Martin W Dünser

Paracelsus Medical University Salzburg, Salzburg, Salzburg, Austria

Are you Martin W Dünser?

Claim your profile

Publications (198)732.97 Total impact

  • Ilse Gradwohl-Matis · Martin W Dünser
    Critical care medicine 07/2015; 43(7):1548-1550. DOI:10.1097/CCM.0000000000001033 · 6.15 Impact Factor
  • Journal of Cardiothoracic and Vascular Anesthesia 05/2015; DOI:10.1053/j.jvca.2015.04.032 · 1.48 Impact Factor
  • Source
    Arthur Kwizera · Martin Dünser · Jane Nakibuuka
  • Ilse Gradwohl-Matis · Sangeeta Mehta · Martin W Dünser
    Intensive Care Medicine 02/2015; DOI:10.1007/s00134-015-3695-3 · 5.54 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients. An anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories; background data, clinical data, decision-making & consequences. A total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32-34°C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3-5 (58%) or CPC 4-5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain. National recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach; EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Resuscitation 02/2015; 90. DOI:10.1016/j.resuscitation.2015.01.018 · 3.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In patients with aortic stenosis, left ventricular systolic torsion (pT) is increased to overcome excessive afterload. This study assessed left ventricular torsion before and immediately after surgical valve replacement and tested the instant effect of fluid loading. Prospective, clinical single-center study. Intensive care unit of a university hospital. 12 patients undergoing elective aortic valve replacement for aortic stenosis. Echocardiography was performed on the day before surgery, within 18 hours after surgery including a fluid challenge, and after 2.5 years. pT decreased early postoperatively by 21.2% (23.4°±5.6° to 18.4°±6.9°; p = 0.012) and reached preoperative values at 2.5 years follow-up (24±7). Peak diastolic untwisting velocity occurred later early postoperatively (13%±8% to 21%±9.4%; p = 0.019) and returned toward preoperative values at follow-up (10.2±4.7°). The fluid challenge increased central venous pressure (8±4 mmHg to 11±4 mmHg; p = 0.003) and reduced peak systolic torsion velocity (138.7±37.6/s to 121.3±32/s; p = 0.032). pT decreased in 3 and increased in 8 patients after fluid loading. Patients whose pT increased had higher early mitral inflow velocity postoperatively (p = 0.04) than those with decreasing pT. Patients with reduced pT after fluid loading received more fluids (p = 0.04) and had a higher positive fluid balance during the intensive care unit stay (p = 0.03). Torsion after fluid loading correlated with total fluid input (p = 0.001) and cumulative fluid balance (p = 0.002). pT decreased early after aortic valve replacement but remained elevated despite elimination of aortic stenosis. After 2.5 years, torsion had returned to preoperative levels. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Cardiothoracic and Vascular Anesthesia 01/2015; DOI:10.1053/j.jvca.2015.01.010 · 1.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Miosis occurs following exposure to toxins that decrease the sympathomimetic tone, increase the cholinergic tone, or exert sedative-hypnotic effects, but has not been reported in insulin poisoning. Case Report A 64-year- old woman without co-morbidities was found unconscious next to an empty insulin pen. Her Glasgow Coma Scale was 3 with absent reflexes, bilateral reactive miosis, and injection marks across the abdominal wall. The patient was endotracheally intubated, mechanically ventilated, and transferred to this hospital. At admission, the blood glucose level was 34 mg/dL. Glasgow Coma Scale remained at 3, with persistent bilateral reactive miosis. The toxicology screening was negative for ethanol, barbiturates, tricyclic antidepressants, phenothiazines, amphetamines, cannabinoids, salicylates, acetaminophen, and cocaine. Cranial computed tomography with angiography and magnetic resonance imaging (MRI) did not show any structural brain lesions. Intravenous glucose was continued at 6-14 g/h for 3 days. On repeated neurological examinations, the patient remained deeply comatose, with partial loss of cranial nerve function. Bilateral reactive miosis persisted for 4 days. From day 5 on, the patient awoke progressively. At discharge, the patient was fully alert and orientated, without a focal neurological deficit. Conclusions Prolonged bilateral reactive miosis can be a clinical symptom accompanying metabolic encephalopathy in severe insulin poisoning. Functional impairment of the pons due to relative hypoperfusion during hypoglycemia may serve as a reasonable pathophysiologic explanation for this phenomenon.
