T Staudinger

Medical University of Vienna, Wien, Vienna, Austria

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Publications (108)340.29 Total impact

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    ABSTRACT: Prognostic factors and outcomes of cancer patients with acute organ failure receiving chemotherapy (CT) in the intensive care unit (ICU) are still incompletely described. We therefore retrospectively studied all patients who received CT in any ICU of our institution between October 2006 and November 2013. Fifty-six patients with hematologic (n = 49; 87.5 %) or solid (n = 7; 12.5 %) malignancies, of which 20 (36 %) were diagnosed in the ICU, were analyzed [m/f ratio, 33:23; median age, 47 years (IQR 32 to 62); Charlson Comorbidity Index (CCI), 3 (2 to 5); Simplified Acute Physiology Score II (SAPS II), 50 (39 to 61)]. The main reasons for admission were acute respiratory failure, acute kidney failure, and septic shock. Mechanical ventilation and vasopressors were employed in 34 patients (61 %) respectively, hemofiltration in 22 (39 %), and extracorporeal life support in 7 (13 %). Twenty-seven patients (48 %) received their first CT in the ICU. Intention of therapy was cure in 46 patients (82 %). Tumor lysis syndrome (TLS) developed in 20 patients (36 %). ICU and hospital survival was 75 and 59 %. Hospital survivors were significantly younger; had lower CCI, SAPS II, and TLS risk scores; presented less often with septic shock; were less likely to develop TLS; and received vasopressors, hemofiltration, and thrombocyte transfusions in lower proportions. After discharge, 88 % continued CT and 69 % of 1-year survivors were in complete remission. Probability of 1- and 2-year survival was 41 and 38 %, respectively. Conclusively, administration of CT in selected ICU cancer patients was feasible and associated with considerable long-term survival as well as long-term disease-free survival.
    Annals of Hematology 07/2014; · 2.87 Impact Factor
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    ABSTRACT: ILA Activve is a new minimally invasive device for extracorporeal CO2-removal (ECCO2-R) using a miniaturized pump, a special gas exchange membrane and a double lumen cannula. We retrospectively analyzed our experiences in twelve patients with hypercapnic respiratory failure undergoing ECCO2-R.Indication for ECCO2-R was hypercapnia due to terminal lung failure during bridging to lung transplantation, pneumonia, and COPD or asthma, respectively. The median duration of ECCO2-R was 8 days (range 2-30). Seven patients were successfully weaned, five died. Patients with primarily hypoxic lung failure were significantly longer ventilated prior to ECCO2-R and had a higher mortality rate. Complications were a retroperitoneal hematoma after cannulation in one patient and repeated system changes due to clotting in two patients. We observed effective CO2 removal in all patients with significant reduction of ventilation pressures and minute volumes at median blood flow rates of 1.2 - 1.4 L/min.The iLA Activve system using venous double lumen cannulas proved to be an effective method for extracorporeal CO2 removal. Invasiveness of ventilation could be reduced. Additional severe impairment of oxygenation or prolonged mechanical ventilation prior to ECCO2-R are factors of adverse prognosis. Use of ECCO2-R should be thoroughly reconsidered in these cases.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 04/2014; · 1.39 Impact Factor
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    ABSTRACT: A patient suffering from severe cutaneous graft versus host disease (GvHD) developed generalized epidermolysis and refractory hypothermia. Due to the insufficient effect of traditional rewarming methods, an endovascular temperature catheter was placed via the femoral vein to achieve and maintain normothermia over a period of 31 days. This case shows that an endovascular temperature modulation device primarily made for short-term use may be safe and effective even over weeks and may offer an alternative to other rewarming methods in patients with severe epidermolysis and burns.
