Hospital zum Heiligen Geist

BackgroundFunctional mitral regurgitation (FMR) has limited effective treatment options. As a transcatheter indirect annuloplasty, the Carillon Mitral Contour System reduces FMR and improves symptoms, but long-term safety and effectiveness are incompletely characterized.MethodsThis prospective, multicenter CINCH registry enrolled heart failure patients with FMR treated with the Carillon Mitral Contour System across 22 centers in Germany. Main outcomes included change in New York Heart Association (NYHA) class and MR severity, heart failure hospitalization (HFH), all-cause mortality rates, and device- or procedure-related serious adverse events at 1 year. Median follow-up was 2.0 years (range, 0-5 years).ResultsAmong 228 patients (age 78 ± 8 years; 51% female; 51% with left ventricular ejection fraction ≥50%), Carillon implantation improved clinical and echocardiographic variables. The rate of NYHA class III or IV symptoms decreased from 81 to 29% at 1 year, and the rate of moderate-to-severe MR (grade 3+/4+) decreased from 84 to 9% at 1 year, with ≥92% showing stable or improved NYHA class and ≥97% showing stable or improved MR grade over 5 years. Decreases in MR grade were associated with improvements in NYHA class (p = 0.048). Kaplan–Meier estimates over 5 years were 54.0% for HFH, 46.9% for all-cause mortality, and 68.3% for the composite of HFH or death. The proportion of patients experiencing any serious device- or procedure-related serious adverse event at 1 year was 1.8%.ConclusionsThe CINCH registry provides real-world evidence supporting the long-term safety, effectiveness, and durability of the Carillon Mitral Contour System in treating FMR.

Background: There are significant differences in the anatomy and physiology of children compared to adults, which have important implications for anesthesia. The incidence of anesthetic complications is higher in children than in adults. Newborns, infants, and children undergoing emergency procedures or those with severe comorbidities are particularly at increased risk for potential complications.Aim of the study: The aim of this work is to identify anesthetic complications associated with the cardiovascular system, along with their management.Material and methods: This work is based on both available literature and the authors' experience. The search process identified relevant articles using valid keywords across electronic databases, including Embase, PubMed, Scopus, Web of Science, and the Cochrane Library. In total, 29 articles published between 1994 and 2022 were deemed eligible for inclusion in our review.Results: Common cardiovascular complications in pediatric anesthesia include sudden cardiac arrest (SCA), hypotension, bradycardia, and arrhythmias. Neonates and infants under 12 months of age have the highest rate of adverse events, both intraoperatively and in the postanesthesia recovery room. Conclusions: The foundation of safe pediatric anesthetic practice consists of careful preoperative assessment, adherence to strict pediatric anesthesia protocols, and the presence of an experienced team. Moreover, only anesthesiologists well-trained in pediatric care should be entrusted with the management of pediatric patients.

Transcranial pulse stimulation (TPS) is a non-invasive neuromodulation method that uses, high-intensity acoustic shockwaves to deliver focused mechanical stimulation to neural tissue with minimal thermal effects. The mechanism of action includes but is not limited to promotion of blood flow and angiogenesis through mechanotransduction. Clinical data to date are limited and preliminary. In Alzheimer’s disease (AD), TPS has demonstrated cognitive and mood improvements in pilot studies and secondary endpoint analysis in first randomized trials. The enhancement of gamma-band oscillations and network connectivity has been reported. Clinical observations in Parkinson’s disease (PD) suggest TPS as a hypothesis-generating approach to address non-motor symptoms—such as depression, cognitive decline, and the freezing of gait—through theoretical modulation of basal ganglia–cortical circuits. TPS is CE-marked in Europe for AD and shows a favorable safety profile; however, ethical considerations arise from the limited evidence base, potential impairment of patient autonomy and judgment in dementia, and the risk of withholding established treatments. TPS should only be offered under structured scientific protocols or within patient registries to ensure rigorous oversight. Ensuring that consent processes account for cognitive capacity, and that TPS is applied as adjunct rather than replacement therapy, is paramount. Future research must include large-scale randomized controlled trials (RCTs), standardize stimulation protocols, deepen mechanistic insight, and embed robust ethical frameworks.

General anesthesia, despite the constant development of anesthesiology, still carries certain risks. To provide safe anesthesia, it is crucial to properly qualify patients and to react in an appropriate manner when problems occur. It is therefore essential to have knowledge of risk factors, pathophysiology, symptoms, and management patterns regarding complications. This review comprehensively describes respiratory complications such as airway spasm, conditions leading to intraoperative hypoxemia, postoperative pulmonary complications (PPC), and complications of cross airway compromise, from aspects including respiratory complications and mechanical injuries. Moreover, events characteristic of this type of anesthesia, such as anaphylaxis, postoperative nausea and vomiting (PONV), neurological complications, accidental awakening during general anesthesia (AAGA), hypothermia, and malignant hyperthermia (MH), have been included. Each complication is elaborated on in terms of risk groups and factors, symptoms, and prevention and treatment options, taking into account the interrelationship of particular conditions. Although that issue is well reported in the literature, this review, in addition to a comprehensive summary of the most important non-cardiovascular and hemodynamic complications, takes into account the latest findings on methods of prevention, diagnosis, and intraoperative monitoring. The article combines a comprehensive compilation of basic information on the most significant complications, including their diagnosis and methods of intervention, along with consideration of the latest scientific developments and indication of future research directions. This review is based on the most recent articles possible, published between 2006 and 2024.

