Publications (72)101.52 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: All mechanically ventilated patients must be weaned from the ventilator at some stage. According to an International Consensus Conference the criteria for "prolonged weaning" are fulfilled if patients fail at least 3 weaning attempts (i. e. spontaneous breathing trial, SBT) or require more than 7 days of weaning after the first SBT. This occurs in about 15 - 20 % of patients.Because of the growing number of patients requiring prolonged weaning a German guideline on prolonged weaning has been developed. It is an initiative of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., DGP) in cooperation with other societies (see acknowledgement) engaged in the field chaired by the Association of Scientific and Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF).This guideline deals with the definition, epidemiology, weaning categories, underlying pathophysiology, therapeutic strategies, the weaning unit, transition to out-of-hospital ventilation and therapeutic recommendations for end of life care. This short version summarises recommendations on prolonged weaning from the German guideline.
    Pneumologie 10/2015; 69(10):595-607. DOI:10.1055/s-0034-1392809
  • J Kerl · G Wenzel · D Heyse · D Dellweg
    Pneumologie 07/2015; 69(07). DOI:10.1055/s-0035-1555585
  • J Kerl · E Höhn · DC Heyse · D Köhler · D Dellweg
    Pneumologie 02/2015; 69(S 01). DOI:10.1055/s-0035-1544599
  • Pneumologie 02/2015; 69(S 01). DOI:10.1055/s-0035-1544597
  • Pneumologie 02/2015; 69(S 01). DOI:10.1055/s-0035-1544888
  • Pneumologie 02/2015; 69(S 01). DOI:10.1055/s-0035-1544884
  • Pneumologie 02/2015; 69(S 01). DOI:10.1055/s-0035-1544596
  • D Heyse · G Schürholz · S Böckling · K Siemon · D Dellweg
    Pneumologie 12/2014; 68(12):811-20. DOI:10.1055/s-0034-1378072
  • Source
  • A Amukobole · K Osseiran · S Böckling · P Haidl · D Dellweg
    Pneumologie 02/2014; 68(S 01). DOI:10.1055/s-0034-1367797
  • Pneumologie 02/2014; 68(S 01). DOI:10.1055/s-0034-1367799
  • A Al-Kharouf · N Sarma · E Höhn · K Siemon · P Haidl · D Köhler · D Dellweg
    Pneumologie 02/2014; 68(S 01). DOI:10.1055/s-0034-1368062
  • [Show abstract] [Hide abstract]
    ABSTRACT: Mechanical ventilation (MV) is an essential part of modern intensive care medicine. MV is performed in patients with severe respiratory failure caused by insufficiency of the respiratory muscles and/or lung parenchymal disease when/after other treatments, i. e. oxygen, body position, secretion management, medication or non invasive ventilation have failed.In the majority of ICU patients weaning is routine and does not present any problems. Nevertheless 40-50 % of the time during mechanical ventilation is spent on weaning. About 20 % of patients need continued MV despite resolution of the conditions which originally precipitated the need for MV.There maybe a combination of reasons; chronic lung disease, comorbidities, age and conditions acquired in ICU (critical care neuromyopathy, psychological problems). According to an International Consensus Conference the criteria for "prolonged weaning" are fulfilled if patients fail at least three weaning attempts or require more than 7 days of weaning after the first spontaneous breathing trial. Prolonged weaning is a challenge. An inter- and multi-disciplinary approach is essential for weaning success. Complex, difficult to wean patients who fulfill the criteria for "prolonged weaning" can still be successfully weaned in specialised weaning units in about 50% of cases.In patients with unsuccessful weaning, invasive mechanical ventilation has to be arranged either at home or in a long term care facility.This S2-guideline was developed because of the growing number of patients requiring prolonged weaning. It is an initiative of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., DGP) in cooperation with other societies engaged in the field.The guideline is based on a systematic literature review of other guidelines, the Cochrane Library and PubMed.The consensus project was chaired by the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) based on a formal interdisciplinary process applying the Delphi-concept. The guideline covers the following topics: Definitions, epidemiology, weaning categories, pathophysiology, the spectrum of treatment strategies, the weaning unit, discharge from hospital on MV and recommendations for end of life decisions. Special issues relating to paediatric patients were considered at the end of each chapter.The target audience for this guideline are intensivists, pneumologists, anesthesiologists, internists, cardiologists, surgeons, neurologists, pediatricians, geriatricians, palliative care clinicians, nurses, physiotherapists, respiratory therapists, ventilator manufacturers.The aim of the guideline is to disseminate current knowledge about prolonged weaning to all interested parties. Because there is a lack of clinical research data in this field the guideline is mainly based on expert opinion.
