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Article: Unapparent systemic effects of regional anticoagulation with citrate in continuous renal replacement therapy: a narrative review.

Boer, Willem / Verbrugghe, Walter / Hoste, Eric / Jacobs, Rita / Jorens, Philippe G

2023 Volume 13, Issue 1, Page(s) 16

Abstract: The use of citrate, through reversible binding of calcium, has become the preferred choice for anticoagulation in continuous renal replacement therapy in the critically ill patient. Though generally considered as very efficacious in acute kidney injury, ... ...

Abstract	The use of citrate, through reversible binding of calcium, has become the preferred choice for anticoagulation in continuous renal replacement therapy in the critically ill patient. Though generally considered as very efficacious in acute kidney injury, this type of anticoagulation can cause acid-base disorders as well as citrate accumulation and overload, phenomena which have been well described. The purpose of this narrative review is to provide an overview of some other, non-anticoagulation effects of citrate chelation during its use as anticoagulant. We highlight the effects seen on the calcium balance and hormonal status, phosphate and magnesium balance, as well as oxidative stress resulting from these unapparent effects. As most of these data on these non-anticoagulation effects have been obtained in small observational studies, new and larger studies documenting both short- and long-term effects should be undertaken. Subsequent future guidelines for citrate-based continuous renal replacement therapy should take not only the metabolic but also these unapparent effects into account.
Language	English
Publishing date	2023-03-11
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2617094-2
ISSN	2110-5820
ISSN	2110-5820
DOI	10.1186/s13613-023-01113-0
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Article ; Online: The electronic medical record: Big data, little information?

Verbrugghe, Walter / Colpaert, Kirsten

Journal of critical care

2019 Volume 54, Page(s) 298–299

MeSH term(s)	Big Data ; Data Management ; Electronic Health Records ; Humans ; Intensive Care Units ; Rapid Sequence Induction and Intubation ; Retrospective Studies
Language	English
Publishing date	2019-01-04
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2019.09.005
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Article: Do-Not-ResuscitateDecision-Making during the COVID-19 Pandemic in a Teaching Hospital: Lessons Learned for the Future.

van de Wiel, Mick / van Ierssel, Sabrina / Verbrugghe, Walter / Mertens, Veerle / Janssens, Annelies

Journal of aging research

2023 Volume 2023, Page(s) 2771149

Abstract: Method: A cross-sectional survey study was conducted between February 2021 and April 2021 for all doctors and doctors in training, working in the Antwerp University Hospital during the COVID-19 pandemic.: Results: 127 doctors participated in this ... ...

Abstract	Method: A cross-sectional survey study was conducted between February 2021 and April 2021 for all doctors and doctors in training, working in the Antwerp University Hospital during the COVID-19 pandemic. Results: 127 doctors participated in this study. The familiarity with the different scores used in the triage during the COVID-10 pandemic was 51% for the Clinical Frailty Scale (CFS) and 20% for the Charlson Comorbidity Index (CCI). Participants indicated that their DNR decision is based on various aspects such as clinical assessment, comorbidities, patient's wishes, age, prognosis, and functional state. Conclusion: The familiarity with the different scores used during triage assessments is low. The total clinical picture of the patient is needed to make a considered decision, and this total picture of the patient seems to be well encompassed by frailty measurement (CFS). Although many participants indicated that the different scores do not offer much added value compared to their clinical assessment, it can help guide DNR decisions, especially for doctors in training.
Language	English
Publishing date	2023-12-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2573906-2
ISSN	2090-2212 ; 2090-2204
ISSN (online)	2090-2212
ISSN	2090-2204
DOI	10.1155/2023/2771149
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Article: Regional Citrate Anticoagulation in Continuous Renal Replacement Therapy: Is Metabolic Fear the Enemy of Logic? A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Jacobs, Rita / Verbrugghe, Walter / Dams, Karolien / Roelant, Ella / Couttenye, Marie Madeleine / Devroey, Dirk / Jorens, Philippe

Life (Basel, Switzerland)

2023 Volume 13, Issue 5

Abstract: Background: Anticoagulation is recommended to maintain the patency of the circuit in continuous renal replacement therapy (CRRT). However, anticoagulation-associated complications can occur. We performed a systematic review and meta-analysis to compare ... ...

