key: cord-255256-8uckmya4
authors: nan
title: Akzeptierte Abstracts für die COVID-19-bedingt abgesagte DGIIN/ÖGIAIN-Jahrestagung 2020
date: 2020-08-18
journal: Med Klin Intensivmed Notfmed
DOI: 10.1007/s00063-020-00711-1
sha: 
doc_id: 255256
cord_uid: 8uckmya4

nan

Sehr geehrte Leserinnen und Leser, dieses Jahr hätte die Gemeinsame Jahrestagung der DGIIN und ÖGIAIN als 52. Jahrestagung in Salzburg stattfinden sollte. Leider kam die COVID-19-Krise dazwischen, und trotz der weit fortgeschrittenen Planungen war es unter Einhaltung der gesetzlichen Vorgaben nicht mehr möglich, eine so große Tagung durchzuführen. Die Planungen beinhalteten auch bereits die Evaluierung der eingereichten Abstracts. Da wir trotz der Absage der Tagung die Autoren, die sich der Mühe unterzogen, ihre Arbeiten in einem Abstract zusammenzufassen, nicht leer ausgehen lassen wollten, haben wir uns entschieden, die von den Gutachtern akzeptierten Abstracts in dieser Ausgabe der Zeitschrift Medizinische Klinik -Intensivmedizin und Notfallmedizin zu publizieren. Somit soll den Autoren Gelegenheit gegeben werden, ihre Daten trotzdem einem breiteren Publikum präsentieren zu können.

Nach den derzeitigen Planungen wird die Jahrestagung im Jahr 2022 wieder in Salzburg stattfinden. Wir hoffen, dass uns die Mitglieder der DGIIN und ÖGIAIN dann auch wieder die Treue halten, und wünschen ihnen eine interessante Lektüre mit den Abstracts der heuer leider ausgefallenen Jahrestagung.

Results: In septic patients we observed a statistically significant decrease in the density of capillaries with a diameter of 5 µm (D5: 3.7 vs. 8.6 mm -2 , p = 0.002), 6 µm (D6: 10.6 vs. 19.7 mm -2 , p = 0.003) and 7 µm (D7: 12.8 vs. 22.1 mm -2 , p = 0.006) compared to healthy controls. Furthermore, D5, D6 and D7 correlated well with several markers of inflammation and critical illness such as lactate (D5: rs = -0.4, p = 0.008; D6: rs = -0.4, p = 0.007; D7: rs = -0.33, p = 0.03), sequential organ failure assessment (SOFA) score (D5: rs = -0.49, p = 0.0002; D6: rs = -0.48, p = 0.0003; D7: rs = -0.4, p = 0.003), interleukin-6 (D5: rs = -0.41, p = 0.004; D6: rs = -0.4, p = 0.006) and procalcitonin (D5: rs = -0.41, p = 0.004; D6: rs = -0.39, p = 0.006). Of note, capillary density in the larger diameter classes of 8-25 µm were neither different between patients and controls, nor did they show a meaningful correlation with relevant clinical parameters. Conclusion: Our data support the hypothesis that microcirculatory impairment in sepsis does not affect all microvessels under 20 µm, but especially the "real capillaries" with a diameter between 5-7 µm. Therefore, a detailed diameter-based assessment of the microvasculature should be evaluated in the future. Aim: Improvements in cannula removal techniques and in particular, a standardized decannulation technique with a suitable closure device, are needed to further improve patient outcomes after percutaneous cannulation. The decannulation techniques described so far are neither sufficiently standardized nor proven enough to be used in the large group of venoarterial extracorporeal membrane oxygenation patients. To meet this challenge, we have established a highly standardized and safe decannulation technique based on the Perclose ProGlide closure system (Abbott Vascular). Methods: Establishment of a highly standardized and safe decannulation technique based on the Perclose ProGlide closure system, which is described in detail with comprehensive instructions for the executive clinician and first application in the context of a pilot study. Results: So far our technique has already been used successfully in 7 patients since January 2019 as a standard procedure on our intensive care unít (ICU) with only one minor complication after the first procedure, i. e. a small pseudoaneurysm likely originating from antegrade perfusion puncture site which was sealed by thrombin injection. Conclusions: Our crossed ProGlide technique using a hemostasis valve Y connector ensuring no blood loss seems to be a very promising decannulation technique. Purpose: Dysfunctional alterations of the microcirculation play a key role in the development of organ damage in sepsis. Therefore, early detection and monitoring of microvascular alterations has been recognized as an important goal in critical care medicine. In this study, we highlight the importance of a quantitative diameter-based analysis approach. Methods: This prospective, observational, cross-sectional study included 34 critically ill septic patients (sepsis 3) recruited from the intensive care units of a university hospital and 17 healthy volunteers served as controls. We used a sidestream dark field (SDF) camera paired with a data acquisition and analysis software (GlycoCheck™) to assess the sublingual microvessels. About 20 videos (6000 vascular segments) per participant were acquired. Using an automated data analysis, the density of red blood cells contained in microvessels (diameter 5-25 µm) was quantified and subdivided according to their particular diameter classes (1 µm each). dererlangung des Kreislaufes (ROSC) war median 2 (1-5) min. Ein erneuter Herz-Kreislauf-Stillstand im Rahmen des ICU-Aufenthaltes wurde bei 26 % (n = 45) der Patienten beobachtet. Insgesamt überlebten 34 % (n = 60) der Patienten nach HKS den ICU-Aufenthalt, davon ein Großteil (75 %, n = 46) mit gutem neurologischem Outcome (CPC I/II) nach Reanimation. Schlussfolgerung ("conclusion"): Das Auftreten eines HKS auf der ICU ist mit einer hohen Mortalität vergesellschaftet. Der HKS ereignet sich in etwa der Hälfte der Fälle innerhalb der ersten 48 h nach ICU-Aufnahme und ist selten kardialer Genese.

