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  • 1
    Online-Ressource
    Online-Ressource
    Extracorporeal Life Support for Patients With Newly Diagnosed HIV and Acute Respiratory Distress Syndrome: A Systematic Review and Analysis of Individual Patient Data
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  ASAIO Journal
    Details
    In: ASAIO Journal, Ovid Technologies (Wolters Kluwer Health)
    Kurzfassung: Extracorporeal membrane oxygenation (ECMO) may improve survival in patients with severe acute respiratory distress syndrome (ARDS). However, presence of immunosuppression is a relative contraindication for ECMO, which is withheld in HIV patients. We performed a systematic review to investigate the outcome of newly diagnosed HIV patients with ARDS receiving ECMO support. Our search yielded 288 publications, with 22 studies finally included. Initial presentation included fever, respiratory distress, and cough. Severe immunodeficiency was confirmed in most patients. Deceased patients had a higher viral load, a lower Horovitz index, and antiretroviral therapy utilized before ECMO. Moreover, ECMO duration was longer ( p = 0.0134), and all deceased suffered from sepsis ( p = 0.0191). Finally, despite the development of therapeutic options for HIV patients, ECMO remains a relative contraindication. We found that ECMO may successfully bridge the time for pulmonary recovery in 93% of patients, with a very good outcome. Using ECMO, the time for antimicrobial therapy, lung-protective ventilation, and immune system restitution may be gained. Further studies clarifying the role of ECMO in HIV are crucial and until these data are available, ECMO might be appropriate in immunocompromised patients. This holds especially true in newly diagnosed HIV patients, who are usually young, without comorbidities, with a good rehabilitation potential.
    Materialart: Online-Ressource
    ISSN: 1058-2916
    URL: Article
    DOI: 10.1097/MAT.0000000000002047
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2023
    ZDB Id: 2083312-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    Online-Ressource
    Online-Ressource
    The increasing doses of methotrexate pharmacokinetics after intravenous administration in rats - model selection
    National Library of Serbia ; 2021
    In:  Military Medical and Pharmaceutical Journal of Serbia Vol. 78, No. 7 ( 2021), p. 708-715
    Details
    In: Military Medical and Pharmaceutical Journal of Serbia, National Library of Serbia, Vol. 78, No. 7 ( 2021), p. 708-715
    Kurzfassung: Background/Aim. Methotrexate (MTX) plays a significant role in the treatment of various diseases, but the toxicity remains the main issue of its use, especially when administered in high doses. Considering altered pharmacokinetics of MTX as a factor strongly implicated in the large interpatient variability and unexpected toxicity in certain patients, the accurate description of MTX pharmacokinetic behaviour of both low and high doses is of the utmost importance. Therefore, the objective of this study was to determine the pharmacokinetics of MTX after intravenous (iv) administration in ascending doses of 5, 40, 80 and 160 mg/kg in rats and to select the appropriate mathematical model describing MTX pharmacokinetics. Methods. Plasma concentrations of MTX were measured using the liquid chromatography - mass spectrometry (LC/MS) method. Pharmacokinetic parameters were calculated by non-compartmental and two-compartmental integer-order analyses. Results. MTX showed linear pharmacokinetics following iv administration up to the dose of 80 mg/kg. The administration of a high dose of MTX (160 mg/kg) resulted in the similar pharmacokinetic behaviour as when applied in the twice lower dose (80 mg/kg), which can be explained by dose-dependent changes in the expression of solute carrier (SLC) and ATP binding cassette (ABC) transport proteins and intracellular metabolism. Furthermore, the classical two-compartment model could not explain the pharmacokinetics of MTX in a small percentage of experimental animals, which opens up new strategies for the use of fractional order pharmacokinetic models in MTX therapy optimisation. Conclusion. These results of pharmacokinetic analyses may be helpful in adjusting the dosage regimen of MTX, but the application of novel pharmacokinetic models, such as those based on fractional calculus, is still needed in the process of MTX therapy optimisation.
    Materialart: Online-Ressource
    ISSN: 0042-8450 , 2406-0720
    URL: Article
    DOI: 10.2298/VSP190430126R
    Sprache: Englisch
    Verlag: National Library of Serbia
    Publikationsdatum: 2021
    ZDB Id: 2169819-3
    SSG: 15,3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
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    Invasive Fungal Infections after Liver Transplantation
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 9 ( 2023-04-30), p. 3238-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 9 ( 2023-04-30), p. 3238-
    Kurzfassung: Invasive fungal infections represent a major challenge in patients who underwent organ transplantation. Overall, the most common fungal infections in these patients are candidiasis, followed by aspergillosis and cryptococcosis, except in lung transplant recipients, where aspergillosis is most common. Several risk factors have been identified, which increase the likelihood of an invasive fungal infection developing after transplantation. Liver transplant recipients constitute a high-risk category for invasive candidiasis and aspergillosis, and therefore targeted prophylaxis is favored in this patient population. Furthermore, a timely implemented therapy is crucial for achieving optimal outcomes in transplanted patients. In this article, we describe the epidemiology, risk factors, prophylaxis, and treatment strategies of the most common fungal infections in organ transplantation, with a focus on liver transplantation.
    Materialart: Online-Ressource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12093238
    Sprache: Englisch
    Verlag: MDPI AG
    Publikationsdatum: 2023
    ZDB Id: 2662592-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
    Online-Ressource
    Online-Ressource
    Small Drainage Volumes of Pleural Effusions Are Associated with Complications in Critically Ill Patients: A Retrospective Analysis
    MDPI AG ; 2021
    In:  Journal of Clinical Medicine Vol. 10, No. 11 ( 2021-06-01), p. 2453-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 10, No. 11 ( 2021-06-01), p. 2453-
    Kurzfassung: Pleural effusions are a common finding in critically ill patients and small bore chest drains (SBCD) are proven to be efficient for pleural drainage. The data on the potential benefits and risks of drainage remains controversial. We aimed to determine the cut-off volume for complications, to investigate the impact of pleural drainage and drained volume on clinically relevant outcomes. Medical records of all critically ill patients undergoing insertion of SBCD were retrospectively examined. We screened 13,003 chest radiographs and included 396 SBCD cases in the final analysis. SBCD drained on average 900 mL, with less amount in patients with complications (p = 0.003). A drainage volume of 975 mL in 24 h represented the optimal threshold for complications. Pneumothorax was the most frequent complication (4.5%), followed by bleeding (0.8%). Female and lighter-weighted patients experienced a higher risk for any complication. We observed an improvement in the arterial partial pressure of oxygen and respiratory quotient (p 〈 0.001). We conclude that the small drainage volumes are associated with complications in critically ill patients—the more you drain, the safer the procedure gets. The use of SBCD is a safe and efficient procedure, further investigations regarding the higher rate of complications in female and lighter-weighted patients are desirable.
    Materialart: Online-Ressource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm10112453
    Sprache: Englisch
    Verlag: MDPI AG
    Publikationsdatum: 2021
    ZDB Id: 2662592-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
    Online-Ressource
    Online-Ressource
    Diagnostic Modalities in Critical Care: Point-of-Care Approach
    MDPI AG ; 2021
    In:  Diagnostics Vol. 11, No. 12 ( 2021-11-25), p. 2202-
    Details
    In: Diagnostics, MDPI AG, Vol. 11, No. 12 ( 2021-11-25), p. 2202-
    Kurzfassung: The concept of intensive care units (ICU) has existed for almost 70 years, with outstanding development progress in the last decades. Multidisciplinary care of critically ill patients has become an integral part of every modern health care system, ensuing improved care and reduced mortality. Early recognition of severe medical and surgical illnesses, advanced prehospital care and organized immediate care in trauma centres led to a rise of ICU patients. Due to the underlying disease and its need for complex mechanical support for monitoring and treatment, it is often necessary to facilitate bed-side diagnostics. Immediate diagnostics are essential for a successful treatment of life threatening conditions, early recognition of complications and good quality of care. Management of ICU patients is incomprehensible without continuous and sophisticated monitoring, bedside ultrasonography, diverse radiologic diagnostics, blood gas analysis, coagulation and blood management, laboratory and other point-of-care (POC) diagnostic modalities. Moreover, in the time of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, particular attention is given to the POC diagnostic techniques due to additional concerns related to the risk of infection transmission, patient and healthcare workers safety and potential adverse events due to patient relocation. This review summarizes the most actual information on possible diagnostic modalities in critical care, with a special focus on the importance of point-of-care approach in the laboratory monitoring and imaging procedures.
    Materialart: Online-Ressource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics11122202
    Sprache: Englisch
    Verlag: MDPI AG
    Publikationsdatum: 2021
    ZDB Id: 2662336-5
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
    Online-Ressource
    Online-Ressource
    Extracorporeal membrane oxygenation for cardiogenic shock: a meta-analysis of mortality and complications
    Springer Science and Business Media LLC ; 2022
    In:  Annals of Intensive Care Vol. 12, No. 1 ( 2022-10-05)
    Details
    In: Annals of Intensive Care, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-10-05)
    Kurzfassung: Venoarterial extracorporeal membrane oxygenation (va-ECMO) is an advanced life support for critically ill patients with refractory cardiogenic shock. This temporary support bridges time for recovery, permanent assist, or transplantation in patients with high risk of mortality. However, the benefit of this modality is still subject of discussion and despite the continuous development of critical care medicine, severe cardiogenic shock remains associated with high mortality. Therefore, this work aims to analyze the current literature regarding in-hospital mortality and complication rates of va-ECMO in patients with cardiogenic shock. Methods We conducted a systematic review and meta-analysis of the most recent literature to analyze the outcomes of va-ECMO support. Using the PRISMA guidelines, Medline (PubMed) and Scopus (Elsevier) databases were systematically searched up to May 2022. Meta-analytic pooled estimation of publications variables was performed using a weighted random effects model for study size. Results Thirty-two studies comprising 12756 patients were included in the final analysis. Between 1994 and 2019, 62% (pooled estimate, 8493/12756) of patients died in the hospital. More than one-third of patients died during ECMO support. The most frequent complications were renal failure (51%, 693/1351) with the need for renal replacement therapy (44%, 4879/11186) and bleeding (49%, 1971/4523), bearing the potential for permanent injury or death. Univariate meta-regression analyses identified age over 60 years, shorter ECMO duration and presence of infection as variables associated with in-hospital mortality, while the studies reporting a higher incidence of cannulation site bleeding were unexpectedly associated with a reduced in-hospital mortality. Conclusions Extracorporeal membrane oxygenation is an invasive life support with a high risk of complications. We identified a pooled in-hospital mortality of 62% with patient age, infection and ECMO support duration being associated with a higher mortality. Protocols and techniques must be developed to reduce the rate of adverse events. Finally, randomized trials are necessary to demonstrate the effectiveness of va-ECMO in cardiogenic shock.
    Materialart: Online-Ressource
    ISSN: 2110-5820
    URL: Article
    DOI: 10.1186/s13613-022-01067-9
    Sprache: Englisch
    Verlag: Springer Science and Business Media LLC
    Publikationsdatum: 2022
    ZDB Id: 2617094-2
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
    Online-Ressource
    Online-Ressource
    ECMO in Cardiogenic Shock: Time Course of Blood Biomarkers and Associated Mortality
    MDPI AG ; 2022
    In:  Diagnostics Vol. 12, No. 12 ( 2022-11-26), p. 2963-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 12 ( 2022-11-26), p. 2963-
    Kurzfassung: Background: Veno-arterial extracorporeal membrane oxygenation (va-ECMO) is a temporary life support for severe cardiogenic shock, gaining time for organ recovery, permanent assistance, or transplantation. In this work, we aimed to investigate the trends of blood biomarkers over the period of ECMO support and their role in patient outcome. Methods: This retrospective study comprised patients receiving va-ECMO support over the period of 14 years at a tertiary university center. Results: Of 435 patients, 62% (268/435) survived to discharge, and the most frequent adverse event was hemorrhage (46%), followed by thrombosis (25%). Deceased patients had increased blood levels of C-reactive protein, procalcitonin, and white blood cells during the whole observation period, with higher peaks compared with survivors. The multivariable model identified hemorrhage (HR 1.73, p = 0.005) and higher levels of procalcitonin (HR 1.01, p = 0.001) as independent risk factors for death. Conclusions: In our population of critically ill patients receiving va-ECMO support, deceased patients had increased inflammatory biomarkers during the whole observation period. Patients having higher values of procalcitonin and experiencing bleeding events showed an increased risk for mortality. Further studies focusing on inflammation in ECMO patients, clarifying its role in patient outcome and potential therapeutic interventions, are warranted.
    Materialart: Online-Ressource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12122963
    Sprache: Englisch
    Verlag: MDPI AG
    Publikationsdatum: 2022
    ZDB Id: 2662336-5
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
    Online-Ressource
    Online-Ressource
    Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
    Elsevier BV ; 2017
    In:  The Lancet Vol. 390, No. 10100 ( 2017-09), p. 1211-1259
    Details
    In: The Lancet, Elsevier BV, Vol. 390, No. 10100 ( 2017-09), p. 1211-1259
    Materialart: Online-Ressource
    ISSN: 0140-6736
    URL: Article
    DOI: 10.1016/S0140-6736(17)32154-2
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2017
    ZDB Id: 2067452-1
    ZDB Id: 3306-6
    ZDB Id: 1476593-7
    SSG: 5,21
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
    Online-Ressource
    Online-Ressource
    Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017
    Elsevier BV ; 2018
    In:  The Lancet Vol. 392, No. 10159 ( 2018-11), p. 2091-2138
    Details
    In: The Lancet, Elsevier BV, Vol. 392, No. 10159 ( 2018-11), p. 2091-2138
    Materialart: Online-Ressource
    ISSN: 0140-6736
    URL: Article
    DOI: 10.1016/S0140-6736(18)32281-5
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2018
    ZDB Id: 2067452-1
    ZDB Id: 3306-6
    ZDB Id: 1476593-7
    SSG: 5,21
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
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    Online-Ressource
    Low-Molecular-Weight Heparin Resistance and Its Viscoelastic Assessment in Critically Ill COVID-19 Patients
    Georg Thieme Verlag KG ; 2022
    In:  Seminars in Thrombosis and Hemostasis Vol. 48, No. 07 ( 2022-10), p. 850-857
    Details
    In: Seminars in Thrombosis and Hemostasis, Georg Thieme Verlag KG, Vol. 48, No. 07 ( 2022-10), p. 850-857
    Kurzfassung: Critically ill COVID-19 patients present an inflammatory and procoagulant status with a high rate of relevant macro- and microvascular thrombosis. Furthermore, high rates of heparin resistance have been described; yet, individualized anticoagulation by drug monitoring has not been sufficiently researched. We analyzed data from critically ill COVID-19 patients treated at Innsbruck Medical University Hospital with routinely adapted low-molecular-weight heparin (LMWH) doses according to anti-Xa peak levels, and regularly performed ClotPro analyses (a viscoelastic hemostatic whole blood test). A total of 509 anti-Xa peak measurements in 91 patients were categorized as below ( 〈 0.008 IU/mL/mg), within (0.008–0–012 IU/mL/mg) or above ( 〉 0.012 IU/mL/mg) expected ranges with respect to the administered LMWH doses. Besides intergroup comparisons, correlations between anti-Xa levels and ClotPro clotting times (CTs) were performed (226 time points in 84 patients). Anti-Xa peak levels remained below the expected range in the majority of performed measurements (63.7%). Corresponding patients presented with higher C-reactive protein and D-dimer but lower antithrombin levels when compared with patients achieving or exceeding the expected range. Consequently, higher enoxaparin doses were applied in the sub-expected anti-Xa range group. Importantly, 47 (51.6%) patients switched between groups during their intensive care unit (ICU) stay. Anti-Xa levels correlated weakly with IN test CT and moderately with Russell's viper venom (RVV) test CT. Critically ill COVID-19 patients present with a high rate of LMWH resistance but with a variable LMWH response during their ICU stay. Therefore, LMWH–anti-Xa monitoring seems inevitable to achieve adequate target ranges. Furthermore, we propose the use of ClotPro's RVV test to assess the coagulation status during LMWH administration, as it correlates well with anti-Xa levels but more holistically reflects the coagulation cascade than anti-Xa activity alone.
    Materialart: Online-Ressource
    ISSN: 0094-6176 , 1098-9064
    URL: Article
    DOI: 10.1055/s-0042-1756304
    Sprache: Englisch
    Verlag: Georg Thieme Verlag KG
    Publikationsdatum: 2022
    ZDB Id: 2072469-X
    Standort Signatur Einschränkungen Verfügbarkeit
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