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Book ; Thesis: Analyse verschiedener Formen kardiozirkulatorischer Dysfunktion, ihres Outcomes sowie der Assoziation mit klinischen Parametern bei Patienten mit schwerer Sepsis und septischem Schock in einer Beobachtungsstudie

Thomas-Rüddel, Daniel

2017

Author's details	von Daniel Oliver Thomas-Rüddel
Language	German ; English
Size	27, XVI Blätter, Illustrationen, Diagramme
Publishing place	Jena
Publishing country	Germany
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Dissertation, Friedrich-Schiller-Universität Jena, 2017
Note	Enthält einen Sonderdruck in englischer Sprache
HBZ-ID	HT019508357
Database	Catalogue ZB MED Medicine, Health

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Article: Diagnostik der Sepsis

Thomas-Rüddel, Daniel

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie

2023 Volume 58, Issue 01, Page(s) 29–38

Abstract: Sepsis occurs both community acquired and as a complication of hospital treatment. The symptoms are usually nonspecific and there is no diagnostic gold standard. The diagnostic differentiation from other clinical pictures is difficult. ... ...

Abstract	Sepsis occurs both community acquired and as a complication of hospital treatment. The symptoms are usually nonspecific and there is no diagnostic gold standard. The diagnostic differentiation from other clinical pictures is difficult. Therefore, the (early) diagnosis of sepsis is still a major challenge for the clinician. Despite multiple biomarkers described in the scientific literature sepsis is still primarily a clinical diagnosis. qSOFA can be a helpful screening tool. Finding and treating the focus of infection is a crucial part of sepsis therapy. Chest X-ray and sonography have limited sensitivity for this purpose. A CT-scan with contrast should be done at least in all patients where the focus of infection is still unclear. An MRI is necessary if spondylodiscitis is suspected, a transesophageal echocardiography if endocarditis is a possible focus. Biomarkers are helpful in guiding therapy but are not part of the initial diagnosis criteria. Blood cultures and microbiological samples from the suspected foci of infection should be taken in all sepsis patients. An initial lactate measurement is also part of the diagnostic workup and necessary for the diagnosis of septic shock.
Keywords	Sepsis ; Diagnostik ; Symptome ; Blutkulturen ; Infektionsfokus ; sepsis ; diagnosis ; symptoms ; blood culture ; focus of infection
Language	German
Publishing date	2023-01-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	1065682-0
ISSN	1439-1074 ; 0939-2661
ISSN (online)	1439-1074
ISSN	0939-2661
DOI	10.1055/a-1813-2293
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Article: Diagnostik der Sepsis

Thomas-Rüddel, Daniel

Intensivmedizin up2date

2023 Volume 19, Issue 01, Page(s) 37–47

Abstract	Sepsis occurs both community acquired and as a complication of hospital treatment. The symptoms are usually nonspecific and there is no diagnostic gold standard. The diagnostic differentiation from other clinical pictures is difficult. Therefore, the (early) diagnosis of sepsis is still a major challenge for the clinician. Despite multiple biomarkers described in the scientific literature sepsis is still primarily a clinical diagnosis. qSOFA can be a helpful screening tool. Finding and treating the focus of infection is a crucial part of sepsis therapy. Chest X-ray and sonography have limited sensitivity for this purpose. A CT-scan with contrast should be done at least in all patients where the focus of infection is still unclear. An MRI is necessary if spondylodiscitis is suspected, a transesophageal echocardiography if endocarditis is a possible focus. Biomarkers are helpful in guiding therapy but are not part of the initial diagnosis criteria. Blood cultures and microbiological samples from the suspected foci of infection should be taken in all sepsis patients. An initial lactate measurement is also part of the diagnostic workup and necessary for the diagnosis of septic shock.
Keywords	Sepsis ; Diagnostik ; Symptome ; Blutkulturen ; Infektionsfokus
Language	German
Publishing date	2023-02-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2180698-6
ISSN	1614-6697 ; 1614-4856
ISSN (online)	1614-6697
ISSN	1614-4856
DOI	10.1055/a-2002-9165
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Article: Diagnostik der Sepsis

Thomas-Rüddel, Daniel

Allgemein- und Viszeralchirurgie up2date

2023 Volume 17, Issue 06, Page(s) 493–503

Keywords	Sepsis ; Diagnostik ; Symptome ; Blutkulturen ; Infektionsfokus ; sepsis ; diagnosis ; symptoms ; blood culture ; focus of infection
Language	German
Publishing date	2023-12-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2317051-7
ISSN	1611-6461 ; 1611-6437
ISSN (online)	1611-6461
ISSN	1611-6437
DOI	10.1055/a-2181-1146
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Article ; Online: (1 → 3)-β-D-Glucan-guided antifungal therapy in adults with sepsis: the CandiSep randomized clinical trial.

