Aileen Hill

University Hospital RWTH Aachen · Departments of Anesthesiology and Intensive Care

Background Recent data from the randomized SUSTAIN CSX trial could not confirm clinical benefits from perioperative selenium treatment in high-risk cardiac surgery patients. Underlying reasons may involve inadequate biosynthesis of glutathione peroxidase (GPx3), which is a key mediator of selenium's antioxidant effects. This secondary analysis aime...

Background A recent large multicentre trial found no difference in clinical outcomes but identified a possibility of increased mortality rates in patients with acute kidney injury (AKI) receiving higher protein. These alarming findings highlighted the urgent need to conduct an updated systematic review and meta-analysis to inform clinical practice....

Zusammenfassung Das Mutterschutzgesetz soll die Mutter und das Kind vor Gefahren, Überforderung und Gesundheitsschädigung am Arbeitsplatz ebenso wie vor finanziellen Einbußen und dem Verlust des Arbeitsplatzes schützen. Allerdings werden die mit dem Mutterschutzgesetz definierten Ziele der Sicherheit und Gesundheit der schwangeren Mitarbeiterin ein...

In Anbetracht des zunehmenden Fachkräftemangels in der Intensivmedizin gilt es, umgehend Maßnahmen zu ergreifen, um auch zukünftig eine gute Versorgungsqualität sowie die Fokussierung der Behandlung auf Patient*innenwohl und -sicherheit gewährleisten zu können. Besondere Bedeutung erlangt hierbei die nachhaltige Gewinnung und Bindung qualifizierter...

Background Evidence on the benefits of fiber-supplemented enteral nutrition (EN) in critically ill patients is inconsistent, and critical care nutrition guidelines lack recommendations based on high-quality evidence. This systematic review and meta-analysis (SRMA) aims to provide a current synthesis of the literature on this topic. Methods For thi...

Introduction: In an acute heart failure setting, proenkephalin A 119–159 (penKid) has emerged as a promising prognostic marker for predicting acute kidney injury (AKI) while bioactive adrenomedullin (bio-ADM) has been proposed as a potential marker for congestion. Research questions: This raises the question of whether they can serve as predictive...

Bei der Ernährung von Intensivpatienten spielt eine adäquate Zufuhr von Energie und Nährstoffen eine wesentliche Rolle. Optimaler Zeitpunkt, Dosierung und Zusammensetzung der Nährstoffzufuhr sind immer wieder Gegenstand kontroverser Diskussionen. Der folgende Beitrag gibt einen praxisrelevanten Überblick über ausgewählte Aspekte der medizinischen E...

Malnutrition plays a crucial role as a risk factor in patients undergoing major abdominal surgery. To mitigate the risk of complications, nutritional prehabilitation has been recommended for malnourished patients and those at severe metabolic risk. Various approaches have been devised, ranging from traditional short-term conditioning lasting 7–14 d...

The Maternity Protection Act is intended to protect the mother and the child from hazards, excessive demands and damage to health in the workplace, and from financial disadvantages and loss of employment. However, the objectives defined by the Maternity Protection Act—the safety and health of the pregnant employee on the one hand and the prevention...

Background CONCISE is an internationally agreed minimum set of outcomes for use in nutritional and metabolic clinical research in critically ill adults. Clinicians and researchers need to be aware of the clinimetric properties of these instruments and understand any limitations to ensure valid and reliable research. This systematic review and meta-...

Background: CONCISE is an internationally agreed minimum set of outcomes for use in nutritional and metabolic clinical research in critically ill adults. Clinicians and researchers need to be aware of the clinimetric properties of these instruments and understand any limitations to ensure valid and reliable research. This systematic review and meta...

Objectives: Evidence supporting glutamine supplementation in severe adult burn patients has created a state of uncertainty due to the variability in the treatment effect reported across small and large randomized controlled trials (RCTs). We aimed to systematically review the effect of glutamine supplementation on mortality in severe adult burn pa...