    01/2015; 16:1-3. DOI:10.12659/AJCR.892324
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionLiberal and over-aggressive use of vasopressors during the initial period of shock resuscitation may compromise organ perfusion and worsen outcome. When transiently applying the concept of permissive hypotension it would be helpful to know at which arterial blood pressure terminal cardiovascular collapse occurs.Methods In this retrospective cohort study, we aimed to identify the arterial blood pressure associated with terminal cardiovascular collapse in 140 patients who died in the intensive care unit while being invasively monitored. Demographic data, co-morbid conditions and clinical data at admission, during 24 hours before and at the time of terminal cardiovascular collapse were collected. The systolic, mean and diastolic arterial blood pressure immediately before terminal cardiovascular collapse was documented. Terminal cardiovascular collapse was defined as an abrupt (<5 min) and exponential decrease in heart rate (>50% compared to preceding values) followed by cardiac arrest.ResultsThe mean¿±¿standard deviation (SD) of the systolic, mean and diastolic arterial blood pressure associated with terminal cardiovascular collapse was 47¿±¿12, 35¿±¿11 and 29¿±¿9 mmHg. Patients with congestive heart failure (39¿±¿13 versus 34¿±¿10 mmHg; P¿=¿0.04), left main stem stenosis (39¿±¿11 versus 34¿±¿11 mmHg; P¿=¿0.03) or acute right heart failure (39¿±¿13 versus 34¿±¿10 mmHg; P¿=¿0.03) had higher arterial blood pressures than patients without these risk factors. Patients with severe valvular aortic stenosis had the highest arterial blood pressures associated with terminal cardiovascular collapse (systolic, 60¿±¿20; mean, 46¿±¿12; diastolic, 36¿±¿10 mmHg), but this difference was not significant. Sepsis patients and patients exposed to sedatives or opioids during the terminal phase exhibited lower arterial blood pressures than patients without sepsis or administration of such drugs.Conclusions The arterial blood pressure associated with terminal cardiovascular collapse in critically ill patients was very low and varied with individual co-morbid conditions (for example congestive heart failure, left main stem stenosis, severe valvular aortic stenosis, acute right heart failure), drug exposition (for example sedatives or opioids) and the type of acute illness (for example sepsis).
    Critical care (London, England) 12/2014; 18(6):719. DOI:10.1186/s13054-014-0719-2
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hemodialysis is considered the renal replacement technique of choice to control life-threatening hypercalcemia. In this case series, the experience with continuous veno-venous hemodiafiltration (CVVHDF) with regional citrate anticoagulation to control five hypercalcemic crises in four patients is summarized. Overall maximum ionized and total calcium levels were ranged from 1.72-2.01 mmol/L and 3.1-4.2 mmol/L, respectively. All patients presented with impaired consciousness, cardiac arrhythmias and/or acute oliguria despite therapy. Trisodium-citrate was administered at 3 mmol/h (hourly calcium replacement 1.15-2.75 mmol). This allowed a controlled decrease of ionized calcium levels below 1.4 mmol/L within 4 hours (IQR, 2.5-10) and resolution of neurological symptoms within 15.5 hours (IQR, 12-22.8). The duration of CVVHDF was one day in those patients in whom hypercalcemia was the reason for admission. Four asymptomatic episodes of mild hypocalcemia occurred in two patients. No patient developed relevant abnormalities of serum sodium levels or pH, experienced cardiac arrhythmia or required transfusion of blood products during CVVHDF. One patient with metastatic bronchial carcinoma experienced rebound hypercalcemic crisis thirteen days following a one day session of CVVHDF with regional citrate anticoagulation.In conclusion, CVVHDF with regional citrate anticoagulation appears to be effective and potentially safe to rapidly normalize calcium levels in hypercalcemic crisis.
