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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
Database	Thieme publisher's database

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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: 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
Database	MEDical Literature Analysis and Retrieval System OnLINE

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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
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Towards an ecological definition of sepsis: a viewpoint.

Bauer, Michael / Shankar-Hari, Manu / Thomas-Rüddel, Daniel O / Wetzker, Reinhard

Intensive care medicine experimental

2021 Volume 9, Issue 1, Page(s) 63

Abstract: In critically ill patients with sepsis, there is a grave lack of effective treatment options to address the illness-defining inappropriate host response. Currently, treatment is limited to source control and supportive care, albeit with imminent approval ...

Abstract	In critically ill patients with sepsis, there is a grave lack of effective treatment options to address the illness-defining inappropriate host response. Currently, treatment is limited to source control and supportive care, albeit with imminent approval of immune modulating drugs for COVID-19-associated lung failure the potential of host-directed strategies appears on the horizon. We suggest expanding the concept of sepsis by incorporating infectious stress within the general stress response of the cell to define sepsis as an illness state characterized by allostatic overload and failing adaptive responses along with biotic (pathogen) and abiotic (e.g., malnutrition) environmental stress factors. This would allow conceptualizing the failing organismic responses to pathogens in sepsis with an ancient response pattern depending on the energy state of cells and organs towards other environmental stressors in general. Hence, the present review aims to decipher the heuristic value of a biological definition of sepsis as a failing stress response. These considerations may motivate a better understanding of the processes underlying "host defense failure" on the organismic, organ, cell and molecular levels.
Language	English
Publishing date	2021-12-29
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2740385-3
ISSN	2197-425X
ISSN	2197-425X
DOI	10.1186/s40635-021-00427-2
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Risk Factors for Invasive Candida Infection in Critically Ill Patients: A Systematic Review and Meta-analysis.

Thomas-Rüddel, Daniel O / Schlattmann, Peter / Pletz, Mathias / Kurzai, Oliver / Bloos, Frank

Chest

2021 Volume 161, Issue 2, Page(s) 345–355

Abstract: Background: Current guidelines recommend empirical antifungal therapy in patients with sepsis with high risk of invasive Candida infection. However, many different risk factors have been derived from multiple studies. These risk factors lack specificity, ...

Abstract	Background: Current guidelines recommend empirical antifungal therapy in patients with sepsis with high risk of invasive Candida infection. However, many different risk factors have been derived from multiple studies. These risk factors lack specificity, and broad application would render most ICU patients eligible for empirical antifungal therapy. Research question: What risk factors for invasive Candida infection can be identified by a systematic review and meta-analysis? Study design and methods: We searched PubMed, Web of Science, ScienceDirect, Biomed Central, and Cochrane and extracted the raw and adjusted OR for each risk factor associated with invasive Candida infection. We calculated pooled ORs for risk factors present in more than one study. Results: We included 34 studies in our meta-analysis resulting in the assessment of 29 possible risk factors. Risk factors for invasive Candida infection included demographic factors, comorbid conditions, and medical interventions. Although demographic factors do not play a role for the development of invasive Candida infection, comorbid conditions (eg, HIV, Candida colonization) and medical interventions have a significant impact. The risk factors associated with the highest risk for invasive Candida infection were broad-spectrum antibiotics (OR, 5.6; 95% CI, 3.6-8.8), blood transfusion (OR, 4.9; 95% CI, 1.5-16.3), Candida colonization (OR, 4.7; 95% CI, 1.6-14.3), central venous catheter (OR, 4.7; 95% CI, 2.7-8.1), and total parenteral nutrition (OR, 4.6; 95% CI, 3.3-6.3). However, dependence between the various risk factors is probably high. Interpretation: Our systematic review and meta-analysis identified patient- and treatment-related factors that were associated with the risk for the development of invasive Candida infection in the ICU. Most of the factors identified were either related to medical interventions during intensive care or to comorbid conditions.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Blood Component Transfusion ; Candidiasis, Invasive/etiology ; Catheterization, Central Venous ; Comorbidity ; Critical Illness ; Humans ; Parenteral Nutrition, Total ; Risk Factors
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-10-18
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2021.08.081
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Article ; Online: The Influence of Positive End-Expiratory Pressure on Leakage and Oxygenation Using a Laryngeal Mask Airway: A Randomized Trial.

Ullmann, Hannah / Renziehausen, Laura / Geil, Dominik / Sponholz, Christoph / Thomas-Rüddel, Daniel / Völker, Maria Theresa / Pietsch, Uta / Krug, Natalie / Bercker, Sven

Anesthesia and analgesia

2022 Volume 135, Issue 4, Page(s) 769–776

Abstract: Background: The value of positive end-expiratory pressure (PEEP) in maintaining oxygenation during ventilation with a laryngeal mask airway (LMA) mask is unclear. To clarify the potential benefit or harm to PEEP application during positive pressure ... ...

