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Article ; Online: Simulation training for emergency skills

Bjoern Zante / Joerg C. Schefold

BMC Medical Education, Vol 20, Iss 1, Pp 1-

effects on ICU fellows’ performance and supervision levels

2020 Volume 8

Abstract: Abstract Background The application of manual emergency skills is essential in intensive care medicine. Simulation training on cadavers may be beneficial. The aim of this study was to analyze a skill-training aiming to enhance ICU-fellows´ performance. ... ...

Abstract	Abstract Background The application of manual emergency skills is essential in intensive care medicine. Simulation training on cadavers may be beneficial. The aim of this study was to analyze a skill-training aiming to enhance ICU-fellows´ performance. Methods A skill-training was prepared for chest tube insertion, pericardiocentesis, and cricothyroidotomy. Supervision levels (SL) for entrustable professional activities (EPA) were applied to evaluate skill performance. Pre- and post-training, SL and fellows´ self- versus consultants´ external assessment was compared. Time on skill training was compared to conventional training in the ICU-setting. Results Comparison of pre/post external assessment showed reduced required SL for chest tube insertion, pericardiocentesis, and cricothyroidotomy. Self- and external assessed SL did not significantly correlate for pre-training/post-training pericardiocentesis and post-training cricothyroidotomy. Correlations were observed for self- and external assessment SL for chest tube insertion and pre-assessment for cricothyroidotomy. Compared to conventional training in the ICU-setting, chest tube insertion training may further be time-saving. Conclusions Emergency skill training separated from a daily clinical ICU-setting appeared feasible and useful to enhance skill performance in ICU fellows and may reduce respective SL. We observed that in dedicated skill-training sessions, required time resources would be somewhat reduced compared to conventional training methods.
Keywords	EPA ; Chest tube ; Pericardiocentesis ; Cricoconiotomy ; Education ; Learning ; Special aspects of education ; LC8-6691 ; Medicine ; R
Language	English
Publishing date	2020-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Physiology education for intensive care medicine residents

Bjoern Zante / Wolf E Hautz / Joerg C Schefold

PLoS ONE, Vol 15, Iss 1, p e

A 15-minute interactive peer-led flipped classroom session.

2020 Volume 0228257

Abstract: INTRODUCTION:In acute care medicine, knowledge of the underlying (patho)-physiology is of paramount importance. This may be especially relevant in intensive care medicine, where individual competence and proficiency greatly depend on knowledge and ... ...

Abstract	INTRODUCTION:In acute care medicine, knowledge of the underlying (patho)-physiology is of paramount importance. This may be especially relevant in intensive care medicine, where individual competence and proficiency greatly depend on knowledge and understanding of critical care physiology. In settings with time constraints such as intensive care units (ICUs), time allotted to education is often limited. We evaluated whether introduction of a short, interactive, peer-led flipped classroom session is feasible and can provide ICU residents with a better understanding of critical care physiology. MATERIALS AND METHODS:Using the flipped classroom concept, we developed a 15-minute peer-led interactive "physiology education" session to introduce a total of 44 residents to critical care physiology. Using a nine-item electronic survey with open questions and a five-point Likert scale, we analysed the overall concept with regard to feasibility, motivation, and subjective learning of critical care physiology. RESULTS:The overall rate of response to the survey was 70.5% (31/44). The residents reported that these sessions sparked their interest (p = 0.005, Chi square 10.52), and that discussion and interaction during these sessions had promoted their knowledge and understanding. Both novice and experienced residents reported that new knowledge was imparted (both p<0.0001, Chi-square 32.97 and 25.04, respectively). CONCLUSIONS:In an environment with time constraints such as the ICU, a 15-minute, interactive, peer-led flipped classroom teaching session was considered feasible and generally appeared useful for teaching critical care physiology to ICU residents. Responses to questions on questionnaires indicated that teaching sessions sparked interest and increased motivation. This approach may theoretically induce a modification in professional behaviour and promote self-directed learning. We therefore support the use of peer-led flipped classroom training sessions in the ICU. Whether these sessions result in improved ICU ...
Keywords	Medicine ; R ; Science ; Q
Subject code	420
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Granulomatosis with polyangiitis (Wegener’s) complicated by splenic rupture and severe acute respiratory distress syndrome

Yannis Ahmad / Gabrielle Morawietz / Hatem Ksouri / Joerg C. Schefold / Patrick Zuercher

Clinical Case Reports, Vol 9, Iss 7, Pp n/a-n/a (2021)

A case report

2021

Abstract: Abstract Even in the absence of disease‐specific radiological signs of granulomatosis with polyangiitis (GPA), severe intrapulmonary GPA may be present. Rapidly establishing the diagnosis with a confirmatory biopsy is key to initiate lifesaving therapy. ...