Background Several case series have highlighted the ADVOS hemodialysis system's efficacy in eliminating water-soluble and protein-bound substances across diverse patient populations, such as multiorgan failure, acute-on-chronic liver failure (ACLF), acidosis, and even COVID-19. The EMOS-Registry, a non-interventional, multi-center patient registry, amassed real-world evidence, culminating in the largest patient cohort treated with ADVOS to date. This study aims to present and analyze the final performance and safety outcomes from the entire dataset comprising 282 participants. Methods Data spanning from January 18, 2017, to August 31, 2020, were collected from five German hospitals, encompassing subsets of patients with acidosis and ACLF grade 3. Performance and safety were assessed through vital signs, clinical laboratory parameters and blood gas analyses. The SOFA Score-Standardized Mortality Ratio (SMR) served to evaluate patient outcomes in the absence of a control group. Results Participants, with a median age of 58 years, predominantly male (64%), exhibited a high requirement for mechanical ventilation (68%) and vasopressors (82%) with a median SOFA Score of 15. Notably, a median of 3 (IQR 2, 5) ADVOS sessions per patient were administered. Following the initial treatment, significant reductions were observed in bilirubin (-1.9 [CI 95% -1.3, -2.5]), creatinine (-0.5 [-0.4, -0.6]), and blood urea nitrogen (-13.1 mg/dL [-10.3, -16.0]) levels. Moreover, there were marked improvements in blood pH (7.34 vs. 7.41, p<0.001), HCO3- (19.4 vs. 24.6 mmol/l, p<0.001) and base excess (-5.6 vs. 0.2 mmol/l, p<0.001). The observed mortality rate (66%) was notably lower than the expected rate based on SOFA Score (84%), resulting in a SMR of 0.79 (95% CI: 0.66-0.93), with a calculated number needed to treat (NNT) of 5.8. Conclusions This study emphasizes the ADVOS system's efficacy in eliminating water-soluble and protein-bound substances and correcting acid-base imbalances across a diverse cohort with multiorgan failure. However, further validation through randomized controlled trials is warranted to solidify these findings.

Background: The frequency of hospitalisation of patients with morbid obesity (Body Mass Index - BMI ≥ 40 kg/m2) is constantly increasing. The hospitalisation in the Intensive Care Units (ICUs) of such a group of patients, in addition to the common problems in care and treatment encountered in the rest of the hospital wards, additionally brings distinct challenges to be faced by the staff.Aim of the study: This review aims to clarify the distinctive physiological characteristics of morbidly obese patients and the resulting challenges during ICU hospitalisation, while also presenting appropriate therapeutic approaches and interventions.Material and methods: Based on the available medical literature and the authors' clinical experience, we have selected articles using PubMed, NIH (National Institutes of Health), SpringerMedizin, and Semantic Scholar, along with guidelines from the Medycyna Praktyczna website, WHO data, and book sources. We reviewed 693 articles, 3 books, and the websites of WHO and Medycyna Praktyczna. The final selection comprised 34 articles (32 in English, 1 in German, 1 in Polish), published between 2004 and 2023, with 12 published after 2020.Results: Morbid obesity disrupts the physiological homeostasis of the body, noticeably affecting the respiratory, cardiovascular or gastrointestinal systems, and is associated with the occurrence of a number of diseases. This necessitates specific distinctions in the intubation procedure, mechanical ventilation strategy as well as drug dosing. In addition, it should be noticed that life-threatening conditions such as acute respiratory distress syndrome (ARDS) or sepsis occur among patients hospitalised in the ICU, requiring additional modifications to the therapy.Conclusions: Morbidly obese ICU patients due to their anatomical and physiological characteristics belong to individuals at risk of difficult intubation requiring specific positioning, preoxygenation and the use of videolaryngoscopes, as well as implementing an appropriate mechanical ventilation strategy. Additionally, altered drug metabolism and distribution in these patients necessitate distinct dosing protocols for effective treatment.

Alzheimer’s disease (AD) is a neurodegenerative disorder that dramatically affects cognitive abilities and represents the most common cause of dementia. Currently, pharmacological interventions represent the main treatment to deal with the symptoms of AD; however, alternative approaches are readily sought. Transcranial pulse stimulation (TPS) is an emerging non-invasive neuromodulation technique that uses short, repetitive shockwaves with the potential to provide a wide range of vascular, metabolic, and neurotrophic changes and that has recently been shown to improve cognitive abilities in AD. This exploratory study aims to gain insight into the neurophysiological effect of one session of TPS in AD as reflected in electroencephalographic measures, e.g., spectral power, coherence, Tsallis entropy (TE), and cross-frequency coupling (cfc). We document changes in power (frontal and occipital), coherence (frontal, occipital and temporal), and TE (temporal and frontal) as well as changes in cfc (parietal-frontal, parietal-temporal, frontal–temporal). Our results emphasize the role of electroencephalographic measures as prospective markers for the neurophysiological effect of TPS.

Interactions between drugs are a common problem in Intensive Care Unit patients, as they mainly have a critical condition that often demands the administration of multiple drugs simultaneously. Antibiotics are among the most frequently used medications, as infectious diseases are often observed in ICU patients. In this review, the most important antibiotic-drug interactions, based on the pharmacokinetic and pharmacodynamic mechanisms, were gathered together and described. In particular, some of the most important interactions with main groups of antibacterial drugs were observed in patients simultaneously prescribed oral anticoagulants, NSAIDs, loop diuretics, and valproic acid. As a result, the activity of drugs can be increased or decreased, as dosage modification might be necessary. It should be noted that these crucial interactions can help predict and avoid negative consequences, leading to better patient recovery. Moreover, since there are other factors, such as fluid therapy or albumins, which may also modify the effectiveness of antibacterial therapy, it is important for anaesthesiologists to be aware of them.