Publications by authors named "Carmen Pfortmueller"
Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.
Study Design And Methods: This was a sub-study of an international, prospective, observational cohort.
Article Synopsis
- - Multi-organ dysfunction in critically ill patients is largely driven by inflammation, which directly impacts the severity of organ damage.
- - Managing this inflammation involves a team effort, including using antibiotics, providing respiratory and circulatory support, and correcting blood coagulation issues, but effective anti-inflammatory drugs are still debated.
- - Xanthohumol (Xn), a natural compound from hops, shows promise as an anti-inflammatory agent due to its ability to inhibit inflammatory pathways and boost antioxidant activity, suggesting it could be beneficial in treating critically ill patients.
Article Synopsis
- Clinical guidelines recommend using buffered crystalloid solutions for critically ill patients, but do not specify which type, prompting a survey of physicians' preferences between acetate- and lactate-buffered solutions.* -
- An international survey of 1321 anesthesiologists and ICU physicians found that the majority used these solutions frequently, with varying availability of both types across different countries.* -
- Most physicians supported a randomized trial comparing the two solutions, rating its clinical importance as significant, but not urgent, with a median score of 5 out of 9.*
Background: Feeding intolerance is common in critically ill patients and can lead to malnutrition. Prokinetic agents may be used to enhance the uptake of nutrition. However, the evidence on the effectiveness and safety of prokinetic agents is sparse, and there is a lack of data on their use in intensive care units (ICU).
View Article and Find Full Text PDFIntroduction: Use of albumin is suggested for some patients with shock, but preferences for its use may vary among intensive care unit (ICU) physicians.
Methods: We conducted an international online survey of ICU physicians with 20 questions about their use of albumin and their opinion towards a randomised trial among adults with shock comparing the use versus no use of albumin.
Results: A total of 1248 respondents participated, with a mean response rate of 37%, ranging from 18% to 75% across 21 countries.
Postoperative fluid overload (FO) after cardiac surgery is common and affects recovery. Predicting FO could help optimize fluid management. This post-hoc analysis of the HERACLES randomized controlled trial evaluated the predictive value of MR-proADM for FO post-cardiac surgery.
View Article and Find Full Text PDFIn this review, we aimed to comprehensively summarize current literature on pathophysiology, relevance, diagnosis and treatment of fluid accumulation in patients with sepsis/septic shock. Fluid accumulation syndrome (FAS) is defined as fluid accumulation (any degree, expressed as percentage from baseline body weight) with new onset organ-failure. Over the years, many studies have described the negative impact of FAS on clinically relevant outcomes.
View Article and Find Full Text PDFBackground: Fluid accumulation (FA) is known to be associated with acute kidney injury (AKI) during intensive care unit (ICU) stay but data on mid-term renal outcome is scarce. The aim of this study was to investigate the association between FA at ICU day 3 and major adverse kidney events in the first 30 days after ICU admission (MAKE30).
Methods: Retrospective, single-center cohort study including adult ICU patients with sufficient data to compute FA and MAKE30.
Importance: Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice.
Objective: To evaluate and describe ICU RBC transfusion practices worldwide.
Background: When caring for mechanically ventilated adults with acute hypoxaemic respiratory failure (AHRF), clinicians are faced with an uncertain choice between ventilator modes allowing for spontaneous breaths or ventilation fully controlled by the ventilator. The preferences of clinicians managing such patients, and what motivates their choice of ventilator mode, are largely unknown. To better understand how clinicians' preferences may impact the choice of ventilatory support for patients with AHRF, we issued a survey to an international network of intensive care unit (ICU) researchers.
View Article and Find Full Text PDFBackground: Fluid overload is associated with excess mortality in septic shock. Current approaches to reduce fluid overload include restrictive administration of fluid or active removal of accumulated fluid. However, evidence on active fluid removal is scarce.
View Article and Find Full Text PDFArticle Synopsis
- - The GODIF trial investigates whether using furosemide to remove excess fluid in ICU patients improves outcomes compared to a placebo, as fluid overload is linked to higher mortality in these patients.
