Kees H Polderman

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (113)894.57 Total impact

  • Kees H Polderman, Joseph Varon
    Circulation 02/2015; 131(7):669-75. · 14.95 Impact Factor
  • Kees H. Polderman, Joseph Varon
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    ABSTRACT: Administering intravenous fluids to support the circulation in critically ill patients has been a mainstay of emergency medicine and critical care for decades, especially (but not exclusively) in patients with distributive or hypovolemic shock. However, in recent years, this automatic use of large fluid volumes is beginning to be questioned. Analysis from several large trials in severe sepsis and/or acute respiratory distress syndrome have shown independent links between volumes of fluid administered and outcome; conservative fluid strategies have also been associated with lower mortality in trauma patients. In addition, it is becoming ever more clear that central venous pressure, which is often used to guide fluid administration, is a completely unreliable parameter of volume status or fluid responsiveness. Furthermore, 2 recently published large multicenter trials (ARISE and ProCESS) have discredited the "early goal-directed therapy" approach, which used prespecified targets of central venous pressure and venous saturation to guide fluid and vasopressor administration. This article discusses the risks of "iatrogenic submersion" and strategies to avoid this risk while still giving our patients the fluids they need. The key lies in combining good clinical judgement, awareness of the potential harm from excessive fluid use, restraint in reflexive administration of fluids, and use of data from sophisticated monitoring tools such as echocardiography and transpulmonary thermodilution. Use of smaller volumes to perform fluid challenges, monitoring of extravascular lung water, earlier use of norepinephrine, and other strategies can help further reduce morbidity and mortality from severe sepsis. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Emergency Medicine 02/2015; · 1.15 Impact Factor
  • Kees H Polderman, Joseph Varon
    Critical care medicine. 11/2014; 42(11):2452-4.
  • Kees H Polderman, Joseph Varon
    Resuscitation 08/2014; 85(8):975-6. · 3.96 Impact Factor
  • Resuscitation 05/2014; 85:S105. · 3.96 Impact Factor
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    ABSTRACT: Therapeutic hypothermia (TH) is recommended to reduce ischemic brain injury after cardiac arrest. The variables that predict heat generation by patients receiving TH are uncertain, as is how this heat generation relates to neurologic outcome. We hypothesized that patient characteristics, medication use, inflammation, and organ injury would be associated with heat generation. We further hypothesized that neurologic outcome would be most strongly associated with heat generation. Surface and intravascular cooling devices were used to provide TH in 57 consecutive cardiac arrest patients. Device water temperatures during the maintenance (33°C) phase were collected. Patient heat generation was quantified as the "heat index" (HI), which was the inverse average water temperature over a minimum of 2 hours of maintenance hypothermia. Variables measuring reduced ischemic injury and improved baseline health were significantly associated with HI. After controlling for presenting rhythm, a higher HI was independently associated with favorable disposition (OR=2.2; 95% CI 1.2 to 4.1; P=0.014) and favorable Cerebral Performance Category (OR=1.8; 95% CI 1.0 to 3.1; P=0.035). Higher HI predicted favorable disposition (receiver-operator area under the curve 0.71, P=0.029). HI was linearly correlated with arteriovenous CO2 (r=0.69; P=0.041) but not O2 (r=0.13; P=0.741) gradients. In cardiac arrest patients receiving TH, greater heat generation is associated with better baseline health, reduced ischemic injury, and improved neurologic function, which results in higher metabolism. HI can control for confounding effects of patient heat generation in future clinical trials of rapid TH and offers early prognostic information.
    Journal of the American Heart Association 04/2014; 3(3):e000580.
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    Kees H Polderman, Joseph Varon
    Critical care (London, England) 04/2014; 18(2):130. · 5.04 Impact Factor
  • Joseph Varon, Kees Polderman
    New England Journal of Medicine 04/2014; 370(14):1358-9. · 54.42 Impact Factor
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    ABSTRACT: Amniotic fluid embolism (AFE) is one of the most catastrophic complications that can occur during pregnancy or in the immediate postpartum period, frequently complicated by profound shock and cardiovascular collapse as well as severe respiratory distress. Therapeutic hypothermia (TH) is now commonly used to improve neurological outcomes after various types of hypoxic injury and is widely used in the treatment of postanoxic injury after cardiac arrest (CA). To our knowledge, no studies have evaluated whether TH could be effectively used in AFE, and its use for this indication has not been described previously. We describe the case of a 32-year-old woman, who developed clinical manifestations of AFE and suffered a CA in the 29th week of her pregnancy. She received prolonged CPR (40 minutes until ROSC) and remained comatose. TH was induced and maintained for a total of 60 hours using an endovascular device, followed by controlled rewarming and maintenance of strict normothermia. The patient survived and was neurologically intact (CPC 1) at 6 months of follow up.
