G Marx

RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany

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Publications (199)666.9 Total impact

  • Gernot Marx · Rainer Beckers
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 08/2015; DOI:10.1007/s00103-015-2232-4 · 1.42 Impact Factor
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    ABSTRACT: The demographic challenge of the ageing society is associated with increasing comorbidity. On the other hand, there will be an ageing workforce in medicine, resulting in an imbalance between the demand and supply of medical care in the near future. In rural areas in particular, this imbalance is already present today. Based on three best practice projects carried out by our telemedical center in Aachen, including emergency medicine, intensive care medicine, and the rehabilitation planning of geriatric trauma care, some experience and the potential of the intersectoral provision of care, supported by telemedicine, are demonstrated. Telemedicine is the provision of medical services over a geographical distance by using tele-communication and data transfer. It has been proven to ensure a constant quality of health care. Telemedical support enables shared expertise independent of time and space, and allows efficient allocation of resources. A review of international experience supports this notion.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 08/2015; DOI:10.1007/s00103-015-2224-4 · 1.42 Impact Factor
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    ABSTRACT: In view of demographic changes over the past few decades, the average age of trauma patients is progressively increasing. We therefore aimed to summarize the specific characteristics of geriatric trauma and to identify potential fields for further research to improve the care of elderly trauma patients. Review of the literature. Due to the diverse risk factors (e.g., pre-existing conditions, limited physiological reserve), geriatric patients are prone to developing severe complications, even after less severe trauma. Yet, age is not considered as the only predictor of worse outcomes, and it should not be considered the only criterion for limiting care in those patients. It is crucial that age-specific treatment guidelines are developed to optimize the outcomes for senior trauma patients. Based on the current literature, these guidelines should emphasize the importance of field triage directly to a trauma center, along with the activation of the trauma team. Furthermore, early intensive monitoring, aggressive resuscitation, and time of surgical intervention are of upmost importance to reduce mortality. The impact of several factors [age, premedical conditions (PMC), decreased physiological reserves, and impaired immune function] on the post-traumatic course of elderly trauma patients needs to be clarified in future experimental and clinical studies for the early identification of geriatric high-risk patients and for the development of age-adapted therapeutic strategies.
    European Journal of Trauma and Emergency Surgery 08/2015; DOI:10.1007/s00068-015-0557-1 · 0.35 Impact Factor
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    ABSTRACT: Patients and medical staff are exposed to high noise levels in ICUs, which may have a negative impact on their health. Due to the diversity of noise sources present, including the operating noise of medical devices, staff conversations and the unwrapping of disposables, noise profiles are varied. Psychoacoustics deals with the analysis of sound, focusing on its effects on physiological perception and stress. The aim of our study was to examine and to classify noise and its psychoacoustic properties in different locations in our ICU at different times. The impact of noise on subjective parameters and stress-related physiological data was also assessed with and without interventional methods. A randomised, controlled, single-blinded clinical trial SETTING: University Hospital, from November 2010 to May 2011. One hundred and forty-four patients in the ICU. In the first part, multidisciplinary psychoacoustic measurement was performed on the patients in our ICU. In the subsequent clinical trial, patients were equipped with effective earplugs, less effective earplugs and no earplugs. Thereafter, active noise cancellation headphones with or without sound masking were employed on a third patient population. Cortisol and α-amylase in saliva, skin conductance measures, vital signs, psychoacoustic analyses and two standardised questionnaires [State-Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Scale (HADS)] were assessed. In the first part, the mean ± standard deviation (SD) subjective loudness was 9.2 ± 4.0 sone. Although absolute sound pressure level and loudness were lower during the night, the number of loud events increased significantly. Skin conductance in the earplug groups was significantly reduced in comparison to that in the control population but not the active noise reduction groups. Nevertheless, noise reduction was found to be comfortable for most patients. Noise in the ICU is of high clinical relevance. Diverse noise reduction methods, such as earplugs and active noise cancellation, are available. The avoidance of unnecessary noise, however, should be the primary focus. German Clinical Trials Register (DRKS00000534).
