S Wolf

Charité Universitätsmedizin Berlin, Berlin, Land Berlin, Germany

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Publications (11)17.84 Total impact

  • ains · Anästhesiologie · Intensivmedizin 11/2005; 40(10):597-601. DOI:10.1055/s-2005-870466 · 0.34 Impact Factor
  • ains · Anästhesiologie · Intensivmedizin 04/2004; 35(01):1-2. DOI:10.1055/s-2000-10846-18 · 0.34 Impact Factor
  • ains · Anästhesiologie · Intensivmedizin 04/2004; 35(01):1-2. DOI:10.1055/s-2000-10846-29 · 0.34 Impact Factor
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    ABSTRACT: Since imbalances in the immune system of the critically ill patient have been demonstrated, the role of the gastrointestinal tract for the pathogenesis of multiple organ failure has been a focus of research in intensive care medicine. Particularly, the integrity of the intestinal barrier function has been studied experimentally and clinically. The enormous number of gram-negative bacteria up to 10(11)/ml intestinal liquid inducing the release of significant amounts of endotoxin, is considered to be a vital threat to the intensive care unit (ICU) patient. Acute failure of the intestinal barrier following various types of severe shock or following parenteral nutrition inducing atrophy of intestinal mucosa may lead to multiple organ dysfunction. Maintenance of hemodynamic stability is a mainstay of therapy of the critically ill. In addition, the intestinal integrity can be preserved by the early onset of enteral nutrition. Moreover, recent concepts of enteral nutrition using immunomodulating nutrients like omega-3-fatty acids, glutamine, arginine, and nucleotides are under clinical evaluation.
    Der Anaesthesist 11/2002; 51(10):843-52. · 0.74 Impact Factor
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    ABSTRACT: Die Bedeutung des Gastrointestinaltraktes wird in den letzten Jahren im Rahmen der wachsenden Erkenntnisse über die immunregulatorischen Imbalancen des kritisch kranken Patienten zunehmend erkannt. Dabei steht aktuell weniger die bloße Nährstoffresorption, sondern vielmehr die Barrierefunktion der Darmschleimhaut im Vordergrund. Die große Anzahl intestinaler vorwiegend gramnegativer Keime und ihrer Toxine stellt unter intensivmedizinischen Bedingungen eine erhebliche Bedrohung für den Patienten dar. Der Verlust der intestinalen Barrierefunktion im Rahmen eines Schocks unterschiedlicher Ätiologie oder auch bei Schleimhautatrophien aufgrund von Nahrungskarenz kann die Induktion proinflammatorischer Kaskaden beim kritisch kranken Patienten bis hin zum Multiorganversagen verursachen. Neben der Aufrechterhaltung der hämodynamischen Stabilität gilt eine frühe enterale Ernährung als wichtige therapeutische Option zur Aufrechterhaltung der intestinalen Barrierefunktion. Bestimmte Nahrungsbestandteile, wie die Omega-3-Fettsäuren Eikosapentaensäure und Docosahexaensäure, die Aminosäuren Glutamin und Arginin sowie Nukleotide sind nach derzeitiger Studienlage bei Subpopulationen von Intensivpatienten von besonderem klinischem Nutzen. Since imbalances in the immune system of the critically ill patient have been demonstrated, the role of the gastrointestinal tract for the pathogenesis of multiple organ failure has been a focus of research in intensive care medicine. Particularly, the integrity of the intestinal barrier function has been studied experimentally and clinically. The enormous number of gram-negative bacteria up to 1011/ml intestinal liquid inducing the release of significant amounts of endotoxin, is considered to be a vital threat to the intensive care unit (ICU) patient. Acute failure of the intestinal barrier following various types of severe shock or following parenteral nutrition inducing atrophy of intestinal mucosa may lead to multiple organ dysfunction. Maintenance of hemodynamic stability is a mainstay of therapy of the critically ill. In addition, the intestinal integrity can be preserved by the early onset of enteral nutrition. Moreover, recent concepts of enteral nutrition using immunomodulating nutrients like omega-3-fatty acids, glutamine, arginine, and nucleotides are under clinical evaluation.
    Der Anaesthesist 01/2002; 51(10):843-852. DOI:10.1007/s00101-002-0378-6 · 0.74 Impact Factor
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    ABSTRACT: A combination of exogenous surfactant and partial liquid ventilation (PLV) with perfluorocarbons should enhance gas exchange, improve respiratory mechanics and reduce tissue damage of the lung in acute lung injury (ALI). We used a small dose of exogenous surfactant with and without PLV in an experimental model of ALI and studied the effects on gas exchange, haemodynamics, lung mechanics, and lung pathology. ALI was induced by repeated lavages (PaO2/FIO2 less than 13 kPa) in 24 anaesthesized, tracheotomized and mechanically ventilated (FIO2 1.0) juvenile pigs. They were treated randomly with either a single intratracheal dose of surfactant (50 mg kg(-1), Curosurf, Serono AG, München, Germany) (SURF-group, n=8), a single intratracheal dose of surfactant (50 mg kg(-1), Curosurf) followed by PLV with 30 ml kg(-1) of perfluorocarbon (PF 5080, 3M, Germany) (SURF-PLV-group, n=8) or no further intervention (controls, n=8). Pulmonary gas exchange, respiratory mechanics, and haemodynamics were measured hourly for a 6 h period. In the SURF-group, the intrapulmonary right-to-left shunt (QS/QT) decreased significantly from mean 51 (SEM 5)% after lavage to 12 (2)%, and PaO2 increased significantly from 8.1 (0.7) to 61.2 (4.7) kPa compared with controls and compared with the SURF-PLV-group (P<0.05). In the SURF-PLV-group, QS/QT decreased significantly from 54 (3)% after induction of ALI to 26 (3)% and PaO2 increased significantly from 7.2 (0.5) to 30.8 (5.0) kPa compared with controls (P<0.05). Static compliance of the respiratory system (C(RS)), significantly improved in the SURF-PLV-group compared with controls (P<0.05). Upon histological examination, the SURF-group revealed the lowest total injury score compared with controls and the SURF-PLV-group (P<0.05). We conclude that in this experimental model of ALI, treatment with a small dose of exogenous surfactant improves pulmonary gas exchange and reduces the lung injury more effectively than the combined treatment of a small dose of exogenous surfactant and PLV.
    BJA British Journal of Anaesthesia 10/2001; 87(4):593-601. DOI:10.1093/bja/87.4.593 · 4.35 Impact Factor
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    ABSTRACT: To study normothermic extracorporeal liver perfusion (NELP) as a means to preserve livers for transplantation and to reverse warm ischemic injury. The authors provide experimental evidence that successful transplantation after 4 hours of normothermic extracorporeal liver perfusion is possible and as reliable as 4 hours of cold preservation in University of Wisconsin solution. NELP preserves liver function completely and can reverse 60 minutes of warm ischemic injury in non-heart-beating donors. Thirty-six German Landrace pigs received transplants in six groups. Group 1 animals received direct transplantation. Group 2 received transplants after 4 hours of cold preservation with University of Wisconsin solution and Group 3 animals after 4 hours of NELP. Group 4 animals sustained 1 hour of warm ischemia before transplantation. Group 5 animals received transplants after 1 hour of warm ischemia and 4 hours of cold preservation and Group 6 animals after 1 hour of warm ischemia and 4 hours of NELP. All animals receiving livers treated by NELP survived more than 7 days after the transplant (Groups 3 and 6). In contrast, all animals in Group 5 developed primary graft nonfunction within 24 hours after transplantation. The technique of NELP holds the potential to keep a mammalian liver outside the body completely functional, possibly for more than 4 hours. NELP can be used for liver preservation before transplantation or for the use of organs from non-heart-beating donors.
    Annals of Surgery 02/2001; 233(1):114-23. DOI:10.1097/00000658-200101000-00017 · 7.19 Impact Factor
  • Transplantation Proceedings 09/1998; 30(5):2318-20. DOI:10.1016/S0041-1345(98)00638-1 · 0.95 Impact Factor
  • Transplantation Proceedings 09/1998; 30(5):2334-5. DOI:10.1016/S0041-1345(98)00643-5 · 0.95 Impact Factor
  • Transplantation Proceedings 09/1998; 30(5):2314-6. DOI:10.1016/S0041-1345(98)00636-8 · 0.95 Impact Factor
  • Transplantation Proceedings 12/1997; 29(7):3036-8. DOI:10.1016/S0041-1345(97)00774-4 · 0.95 Impact Factor