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  1. 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
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Intensive Care Unit-Acquired Weakness – diagnostischer Stellenwert des neuromuskulären Ultraschalls.

    Klawitter, Felix / Walter, Uwe / Axer, Hubertus / Ehler, Johannes

    Die Anaesthesiologie

    2023  Volume 72, Issue 8, Page(s) 543–554

    Abstract: Intensive care unit-acquired weakness (ICUAW) is one of the most common neuromuscular complications in intensive care medicine. The clinical diagnosis and assessment of the severity using established diagnostic methods (e.g., clinical examination using ... ...

    Title translation Intensive care unit-acquired weakness-Diagnostic value of neuromuscular ultrasound.
    Abstract Intensive care unit-acquired weakness (ICUAW) is one of the most common neuromuscular complications in intensive care medicine. The clinical diagnosis and assessment of the severity using established diagnostic methods (e.g., clinical examination using the Medical Research Council Sum Score or electrophysiological examination) can be difficult or even impossible, especially in sedated, ventilated and delirious patients. Neuromuscular ultrasound (NMUS) has increasingly been investigated in ICUAW as an easy to use noninvasive and mostly patient compliance-independent diagnostic alternative. It has been shown that NMUS appears to be a promising tool to detect ICUAW, to assess the severity of muscular weakness and to monitor the clinical progression. Further studies are needed to standardize the methodology, to evaluate the training effort and to optimize outcome predication. The formulation of an interdisciplinary neurological and anesthesiological training curriculum is warranted to establish NMUS as a complementary diagnostic method of ICUAW in daily clinical practice.
    MeSH term(s) Critical Care ; Critical Illness ; Intensive Care Units ; Muscle Weakness/diagnostic imaging ; Muscular Diseases ; Polyneuropathies ; Humans
    Language German
    Publishing date 2023-06-13
    Publishing country Germany
    Document type English Abstract ; Journal Article ; Review
    ISSN 2731-6866
    ISSN (online) 2731-6866
    DOI 10.1007/s00101-023-01300-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Mitochondrial Dysfunction in Intensive Care Unit-Acquired Weakness and Critical Illness Myopathy: A Narrative Review.

    Klawitter, Felix / Ehler, Johannes / Bajorat, Rika / Patejdl, Robert

    International journal of molecular sciences

    2023  Volume 24, Issue 6

    Abstract: Mitochondria are key structures providing most of the energy needed to maintain homeostasis. They are the main source of adenosine triphosphate (ATP), participate in glucose, lipid and amino acid metabolism, store calcium and are integral components in ... ...

    Abstract Mitochondria are key structures providing most of the energy needed to maintain homeostasis. They are the main source of adenosine triphosphate (ATP), participate in glucose, lipid and amino acid metabolism, store calcium and are integral components in various intracellular signaling cascades. However, due to their crucial role in cellular integrity, mitochondrial damage and dysregulation in the context of critical illness can severely impair organ function, leading to energetic crisis and organ failure. Skeletal muscle tissue is rich in mitochondria and, therefore, particularly vulnerable to mitochondrial dysfunction. Intensive care unit-acquired weakness (ICUAW) and critical illness myopathy (CIM) are phenomena of generalized weakness and atrophying skeletal muscle wasting, including preferential myosin breakdown in critical illness, which has also been linked to mitochondrial failure. Hence, imbalanced mitochondrial dynamics, dysregulation of the respiratory chain complexes, alterations in gene expression, disturbed signal transduction as well as impaired nutrient utilization have been proposed as underlying mechanisms. This narrative review aims to highlight the current known molecular mechanisms immanent in mitochondrial dysfunction of patients suffering from ICUAW and CIM, as well as to discuss possible implications for muscle phenotype, function and therapeutic approaches.
    MeSH term(s) Humans ; Critical Illness ; Muscular Diseases/metabolism ; Muscle, Skeletal/metabolism ; Intensive Care Units ; Muscle Weakness/metabolism ; Mitochondria/metabolism ; Critical Care
    Language English
    Publishing date 2023-03-14
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2019364-6
    ISSN 1422-0067 ; 1422-0067 ; 1661-6596
    ISSN (online) 1422-0067
    ISSN 1422-0067 ; 1661-6596
    DOI 10.3390/ijms24065516
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  4. Article ; Online: Neuromuscular Ultrasound in Intensive Care Unit-Acquired Weakness: Current State and Future Directions.