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 03/2014;
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    ABSTRACT: Acute respiratory failure (ARF) is the main reason for intensive care unit (ICU) admissions in patients with hematologic malignancies (HM). We report the first series of adult patients with ARF and HM treated with extracorporeal membrane oxygenation (ECMO). This is a retrospective cohort study on 14 patients with HM (aggressive non-Hodgkin lymphoma (NHL) n = 5; highly aggressive NHL, that is acute lymphoblastic leukemia or Burkitt's lymphoma, n = 5; Hodgkin's lymphoma, n = 2; acute myeloid leukemia, n = 1; multiple myeloma, n = 1) receiving ECMO support due to ARF (all data as medians and interquartile ranges; age: 32 years (22 to 51); simplified acute physiology score II (SAPS II): 51 (42 to 65)). Etiology of ARF was pneumonia (n = 10), thoracic manifestation of NHL (n = 2), sepsis of non-pulmonary origin (n = 1), and transfusion related acute lung injury (n = 1). Diagnosis of HM was established during ECMO in four patients, and five firstly received (immuno-) chemotherapy on ECMO. Prior to ECMO, the PaO2/FiO2-ratio was 60 (53 to 65) and the lung injury score 3.3 (3.3 to 3.7). Three patients received veno-arterial ECMO due acute circulatory failure in addition to ARF, all other patients received veno-venous ECMO. All patients needed vasopressors and five needed hemofiltration. Thrombocytopenia occurred in all patients (lowest platelet count was 20 (11 to 21) G/L). Five major bleeding events were noted. ECMO duration was 8.5 (4 to 16) days. ICU and hospital survival was 50%. All survivors were alive at follow-up (36 (10 to 58) months), five patients were in complete remission, one in partial remission, and one had relapsed. ECMO therapy is feasible in selected patients with HM and ARF and can be associated with long-term disease-free survival.
    Critical care (London, England) 01/2014; 18(1):R20. · 4.72 Impact Factor
  • P Schellongowski, T Staudinger
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    ABSTRACT: The occurrence of hyperleukocytosis (leukocytes > 100.000/μl) is associated with complications such as leukostasis, tumor lysis and consumption coagulopathy in patients with acute leukemia much more often than in patients with chronic malignant hematological diseases. To manage these situations may be complex as organ failure is often imminent or manifest, infectious complications arise and indications for induction chemotherapy are usually urgent. Prophylaxis and therapy of the tumor lysis syndrome consists of hydration, lowering of uric acid and the management of electrolyte disturbances. Leukostasis requires immediate reduction of the leukocyte count by leukapheresis, administration of hydroxycarbamide and, ultimately, by causative and specific treatment of the underlying disease itself. In patients with curable diseases or favorable long-term prognosis, transfer to the intensive care unit must be evaluated early in the course of impending organ dysfunction, especially in cases of acute respiratory failure.
    Der Internist 08/2013; · 0.33 Impact Factor
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    ABSTRACT: Sepsis is one of the leading causes of death in intensive care units (ICUs) and has enormous relevance in health economics. There is growing evidence, however, that a significant percentage of patients with sepsis are not treated in an ICU. The aim of this study was to describe the epidemiology and short- and long-term mortality of sepsis according to patients' location on general wards or in an ICU over a period of a year. We retrospectively collected data on patients with sepsis admitted to the General Hospital of Vienna during a 12-month period. We used world health organization (WHO) ICD-10 classification as the selection criterion and analyzed demographic data, length of stay, and 28-day, hospital, and 3-year mortality on general wards and in the ICU. A total of 68,305 inpatient admission episodes between January 1 and December 31, 2007 were screened for sepsis. Using ICD-10 codes we identified 139 patients with sepsis, giving a cumulative hospital incidence of 2 cases/1,000 admissions; 32 % of these patients needed ICU treatment. The overall 28-day mortality rate was 29.5 %, increasing to 55.4 % 3 years after hospital discharge. On general wards the 28-day mortality rate was 12.6 %, increasing to 42.1 % 3 years after discharge; the respective rates for the ICU were 65.9 and 84.1 %. Sepsis is a disease of predominantly elderly patients. The majority of sepsis occurred on general wards and about 30 % in the ICU. Considerable number of patients with sepsis on general wards died after hospital discharge, thus the often used 28-day in-hospital mortality rate may fail to capture the true impact of sepsis on subsequent outcome.
