Hinnerk Wulf

Universitätsklinikum Gießen und Marburg , Marburg, Hesse, Germany

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Publications (104)189.39 Total impact

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    ABSTRACT: The ability of an evoked motor response (EMR) with nerve stimulation to detect intraneural needle placement reliably at low current intensity has recently been challenged. In this study, we hypothesized that current intensity is higher in needle-nerve contact than in intraneural needle placement. Brachial plexus nerves were exposed surgically in 6 anesthetized pigs. An insulated needle connected to a nerve stimulator was placed either with 1 mm distance to the nerve (control position), adjacent to nerve epineurium (needle-nerve contact position), or inside the nerve (intraneural position). Three pulse duration settings were applied in random fashion (0.1, 0.3, or 1.0 milliseconds) at each needle position. Starting at 0.0 mA, electrical current was increased until a minimal threshold current resulting in a specific EMR was observed. Fifty threshold current measurements were scheduled for each needle position-pulse duration setting. Four hundred-fifty threshold currents in 50 peripheral nerves were measured. Threshold current intensities (mA) to elicit EMR showed small differences between the needle-nerve contact position [median (25th-75th percentiles); 0.1 milliseconds: 0.12 (0.08-0.18) mA; 0.3 milliseconds: 0.10 (0.06-0.12) mA; 1.0 milliseconds: 0.06 (0.04-0.10) mA] and the intraneural position (0.1 milliseconds: 0.12 [0.10-0.16] mA; 0.3 milliseconds: 0.08 [0.06-0.10] mA; 1.0 milliseconds: 0.06 [0.06-0.08] mA) that are neither statistically significant nor clinically relevant. Regardless of the pulse duration that was applied, the 98.33% confidence interval revealed a difference of at most 0.02 mA. However, threshold current intensities to elicit EMR were lower for the needle-nerve contact position than for the control position (0.1 milliseconds: 0.28 [0.26-0.32] mA; 0.3 milliseconds: 0.20 [0.16-0.22] mA; 1.0 milliseconds: 0.12 [0.10-0.14] mA). The confidence interval for differences suggests minimal current intensity to elicit a motor response that cannot reliably discern between a needle-nerve contact from intraneural needle placement. In addition, an EMR at threshold currents <0.2 mA (irrespective of the applied pulse duration) indicates intraneural needle placement or needle-nerve contact.
    Anesthesia and analgesia 11/2013; · 3.08 Impact Factor
  • Klaus Kerwat, Hinnerk Wulf
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    ABSTRACT: There is a plethora of laws, regulations, guidelines and recommendations relating to infection control and hygiene. Major issues are the prevention of nosocomial infections, staff protection and environmental protection. Of the highest relevance are the infection control law [Infektionsschutzgesetz (IfSG)], the hygiene regulations of the German federal states [Hygieneverordnungen der Bundesländer], the German technical rules for biological materials [Technische Regel Biologische Arbeitsstoffe 250 (TRBA 250)] - biological materials in health-care and welfare work [Biologische Arbeitsstoffe im Gesundheitswesen und in der Wohlfahrtspflege], the guidelines for hospital hygiene and prevention of infection of the commission for hospital hygiene and prevention of infection of the Robert-Koch Institute [Richtlinie für Krankenhaushygiene und Infektionsprävention von der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut], the recommendations of the commission on anti-infectives, resistance and therapy of the Robert-Koch Institute [Empfehlungen der Kommission Antiinfektiva, Resistenz und Therapie (ART) beim Robert Koch-Institut]. Of subordinate importance are, e.g., the recommendations of the German Society for Anesthesiology and Intensive Medicine (DGAI). It is practically impossible for an anesthesiologist working in a hospital to have knowledge of all laws, regulations, guidelines and recommendations. And this is also not reasonable. Thus it is necessary to distinguish the relevant from the irrelevant. Checklists can be useful here. The most important and effective individual action in hospital hygiene is and remains hand hygiene as is propagated in the action "clean hands", irrespective of all laws, regulations, guidelines and recommendations.
