Hinnerk Wulf

Philipps University of Marburg, Marburg, Hesse, Germany

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Publications (137)229.19 Total impact

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    ABSTRACT: Introduction. Bacterial colonization of catheter tips is common in regional anesthesia and is a suspected risk factor for infectious complications. This is the first study evaluating the effect of CHG-impregnated dressings on bacterial colonization of regional anesthesia catheters in a routine clinical setting. Methods. In this prospective study, regional anesthesia catheter infection rates were examined in two groups of patients with epidural and peripheral regional catheters. In the first group, regional anesthesia was dressed with a conventional draping. The second group of patients underwent catheter dressing using a CHG-impregnated draping. Removed catheters and the insertion sites were both screened for bacterial colonization. Results. A total of 337 catheters from 308 patients were analysed. There was no significant reduction of local infections in either epidural or peripheral regional anesthesia catheters in both CHG and conventional groups. In the conventional group, 21% of the catheter tips and 41% of the insertion sites showed positive culture results. In the CHG-group, however, only 3% of the catheter tips and 8% of the insertion sites were colonised. Conclusion. CHG dressings significantly reduce bacterial colonization of the tip and the insertion site of epidural and peripheral regional catheters. However, no reductions in rates of local infections were seen.
    BioMed Research International 03/2015; 2015. DOI:10.1155/2015/149785
  • Anasthesiologie und Intensivmedizin 02/2015; 2015(56):S53.
  • Anasthesiologie und Intensivmedizin 02/2015; 2015(56):S49.
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    ABSTRACT: Adequate pain management is essential for preventing hemodynamic instability which can affect the perfusion of vital organs during the perioperative period, particularly in geriatric patients. For hip arthroplasty, peripheral nerve block is frequently used, limiting the adverse effects of opioid and non-opioid analgesics. The aim was to survey the impact of a supplementary single shot femoral nerve block (FNB) on hemodynamic stability and pain level.METHODS: After registration at German Clinical Trial Register (DRKS-ID): DRKS00000752. and Ethics Committee approval (University Hospital of Marburg), 80 patients who underwent elective hip surgery were included. Half of them were randomly assigned to receive a FNB followed by general anesthesia; a control group received only general anesthesia as standard procedure (STD). Blood pressure and heart rate were measured and recorded every five minutes during surgery and stay at the postanesthesia care unit (PACU). Fifty-two patients were included for statistical analysis. The FNB group had significantly lower systolic blood pressures during and after surgery and lower diastolic blood pressure postoperatively, heart rate, as well as opioid and non-steroidal anti-inflammatory consumption. Femoral nerve block improved perioperative hemodynamic stability mostly likely attributable to an overall reduced sympathico adrenergic tone.
    Technology and health care: official journal of the European Society for Engineering and Medicine 02/2015; DOI:10.3233/THC-150898
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    ABSTRACT: TASK-1 channels have emerged as promising drug targets against atrial fibrillation, the most common arrhythmia in the elderly. While TASK-3, the closest relative of TASK-1, was previously not described in cardiac tissue, we found a very prominent expression of TASK-3 in right human auricles. Transcriptional profiling revealed that TASK-3 in the human heart is also expressed at similar levels in the atria and sinoatrial node, while in the atrioventricular node and the ventricles TASK-3 expression levels were even more pronounced. Immunocytochemistry experiments of human right auricular cardiomyocytes showed that TASK-3 is primarily localized at the plasma membrane. Single-channel recordings of right human auricles in the cell-attached mode, using divalent-cation-free solutions, revealed a TASK-1-like channel with a single-channel conductance of about 30 pS. While homomeric TASK-3 channels were not found, we observed an intermediate single-channel conductance of about 55 pS, possibly reflecting the heteromeric channel formed by TASK-1 and TASK-3. Subsequent experiments with TASK-1/TASK-3 