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 12/2014; 61(2). DOI:10.1097/MAT.0000000000000186 · 1.39 Impact Factor
  • Andreas Brunauer · Daniel Dankl · Martin W Dünser
    [Show abstract] [Hide abstract]
    ABSTRACT: To the Editor,A 44-year-old man (185 cm, 80 kg) was mechanically ventilated and referred to a university hospital because of severe pneumonia-associated acute respiratory distress syndrome (ARDS; Fig. 1a). A few hours after intensive care unit admission, veno-venous extracorporeal membrane oxygenation (ECMO; outflow cannula—23 Fr: right femoral vein; inflow cannula—19 Fr: right internal jugular vein) had to be initiated because of refractory hypoxemia (PaO2, 53 mmHg) and hypercapnia (PaCO2, 144 mmHg) regardless of invasive ventilator settings (biphasic positive airway pressure with inspiratory oxygen concentration, 100 %; positive end-expiratory pressure, 15 mbar; peak pressure, 36 mbar; respiratory rate, 32 bpm). To hasten lung recruitment, the decision was made to put the patient into the prone position. However, full prone position led to compression of lines at their insertion site by the patient's weight, compromised extracorporeal blood flow and lowered the efficacy of ECMO thera ...
    Wiener klinische Wochenschrift 12/2014; 127(3-4). DOI:10.1007/s00508-014-0645-y · 0.79 Impact Factor
  • M M Berger · I Gradwohl-Matis · A Brunauer · H Ulmer · M W Dünser
    [Show abstract] [Hide abstract]
    ABSTRACT: Perioperative fluid management plays a fundamental role in maintaining organ perfusion, and is considered to affect morbidity and mortality. Targets according to which fluid therapy should be administered are poorly defined. This systematic review aimed to identify specific targets for perioperative fluid therapy.
    Minerva anestesiologica 09/2014; · 2.27 Impact Factor
  • I Gradwohl-Matis · A Brunauer · D Dankl · M Dünser
    [Show abstract] [Hide abstract]
    ABSTRACT: Restoration of adequate tissue perfusion is the goal of resuscitation in septic shock. A growing understanding of microcirculatory dysfunction in sepsis led to a change in resuscitation practice away from targeting arterial and central venous pressures and towards tissue perfusion-guided protocols. This change in the approach to resuscitation was accompanied by a change in the role of vasoconstrictors. This review summarizes the pathophysiological and therapeutic mainstays of septic shock resuscitation and attempts to critically evaluate the scientific evidence on the use of vasopressin as a non-adrenergic vasoconstrictor in septic shock. Based on the published study results vasopressin appears to be of potential benefit in adult patients with moderate septic shock (norepinephrine requirements < 15 μg/min) and lacking signs of systemic hypoperfusion (e.g. normal arterial lactate levels). A vasopressin infusion with the sole target to increase arterial blood pressure despite the presence of systemic hypoperfusion is dangerous and can result in a critical deterioration of tissue perfusion.
    Der Anaesthesist 05/2014; 63(6). DOI:10.1007/s00101-014-2335-6 · 0.74 Impact Factor
  • Chest 05/2014; 145(5):e14-6. DOI:10.1378/chest.13-2140 · 7.