Abstract	Abstract Even in the absence of disease‐specific radiological signs of granulomatosis with polyangiitis (GPA), severe intrapulmonary GPA may be present. Rapidly establishing the diagnosis with a confirmatory biopsy is key to initiate lifesaving therapy.
Keywords	ARDS ; ECMO ; granulomatosis with polyangiitis ; GPA ; Wegener's ; Medicine ; R ; Medicine (General) ; R5-920
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Fluid Overload Phenotypes in Critical Illness—A Machine Learning Approach

Anna S. Messmer / Michel Moser / Patrick Zuercher / Joerg C. Schefold / Martin Müller / Carmen A. Pfortmueller

Journal of Clinical Medicine, Vol 11, Iss 336, p

2022 Volume 336

Abstract: Background: The detrimental impact of fluid overload (FO) on intensive care unit (ICU) morbidity and mortality is well known. However, research to identify subgroups of patients particularly prone to fluid overload is scarce. The aim of this cohort study ...

Abstract	Background: The detrimental impact of fluid overload (FO) on intensive care unit (ICU) morbidity and mortality is well known. However, research to identify subgroups of patients particularly prone to fluid overload is scarce. The aim of this cohort study was to derive “FO phenotypes” in the critically ill by using machine learning techniques. Methods: Retrospective single center study including adult intensive care patients with a length of stay of ≥3 days and sufficient data to compute FO. Data was analyzed by multivariable logistic regression, fast and frugal trees (FFT), classification decision trees (DT), and a random forest (RF) model. Results: Out of 1772 included patients, 387 (21.8%) met the FO definition. The random forest model had the highest area under the curve (AUC) (0.84, 95% CI 0.79–0.86), followed by multivariable logistic regression (0.81, 95% CI 0.77–0.86), FFT (0.75, 95% CI 0.69–0.79) and DT (0.73, 95% CI 0.68–0.78) to predict FO. The most important predictors identified in all models were lactate and bicarbonate at admission and postsurgical ICU admission. Sepsis/septic shock was identified as a risk factor in the MV and RF analysis. Conclusion: The FO phenotypes consist of patients admitted after surgery or with sepsis/septic shock with high lactate and low bicarbonate.
Keywords	fluid resuscitation ; fluid overload ; intensive care ; risk factors ; Medicine ; R
Subject code	310
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Successful resuscitation from prolonged hypothermic cardiac arrest without extracorporeal life support

Melanie Kuhnke / Roland Albrecht / Joerg C. Schefold / Peter Paal

Journal of Medical Case Reports, Vol 13, Iss 1, Pp 1-

a case report

2019 Volume 4

Abstract: Abstract Background We report a case of successful prolonged cardiopulmonary resuscitation (5 hours and 44 minutes) following severe accidental hypothermia with cardiac arrest treated without rewarming on extracorporeal life support. Case presentation A ... ...

Abstract	Abstract Background We report a case of successful prolonged cardiopulmonary resuscitation (5 hours and 44 minutes) following severe accidental hypothermia with cardiac arrest treated without rewarming on extracorporeal life support. Case presentation A 52-year-old Italian mountaineer, was trapped in a crevasse and rescued approximately 7 hours later by a professional rescue team. After extrication, he suffered a witnessed cardiac arrest with ventricular fibrillation. Immediate defibrillation and cardiopulmonary resuscitation were started. His core temperature was 26.0 °C. Due to weather conditions, air transport to an extracorporeal life support center was not possible. Thus, he was rewarmed with conventional rewarming methods in a rural hospital. Auto-defibrillation occurred at a core temperature of 29.8 °C after 5 hours and 44 minutes of continued cardiopulmonary resuscitation. With a core temperature of 33.4 °C, he was finally admitted to a level 1 trauma center and extracorporeal life support was no longer required. Seven weeks following the accident, he was discharged home with complete neurological recovery. Conclusions Successful rewarming from severe hypothermia without extracorporeal life support use as performed in this case suggests that patients with primary hypothermic cardiac arrest have a chance of a favorable neurological outcome even after several hours of cardiac arrest when cardiopulmonary resuscitation and conventional rewarming are performed continuously. This may be especially relevant in remote areas, where extracorporeal life support rewarming is not available.
Keywords	Hypothermia ; Cardiac arrest ; Cardiopulmonary resuscitation ; ECLS ; Mechanical CPR ; Medicine ; R
Language	English
Publishing date	2019-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Adrenomedullin in COVID-19 induced endotheliitis