    ains · Anästhesiologie · Intensivmedizin 11/2013; 48(11-12):703-5. · 0.39 Impact Factor
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    ABSTRACT: Mechanical ventilation with an automated ventilator is recommended during cardiopulmonary resuscitation with a secured airway. We investigated the influence of intermittent positive-pressure ventilation, bilevel ventilation, and the novel ventilator mode chest compression synchronized ventilation, a pressure-controlled ventilation triggered by each chest compression, on gas exchange, hemodynamics, and return of spontaneous circulation in a pig model. Animal study. University laboratory. Twenty-four three-month-old female domestic pigs. The study was performed on pigs under general anesthesia with endotracheal intubation. Arterial and central venous catheters were inserted and IV rocuronium (1 mg/kg) was injected. After 3 minutes of cardiac arrest (ventricular fibrillation at t = 0 min), animals were randomized into intermittent positive-pressure ventilation (control group), bilevel, or chest compression synchronized ventilation group. Following 10 minute uninterrupted chest compressions and mechanical ventilation, advanced life support was performed (100% O2, up to six defibrillations, vasopressors). Blood gas samples were drawn at 0, 4 and 13 minutes. At 13 minutes, hemodynamics was analyzed beat-to-beat in the end-inspiratory and end-expiratory cycle comparing the IPPV with the bilevel group and the CCSV group. Data were analyzed with the Mann-Whitney U test. Return of spontaneous circulation was achieved in five of eight (intermittent positive-pressure ventilation), six of eight (bilevel), and four of seven (chest compression synchronized ventilation) pigs. The results of arterial blood gas analyses at t = 4 minutes and t = 13 minutes (torr) were as follows: PaO2 intermittent positive-pressure ventilation, 143 (76/256) and 262 (81/340); bilevel, 261 (109/386) (p = 0.195 vs intermittent positive-pressure ventilation) and 236 (86/364) (p = 0.878 vs intermittent positive-pressure ventilation); and chest compression synchronized ventilation, 598 (471/650) (p < 0.001 vs intermittent positive-pressure ventilation) and 634 (115/693) (p = 0.054 vs intermittent positive-pressure ventilation); PaCO2 intermittent positive-pressure ventilation, 40 (38/43) and 45 (36/52); bilevel, 39 (35/41) (p = 0.574 vs intermittent positive-pressure ventilation) and 46 (42/49) (p = 0.798); and chest compression synchronized ventilation, 28 (27/32) (p = 0.001 vs intermittent positive-pressure ventilation) and 26 (18/29) (p = 0.004); mixed venous pH intermittent positive-pressure ventilation, 7.34 (7.31/7.35) and 7.26 (7.25/7.31); bilevel, 7.35 (7.29/7.37) (p = 0.645 vs intermittent positive-pressure ventilation) and 7.27 (7.17/7.31) (p = 0.645 vs intermittent positive-pressure ventilation); and chest compression synchronized ventilation, 7.34 (7.33/7.39) (p = 0.189 vs intermittent positive-pressure ventilation) and 7.35 (7.34/7.36) (p = 0.006 vs intermittent positive-pressure ventilation). Mean end-inspiratory and end-expiratory arterial pressures at t = 13 minutes (mm Hg) were as follows: intermittent positive-pressure ventilation, 28.0 (25.0/29.6) and 27.9 (24.4/30.0); bilevel, 29.1 (25.6/37.1) (p = 0.574 vs intermittent positive-pressure ventilation) and 28.7 (24.2/36.5) (p = 0.721 vs intermittent positive-pressure ventilation); and chest compression synchronized ventilation, 32.7 (30.4/33.4) (p = 0.021 vs intermittent positive-pressure ventilation) and 27.0 (24.5/27.7) (p = 0.779 vs intermittent positive-pressure ventilation). Both intermittent positive-pressure ventilation and bilevel provided similar oxygenation and ventilation during cardiopulmonary resuscitation. Chest compression synchronized ventilation elicited the highest mean arterial pressure, best oxygenation, and a normal mixed venous pH during cardiopulmonary resuscitation.
