Publications by authors named "Peter Kranke"

Objectives: We present the 'COVID-19 evidence ecosystem' (CEOsys) as a German network to inform pandemic management and to support clinical and public health decision-making. We discuss challenges faced when organizing the ecosystem and derive lessons learned for similar networks acting during pandemics or health-related crises.

Study Design And Setting: Bringing together 18 university hospitals and additional institutions, CEOsys key activities included research prioritization, conducting living systematic reviews (LSRs), supporting evidence-based (living) guidelines, knowledge translation (KT), detecting research gaps, and deriving recommendations, backed by technical infrastructure and capacity building.

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Securing an airway enables the oxygenation and ventilation of the lungs and is a potentially life-saving medical procedure. Adverse and critical events are common during airway management, particularly in neonates and infants. The multifactorial reasons for this include patient-dependent, user-dependent and also external factors.

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Article Synopsis
  • Postoperative pulmonary embolism (PE) is a serious complication that can be effectively treated using ECMO therapy, particularly in hospitals equipped with experienced staff and advanced technical capabilities.
  • A study analyzing over 13 million surgical procedures in Germany from 2012 to 2019 revealed that hospitals with more than 20 ECMO applications per year had a significantly reduced failure to rescue (FtR) rate of 24.4% in high-risk surgeries related to PE.
  • The availability and expertise in ECMO therapy were linked to better patient outcomes, highlighting that even if ECMO wasn't used directly, its presence enhances overall care for patients facing postoperative PE complications.
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Introduction: Fitness trackers can provide continuous monitoring of vital signs and thus have the potential to become a complementary, mobile and effective tool for early detection of patient deterioration and post-operative complications.

Methods: To evaluate potential implementations in acute care setting, we included 36 patients after moderate to major surgery in a recent randomised pilot trial to compare the performance of vital sign monitoring by three different fitness trackers (Apple Watch 7, Garmin Fenix 6pro and Withings ScanWatch) with established standard clinical monitors in post-anaesthesia care units and monitoring wards.

Results: During a cumulative period of 56 days, a total of 53,197 heart rate (HR) measurements, as well as 12,219 measurements of the peripheral blood oxygen saturation (SpO) and 28,954 respiratory rate (RR) measurements were collected by fitness trackers.

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Background: Thromboembolic events are common complications of COVID-19. Clinical study results on safety and efficacy of anticoagulation in COVID-19 are controversial.

Material And Methods: This report is the second update of our systematic review with meta-analysis on randomized controlled trials (RCTs) comparing standard thromboprophylaxis, intermediate or therapeutic dose anticoagulation or no anticoagulation in COVID-19 in- and outpatients.

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  • Severe maternal hemorrhage is the leading cause of maternal death globally, prompting advances in Patient Blood Management over the past 20 years.
  • The use of cell salvage during surgeries with significant blood loss is recommended to maintain patients' blood volume and reduce reliance on donor red blood cell transfusions.
  • Despite historical concerns about risks such as amniotic fluid embolism, current evidence supports the safe and effective use of cell salvage in obstetrics, particularly for high-risk patients, making it a cost-effective practice.
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Objectives: Determination of the procedure-specific, risk-adjusted probability of nausea.

Design: Cross-sectional analysis of clinical and patient-reported outcome data. We used a logistic regression model with type of operation, age, sex, preoperative opioids, antiemetic prophylaxis, regional anaesthesia, and perioperative opioids as predictors of postoperative nausea.

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Purpose Of Review: Clinical management of postdural puncture headache (PDPH) remains an interdisciplinary challenge with significant impact on both morbidity and quality of life. This review aims to give an overview of the most recent literature on prophylactic and therapeutic measures and to discuss novel findings with regard to currently published consensus practice guideline recommendations.

Recent Findings: Although current evidence does not support a recommendation of any specific prophylactic measure, new data is available on the use of intrathecal catheters to prevent PDPH and/or to avoid invasive procedures.

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Background: Acute and chronic postoperative pain are important healthcare problems, which can be treated with a combination of opioids and regional anaesthesia. The erector spinae plane block (ESPB) is a new regional anaesthesia technique, which might be able to reduce opioid consumption and related side effects.

Objectives: To compare the analgesic effects and side effect profile of ESPB against no block, placebo block or other regional anaesthetic techniques.

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Climate change is a defining issue for our generation. The carbon footprint of clinical practice accounts for 4.7% of European greenhouse gas emissions, with the European Union ranking as the third largest contributor to the global healthcare industry's carbon footprint, after the United States and China.

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Article Synopsis
  • The study aimed to assess the relationship between prehospital blood glucose (PBG) levels and outcomes such as hospitalization and mortality in critically ill patients.
  • Analyzed data from 970 patients showed that those with elevated PBG (≥140 mg/dL) had higher odds of hospitalization, ICU admission, and in-hospital mortality compared to those with normal glucose levels.
  • The findings suggest that monitoring PBG could be a valuable tool for risk assessment in emergency medicine, as it correlates with increased health risks and longer hospital stays.
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Background: Iron deficiency (ID) is the leading cause of anemia worldwide. The prevalence of preoperative ID ranges from 23 to 33%. Preoperative anemia is associated with worse outcomes, making it important to diagnose and treat ID before elective surgery.

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Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups.

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Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups.

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Background: Qualitative data on the opinions of anaesthesiologists regarding the impact of peri-operative night-time working conditions on patient safety are lacking.

Objectives: This study aimed to achieve in-depth understanding of anaesthesiologists' perceptions regarding the impact of night-time working conditions on peri-operative patient safety and actions that may be undertaken to mitigate perceived risks.

Design: Qualitative analysis of responses to two open-ended questions.

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Blood oxygen saturation is an important clinical parameter, especially in postoperative hospitalized patients, monitored in clinical practice by arterial blood gas (ABG) and/or pulse oximetry that both are not suitable for a long-term continuous monitoring of patients during the entire hospital stay, or beyond. Technological advances developed recently for consumer-grade fitness trackers could-at least in theory-help to fill in this gap, but benchmarks on the applicability and accuracy of these technologies in hospitalized patients are currently lacking. We therefore conducted at the postanaesthesia care unit under controlled settings a prospective clinical trial with 201 patients, comparing in total >1,000 oxygen blood saturation measurements by fitness trackers of three brands with the ABG gold standard and with pulse oximetry.

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Medical practice guidelines (MPGs) are important in medicine to ensure well tolerated and effective healthcare. They provide evidence-based recommendations for healthcare professionals in daily clinical settings. MPGs help patients and practitioners make informed decisions, ensure quality of care, allocate healthcare resources effectively and reduce legal liability.

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Article Synopsis
  • Postpartum hemorrhage (PPH) affects about 4% of deliveries in high-income countries and is increasing due to more caesarean sections and higher maternal health issues.
  • Preventive measures like administering uterotonics can lower the risk of severe bleeding, and early diagnosis through accurate blood loss measurement is crucial for better outcomes.
  • Effective treatment involves identifying the cause of bleeding, stopping it with uterotonics and surgical methods, restoring blood volume through transfusions, and using lab tests for proper factor replacement.
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