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dermatomyositis is a chronic inflammatory disorder characterized by muscular and dermatologic symptoms with variable internal organ involvement. This is the first report on a patient with acute dermatomyositis and fulminant systemic capillary leak syndrome. A 69-year-old Caucasian woman with chronic dermatomyositis presented with clinical signs of severe hypovolemic shock and pronounced hemoconcentration (hematocrit, 69%). Her colloid osmotic pressure was 4.6mmHg. Following a bolus dose of prednisolone (500mg), fluid resuscitation was initiated. During volume loading, anasarca and acute respiratory distress rapidly developed. Echocardiography revealed an underfilled, hypokinetic, diastolic dysfunctional left ventricle with pericardial effusion but no signs of tamponade. Despite continued fluid resuscitation and high-dosed catecholamine therapy, the patient died from refractory shock 12 hours after intensive care unit admission. A laboratory analysis of her complement system suggested the presence of C1 inhibitor deficiency as the cause for systemic capillary leakage. The post-mortem examination revealed bilateral pleural, pericardial and peritoneal effusions as well as left ventricular hypertrophy with patchy myocardial fibrosis. Different patterns of endomysial/perimysial lymphocytic infiltrations adjacent to degenerated cardiomyocytes in her myocardium and necrotic muscle fibers in her right psoas major muscle were found in the histological examination. This case report indicates that acute exacerbation of chronic dermatomyositis can result in a fulminant systemic capillary leak syndrome with intense hemoconcentration, hypovolemic shock and acute heart failure. In the presented patient, the cause for diffuse capillary leakage was most probably acquired angioedema, a condition that has been associated with both lymphoproliferative and autoimmunologic disorders.
    Journal of Medical Case Reports 01/2014; 8(1):28. DOI:10.1186/1752-1947-8-28
  • Martin W Dünser · Ilse Gradwohl-Matis
    Critical care medicine 12/2013; 41(12):2838-40. DOI:10.1097/CCM.0b013e31829caf7a · 6.15 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ventricular torsion is an important component of cardiac function. The effect of septic shock on left ventricular torsion is not known. Because torsion is influenced by changes in preload, we compared the effect of fluid loading on left ventricular torsion in septic shock with the response in matched healthy control subjects. We assessed left ventricular torsion parameters using transthoracic echocardiography in 11 patients during early septic shock and in 11 age- and sex-matched healthy volunteers before and after rapid volume loading with 250 mL of a Ringer's lactate solution. Peak torsion and peak apical rotation were reduced in septic shock (10.2 ± 5.2° and 5.6 ± 5.4°) compared with healthy volunteers (16.3 ± 4.5° and 9.6 ± 1.5°; P = 0.009 and P = 0.006 respectively). Basal rotation was delayed and diastolic untwisting velocity reached its maximum later during diastole in septic shock patients than in healthy volunteers (104 ± 16% vs 111 ± 14% and 13 ± 5% vs 21 ± 10%; P = 0.03 and P = 0.034, respectively). Fluid challenge increased peak torsion in both groups (septic shock, 10.2 ± 5.3° vs 12.6 ± 3.9°; healthy volunteers, 16.3 ± 4.5° vs 18.1 ± 6°; P = 0.01). Fluid challenge increased left ventricular stroke volume in septic shock patients (P = 0.003). Compared with healthy volunteers, left ventricular torsion is impaired in septic shock patients. Fluid loading attenuates torsion abnormalities in parallel with increasing stroke volume. Reduced torsional motion might constitute a relevant component of septic cardiomyopathy, a notion that merits further testing in larger populations.
    The Canadian journal of cardiology 12/2013; 29(12):1665-1671. DOI:10.1016/j.cjca.2013.10.007 · 3.94 Impact Factor
  • Source
    Martin W Dünser · Jukka Takala · Andreas Brunauer · Jan Bakker
    [Show abstract] [Hide abstract]
    ABSTRACT: Definitions of shock and resuscitation endpoints traditionally focus on blood pressures and cardiac output. This carries a high risk of overemphasizing systemic hemodynamics at the cost of tissue perfusion. In line with novel shock definitions and evidence of the lack of a correlation between macro- and microcirculation in shock, we recommend that macrocirculatory resuscitation endpoints, particularly arterial and central venous pressure as well as cardiac output, be reconsidered. In this viewpoint article, we propose a three-step approach of resuscitation endpoints in shock of all origins. This approach targets only a minimum individual and context-sensitive mean arterial blood pressure (for example, 45 to 50 mm Hg) to preserve heart and brain perfusion. Further resuscitation is exclusively guided by endpoints of tissue perfusion irrespectively of the presence of arterial hypotension ('permissive hypotension'). Finally, optimization of individual tissue (for example, renal) perfusion is targeted. Prospective clinical studies are necessary to confirm the postulated benefits of targeting these resuscitation endpoints.