    Pneumologie 01/2014; 68(1):19-75. DOI:10.1055/s-0033-1359038
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Regional weaning centers play a more and more important role in the weaning process of long-term ventilated patients. The medical center Kloster Grafschaft is one of the oldest and largest centers in Germany. There is very little published data from larger weaning centers in Europe. Methods: From 2007 to 2011 all weaning patients were registered in a database. Additional information of the transferring hospitals was inquired. Prolonged weaning was defined by a period of at least 7 days of mechanical ventilation as well as three unsuccessful weaning trials. Results: Data from 867 of 916 registered patients could be analyzed. 71.1% could be successfully weaned from mechanical ventilation. All patients were suffering from a hypercapnic insufficiency as well as a variety of secondary diagnoses, on average 15.1 per patient. The median of age was 70 years, 62 % were male. Prior to hospital transfer patients had been ventilated for a median of 41 days. Time to successful removal of the artificial airway was 8 days according to the DRG code directive and 13.4 days when non-invasive ventilation (NIV) time was included. Of the 616 patients who could be successfully weaned, 42 % were discharged on NIV. Out of the 251 patients who could not be weaned, 107 were discharged. The remaining 144 (16.7 %) patients died, 33 % due to the primary underlying disease or a complication. 66 % of the deceased patients received palliative care. Patients with successful and unsuccessful weaning did not differ by age, by duration of mechanical ventilation or time until tracheostomy. Postoperative patients could be weaned more often than medical patients (p < 0.05). Discrimination between patients with successful and unsuccessful weaning was not possible by the point in time of the first spontaneous breathing trial in regard to the duration of ventilation but only by the duration of this trial after transfer to our unit (150 vs. 60 min; p < 10-6). The TISS-28 and the SAPS-II-Score did not differ between the two groups. Patients with successful weaning had less agitation according to the RASS-Score (0.47 vs. 0.15; p < 0.005). Conclusion: It becomes apparent that in a specialized weaning center the majority of difficult to wean patients can be liberated in short time from mechanical ventilation.
    DMW - Deutsche Medizinische Wochenschrift 11/2013; 139(11). DOI:10.1055/s-0033-1349650 · 0.54 Impact Factor
  • Source
    Jens Kerl · Thordis Arnold · Dominic Dellweg · Dieter Köhler
    21. Jahrestagung der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin (DGSM), Wiesbaden 17.-19.10.2013, Wiesbaden; 10/2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare the treatment effect of noninvasive positive pressure ventilation (NPPV) and anticyclic servoventilation in patients with continuous positive airway pressure (CPAP)-induced central sleep apnea (complex sleep apnea). Randomized controlled trial. Sleep center. Thirty patients who developed complex sleep apnea syndrome (CompSAS) during CPAP treatment. NPPV or servoventilation. Patients were randomized to NPPV or servo-ventilation. Full polysomnography (PSG) was performed after 6 weeks. On CPAP prior to randomization, patients in the NPPV and servoventilator arm had comparable apnea-hypopnea indices (AHI, 28.6 ± 6.5 versus 27.7 ± 9.7 events/h (mean ± standard deviation [SD])), apnea indices (AI,19 ± 5.6 versus 21.1 ± 8.6 events/h), central apnea indices (CAI, 16.7 ± 5.4 versus 18.2 ± 7.1 events/h), oxygen desaturation indices (ODI,17.5 ± 13.1 versus 24.3 ± 11.9 events/h). During initial titration NPPV and servoventilation significantly improved the AHI (9.1 ± 4.3 versus 9 ± 6.4 events/h), AI (2 ± 3.1 versus 3.5 ± 4.5 events/h) CAI (2 ± 3.1 versus 2.5 ± 3.9 events/h) and ODI (10.1 ± 4.5 versus 8.9 ± 8.4 events/h) when compared to CPAP treatment (all P < 0.05). After 6 weeks we observed the following differences: AHI (16.5 ± 8 versus 7.4 ± 4.2 events/h, P = 0.027), AI (10.4 ± 5.9 versus 1.7 ± 1.9 events/h, P = 0.001), CAI (10.2 ± 5.1 versus 1.5 ± 1.7 events/h, P < 0.0001)) and ODI (21.1 ± 9.2 versus 4.8 ± 3.4 events/h, P < 0.0001) for NPPV and servoventilation, respectively. Other sleep parameters were unaffected by any form of treatment. After 6 weeks, servoventilation treated respiratory events more effectively than NPPV in patients with complex sleep apnea syndrome. Dellweg D; Kerl J; Hoehn E; Wenzel M; Koehler D. Randomized controlled trial of noninvasive positive pressure ventilation (NPPV) versus servoventilation in patients with CPAP-induced central sleep apnea (complex sleep apnea). SLEEP 2013;36(8):1163-1171.