    Wiener klinische Wochenschrift 05/2013; · 0.81 Impact Factor
  • T Staudinger
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    ABSTRACT: Critically ill cancer patients on intensive units with hematological or oncological underlying diseases are a special situation: the underlying disease may be incurable, acute problems are often therapy associated and immunosuppression is regularly present. Due to evolving knowledge about special aspects of these patients and optimized supportive therapy, the prognosis has substantially improved during the last decades. General reluctance to admit cancer patients to an intensive care unit is therefore no longer justified. Reasons for admission are often infections and/or respiratory failure. Extensive diagnostic measures, causal and supportive therapy of sepsis according to current guidelines has led to improved outcome even in cancer patients. In respiratory failure, non-invasive ventilation is the key to improved prognosis if used early enough and indications, contraindications and break-off criteria are strictly followed. The prognosis of critically ill cancer patients is determined by the severity of the acute problem and not by the underlying disease.
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 03/2013;
  • M Kochanek, T Staudinger
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 02/2013;
  • T Staudinger, P Schellongowski
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    ABSTRACT: Many factors contribute to making critically ill patients with underlying hematological or oncological diseases into a special collective on intensive care units, such as an often incurable or at least doubtfully curable underlying disease, therapy associated complications and a commonly present immunosuppression. The prognosis of these patients has clearly improved in recent years so that a general reluctance in deciding to treat these patients in intensive care units can no longer be justified. Comprehensive infection diagnostics and a guideline oriented causal and supportive treatment can improve the prognosis of sepsis even in hematology/oncology patients. In the therapy of respiratory failure non-invasive ventilation is of great importance for a reduction in mortality if used early and contraindications, such as termination criteria are considered. Considerations on long-term prognosis, quality of life and palliative care are increasingly becoming topics in intensive care medicine.
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 02/2013;
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    ABSTRACT: Background Patients with follicular lymphoma ineligible for standard treatment with the anti-CD20 antibody rituximab represent a considerable challenge as they require alternative therapeutic approaches. Patient and methods We describe a patient who experienced a severe episode of serum sickness. Antichimeric antibodies against rituximab were verified in an early stage of disease, rendering further use of the drug impossible. After five treatment lines he developed progressive follicular lymphoma with skin involvement, which was treated with lenalidomide monotherapy. Results Six cycles of lenalidomide monotherapy (25 mg orally for 21 days, 1 week off) led to a very good partial response rendering the patient eligible for autologous stem cell transplantation. Data on efficacy of lenalidomide in follicular lymphoma are reviewed. Conclusion As shown here, single-agent lenalidomide represent a therapeutic option for pretreated patients with follicular lymphoma ineligible for rituximab.
    memo - Magazine of European Medical Oncology 01/2013; 6(2).
  • P. Schellongowski, T. Staudinger
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    ABSTRACT: Das Auftreten einer Hyperleukozytose mit peripherer Leukozytenzahl > 100.000/μl ist bei akuten Leukämien wesentlich häufiger als bei chronisch verlaufenden malignen hämatologischen Systemerkrankungen mit dem Auftreten bedrohlicher Komplikationen wie Leukostase, Tumorlyse und Verbrauchskoagulopathie vergesellschaftet. Klinisch handelt es sich in der Regel um komplexe Situationen mit drohendem oder manifestem Organversagen, Infektionskomplikationen sowie einer Indikation für den kurzfristigen Beginn oder die Fortführung einer Induktionschemotherapie. Während die Prophylaxe bzw. Therapie des Tumorlysesyndroms in Hydrierung, Harnsäuresenkung und Ausgleich des Elektrolythaushalts besteht, erfordert eine klinisch manifeste Leukostase die rasche Reduktion der Zellzahl durch Leukapherese, Hydroxycarbamid und schließlich eine kausale und spezifische Therapie der Grunderkrankung. Treten bei Patienten mit kurativen Therapieansätzen oder guter Langzeitprognose Organdysfunktionen auf, muss insbesondere bei respiratorischem Versagen frühzeitig eine Evaluation der intensivmedizinischen Therapieoptionen erfolgen.