High to low bicarbonate replacement fluid switch in alkalotic patients during continuous venovenous hemofiltration with regional citrate anticoagulation-a retrospective single centre analysis Goal of the study: The aim of our study was to compare the replacement fluids (RF) Phoxilium (30 mmol/ l HCO3-) and Biphozyl (22 mmol/ l HCO3-) during continuous renal replacement therapy (CVVH) with regional citrate anticoagulation (RCA) in alkalotic critically ill patients. Consequently, we hypothesized that the HCO3-, hypothesis 1 (H1), BE (H2) and CO 2 (H3) levels would significantly decrease after the RF change (Phoxilium to Biphozyl), with the pH (H4) stabilizing thereafter at physiological levels.

Methods: This retrospective study evaluated intensive care unit patients who underwent CVVH with RCA between 2016 and 2017. Patients were eligible for inclusion if they were 1) aged ≥ 18 years, 2) admitted to ICU, had 3) the indications for CVVH as determined by the attending physician, 4) a change of replacement fluid from Phoxilium® to Biphozyl® based on a persistent blood HCO3-concentration ≥ 26 mmol/ l. Patients were excluded in case of CVVH duration less than 48 h and < 12 h of CVVH treatment duration with Phoxilium® as well as Biphozyl®. Overall targeted observation period including data collection was from -72 h until +72 h around RF switch. Student's t-test was used to test H 1-4. All tests were 2-sided (significance level 5%). Results: In the study 42 (27 male, 15 female, mean age 57 years, BMI 26) out of 153 CVVH-RCA patients were eligible for analysis. After switching the RF the mean HCO3-[H1] significantly decreased from 27.9 mmol/l (SD± 1.4 mmol/l) to 26.0 mmol/l (SD± 2.7 mmol/l) within 24 h (p = 0.001). The mean BE [H2] significantly decreased from 4.1 mmol/l (SD± 1.5 mmol/l) to 1.8 mmol/l (SD± 3.1 mmol/l) within 24 h (p = 0.001). The mean PaCO 2 [H3] decrease from 43.6 mmHg (SD± 5.3 mmHg) to 41.2 mmHg (SD± 7.1 mmHg) within 24 h was not significant (p = 0.138). During the RF change the mean pH [H4] was 7.43 (SD± 0.05) and did not change significantly for at least 72 h (pH 7.43, SD± 0.05) thereafter (p = 0.802) (. Fig. 1) . Conclusions: Switching from high to low bicarbonate RF in alkalotic patients during CVVH with RCA seems to be an appropriate approach for acid-base control, although the PaCO 2 was not significantly decreased. Further research is warranted.