    Therapeutic hypothermia and temperature management. 03/2014;
  • Therapeutic hypothermia and temperature management. 03/2014; 4(1):3-7.
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    Kees H Polderman
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    ABSTRACT: This article discusses the potential of levosimendan to treat calcium-induced myocardial dysfunction associated with deep hypothermia. Moderate hypothermia (30 to 34°C) usually improves myocardial contractility and stabilizes heart rhythm, but deep hypothermia can cause severe myocardial dysfunction, which is mediated by intracellular calcium overload. In experimental studies, levosimendan appears effective in reversing this. Clinical studies are needed to confirm these findings and to determine whether levosimendan could also be used for accidental hypothermia and perhaps to mitigate diastolic dysfunction under moderate hypothermia.
    Critical care (London, England) 12/2013; 17(6):1018. · 5.04 Impact Factor
  • Joseph Varon, Kees Polderman
    Resuscitation 03/2013; · 3.96 Impact Factor
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    ABSTRACT: INTRODUCTION: Mild therapeutic hypothermia (MTH) is a worldwide used therapy to improve neurological outcome in patients successfully resuscitated after cardiac arrest (CA). Preclinical data suggest that timing and speed of induction are related to reduction of secondary brain damage and improved outcome. METHODS: Aiming at a rapid induction and stable maintenance phase, MTH induced via continuous peritoneal lavage (PL) using Velomedix(R) Inc. automated PL system was evaluated and compared to historical controls in which hypothermia was achieved using cooled saline intravenous infusions and cooled blankets. RESULTS: In sixteen PL patients time to reach core target temperature of 32.5oC was 30 minutes (interquartile range [IQR]: 19-60), which was significantly faster compare to 150 minutes (IQR: 112-240) in controls. The median rate of cooling during the induction phase in the PL group of 4.1oC/hr (IQR: 2.2-8.2) was significantly faster compared to 0.9oC/hr (IQR: 0.5-1.3) in controls. During the 24 hours maintenance phase mean core temperature in the PL patients was 32.38+/-0.18oC (range: 32.03-32.69oC) and in control patients 32.46+/-0.48oC (range: 31.20-33.63oC), indicating more steady temperature control in the PL group compared to controls. Furthermore, the coefficient of variation (VC) for temperature during the maintenance phase was lower in the PL group (VC: 0.5%) compared to the control group (VC: 1.5%). In contrast to 23% of the control patients, none of the PL patients showed overshoot of hypothermia below 31oC during the maintenance phase. Survival and neurological outcome was not different between the two groups. Neither shivering nor complications related to insertion or use of the PL method were observed. CONCLUSIONS: Using PL in post CA patients results in rapidly reached target temperature and a very precise maintenance, unprecedented in clinical studies evaluating MTH techniques. This opens the way to investigate the effects on neurological outcome and survival of ultra-rapid cooling compared to standard cooling in controlled trials in various patient groups. Trial registration: ClinicalTrials.Gov NCT01016236.
    Critical care (London, England) 02/2013; 17(1):R31. · 5.04 Impact Factor
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: Cardiac arrest is the most common cause of death in North America. Neurocritical care interventions, including therapeutic hypothermia (TH), have significantly improved neurological outcomes in patients successfully resuscitated from cardiac arrest. Therefore, resuscitation following cardiac arrest was chosen as an Emergency Neurological Life Support protocol. Patients remaining comatose following resuscitation from cardiac arrest and who are not bleeding are potential candidates for TH. This protocol will review induction, maintenance, and re-warming phases of TH, along with management of TH side effects. Aggressive shivering suppression is necessary with this treatment to ensure the maintenance of a target temperature. Ancillary testing, including electrocardiography, computed tomography imaging of the brain, continuous electroencephalography, monitoring, and correction of electrolyte, blood gas, and hematocrit changes are also necessary to optimize outcomes.
    Neurocritical Care 08/2012; 17 Suppl 1(S1):21-8. · 3.04 Impact Factor
  • Kees H Polderman
    Critical Care 06/2012; 16(2). · 5.04 Impact Factor
  • Kees H Polderman
    Critical Care 06/2012; 16(2). · 5.04 Impact Factor
  • Kees H Polderman, Peter J D Andrews
    The Lancet Neurology 05/2011; 10(5):404-5; author reply 406-7. · 21.82 Impact Factor
  • Kees H Polderman
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    ABSTRACT: In vitro studies and clinical observations suggest that both accidental and controlled/therapeutic hypothermia have a strong immunosuppressive effect, and that hypothermia increases the risk of infections, especially wound infections and pneumonia. In the previous issue of Critical Care, Kamps and colleagues report that when hypothermia was used for prolonged periods in patients with severe traumatic brain injury in conjunction with selective decontamination of the digestive tract, the risks of infection were the same or lower in patients treated with therapeutic cooling. The risk of infection is widely regarded as the most important danger of therapeutic cooling. The findings of Kamps and colleagues need to be verified in prospective trials and in higher-resistance environments, but raise the possibility of cooling for prolonged periods with greatly reduced risk. We may be able to have our cake and eat it.
    Critical care (London, England) 03/2011; 15(2):144. · 5.04 Impact Factor
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    ABSTRACT: Traumatic brain injury is a major cause of death and severe disability worldwide with 1,000,000 hospital admissions per annum throughout the European Union.Therapeutic hypothermia to reduce intracranial hypertension may improve patient outcome but key issues are length of hypothermia treatment and speed of re-warming. A recent meta-analysis showed improved outcome when hypothermia was continued for between 48 hours and 5 days and patients were re-warmed slowly (1 °C/4 hours). Previous experience with cooling also appears to be important if complications, which may outweigh the benefits of hypothermia, are to be avoided. This is a pragmatic, multi-centre randomised controlled trial examining the effects of hypothermia 32-35 °C, titrated to reduce intracranial pressure <20 mmHg, on morbidity and mortality 6 months after traumatic brain injury. The study aims to recruit 1800 patients over 41 months. Enrolment started in April 2010.Participants are randomised to either standard care or standard care with titrated therapeutic hypothermia. Hypothermia is initiated with 20-30 ml/kg of intravenous, refrigerated 0.9% saline and maintained using each centre's usual cooling technique. There is a guideline for detection and treatment of shivering in the intervention group. Hypothermia is maintained for at least 48 hours in the treatment group and continued for as long as is necessary to maintain intracranial pressure <20 mmHg. Intracranial hypertension is defined as an intracranial pressure >20 mmHg in accordance with the Brain Trauma Foundation Guidelines, 2007. The Eurotherm3235Trial is the most important clinical trial in critical care ever conceived by European intensive care medicine, because it was launched and funded by the European Society of Intensive Care Medicine and will be the largest non-commercial randomised controlled trial due to the substantial number of centres required to deliver the target number of patients. It represents a new and fundamental step for intensive care medicine in Europe. Recruitment will continue until January 2013 and interested clinicians from intensive care units worldwide can still join this important collaboration by contacting the Trial Coordinating Team via the trial website http://www.eurotherm3235trial.eu. Current Controlled Trials ISRCTN34555414.
    Trials 01/2011; 12:8. · 2.12 Impact Factor
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: OBJECTIVES: To address the issues of Prevention and Management of Acute Renal Failure in the ICU Patient, using the format of an International Consensus Conference. METHODS AND QUESTIONS: Five main questions formulated by scientific advisors were addressed by experts during a 2-day symposium and a Jury summarized the available evidence: (1) Identification and definition of acute kidney insufficiency (AKI), this terminology being selected by the Jury; (2) Prevention of AKI during routine ICU Care; (3) Prevention in specific diseases, including liver failure, lung Injury, cardiac surgery, tumor lysis syndrome, rhabdomyolysis and elevated intraabdominal pressure; (4) Management of AKI, including nutrition, anticoagulation, and dialysate composition; (5) Impact of renal replacement therapy on mortality and recovery. RESULTS AND CONCLUSIONS: The Jury recommended the use of newly described definitions. AKI significantly contributes to the morbidity and mortality of critically ill patients, and adequate volume repletion is of major importance for its prevention, though correction of fluid deficit will not always prevent renal failure. Fluid resuscitation with crystalloids is effective and safe, and hyperoncotic solutions are not recommended because of their renal risk. Renal replacement therapy is a life-sustaining intervention that can provide a bridge to renal recovery; no method has proven to be superior, but careful management is essential for improving outcome.
    American Journal of Respiratory and Critical Care Medicine 05/2010; 181(10):1128-55. · 11.04 Impact Factor

Publication Stats

4k Citations
894.57 Total Impact Points

Institutions

  • 2009–2014
    • University of Pittsburgh
      • Department of Critical Care Medicine
      Pittsburgh, Pennsylvania, United States
  • 2006–2009
    • University Medical Center Utrecht
      • Intensive Care Centrum
      Utrecht, Utrecht, Netherlands
  • 2002–2008
    • VU University Medical Center
      • Department of Surgery
      Amsterdamo, North Holland, Netherlands
  • 1990–2005
    • VU University Amsterdam
      • Department of Adult Intensive Care
      Amsterdamo, North Holland, Netherlands
  • 2004
    • Gelderse Vallei Hospital
      Ede, Gelderland, Netherlands
  • 2003
    • Academisch Medisch Centrum Universiteit van Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 1993–1996
    • University of Amsterdam
      • Department of Internal Medicine
      Amsterdam, North Holland, Netherlands