    Der Internist 01/2013; 54(9). · 0.33 Impact Factor
  • T Staudinger
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    ABSTRACT: In recent years the range of products for extracorporeal lung support has substantially expanded. In principle systems generating high blood flow and thus enabling oxygenation and decarboxylation, corresponding to classical extracorporeal membrane oxygenation (ECMO), can be distinguished from low-flow systems, enabling decarboxylation only. Technical progress and new data have led to a novel insight into the role of ECMO as an invasive, ultimate therapy in refractory life-threatening lung failure towards a broader range of applications even in spontaneously breathing and awake patients. Indications for extracorporeal decarboxylation, initially thought to enable most protective ventilator settings, have been extended to forms of hypercapnic lung failure and towards avoidance of intubation and mechanical ventilation itself in patients with isolated hypercapnia and failure of non-invasive ventilation. It has to be emphasized however, that due to a still sparse amount of literature and potentially deleterious complications associated with extracorporeal lung support, these kinds of therapies should be reserved for specialized and experienced centers.
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 10/2012;
  • P Schellongowski, T Staudinger
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    ABSTRACT: The life expectancy and prevalence of malignant diseases is continuously on the rise, which inevitably leads to an increase of critically ill cancer patients. This article explains why the prognosis of cancer patients in the intensive care unit has markedly improved over the last decades, what the reasons for admission are and which risk factors affect mortality. Furthermore, the importance of correct patient selection and other specific topics will be discussed. Accordingly, acute respiratory failure for example is the most common organ dysfunction in these patients and has specific prognostic, diagnostic and therapeutic characteristics. The successful management of cancer patients in the intensive care unit requires specific knowledge of the intensive care physician and an excellent cooperation with the treating hematologist and oncologist.
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 06/2012; 107(5):386-90.
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    ABSTRACT: Severe falciparum malaria is associated with considerable rates of mortality, despite the administration of appropriate anti-malarial treatment. Since overall survival is associated with total parasite biomass, blood exchange transfusion has been proposed as a potential method to rapidly reduce peripheral parasitaemia. However, current evidence suggests that this treatment modality may not improve outcome. Automated red blood cell exchange (also referred to as "erythrocytapheresis") has been advocated as an alternative method to rapidly remove parasites from circulating blood without affecting patients' volume and electrolyte status. However, only limited evidence from case reports and case series is available for this adjunctive treatment. This retrospective cohort study describes the use of automated red blood cell exchange for the treatment of severe malaria at the Medical University of Vienna. Epidemiologic data for imported malaria cases in Austria are reported and data of patients treated for malaria at the General Hospital/Medical University of Vienna were extracted from electronic hospital records. Between 2000 and 2010, 146 patients were hospitalized at the Medical University of Vienna due to malaria and 16 of those were classified as severe malaria cases. Eleven patients of this cohort were potentially eligible for an adjunctive treatment with automated red blood cell exchange. Five patients eventually underwent this procedure within a period of seven hours (range: 3-19 hours) after hospital admission. Six patients did not undergo this adjunctive treatment following the decision of the treating physician. The procedure was well tolerated in all cases and rapid reduction in parasite counts was achieved without occurrence of haemodynamic complications. One patient died within seven days, whereas four patients survived without any sequelae. Automated red blood cell exchange was a safe and efficient procedure to rapidly clear peripheral parasitaemia. Whether the fast reduction in parasite biomass may ultimately improve patient survival remains however unclear. Randomized controlled trials are needed to conclusively appreciate the value of this adjunctive treatment.
    Malaria Journal 05/2012; 11:158. · 3.49 Impact Factor
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    ABSTRACT: Prone position is known to improve oxygenation in patients with acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). Supine upright (semirecumbent) position also exerts beneficial effects on gas exchange in this group of patients. We evaluated the effect of combining upright and prone position on oxygenation and respiratory mechanics in patients with ALI or ARDS in a prospective randomized cross-over study. After turning them prone from a supine position, we randomized the patients to a prone position or combined prone and upright position. After 2 hours, the position was changed to the other one for another 6 hours. The gas exchange and static compliance of the respiratory system, lungs, and chest wall were assessed in the supine position as well as every hour in the prone position. Twenty patients were enrolled in the study. The PaO₂/FiO₂ ratio improved significantly from the supine to the prone position and further significantly increased with additional upright position. Fourteen (70%) patients were classified as responders to the prone position, whereas 17 (85%) patients responded to the prone plus upright position compared with the supine position (P = n.s.). No statistically significant changes were found with respect to compliance. Combining the prone position with the upright position in patients with ALI or ARDS leads to further improvement of oxygenation. Clinical Trials No. NCT00753129.
