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Detlef Kindgen-Milles

Publications and source records attributed to Detlef Kindgen-Milles.

6 recordsLinked to original sources
PubMed2005

Study protocol: the DOse REsponse Multicentre International collaborative initiative (DO-RE-MI).

INTRODUCTION: Current practices for renal replacement therapy in intensive care units (ICUs) remain poorly defined. The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI) will address the issue of how the different modes of renal replacement therapy are currently chosen and performed. Here, we describe the study protocol, which was approved by the Scientific and Steering Committees. METHODS: DO-RE-MI is an observational, multicentre study conducted in ICUs. The primary end-point will be the delivered dose of dialysis, which will be compared with ICU mortality, 28-day mortality, hospital mortality, ICU length of stay and number of days of mechanical ventilation. The secondary end-point will be the haemodynamic response to renal replacement therapy, expressed as percentage reduction in noradrenaline (norepinephrine) requirement. Based on the the sample analysis calculation, at least 162 patients must be recruited. Anonymized patient data will be entered online in electronic case report forms and uploaded to an internet website. Each participating centre will have 2 months to become acquainted with the electronic case report forms. After this period official recruitment will begin. Patient data belong to the respective centre, which may use the database for its own needs. However, all centres have agreed to participate in a joint effort to achieve the sample size needed for statistical analysis. CONCLUSION: The study will hopefully help to collect useful information on the current practice of renal replacement therapy in ICUs. It will also provide a centre-based collection of data that will be useful for monitoring all aspects of extracorporeal support, such as incidence, frequency, and duration.

Blood Pressure↗
PubMed2005

Nasal-continuous positive airway pressure reduces pulmonary morbidity and length of hospital stay following thoracoabdominal aortic surgery.

STUDY OBJECTIVES: Patients who undergo surgical repair of thoracoabdominal aortic aneurysms have a high risk for the development of respiratory complications, which cause significant postoperative morbidity and prolong hospitalization, compared to patients who undergo other types of surgery. We studied whether prophylactic noninvasive application of nasal continuous positive airway pressure (nCPAP) administered via a facemask immediately after extubation may reduce pulmonary morbidity and shorten the length of hospitalization. DESIGN: Prospective randomized clinical trial. SETTING: Surgical ICU of a university hospital. PATIENTS: Fifty-six patients following elective prosthetic replacement of the thoracoabdominal aorta, of whom 6 patients were excluded because they had received prolonged mechanical ventilation. INTERVENTIONS: Following extubation in the ICU, nCPAP was applied for 12 to 24 h at an airway pressure of 10 cm H2O to patients in the study group (n = 25). Subjects in the control group (n = 25) received standard treatment including intermittent nCPAP (10 cm H2O for 10 min) every 4 h. MEASUREMENTS AND RESULTS: In the study group, nCPAP was applied for a mean (+/- SD) duration of 23 +/- 3 h at an airway pressure of 10 +/- 1 cm H2O, which improved pulmonary oxygen transfer without altering hemodynamics (ie, heart rate, mean arterial BP, and central venous pressure). The application of nCPAP was associated with fewer pulmonary complications (Pa(O2)/fraction of inspired oxygen [F(IO2)] <100, atelectasis, pneumonia, reintubation rate) compared to the control group (7 of 25 patients vs 24 of 25 subjects, respectively; p = 0.019). The mean duration of intensive care treatment tended to be shorter in the study group compared to the control group (8 +/- 1 vs 12 +/- 2 days, respectively; difference not significant), while the mean length of hospital stay was shorter with nCPAP therapy (22 +/- 2 vs 34 +/- 5 days, respectively; p = 0.048). CONCLUSIONS: The prophylactic application of nCPAP at airway pressures of 10 cm H2O significantly reduced pulmonary morbidity and length of hospital stay following the surgical repair of thoracoabdominal aortic aneurysms. Thus, it can be recommended as a standard treatment procedure for this patient group.

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PubMed2003

Assessment of microvascular oxygen saturation in gastric mucosa in volunteers breathing continuous positive airway pressure.

