Andreas Valentin

Medical University of Vienna | MedUni Vienna · Department of Emergency Medicine

Background Limited evidence suggests variation in mortality of older critically ill adults across Europe. We aimed to investigate regional differences in mortality among very old ICU patients. Methods Multilevel analysis of two international prospective cohort studies. We included patients ≥80 yr old from 322 ICUs located in 16 European countries....

Background Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods We i...

Background: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score...

Abstract Background The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to...

Female and male very elderly intensive patients (VIPs) might differ in characteristics and outcomes. We aimed to compare female versus male VIPs in a large, multinational collective of VIPs with regards to outcome and predictors of mortality. In total, 7555 patients were included in this analysis, 3973 (53%) male and 3582 (47%) female patients. The...

Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determi...

Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed. Methods: In total, 5063 VIPs were included in this analysis,...

OBJECTIVES To develop a scoring system model that predicts mortality within 30 days of admission of patients older than 80 years admitted to intensive care units (ICUs). DESIGN Prospective cohort study. SETTING A total of 306 ICUs from 24 European countries. PARTICIPANTS Older adults admitted to European ICUs (N = 3730; median age = 84 years [in...

In the original publication Dr Patrick Meybohm of the Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt University Hospital, Frankfurt, Germany was inadvertently omitted from the list of investigators.

Purpose: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. Methods: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. Results: LST limitation was iden...

Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to st...

This book is one of the first to comprehensively summarise the latest thinking and research in the rapidly evolving field of quality management in intensive care. Quality indicators and outcome measures are discussed with a practical focus on patient-centred, evidence-based implementation for safer and more effective clinical practice. Chapters on...

Background: Delayed vasospasm (VSP) following aneurysmal subarachnoid hemorrhage (aSAH) remains a major source of morbidity. Milrinone was recently suggested as an invasive VSP treatment option. It is a phosphodiesterase III inhibitor with vasodilating and additional positive inotrope and anti-inflammatory effects. Methods: In this preliminary s...

Introduction: The aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units (ICU) and Intermediate Care Units (IMCU) have lower in-hospital mortality than those admitted to ICUs without an IMCU. Methods: An observational multinational cohort study performed on patients admitted to participating ICUs durin...

The aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units (ICU) and Intermediate Care Units (IMCU) have lower in-hospital mortality than those admitted to ICUs without an IMCU.Methods An observational multinational cohort study performed on patients admitted to participating ICUs during a four-week perio...

Die Idealvorstellung einer nahezu fehlerlosen modernen Medizin wurde in den vergangenen Jahren nachhaltig in Frage gestellt. Der vorliegende Beitrag beschäftigt sich mit der Frage, warum das Thema Fehler gerade auch an Intensivstationen von eminenter Bedeutung ist und welche präventiven Maßnahmen das Risiko für Fehler reduzieren können.Die Erfassun...

The very complex process of intensive care is accompanied by a not unexpected accumulation of risk for error and adverse events. The present review addresses strategies to decrease care errors in several domains of daily intensive care practice. Strategies to decrease care errors now focus on a systematic approach by identifying latent system failu...

The present work provides assistance for physicians concerning decision making in clinical borderline situations in the ICU. Based on a structured checklist the two fundamental aspects of any medical decision, the medical indication and the patient's preference are queried in a systematic way. Four possible steps of withholding and/or withdrawing t...

The task of physicians is to maintain life, to protect and re-establish health as well as to alleviate suffering and to accompany the dying until death, under consideration of the self-determination rights of patients. Increasingly more and differentiated options for this are becoming available in intensive care medicine. Within the framework of pr...

Purpose: To assess the frequency and contributing factors of medication and dislodgement errors attributable to common routine processes in a cohort of intensive care units, with a special focus on the potential impact of safety climate. Methods: A prospective, observational, 48 h cross sectional study in 57 intensive care units (ICUs) in Austri...

BACKGROUND:: Hospitals face an increasing pressure toward efficiency and cost reduction while ensuring patient safety. This warrants a closer examination of the trade-off between production and protection posited in the literature for a high-risk hospital setting (intensive care). PURPOSES:: On the basis of extant literature and concepts on both sa...

