Publications by authors named "Ulrich Strauch"

9 Publications

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The QUality of Interhospital Transportation in the Euregion Meuse-Rhine (QUIT-EMR) score: a cross-validation study.

BMJ Open 2021 Nov 19;11(11):e051100. Epub 2021 Nov 19.

Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.

Objectives: Interhospital transports of critically ill patients are high-risk medical interventions. Well-established parameters to quantify the quality of transports are currently lacking. We aimed to develop and cross-validate a score for interhospital transports.

Setting: An expert panel developed a score for interhospital transport by a Mobile Intensive Care Unit (MICU), the QUality of Interhospital Transportation in the Euregion Meuse-Rhine (QUIT-EMR) score. The QUIT-EMR score is an overall sum score that includes component scores of monitoring and intervention variables of the neurological (proxy for airway patency), respiratory and circulatory organ systems, ranging from -12 to +12. A score of 0 or higher defines an adequate transport. The QUIT-EMR score was tested to help to quantify the quality of transport.

Participants: One hundred adult patients were randomly included and the transport charts were independently reviewed and classified as adequate or inadequate by four transport experts (ie, anaesthetists/intensivists).

Outcome Measures: Subsequently, the level of agreement between the QUIT-EMR score and expert classification was calculated using Gwet's AC.

Results: From April 2012 to May 2014, a total of 100 MICU transports were studied. The median (IQR) QUIT-EMR score was 1 (0-2). Experts classified six transports as inadequate. The percentage agreement between the QUIT-EMR score and experts' classification for adequate/inadequate transport ranged from 84% to 92% (Gwet's AC0.81-0.91). The interobserver agreement between experts was 87% to 94% (Gwet's AC0.89-0.98).

Conclusion: The QUIT-EMR score is a novel validated tool to score MICU transportation adequacy in future studies contributing to quality control and improvement.

Trial Registration Number: NTR 4937.
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November 2021

Differences and Similarities Among Coronavirus Disease 2019 Patients Treated in Seven ICUs in Three Countries Within One Region: An Observational Cohort Study.

Crit Care Med 2021 Oct 12. Epub 2021 Oct 12.

Department of Intensive Care, Ziekenhuis Oost-Limburg, Genk, Belgium. UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium. Department of Intensive Care, Maastricht University Medical Center +, Maastricht, The Netherlands. Department of Intensive Care, Laurentius Ziekenhuis, Roermond, The Netherlands. Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands. Department of Intensive Care, Jessa Hospital, Hasselt, Belgium. Department of Intensive Care, VieCuri Medisch Centrum, Venlo, The Netherlands. Department of Intensive Care, Zuyderland Medisch Centrum, Heerlen/Sittard, The Netherlands. Department of Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands. School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands. Division for Acute and Emergency Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands. Department of Intensive Care, University Hospital Rheinisch Westfälische Hochschule Aachen, Aachen, Germany.

Objectives: To investigate healthcare system-driven variation in general characteristics, interventions, and outcomes in coronavirus disease 2019 (COVID-19) patients admitted to the ICU within one Western European region across three countries.

Design: Multicenter observational cohort study.

Setting: Seven ICUs in the Euregio Meuse-Rhine, one region across Belgium, The Netherlands, and Germany.

Patients: Consecutive COVID-19 patients supported in the ICU during the first pandemic wave.

Interventions: None.

Measurements And Main Results: Baseline demographic and clinical characteristics, laboratory values, and outcome data were retrieved after ethical approval and data-sharing agreements. Descriptive statistics were performed to investigate country-related practice variation. From March 2, 2020, to August 12, 2020, 551 patients were admitted. Mean age was 65.4 ± 11.2 years, and 29% were female. At admission, Acute Physiology and Chronic Health Evaluation II scores were 15.0 ± 5.5, 16.8 ± 5.5, and 15.8 ± 5.3 (p = 0.002), and Sequential Organ Failure Assessment scores were 4.4 ± 2.7, 7.4 ± 2.2, and 7.7 ± 3.2 (p < 0.001) in the Belgian, Dutch, and German parts of Euregio, respectively. The ICU mortality rate was 22%, 42%, and 44%, respectively (p < 0.001). Large differences were observed in the frequency of organ support, antimicrobial/inflammatory therapy application, and ICU capacity. Mixed-multivariable logistic regression analyses showed that differences in ICU mortality were independent of age, sex, disease severity, comorbidities, support strategies, therapies, and complications.