    Klawitter, Felix / Walter, Uwe / Axer, Hubertus / Patejdl, Robert / Ehler, Johannes

    Medicina (Kaunas, Lithuania)

    2023  Volume 59, Issue 5

    Abstract: Intensive care unit-acquired weakness (ICUAW) is one of the most common causes of muscle atrophy and functional disability in critically ill intensive care patients. Clinical examination, manual muscle strength testing and monitoring are frequently ... ...

    Abstract Intensive care unit-acquired weakness (ICUAW) is one of the most common causes of muscle atrophy and functional disability in critically ill intensive care patients. Clinical examination, manual muscle strength testing and monitoring are frequently hampered by sedation, delirium and cognitive impairment. Many different attempts have been made to evaluate alternative compliance-independent methods, such as muscle biopsies, nerve conduction studies, electromyography and serum biomarkers. However, they are invasive, time-consuming and often require special expertise to perform, making them vastly impractical for daily intensive care medicine. Ultrasound is a broadly accepted, non-invasive, bedside-accessible diagnostic tool and well established in various clinical applications. Hereby, neuromuscular ultrasound (NMUS), in particular, has been proven to be of significant diagnostic value in many different neuromuscular diseases. In ICUAW, NMUS has been shown to detect and monitor alterations of muscles and nerves, and might help to predict patient outcome. This narrative review is focused on the recent scientific literature investigating NMUS in ICUAW and highlights the current state and future opportunities of this promising diagnostic tool.
    MeSH term(s) Humans ; Muscle Weakness/diagnostic imaging ; Muscle Weakness/etiology ; Intensive Care Units ; Critical Care ; Neuromuscular Diseases/diagnostic imaging ; Neuromuscular Diseases/complications ; Electromyography ; Frailty
    Language English
    Publishing date 2023-04-27
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2188113-3
    ISSN 1648-9144 ; 1010-660X
    ISSN (online) 1648-9144
    ISSN 1010-660X
    DOI 10.3390/medicina59050844
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  5. Article: Iatrogenes intramurales Hämatom des Duodenums nach Gastroskopie beim Kind. Diagnostische und therapeutische Überlegungen. Iatrogenic intramural hematoma of the duodenum after gastroscopy in the child. Diagnostic and therapeutic considerations

    Müller, C. / Spang, C. / Ehler, J. / Hauenstein, C.

    Pädiatrische Praxis

    2021  Volume 96, Issue 1, Page(s) 83

    Language German
    Document type Article
    ZDB-ID 123435-3
    ISSN 0030-9346
    Database Current Contents Medicine

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  6. Article: Iatrogenes intramurales Hämatom des Duodenums nach Gastroskopie beim Kind. Diagnostische und therapeutische Überlegungen. Iatrogenic intramural hematoma of the duodenum after gastroscopy in the child. Diagnostic and therapeutic considerations

    Müller, C. / Spang, C. / Ehler, J. / Hauenstein, C.

    Chirurgische Praxis

    2021  Volume 88, Issue 4, Page(s) 638

    Language German
    Document type Article
    ZDB-ID 500633-8
    ISSN 0009-4846
    Database Current Contents Medicine

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  7. Article ; Online: Welche Biomarker zu Diagnosestellung und Steuerung der antiinfektiven Therapie bei Sepsis?

    Ehler, Johannes / Busjahn, Christoph / Schürholz, Tobias

    Der Anaesthesist

    2021  Volume 71, Issue 1, Page(s) 3–11

    Abstract: To date no biomarker has been identified bringing together perfect sensitivity and specificity to discriminate between inflammation and infections. Since the 1930s new markers of tissue damage and endothelial damage have been identified but which are ... ...

