Adjuvant hemoadsorption therapy in patients with severe COVID-19 and related organ failure requiring CRRT or ECMO therapy: A case series.

Introduction: Severe cases of the COVID-19 are often associated with the development of a fulminant sepsis-like state with a concomitant cytokine release syndrome. Recently, immunomodulating approaches to treat such a hyperinflammation have come into focus, including the use of new extracorporeal organ support therapies such as CytoSorb hemoadsorption designed to remove cytokines and other circulating mediators from blood.

Patients And Methods: Thirteen critically ill COVID-19 patients with ARDS who received either ECMO therapy and/or CRRT with concomitant multiple organ failure were included.

Analysis of Inflammatory Mediator Profiles in Sepsis Patients Reveals That Extracellular Histones Are Strongly Elevated in Nonsurvivors.

The timely recognition of sepsis and the prediction of its clinical course are challenging due to the complex molecular mechanisms leading to organ failure and to the heterogeneity of sepsis patients. Treatment strategies relying on a "one-fits-all" approach have failed to reduce mortality, suggesting that therapeutic targets differ between patient subgroups and highlighting the need for accurate analysis of the molecular cascades to assess the highly variable host response. Here, we characterized a panel of 44 inflammatory mediators, including cytokines, chemokines, damage-associated molecular patterns, and coagulation-related factors, as well as markers of endothelial activation in 30 patients suffering from renal failure in the course of sepsis.

SARS-CoV-2: recommendations for treatment in intensive care medicine.

Coronavirus disease 2019 (COVID-19) progresses mildly in most of the cases; however, about 5% of the patients develop a severe acute respiratory distress syndrome (ARDS). Of all COVID-19 patients 3% need intensive care treatment, which becomes a great challenge for anesthesiology and intensive care medicine, medically, hygienically and for technical safety requirements. For these reasons, only experienced medical and nursing staff in the smallest grouping possible should be assigned.

Clearance of Selected Plasma Cytokines with Continuous Veno-Venous Hemodialysis Using Ultraflux EMiC2 versus Ultraflux AV1000S.

Background: High cutoff hemofilters might support the restoration of immune homeostasis in systemic inflammation by depleting inflammatory mediators from the circulation.

Methods: Interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor-alpha depletion was assessed in 30 sepsis patients with acute renal failure using continuous veno-venous hemodialysis with high cutoff versus standard filters (CVVHD-HCO vs. CVVHD-STD) over 48 h.

Automated control of mechanical ventilation during general anaesthesia: study protocol of a bicentric observational study (AVAS).

Introduction: Automated control of mechanical ventilation during general anaesthesia is not common. A novel system for automated control of most of the ventilator settings was designed and is available on an anaesthesia machine.

Methods And Analysis: The 'Automated control of mechanical ventilation during general anesthesia study' (AVAS) is an international investigator-initiated bicentric observational study designed to examine safety and efficacy of the system during general anaesthesia.

Abrupt recent trend changes in atmospheric nitrogen dioxide over the Middle East.

Nitrogen oxides, released from fossil fuel use and other combustion processes, affect air quality and climate. From the mid-1990s onward, nitrogen dioxide (NO2) has been monitored from space, and since 2004 with relatively high spatial resolution by the Ozone Monitoring Instrument. Strong upward NO2 trends have been observed over South and East Asia and the Middle East, in particular over major cities.

[Definitions, decision-making and documentation in end of life situations in the intensive care unit].

The present work provides assistance for physicians concerning decision making in clinical borderline situations in the ICU. Based on a structured checklist the two fundamental aspects of any medical decision, the medical indication and the patient's preference are queried in a systematic way. Four possible steps of withholding and/or withdrawing therapy are discussed.

A European survey of nosocomial infection control and hospital-acquired pneumonia prevention practices.

Objectives: We aimed to examine organizational, structural and routine infection control measures provided by European ICUs and staff practices in ventilator-associated pneumonia prevention in relation with current recommendations.

Methods: European ICU staffs were invited to complete a web-based 20 closed-item questionnaire.

Results: 675 nurses and 886 physicians from 13 countries answered the questionnaire.

[Evaluation of the potential organ donor with special regards to heart donation].

Regarding limited availability of organ donors for heart transplantation, it is necessary to discuss optimal donor evaluation and donor management. In this manuscript general donor-related parameters as well as heart-specific parameters are discussed regarding international literature. In addition, "marginal" donors and in contrast "optimal" donors are defined.

Dual color localization microscopy of cellular nanostructures.

The dual color localization microscopy (2CLM) presented here is based on the principles of spectral precision distance microscopy (SPDM) with conventional autofluorescent proteins under special physical conditions. This technique allows us to measure the spatial distribution of single fluorescently labeled molecules in entire cells with an effective optical resolution comparable to macromolecular dimensions. Here, we describe the application of the 2CLM approach to the simultaneous nanoimaging of cellular structures using two fluorochrome types distinguished by different fluorescence emission wavelengths.