Abstract	Background: Anticoagulation is recommended to maintain the patency of the circuit in continuous renal replacement therapy (CRRT). However, anticoagulation-associated complications can occur. We performed a systematic review and meta-analysis to compare the efficacy and safety of citrate anticoagulation to heparin anticoagulation in critically ill patients treated with CRRT. Methods: Randomised controlled trials (RCTs) evaluating the safety and efficacy of citrate anticoagulation and heparin in CRRT were included. Articles not describing the incidence of metabolic and/or electrolyte disturbances induced by the anticoagulation strategy were excluded. The PubMed, Embase, and MEDLINE electronic databases were searched. The last search was performed on 18 February 2022. Results: Twelve articles comprising 1592 patients met the inclusion criteria. There was no significant difference between the groups in the development of metabolic alkalosis (RR = 1.46; (95% CI (0.52-4.11); Conclusion: regional citrate anticoagulation is a safe anticoagulant for critically ill patients who require CRRT, as no significant differences were found in metabolic complications between the groups. Additionally, citrate has a lower risk of bleeding and circuit loss than heparin.
Language	English
Publishing date	2023-05-17
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life13051198
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Article: Thrombotic microangiopathy after traumatic brain injury: A case report and review of the literature.

Van Meerbeeck, Xavier / Janssen, Leen / Vleut, Rowena / Verdonck, Philip / Gadisseur, Alain / De Paep, Rudi / Verbrugghe, Walter / Jorens, Philippe

Clinical case reports

2023 Volume 11, Issue 9, Page(s) e7838

Abstract: Key clinical message: This case report supports that trauma can rarely cause thrombotic microangiopathy (TMA). Early recognition is important due to a high mortality of untreated TMA, but diagnosis can be delayed by attributing lab abnormalities as due ... ...

Abstract	Key clinical message: This case report supports that trauma can rarely cause thrombotic microangiopathy (TMA). Early recognition is important due to a high mortality of untreated TMA, but diagnosis can be delayed by attributing lab abnormalities as due to blood loss. Abstract: Major trauma can provoke coagulopathy, ranging from hypo- to hypercoagulation. Thrombotic microangiopathy (TMA), characterized by hemolytic anemia, renal failure, thrombocytopenia, and intravascular hemolysis, results in bleeding tendency but also microvascular thrombosis. We report a rare case of isolated traumatic brain injury leading to TMA treated with plasmapheresis.
Language	English
Publishing date	2023-09-08
Publishing country	England
Document type	Case Reports
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.7838
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Article ; Online: Data-Driven Medicine: A Meaningful Use of Patient Data to Improve Process Adherence and Patient Outcome of Mechanically Ventilated Subjects.

Verbrugghe, Walter / Jorens, Philippe G

Respiratory care

2017 Volume 62, Issue 3, Page(s) 382–383

MeSH term(s)	Humans ; Meaningful Use ; Respiration, Artificial
Language	English
Publishing date	2017
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.05457
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Article ; Online: Beta-Trace Protein as a Potential Marker of Acute Kidney Injury: A Pilot Study.

Leyssens, Katrien / Van Regenmortel, Niels / Roelant, Ella / Guerti, Khadija / Couttenye, Marie Madeleine / Jorens, Philippe G / Verbrugghe, Walter / Van Craenenbroeck, Amaryllis H

Kidney & blood pressure research

2021 Volume 46, Issue 2, Page(s) 185–195

Abstract: Introduction: Acute kidney injury (AKI) is a frequent complication among patients in the intensive care unit (ICU). The limitations of serum Cr (sCr) in timely detecting AKI are well known. Beta-trace protein (BTP) is emerging as a novel endogenous ... ...

