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Article ; Online: Bowel Perforation During Haemophagocytic Lymphohistiocytosis Treatment with Corticosteroids and Anakinra.

Adamski, Jan / Jäschke, Björn / Nieminen, Tuomas / Weigl, Wojciech

European journal of case reports in internal medicine

2021 Volume 8, Issue 10, Page(s) 2759

Abstract: We report the use of anakinra to treat a case of a 64-year-old man diagnosed with haemophagocytic lymphohistiocytosis (HLH) with neurological involvement. After the administration of intravenous pulse corticosteroid therapy, immunoglobulin and anakinra ... ...

Abstract	We report the use of anakinra to treat a case of a 64-year-old man diagnosed with haemophagocytic lymphohistiocytosis (HLH) with neurological involvement. After the administration of intravenous pulse corticosteroid therapy, immunoglobulin and anakinra the patient showed neurological recovery. However, the recovery was complicated by the perforation of a pre-existing bowel diverticulum. The effect of anakinra on bowel inflammation has not yet been clearly established. It can potentially augment bowel inflammation and contribute to the risk of bowel perforation associated with the concomitant use of corticosteroids. Learning points: Anakinra can potentially augment bowel inflammation.The concomitant use of anakinra and corticosteroids may increase the risk of bowel perforation.Use of anakinra and corticosteroids in patients with pre-existing gastrointestinal diseases requires vigilant observation for abdominal symptoms.
Language	English
Publishing date	2021-10-12
Publishing country	Italy
Document type	Journal Article
ISSN	2284-2594
ISSN (online)	2284-2594
DOI	10.12890/2021_002842
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Article ; Online: Methods of assessing fluid responsiveness in septic shock patients: a narrative review.

Weigl, Wojciech / Adamski, Jan / Onichimowski, Dariusz / Nowakowski, Piotr / Wagner, Bodo

Anaesthesiology intensive therapy

2022 Volume 54, Issue 2, Page(s) 175–183

Abstract: A growing body of evidence shows that some septic patients experience fluid overload, which leads to an increased number of serious complications and death. This is because the majority of septic patients are fluid non-responders. Therefore, a reliable ... ...

Abstract	A growing body of evidence shows that some septic patients experience fluid overload, which leads to an increased number of serious complications and death. This is because the majority of septic patients are fluid non-responders. Therefore, a reliable distinction of which patient would benefit from fluid boluses is crucial in current sepsis mana-gement. Several methods used to assess fluid responsiveness have been developed. The principle of "dynamic" measurements (in contrast to static indices such as central venous pressure) involves the induction of a change in cardiac preload and the measurement of its effect on stroke volume. Dynamic methods are based on either heart-lung interaction during mechanical ventilation or on an assessment of change in cardiac stroke volume in response to fluid provocative stimuli such as rapid fluid administration, passive leg raising, or the end-expiratory occlusion test. Most dynamic measurements are easy to perform and interpret as well as being available at the bedside. However, they vary in their invasiveness, difficulty in performance, reliability, and limitations. In this study, we provide an overview of various methods for assessing fluid responsiveness and indicate those that potentially lead to haemodynamically guided fluid restrictive treatment that would prevent fluid overload in septic patients.
MeSH term(s)	Cardiac Output ; Central Venous Pressure ; Fluid Therapy/methods ; Hemodynamics/physiology ; Humans ; Reproducibility of Results ; Sepsis/therapy ; Shock, Septic/therapy ; Stroke Volume
Language	English
Publishing date	2022-04-12
Publishing country	Poland
Document type	Journal Article ; Review
ISSN	1731-2531
ISSN (online)	1731-2531
DOI	10.5114/ait.2022.115368
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Article ; Online: Predictors of treatment limitations in Finnish intensive care units.

Adamski, Jan / Weigl, Wojciech / Musialowicz, Tadeusz / Lahtinen, Pasi / Reinikainen, Matti

Acta anaesthesiologica Scandinavica

2022 Volume 66, Issue 4, Page(s) 526–538

Abstract: Background: Few studies have examined the factors that predict the limitations of life-sustaining treatment (LST) to patients in intensive care units (ICUs). We aimed to identify variables associated with the decision of withholding of life support ( ... ...