    Critical care medicine 10/2013; · 6.37 Impact Factor
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    ABSTRACT: Objective: Positive pressure ventilation may cause lung injury that might be accelerated by high peak airway pressures as during chest compressions. We investigated the effects of the novel ventilator mode CCSV [1] compared with IPPV [2] on lung injury following resuscitation and return of spontaneous circulation (ROSC) in a pig model. Methods: After approval by local authorities 22 pigs were investigated as follows: The animals underwent anesthesia with endotracheal intubation, ventricular fibrillation was induced (t=0 min) and continuous chest compressions were started (t=3min). The pigs were mechanically ventilated with either IPPV (FiO2 1.0, tidal volumes (TV) 7ml/kg, respiratory rate 10/min, PEEP=0mbar) or CCSV, a pressure-controlled and with each chest compression synchronized breathing pattern. CCSV is designed to insufflate a pressure controlled gas flow (FiO2 1.0; Pinsp=60mbar) triggered by the beginning of each compression with a fixed inspiratory time of only 265ms. Defibrillation was applied at t=13min. Upon ROSC ventilation was changed to a pressure controlled mode with FiO2 0.4, TV 7ml/kg, respiratory rate 10/min, PEEP=5mbar in both groups for one hour. The animals were then euthanized. Post mortem samples of lung tissue were taken from the left and right lower lobes including visceral pleura. Following standard staining with Haematoxylin and Eosin the tissue sections were examined for morphological signs of ventilator associated lung injury (VALI) under the light microscope. Alveolar distances were measured as additional markers of VALI. The findings were evaluated by three independent observers and graded I-IV. The Mann-U-test was used for statistical analysis, and results were presented as median (25%/75%percent.) Results: CCSV vs IPPV: Emphysematous changes measured by alveolar distance: 1(1/2) vs 1.5(1/2);p=0.16. Intraparenchymal cysts: 1(1/1) vs 1(1/1);p=0.3. Interstitial congestion: 1(1/2) vs 1(1/1.75);p=0.4. Interstitial thickening: 2(2/3) vs 2(1/2.75);p=0.04*. Alveolar hemorrhage: 1(1/2) vs 1(1/2);p=0.6. Organization of alveolar exudates: 1(1/1) vs 1(1/1);p=0.6. Conclusions: Ventilation with CCSV and IPPV during resuscitation causes only minor lung tissue injury. Morphological signs of VALI are negligible and too small to favor either ventilation mode. References: [1] Kill C et al.: Resuscitation 82S1(2011)S15, [2] Deakin CD et al.:Resuscitation 81 (2010)1319, [3] Quintel M et al.: Crit Care Med 26 (1998)833-843.
    Resuscitation 10/2013; 84:S15. · 4.10 Impact Factor
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    Resuscitation 10/2013; 84:S62. · 4.10 Impact Factor
  • Klaus Kerwat, Hinnerk Wulf
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    ABSTRACT: As a general rule drinking water in hospitals does not represent a risk for the normal patient. However, for high-risk patients with compromised immune defense systems drinking water in hospitals may become a source of nosocomial infections. It may be contaminated with microorganisms that may have the potential to be infectious agents in the hospital environment. Of particular significance in such circumstances are the Gram-negative rods such as Pseudomonas aeruginosa, Acinetobacter spp. and Legionella bacteria. Accordingly, specific behavior patterns and measures in the handling of drinking water in hospitals are meaningful in order to reduce the risks of water-associated nosocomial infections.