Conclusions: COVID-19 patients admitted to ICUs within one region, the Euregio Meuse-Rhine, differed significantly in general characteristics, applied interventions, and outcomes despite presumed genetic and socioeconomic background, admission diagnosis, access to international literature, and data collection are similar. Variances in healthcare systems' organization, particularly ICU capacity and admission criteria, combined with a rapidly spreading pandemic might be important drivers for the observed differences. Heterogeneity between patient groups but also healthcare systems should be presumed to interfere with outcomes in coronavirus disease 2019.
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October 2021

Serial measurements in COVID-19-induced acute respiratory disease to unravel heterogeneity of the disease course: design of the Maastricht Intensive Care COVID cohort (MaastrICCht).

BMJ Open 2020 09 29;10(9):e040175. Epub 2020 Sep 29.

Department of Intensive Care, Maastricht University Medical Center+, Maastricht, The Netherlands.

Introduction: The course of the disease in SARS-CoV-2 infection in mechanically ventilated patients is unknown. To unravel the clinical heterogeneity of the SARS-CoV-2 infection in these patients, we designed the prospective observational Maastricht Intensive Care COVID cohort (MaastrICCht). We incorporated serial measurements that harbour aetiological, diagnostic and predictive information. The study aims to investigate the heterogeneity of the natural course of critically ill patients with a SARS-CoV-2 infection.

Methods And Analysis: Mechanically ventilated patients admitted to the intensive care with a SARS-CoV-2 infection will be included. We will collect clinical variables, vital parameters, laboratory variables, mechanical ventilator settings, chest electrical impedance tomography, ECGs, echocardiography as well as other imaging modalities to assess heterogeneity of the course of a SARS-CoV-2 infection in critically ill patients. The MaastrICCht is also designed to foster various other studies and registries and intends to create an open-source database for investigators. Therefore, a major part of the data collection is aligned with an existing national intensive care data registry and two international COVID-19 data collection initiatives. Additionally, we create a flexible design, so that additional measures can be added during the ongoing study based on new knowledge obtained from the rapidly growing body of evidence. The spread of the COVID-19 pandemic requires the swift implementation of observational research to unravel heterogeneity of the natural course of the disease of SARS-CoV-2 infection in mechanically ventilated patients. Our study design is expected to enhance aetiological, diagnostic and prognostic understanding of the disease. This paper describes the design of the MaastrICCht.

Ethics And Dissemination: Ethical approval has been obtained from the medical ethics committee (Medisch Ethische Toetsingscommissie 2020-1565/3 00 523) of the Maastricht University Medical Centre+ (Maastricht UMC+), which will be performed based on the Declaration of Helsinki. During the pandemic, the board of directors of Maastricht UMC+ adopted a policy to inform patients and ask their consent to use the collected data and to store serum samples for COVID-19 research purposes. All study documentation will be stored securely for fifteen years after recruitment of the last patient. The results will be published in peer-reviewed academic journals, with a preference for open access journals, while particularly considering deposition of the manuscripts on a preprint server early.

Trial Registration Number: The Netherlands Trial Register (NL8613).
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September 2020

Coach Competences to Induce Positive Affective Reactions in Sport and Exercise-A Qualitative Study.

Sports (Basel) 2019 Jan 8;7(1). Epub 2019 Jan 8.

Institute of Sports and Sports Science, Karlsruher Institute of Technology, 76131 Karlsruhe, Germany.