Gender differences in acid-base metabolism during continuous venovenous hemofiltration with regional citrate anticoagulation Goal of the study: The aim of our study was to compare the replacement fluids (RF) Phoxilium (30 mmol/ l HCO3-) and Biphozyl (22 mmol/ l HCO3-) during continuous renal replacement therapy (CVVH) with regional citrate anticoagulation (RCA) in alkalotic critically ill women and men. It was hypothesized that the HCO3-(hypothesis h 1), base excess (BE) (h 2) and pH (h 3) levels as well as the death rate at 90 days (h 4) dif-Goal of the study: Neither the feasibility nor the cardiodepressive and vasodepressive effects of isoflurane sedation in patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment for cardiogenic shock have been investigated. As the vast majority of patients with severe cardiogenic shock treated with VA-ECMO are unconscious and mechanically ventilated, the question arises to what extent a volatile sedation strategy using isoflurane is feasible in these patients, impacts the ventilation duration and intensive care unit (ICU) stay, influences catecholamine dosages and VA-ECMO flow support, and impacts treatment costs. Methods: A total of 32 cardiogenic shock patients with VA-ECMO treatment under sedation with volatile isoflurane on our cardiac ICU were enrolled in this retrospective single center study and were matched by propensity score in a 1:1 ratio with intravenously (IV) sedated patients. Results and discussion: In this study 32 patients in our registry treated with VA-ECMO were sedated with isoflurane. The mean age of the patients was 58.4 ± 13.8 years for conventional sedation and 56.3 ± 11.5 years for isoflurane sedation (p = 0.51). Administration of isoflurane was associated with lower IV sedative drug use during VA-ECMO treatment (86% versus 32%, p = 0.01). Mean systolic arterial pressure was similar (94.3 ± 12.6 mmHg versus 92.9 ± 10.5 mmHg, p = 0.65), but mean heart rate was significantly higher in the conventional sedation group in contrast to the isoflurane group (85.2 ± 20.5/min versus 74.7 ± 15.0/min; p = 0.02). Importantly, catecholamine dose, VA-ECMO blood flow and VA-ECMO gas flow during the first 5 days, ventilation time of survivors (304 ± 143 h versus 398 ± 272 h, p = 0.16), bleeding complications at least classified as BAR-C3a or higher (59.3% versus 65.3%, p = 0.76) and 30-day mortality (59.2% versus 63.4%, p = 0.80) were similar in both groups. The overall sedation cost per patient was significantly lower in the conventional group in comparison to the isoflurane group (537 ± 624 € versus 1280 ± 837 €, p < 0.001). Conclusion: Volatile sedation with isoflurane is feasible, albeit with higher costs, in patients with cardiogenic shock and VA-ECMO treatment and was not associated with higher catecholamine dosage and ECMO flow rate compared to IV sedation. Background: Acute kidney injury (AKI) is a major problem in critically ill patients admitted to an intensive care unit (ICU) causing both high mortality and morbidity. The aim of this study was to explore sex differences in critically ill patients admitted to an ICU who had at least one episode of AKI Methods: All patients admitted to the ICU of the University Hospital Innsbruck between 1-January 2015 and 31 December 2018 were eligible for inclusion, if they developed at least one AKI episode after ICU admission. Severity of AKI was categorized according to KDIGO Methods: This retrospective study evaluated intensive care unit patients who underwent CVVH with RCA between 2016 and 2017. Patients were found eligible for inclusion if they were 1) aged ≥ 18 years, 2) admitted to ICU, had 3) the indications for CVVH as determined by the attending physician, 4) a change of RF from Phoxilium® to Biphozyl® based on a persistent blood HCO3-concentration ≥ 26 mmol/ l. Patients were excluded in case of CVVH duration less than 48 h and < 12 h of CVVH treatment duration with Phoxilium® as well as Biphozyl®. Overall targeted observation period including data collection was ± 72 h from the switch of the RF. Mann-Whitney U-test and Student's t-test was used to test h 1-3, Kaplan-Meier method and logrank test was used for h 4. All tests 2-sided. Results: In this study 42 of 153 CVVH-RCA patients were eligible for analysis. Of these 15 (35%) were women (mean age 57 years, height 166 cm, median weight 72 kg, BMI 27) and 27 (64%) men (mean age 57 years, height 177 cm, median weight 74 kg, BMI 25). During therapy with Phoxilium HCO3-(p = 0.011, h 1) and BE (p = 0.005, h 2) levels differed significantly (p < 0.05) between women and men, whereas pH (p = 0.181, h 3) did not. During therapy with Biphozyl HCO3-(p = 0.650, h 1), BE (p = 0.545, h 2) and pH (p = 0.578, h 3) did not differ significantly between women and men. Mortality at 90 days (p = 0.966, h 4) showed no significant difference between women and men (. Fig. 1) . Conclusions: We found significant differences for HCO3-and BE levels during therapy with Phoxilium in alkalotic critically ill women and