Abstract	Background: Few studies have examined the factors that predict the limitations of life-sustaining treatment (LST) to patients in intensive care units (ICUs). We aimed to identify variables associated with the decision of withholding of life support (WHLS) at admission, WHLS during ICU stay and the withdrawal of ongoing life support (WDLS). Methods: This retrospective observational study comprised 17,772 adult ICU patients who were included in the nationwide Finnish ICU Registry in 2016. Factors associated with LST limitations were identified using hierarchical logistic regression. Results: The decision of WHLS at admission was made for 822 (4.6%) patients, WHLS during ICU stay for 949 (5.3%) patients, and WDLS for 669 (3.8%) patients. Factors strongly predicting WHLS at admission included old age (adjusted odds ratio [OR] for patients aged 90 years or older in reference to those younger than 40 years was 95.6; 95% confidence interval [CI], 47.2-193.5), dependence on help for activities of daily living (OR, 3.55; 95% CI, 3.01-4.2), and metastatic cancer (OR, 4.34; 95% CI, 3.16-5.95). A high severity of illness predicted later decisions to limit LST. Diagnoses strongly associated with WHLS at admission were cardiac arrest, hepatic failure and chronic obstructive pulmonary disease. Later decisions were strongly associated with cardiac arrest, hepatic failure, non-traumatic intracranial hemorrhage, head trauma and stroke. Conclusion: Early decisions to limit LST were typically associated with old age and chronic poor health whereas later decisions were related to the severity of illness. Limitations are common for certain diagnoses, particularly cardiac arrest and hepatic failure.
MeSH term(s)	Activities of Daily Living ; Adult ; Finland/epidemiology ; Heart Arrest ; Humans ; Intensive Care Units ; Life Support Care ; Liver Failure ; Prospective Studies ; Retrospective Studies ; Withholding Treatment
Language	English
Publishing date	2022-03-04
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	80002-8
ISSN	1399-6576 ; 0001-5172
ISSN (online)	1399-6576
ISSN	0001-5172
DOI	10.1111/aas.14035
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Article ; Online: Bowel Perforation During Haemophagocytic Lymphohistiocytosis Treatment with Corticosteroids and Anakinra

Jan Adamski / Björn Jäschke / Tuomas Nieminem / Wojciech Weigl

European Journal of Case Reports in Internal Medicine (2021)

2021

Abstract: We report the use of anakinra to treat a case of a 64-year-old man diagnosed with hemophagocytic lymphohistiocytosis (HLH) with neurological involvement. After the administration of intravenous pulse corticosteroid therapy, immunoglobulin, and anakinra, ... ...

Abstract	We report the use of anakinra to treat a case of a 64-year-old man diagnosed with hemophagocytic lymphohistiocytosis (HLH) with neurological involvement. After the administration of intravenous pulse corticosteroid therapy, immunoglobulin, and anakinra, the patient showed neurological recovery. However, the recovery was complicated by the perforation of a pre-existing bowel diverticulum. The effect of anakinra on bowel inflammation has not yet been clearly established. It can potentially augment bowel inflammation and contribute to the risk of bowel perforation associated with the concomitant use of corticosteroids.
Keywords	diverticulitis ; haemophagocytic lymphohistiocytosis (hlh) ; gut ; interkeukin-1 (il-1) receptor antagonist ; gastrointestinal diseases ; Medicine ; R
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	SMC MEDIA SRL
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Unchanged Cognitive Performance and Concurrent Prefrontal Blood Oxygenation After Accelerated Intermittent Theta-Burst Stimulation in Depression: A Sham-Controlled Study.

Struckmann, Wiebke / Persson, Jonas / Gingnell, Malin / Weigl, Wojciech / Wass, Caroline / Bodén, Robert

Frontiers in psychiatry

2021 Volume 12, Page(s) 659571

Abstract: Aim: ...