Positive affective reactions are a crucial aspect in physical activity maintenance. Affective reactions to sport and exercise were found to be important factors of physical activity. Coaches could be an important medium to induce positive affective reactions of participants in sport and exercise. Understanding how coaches trigger positive affective reactions (AR) during physical activity is a crucial aspect for increasing maintenance in sport and exercise. The aim of this study is to identify the competences of the coaches which are associated with perceived positive AR of participants during sport and exercise. To identify these factors, semistructured in-depth interviews were conducted with 18 participants, who take part in sport and exercise (nine female and nine male) of heterogeneous age (mean age 42.6; SD = 19.25; under 30 years, 30 to 60 years, 60 years and above) and who have different athletic backgrounds (individual sports, team sports, and gym classes). Four key coach competence factors were identified and used to design an integrated model. Three general competences: context sensitivity, social⁻emotional competences, professional competences, and the specific competences in the behaviour-related competences.
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January 2019

Clinical implementation of electric impedance tomography in the treatment of ARDS: a single centre experience.

J Clin Monit Comput 2019 Apr 29;33(2):291-300. Epub 2018 May 29.

Department of Intensive Care, Maastricht University Medical Centre+, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.

To report on our clinical experience using EIT in individualized PEEP titration in ARDS. Using EIT assessment, we optimized PEEP settings in 39 ARDS patients. The EIT PEEP settings were compared with the physicians' PEEP settings and the PEEP settings according to the ARDS network. We defined a PEEP difference equal to or greater than 4 cm HO as clinically relevant. Changes in lung compliance and PaO/FiO-ratio were compared in patients with EIT-based PEEP adjustments and in patients with unaltered PEEP. In 28% of the patients, the difference in EIT-based PEEP and physician-PEEP was clinically relevant; in 36%, EIT-based PEEP and physician-PEEP were equal. The EIT-based PEEP disagreed with the PEEP settings according to the ARDS network. Adjusting PEEP based upon EIT led to a rapid increase in lung compliance and PaO/FiO-ratio. However, this increase was also observed in the group where the PEEP difference was less than 4 cm HO. We hypothesize that this can be attributed to the alveolar recruitment during the PEEP trial. EIT based individual PEEP setting appears to be a promising method to optimize PEEP in ARDS patients. The clinical impact, however, remains to be established.
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April 2019

QUIT EMR trial: a prospective, observational, multicentre study to evaluate quality and 24 hours post-transport morbidity of interhospital transportation of critically ill patients: study protocol.

BMJ Open 2017 03 10;7(3):e012861. Epub 2017 Mar 10.

Emergency Medical Service, Fire Department, Aachen, Germany.

Introduction: It is widely accepted that transportation of critically ill patients is high risk. Unfortunately, however, there are currently no evidence-based criteria with which to determine the quality of various interhospital transport systems and their impact on the outcomes for patients. We aim to rectify this by assessing 2 scores which were developed in our hospital in a prospective, observational study. Primarily, we will be examining the Quality of interhospital critical care transportation in the Euregion Meuse-Rhine (QUIT EMR) score, which focuses on the quality of the transport system, and secondarily the SEMROS (Simplified EMR outcome score) which detects changes in the patient's clinical condition in the 24 hours following their transportation.

Methods And Analysis: A web-based application will be used to document around 150 pretransport, intratransport and post-transport items of each patient case.To be included, patients must be at least 18-years of age and should have been supervised by a physician during an interhospital transport which was started in the study region.The quality of the QUIT EMR score will be assessed by comparing 3 predefined levels of transport facilities: the high, medium and low standards. Subsequently, SEMROS will be used to determine the effect of transport quality on the morbidity 24 hours after transportation.It is estimated that there will be roughly 3000 appropriate cases suitable for inclusion in this study per year. Cases shall be collected from 1 April 2015 until 31 December 2017.

Ethics And Dissemination: This trial was approved by the Ethics committees of the university hospitals of Maastricht (Netherlands) and Aachen (Germany). The study results will be published in a peer reviewed journal. Results of this study will determine if a prospective randomised trial involving patients of various categories being randomly assigned to different levels of transportation system shall be conducted.

Trial Registration Number: NTR4937.
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March 2017

Short-term outcomes and mortality after interhospital intensive care transportation: an observational prospective cohort study of 368 consecutive transports with a mobile intensive care unit.

BMJ Open 2015 Apr 28;5(4):e006801. Epub 2015 Apr 28.

Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.