Zusammenfassung Dieses zweite Positionspapier der Sektion Metabolismus und Ernährung der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI) gibt Empfehlungen zum laborchemischen Monitoring der Makro- und Mikronährstoffzufuhr sowie zum Einsatz der indirekten Kalorimetrie im Rahmen der medizinischen Ernährungstherapie er...

A comment on three large international studies on the medical nutrition therapy of critically ill patients in the ICU

Commenting Protein Optimum in Intensive Care

Introduction Various clinical scores have been developed to predict organ dysfunction and mortality in patients undergoing cardiac surgery, but outcome prediction may be inaccurate for some patient groups. Proenkephalin A (penKid) and bioactive adrenomedullin (bio-ADM) have emerged as promising biomarkers correlating with shock and organ dysfunctio...

Many critically ill patients are vitamin D and vitamin C deficient and the current international guidelines state that hypovitaminoses should be compensated. However, uncertainty about optimal dosage, timing and indication exists in clinical routine, mainly due to the conflicting evidence. This narrative review discusses both micronutrients with re...

Micronutrient supplementation as part of the medical nutrition therapy for critically ill patients has received much attention in the past few years. Nevertheless, in clinical practice uncertainty remains about the optimal supplementation strategy, including which substance at which dosage should be administered at what time to specific groups of p...

Zusammenfassung Die Ernährungstherapie des einzelnen Intensivpatienten stellt im klinischen Alltag oft eine Herausforderung dar: Nicht nur die Schwere der akuten Erkrankung – auch das Alter, Komorbiditäten, Ernährungszustand und der erwartete Verlauf sind zu berücksichtigen. Dieser Beitrag beschreibt basierend auf nationalen und internationalen Lei...

Patients receiving extracorporeal membrane oxygenation (ECMO) inherit substantial disease-associated metabolic, endocrinologic, and immunologic modifications. Along with the technical components of ECMO, the aforementioned alterations may affect patients' needs and feasibility of adequate macronutrient and micronutrient supply and intake. Thus, pat...

Background: Prehabilitation is gaining increasing interest and shows promising effects on short- and long-term outcomes among patients undergoing major surgery. The effect of multimodal, interdisciplinary prehabilitation has not yet been studied in patients with severe heart failure scheduled for the implantation of a left-ventricular assist device...

In 1747, an important milestone in the history of clinical research was set, as the Scottish surgeon James Lind conducted the first randomized controlled trial. Lind was interested in scurvy, a severe vitamin C deficiency which caused the death of thousands of British seamen. He found that a dietary intervention with oranges and lemons, which are r...

Background Clinical research on nutritional and metabolic interventions in critically ill patients is heterogenous regarding time points, outcomes and measurement instruments used, impeding intervention development and data syntheses, and ultimately worsening clinical outcomes. We aimed to identify and develop a set of core outcome domains and asso...

Objectives: Concise definitive review of how to read and critically appraise a systematic review. Data sources: None. Study selection: Current literature describing the conduct, reporting, and appraisal of systematic reviews and meta-analyses. Data extraction: Best practices for conducting, reporting, and appraising systematic review were su...

We thank Vargas et al (1) for their interest in our recently published study in Critical Care Medicine (2). By analyzing the fragility index (FI) of all randomized controlled trials (RCTs) included in our systematic review and performing a trial sequential analysis (TSA) of our meta-analysis of overall mortality, they agreed with our position that...

Background: Clinical research on nutritional and metabolic interventions in critically ill patients is heterogenous regarding time points, outcomes and measurement instruments used, impeding intervention development and data syntheses, and ultimately worsening clinical outcomes. We aimed to identify and develop a set of core outcome domains and ass...

Zusammenfassung Die Erhebung des Ernährungsstatus zum Zeitpunkt der Aufnahme im Intensiv- oder Intermediate Care Bereich hat sowohl prognostische als auch therapeutische Relevanz im Hinblick auf die Planung einer individualisierten medizinischen Ernährungstherapie (engl. „medical nutrition therapy“, MNT). Diese Planung wird im Rahmen der Erstversor...

Background Parenteral lipid emulsions in critical care are traditionally based on soybean oil (SO) and rich in pro-inflammatory omega-6 fatty acids (FAs). Parenteral nutrition (PN) strategies with the aim of reducing omega-6 FAs may potentially decrease the morbidity and mortality in critically ill patients. Methods A systematic search of MEDLINE,...