Bloos, Frank / Held, Jürgen / Kluge, Stefan / Simon, Philipp / Kogelmann, Klaus / de Heer, Geraldine / Kuhn, Sven-Olaf / Jarczak, Dominik / Motsch, Johann / Hempel, Gunther / Weiler, Norbert / Weyland, Andreas / Drüner, Matthias / Gründling, Matthias / Meybohm, Patrick / Richter, Daniel / Jaschinski, Ulrich / Moerer, Onnen / Günther, Ulf /

Schädler, Dirk / Weiss, Raphael / Putensen, Christian / Castellanos, Ixchel / Kurzai, Oliver / Schlattmann, Peter / Cornely, Oliver A / Bauer, Michael / Thomas-Rüddel, Daniel

Intensive care medicine

2022 Volume 48, Issue 7, Page(s) 865–875

Abstract: Purpose: To investigate whether (1 → 3)-β-d-Glucan (BDG)-guidance shortens time to antifungal ...

Abstract	Purpose: To investigate whether (1 → 3)-β-d-Glucan (BDG)-guidance shortens time to antifungal therapy and thereby reduces mortality of sepsis patients with high risk of invasive Candida infection (ICI). Methods: Multicenter, randomized, controlled trial carried out between September 2016 and September 2019 in 18 intensive care units enrolling adult sepsis patients at high risk for ICI. Patients in the control group received targeted antifungal therapy driven by culture results. In addition to targeted therapy, patients in the BDG group received antifungals if at least one of two consecutive BDG samples taken during the first two study days was ≥ 80 pg/mL. Empirical antifungal therapy was discouraged in both groups. The primary endpoint was 28-day-mortality. Results: 339 patients were enrolled. ICI was diagnosed in 48 patients (14.2%) within the first 96 h after enrollment. In the BDG-group, 48.8% (84/172) patients received antifungals during the first 96 h after enrollment and 6% (10/167) patients in the control group. Death until day 28 occurred in 58 of 172 patients (33.7%) in the BDG group and 51 of 167 patients (30.5%) in the control group (relative risk 1.10; 95% confidence interval, 0.80-1.51; p = 0.53). Median time to antifungal therapy was 1.1 [interquartile range (IQR) 1.0-2.2] days in the BDG group and 4.4 (IQR 2.0-9.1, p < 0.01) days in the control group. Conclusions: Serum BDG guided antifungal treatment did not improve 28-day mortality among sepsis patients with risk factors for but unexpected low rate of IC. This study cannot comment on the potential benefit of BDG-guidance in a more selected at-risk population.
MeSH term(s)	Adult ; Antifungal Agents/therapeutic use ; Candidiasis, Invasive/drug therapy ; Glucans/therapeutic use ; Humans ; Sensitivity and Specificity ; Sepsis/complications ; Sepsis/drug therapy ; beta-Glucans
Chemical Substances	Antifungal Agents ; Glucans ; beta-Glucans
Language	English
Publishing date	2022-06-16
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-022-06733-x
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Article: Perceptions of Quality of Interprofessional Collaboration, Staff Well-Being and Nonbeneficial Treatment: A Comparison between Nurses and Physicians in Intensive and Palliative Care.

Schwarzkopf, Daniel / Bloos, Frank / Meißner, Winfried / Rüddel, Hendrik / Thomas-Rüddel, Daniel O / Wedding, Ulrich

Healthcare (Basel, Switzerland)

2024 Volume 12, Issue 6

Abstract: This study assessed differences in interprofessional collaboration, perception of nonbeneficial care, and staff well-being between critical care and palliative care teams. In six German hospitals, a staff survey was conducted between December 2013 and ... ...