    Title translation Which biomarkers for diagnosis and guidance of anti-infection treatment in sepsis?
    Abstract To date no biomarker has been identified bringing together perfect sensitivity and specificity to discriminate between inflammation and infections. Since the 1930s new markers of tissue damage and endothelial damage have been identified but which are incapable of identifying infections in every clinical setting to enable initiation of early antibiotic treatment. In this review the most important classical biomarkers and upcoming new PCR-based approaches are addressed. These markers are highlighted with respect to special clinical settings and to control the success of antibiotic treatment. The issue of discrimination between inflammation and infection is not yet solved. Based on one single biomarker it is impossible to decide whether infection is the reason for the patient's worsening condition but the combination of biomarkers or the integration of new biomarkers may be a meaningful supplement. The measurement of different biomarkers of infection or inflammation is part of the routine in critical care and will be essential in the future.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Biomarkers ; Humans ; Sepsis/diagnosis ; Sepsis/drug therapy
    Chemical Substances Anti-Bacterial Agents ; Biomarkers
    Language German
    Publishing date 2021-11-12
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 260-4
    ISSN 1432-055X ; 0003-2417
    ISSN (online) 1432-055X
    ISSN 0003-2417
    DOI 10.1007/s00101-021-01067-7
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  8. Article ; Online: Neurofilament light chains to assess sepsis-associated encephalopathy: Are we on the track toward clinical implementation?

    Bircak-Kuchtova, Barbora / Chung, Ha-Yeun / Wickel, Jonathan / Ehler, Johannes / Geis, Christian

    Critical care (London, England)

    2023  Volume 27, Issue 1, Page(s) 214

    Abstract: Sepsis is the most common cause of admission to intensive care units worldwide. Sepsis patients frequently suffer from sepsis-associated encephalopathy (SAE) reflecting acute brain dysfunction. SAE may result in increased mortality, extended length of ... ...

    Abstract Sepsis is the most common cause of admission to intensive care units worldwide. Sepsis patients frequently suffer from sepsis-associated encephalopathy (SAE) reflecting acute brain dysfunction. SAE may result in increased mortality, extended length of hospital stay, and long-term cognitive dysfunction. The diagnosis of SAE is based on clinical assessments, but a valid biomarker to identify and confirm SAE and to assess SAE severity is missing. Several blood-based biomarkers indicating neuronal injury have been evaluated in sepsis and their potential role as early diagnosis and prognostic markers has been studied. Among those, the neuroaxonal injury marker neurofilament light chain (NfL) was identified to potentially serve as a prognostic biomarker for SAE and to predict long-term cognitive impairment. In this review, we summarize the current knowledge of biomarkers, especially NfL, in SAE and discuss a possible future clinical application considering existing limitations.
    MeSH term(s) Humans ; Sepsis-Associated Encephalopathy/complications ; Sepsis-Associated Encephalopathy/diagnosis ; Intermediate Filaments ; Sepsis/complications ; Sepsis/diagnosis ; Biomarkers ; Brain Diseases
    Chemical Substances Biomarkers
    Language English
    Publishing date 2023-05-31
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/s13054-023-04497-4
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    Zs.A 5517: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  9. Article: Sonographic Evaluation of Muscle Echogenicity for the Detection of Intensive Care Unit-Acquired Weakness: A Pilot Single-Center Prospective Cohort Study.

    Klawitter, Felix / Walter, Uwe / Patejdl, Robert / Endler, Josefine / Reuter, Daniel A / Ehler, Johannes

    Diagnostics (Basel, Switzerland)

    2022  Volume 12, Issue 6

    Abstract: Qualitative assessment by the Heckmatt scale (HS) and quantitative greyscale analysis of muscle echogenicity were compared for their value in detecting intensive care unit-acquired weakness (ICU-AW). We performed muscle ultrasound (MUS) of eight skeletal ...