Darius Cameron Wilson / Joerg C. Schefold / Jaume Baldirà / Thibaud Spinetti / Kordo Saeed / Gunnar Elke

Critical Care, Vol 24, Iss 1, Pp 1-

2020 Volume 2

Keywords	Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; covid19
Language	English
Publishing date	2020-07-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Immunothrombosis and Complement Activation Contribute to Disease Severity and Adverse Outcome in COVID-19

Tiphaine Ruggeri / Yasmin De Wit / Noëlia Schärz / Gerard van Mierlo / Anne Angelillo-Scherrer / Justine Brodard / Joerg C. Schefold / Cédric Hirzel / Ilse Jongerius / Sacha Zeerleder

Journal of Innate Immunity, Vol 15, Iss 1, Pp 850-

2023 Volume 864

Abstract: Severe COVID-19 is characterized by systemic inflammation and multiple organ dysfunction syndrome (MODS). Arterial and venous thrombosis are involved in the pathogenesis of MODS and fatality in COVID-19. There is evidence that complement and neutrophil ... ...

Abstract	Severe COVID-19 is characterized by systemic inflammation and multiple organ dysfunction syndrome (MODS). Arterial and venous thrombosis are involved in the pathogenesis of MODS and fatality in COVID-19. There is evidence that complement and neutrophil activation in the form of neutrophil extracellular traps are main drivers for development of microvascular complications in COVID-19. Plasma and serum samples were collected from 83 patients infected by SARS-CoV-2 during the two first waves of COVID-19, before the availability of SARS-CoV-2 vaccination. Samples were collected at enrollment, day 11, and day 28; and patients had differing severity of disease. In this comprehensive study, we measured cell-free DNA, neutrophil activation, deoxyribonuclease I activity, complement activation, and D-dimers in longitudinal samples of COVID-19 patients. We show that all the above markers, except deoxyribonuclease I activity, increased with disease severity. Moreover, we provide evidence that in severe disease there is continued neutrophil and complement activation, as well as D-dimer formation and nucleosome release, whereas in mild and moderate disease all these markers decrease over time. These findings suggest that neutrophil and complement activation are important drivers of microvascular complications and that they reflect immunothrombosis in these patients. Neutrophil activation, complement activation, cell-free DNA, and D-dimer levels have the potential to serve as reliable biomarkers for disease severity and fatality in COVID-19. They might also serve as suitable markers with which to monitor the efficacy of therapeutic interventions in COVID-19.
Keywords	thrombosis ; cell-free dna ; complement activation ; covid-19 ; neutrophil activation ; Medicine ; R ; Internal medicine ; RC31-1245
Subject code	610
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	Karger Publishers
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Characterization of sound pressure levels and sound sources in the intensive care unit

Aileen C. Naef / Samuel E. J. Knobel / Nicole Ruettgers / Marilyne Rossier / Marie-Madlen Jeitziner / Bjoern Zante / René M. Müri / Joerg C. Schefold / Tobias Nef / Stephan M. Gerber

Frontiers in Medicine, Vol

a 1 week observational study

2023 Volume 10

Abstract: BackgroundExposure to elevated sound pressure levels within the intensive care unit is known to negatively affect patient and staff health. In the past, interventions to address this problem have been unsuccessful as there is no conclusive evidence on ... ...

