Publications (11)23.49 Total impact
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Article: A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients.
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ABSTRACT: To compare the quality of analgesia provided by a remifentanil-based analgesia regime with that provided by a fentanyl-based regime in critically ill patients. This was a registered, prospective, two-center, randomized, triple-blind study involving adult medical and surgical patients requiring mechanical ventilation (MV) for more than 24 h. Patients were randomized to either remifentanil infusion or a fentanyl infusion for a maximum of 30 days. Sedation was provided using propofol (and/or midazolam if required). Primary outcome was the proportion of patients in each group maintaining a target analgesia score at all time points. Secondary outcomes included duration of MV, discharge times, and morbidity. At planned interim analysis (n = 60), 50% of remifentanil patients (n = 28) and 63% of fentanyl patients (n = 32) had maintained target analgesia scores at all time points (p = 0.44). There were no significant differences between the groups with respect to mean duration of ventilation (135 vs. 165 h, p = 0.80), duration of hospital stay, morbidity, or weaning. Interim analysis strongly suggested futility and the trial was stopped. The use of remifentanil-based analgesia in critically ill patients was not superior regarding the achievement and maintenance of sufficient analgesia compared with fentanyl-based analgesia.European Journal of Intensive Care Medicine 03/2011; 37(3):469-76. · 5.17 Impact Factor -
Article: Peer reviewing critical care: a pragmatic approach to quality management.
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ABSTRACT: Critical care medicine frequently involves decisions and measures that may result in significant consequences for patients. In particular, mistakes may directly or indirectly derive from daily routine processes. In addition, consequences may result from the broader pharmaceutical and technological treatment options, which frequently involve multidimensional aspects. The increasing complexity of pharmaceutical and technological properties must be monitored and taken into account. Besides the presence of various disciplines involved, the provision of 24-hour care requires multiple handovers of significant information each day. Immediate expert action that is well coordinated is just as important as a professional handling of medicine's limitations.Intensivists are increasingly facing professional quality management within the ICU (Intensive Care Unit). This article depicts a practical and effective approach to this complex topic and describes external evaluation of critical care according to peer reviewing processes, which have been successfully implemented in Germany and are likely to gain in significance.German medical science : GMS e-journal 01/2010; 8:Doc23. -
Article: Quality indicators in intensive care medicine: why? Use or burden for the intensivist.
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ABSTRACT: In order to improve quality (of therapy), one has to know, evaluate and make transparent, one's own daily processes. This process of reflection can be supported by the presentation of key data or indicators, in which the real as-is state can be represented. Quality indicators are required in order to depict the as-is state.Quality indicators reflect adherence to specific quality measures. Continuing registration of an indicator is useless once it becomes irrelevant or adherence is 100%. In the field of intensive care medicine, studies of quality indicators have been performed in some countries. Quality indicators relevant for medical quality and outcome in critically ill patients have been identified by following standardized approaches.Different German societies of intensive care medicine have finally agreed on 10 core quality indicators that will be valid for two years and are currently recommended in German intensive care units (ICUs).German medical science : GMS e-journal 01/2010; 8:Doc22. -
Article: Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care--short version.
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ABSTRACT: Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2(nd) Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%). Between 2006-2009, the existing guidelines from the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) were developed into 3(rd) Generation Guidelines for the securing and optimization of quality of analgesia, sedation and delirium management in the intensive care unit (ICU). In collaboration with another 10 professional societies, the literature has been reviewed using the criteria of the Oxford Center of Evidence Based Medicine. Using data from 671 reference works, text, diagrams and recommendations were drawn up. In the recommendations, Grade "A" (very strong recommendation), Grade "B" (strong recommendation) and Grade "0" (open recommendation) were agreed. As a result of this process we now have an interdisciplinary and consensus-based set of 3(rd) Generation Guidelines that take into account all critically illness patient populations. The use of protocols for analgesia, sedation and treatment of delirium are repeatedly demonstrated. These guidelines offer treatment recommendations for the ICU team. The implementation of scores and protocols into routine ICU practice is necessary for their success.German medical science : GMS e-journal 01/2010; 8:Doc02. -
Article: [Evidence-based anti-infective program "ABx" - Online-program for anti-infective therapy broadens functions for local adaptations].