Aufgabe des Arztes ist es, unter Beachtung des Selbstbestimmungsrechtes des Patienten Leben zu erhalten, Gesundheit zu schutzen und wiederherzustellen sowie Leiden zu lindern und Sterbenden bis zum Tod beizustehen. Der Intensivmedizin stehen dazu immer mehr und differenziertere Moglichkeiten zur Verfugung. Der Arzt hat im Rahmen seiner professionel...

Recognition and analysis of error constitutes an essential tool for quality improvement in intensive care units (ICUs). The potential for the occurrence of error is considerably high in ICUs. Although errors will never be completely preventable, it is necessary to reduce frequency and consequences of error. A system approach needs to consider human...

To define a set of indicators that could be used to improve quality in intensive care medicine. An European Society of Intensive Care Medicine Task Force on Quality and Safety identified all commonly used key quality indicators. This international Task Force consisted of 18 experts, all with a self-proclaimed interest in the area. Through a modifie...

Objective: To provide guidance and recommendations for the planning or renovation of intensive care units (ICUs) with respect to the specific characteristics relevant to organizational and structural aspects of intensive care medicine. Methodology: The Working Group on Quality Improvement (WGQI) of the European Society of Intensive Care Medicine...

Patient safety is an essential paradigm in the practice of intensive care medicine. Several reports have demonstrated an urgent need for intensive care units (ICUs) to improve the safety of key processes, such as the administration of drugs. A very first step in the effort to reduce the number of adverse events is to raise awareness and to recogniz...

During the past decade there has been growing interest in the development of practice guidelines on medical end-of-life decisions. A questionnaire about awareness and use of end-of-life decision guidelines was applied by e-mail in a cross-sectional survey among 1494 attendants of Austrian intensive care medicine conferences held in 2008. Of a total...

Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial. Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry. Two hundred twenty patients admit...

Background: The Vienna Safety Climate Questionnaire measures seven safety climate aspects. As the overall aim of surveys on safety climate is to assist the improvement of safety, the link between safety climate and safety outcome is most important. So the aim of the construction process was to achieve a high criterion validity.

Intensive care patients are per definition at risk for an unfavourable outcome while at the same time being exposed to the risks of a very complex and invasive process of care. This review addresses this extrinsic risk with respect to causative factors and strategies for risk reduction. A growing amount of evidence shows that the actual risk of an...

Emergency physicians and intensivists are increasingly faced with situations requiring them to care for patients for whom no curative treatment options are available. This is due to the epidemiologic evolution as well as the trend to delegate end-of-life decisions to emergency services and intensive care units. Difficult decisions under time pressu...

In der Intensiv- und Notfallmedizin sind häufig Entscheidungen in komplexen Situationen zu treffen. Neben prozeduralen Fähigkeiten sind daher sog. „nichttechnische Fähigkeiten“ wie kognitive Fähigkeiten für intensivmedizinisches Handeln von größter Bedeutung. Dieser Beitrag gibt einen kurzen Überblick über Entscheidungsabläufe und Faktoren, von den...

Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs. To record the prevalence, characteristics, and risk factors for conflicts in ICUs. One-day cross-sectional survey of ICU clinicians. Data on perceived conflicts in the week before the survey da...

A positive relationship between patient volume and outcome has been demonstrated for a variety of clinical conditions and procedures, but the evidence is sparse for critically ill patients. To evaluate the relationship between patient volume and outcome in a large cohort of critically ill patients. Prospective multicenter cohort study, January 1998...

To assess on a multinational level the frequency, characteristics, contributing factors, and preventive measures of administration errors in parenteral medication in intensive care units. Observational, prospective, 24 hour cross sectional study with self reporting by staff. 113 intensive care units in 27 countries. 1328 adults in intensive care. N...