    ains · Anästhesiologie · Intensivmedizin 10/2013; 48(10):598-9. · 0.39 Impact Factor
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    ABSTRACT: INTRODUCTION: Needle visualization in ultrasound-guided regional anesthesia can be improved by using needles of echogenic design with higher rate of reflection of ultrasound waves. Imaging solutions such as compound imaging might further improve imaging of both needle and tissue; these effects have not yet been studied. We hypothesized that compound imaging would significantly improve needle visibility, regardless of the insertion angle or needle type used. The effects of compound imaging on needle artifacts and tissue imaging were also investigated. METHODS: A total of 200 video clips of in-plane needle insertions were obtained in embalmed cadavers with a conventional needle and an echogenic needle at 5 different insertion angles, with both conventional B-mode ultrasound imaging and compound imaging technology. Visibility of the needle shaft and needle tip as well as the needle artifact rate were assessed by a blinded investigator on a 4-point ordinal scale. The effects on tissue image quality and speckle artifacts were also assessed. Stepwise linear regression was performed to differentiate effects on needle visibility scores. RESULTS: Imaging of the needle shaft and tip was significantly enhanced when compound imaging technology was used (P < 0.0001). Use of echogenically designed needles or shallow needle insertion angles improved visibility of both shaft and tip (both P < 0.0001). With compound imaging, there are fewer needle artifacts, and tissue imaging quality and speckle artifact rate are significantly improved. CONCLUSIONS: Compound imaging technology enhances needle imaging with both echogenic and conventional needles. Tissue imaging and speckle artifacts are also optimized. Echogenic needle design results in better needle visibility scores in both B-mode and compound imaging.
    Regional anesthesia and pain medicine 06/2013; · 4.16 Impact Factor
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    ABSTRACT: BACKGROUND:Sleep disturbances after general surgery have been described. In this study, we assessed rapid eye movement (REM) sleep in patients undergoing knee replacement surgery using a regional anesthetic technique.METHODS:Ambulatory polysomnography (PSG) was performed on 3 nights: the night before surgery (PSG1), the first night after surgery (PSG2), and the fifth postoperative night (PSG3). Postoperative analgesia was maintained with peripheral nerve catheters for the first 3 days and with oral opioids thereafter. In addition, nonsteroidal antiinflammatory drugs were administered. Postoperative pain was monitored using a visual analog scale.RESULTS:PSG was performed in 12 patients, 6 men and 6 women, with a mean age of 61 (±12) years. REM sleep was reduced from PSG1 (median 16.4%) to PSG2 (median 6.3%; P = 0.02). The Hodges-Lehmann estimate for the median reduction is -7.8% (95% confidence interval -14.8% to -0.7%). During PSG3, significantly more REM sleep was detected (median 15.4%) compared with PSG2 (P = 0.01). The Hodges-Lehmann estimate for this median increase is 10.0% (95% confidence interval 1.7%-25.3%).CONCLUSION:Postoperative reduction of REM sleep also occurs after surgery and regional anesthesia.
    Anesthesia and analgesia 03/2013; · 3.08 Impact Factor
  • Clemens Kill, Hinnerk Wulf, Wolfgang Dersch
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    ABSTRACT: Oxygen is the best known and well accepted medication in emergency medicine. In most emergencies high doses of oxygen are an essential part of treatment and seemed to be nearly free of adverse effects. Studies of the last two decades show hints to possible adverse effects of hyperoxia during post-resuscitation-care and myocardial infarction. These results should be critically reviewed and may lead to a rational use of oxygen in emergency care.
    ains · Anästhesiologie · Intensivmedizin 03/2013; 48(2):84-9. · 0.39 Impact Factor
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    ABSTRACT: Up to the present day, pain management in the ICU (Intensive Care Units)is a unresolved clinical problem due to patient heterogeneity with complex variation inetiopathology and treatment of the underlying diseases. Therefore, therapeutic strategies in terms of standard operating procedure (SOP) are a necessary to improve the pain management for intensive care patients. Common guidelines for analgosedation are often inadequate to reflect the clinical situation. In particular, for an ICU setting without permanent presence of a physician a missing pain management SOP resulting in delayed pain therapy caused by a therapeutic uncertainty of the nurse staff.In addition to our pre-existing SOP for analgosedation we implemented a pain management SOP for our interdisciplinary, anaesthesiologic ICU. A exploratory survey among the nurse staff was conducted to assess the efficacy of the SOP. The results of the evaluation after a 6 month follow-up indicated a faster onset of pain management and good acceptance by the nursing staff.