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ABSTRACT: National and international evidence based recommendations for anti-infective therapies in the intensive care unit are difficult to implement into daily clinical work. However, adequate and early applications of anti-infective therapies are important outcome factors for the clinical course of severe infections. With support of the German Society of Anaesthesiology and Intensive Care Medicine and the Association of German Anaesthesiologists (DGAI/BDA) a web based anti-infective program was developed to address these issues. The program includes interdisciplinary consented evidence based algorithms to help with immediate diagnostics and initial anti-infective therapies. Currently, with the title "ABx local" a subproject is launched to broaden program functions. It unifies current evidence based recommendations and local internal standards or comments on one platform to achieve priority of therapy options e.g. based on resistance patterns.ains · Anästhesiologie · Intensivmedizin 08/2009; 44(7-8):500-1. · 0.41 Impact Factor -
Article: [Incident reporting systems in anesthesiology--methods and benefits using the example of PaSOS].
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ABSTRACT: Preventing patient harm is one of the main tasks for the field of anesthesiology from early on. With the introduction of the national German incident reporting system PaSOS, which is hosted by the German anesthesia society, anesthesiology is again leading the field of patient safety. Important elements, success factors and background information for the introduction of successful incident reporting systems in an organization are given. Examples by and from PaSOS are given.ains · Anästhesiologie · Intensivmedizin 10/2008; 43(9):628-32. · 0.41 Impact Factor -
Article: [Optimisation of sedation practice in ICU by implementing of S2e Guidelines].
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ABSTRACT: The S2e Guidelines for sedation practice of the German Society for Anaesthesiology and Intensive Care recommend a clear prior definition of depth of sedation to be achieved in a given case, monitoring of depth of sedation by means of scoring systems, appropriate selection of analgesics and sedatives and the use of patient-oriented treatment regimens. These measures not only reduce significantly length of artificial respiration, length of time spent on the intensive care unit and overall length of stay in the hospital but also the frequency of complications. Therefore, implementation of the Guidelines will result in significant reductions in costs in a given case. This is a decisive economic benefit for any hospital working under the restraints of the DRG system.ains · Anästhesiologie · Intensivmedizin 02/2008; 43(1):38-43. · 0.41 Impact Factor -
Article: Changes in sedation management in German intensive care units between 2002 and 2006: a national follow-up survey.
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ABSTRACT: The aim of this study, conducted in 2006, was to find out whether changes in sedation management in German intensive care units took place in comparison with our survey from 2002. We conducted a follow-up survey with a descriptive and comparative cross-sectional multi-center design. A postal survey was sent between January and May 2006, up to four times, to the same 269 hospitals that participated in our first survey in 2002. The same questionnaire as in 2002 was used with a few additional questions. Two hundred fourteen (82%) hospitals replied. Sixty-seven percent of the hospitals carried out changes in sedation management since the 2002 survey. Reasons for changes were published literature (46%), national guidelines (29%), and scientific lectures (32%). Sedation protocols (8% versus 52%) and a sedation scale (21% versus 46%) were used significantly more frequently. During sedation periods of up to 24 hours, significantly less midazolam was used (46% versus 35%). In comparison to 2002, sufentanil and epidural analgesia were used much more frequently in all phases of sedation, and fentanyl more rarely. For periods of greater than 72 hours, remifentanil was used more often. A daily sedation break was introduced by 34% of the hospitals, and a pain scale by 21%. The increased implementation of protocols and scoring systems for the measurement of sedation depth and analgesia, a daily sedation break, and the use of more short-acting analgesics and sedatives account for more patient-oriented analgesia and sedation in 2006 compared with 2002.Critical care (London, England) 02/2007; 11(6):R124. · 4.61 Impact Factor -
Article: Sedation and analgesia in German intensive care units: how is it done in reality? Results of a patient-based survey of analgesia and sedation.