Background: Systemic inflammation and oxidative stress remain the main cause of complications in heart failure patients receiving a left ventricular assist device (LVAD). Selenoproteins are a cornerstone of antioxidant defense mechanisms for improving inflammatory conditions. Methods: We conducted a monocentric double-blinded, randomized pilot t...

Objectives: To conduct a systematic review and meta-analysis to evaluate the impact of IV vitamin C on outcomes in critically ill patients. Data Sources: Systematic search of MEDLINE, EMBASE, CINAHL, and the Cochrane Register of Controlled Trials. Study Selection: Randomized controlled trials testing IV vitamin C in critically ill patients....

Background: While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. Methods: Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient gr...

Background: Uncertainty remains about the best route and timing of medical nutrition therapy in the acute phase of critical illness. Early combined enteral (EN) and parenteral nutrition (PN) may represent an attractive option to achieve recommended energy and protein goals in select patient groups. This meta-analysis aims to update and summarize th...

Background: Uncertainty remains about the best route and timing of medical nutrition therapy in the acute phase of critical illness. Early combined enteral (EN) and parenteral nutrition (PN) may represent an attractive option to achieve recommended energy and protein goals in select patient groups. This meta-analysis aims to update and summarize t...

Cardiac surgery (CSX) can be lifesaving in elderly patients (age ≥ 80 years) but may still be associated with complications and functional decline. Frailty represents a determinant to outcomes in critically ill patients, but little is known about its influence on elderly CSX-patients. This is a secondary exploratory analysis of a multi-center, pros...

The authors thank the readers for pointing out the issues [1] in their publication [2], and wish to make a correction in the published version of their paper as the response of the readers' Comment. p-values have been corrected in the following parts of the paper.

This review provides an overview for health care teams involved in the perioperative care of cardiac surgery patients. The intention is to summarize key determinants of delirium, its impact on short- and long-term outcomes as well as to discuss effective management strategies. The first component of this review examines the prevalence and the facto...

Introduction There is a need to improve the efficiency of clinical trials in burn care. The objective of this study was to validate “Persistent Organ Dysfunction” (POD) plus death as endpoint in burn patients and to demonstrate its statistical efficiency. Methods This secondary outcome analysis of a dataset from a prospective international multice...

Cardiac surgery is performed more often in a population with an increasing number of comorbidities. Although these surgeries can be lifesaving, they disturb homeostasis and may induce a temporary overall loss of physiologic function. The required postoperative intensive care unit and hospital stay often lead to a mid- to long-term decline of nutrit...

Although nutritional support belongs to the key components of intensive care treatment, it still remains largely inadequate in the postoperative treatment of cardiac surgery patients. Ong et al demonstrated in their observational study that patients with complicated postoperative courses had an increased need for an intense postoperative nutrition...

While medical nutrition therapy is an essential part of the care for critically ill patients, uncertainty exists about the right form, dosage, timing and route in relation to the phases of critical illness. As enteral nutrition (EN) is often withheld or interrupted during the ICU stay, combined EN and parenteral nutrition (PN) may represent an effe...

Medical nutrition therapy in daily intensive care often is challenging for the clinician. The severity of disease with possible compromises of conscience, hemodynamics, respiration, renal and gastrointestinal systems requires an individual adaptation of the nutrient-supply adjusted to the disease phase and secondary metabolic tolerance. For these a...

Background The ethical framework for fluid management in the palliative care setting can vary. Objectives What are the relevant ethical implications related to dehydration during end-of-life care and what are the special requirements we need to consider as far as “terminal dehydration” is concerned? Materials and methods A comprehensive literatur...

Background: The legal framework for fluid management in the palliative care setting varies between continents and even between countries. Objectives: What legal implications must be taken into account in Germany in dealing with "terminal" dehydration? Materials and methods: Relevant publications in English and German have been identified. Nota...