    Critical care (London, England) 09/2011; 15(5):R230. · 4.72 Impact Factor
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    ABSTRACT: Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment option for various hematologic disorders. However, life-threatening adverse events resulting from treatment-related toxicity, severe infections, and/or graft-versus-host disease (GvHD) can occur. We report on a 64-year-old patient suffering from secondary acute myeloid leukemia (AML) who underwent successful allogeneic HSCT while on invasive mandatory ventilation (IMV). The patient received reduced intensity conditioning (RIC) according to the FLAMSA-protocol. Acute respiratory failure occurred one day before scheduled HSCT. Following emergency endotracheal intubation the patient was transferred to the intensive care unit (ICU). Because of respiratory deterioration, stem cell infusion was postponed. After stabilization of respiratory parameters, HSCT was performed during IMV which was continued for seven days. Following hematopoietic regeneration the patient was discharged in good condition on day 35 after HSCT. This case illustrates that intubation and mechanical ventilation do not necessarily exclude leukemic patients from HSCT.
    Wiener klinische Wochenschrift 06/2011; 123(11-12):354-8. · 0.81 Impact Factor
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    ABSTRACT: We report on 17 patients with influenza A H1N1v-associated Adult Respiratory Distress Syndrome who were admitted to the intensive care unit (ICU) between June 11th 2009 and August 10th 2010 (f/m: 8/9; age: median 39 (IQR 29-54) years; SAPS II: 35 (29-48)). Body mass index was 26 (24-35), 24% were overweight and 29% obese. The Charlson Comorbidity Index was 1 (0-2) and all but one patient had comorbid conditions. The median time between onset of the first symptom and admission to the ICU was 5 days (range 0-14). None of the patients had received vaccination against H1N1v. Nine patients received oseltamivir, only two of them within 48 hours of symptom onset. All patients developed severe ARDS (PaO(2)/FiO(2)-Ratio 60 (55-92); lung injury score 3.8 (3.3-4.0)), were mechanically ventilated and on vasopressor support. Fourteen patients received corticosteroids, 7 patients underwent hemofiltration, and 10 patients needed extracorporeal membrane-oxygenation (ECMO; 8 patients veno-venous, 2 patients veno-arterial), three patients Interventional Lung Assist (ILA) and two patients pump driven extracorporeal low-flow CO(2)-elimination (ECCO(2)-R). Seven of 17 patients (41%) died in the ICU (4 patients due to bleeding, 3 patients due to multi-organ failure), while all other patients survived the hospital (59%). ECMO mortality was 50%. The median ICU length-of-stay was 26 (19-44) vs. 21 (17-25) days (survivors vs. nonsurvivors), days on the ventilator were 18 (14-35) vs. 20 (17-24), and ECMO duration was 10 (8-25) vs. 13 (11-16) days, respectively (all p = n.s.). Compared to a control group of 241 adult intensive care unit patients without H1N1v, length of stay in the ICU, rate of mechanical ventilation, days on the ventilator, and TISS 28 scores were significantly higher in patients with H1N1v. The ICU survival tended to be higher in control patients (79 vs. 59%; p = 0.06). Patients with H1N1v admitted to either of our ICUs were young, overproportionally obese and almost all with existing comorbidities. All patients developed severe ARDS, which could only be treated with extracorporeal gas exchange in an unexpectedly high proportion. Patients with H1N1v had more complicated courses compared to control patients.