    European Journal of Anaesthesiology 07/2015; DOI:10.1097/EJA.0000000000000313 · 2.94 Impact Factor
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    ABSTRACT: Myocardial dysfunction in sepsis has been linked to inflammation caused by pathogen-associated molecular patterns (PAMPs) as well as by host danger-associated molecular patterns (DAMPs). These include soluble heparan sulfate (HS), which triggers the devastating consequences of the pro-inflammatory cascades in severe sepsis and septic shock. Thus, there is increasing interest in the development of anti-infective agents, with effectiveness against both PAMPs and DAMPs. We hypothesized that a synthetic antimicrobial peptide (peptide 19-2.5) inhibits inflammatory response in murine cardiomyocytes (HL-1 cells) stimulated with PAMPs, DAMPs or serum from patients with septic shock by reduction and/or neutralization of soluble HS. In the current study, our data indicate that the treatment with peptide 19-2.5 decreases the inflammatory response in HL-1 cells stimulated with either PAMPs or DAMPs. Furthermore, our work shows that soluble HS in serum from patients with Gram-negative or Gram-positive septic shock induces a strong pro-inflammatory response in HL-1 cells, which can be effectively blocked by peptide 19-2.5. Based on these findings, peptide 19-2.5 is a novel anti-inflammatory agent interacting with both PAMPs and DAMPs, suggesting peptide 19-2.5 may have the potential for further development as a broad-spectrum anti-inflammatory agent in sepsis-induced myocardial inflammation and dysfunction.
    PLoS ONE 05/2015; 10(5):e0127584. DOI:10.1371/journal.pone.0127584 · 3.23 Impact Factor
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    ABSTRACT: Zinc is crucial for immune function. In addition, the redistribution of zinc and other nutrients due to infection is an integral part of the host immune response to limit availability to pathogens. However, the major zinc binding protein albumin is down regulated during the acute phase response, implicating a decrease in zinc binding capacity. A prospective animal study with eight female German landrace pigs was conducted to investigate alterations in zinc binding capacity, total serum zinc and free zinc levels in the initial phase of sepsis. Sepsis was induced by instillation of autologous feces via midline laparotomy. Total serum zinc declined significantly after 1 h (10.89 ± 0.42 µM vs. 7.67 ± 0.41 µM, p < 0.001), total serum copper and iron reached a significant reduction at 4 h. Urinary excretion of zinc declined in line with total serum zinc. In comparison to total serum zinc, free zinc levels declined to a lesser, though significant, extent. Zinc binding capacity of serum decreased over time, whereby free zinc levels after addition of zinc correlated negatively with total serum protein and albumin levels. In addition IL-6 and TNF-α concentrations were measured and increased significantly 2 h after induction of sepsis. Hence, total serum zinc was the first marker of inflammation in our experiment, and might therefore be a promising biomarker for the early diagnosis of sepsis. Furthermore the observation of a substantially different serum free zinc homeostasis during sepsis provides valuable information for a potential therapeutic zinc supplementation, which has to take buffering capacity by serum proteins into account.
    Biology of Metals 05/2015; 28(4). DOI:10.1007/s10534-015-9858-4 · 2.50 Impact Factor
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    ABSTRACT: Background: Intensive care medicine (ICM) is a key discipline in medicine, but nonetheless only few topics are inte grated in undergraduate curricula. Students are easily overwhelmed by the complexity of ICM. Because of an unpredictable workload and regular intermissions, student tutoring by physicians in ICM clerkships is very difficult and can hardly be structured. The previous knowledge of ICM seems to be less detailed than in other medical disciplines. Peer-assisted learning (PAL) is a well-known and reliable concept of learning and teaching. During ICM clerkships PAL might be a useful approach to give students the opportunity of receiving continuous tutoring. Furthermore, it offers students the chance to become more acquainted with the theory and practice in intensive care medicine. Methods: During their practical clerkships the medical students in their fourth and fifth year spend a period of four weeks with clerkships in the fields of anaesthesiology, intensive care medicine and emergency medicine. The PAL concept was implemented and evaluated as a part of this scheme. Learning objectives were defined by experienced medical teachers. Student-tutors were selected as peer tutors and trained by physicians concerning skills and knowledge about the procedures in an intensive care unit (ICU). Furthermore, they were taught basic didactical principles. All participants were assigned to two groups, i.e. a PAL group, who had peer tutors and a control group (KG) without PAL. Instead of PAL, the members of the control group took part an additional seminar led by an experienced ICU physician. For evaluation purposes, questionnaires regarding knowledge acceptance and course rating were developed. Results: A structured PAL concept was developed for clinical clerkship in ICM. During the last academic year, 221 students participated in this clerkship. Data from 142 students (61% female, 39% male: age mean 24.1, SD±2.1) were collected. The control/reference group consisted of 83, the PAL group of 59 participants. Independent of their respective group affiliations, both groups rated the clerkship as positive. There were no differences in knowledge, familiarity with ward procedures and course rating. More than 90% of the medical teachers evaluated the PAL concept as beneficial, whereas 60% considered teaching without peers to interfere with patient care and daily work. PAL was rated as positive in terms of the students' learning achievement. The majority (96%) of medical teachers advocated for the continuation of PAL during ICU clerkship. Conclusion: The implementation of PAL in ICU clerkship works well, and there is a high acceptance among both students and medical teachers. The students' view was more critical than that of the teachers. Nonetheless, the PAL concept is a considerable opportunity to implement clerkship in an ICU. The PAL concept also preserves/saves the resources of a professional teacher on ward. On the whole, the PAL concepts received a good evaluation by the participating students and medical teachers. The transferability of this study to other areas of university teaching seems possible and should be examined in future studies.