Abstract	This study assessed differences in interprofessional collaboration, perception of nonbeneficial care, and staff well-being between critical care and palliative care teams. In six German hospitals, a staff survey was conducted between December 2013 and March 2015 among nurses and physicians in intensive and palliative care units. To allow comparability between unit types, a matching was performed for demographic characteristics of staff. N = 313 critical care and 79 palliative care staff participated, of which 72 each were successfully matched. Critical care nurses perceived the poorest overall quality of collaboration compared with critical care physicians and palliative care physicians and nurses. They also reported less inclusive leadership from attendings and head nurses, and the least collaboration on care decisions with physicians. They were most likely to perceive nonbeneficial care, and they reported the lowest levels of job satisfaction and the highest intention to leave the job. In partial correlations, aspects of high-quality collaboration were associated with less perceived nonbeneficial care and higher staff well-being for both critical care and palliative care staff. Our findings indicate that critical care teams could improve collaboration and enhance well-being, particularly among nurses, by adopting principles of collaborative work culture as established in palliative care.
Language	English
Publishing date	2024-03-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare12060602
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Article ; Online: Jenseits von Husten und Pulsoxymetrie … Welche Symptome sind wichtig bei COVID-19?

Thomas-Rüddel, D / Bauer, M

Der Anaesthesist

2020 Volume 69, Issue 9, Page(s) 684

Title translation	Beyond coughing and pulse oximetry….Which symptoms are important in COVID-19?
MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Humans ; Myalgia ; Oximetry ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2
Keywords	covid19
Language	German
Publishing date	2020-08-11
Publishing country	Germany
Document type	Letter ; Comment
ZDB-ID	260-4
ISSN	1432-055X ; 0003-2417
ISSN (online)	1432-055X
ISSN	0003-2417
DOI	10.1007/s00101-020-00824-4
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Article ; Online: Lebensbedrohliche euglykämische Ketoacidose unter Therapie mit Empagliflozin beim kardiochirurgischen Patienten: seltener Einzelfall oder zukünftig ein häufiges Problem?

Wachter, H / von Loeffelholz, C / Thomas-Rüddel, D O / Bargenda, S / Birkenfeld, A L / Bauer, M / Ehler, J

Die Anaesthesiologie

2024

Title translation	Life-threatening euglycemic ketoacidosis under treatment with empagliflozin in cardiac surgery patients: rare isolated case or a frequent problem in the future?
Language	German
Publishing date	2024-04-18
Publishing country	Germany
Document type	Journal Article
ISSN	2731-6866
ISSN (online)	2731-6866
DOI	10.1007/s00101-024-01406-4
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Article ; Online: Sepsis and underlying comorbidities in intensive care unit patients : Analysis of the cause of death by different clinicians-a pilot study.

Thomas-Rüddel, Daniel O / Fröhlich, Holger / Schwarzkopf, Daniel / Bloos, Frank / Riessen, Reimer

Medizinische Klinik, Intensivmedizin und Notfallmedizin

2023 Volume 119, Issue 2, Page(s) 123–128

Abstract: Background: There is an ongoing debate as to whether death with sepsis is primarily caused by sepsis or, more often, by the underlying disease. There are no data on the influence of a researcher's background on such an assessment. Therefore, the aim of ... ...

Title translation	Sepsis und bestehende Komorbiditäten bei internistischen Intensivpatienten : Analyse der Todesursache durch unterschiedliche Kliniker – eine Pilotstudie.
Abstract	Background: There is an ongoing debate as to whether death with sepsis is primarily caused by sepsis or, more often, by the underlying disease. There are no data on the influence of a researcher's background on such an assessment. Therefore, the aim of this analysis was to assess the cause of death in sepsis and the influence of an investigator's professional background on such an assessment. Materials and methods: We performed a retrospective observational cohort study of sepsis patients treated in the medical intensive care unit (ICU) of a tertiary care center. For deceased patients, comorbidities and severity of illness were documented. The cause of death (sepsis or comorbidities or both combined) was independently assessed by four assessors with different professional backgrounds (medical student, senior physician in the medical ICU, anesthesiological intensivist, and senior physician specialized in the predominant comorbidity). Results: In all, 78 of 235 patients died in hospital. Agreement between assessors about cause of death was low (κ 0.37, 95% confidence interval 0.29-0.44). Depending on the assessor, sepsis was the sole cause of death in 6-12% of cases, sepsis and comorbidities in 54-76%, and comorbidities alone in 18-40%. Conclusions: In a relevant proportion of patients with sepsis treated in the medical ICU, comorbidities contribute significantly to mortality, and death from sepsis without relevant comorbidities is a rare event. Designation of the cause of death in sepsis patients is highly subjective and may be influenced by the professional background of the assessor.
MeSH term(s)	Humans ; Pilot Projects ; Retrospective Studies ; Cause of Death ; Sepsis/therapy ; Intensive Care Units ; Comorbidity ; Hospital Mortality ; Shock, Septic/therapy
Language	English
Publishing date	2023-06-28
Publishing country	Germany
Document type	Observational Study ; Journal Article
ZDB-ID	2636018-4
ISSN	2193-6226 ; 1435-1420 ; 0723-5003 ; 2193-6218 ; 0175-3851
ISSN (online)	2193-6226 ; 1435-1420
ISSN	0723-5003 ; 2193-6218 ; 0175-3851
DOI	10.1007/s00063-023-01037-4
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Article ; Online: (1,3)-β-D-glucan-based diagnosis of invasive Candida infection versus culture-based diagnosis in patients with sepsis and with an increased risk of invasive Candida infection (CandiSep): study protocol for a randomized controlled trial.