men, without an effect based on the volume of distribution. Since no significant differences between women and men were found during therapy with Biphozyl, this possibly indicates that RF with lower HCO3-concentrations may be beneficial for both sexes; however, we did not find significant differences in mortality. Further research is warranted. Fig. 1 9 ( zu "High to low bicarbonate replacement fluid switch in alkalotic patients during continuous venovenous hemofiltration with regional citrate anticoagulation-a retrospective single centre analysis") Trends of HCO3-, BE, PaCO2 and pH over 72 h before and after switching (t0) the replacement fluid from Phoxilium® to Biphozyl® Methods: This was a post hoc analysis of 62 patients (29 female and 33 male) from a prospective study, which investigated the potential influence of altered CA on the incidence of postoperative cognitive disorders (POCD) after major noncardiac surgery with the patient under general anesthesia. Patients enrolled in this study were aged 60 years or older and had no history of cerebrovascular or neurodegenerative disease. The CA monitoring was performed using continuous measurement of the cerebral oximetry index (COx) from incision to closure, where COx represents the moving correlation coefficient between near infrared spectroscopy (NIRS) based measurement of regional cerebral oxygen saturation and mean arterial blood pressure (MAP). For data processing and COx calculation the ICM+ software (University of Cambridge, Cambridge, UK) was used. A COx <0.3 indicated intact CA, whereas a COx ≥ 0.3 indicated impaired CA and represents an increasing correlation between CBF and MAP. The association of gender with intraoperative COx and variables that were considered clinically relevant were analyzed with multivariate analysis. Results: The time with COx ≥0.3 was significantly higher in male patients (males, 42.6%, IQR 35.9-49.5); females, 32.9%, IQR 26.1-42.4, p = 0.007). Average COx during the monitored time period was also higher in men (males, 0.19, IQR 0.11-0.26); females, 0.07, IQR 0.01-0.19, p = 0.02). Male gender was significantly associated with impaired CA in the multivariable analysis (B = -7.667, 95% CI: -13.506;-1.827, p = 0.011). Interestingly, there were no significant differences in average MAP, maximum MAP and minimum MAP between men and women. Conclusion: Women demonstrated better intraoperative CA at the same intraoperative MAP levels as men. Our findings underline the importance of individualized blood pressure targets that may be sex-dependent. Future clinical studies investigating the impact of our findings on perioperative neurological outcome are urgently needed. C (mean 2.48 ± 1.18 vs. 2.36 ± 1.14; p < 0.01). Glomerular filtration rates (GFR) also showed significant differences between women and men when derived from creatinine (mean 41.88 ± 22.1 vs. 43.41 ± 18.76; p < 0.01) and from cystatin C (mean 31.79 ± 19.48 vs. 31.86 ± 16.73; p < 0.01). Conclusion: While most assessed parameters showed no significant differences between women and men, both maximum creatinine and maximum cystatin C and their correspondingly minimum GFRs were significantly different between both sexes. This is an important finding, since the same creatinine criteria are considered for staging of AKI, independent of possible influencing factors on creatinine, such as muscle mass. Background: Cerebral autoregulation (CA) is a mechanism that keeps cerebral blood flow (CBF) constant over a wide range of blood pressures, thereby ensuring the high metabolic demand of the brain [1, 2] . Previous studies have shown better cerebrovascular reactivity, and higher blood flow velocities in women under various conditions [3] [4] [5] ; however, sex-related differences in CA in the perioperative setting are widely unexplored despite their potential impact on an individualized hemodynamic management. Therefore, this study aimed to investigate sex-related differences in CA in patients undergoing major noncardiac surgery with the patient under general anesthesia. Üblicherweise erfolgt eine Lagekontrolle mittels Röntgen-Thorax sowie EKG-Ableitung, doch auch hier kann eine fehlerhafte Lage nicht ausgeschlossen werden [3] . Die Komplikationsraten können durch sonographisch gesteuerte Punktion deutlich (8,7% vs. 1,8%) reduziert werden, auch eine sonographische Lagekontrolle des Seldinger-Drahtes und des Katheters ist so möglich [1] . Objective: Percutaneous dilatational tracheotomy has become a routine procedure in intensive care units (ICUs); however, given the high and steadily growing number of patients receiving anticoagulation, dual antiplatelet therapy, or even a combination of both (also known as triple therapy), there are concerns about the safety of the procedure, in particular for critically ill patients with a high risk of bleeding. In this retrospective study, we investigated whether percutaneous dilatational tracheotomy in this high-risk population was associated with elevated procedural complications.