tandem channels or with co-expressed TASK-1 and TASK-3 channels in HEK293 cells or Xenopus oocytes, supported that the 55 pS channels observed in right auricles have electrophysiological characteristics of TASK-1/TASK-3 heteromers. In addition, co-expression experiments and single-channel recordings suggest that heteromeric TASK-1/TASK-3 channels have a predominant surface expression and a reduced affinity for TASK-1 blockers. In summary, the evidence for heteromeric TASK-1/TASK-3 channel complexes together with an altered pharmacologic response to TASK-1 blockers in vitro is likely to have further impact for studies isolating ITASK-1 from cardiomyocytes and for the development of drugs specifically targeting TASK-1 in atrial fibrillation treatment. Copyright © 2015. Published by Elsevier Ltd.
    Journal of Molecular and Cellular Cardiology 02/2015; 81. DOI:10.1016/j.yjmcc.2015.01.017
  • Infectious Disease in Clinical Practice 01/2015; 23(1):54-56. DOI:10.1097/IPC.0000000000000208
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    ABSTRACT: Perineural hematoma may occur during performance of peripheral nerve blocks. The aim of this study was to test the hypothesis that an iatrogenic hematoma in the immediate vicinity of a peripheral nerve may cause histologic evidence of nerve injury.
    Regional Anesthesia and Pain Medicine 10/2014; DOI:10.1097/AAP.0000000000000170
  • Klaus Kerwat, Hinnerk Wulf
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    ABSTRACT: Resistance against antibiotics is continuously increasing throughout the world and has become a very serious problem. For just this reason "Antibiotic Stewardship Programs" have been developed. These programs are intended to lead to a sustained improvement in the situation and to assure a rational practice for the prescription of anti-infective agents in medical facilities. The aim is to prescribe the correct antibiotic therapy to the right patient at the most appropriate point in time. An AWMF S3 guideline on this topic published by the German Society for Infectiology (S3-Leitlinie StrategienzurSicherungrationalerAntibiotika-AnwendungimKrankenhaus.AWMF-Registernummer 092/001 - S3 Guideline on Strategies for the Rational Use of Antibiotics in Hospitals. AWMF - Registry Number 092/001) has been available since the end of 2013. An essential aspect therein is the expert interdisciplinary cooperation of a team comprising a clinically experienced infectiologist, a hospital pharmacist and a consultant for microbiology.
  • ains · Anästhesiologie · Intensivmedizin 08/2014; 49(07/08):484-487. DOI:10.1055/s-0034-1386711
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    ABSTRACT: Ehlers-Danlos syndrome (EDS, ORPHA98249) comprises a group of clinically and genetically heterogeneous heritable connective tissue disorders, chiefly characterized by joint hypermobility and instability, skin texture anomalies, and vascular and soft tissue fragility. As many tissues can be involved, the underlying molecular defect can manifest itself in many organs and with varying degrees of severity, with widespread implications for anesthesia and perioperative management. This review focuses on issues relevant for anesthesia for elective and emergency surgery in EDS. We searched the literature for papers related to all EDS variants; at the moment most of the published data deals with the vascular subtype and, to a lesser extent, classic and hypermobility EDS. Knowledge is fragmented and consists mostly of case reports, small case series and expert opinion. Because EDS patients commonly require surgery, we have summarized some recommendations for general, obstetrical and regional anesthesia, as well as for hemostatic therapy.
    Orphanet Journal of Rare Diseases 07/2014; 9(1):109. DOI:10.1186/s13023-014-0109-5
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    ABSTRACT: Purpose of review Neural toxicity of substances injected into the intrathecal space has been a matter of debate since the introduction of spinal anesthesia in clinical practice. In recent years, new local anesthetics and adjuvants have been proposed for intrathecal use, and new techniques such as the use of ultrasound have been propagated. The present review summarizes recent clinical and experimental data on the neurotoxic effects of drugs and substances used for or in conjunction with spinal anesthesia. Recent findings Chloroprocaine has been demonstrated to be associated with a lower risk of transient neurologic symptoms compared with lidocaine. However, despite extensive research, the issue