OBJECTIVE: Adequate oxygenation of the gastrointestinal mucosa to preserve its barrier function is a basic objective in the prevention of multiple organ failure. Sustaining a positive airway pressure during the entire respiratory cycle remains a cornerstone in the therapeutic regimen to improve systemic oxygenation. Whereas increased systemic oxygenation during breathing continuous positive airway pressure has been shown, the impact of continuous positive airway pressure on regional oxygenation in the gastrointestinal tract has not yet been evaluated. We hypothesized that continuous positive airway pressure decreases microvascular oxygen saturation in gastric mucosa. DESIGN: Prospective, randomized study. SETTING: University department of anesthesiology. PARTICIPANTS: Twelve healthy volunteers. INTERVENTIONS: Incremental increases of continuous positive airway pressure (0, 5, and 10 cm H(2)O) and subsequent release of continuous positive airway pressure. MEASUREMENTS AND MAIN RESULTS: We continuously measured microvascular oxygen saturation in gastric mucosa by reflectance spectrophotometry. Systemic oxygen saturation, end-tidal Pco(2), respiratory rate, heart rate, and arterial blood pressure were obtained noninvasively. In every volunteer, microvascular oxygen saturation in gastric mucosa was reduced corresponding to the level of continuous positive airway pressure, although systemic variables, especially systemic oxygen saturation, did not change. Continuous positive airway pressure reduced microvascular oxygen saturation in gastric mucosa from 59 +/- 7% (baseline with 0 cm H(2)O continuous positive airway pressure, mean +/- sd) to 54 +/- 8% (p <.05) during 5 cm H(2)O continuous positive airway pressure and to 50 +/- 9% (p <.05) during 10 cm H(2)O continuous positive airway pressure, returning to 59 +/- 7% during spontaneous breathing with 0 cm H(2)O continuous positive airway pressure. End-tidal Pco(2), respiratory rate, as well as hemodynamic variables, remained stable. CONCLUSIONS: Reflectance spectrophotometry meticulously monitored changes in microvascular oxygen saturation in gastric mucosa during breathing continuous positive airway pressure. Microvascular oxygen saturation in gastric mucosa decreased with increasing levels of continuous positive airway pressure despite steady systemic variables. These results suggest that the impact of altering airway pressures on splanchnic oxygenation is not mirrored necessarily by concomitant changes in systemic circulation. Moreover, if these findings also apply to critically ill patients, monitoring microvascular oxygen saturation in gastric mucosa would be useful to further optimize the setting of ventilation variables.

Adult↗
PubMed2002

Prophylactic nasal continuous positive airway pressure after major vascular surgery: results of a prospective randomized trial.

BACKGROUND: The efficacy of nasal continuous positive airway pressure (nCPAP) as a prophylactic method for preventing cardiopulmonary complications after major vascular surgery has not been investigated. PATIENTS/METHODS: In a prospective randomized trial, 204 patients undergoing elective midline laparotomy for vascular surgery were randomized to receive standard therapy ( n=105) or additional prophylactic nCPAP ( n=99) for the first postoperative night. Postoperative oxygenation, incidence of severe cardiac, and pulmonary complications, length of intensive care surveillance and length of total postoperative hospital stay (LOS) were compared. RESULTS: Prophylactic nCPAP significantly reduced the number of patients with severe oxygenation disturbances defined as paO(2) < 70 mmHg with FiO(2) > or = 0.7 (5 versus 17, P=.01). There were no differences with respect to death, cardiac and pulmonary complications, length of intensive care surveillance or LOS. CONCLUSION: Prophylactic 12 h nCPAP significantly reduces the occurrence of postoperative oxygenation disturbances but has no effect on cardiac or pulmonary complications, need for intensive care, LOS or mortality after major vascular surgery.

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PubMed2002

Clinical evaluation of reflectance spectrophotometry for the measurement of gastric microvascular oxygen saturation in patients undergoing cardiopulmonary bypass.

OBJECTIVE: To evaluate the impact of cardiopulmonary bypass (CPB) on gastric mucosal oxygen saturation assessed by reflectance spectrophotometry in patients undergoing coronary artery bypass graft surgery. DESIGN: Prospective, observational study. SETTING: A division of cardiothoracic anesthesia in a university hospital. PARTICIPANTS: Twelve consecutive patients undergoing CPB. INTERVENTIONS: Monitoring, anesthesia, surgical procedure, and CPB for the patients followed routine clinical protocol as established in the departments. Microvascular oxygen saturation in gastric mucosa was assessed by reflectance spectrophotometry before, during, and after CPB. MEASUREMENTS AND MAIN RESULTS: Gastric mucosal oxygen saturation averaged 65 +/- 7% (mean +/- SD) before CPB, decreased significantly to 57 +/- 9% during CPB (p < 0.01), and was 59 +/- 8% after CPB. These changes in regional oxygen saturation were not mirrored in variables of systemic oxygenation. Gastric mucosal oxygen saturation always showed instantaneous reactions to various surgical and pharmacologic interventions. CONCLUSION: Reflectance spectrophotometry allowed the authors to assess gastric mucosal oxygen saturation with a high repetition rate, regardless of spontaneous circulation with pulsatile flow or nonpulsatile flow during CPB. This technique provided the means to monitor on-line the course of tissue oxygen saturation throughout the operative procedure. Reflectance spectrophotometry is an appropriate and sensitive assessment tool to monitor gastric mucosal oxygen saturation in patients undergoing CPB.

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