    Wiener klinische Wochenschrift 04/2011; 123(7-8):209-14. · 0.81 Impact Factor
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    ABSTRACT: Purpose To describe the clinical features, risk factors for severe disease and effectiveness of oseltamivir in patients with 2009 pandemic influenza A (H1N1) virus infection. Methods In a prospective, cross-sectional, multicentre study, data on 540 patients with confirmed 2009 H1N1 infection from seven Austrian hospitals were collected using a standardised online case-history form. Results The median age of the patients was 19.3 years (range 26 days–90.8 years); point-of-care testing yielded false-negative results in 60.2% of the 176 cases tested. The most common symptoms were fever, cough, fatigue and headache. Overall, 343 patients (63.5%) were hospitalised, 49 (9.1%) were admitted to an intensive care unit (ICU) and 14 (4.1%) died. Case fatality rates were highest (9.1%) in those aged 65 years or older. Factors significantly associated with a higher risk for ICU admission included age, neurological disease, adipositas, and both interstitial pathology and lobular pathology on chest X-ray. No association with pregnancy, malignancy or immunosup-pressive therapy was detected. Antiviral treatment signifi-cantly reduced the duration of fever by 0.66 days and lowered the risk of ICU admission, but had no significant benefit on survival. Conclusions During the 2009 H1N1 influenza pandemic, elderly or obese patients and those with neurological dis-ease had an increased risk for severe H1N1 infection in On behalf of the Austrian Clinical Influenza Study Group. Collaborators:
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    ABSTRACT: Acute myeloid leukemia is a life-threatening disease associated with high mortality rates. A substantial number of patients require intensive care. This investigation analyzes risk factors predicting admission to the intensive care unit in patients with acute myeloid leukemia eligible for induction chemotherapy, the outcome of these patients, and prognostic factors predicting their survival. A total of 406 consecutive patients with de novo acute myeloid leukemia (15-89 years) were analyzed retrospectively. Markers recorded at the time of diagnosis included karyotype, fibrinogen, C-reactive protein, and Charlson comorbidity index. In patients requiring critical care, the value of the Simplified Acute Physiology Score II, the need for mechanical ventilation, and vasopressor support were recorded at the time of intensive care unit admission. The independent prognostic relevance of the parameters was tested by multivariate analysis. Sixty-two patients (15.3%) required intensive care, primarily due to respiratory failure (50.0%) or life-threatening bleeding (22.6%). Independent risk factors predicting intensive care unit admission were lower fibrinogen concentration, the presence of an infection, and comorbidity. The survival rate was 45%, with the Simplified Acute Physiology Score II being the only independent prognostic parameter (P<0.05). Survival was inferior in intensive care patients compared to patients not admitted to an intensive care unit. However, no difference between intensive care and non-intensive care patients was found concerning continuous complete remission at 6 years or survival at 6 years in patients who survived the first 30 days after diagnosis (non-intensive care patients: 28%; intensive care patients: 20%, P>0.05). Ongoing infections, low fibrinogen and comorbidity are predictive for intensive care unit admission in acute myeloid leukemia. Although admission was a risk factor for survival, continuous complete remission and survival of patients alive at day 30 were similar in patients who were admitted or not admitted to an intensive care unit.
    Haematologica 11/2010; 96(2):231-7. · 5.94 Impact Factor
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    ABSTRACT: We report the case of a 55-year-old male European who became septic after he returned from a four-week holiday to Uganda. Soon after; he was diagnosed with severe falciparum malaria and developed multi-organ failure. Due to the worsening condition of the patient, drotrecogin alfa (activated) was started, soon after which the patient's condition significantly improved. He returned home on day 36 after admission, without neurologic sequelae. Looking at those few cases of severe forms of malaria where drotrecogin alfa (activated) was successfully used, it should at least be considered for administration in patients with severe falciparum malaria with disseminated intravascular coagulation and cerebral involvement who do not respond to or deteriorate during standard treatment.
    Anaesthesia and intensive care 07/2010; 38(4):751-4. · 1.40 Impact Factor

Publication Stats

1k Citations
340.29 Total Impact Points

Institutions

  • 1995–2014
    • Medical University of Vienna
      • • Intensive Care Unit
      • • Institut für Sozialmedizin
      • • Universitätsklinik für Innere Medizin I
      Wien, Vienna, Austria
  • 2013
    • University of Cologne
      Köln, North Rhine-Westphalia, Germany
  • 1996–2010
    • Vienna General Hospital
      Wien, Vienna, Austria
  • 2005
    • IST Austria
      Klosterneuberg, Lower Austria, Austria
  • 1993–2003
    • University of Vienna
      • • Universitätsklinik für Innere Medizin I
      • • Department of Internal Medicine III
      Vienna, Vienna, Austria