    ains · Anästhesiologie · Intensivmedizin 03/2013; 48(3):150-4. · 0.39 Impact Factor
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    ABSTRACT: In der Helsinki-Deklaration "Patientensicherheit in der Anästhesio-logie" wird gefordert, für bestimmte sicherheitsrelevante Aspekte in der Anästhesie schriftliche interne Handlungsempfehlungen fest-zulegen und diese für alle Mitarbeiter/innen zugänglich zu machen. Im Folgenden soll als erstes der geforderten Themen dieser Reihe eine SOP (standard operating procedure) zur Lokalanästhetika-Intoxikation vorgestellt werden. Diese Muster-SOP ist zwar so gut es geht "evi-dence-based" und orientiert sich an (inter-)nationalen Empfehlungen der Fachgesellschaften. Diese "Marburger-Lokalanästhetika-Intoxika-tions-SOP" ist aber nur eine von vielen Ausgestaltungsmöglichkeiten und soll dem Leser Anregung und Grundlage sein für eine auf den eigenen Bereich abgestimmte individuelle Empfehlung. Nebenwirkungen und Komplikationen von Lokalanästhetika Lokalanästhetika bewirken als Natriumkanalblocker in ers-ter Linie ▶ kardiale Nebenwirkungen (Leitungs-verzögerung bis zur Asystolie, aber auch Tachyarrhythmie) und ▶ zentralnervöse Nebenwirkungen (bis hin zum generalisierten Krampfanfall). Die Intoxikation mit lipophilen Lokal-anästhetika ist trotz des weitverbreiteten Einsatzes der Substanzen eine sehr selte-ne Komplikation [1, 2]. Allerdings sind die Folgen im Einzelfall gravierend und mit enormen potenziellen iatrogenen Schädigungen bzw. dem Tod des Patien-ten verbunden [3].
    Anästhesie, Intensivtherapie, Notfallmedizin 01/2013; 48(1):32-35.
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    ABSTRACT: Background Unconscious patients with severe trauma often require urgent endotracheal intubation. In trauma victims with possible cervical spine injury, any movement of the head and neck should be avoided.Study Objectives We investigated the effect of GlideScope videolaryngoscopy on cervical spine movement compared with conventional laryngoscopy in anesthetized patients with unsecured cervical spines.Methods Sixty patients scheduled for elective surgery with general anesthesia and without anticipated airway problems were enrolled in the study after ethics committee approval and written informed consent. Intubation was performed with videolaryngoscopy (GlideScope®, Verathon Inc., Bothell, WA) or conventional laryngoscopy (MacIntosh). Using video motion analysis with a lateral view, the maximum extension angle α was measured with reference to anatomical points (baseline and line drawn from processus mastoideus to os frontale [glabella]). Values were analyzed using Mann Whitney U-tests.ResultsThe deviation of α was a median 11.8° in the videolaryngoscope group and 14.3° in the conventional group (p = 0.045), with a maximum of 19.2° (videolaryngoscopy) vs. 29.3° (conventional). Intubation by physicians with some experience in videolaryngoscopy was associated with a reduced angle deviation (α = 10.3°) compared to inexperienced physicians (12.8°, p = 0.019). Intubation time was a median 24 s (min/max 12/75 s) in the MacIntosh group and 53 s (min/max 28/210 s) in the GlideScope group. In 3 patients randomized to the conventional group in whom conventional intubation failed, intubation could be successfully performed using videolaryngoscopy.Conclusion GlideScope videolaryngoscopy reduces movements of the cervical spine in patients with unsecured cervical spines and therefore might reduce the risk of secondary damage during emergency intubation of patients with cervical spine trauma.