    Critical care (London, England) 10/2013; 17(5):326. DOI:10.1186/cc12727
  • Source
    Ilse Gradwohl-Matis · Martin W Dünser
    [Show abstract] [Hide abstract]
    ABSTRACT: One of the rationales for the use of vasopressin in septic shock has been its potential cardioprotective mechanisms. Lower heart rates, higher arterial pressures, and fewer norepinephrine doses during vasopressin therapy were hypothesized to protect the heart from myocardial ischemia. In a prospective sub-study of the VASST (Vasopressin in Septic Shock Trial) project, Mehta and colleagues specifically evaluated this hypothesis but failed to find lower cardiac biomarkers or fewer ischemic electrocardiogram changes in patients receiving vasopressin compared with subjects receiving norepinephrine alone. After recent evidence of a lacking survival benefit, the present study results further challenge the future role of vasopressin as a vasopressor in septic shock.
    Critical care (London, England) 10/2013; 17(5):1002. DOI:10.1186/cc12772
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this prospective, observational study, the rate of antibiotic resistance in cultures sampled from sepsis patients was determined in an intensive care unit of a low-middle income country. Critically ill patients suffering from bacterial sepsis were eligible for enrollment. Aside from demographic, disease-related and sepsis-specific parameters, the type of microbiological sample and cultured microorganism as well as the resistance pattern (extensively resistant bacteria, multi-drug resistant bacteria) were documented. Descriptive statistical methods, parametric and non-parametric tests were used. 215 sepsis patients were included. 193 ofthe 410 cultured organisms (47.1%) showed antibiotic resistance [extensively resistant bacteria, n = 90 (11%); multi-drug resistant bacteria, n = 103 (25.1%)]. 51.6% of the patients were infected by > or = 1 resistant bacteria. Bacteria with an exceptionally high rate of antibiotic resistance were Acinetobacter baumannii (90%), Enterobacter spp (60%) and coagulase-negative Staphylococci (60%). Patients infected with resistant bacteria more often received inadequate empirical antibiotic therapy (36.9 vs. 13.5%, p < 0.001), required mechanical ventilation (66.7 vs. 42.3%, p < 0.001) and renal replacement therapy (28.8 vs. 9.6%, p < 0.001) more frequently, and had a longer stay in the intensive care unit [5 (3-9.5) vs. 5 (2-8)%, p < 0.001] than patients with sepsis due to non-resistant bacteria. There was a trend towards a higher mortality in patients with resistant bacteria (43.2 vs. 31.7%, p = 0.09). Resistant bacteria were detected in up to 50% of microbiological samples from critically ill sepsis patients in the intensive care unit of a low-middle-income country. Antibiotic resistance appears to be a relevant problem of sepsis management in a resource-limited setting.
    Middle East journal of anaesthesiology 10/2013; 22(3):293-300.
  • Thomas Michalski · Roman Gottardi · Martin W Dünser
    Emergency Medicine Journal 08/2013; 31(5). DOI:10.1136/emermed-2013-202975 · 1.78 Impact Factor

Publication Stats

3k Citations
732.97 Total Impact Points

Institutions

  • 2011–2015
    • Paracelsus Medical University Salzburg
      • University Clinic of Anaesthesiology, Perioperative Medicine and General Intensive Care
      Salzburg, Salzburg, Austria
  • 2006–2015
    • Inselspital, Universitätsspital Bern
      • Department of Intensive Care Medicine
      Berna, Bern, Switzerland
  • 2013
    • Universität Bern
      Berna, Bern, Switzerland
  • 1990–2012
    • University of Innsbruck
      • • Institute of Biochemistry
      • • Institut für Psychologie
      Innsbruck, Tyrol, Austria
  • 2010
    • Karolinska Institutet
      Solna, Stockholm, Sweden