Design: Retrospective single center study with analysis of all percutaneous dilatational tracheotomies performed in our cardiac ICU from January 2018 to May 2019. Setting: Munich University Hospital cardiac ICU. Patients and Interventions: a total of 34 patients who underwent percutaneous dilatational tracheotomy according to the Ciaglia technique with accompanying bronchoscopy in our cardiac ICU from January 2018 to May 2019 were included. Patients were stratified into clinically relevant risk groups based on anticoagulation and antiplatelet therapy considering

Regulation of cerebral autoregulation by carbon dioxide

Cerebral blood flow autoregulation and dysautoregulation

Sex dependency of cerebrovascular CO2 reactivity in normal subjects

Influence of biological factors on changes in mean cerebral blood flow velocity in normal ageing: a transcranial Doppler study

Elderly women regulate brain blood flow better than men do

Seltene Ursache zerebraler Ischämien: Intraarterielle Fehllage eines ZVK -Ein Fallbericht

Abb. 1 9 a Röntgen-Thorax nach ZVK-Anlage; ZVK-Spitze: roter Pfeil. b Sonographie der Halsgefäße rechts nach Übernahme; ZVK: roter Pfeil standard laboratory coagulation parameters, i. e. activated partial thromboplastin time, international normalized ratio, and platelet count with differentiated analysis of procedure-related complications in each risk group until hospital discharge. Measurements and main results: A total of 34 patients who underwent percutaneous dilatational tracheotomy were included and assigned to 5 clinically relevant treatment groups: IV unfractionated heparin (prophylactic dosage, n = 4), IV unfractionated heparin (therapeutic dosage, n = 4), aspirin and IV unfractionated heparin (therapeutic dosage, n = 7), dual antiplatelet therapy with IV unfractionated heparin (prophylactic dosage, n = 5), and dual antiplatelet therapy with IV unfractionated heparin (therapeutic dosage, n = 14). Bleedings without surgical intervention or blood transfusion was documented in three patients in the whole cohort, but no bleeding occurred in the triple therapy group. These were exclusively caused by skin bleeding at the immediate puncture site, each of which could be easily treated with one or two single stitches. There were no severe bleeding complications or potentially life-threatening procedure-related complications. Additionally, the rate of complications in patients with elevated body mass index was not increased. Conclusions: Bronchoscopy-guided percutaneous dilatational tracheotomy according to the Ciaglia technique with careful consideration of all potential indications and contraindications may be a safe and low-complication procedure for airway management, even in patients receiving dual antiplatelet therapy and therapeutic anticoagulation simultaneously in our cohort with a high risk of bleeding.

Interdisziplinäre Operative Intensivstation, Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar, DeutschlandWir berichten über eine 29-jährige Zeugin Jehovas, die nach Spontanabort in der 25. Schwangerschaftswoche ein akutes Nierenversagen und eine schwere Anämie bedingt durch Blutverlust und Hämolyse erlitt. Trotz Umsetzung aller Empfehlungen des "patient blood management" fiel der Hämoglobinwert (Hb) kontinuierlich ab. An Tag 10 wurde sie bei Hb 1,9 g/ dl plötzlich bewusstlos und musste intubiert und beatmet werden. Wegen organprotektiver Effekte und der guten Steuerbarkeit wurde sie inhalativ mit Isofluran sediert. Isofluran ermöglichte jeweils eine rasche neurologische Beurteilbarkeit in Sedierungsfenstern sowie eine regelmäßige, ruhige Spontanatmung bei tiefer Sedierung mit reduziertem Sauerstoffverbrauch. Als Ausdruck einer posthypoxischen Enzephalopathie zeigte sie in den Sedierungsfenstern Krampfanfälle, die im EEG bestätigt und antikonvulsiv behandelt wurden. Bei Hb 1,8 g/dl erhielt sie 2 Infusionsbeutel mit polymerisiertem bovinem Hämoglobin (Hemopure, HbO2 Therapeutics LLC, Souderton, PA, USA), wegen der kurzen Halbwertszeit mehrmals wiederholt an den Folgetagen. Eine beachtliche Methämoglobinämie wurde festgestellt. Auch nach Abzug des Met-Hb zeigte das Gesamt-Hb Anstiege um 0,4-0,8 g/dl nach den Gaben. Die Sauerstofftransportkapazität konnte damit initial um 33% gesteigert werden. Es kam zu einer vollständigen neurologischen Erholung, und die Patientin wurde schließlich vom Respirator entwöhnt, jedoch weiterhin dialysepflichtig nach 38 Tagen in eine andere Klink verlegt. Schlussfolgerung: Wenn die Gabe von Fremdblut keine Option darstellt, kann durch Gabe von polymerisiertem bovinem Hämoglobin als Ultima-Ratio-Therapie die Sauerstofftransportkapazität vorübergehend erhöht werden. Eine inhalative Sedierung mit Isofluran zur Senkung des Sauerstoffverbrauchs.