    Journal of Emergency Medicine 01/2013; · 1.33 Impact Factor
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    ABSTRACT: Nowadays almost all operating rooms are equipped with air conditioning (AC units). Their main purpose is climatization, like ventilation, moisturizing, cooling and also the warming of the room in large buildings. In operating rooms they have an additional function in the prevention of infections, especially the avoidance of postoperative wound infections. This is achieved by special filtration systems and by the creation of specific air currents. Since hypothermia is known to be an unambiguous factor for the development of postoperative wound infections, patients are often actively warmed intraoperatively using warm air blankets (forced-air warming units). In such cases it is frequently discussed whether such warm air blankets affect the performance of AC units by changing the air currents or whether, in contrast, have exactly the opposite effect. However, it has been demonstrated in numerous studies that warm air blankets do not have any relevant effect on the functioning of AC units. Also there are no indications that their use increases the rate of postoperative wound infections. By preventing the patient from experiencing hypothermia, the rate of postoperative wound infections can even be decreased thereby.
    ains · Anästhesiologie · Intensivmedizin 01/2013; 48(1):36-7. · 0.39 Impact Factor
  • Clemens Kill, Hinnerk Wulf, Wolfgang Dersch
    ains · Anästhesiologie · Intensivmedizin 01/2013; 48(02):84-89. · 0.39 Impact Factor
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    ABSTRACT: BACKGROUND:For nerve stimulator-guided regional anesthesia, one has to compromise between a presumed low success rate (using a high-current threshold) and a presumed increased risk of nerve damage (using a low-current threshold). We hypothesized that high-current thresholds in the range of 0.9 to 1.1 mA are not inferior with respect to the procedural and latency times compared with low threshold currents in the range of 0.3 to 0.5 mA for nerve stimulation in brachial plexus blocks.METHODS:Two hundred five patients scheduled for elective surgery were randomized to a low (0.3-0.5 mA, n = 103) or a high (0.9-1.1 mA, n = 102) stimulation current threshold for the axillary plexus block with 40 mL local anesthetic mixture (20 mL, each of prilocaine 1% and ropivacaine 0.75%). The primary end point was the time to complete sensory block. The secondary outcome measures were the time to readiness for surgery (defined as the time from the start of block procedure to complete sensory block) and the block performance time. The noninferiority margin was set at 5 minutes and was evaluated using the two-sided 95% bootstrap-confidence intervals ([CIs] 100,000 replications) for differences in means.RESULTS:The mean times to complete sensory block revealed a significant decrease with the low-current group (17.9 ± 12.1 (mean ± SD) versus 22.8 ± 12.4 minutes; 95% CI, 1.1 to 8.6; p = 0.012). The time to readiness for surgery was 30.3 ± 13.8 minutes in the low-current group and 31.7 ± 12.9 minutes in the high-current group (95% CI, -2.7 to 5.5; p = 0.49). The performance time was significantly shorter in the high-current threshold group (9.5 ± 4.7 versus 11.9 ± 5.7 minutes; 95% CI, -4 to 1.1; p = 0.001).CONCLUSION:Noninferiority for the high-current threshold technique could neither be confirmed for the primary end point nor for secondary end points. However, we consider a difference in mean times of approximately 8.5 minutes to achieve readiness for surgery acceptable for clinical practice.