Full recovery of an avalanche victim with profound hypothermia and prolonged cardiac arrest treated by extracorporeal re-warming.

Survival of hypothermic avalanche victims with cardiac arrest is rare. This report describes full recovery of a 29-year-old backcountry skier completely buried for 100 min at 3.0m (9.

[Anesthesia in liver transplantation].

In the year 2006 over 1000 liver transplantation (LTX) were performed in Austria, Germany and Switzerland. The feasible association of liver failure with pathologic affections of all other organ systems requires a thorough examination of the potential liver host and a carefully guided anaesthesia. A comprehensive monitoring of the patient and an elaborate therapeutic concept is necessary to meet the peculiar pathophysiologic conditions during LTX.

Influence of negative expiratory pressure ventilation on hemodynamic variables during severe hemorrhagic shock.

Objective: Outcome after trauma with severe hemorrhagic shock is still dismal. Since the majority of blood is present in the venous vessels, it might be beneficial to perform venous recruiting via the airway during severe hemorrhagic shock. Therefore, the purpose of our study was to evaluate the effects of negative expiratory pressure ventilation on mean arterial blood pressure, cardiac output, and short-term survival during severe hemorrhagic shock.

Photorealistic images of objects in effective negative-index materials.

Using a ray-tracing approach, we calculate photorealistic images and simple movies of objects in a material with negative index of refraction. Our results show several surprising and drastic effects, for example reversal of apparent object velocity, extreme distortions of object shape, and even apparent loss of connectivity of simple objects. The material presented aims at giving both researchers and laymen an intuition and visual understanding for the unusual optical properties of negative-index materials.

Effects of face mask ventilation in apneic patients with a resuscitation ventilator in comparison with a bag-valve-mask.

Bag-valve-mask ventilation in an unprotected airway is often applied with a high flow rate or a short inflation time and, therefore, a high peak airway pressure, which may increase the risk of stomach inflation and subsequent pulmonary aspiration. Strategies to provide more patient safety may be a reduction in inspiratory flow and, therefore, peak airway pressure. The purpose of this study was to evaluate the effects of bag-valve-mask ventilation vs.

Influence of positive end-expiratory pressure ventilation on survival during severe hemorrhagic shock.

Study Objective: Although a moderate positive end-expiratory pressure (PEEP) level is widely recommended, it is unknown whether moderate PEEP during mechanical ventilation has adverse effects during severe hemorrhagic shock. Therefore, the purpose of our study was to evaluate the effects of 0 cm H2O PEEP versus 5 cm H2O PEEP versus 10 cm H2O PEEP on short-term survival in a porcine model of severe hemorrhagic shock. Secondary study endpoints were hemodynamic variables and blood gases.

Left and right lobe split-liver transplantation for two paediatric recipients from a 9-year-old donor.

Liver splitting increased the number of grafts for paediatric recipients. Usually the two left lateral segments are given to a child and the remaining liver to an adult recipient. Splitting into a right and a left lobe may allow a small adult to benefit from the left lobe while the right lobe goes to another adult recipient.

Recruitment maneuvers during prone positioning in patients with acute respiratory distress syndrome.

Objective: To evaluate the interaction of recruitment maneuvers and prone positioning on gas exchange and venous admixture in patients with early extrapulmonary acute respiratory distress syndrome ventilated with high levels of positive end-expiratory pressure. We hypothesized that a sustained inflation performed after 6 hrs of prone positioning would induce sustained improvement in oxygenation (Pao2/Fio2) and venous admixture.

Design: Prospective, interventional study.

Developing a strategy to improve ventilation in an unprotected airway with a modified mouth-to-bag resuscitator in apneic patients.

The strategies to ensure safety during ventilation of an unprotected airway are limiting airway pressure and/or inspiratory flow. In this prospective, randomized study we assessed the effect of face mask ventilation with small tidal volumes in the modified mouth-to-bag resuscitator (maximal volume, 500 mL) versus a pediatric self-inflatable bag versus automatic pressure-controlled ventilation in 40 adult apneic patients during induction of anesthesia. The mouth-to-bag resuscitator requires the rescuer to blow up a balloon inside the self-inflating bag that subsequently displaces air which then flows into the patient's airway.

[Is it possible to reduce CMV-infections after heart transplantation with a three-month antiviral prophylaxis? 7 years experience with ganciclovir].

Background: In the early phase after heart transplantation (HTX) patients are at high risk for infection because of intensified immunosuppression. This retrospective study evaluates the efficacy of a three-month antiviral cytomegalovirus (CMV) prophylaxis.

Patients And Methods: 133 patients received a three-month combined intravenous and oral CMV prophylaxis with Ganciclovir (Cymevene after HTX between 1997 and April 2003 (group II).