Abstract	Introduction: Acute kidney injury (AKI) is a frequent complication among patients in the intensive care unit (ICU). The limitations of serum Cr (sCr) in timely detecting AKI are well known. Beta-trace protein (BTP) is emerging as a novel endogenous glomerular filtration rate marker. The aim of this study was to explore the role of BTP as a marker of AKI. Methods: Patients admitted to the ICU undergoing surgery were included. BTP, sCr, Cystatin C (CysC), and neutrophil gelatinase-associated lipocalin (NGAL) were measured preoperatively, postoperatively (post-op), and at the first (D1) and second (D2) post-op day. AKI was defined as an increase of sCr to ≥1.5-fold from baseline within 2 days after surgery. Results: Of the 52 patients studied, 10 patients (19%) developed AKI. Patients with AKI were older (69.6 ± 10.7 vs. 58.1 ± 16.7 years, p = 0.043) and had a longer length of ICU stay (13 [IQR 6-49] vs. 6 [IQR 5-8] days, p = 0.032). Between the 2 groups, the evolution of BTP, sCr, CysC, and NGAL over time differed significantly, with overall higher values in the AKI group. ROC analysis for the detection of AKI within 2 days after surgery showed a great accuracy for BTP. The area under the curve (AUC) for BTP post-op; D1; and D2 was, respectively, 0.869 ± 0.049; 0.938 ± 0.035; and 0.943 ± 0.032. The discriminative power of a BTP measurement on D1 was superior in detecting AKI compared to NGAL (adjusted p value = 0.027). We could not detect a significant difference between the AUCs of other biomarkers (NGAL, sCr, and CysC). Conclusion: Serum BTP is a promising marker for diagnosing AKI in ICU patients undergoing surgery.
MeSH term(s)	Acute Kidney Injury/blood ; Aged ; Biomarkers/blood ; Female ; Humans ; Intramolecular Oxidoreductases/metabolism ; Lipocalins/metabolism ; Male ; Middle Aged ; Pilot Projects
Chemical Substances	Biomarkers ; Lipocalins ; Intramolecular Oxidoreductases (EC 5.3.-) ; prostaglandin R2 D-isomerase (EC 5.3.99.2)
Language	English
Publishing date	2021-03-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1326018-2
ISSN	1423-0143 ; 1420-4096
ISSN (online)	1423-0143
ISSN	1420-4096
DOI	10.1159/000514173
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Article: Red cell distribution width (RDW) as a biomarker for respiratory failure in a pediatric ICU.

Schepens, Tom / De Dooy, Jozef J / Verbrugghe, Walter / Jorens, Philippe G

Journal of inflammation (London, England)

2017 Volume 14, Page(s) 12

Abstract: Background: The red cell distribution width (RDW) is a widely available, inexpensive, and highly reproducible test that reflects the range of the red cell sizes. Any process that releases reticulocytes in the circulation will result in an increase in ... ...

Abstract	Background: The red cell distribution width (RDW) is a widely available, inexpensive, and highly reproducible test that reflects the range of the red cell sizes. Any process that releases reticulocytes in the circulation will result in an increase in RDW. Elevated RDW values are linked to worsened pulmonary function in the adult population. We performed a retrospective cohort study to describe the association between RDW and respiratory failure in critically ill children in a in a pediatric intensive care unit (PICU) in a tertiary university hospital. Subjects: All patients admitted between January 2009 and June 2015 were considered eligible for inclusion. Methods: Retrospective cohort study. Results: In total, 960 patients were included in the cohort analysis. Of those patients, 149 (15.5%) had elevated RDW values. RDW on admission was associated with lower 28 day ventilator-free days. The highest quintile of RDW was associated with the need for mechanical ventilation, even when correcting for anaemia, age and Pediatric Risk of Mortality (PRISM) scores. In the subgroup of ventilated patients, RDW was associated with nadir PaO Conclusion: The RDW value on admission of our PICU patients is associated with a greater need for invasive mechanical ventilation, lower 28 day ventilator-free days and lower nadir P/F ratios in the patients with highest RDW values on admission. RDW may be a valuable, cheap and universally available, prognostic parameter for respiratory dysfunction in the PICU.
Language	English
Publishing date	2017-06-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2164385-4
ISSN	1476-9255
ISSN	1476-9255
DOI	10.1186/s12950-017-0160-9
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Article: Reoperation for bleeding after cardiac surgery.