    Anesthesia and analgesia 12/2012; · 3.08 Impact Factor
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    ABSTRACT: Objective: Guidelines recommend mechanical ventilation with Intermitted Positive Pressure Ventilation (IPPV) during resuscita-tion. Mechanisms of chest compression might influence mechanical ventilation. We investigated the gas exchange using Chest Com-pression Synchronized Ventilation (CCSV) compared with IPPV in a pig model. 1 Methods: After approval by local authorities 44 pigs underwent anaesthesia with intubation. After 3 min of ventricular fibrilla-tion continuous chest compressions followed for 24 min. Pigs were mechanical ventilated with IPPV (FiO 2 1.0, tidalvolumes 7 ml/kg, respiratoryrate 10 min, PEEP = 0mbar) or Chest Compres-sion Synchronized Ventilation (CCSV), a pressure–controlled and with each chest compression synchronized breathing pattern (FiO 2 1.0, Pinsp = 60 mbar, inspiratory time 265 ms)., p = 0.3; PaCO 2 39 mmHg (37–42) vs. 39 mmHg (36–41), p = 0.5; PaO 2 86 mmHg (81–94) vs. 92 mmHg (83–97), p = 0.3; SaO 2 98% (97,98) vs. 98% (97–99), p = 0.16. t:=;8 min pH 7.39 (7.34–7.43) vs. 7.28 (7.20–7.34), p < 0.0001; PaCO 2 44 mmHg (35–49) vs. 58 mmHg (53–66), p < 0.0001; PaO 2 317 mmHg (175–492) vs. 88 mmHg (55–122), p = 0.0002; SaO 2 100% (99.6–100) vs. 93% (78–98), p < 0.0001. t = 12 min pH 7.36 (7.31–7.44) vs. 7.21 (7.10–7.28), p < 0.0001; PaCO 2 41 mmHg (32–50) vs. 60 mmHg (52–75) p < 0.0001; PaO 2 383 mmHg (132–456) vs. 97 mmHg (68–155), p = 0.001; SaO 2 100% (98–100) vs. 97% (80–99), p = 0.001. Conclusions: Chest Compression Synchronized Ventilation (CCSV) increases oxygenation and avoids hypercarbia during resus-citation in a pig model compared to the recommended standard IPPV 2 . Purpose of the study: Despite considerable effort over the last decades a valid scoring system to assess patients survival after out of hospital cardiac arrest (OOHCA) is not available. Hence, health care professionals are required to base delicate decisions upon experience and gut feeling. Improvement of the predictability of patient's survival would be of major medical and socioeconomic interest and could save medical resources. The objective was there-fore to develop an improved outcome prediction tool for patients after OOHCA. Materials and methods: The current study was a retrospec-tive cohort-study based on a cardiac arrest-registry. Multivariate logistic regression was applied on a set of variables before restora-tion of spontaneous circulation deemed to have high predictive power (23 variables for witnessed OOHCA, 19 variables for non-witnessed OOHCA). To obtain reliable estimates of the classification performance as well as reliable confidence intervals a 10–fold cross-validation was done. The main performance parameter was the area under the ROC curve (AUC), classifying patients into survivors/non-survivors after 30–days. Results: Data of 1447 witnessed and 279 non-witnessed OOHCA patients were analysed. The average AUC was 0.806 [CI 0.784–0.829] for witnessed OOHCA and 0.6300 [CI 0.533–0.727] for non-witnessed OOHCA respectively. For witnessed OOHCA this was significantly better than the AUC for any single considered vari-able. For witnessed OOHCA, the single most predictive variable was "minutes to sustained ROSC" (AUC: 0.700 [CI 0.672 0.728]), for non-witnessed OOHCA it was "total doses of adrenaline" (AUC: 0.692 [CI 0.606 0.779]). Conclusions: The current results, although preliminary, are promising to increase prognostication accuracy and we are con-fident that they can serve as basis for a survival score in OOHCA-patients.
    Resuscitation 10/2012; 4948:44-7. · 4.10 Impact Factor
  • Klaus Kerwat, Hinnerk Wulf
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    ABSTRACT: An ever occurring problem in the health-care services is the handling of patients who are carriers of multi-resistant pathogens (MRP). As a general rule, these patients must be isolated. Thus, the transport of these patients not only within but also outside of the hospital can be a problem. It is not just a matter of making the necessary transport of the afflicted patient, e.g., to examination suites or operating rooms, possible but also above all of protecting other patients and personnel from transmission and potential infection with the pathogen. As a rule, the measures of "standard hygiene" are sufficient for an adequate protection of patients and personnel. Above all, hand disinfection is of decisive importance.