Objectives: To evaluate short-term outcomes and mortality after interhospital transportation of intensive care patients performed by a mobile intensive care unit (MICU).

Setting: This study was performed in the tertiary care process of interhospital transportation using the local MICU system in the South East of the Netherlands.

Participants: Between March 2009 and December 2011, all transports of adult patients being performed by the local MICU centre have been documented; data on 42 variables, including a 24 h follow-up Sequential Organ Failure Assessment (SOFA) score of 368 consecutive interhospital transports of intensive care patients, were recorded. In 24 cases, the follow-up SOFA score was missing, so 344 data sets were included.

Interventions: No interventions have been done.

Primary/secondary Outcome Measures: Primary outcome measures were the mean SOFA score before and 24 h after transport, and the 24 h post-transport mortality. Moreover, the differences between the groups of 24 h post-transport survivors and non-survivors have been analysed.

Results: The mean SOFA score before transport was 8.8 for the whole population and 8.6 for those patients who were alive 24 h after transport, with a mean SOFA score of 8.4 after transport. The adverse events rate was 6.4%. Fourteen patients (4.1%) died within 24 h after transport. Patients in this group had a higher SOFA score, lower pH, higher age and more additional medical support devices than those patients in the survivor group.

Conclusions: The non-significant decrease in the post-transport SOFA score and the lack of an association between transport and 24 h post-transport mortality indicates that in the study setting, interhospital transportation of intensive care patients performed by a MICU system was not associated with a clinically relevant deterioration of the patient.
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April 2015

Under-the-counter acquired acute coronary syndrome: Methaemoglobinaemia.

Eur Heart J Acute Cardiovasc Care 2016 Dec 2;5(8):549-550. Epub 2015 Apr 2.

Department of Intensive Care Medicine, Maastricht University Medical Centre, the Netherlands.

A 73-year-old male suffers a type-2 inferior myocardial infarction and is found unconscious, hypotensive and centrally cyanotic. His arterial blood gas analysis shows a chocolate-brown discoloration, with pO2 45.1 kPa, HbO2 48.9%, MetHb 51%, BE -9 and a lactate of 3.7 mmol/l. Administration of 200 mg of methylene blue intravenously, normalizes the patient's abnormalities. His life-threatening acquired methaemoglobinaemia appears secondary to under-the-counter viagra.
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December 2016

Accuracy of end-tidal CO2 capnometers in post-cardiac surgery patients during controlled mechanical ventilation.

J Emerg Med 2013 Jul 30;45(1):130-5. Epub 2013 Jan 30.

Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands.

Background: The determination of end-tidal carbon dioxide (etCO2) is very helpful in cardiac resuscitation for confirmation and monitoring of endotracheal tube placement and as an indicator of return of circulation and effectiveness of chest compressions. There is now also widespread use of capnometry on-site at emergency and trauma fields.

Objective: We studied the accuracy and correlation of three capnometers (EMMA, Medtronic, and Evita) with partial pressure of arterial CO2 (PaCO2) measurements.

Methods: The three capnometers were placed in-line in the ventilator tubing of the patient. Forty sedated and mechanically ventilated post-cardiac surgery patients were studied. Twenty consecutive etCO2 values were collected simultaneously from all three monitors while drawing an arterial blood sample. Paired sample t-test and Pearson correlation were used to compare the capnometers and their correlation with PaCO2.

Results: The correlation of etCO2 measurements between all three capnometers was good (Emma vs. Evita: 0.874, Emma vs. Medtronic: 0.949, Evita vs. Medtronic: 0.878). The correlation of PaCO2 with the Evita is the lowest (0.671) as compared to the EMMA (0.693) and the Medtronic (0.727). The lowest dispersion of the difference between etCO2 and PaCO2 was seen in EMMA (3.30), the highest in Evita (3.98).

Conclusions: A good correlation between etCO2 and PaCO2 was shown with the three capnometers in the present study. However, etCO2 measurements were not valid to estimate PaCO2 in these patients. Therefore, capnometry cannot be used to replace serial blood gas analyses completely, but may be a good cardiopulmonary trend monitor and alerting system in catastrophic events.
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July 2013