De La Porte, Vincent M / De Meyer, Gregory R A / Schepens, Tom / Verbrugghe, Walter / Laga, Steven / Allegaert, Mathias / Mertens, Pieter / Rodrigus, Inez / Jorens, Philippe G

Acta chirurgica Belgica

2022 Volume 122, Issue 5, Page(s) 312–320

Abstract: Background: Postoperative cardio-surgical haemostatic management is centre-specific and experience-based, which leads to a variability in patient care. This study aimed to identify which postoperative haemostatic interventions may reduce the need for ... ...

Abstract	Background: Postoperative cardio-surgical haemostatic management is centre-specific and experience-based, which leads to a variability in patient care. This study aimed to identify which postoperative haemostatic interventions may reduce the need for reoperation after cardiac surgery in adults. Methods: A retrospective case-control study in a tertiary centre. Adult, elective, primary cardiac surgical patients were selected ( Results: Rate of cardiac surgical reoperation was 2% in the study population. Three variables were found to be associated with cardiac reoperation: preoperative administration of fresh frozen plasma (OR 5.45, CI 2.34-12.35), cumulative volume of chest tube drainage and cumulative count of packed red blood cells transfusion on ICU (OR 1.98, CI 1.56-2.51). Conclusion: No significant difference among specific types of postoperative haemostatic interventions was found between patients who needed reoperation and those who did not. Perioperative transfusion of fresh frozen plasma, postoperative transfusion of packed cells and cumulative volume of chest tube drainage were associated with reoperation after cardiac surgery. These variables could help predict the need for reoperation.
MeSH term(s)	Adult ; Blood Loss, Surgical ; Cardiac Surgical Procedures/adverse effects ; Case-Control Studies ; Hemostatics ; Humans ; Reoperation ; Retrospective Studies
Chemical Substances	Hemostatics
Language	English
Publishing date	2022-08-03
Publishing country	England
Document type	Journal Article
ZDB-ID	210274-2
ISSN	0001-5458
ISSN	0001-5458
DOI	10.1080/00015458.2020.1847463
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Article: Neurally adjusted ventilatory assist: a ventilation tool or a ventilation toy?

Verbrugghe, Walter / Jorens, Philippe G

Respiratory care

2011 Volume 56, Issue 3, Page(s) 327–335

Abstract: Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to various modes of assisted ventilation. Neurally adjusted ventilatory assist (NAVA) is the newest development. The ... ...

Abstract	Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to various modes of assisted ventilation. Neurally adjusted ventilatory assist (NAVA) is the newest development. The implementation of NAVA requires the introduction of a catheter to measure the electrical activity of the diaphragm (EA(di)). NAVA relies, opposite to conventional assisted ventilation modes, on the EA(di) to trigger the ventilator breath and to adjust the ventilatory assist to the neural drive. The amplitude of the ventilator assist is determined by the instantaneous EA(di) and the NAVA level set by the clinician. The NAVA level amplifies the EA(di) signal and determines instantaneous ventilator assist on a breath-to-breath basis. Experimental and clinical data suggest superior patient-ventilator synchrony with NAVA. Patient-ventilator asynchrony is present in 25% of mechanically ventilated patients in the intensive care unit and may contribute to patient discomfort, sleep fragmentation, higher use of sedation, development of delirium, ventilator-induced lung injury, prolonged mechanical ventilation, and ultimately mortality. With NAVA, the reliance on the EA(di) signal, together with an intact ventilatory drive and intact breathing reflexes, allows integration of the ventilator in the neuro-ventilatory coupling on a higher level than conventional ventilation modes. The simple monitoring of the EA(di) signal alone may provide the clinician with important information to guide ventilator management, especially during the weaning process. Although, until now, little evidence proves the superiority of NAVA on clinically relevant end points, it seems evident that patient populations (eg, COPD and small children) with major patient-ventilator asynchrony may benefit from this new ventilatory tool.
MeSH term(s)	Adult ; Child ; Humans ; Respiration, Artificial/methods ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/physiopathology ; Respiratory Insufficiency/therapy ; Respiratory Mechanics/physiology ; Ventilator-Induced Lung Injury/prevention & control ; Ventilators, Mechanical
Language	English
Publishing date	2011-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603252-7
ISSN	0020-1324 ; 0098-9142
ISSN	0020-1324 ; 0098-9142
DOI	10.4187/respcare.00775
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