    ains · Anästhesiologie · Intensivmedizin 09/2012; 47(9):564-5. · 0.39 Impact Factor
  • Klaus Kerwat, Hinnerk Wulf
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    ABSTRACT: According to §6, section 3 of the German Protection against Infections Act [Infektionsschutzgesetz (IfSG)] an outbreak is defined as the occurrence in large numbers of nosocomial infections for which an epidemiological relationship is probable or can be assumed. About 2-10% of nosocomial infections in hospitals (about 5% in intensive care wards) occur within the framework of an outbreak. The heaped occurrence of nosocomial infections can be declared according to the prescribed surveillance of nosocomial infections (§23 IfSG) when, in the course of this assessment, a statistically significant increase in the rate of infections becomes apparent. On the other hand, the occurrence of an outbreak can also be recognized through the vigilance of all involved personnel and a general sensibilization towards this subject. The names of patients involved in outbreaks need not be reported to the responsible health authorities. As a consequence of the report the health authorities become involved in the investigation to determine the cause and its elimination, and to provide support and advice. The outbreak management should be oriented on the respective recommendations of the Robert Koch Institute.
    ains · Anästhesiologie · Intensivmedizin 04/2012; 47(4):238-9. · 0.39 Impact Factor
  • Clemens Kill, Wolfgang Dersch, Hinnerk Wulf
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    ABSTRACT: Artificial ventilation is one of the best known resuscitation procedures. It is generally accepted that there must be oxygen delivery to vital organs during cardiac arrest and resuscitation in order to prevent irreversible damage, but there is an increasing number of ventilation concepts for resuscitation. Traditional and alternative methods of ventilation are reviewed. The need for positive-pressure ventilation during resuscitation as an essential gold standard might be overestimated at least in the first minutes of cardiopulmonary resuscitation (CPR). The co-founders of the concept of cardiocerebral resuscitation could show positive effects of a sole passive oxygenation at the beginning of advanced life support (ALS). Research was published on continuous positive airway pressure (CPAP) ventilation as well as on CPAP plus pressure support ventilation. In addition to positive-pressure ventilation, the use of an impedance threshold device, partly in addition with active compression-decompression CPR, was investigated in both experimental and clinical settings. None of these methods alone could be proven to improve the outcome of cardiac arrest. The role of high oxygen concentration during CPR also remains unclear. Positive-pressure ventilation with pure oxygen remains, in clinical practice, the gold standard in ALS. Further research should focus on the role of passive oxygenation during early ALS. The concentration of oxygen needed during resuscitation has to be defined and alternative ventilation patterns, regarding the impact of CPR, should be investigated.
    Current opinion in critical care 03/2012; 18(3):251-5. · 2.67 Impact Factor
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    ABSTRACT: A 69-year-old woman reported that underwent endonasal frontal sinus surgery under general anesthesia. In her medical history the patient reports a multiple occurrence of angina pectoris attacks, especially in stressful situations. Coronary heart disease has so far been excluded. At preoperative presentation of this patient was in good general and nutritional state. Intraoperative hypotension had to be treated with norepinephrine. In the recovery room, the patient developed angina pectoris symptoms and the ECG showed T negativity. The patient was admitted on an ICU. Coronary angiography showed left ventricular apical ballooning with a transient akinesia typical of the left ventricle, as is seen in a Tako-Tsubo syndrome. The symptoms are similar to acute coronary artery disease, but without stenosis of coronary arteries. Physical or emotional stress is known to trigger Tako-Tsubo Syndrome, but the exact etiology or pathophysiology remains somewhat unclear.
    ains · Anästhesiologie · Intensivmedizin 01/2012; 47(1):22-4. · 0.39 Impact Factor

Publication Stats

677 Citations
304 Downloads
189.39 Total Impact Points

Institutions

  • 2008–2013
    • Universitätsklinikum Gießen und Marburg
      • • Klinik für Anästhesie und Intensivtherapie
      • • Klinik für Anästhesie und Operative Intensivmedizin
      Marburg, Hesse, Germany
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany
  • 2003–2013
    • Philipps-Universität Marburg
      • Klinik für Anästhesie und Intensivtherapie (Marburg)
      Marburg, Hesse, Germany