Abstract	Aim:
Language	English
Publishing date	2021-06-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2021.659571
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Article ; Online: Modulation of the prefrontal blood oxygenation response to intermittent theta-burst stimulation in depression: A sham-controlled study with functional near-infrared spectroscopy.

Struckmann, Wiebke / Persson, Jonas / Weigl, Wojciech / Gingnell, Malin / Bodén, Robert

The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry

2020 Volume 22, Issue 4, Page(s) 247–256

Abstract: Objective: To better understand the neural mechanisms behind the effect of intermittent theta-burst stimulation (iTBS), we investigated how the prefrontal blood oxygenation response measured by changes in oxygenated haemoglobin (oxy-Hb) was modulated ... ...

Abstract	Objective: To better understand the neural mechanisms behind the effect of intermittent theta-burst stimulation (iTBS), we investigated how the prefrontal blood oxygenation response measured by changes in oxygenated haemoglobin (oxy-Hb) was modulated during a sham-controlled iTBS treatment course, and whether this was related to depressive symptom change. Methods: In this randomised, double-blind study, patients with ongoing treatment-resistant depression received either active ( Results: Patients receiving active iTBS had an increase of the event-related oxy-Hb response compared to the sham group on the fifth (bilateral prefrontal cortices Conclusions: This study describes a modulation of the blood oxygenation response over the prefrontal cortex that was built up during the course of active iTBS treatment in depression.
MeSH term(s)	Depression ; Depressive Disorder, Treatment-Resistant ; Humans ; Prefrontal Cortex ; Spectroscopy, Near-Infrared ; Theta Rhythm ; Transcranial Magnetic Stimulation
Language	English
Publishing date	2020-07-08
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	2051402-5
ISSN	1814-1412 ; 1562-2975
ISSN (online)	1814-1412
ISSN	1562-2975
DOI	10.1080/15622975.2020.1785007
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Article ; Online: HIGH-MOLECULAR-WEIGHT HYALURONAN-A POTENTIAL ADJUVANT TO FLUID RESUSCITATION IN ABDOMINAL SEPSIS?

Barrueta Tenhunen, Annelie / van der Heijden, Jaap / Dogné, Sophie / Flamion, Bruno / Weigl, Wojciech / Frithiof, Robert / Skorup, Paul / Larsson, Anders / Tenhunen, Jyrki

Shock (Augusta, Ga.)

2023 Volume 59, Issue 5, Page(s) 763–770

Abstract: Abstract: While fluid resuscitation is fundamental in the treatment of sepsis-induced tissue hypoperfusion, a sustained positive fluid balance is associated with excess mortality. Hyaluronan, an endogenous glycosaminoglycan with high affinity to water, ... ...

Abstract	Abstract: While fluid resuscitation is fundamental in the treatment of sepsis-induced tissue hypoperfusion, a sustained positive fluid balance is associated with excess mortality. Hyaluronan, an endogenous glycosaminoglycan with high affinity to water, has not been tested previously as adjuvant to fluid resuscitation in sepsis. In a prospective, parallel-grouped, blinded model of porcine peritonitis sepsis, we randomized animals to intervention with adjuvant hyaluronan (add-on to standard therapy, n = 8) or 0.9% saline (n = 8). After the onset of hemodynamic instability, the animals received an initial bolus of 0.1% hyaluronan (1 mg/kg/10 min) or placebo (0.9% saline) followed by a continuous infusion of 0.1% hyaluronan (1 mg/kg/h) or saline during the experiment. We hypothesized that the administration of hyaluronan would reduce the volume of fluid administered (aiming at stroke volume variation <13%) and/or attenuate the inflammatory reaction. Total volumes of intravenous fluids infused were 17.5 ± 11 versus 19.0 ± 7 mL/kg/h in intervention and control groups, respectively ( P = 0.442). Plasma IL-6 increased to 2,450 (1,420-6,890) pg/mL and 3,690 (1,410-11,960) pg/mL (18 hours of resuscitation) in the intervention and control groups (nonsignificant). The intervention counteracted the increase in proportion of fragmented hyaluronan associated with peritonitis sepsis (mean peak elution fraction [18 hours of resuscitation] intervention group: 16.8 ± 0.9 versus control group: 17.9 ± 0.6 [ P = 0.031]). In conclusion, hyaluronan did not reduce the volume needed for fluid resuscitation or decrease the inflammatory reaction, even though it counterbalanced the peritonitis-induced shift toward increased proportion of fragmented hyaluronan.
MeSH term(s)	Animals ; Swine ; Hyaluronic Acid/therapeutic use ; Saline Solution ; Prospective Studies ; Sepsis ; Fluid Therapy ; Resuscitation ; Peritonitis/therapy ; Peritonitis/complications
Chemical Substances	Hyaluronic Acid (9004-61-9) ; Saline Solution
Language	English
Publishing date	2023-02-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1185432-7
ISSN	1540-0514 ; 1073-2322
ISSN (online)	1540-0514
ISSN	1073-2322
DOI	10.1097/SHK.0000000000002089
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Article ; Online: Intensive care patient survival after limiting life-sustaining treatment-The FINNEOL* national cohort study.

