments of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands Departments of Anesthesiology, Intensive Care and Pain Medicine, Nieuwegein, The Netherlands.

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http://dx.doi.org/10.1097/SLA.0000000000001774DOI Listing
December 2017

Postoperative Interleukin-6 Level and Early Detection of Complications After Elective Major Abdominal Surgery.

Ann Surg 2016 06;263(6):1207-12

*Department of Anesthesiology, Intensive Care and Pain Medicine†Department of Clinical Chemistry‡Department of Surgery§Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands.

Objective: To assess the association of systemic inflammation and outcome after major abdominal surgery.

Background: Major abdominal surgery carries a high postoperative morbidity and mortality rate. Studies suggest that inflammation is associated with unfavorable outcome.

Methods: Levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α and the systemic inflammatory response syndrome (SIRS) were assessed in 137 patients undergoing major abdominal surgery. Blood samples were drawn on days 0, 1, 3, and 7, and SIRS was scored during 48 hours after surgery. Primary outcome was a composite of mortality, pneumonia, sepsis, anastomotic dehiscence, wound infection, noncardiac respiratory failure, atrial fibrillation, congestive heart failure, myocardial infarction, and reoperation within 30 days of surgery.

Results: An IL-6 level more than 432 pg/mL on day 1 was associated with an increased risk of complications (adjusted odds ratio: 3.3; 95% confidence interval [CI]: 1.3-8.5) and a longer median length of hospital stay (7 vs 12 days, P < 0.001). As a single test, an IL-6 cut-off level of 432 pg/mL on day 1 yielded a specificity of 70% and a sensitivity of 64% for the prediction of complications (area under the curve: 0.67; 95% CI: 0.56-0.77). Levels of CRP started to discriminate from day 3 onward with a specificity of 87% and a sensitivity of 58% for a cut-off level of 203 mg/L (AUC: 0.73; 95% CI: 0.63-0.83).

Conclusions: A high IL-6 level on day 1 is associated with postoperative complications. Levels of IL-6 help distinguish between patients at low and high risk for complications before changes in levels of CRP.
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http://dx.doi.org/10.1097/SLA.0000000000001342DOI Listing
June 2016

The systemic inflammatory response syndrome predicts short-term outcome after transapical transcatheter aortic valve implantation.

J Cardiothorac Vasc Anesth 2015 Apr 31;29(2):283-7. Epub 2015 Jan 31.

Departments of Anesthesiology, Intensive Care and Pain Medicine. Electronic address:

Objective: Despite the minimally invasive nature of transcatheter aortic valve implantation (TAVI), the incidence of acute kidney injury (AKI) and mortality is of major concern. Several studies showed that outcome was influenced by the systemic inflammatory response syndrome (SIRS) in patients undergoing percutaneous TAVI. The purpose of this study was to investigate whether SIRS after transapical TAVI was associated with short-term outcome.

Design: Retrospective analysis of prospectively collected data.

Setting: Intensive care unit in a tertiary-care hospital.

Participants: In 121 patients undergoing transapical TAVI for severe aortic stenosis between March 2010 and October 2013, the incidence of SIRS during the first 48 hours was studied. The relation between the occurrence of SIRS and any adverse event during hospital stay was investigated. Any adverse event was defined as the composite of mortality, AKI, infection, stroke, myocardial infarction, and bleeding.

Intervention: none.

Measurements And Main Results: Sixty-five (53.7%) patients developed SIRS during 48 hours after transapical TAVI. The occurrence of SIRS was associated independently with an increased risk of any adverse event (adjusted odds ratio: 4.0, 95% confidence interval [CI]: 1.6-9.6; p=0.002), which was mainly an increased risk of death (odds ratio: 5.5, 95% CI: 1.1-25.9; p=0.031). Patients with SIRS had a longer median duration of intensive care unit stay compared with patients without SIRS (2 v 1 day; p<0.001).

Conclusions: SIRS predicts short-term outcome in patients undergoing transapical TAVI.
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http://dx.doi.org/10.1053/j.jvca.2014.10.005DOI Listing
April 2015

Maintaining endotracheal tube cuff pressure at 20 mm Hg to prevent dysphagia after anterior cervical spine surgery; protocol of a double-blind randomised controlled trial.

BMC Musculoskelet Disord 2013 Sep 25;14:280. Epub 2013 Sep 25.

Department of Neurosurgery, Medical Center Haaglanden, PO Box 432, 2501 CK The Hague, The Netherlands.

Background: In anterior cervical spine surgery a retractor is obligatory to approach the spine. Previous studies showed an increase of endotracheal tube cuff pressure after placement of a retractor. It is known that high endotracheal tube cuff pressure increases the incidence of postoperative dysphagia, hoarseness, and sore throat. However, until now no evidence supports the fact whether adjusting the endotracheal tube cuff pressure during anterior cervical spine surgery will prevent this comorbidity. We present the design of a randomized controlled trial to determine whether adjusting endotracheal tube cuff pressure after placement of a retractor during anterior cervical spine surgery will prevent postoperative dysphagia.

Methods/design: 177 patients (aged 18-90 years) scheduled for anterior cervical spine surgery on 1 or more levels will be included. After intubation, endotracheal tube cuff pressure is manually inflated to 20 mm Hg in all patients. Patients will be randomized into two groups. In the control group endotracheal tube cuff pressure is not adjusted after retractor placement. In the intervention group endotracheal tube cuff pressure after retractor placement is maintained at 20 mm Hg and air is withdrawn when cuff pressure exceeds 20 mm Hg. Endotracheal tube cuff pressure is measured after intubation, before and after placement and removal of the retractor. Again air is inflated if cuff pressure sets below 20 mmHg after removal of the retractor. The primary outcome measure is postoperative dysphagia. Other outcome measures are postoperative hoarseness, postoperative sore throat, degree of dysphagia, length of hospital stay, and pneumonia. The study is a single centre double blind randomized trial in which patients and research nurses will be kept blinded for the allocated treatment during the follow-up period of 2 months.

Discussion: Postoperative dysphagia occurs frequently after anterior cervical spine surgery. This may be related to high endotracheal tube cuff pressure. Whether adaptation and maintaining the pressure after placement of the retractor will decrease the incidence of dysphagia, has to be determined by this trial.

Trial Registration: Netherlands Trial Register (NTR) 3542: http://www.trialregister.nl.
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http://dx.doi.org/10.1186/1471-2474-14-280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848991PMC
September 2013
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