Background: Oxidative stress contributes to organ dysfunction after cardiac surgery and still represents a major problem. Antioxidants, such as vitamins C and E might be organ protective. Methods: The primary objective of this prospective observational study was the description to evaluate the perioperative vitamin C and E levels in 56 patients...

Background: Cardiac surgery is associated with oxidative stress and systemic inflammation, which both contribute to postoperative organ dysfunction. Vitamin C is a pleiotropic, antioxidant, and potentially organ-protective micronutrient. Past clinical trials and meta-analyses have focused predominantly on occurrence of postoperative atrial fibrill...

Rationale: A combination of enteral nutrition (EN) and parenteral nutrition (PN) may avoid large nutrition debts in critically ill patients. One strategy is the combined use of EN and PN (EN+PN) starting early after admission to the intensive care unit. Another possibility is the early initiation of EN with delayed start of supplemental PN if the n...

Systemic and localized ischemia and reperfusion injury remain clinically relevant issues after organ transplantation and contribute to organ dysfunctions, among which acute kidney injury is one of the most common. An in vitro test-circuit for normothermic perfusion of porcine kidneys after warm ischemia was used to investigate the antioxidant prope...

Background Cardiovascular surgery patients with a prolonged intensive care unit (ICU) stay may benefit most from early nutrition support. Using established scoring systems for nutrition assessment and operative risk stratification, we aimed to develop a model to predict a prolonged ICU stay ≥5 days in order to identify patients who will benefit fro...

Background & aims: Recent studies indicate that vitamin D deficiency is associated with increased morbidity and mortality in critically ill patients. Knowledge about the functional role and clinical relevance of vitamin D for patients undergoing cardiac surgery is sparse. Therefore, we investigated the clinical significance of vitamin D levels on...

Vitamin C, an enzyme cofactor and antioxidant, could hasten the resolution of inflammation, oxidative stress, and microvascular dysfunction. While observational studies have demonstrated that critical illness is associated with low levels of vitamin C, randomized controlled trials (RCTs) of vitamin C, alone or in combination with other antioxidants...

The pleiotropic biochemical and antioxidant functions of vitamin C have sparked recent interest in its application in intensive care. Vitamin C protects important organ systems (cardiovascular, neurologic and renal systems) during inflammation and oxidative stress. It also influences coagulation and inflammation; its application might prevent organ...

Objectives: The first aim was the development of a human blood miniature mock-loop system consisting of 2 identical extracorporeal circuits, which enable systematic head-to-head comparisons of test substances. In a second step, we evaluated the suitability of the mock-loop system, by comparing 2 different brands of heparin (ROTEXMEDICA vs B.BRAUN)...

The pleiotropic biochemical and antioxidant functions of Vitamin C (Vit C) have recently sparked interest in its application in intensive care. Vit C protects important organ systems such as the cardiovascular, neurologic and renal system during inflammation and oxidative stress. Vit C also influences the systems of coagulation and inflammation and...

Zusammenfassung Der präoperative Ernährungsstatus und die perioperative Ernährungsstrategie spielen eine wichtige Rolle für das Outcome herzchirurgischer Patienten – dennoch gibt es nur wenige Studien zu Ernährungskonzepten für diese Patientengruppe. In diesem Beitrag werden die Ursachen der Mangelernährung, der Einfluss der Ernährungstherapie auf...

Nutrition support is increasingly recognized as a clinically relevant aspect of the intensive care treatment of cardiac surgery patients. However, evidence from adequate large-scale studies evaluating its clinical significance for patients' mid-to long-term outcome remains sparse. Considering nutrition support as a key component in the perioperativ...

Nutrition support is increasingly recognized as a clinically relevant aspect of the intensive care treatment of cardiac surgery patients. However, evidence from adequate large-scale studies evaluating its clinical significance for patients’ mid- to long-term outcome remains sparse. Considering nutrition support as a key component in the perioperati...

The artificial placenta as a fascinating treatment alternative for neonatal lung failure has been the subject of clinical research for over 50 years. Pumpless systems have been in use since 1986. However, inappropriate dimensioning of commercially available oxygenators has wasted some of the theoretical advantages of this concept. Disproportional s...