Das Konzept des „Medical Emergency Teams“ bringt die Expertise von Intensivmedizinern über die Grenzen der Intensivstation hinaus und zielt darauf ab im Krankenhaus frühzeitig kritische Patienten zu erkennen und zeitgerecht zu intervenieren. Zur Erkennung einer kritischen Situation werden einfach zu handhabende Kriterien eingesetzt, bei deren Errei...

To link generic research on patient safety and the reliability of care to the specific context of the critically ill patient and the environment of the intensive care unit. Many improvements in patient safety could be implemented through changes in clinical behaviour and within existing resources. These changes require high-level institutional supp...

Takotsubo syndrome may be associated with neuromuscular disorders, but has never been described in a patient with mitochondrial disorder. A 75-year-old woman developed muscle cramps, ptosis, fasciculations and slowly progressive weakness and wasting of all four limbs, starting 2.5 years earlier. After exclusion of various differential diagnoses, in...

In view of ethical considerations and the limited resources in intensive care medicine, the present investigation aims to give a descriptive overview of the prognosis and therapeutic activity for the oldest age group of elderly patients admitted to an intensive care unit (ICU) in comparison with younger ICU patients. 3069 patients admitted to the I...

To assess on a multinational level the prevalence and corresponding factors of selected unintended events that compromise patient safety (sentinel events) in intensive care units (ICUs). An observational, 24-h cross-sectional study of incidents in five representative categories. 205 ICUs worldwide Events were reported by intensive care unit staff m...

Ohne Zusammenfassung

Stroke patients with atrial fibrillation (AF) have a poorer neurological outcome than stroke patients without AF. Whether stroke patients with AF also have a higher rate of medical complications is unknown. The aim of the study was to compare the in-hospital course of acute stroke patients with and without AF. The Austrian Stroke registry was a pro...

The electrocardiograms of patients with pneumothorax show a variety of changes which can mimic myocardial ischemia. In most of these cases ECG abnormalities return to normal after resolution of the pneumothorax and are not related to any underlying cardiac disease. We describe a case of a 76-year old woman who was admitted because of dyspnea and fa...

To determine whether gender-related differences exist in the provided level of care and outcome in a large cohort of critically ill patients. Prospective, observational cohort study with data collection from January 1, 1998, to December 31, 2000. Thirty-one intensive care units in Austria. A total of 25,998 adult patients, consecutively admitted to...

A 58-year-old man with an acute stroke suffered from splenic rupture. Streptococcus bovis was found in blood cultures, and gram-negative cocci were found in the infarcted spleen. Hemorrhagic transformation of the stroke occurred. Echocardiography showed aortic endocarditis. Cardiac surgery was not performed because of concern about cerebral bleedin...

Intracranial pressure (ICP) monitoring is frequently used in intensive care treatment of patients with intracranial hemorrhage. Data demonstrating an improved outcome from this intervention are lacking. We analyzed standardized mortality ratios in patients with and without ICP monitoring to determine its efficacy. A nonrandomized study of case reco...

Der Herz-Kreislauf-Stillstand stellt durch sein oft plötzliches Eintreten eine Herausforderung für Laien und medizinisches Personal dar. Die Inzidenz des plötzlichen Herz-Kreislauf-Stillstands außerhalb des Krankenhauses beträgt in Abhängigkeit von verschiedenen örtlichen Gegebenheiten zwischen 36 und 128 pro 100.000 Einwohner im Jahr. Nur 5–10% de...

After total thyroidectomy because of hyperthyroidism, hypothyroidism developed in a 78-year-old woman. Despite replacement therapy with levothyroxine sodium in continuously increasing doses, worsening hypothyroidism led to respiratory failure, necessitating artificial ventilation. The addition of liothyronine resulted in complete recovery. Impaired...

Zusammenfassung: Personen mit koronarer Herzkrankheit, Herzinsuffizienz, aber auch zyanotischen Vitien, können in den meisten Fällen problemlos Flugreisen antreten. Voraussetzung sind ein stabiler kardialer Zustand und eine genaue kardiologische Untersuchung inklusive Echokardiographie und Belastungs-EKG vor Antritt der Reise. Eine sorgfältige Reis...