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ABSTRACT: This study carried out the first patient-oriented survey on the practice of analgesia and sedation in German intensive care units, examining whether the goals of early spontaneous breathing and awake, cooperative patients are achieved. A postal survey was sent to 261 hospitals in Germany. Each hospital received three patient-oriented forms with questions regarding current agents and techniques for analgesia and sedation of a specific patient. Responses were obtained from 220 (84%) hospitals which returned 305 questionnaires. Patients' Ramsay sedation scale was significantly higher in all phases of analgesia and sedation, indicating that the patients were more deeply sedated than currently intended by the therapist. Propofol was used for most of the patients during short-term sedation (57%) and during weaning (48%). The preferred agent for sedation longer than 72[Symbol: see text]h was midazolam (66%). The choice of agents and techniques for analgesia and sedation in the intensive care unit thus follows the German guidelines. The fact that the patients were more deeply sedated than intended by the therapist in all phases of sedation may be due to the low use of sedation scales and clinical practice guidelines or to the lack of training in using these techniques.Intensive Care Medicine 09/2006; 32(8):1137-42. · 5.40 Impact Factor -
Article: Practice of sedation and analgesia in German intensive care units: results of a national survey.
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ABSTRACT: Sedation and analgesia are provided by using different agents and techniques in different countries. The goal is to achieve early spontaneous breathing and to obtain an awake and cooperative pain-free patient. It was the aim of this study to conduct a survey of the agents and techniques used for analgesia and sedation in intensive care units in Germany. A survey was sent by mail to 261 hospitals in Germany. The anesthesiologists running the intensive care unit were asked to fill in the structured questionnaire about their use of sedation and analgesia. A total of 220 (84%) questionnaires were completed and returned. The RAMSAY sedation scale was used in 8% of the hospitals. A written policy was available in 21% of hospitals. For short-term sedation in most hospitals, propofol was used in combination with sufentanil or fentanyl. For long-term sedation, midazolam/fentanyl was preferred. Clonidine was a common part of up to two-thirds of the regimens. Epidural analgesia was used in up to 68%. Neuromuscular blocking agents were no longer used. In contrast to the US 'Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult', our survey showed that in Germany different agents, and frequently neuroaxial techniques, were used.Critical care (London, England) 05/2005; 9(2):R117-23. · 4.61 Impact Factor -
Article: Validity and reliability of the DDS for severity of delirium in the ICU.
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ABSTRACT: Until now, there has been no gold standard for monitoring delirium in intensive care unit (ICU) patients. In this prospective cohort study, a new score, the Delirium Detection Score (DDS), for severity of delirium in the ICU was evaluated. After ethical approval and written informed consent, intensive care doctors and nurses assessed 1073 consecutive patients in surgical ICUs using the DDS together with the Ramsay Sedation Scale (RSS). The DDS is composed of eight criteria (orientation, hallucination, agitation, anxiety, seizures, tremor, paroxysmal sweating, and altered sleep- wake rhythm). Additionally, intensive care doctors had to document the Sedation-Agitation Scale (SAS) combined with a defined clinical assessment. For interrater reliability, pair of evaluators assessed patients in a blinded fashion at the same time. RSS1 (9%) was associated with a significantly (p < 0.001) higher DDS than RSS levels 2-6. The DDS increased with the severity of delirium (p < 0.001). The receiver operating characteristics (ROC) for the differentiation between no delirium (SAS < 4) and symptoms of delirium at all (SAS 5-7) showed an area under the curve (AUC) of 0.802 (95% confidential interval (CI): 0.719-0.898; p < 0.001) and 69% sensitivity and 75% specificity was determined. For reliability, a Cronbach's alpha of 0.667 was calculated. The paired comparisons revealed an intraclass correlation between 0.642 and 0.758. The DDS demonstrated good validity with excellent sensitivity and specificity for delirium. The severity of delirium can be more accurately estimated by the DDS. By its composition of several items, the DDS might help to start a symptom-guided therapy immediately.Neurocritical Care 02/2005; 2(2):150-8. · 2.47 Impact Factor
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Institutions
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2005–2011
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Charité Universitätsmedizin Berlin
- Department of Anesthesiology and Operative Intensive Care Medicine
Berlin, Land Berlin, Germany
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