Bloos, Frank / Held, Jürgen / Schlattmann, Peter / Brillinger, Nicole / Kurzai, Oliver / Cornely, Oliver A / Thomas-Rüddel, Daniel

Trials

2018 Volume 19, Issue 1, Page(s) 472

Abstract: ... to initiate timely antifungal therapy in patients with sepsis. Elevated serum (1,3)-β-D-glucan (BDG ...

Abstract	Background: The time to diagnosis of invasive Candida infection (ICI) is often too long to initiate timely antifungal therapy in patients with sepsis. Elevated serum (1,3)-β-D-glucan (BDG) concentrations have a high diagnostic sensitivity for detecting ICI. However, the clinical significance of elevated BDG concentrations is unclear in critically ill patients. The goal of this study is to investigate whether measurement of BDG in patients with sepsis and a high risk for ICI can be used to decrease the time to empiric antifungal therapy and thus, increase survival. Methods/design: This prospective multicenter open randomized controlled trial is being conducted in 19 German intensive care units. All adult patients with severe sepsis or septic shock and an increased risk for ICI are eligible for enrolment. Risk factors are total parenteral nutrition, previous abdominal surgery, previous antimicrobial therapy, and renal replacement therapy. Patients with proven ICI or those already treated with systemic antifungal substances are excluded. Patients are allocated to a BDG or standard care group. The standard care group receives targeted antifungal therapy as necessary. In the BDG group, BDG serum samples are taken after randomization and 24 h later. Antifungal therapy is initiated if BDG is ≥80 pg/ml in at least one sample. We plan to enroll 312 patients. The primary outcome is 28-day mortality. Other outcomes include antifungal-free survival within 28 days after enrolment, time to antifungal therapy, and the diagnostic performance of BDG compared to other laboratory tests for early ICI diagnosis. The statistical analysis will be performed according to the intent-to-treat principle. Discussion: Because of the high risk of death, American guidelines recommend empiric antifungal therapy in sepsis patients with a high risk of ICI despite the limited evidence for such a recommendation. In contrast, empiric antifungal therapy is not recommended by European guidelines. BDG may offer a way out of this dilemma since BDG potentially identifies patients in need of early antifungals. However, the evidence for such an approach is inconclusive. This clinical study will generate solid evidence for health-care providers and authors of guidelines for the use of BDG in critically ill patients. Trial registration: Clinicaltrials.gov, NCT02734550 . Registered 12 April 2016.
MeSH term(s)	Antifungal Agents/therapeutic use ; Bacteriological Techniques ; Biomarkers/blood ; Candida/drug effects ; Candida/isolation & purification ; Candida/metabolism ; Candidiasis, Invasive/blood ; Candidiasis, Invasive/diagnosis ; Candidiasis, Invasive/drug therapy ; Candidiasis, Invasive/microbiology ; Early Diagnosis ; Female ; Germany ; Humans ; Male ; Multicenter Studies as Topic ; Predictive Value of Tests ; Prospective Studies ; Proteoglycans ; Randomized Controlled Trials as Topic ; Reproducibility of Results ; Sepsis/blood ; Sepsis/diagnosis ; Sepsis/drug therapy ; Sepsis/microbiology ; Severity of Illness Index ; Time Factors ; Time-to-Treatment ; Up-Regulation ; beta-Glucans/blood
Chemical Substances	Antifungal Agents ; Biomarkers ; Proteoglycans ; beta-Glucans ; polysaccharide-K (3X48A86C8K)
Language	English
Publishing date	2018-09-04
Publishing country	England
Document type	Clinical Trial Protocol ; Comparative Study ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-018-2868-0
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