To study incidence, clinical course and prognostic factors in patients admitted to medical intensive care units (ICUs) because of a complicated course of infective endocarditis. This was a retrospective multicenter observational study of 4106 patients admitted to four medical ICUs in one tertiary hospital and one university hospital between 1994 an...

Air travel of persons with coronary heart disease, heart failure and cyanotic congenital heart disease will be without complications and problems in the most cases. Prerequisite for an uneventful flight are stable cardiac conditions and an extensive cardiac examination including echocardiography and exercise testing before starting the journey. Car...

To evaluate the performance of the logistic organ dysfunction (LOD) system for the assessment of morbidity and mortality in multiple organ dysfunction/failure (MOD/F) in an independent database and to evaluate the use of sequential LOD measurements for the prediction of outcome. Prospective, multicentric cohort study in 13 adult medical, surgical,...

Severe infection with Burkholderia pseudomallei (formerly Pseudomonas pseudomallei), the bacterium causing melioidosis, is a common cause of acquired septicaemia in south-east Asia and northern Australia. A few cases of infected travellers returning to European countries have been reported. Melioidosis is a tropical disease, the clinical presentati...

To validate SAPS II-AM, a recently customized version of the Simplified Acute Physiology Score II (SAPS II) in a larger cohort of Austrian intensive care patients and to evaluate the effect of the customization process on the ratio of observed to expected mortality. Prospective, multicentric cohort study. A total of 2,901 patients consecutively adm...

The diagnosis of pulmonary embolism (PE)is still an unresolved problem. The aim of this prospective observational study was to derive and validate a prediction rule (PEscore) by which PE can be diagnosed by easily obtainable and rapidly available investigations. Included were consecutive patients with a clinical suspicion of PE admitted to a commun...

The aim of this retrospective study was to determine in-hospital mortality and morbidity secondary to intracerebral hemorrhage and to analyse variables considered to be significantly associated with survival in these patients. The study cohort consisted of 135 consecutive patients with intracerebral hemorrhage, admitted to a large community hospita...

INTRODUCTION: Severity scoring systems like the Simplified Acute Physiology Score II (SAPS II) have been developed for outcome prediction in a general ICU population. Performance of the SAPS II as of other scoring systems is influenced by the so called case mix. SAPS II contains no diagnostic categories, but it is known that prognostic accuracy dif...

To evaluate the ability of an interdisciplinary data set (recently defined by the Austrian Working Group for the Standardization of a Documentation System for Intensive Care [ASDI]) to assess intensive care units (ICUs) by means of the Simplified Acute Physiology Score II (SAPS II) for the severity of illness and the simplified Therapeutic Interven...

Coil embolization of tumor-related coronary arteries was successful in interrupting coronary supply to a cardiac metastasis from uterine leiomyosarcoma. In patients with cardiac metastases of highly malignant tumors this may be a palliative therapeutic approach.

To evaluate the prognostic performance of the original Simplified Acute Physiology Score (SAPS) II in Austrian intensive care patients and to evaluate the impact of customization. Analysis of the database of a multicenter study. Nine adult medical, surgical, and mixed intensive care units (ICUs) in Austria. A total of 1733 patients consecutively ad...

Isolated left ventricular abnormal trabeculation (ILVAT) is defined as > 3 coarse trabeculations of the left ventricular wall, apically to the papillary muscles, in hearts without congenital malformations. The aims of the study were to assess by echocardiography the prevalence of ILVAT, to confirm the diagnosis by cardiac magnetic resonance imaging...

Introduction: To adjust the originally described Simplified Acute Physiology Score II (SAPS II) [1] for application in Austrian intensive care patients and to validate a recently customized version [2]. Methods: Analysis of data of a national ICU database [3] collected in thirteen adult medical, surgical and mixed ICUs in Austria with a total of 35...

Introduction: Although Intensive Care Medicine accounts for 7.8 % of the yearly hospital costs there exist no data about ICU patients yet. Goal of the ASDI project is to provide these data for cost-effectiveness studies. This, preliminary study was conducted to test the developed national database server and to find a possibility of stratifying ICU...