    Anasthesiologie und Intensivmedizin 05/2015; 56(5):206-215. · 1.09 Impact Factor
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    ABSTRACT: Ventilator-induced diaphragmatic dysfunction is associated with the generation of oxidative stress, enhanced proteolysis, autophagy and reduced protein synthesis in the diaphragm. Sevoflurane is a common operating room anesthetic and can be used in the intensive care medicine as well. Besides its anesthetic properties, its use in cardiac ischemia-reperfusion models can maintain protein synthesis and inhibit generation of reactive oxygen species, if used at the beginning of heart surgery. This study has been performed on the hypothesis that sevoflurane might protect against ventilator-induced diaphragmatic dysfunction by preventing the production of oxidative stress. Four-month-old, male Sprague-Dawley rats sedated with sevoflurane (minimal alveolar concentration = 1) were either mechanically ventilated (MV) for 12 hours (n = 8) or allowed to breathe spontaneously (SB) for 12 hours (n = 8). An acutely anesthetized group was used as a control (Con) group (n = 8). After euthanization, diaphragmatic contractile properties, fiber cross-sectional areas, proteolysis (calpain-1 and caspase-3), and oxidative stress (lipid peroxidation, protein oxidation) were examined. After testing for normality, 1-way or 2-way analysis of variance with the Dunnett post hoc test was used to test for significance. The diaphragm contractile force was similarly reduced at all stimulation frequencies in the SB and MV groups compared with controls. Markers of oxidative stress and fiber cross-sectional areas were unaltered between Con and SB/MV, respectively. The calcium-dependent proteases (calpain-1 and caspase-3) were enhanced in the MV group. The p-AKT/AKT ratio and p-FoxO1/FoxO1 ratio were significantly and similarly reduced after sevoflurane exposure in the SB and MV group compared with Con group. Exposure to sevoflurane did not induce oxidative stress. It led to reduction in diaphragmatic force. In the MV group, sevoflurane led to the activation of atrophy signaling pathways. These findings are of particular importance for clinical utilization in intensive care units and question its use, especially during the phases of SB.
    Anesthesia and analgesia 04/2015; 121(1). DOI:10.1213/ANE.0000000000000736 · 3.47 Impact Factor
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    G Marx
    Medizinische Klinik - Intensivmedizin und Notfallmedizin 03/2015; 110(2). DOI:10.1007/s00063-015-0004-4 · 0.56 Impact Factor
  • C S Bruells · A Schindler · G Marx
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    ABSTRACT: Besides albumin, which is gained from human donors, synthetic colloids have been playing a dominant role in treating patients in shock and are standard therapy in intensive care units (ICU). Since the publication of large randomized controlled trials indicating negative effects on renal function, their use has been questioned, especially for hydroxyethyl starch products. The preliminary assumption that these side effects are only existent in first or secondary generation starch fluids was proven incorrect. In fact, the use of hydroxyethyl starch products in critically ill patients is prohibited by the European Medicines Agency. Several methodological limitations exist in each of these trials that limit the evidence value of these investigations, although they served as the basis for the negative judgment of the European Medicines Agency. In addition, a large randomized controlled trial on the efficacy of gelatin is lacking. The use of colloids in ICU patients is indicated in cases where crystalloid volume therapy is inadequate. Especially during the first 6 h of sepsis, when aggressive volume therapy is decisive for patient outcome, colloids may be relevant to increase patient survival. The latest guideline on treatment with colloids has been published in the German S3 guideline "Intravascular volume therapy in adults."