    Abstract Qualitative assessment by the Heckmatt scale (HS) and quantitative greyscale analysis of muscle echogenicity were compared for their value in detecting intensive care unit-acquired weakness (ICU-AW). We performed muscle ultrasound (MUS) of eight skeletal muscles on day 3 and day 10 after ICU admission. We calculated the global mean greyscale score (MGS), the global mean z-score (MZS) and the global mean Heckmatt score (MHS). Longitudinal outcome was defined by the modified Rankin scale (mRS) and Barthel index (BI) after 100 days. In total, 652 ultrasound pictures from 38 critically ill patients (18 with and 20 without ICU-AW) and 10 controls were analyzed. Patients with ICU-AW had a higher MHS on day 10 compared to patients without ICU-AW (2.6 (0.4) vs. 2.2 (0.4),
    Language English
    Publishing date 2022-06-02
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662336-5
    ISSN 2075-4418
    ISSN 2075-4418
    DOI 10.3390/diagnostics12061378
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  10. Article ; Online: „Intensive Care Unit-Acquired Weakness“ : Eine bundesweite Umfrage zu Diagnostik, Monitoring und Therapiestrategien auf deutschen Intensivstationen.

    Klawitter, Felix / Schaller, Stefan J / Söhle, Martin / Reuter, Daniel A / Ehler, Johannes

    Die Anaesthesiologie

    2022  Volume 71, Issue 8, Page(s) 618–625

    Abstract: Background: Intensive care unit-acquired weakness (ICU-AW) is one of the most frequent causes of neuromuscular dysfunction in intensive care medicine. To date no evidence-based recommendations exist for the diagnostics, monitoring or further intensive ... ...

    Title translation Intensive Care Unit-Acquired Weakness : A nationwide survey on diagnostics, monitoring and treatment strategies on German intensive care units.
    Abstract Background: Intensive care unit-acquired weakness (ICU-AW) is one of the most frequent causes of neuromuscular dysfunction in intensive care medicine. To date no evidence-based recommendations exist for the diagnostics, monitoring or further intensive care treatment.
    Objective: To evaluate the current clinical practice of diagnostics, monitoring and treatment strategies of ICU-AW on intensive care units in Germany.
    Material and methods: We conducted an online survey with a self-designed questionnaire and invited 448 members of the Scientific Working Group for Intensive Care Medicine (WAKI) and the Scientific Working Group for Neuroanesthesia (WAKNA) to participate.
    Results: A total of 68/448 (15.2%) questionnaires were analyzed. Of the participants 13.4% (9/67) stated that a structured diagnostic approach for the detection of ICU-AW is applied in their units. The clinical examination was the preferred method for screening (60/68; 88.2%) and follow-up (57/65; 87.7%). Scores, such as the Medical Research Council sum score (MRC-SS) seem to be less important for the screening (7/68; 10.3%) and follow-up assessment (7/65; 10.8%). Mobilization with physiotherapy (45/68; 66.2%) is the most common strategy applied to treat ICU-AW. A lack of physiotherapists (64/68; 94.1%) and intensive care nurses (57/68; 83.8%) are the main deficits identified in the care of patients with ICU-AW. The majority of the study participants (62/68; 91.2%) would welcome evidence-based guidelines for diagnostics, monitoring and treatment approaches in ICU-AW.
    Discussion: To date comprehensive recommendations for diagnostics, monitoring, prevention and treatment of ICU-AW are still lacking in German intensive care units. The introduction of new diagnostic approaches could help to detect ICU-AW and therefore to initiate earlier preventive and treatment approaches.
    MeSH term(s) Critical Care ; Humans ; Intensive Care Units ; Muscle Weakness/diagnosis ; Respiration, Artificial/adverse effects ; Surveys and Questionnaires
    Language German
    Publishing date 2022-02-02
    Publishing country Germany
    Document type Journal Article
    ISSN 2731-6866
    ISSN (online) 2731-6866
    DOI 10.1007/s00101-022-01089-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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