Abstract	BackgroundExposure to elevated sound pressure levels within the intensive care unit is known to negatively affect patient and staff health. In the past, interventions to address this problem have been unsuccessful as there is no conclusive evidence on the severity of each sound source and their role on the overall sound pressure levels. Therefore, the goal of the study was to perform a continuous 1 week recording to characterize the sound pressure levels and identify negative sound sources in this setting.MethodsIn this prospective, systematic, and quantitative observational study, the sound pressure levels and sound sources were continuously recorded in a mixed medical–surgical intensive care unit over 1 week. Measurements were conducted using four sound level meters and a human observer present in the room noting all sound sources arising from two beds.ResultsThe mean 8 h sound pressure level was significantly higher during the day (52.01 ± 1.75 dBA) and evening (50.92 ± 1.66 dBA) shifts than during the night shift (47.57 ± 2.23; F(2, 19) = 11.80, p < 0.001). No significant difference was found in the maximum and minimum mean 8 h sound pressure levels between the work shifts. However, there was a significant difference between the two beds in the based on location during the day (F(3, 28) = 3.91, p = 0.0189) and evening (F(3, 24) = 5.66, p = 0.00445) shifts. Cleaning of the patient area, admission and discharge activities, and renal interventions (e.g., dialysis) contributed the most to the overall sound pressure levels, with staff talking occurring most frequently.ConclusionOur study was able to identify that continuous maintenance of the patient area, patient admission and discharge, and renal interventions were responsible for the greatest contribution to the sound pressure levels. Moreover, while staff talking was not found to significantly contribute to the sound pressure levels, it was found to be the most frequently occurring activity which may indirectly influence patient wellbeing. Overall, ...
Keywords	intensive care unit ; noise ; sound level meters ; hospital ; decibels ; sound pressure levels ; Medicine (General) ; R5-920
Subject code	780
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Protocolised early de-resuscitation in septic shock (REDUCE)

David Berger / Alexa Hollinger / Martin Siegemund / Martin Müller / Carmen A Pfortmueller / Miodrag Filipovic / Joerg C Schefold / Anna Messmer / Urs Pietsch / Philipp Buehler / Jan Waskowski / Dominik E Uehlinger

BMJ Open, Vol 13, Iss

protocol for a randomised controlled multicentre feasibility trial

2023 Volume 9

Abstract: Background Fluid overload is associated with excess mortality in septic shock. Current approaches to reduce fluid overload include restrictive administration of fluid or active removal of accumulated fluid. However, evidence on active fluid removal is ... ...

Abstract	Background Fluid overload is associated with excess mortality in septic shock. Current approaches to reduce fluid overload include restrictive administration of fluid or active removal of accumulated fluid. However, evidence on active fluid removal is scarce. The aim of this study is to assess the efficacy and feasibility of an early de-resuscitation protocol in patients with septic shock.Methods All patients admitted to the intensive care unit (ICU) with a septic shock are screened, and eligible patients will be randomised in a 1:1 ratio to intervention or standard of care. Intervention: Fluid management will be performed according to the REDUCE protocol, where resuscitation fluid will be restricted to patients showing signs of poor tissue perfusion. After the lactate has peaked, the patient is deemed stable and assessed for active de-resuscitation (signs of fluid overload). The primary objective of this study is the proportion of patients with a negative cumulative fluid balance at day 3 after ICU. Secondary objectives are cumulative fluid balances throughout the ICU stay, number of patients with fluid overload, feasibility and safety outcomes and patient-centred outcomes. The primary outcome will be assessed by a logistic regression model adjusting for the stratification variables (trial site and chronic renal failure) in the intention-to-treat population.Ethics and dissemination The study was approved by the respective ethical committees (No 2020–02197). The results of the REDUCE trial will be published in an international peer-reviewed medical journal regardless of the results.Trial registration number ClinicalTrials.gov, NCT04931485.
Keywords	Medicine ; R
Subject code	532
Language	English
Publishing date	2023-09-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Correction

Jan Waskowski / Carmen A. Pfortmueller / Noelle Schenk / Roman Buehlmann / Juerg Schmidli / Gabor Erdoes / Joerg C. Schefold

PLoS ONE, Vol 16, Iss

(TIMP2) x (IGFBP7) as early renal biomarker for the prediction of acute kidney injury in aortic surgery (TIGER). A single center observational study

2021 Volume 10

Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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