Adamski, Jan / Weigl, Wojciech / Lahtinen, Pasi / Reinikainen, Matti / Kaminski, Tadeusz / Pietiläinen, Laura / Musialowicz, Tadeusz

Acta anaesthesiologica Scandinavica

2020 Volume 64, Issue 8, Page(s) 1144–1153

Abstract: Background: Few studies have examined survival in intensive care unit (ICU) patients after the restriction of life-sustaining treatment (LST). We aimed to analyse independent factors associated with hospital and 12-month survival rates in ICU patients ... ...

Abstract	Background: Few studies have examined survival in intensive care unit (ICU) patients after the restriction of life-sustaining treatment (LST). We aimed to analyse independent factors associated with hospital and 12-month survival rates in ICU patients after treatment restrictions. Methods: This retrospective observational study examined all patients treated in adult ICUs from 1 January 2016 until 31 December 2016 included in the Finnish ICU Registry. Multivariable logistic regression analysis was performed to explain the effect on survival. Results: Decisions to limit LST were made for 2444 patients (13.7%; 95% CI 13.2-14.2). ICU, hospital, and 12-month survival rates were 71% (95% CI 69-73), 49% (95% CI 47-51), and 24% (95% CI 22-26), respectively. In patients for whom life support was withheld, increased 12-month survival rates were associated with admission from the operating theatre (OR 1.9, 95% CI 1.1-3.4), good pre-hospital physical fitness (OR 4.7, 95% Cl 1.2-16.8) and being housed at home (OR 2.0, 95% Cl 1.4-2.8). Decreased survival rates were associated with admission from a hospital ward (OR 0.67, 95% Cl 0.5-0.9), higher comorbidity (OR 0.6, 95% Cl 0.4-0.9), cancer (OR 0.4, 95%CI 0.2-0.9), greater illness severity (SAPS II; OR 0.98, 95% Cl 0.98-0.99), and higher care intensity (TISS-76; OR 0.93, 95% Cl 0.92-0.95). Conclusion: Survival among ICU patients with limited treatment was higher than expected. Advanced age was not associated with higher mortality, potentially because treatment restrictions may be set more easily for older patients.
MeSH term(s)	Age Factors ; Aged ; Aged, 80 and over ; Cohort Studies ; Critical Care/methods ; Critical Illness/mortality ; Female ; Finland/epidemiology ; Humans ; Male ; Middle Aged ; Registries ; Retrospective Studies ; Survival Analysis ; Withholding Treatment/statistics & numerical data
Language	English
Publishing date	2020-06-01
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	80002-8
ISSN	1399-6576 ; 0001-5172
ISSN (online)	1399-6576
ISSN	0001-5172
DOI	10.1111/aas.13612
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Article: Multiwavelength time-resolved near-infrared spectroscopy of the adult head: assessment of intracerebral and extracerebral absorption changes.

Gerega, Anna / Milej, Daniel / Weigl, Wojciech / Kacprzak, Michal / Liebert, Adam

Biomedical optics express

2018 Volume 9, Issue 7, Page(s) 2974–2993

Abstract: An optical technique based on diffuse reflectance measurement combined with indocyanine green (ICG) bolus tracking is extensively tested as a method for the clinical assessment of brain perfusion at the bedside. We report on multiwavelength time-resolved ...

Abstract	An optical technique based on diffuse reflectance measurement combined with indocyanine green (ICG) bolus tracking is extensively tested as a method for the clinical assessment of brain perfusion at the bedside. We report on multiwavelength time-resolved diffuse reflectance spectroscopy measurements carried out on the head of a healthy adult during the intravenous administration of a bolus of ICG. Intracerebral and extracerebral changes in absorption were estimated from an analysis of changes in statistical moments (total number of photons, mean time of flight and variance) of the distributions of times of flight (DTOF) of photons recorded simultaneously at 16 wavelengths from the range of 650-850 nm using sensitivity factors estimated by diffusion approximation based on a layered model of the studied medium. We validated the proposed method in a series of phantom experiments and in-vivo measurements. The results obtained show that changes in the concentration of the ICG can be assessed as a function of time of the experiment and depth in the tissue. Thus, the separation of changes in ICG concentration appearing in intra- and extracerebral tissues can be estimated from optical data acquired at a single source-detector pair of fibers/fiber bundles positioned on the surface of the head.
Language	English
Publishing date	2018-06-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2572216-5
ISSN	2156-7085
ISSN	2156-7085
DOI	10.1364/BOE.9.002974
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Article ; Online: ICU mortality and variables associated with ICU survival in Poland: A nationwide database study.

Weigl, Wojciech / Adamski, Jan / Goryński, Paweł / Kański, Andrzej / Hultström, Michael

European journal of anaesthesiology

2018 Volume 35, Issue 12, Page(s) 949–954

Abstract: Background: Recently published international comparison data across European countries revealed high mortality rates in Polish ICUs.: Objectives: Estimation of the rate of ICU mortality and identification of variables associated with ICU survival in ... ...

Abstract	Background: Recently published international comparison data across European countries revealed high mortality rates in Polish ICUs. Objectives: Estimation of the rate of ICU mortality and identification of variables associated with ICU survival in Poland. Design: Retrospective analyses of a database reporting ICU stays in Poland. Settings and patients: The study included data from all adult patients admitted to an ICU in Poland from 1 January 2012 to 31 December 2012. Main outcome measures: ICU mortality and variables associated with ICU survival. Results: A total of 48 282 patients were treated in 347 ICUs (mean age 63.1 ± 16.8 years, 59% men) with 20 278 deaths (42.0%). Variables associated with ICU survival were: tertiary level of hospital care [relative risk (RR) 0.86, 95% confidence interval (CI) 0.80 to 0.92, P < 0.001]; high annual patient volume in the ICU (RR 0.9995 patient year, 95% CI 0.9994 to 0.9996, P < 0.001); younger patient age (RR 1.025 year, 95% CI 1.024 to 1.026, P < 0.001); female sex (RR 0.92, 95% CI 0.88 to 0.96; P < 0.001); and lower number of comorbidities (RR 1.33, 95% CI 1.31 to 1.35, P < 0.001). Conclusion: ICU mortality was high in Poland. Structural variables, such as the level of hospital care and annual patient volume, may be associated with ICU survival.
MeSH term(s)	Aged ; Aged, 80 and over ; Databases, Factual/trends ; Female ; Hospital Mortality/trends ; Humans ; Intensive Care Units/trends ; Male ; Middle Aged ; Poland/epidemiology ; Retrospective Studies ; Survival Rate/trends
Language	English
Publishing date	2018-09-19
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	605770-6
ISSN	1365-2346 ; 0265-0215
ISSN (online)	1365-2346
ISSN	0265-0215
DOI	10.1097/EJA.0000000000000889
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