of chloroprocaine or bisulfite neurotoxicity has not yet been resolved. Recent experimental data have identified a smaller neurotoxic potential for ropivacaine compared to levobupivacaine, procaine and bupivacaine. The addition of epinephrine has not been shown to increase lidocaine neurotoxicity. In-vivo experimental data suggest that lidocaine and bupivacaine neurotoxicity is not enhanced in diabetic patients. Furthermore, intrathecal introduction of aqueous ultrasound gel has been demonstrated to cause a distinct neuroinflammatory reaction. Finally, a large cohort study did not find the use of chlorhexidine gluconate for skin disinfection before neuraxial block to be associated with the risk of adhesive arachnoiditis. Summary Clinical data suggest a high safety profile for intrathecal drugs and substances used for or in conjunction with spinal anesthesia. Recent experimental models for toxicity have provided further insight into the mechanisms and demonstrated possible, albeit clinically small differences in the relative neurotoxic potential of intrathecal drugs. This may contribute to a further increase in the safe use of spinal anesthesia in the clinical setting.
    Current Opinion in Anaesthesiology 07/2014; 27(5). DOI:10.1097/ACO.0000000000000108
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    ABSTRACT: The standards of treatment of patients suffering cardiac arrest is defined by international guidelines for cardiopulmonary resuscitation, that are updated every five years. Scientific knowledge is continuously increasing and recent studies should be considered and discussed to improve the results of daily emergency care. There are some leading topics of the ongoing discussion concerning airwaymanagement, mechanical ventilation, mechanical cpr-devices and extracorporal life support. The strategies of postresuscitation care are also in the focus of interest. This review presents and discusses the value of recent investigations on resuscitation science.
  • Resuscitation 05/2014; 85:s29-20. DOI:10.1016/j.resuscitation.2014.03.080
  • Klaus Kerwat, Marcel Goedecke, Hinnerk Wulf
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    ABSTRACT: Vaccinations are among the most efficient and important preventive medical procedures. Modern vaccines are well tolerated. In Germany there are no longer laws for mandatory vaccinations, either for the general public or for medical personnel. Vaccinations are now merely "officially recommended" by the top health authorities on the basis of recommendations from the Standing Committee on Vaccinations (STIKO) of the Robert Koch Institute (RKI) according to § 20 para 3 of the Protection against Infection law (IfSG). The management of vaccine damage due to officially recommended vaccinations is guaranteed by the Federal States. Whereas vaccinations in childhood are generally considered to be a matter of course, the willingness to accept them decreases markedly with increasing age. In the medical sector vaccinations against, for example, hepatitis B are well accepted while other vaccinations against, for example, whooping cough or influenza are not considered to be so important. The fact that vaccinations, besides offering protection for the medical personnel, may also serve to protect the patients entrusted to medical care from nosocomial infections is often ignored.
  • Klaus Kerwat, Hinnerk Wulf
    04/2014; 3(01):50-54. DOI:10.1055/s-0034-1372240
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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; DOI:10.1213/ANE.0b013e3182a94454
  • 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. DOI:10.1055/s-0033-1361976
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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; 42(2). DOI:10.1097/CCM.0b013e3182a63fa0
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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. DOI:10.1016/j.resuscitation.2013.08.052
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    Resuscitation 10/2013; 84:S62. DOI:10.1016/j.resuscitation.2013.08.159

Publication Stats

1k Citations
229.19 Total Impact Points

Institutions

  • 2003–2015
    • Philipps University of Marburg
      • Klinik für Anästhesie und Intensivtherapie (Marburg)
      Marburg, Hesse, Germany
  • 2008–2014
    • Universitätsklinikum Gießen und Marburg
      • • Klinik für Anästhesie und Intensivtherapie
      • • Klinik für Anästhesie und Operative Intensivmedizin
      Marburg, Hesse, Germany
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany