Jens Kleffmann

Publications (6) View all

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  Available from: Jens Kleffmann

  Article: Effect of Early Physiotherapy on Intracranial Pressure and Cerebral Perfusion Pressure.

  Christian Roth, Hubertus Stitz, Anas Kalhout, Jens Kleffmann, Wolfgang Deinsberger, Andreas Ferbert
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  ABSTRACT: BACKGROUND: Physiotherapy plays an important role in the therapy of patients with acute cerebral diseases. Studies concerning the effects of physiotherapy on intracerebral pressure (ICP) and cerebral perfusion pressure (CPP) are, however, rare. METHODS: An observational study was performed on critically ill patients who were receiving ICP measurements and who were treated with passive range of motion (PROM) on our neuro-intensive care unit. ICP, CPP, mean arterial pressure (MAP) and heart rate were recorded continuously every minute, beginning 15 min before, during (26 min) and 15 min after treatment with PROM. Patients with mean ICP <15 mmHg (Group 1) and patients with mean ICP ≥15 mmHg (Group 2) before physiotherapy were analyzed separately. RESULTS: Overall there were 84 patients (f:m = 1:1) with 298 treatments units, 224 in Group 1 and 74 in Group 2, respectively. Mean ICP before treatment was 11.5 ± 5.1 mmHg, with a significant decrease of 1 mmHg during therapy (p = 2.0e-10). This was also true for Group 1 (baseline ICP 9.4 ± 3.7 mmHg, decrease of 0.7 mmHg, p = 3.8e-6) and Group 2 (baseline ICP 18.1 ± 2.7 mmHg, decrease of 2 mmHg, p = 3.7e-6). However, a persistent ICP reduction after therapy was seen only in Group 2. There were no significant differences between mean CPP and MAP comparing ICP before and after PROM in all groups. No adverse side effects of PROM were observed. CONCLUSIONS: Physiotherapy with PROM can be used safely in patients with acute neurological diseases, even if ICP is elevated before therapy.
  Neurocritical Care 12/2012; · 2.47 Impact Factor
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  Article: Comparison of Spontaneous Intracerebral Hemorrhage Treatment in Germany Between 1999 and 2009: Results of a Survey.

  Christian Roth, Stefanie Kästner, Mehrdad Salehi, Jens Kleffmann, Dieter-Karsten Böker, Wolfgang Deinsberger
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  ABSTRACT: BACKGROUND AND PURPOSE: The aim of our study was to examine surgical practice in the therapy of spontaneous intracerebral hemorrhage in Germany over a period of 10 years. METHODS: In 1999 and 2009 a questionnaire with 10 different cases of spontaneous intracerebral hemorrhage was sent to all neurosurgical centers in Germany. It included a cranial CT as well as a case description. The question asked if a conservative or surgical procedure was most suitable. When choosing surgery, the participants could decide between large open approach or microsurgery as well as stereotactic aspiration or external ventricular drainage. RESULTS: In 1999, 85 of 121 (70%) and in 2009 111 of 125 (89%) questionnaires could be evaluated. The results of the questionnaires from 1999 and 2009 showed no difference in the decision for or against a surgical procedure, except for a move toward conservative treatment in 1 patient with a massive spontaneous intracerebral hemorrhage. In 2 cases of isolated basal ganglia bleeding, a conservative approach was chosen by approximately 98% of the participants both in 1999 and in 2009. In all other cases of spontaneous intracerebral hemorrhage, in particular when the patient was in poor clinical condition, the decision was very heterogeneous. CONCLUSIONS: Despite new studies, there were no significant differences regarding the decision for or against a surgical procedure in 1999 and 2009. Although clearly unfavorable prognostic factors are known, many patients still undergo a surgical procedure. It appears that at least spontaneous intracerebral hemorrhage in the area of the basal ganglia is a unique domain of conservative treatment.
  Stroke 11/2012; · 5.73 Impact Factor
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  Article: Effect of percutaneous tracheostomy on intracerebral pressure and perfusion pressure in patients with acute cerebral dysfunction (TIP Trial): an observational study.

  Jens Kleffmann, Roman Pahl, Wolfgang Deinsberger, Andreas Ferbert, Christian Roth
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  ABSTRACT: Bedside percutaneous tracheostomy (PT) is very commonly used for patients who require prolonged mechanical ventilation. The effect of tracheostomy on intracranial pressure (ICP) is currently a subject of controversy. The aim of our study is to clarify the relation between PT and its effect on ICP and cerebral perfusion pressure. 38 patients on our intensive care unit were included prospectively in an observational study. We examined mean values of HF, SpO(2), ICP, CPP, and MAP for changes over five different phases of the procedure using paired Mann-Whitney U tests. A p value of <0.05 was considered significant. p values were Bonferroni corrected for multiple testing. PT was performed on 38 patients (f = 19, m = 19; mean = 56 years). Median ICP before intervention was 9 mmHg. During positioning of the patient, ICP had risen to 14, during bronchoscopy to 16, and during tracheostomy to 18 mmHg, all being significantly higher than baseline level. Monitoring of MAP showed a significant increase to 101 mmHg only during tracheostomy. SpO(2) and HF did not show any significant changes. Mean duration of positioning, bronchoscopy and tracheostomy was 19, 10, and 17 min. 8 patients received osmotherapy due to a rise of ICP of more than 30 mmHg. PT only leads to a significant rise of ICP during the procedure. Nevertheless, therapy of ICP is necessary in some patients. From our point of view, therefore, tracheostomy should only be performed under continuous monitoring of ICP and CPP in patients with severe cerebral dysfunctions and critically elevated ICP.
  Neurocritical Care 04/2012; 17(1):85-9. · 2.47 Impact Factor
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  Article: Dosage-sensitive network in polycystic kidney and liver disease: multiple mutations cause severe hepatic and neurological complications.

  Jens Kleffmann, Valeska Frank, Andreas Ferbert, Carsten Bergmann
  Journal of Hepatology 03/2012; 57(2):476-7. · 9.26 Impact Factor
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  Article: Mimikry einer Herpes-Enzephalitis durch Glioblastoma multiforme Mimikry of Herpes Encephalitis by Glioblastoma Multiforme

  Autoren J Kleffmann, C Roth, M Hügens-Penzel, W Deinsberger, A Ferbert, Korrespondenzadresse Jens Dr, Kleffmann
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  ABSTRACT: Herpes encephalitis (HSE) is an acute illness. Imaging is an important part of the diagnostic work-up of HSE. In early stages one can see a manifestation in the insular cortex as well as in the fornix. These MRI findings are rather typical for HSE. We present three cases treated in our hospital over the past ten years. In these cases the clinical symptoms and signs as well as the morphological findings were compatible with the HSE diagnostic criteria. Later on, a glioblastoma multiforme was found in all three cases.
  Fortschritte der Neurologie · Psychiatrie 03/2012; · 0.74 Impact Factor