Abstract	Background: The value of positive end-expiratory pressure (PEEP) in maintaining oxygenation during ventilation with a laryngeal mask airway (LMA) mask is unclear. To clarify the potential benefit or harm to PEEP application during positive pressure ventilation with a ProSeal LMA® mask, we compared the effect of PEEP versus zero end-expiratory pressure (ZEEP) on gas leakage and oxygenation. We hypothesized that a PEEP of 8 mbar (8.2 cm H 2 O) would be associated with an increased incidence of gas leakage compared to ZEEP. Methods: We designed a prospective, controlled, randomized, single-blinded, multicenter clinical trial. Patients >18 years of age with an American Society of Anesthesiologists (ASA) physical status I/II without increased risk of aspiration were enrolled if they were scheduled for elective surgery under general anesthesia with an LMA mask. Patients were randomized to a control group managed with ZEEP or an intervention group managed with a PEEP of 8 mbar. Both groups received positive pressure ventilation. The primary end point was the occurrence of gas leakage. The Student t test and χ 2 test were used for statistical analysis. Results: A total of 174 patients were enrolled in the ZEEP group, and 208 were enrolled in the PEEP group. The incidence of gas leakage did not differ between the 2 groups (ZEEP: 23/174, 13.2%; PEEP: 42/208, 20.2%; P = .071; odds ratio [OR], 1.611; 95% confidence interval [CI], 0.954-2.891). However, more patients required reseating of the LMA mask in the PEEP group (ZEEP: 5/174, 2.9%; PEEP: 18/208, 8.7%; P = .018; OR, 3.202; 95% CI, 1.164-8.812). The need for endotracheal intubation did not differ between groups (ZEEP: 2/174, 1.1%; PEEP: 7/208, 3.4%; P = .190; OR, 2.995; 95% CI, 0.614-14.608). After positive pressure ventilation for 25 minutes, the mean peripheral oxygen saturation (Sp o2 ) was higher in the PEEP than in the ZEEP group (98.5 [1.9]% vs 98.0 [1.4]%; P = .01). Peak inspiratory pressure (PIP; 16 [2] vs 12 [4] mbar; P < .001) and dynamic compliance (57 [14] vs 49 [14] mL/mbar; P < .001) were both higher in the PEEP group than in the ZEEP group. Conclusions: Use of PEEP did not affect the overall incidence of gas leakage. However, PEEP did result in a higher incidence of attempts to reseat the LMA mask compared to ZEEP, whereas the incidence of rescue intubation did not differ between groups. We concluded that a PEEP of 8 mbar did not increase overall gas leakage during positive pressure ventilation with an LMA mask, but it did slightly improve gas exchange and compliance. Overall, our study does not provide strong arguments for using PEEP during ventilation with an LMA mask in elective surgery.
MeSH term(s)	Anesthesia, General/adverse effects ; Humans ; Laryngeal Masks/adverse effects ; Positive-Pressure Respiration/adverse effects ; Prospective Studies ; Respiration, Artificial
Language	English
Publishing date	2022-06-20
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006115
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Article ; Online: Epirubicin for the Treatment of Sepsis and Septic Shock (EPOS-1): study protocol for a randomised, placebo-controlled phase IIa dose-escalation trial.

Thomas-Rüddel, Daniel / Bauer, Michael / Moita, Luís Ferreira / Helbig, Christiane / Schlattmann, Peter / Ehler, Johannes / Rahmel, Tim / Meybohm, Patrick / Gründling, Matthias / Schenk, Heiko / Köcher, Thomas / Brunkhorst, Frank M / Gräler, Markus / Heger, Ann-Julika / Weis, Sebastian

BMJ open

2024 Volume 14, Issue 4, Page(s) e075158

Abstract: Introduction: Sepsis remains the major cause of death among hospitalised patients in intensive care. While targeting sepsis-causing pathogens with source control or antimicrobials has had a dramatic impact on morbidity and mortality of sepsis patients, ... ...

Abstract	Introduction: Sepsis remains the major cause of death among hospitalised patients in intensive care. While targeting sepsis-causing pathogens with source control or antimicrobials has had a dramatic impact on morbidity and mortality of sepsis patients, this strategy remains insufficient for about one-third of the affected individuals who succumb. Pharmacological targeting of mechanisms that reduce sepsis-defining organ dysfunction may be beneficial. When given at low doses, the anthracycline epirubicin promotes tissue damage control and lessens the severity of sepsis independently of the host-pathogen load by conferring disease tolerance to infection. Since epirubicin at higher doses can be myelotoxic, a first dose-response trial is necessary to assess the potential harm of this drug in this new indication. Methods and analysis: Epirubicin for the Treatment of Sepsis and Septic Shock-1 is a randomised, double-blind, placebo-controlled phase 2 dose-escalation phase IIa clinical trial to assess the safety of epirubicin as an adjunctive in patients with sepsis. The primary endpoint is the 14-day myelotoxicity. Secondary and explorative outcomes include 30-day and 90-day mortality, organ dysfunction, pharmacokinetic/pharmacodynamic (PK/PD) and cytokine release. Patients will be randomised in three consecutive phases. For each study phase, patients are randomised to one of the two study arms (epirubicin or placebo) in a 4:1 ratio. Approximately 45 patients will be recruited. Patients in the epirubicin group will receive a single dose of epirubicin (3.75, 7.5 or 15 mg/m Ethics and dissemination: The protocol is approved by the German Federal Institute for Drugs and Medical Devices. The results will be submitted for publication in peer-reviewed journals. Trial registration number: NCT05033808.
MeSH term(s)	Adult ; Female ; Humans ; Male ; Clinical Trials, Phase II as Topic ; Dose-Response Relationship, Drug ; Double-Blind Method ; Epirubicin/administration & dosage ; Epirubicin/adverse effects ; Epirubicin/therapeutic use ; Randomized Controlled Trials as Topic ; Sepsis/drug therapy ; Shock, Septic/drug therapy
Chemical Substances	Epirubicin (3Z8479ZZ5X)
Language	English
Publishing date	2024-04-22
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-075158
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