    Medizinische Klinik - Intensivmedizin und Notfallmedizin 03/2015; 110(2). DOI:10.1007/s00063-015-0005-3 · 0.56 Impact Factor
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    ABSTRACT: Background and Object: In recent years there has been a growing number of innovative concepts applying to vocational training, advanced professional training, and continuing further qualifications. As yet, only few structured and evaluated projects existed, especially as far as the field of advanced professional training is concerned. The Aachen clinical mentor concept is an advanced professional training curriculum in anaesthesiological intensive care medicine. Its effects were examined in our pilot study. Methods: A structured concept for the advanced professional training of approx. 40 assistant physicians was implemented. This included that the planning and organization of structured advanced professional training elements was to be organized by a medical specialist. It consisted of a structural-administrative (assistance, writing of preferential duty rosters, scripts), content-specific theoretical (relevant literature, journal clubs) and content-specific practical measures (checklist skills, training programme and checklist application). The impact of our concept was reviewed with the aid of a questionnaire in pre-post design. The questionnaire was filled out before (t1) and nine months after concept implementation (t2). Results: The statistical evaluation included 37 questionnaires. Six questions belonging to the structural-administrative subject complex resulted in significant opinion changes in the assistant in charge of advanced professional training (e.g. more positive opinion preparation of activity). Significant changes were determined as a result of five questions belonging to the content-specific theoretical subject complex (e.g. more positive opinion knowledge or self-assuredness when writing discharge letters). In addition, a significantly more positive opinion concerning 7 items of self-assessment in practical skills was noticed. A significantly more positive estimation of 10 questions related to the work-life balance" was registered as well. Conclusions: The implementation of a clinical mentorship concept in a surgical intensive medical care unit of a university hospital was able to significantly improve both the self-assessment of the employees concerning their own clinical skills and their contentedness with the advanced professional training programme. Hence there is good reason to assume that a further exploration of this concept will be applicable at other locations.
    Anasthesiologie und Intensivmedizin 03/2015; 56(3):112-118. · 1.09 Impact Factor
  • M Dreher · N Marx · G Marx · J Bickenbach
    Pneumologie 02/2015; 69(S 01). DOI:10.1055/s-0035-1544885
  • ains · Anästhesiologie · Intensivmedizin 02/2015; 50(2):77-77. · 0.44 Impact Factor
  • Gernot Marx
    ains · Anästhesiologie · Intensivmedizin 02/2015; 50(2):112-112. · 0.44 Impact Factor
  • G. Marx · A. W. Schindler
    Der Anaesthesist 01/2015; 64(1):71-71. DOI:10.1007/s00101-014-2405-9 · 0.76 Impact Factor
  • 01/2015; 3(Suppl 1):A256. DOI:10.1186/2197-425X-3-S1-A256
  • Der Gynäkologe 01/2015; 48(1). DOI:10.1007/s00129-014-3489-7
  • 01/2015; 3(Suppl 1):A302. DOI:10.1186/2197-425X-3-S1-A302
  • 01/2015; 3(Suppl 1):A516. DOI:10.1186/2197-425X-3-S1-A516

Publication Stats

2k Citations
666.90 Total Impact Points


  • 2009–2014
    • RWTH Aachen University
      • • Klinik für Operative Intensivmedizin und Intermediate Care
      • • Department of Anaesthesiology
      Aachen, North Rhine-Westphalia, Germany
  • 2008–2014
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany
  • 1996–2012
    • Hannover Medical School
      • Clinic for Anaesthesiology and Intensive Care Medicine
      Hanover, Lower Saxony, Germany
  • 2004–2011
    • Friedrich-Schiller-University Jena
      • • Clinic of General, Visceral and Vascular Surgery
      • • Department of Anaesthesiology and Intensive Care Medicine
      Jena, Thuringia, Germany
  • 2006–2008
    • Universitätsklinikum Jena
      • Klinik für Anästhesiologie und Intensivmedizin
      Jena, Thuringia, Germany
  • 2001–2005
    • Royal Liverpool and Broadgreen University Hospitals NHS Trust
      • Department of Anaesthesia
      Liverpool, England, United Kingdom
    • University of Liverpool
      • Department of Clinical Sciences
      Liverpool, England, United Kingdom