- - Involving 1000 stable adult ICU patients, the trial employs a randomized, blinded, and pragmatic design to measure the primary outcome of days alive and out of the hospital within 90 days after treatment.
- - The statistical analysis plan includes rigorous methods for comparing treatment groups and considers various prognostic variables to enhance the reliability of the findings regarding furosemide's effectiveness.
Purpose: Maintenance and hidden/creep fluids are a major source of fluid and sodium intake in intensive care unit (ICU) patients. Recent research indicates that low versus high sodium content maintenance fluids could decrease fluid and sodium burden. We conducted a systematic review (SR) with meta-analysis to summarize the impact of maintenance fluid choice on total daily sodium in ICU patients.
View Article and Find Full Text PDFPurpose: To assess long-term outcomes of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock included in the European Conservative versus Liberal Approach to Fluid Therapy in Septic Shock in Intensive Care (CLASSIC) trial.
Methods: We conducted the pre-planned analyses of mortality, health-related quality of life (HRQoL) using EuroQol (EQ)-5D-5L index values and EQ visual analogue scale (VAS), and cognitive function using Mini Montreal Cognitive Assessment (Mini MoCA) test at 1 year. Deceased patients were assigned numerical zero for HRQoL as a state equal to death and zero for cognitive function outcomes as worst possible score, and we used multiple imputation for missing data on HRQoL and cognitive function.
Purpose: To systematically assess test performance of patient-adapted D-dimer cut-offs for the diagnosis of venous thromboembolism (VTE).
Methods: Systematic review and analysis of articles published in PubMed, Embase, ClinicalTrials.gov, and Cochrane Library databases.
Purpose: To evaluate the impact of active fluid de-resuscitation on mortality in critically ill patients with septic shock.
Methods: A systematic search was performed on PubMed, EmBase, and the Cochrane Library databases. Trials investigating active fluid de-resuscitation and reporting data on mortality in patients with septic shock were eligible.
Objective: Patients with heart failure (HF) and cardiogenic shock are especially prone to the negative effects of fluid overload (FO); however, fluid resuscitation in respective patients is sometimes necessary resulting in FO. We aimed to study the association of FO at ICU discharge with 30-day mortality in patients admitted to the ICU due to severe heart failure and/or cardiogenic shock.
Methods: Retrospective, single-center cohort study.
Aims Of The Study: To describe reasons for medical emergency team (MET) activation over time, to analyse outcomes, and to describe the circadian distribution of MET calls and Intensive Care Unit (ICU) admissions following MET activation.
Methods: Monocentric retrospective observational study of prospectively collected data on all MET calls between 1 of January 2012 until 31 of May 2019. We analysed data on baselines, referring wards, and disposition of all MET patients.
Unlabelled: Data on long-term effects of post-extubation dysphagia is lacking. We investigate mid- and long-term clinical outcomes in a large sample of ICU patients with systematic dysphagia screening.
Design: Outcome analysis with a follow-up of 6 years or death (whichever occurred earlier) of ICU patients from a prospective observational trial (Dysphagia in Mechanically Ventilated ICU Patients study) with systematic dysphagia screening.
Background: Intravenous fluids are recommended for the treatment of patients who are in septic shock, but higher fluid volumes have been associated with harm in patients who are in the intensive care unit (ICU).
Methods: In this international, randomized trial, we assigned patients with septic shock in the ICU who had received at least 1 liter of intravenous fluid to receive restricted intravenous fluid or standard intravenous fluid therapy; patients were included if the onset of shock had been within 12 hours before screening. The primary outcome was death from any cause within 90 days after randomization.
Introduction: As new treatments have become established, more frail pre-ICU patients are being admitted to intensive care units (ICUs); this is creating new challenges to provide adequate care and to ensure that resources are allocated in an ethical and economical manner. This systematic review evaluates the current standard for assessing frailty on the ICU, including methods of assessment, time point of measurements, and cut-offs.
Methods: A systematic search was conducted on MEDLINE, Clinical Trials, Cochrane Library, and Embase.