    Sleep 08/2013; 36(8):1163-71. DOI:10.5665/sleep.2878 · 4.59 Impact Factor
  • P Haidl · D Dellweg
    DMW - Deutsche Medizinische Wochenschrift 06/2013; 138(23):1233-1235. DOI:10.1055/s-0033-1343179 · 0.54 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Non-invasive ventilation (NIV) has become a common treatment for acute and chronic respiratory failure. In comparison with conventional invasive mechanical ventilation, NIV has the advantages of reducing patient discomfort, procedural complications, and mortality. However, NIV is associated with frequent uncomfortable or even life-threatening adverse effects, and patients should be thoroughly screened beforehand to reduce potential severe complications. We performed a detailed review of the relevant medical literature for NIV complications. All major NIV complications are potentially life-threatening and can occur in any patient, but are strongly correlated with the degree of pulmonary and cardiovascular involvement. Minor complications can be related to specific structural features of NIV interfaces or to variable airflow patterns. This extensive review of the literature shows that careful selection of patients and interfaces, proper setting of ventilator modalities, and close monitoring of patients from the start can greatly reduce NIV complications.
    BJA British Journal of Anaesthesia 04/2013; 110(6). DOI:10.1093/bja/aet070 · 4.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background:Oxygen therapy is usually combined with a humidification device to prevent mucosal dryness. Depending of the cannula design oxygen can be administered pre- or intra-nasally (administration of oxygen in front of the nasal ostia versus cannula system inside the nasal vestibulum). The impact of the cannula design on intra-nasal humidity however has not been investigated to date.Objective:First, to develop a system, that samples air from the nasal cavity and analyses the humidity of these samples. Second, to investigate nasal humidity during pre-nasal and intra-nasal oxygen application with and without humidification.Methods:We first developed and validated a sampling and analysis system to measure humidity from air samples. By means of this system we measured inspiratory air samples from 12 individuals who received nasal oxygen with an intra-nasal and pre-nasal cannula at different flows with and without humidification.Results:The sampling and analysis system showed good correlation to a standard hygrometer within the tested humidity range (r = 0.992, p < 0.001).In our subjects intranasal humidity dropped significantly from 40.3 ± 8.7 % to 35.3 ± 5.8 %, 32 ± 5.6 % and 29.0 ± 6.8 % at a flow of one, two and three litres respectively when oxygen was given intra-nasally without humidification (p=0.001, p<0.001 and p<0.001 respectively). We observed no significant change in airway humidity when oxygen was given pre-nasally without humidification. With the addition of humidification we observed no significant change in humidity at any flow rate and independent of pre- or intranasal oxygen administration.Conclusion:Pre-nasal administration of dry oxygen achieves similar levels of intranasal humidity as intranasal administration in combination with a bubble through humidifier. Pre-nasal oxygen simplifies application and may reduce therapy cost.
    Respiratory care 01/2013; 58(8). DOI:10.4187/respcare.02215 · 1.84 Impact Factor
  • Source
    J. Kerl · D. Dellweg · D. Köhler
    [Show abstract] [Hide abstract]
    ABSTRACT: Hintergrund Die Analyse und Extraktion von Informationen aus Pulswellen wird zunehmend in der medizinischen Diagnostik eingesetzt. Der diagnostische Wert dieser Parameter für schlafmedizinische Untersuchungen, insbesondere im Hinblick auf kardiovaskuläre Risikofaktoren bei Schlafapnoe, aber auch deren Einschränkungen werden erörtert. Methoden Die Studienlage zur Verwendung von Pulswellen bei der Bestimmung physiologischer Parameter wird vorgestellt. Mit Messgeräten von SOMNOscreen® (SOMNOmedics®, Randersacker) im eigenen Labor aufgezeichnete Beispiele zeigen die Mindestvoraussetzungen bei der Qualität der verwendeten Signale (Pulswelle und EKG). Ergebnisse Auf der Basis einer direkten oder indirekten Analyse von Pulswellen lassen sich Parameter wie Pulsfrequenz, Pulsfrequenzvariabiliät, Pulswellenvariabilität, Pulstransitzeit, Pulswellengeschwindigkeit, systolischer und diastolischer Blutdruck, Sklerosierungsgrad zentraler arterieller Gefäße, endotheliale Funktion/Dysfunktion, Unterscheidung obstruktiver und zentraler Apnoen sowie kardiovaskuläre Risikostratifizierung ableiten. Pulswelle und EKG müssen jedoch bestimmte Formmerkmale aufweisen, damit valide Daten erhoben werden können. Schlussfolgerungen Die Ergebnisse werden im Hinblick auf die Anwendung bei schlafmedizinischen Routineuntersuchungen bewertet. Methodisch aufwendige Untersuchungen, die i. d. R. wissenschaftlichen experimentellen Laborstudien vorbehalten bleiben, werden von leicht zugänglichen Methoden unterschieden, die entweder zum Standard in der Polysomonographie gehören oder leicht zu integrieren sind.
    Somnologie - Schlafforschung und Schlafmedizin 12/2012; 16(4). DOI:10.1007/s11818-012-0596-3