Claudia Spies

Claudia Spies
Charité Universitätsmedizin Berlin | Charité · Department of Anesthesiology and Operative Intensive Care Medicine

About

974
Publications
186,132
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
26,678
Citations

Publications

Publications (974)
Article
Full-text available
Background: Routine data have shown a stark increase in home mechanical ventilation (HMV) in Germany in recent years. However, the development of HMV in the first year of the COVID-19 pandemic is unknown. Methods: Case numbers of initiations, control examinations, and terminations of invasive and non-invasive HMV in 2017 – 2020 were analysed. ICD-1...
Article
BACKGROUND: Previous studies suggest a role of the thalamus in cognitive function, while others implicate it as a central effect site of anesthetics. Yet, its role in postoperative neurocognition in the aging brain remains uncertain. We used presurgical thalamic volume as a functional indicator and determined its association with postoperative deli...
Article
Purpose: COVID-19 pandemic containment measures have led to changes in various areas of life, including restrictions on health care. Patients with chronic pain may have faced an increased burden during pandemic and the resources of this vulnerable population are unknown. Therefore, a qualitative study was conducted to understand how people with chr...
Article
Full-text available
Introduction There is only moderate adherence to evidence-based practice in critical care. Care bundles can be used to increase adherence to best clinical practice. Components of bundle interventions, bundle implementation rates, barriers and facilitators of bundle implementation, and the effect of care bundles on short-term patient outcomes such a...
Article
Full-text available
Background: The impact of physiotherapy on insulin sensitivity and peripheral glucose metabolism in critically ill patients is not well understood. Methods: This pooled analysis investigates the impact of different physiotherapeutic strategies on insulin sensitivity in critically ill patients. We pooled data from two previous trials in adult pat...
Article
Full-text available
Background and Objectives: In 2012, the umbrella term post-intensive care syndrome (PICS) was introduced to capture functional long-term impairments of survivors of critical illness. We present a bibliometric network analysis of the PICS research field. Materials and Methods: The Web of Science core database was searched for articles published in 2...
Article
Full-text available
Objective: Studies have suggested that inflammation contributes to the pathogenesis of postoperative delirium, but previous results on the proinflammatory cytokine IL-8 in plasma are contradictory. Additionally, a significant fraction of IL-8 is bound to erythrocytes, but the relevance of whole blood IL-8 in delirium has not been studied. In this...
Article
BACKGROUND Frailty is a multi-etiological geriatric syndrome of run-down physical reserves with high vulnerability to stressors. Transitions between physical robustness and frailty often occur in the context of medical interventions. Studies suggest that neurological disorders contribute to faster progression of frailty. In a previous cross-section...
Article
Full-text available
Packed red blood cells (PRBCs), stored for prolonged intervals, might contribute to adverse clinical outcomes in critically ill patients. In this study, short-term outcome after transfusion of PRBCs of two storage duration periods was analyzed in patients with Acute Respiratory Distress Syndrome (ARDS). Patients who received transfusions of PRBCs w...
Preprint
Full-text available
Background Delirium is a frequent complication of elective surgery in elderly patients, associated with an increased risk of long-term cognitive impairment and dementia. Disturbances in the functional brain network were previously reported during delirium. We hypothesized persisting alterations in functional brain networks three months after electi...
Article
Full-text available
Background Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are frequent and serious complications after surgery. We aim to investigate the association between genetic variants in cholinergic candidate genes according to the Kyoto encyclopedia of genes and genomes - pathway: cholinergic neurotransmission with the developm...
Article
Full-text available
The benzodiazepine, midazolam, is one of the most frequently used sedatives in intensive care medicine, but it has an unfavorable pharmacokinetic profile when continuously applied. As a consequence, patients are frequently prolonged and more deeply sedated than intended. Due to its distinct pharmacological features, including a cytochrome P450-inde...
Chapter
This article provides a brief overview of the relevance, objectives and content of the Nova Acta Leopoldina “Mission – Innovation: Telematics, eHealth and High-Definition Medicine in Patient-Centered Acute Medicine”.
Book
Full-text available
Through the application of new technologies and modern data processing with artificial intelligence (AI) capabilities, patient-centered innovations can flourish. Moving forward, patient-centered care must remain the focus of our efforts - digital applications do not fulfil an end in themselves. This volume presents the critical analyses of internat...
Chapter
precipitating factors, the incidence ranges between 10 – 50 %. POD is associated with loss of autonomy, increased morbidity and mortality and long-term neurocognitive disorders (NCD) in approximately 5 – 10 % of the POD patients. This article will focus on mechanisms involved in the development of POD and NCD, such as inflammation, toxicity, hypoxi...
Article
Full-text available
Background and Objectives: Mortality on Intensive Care Units (ICUs) is high and death frequently occurs after decisions to limit life-sustaining therapies. An advance directive is a tool meant to preserve patient autonomy by guiding anticipated future treatment decisions once decision-making capacity is lost. Since September 2009, advance directive...
Article
Full-text available
The aim of this study was to synthesize quantitative research that identified ranking lists of the most severe stressors of patients in the intensive care unit, as perceived by patients, relatives, and health care professionals (HCP). We conducted a systematic literature search in PubMed, MEDLINE, EMBASE, PsycInfo, CINAHL, and Cochrane Library from...
Preprint
Full-text available
Background: Dexmedetomidine may have a delirium preventive effect in high-risk surgical patients. Accurate frontal EEG-guided anesthesia can decrease the incidence of postoperative delirium by avoiding too deep anesthesia. Aim of our study is to evaluate the incidence of postoperative delirium under intraoperative frontal EEG neuromonitoring during...
Article
Full-text available
Background: Delirium screening instruments (DSIs) should be used to detect delirium, but they only show moderate sensitivity in patients with neurocritical illness. We explored whether, for these patients, DSI validity is impacted by patient-specific covariates. Methods: Data were prospectively collected in a single-center quality improvement proj...
Article
Full-text available
Infections and perioperative stress can lead to neuroinflammation, which in turn is linked to cognitive impairments such as postoperative delirium or postoperative cognitive dysfunctions. The α2-adrenoceptor agonist dexmedetomidine (DEX) prevents cognitive impairments and has organo-protective and anti-inflammatory properties. Macroautophagy (autop...
Article
Objective Systemic inflammation and monocyte counts have previously been associated with changes in resting state functional connectivity (rsFC) in cross-sectional neuroimaging studies. We therefore investigated this association in a longitudinal study of older patients. Methods We performed a secondary analysis of longitudinal data from older pat...
Article
Full-text available
Background: Etomidate is typically used as an induction agent in cardiac surgery because it has little impact on hemodynamics. It is a known suppressor of adrenocortical function and may increase the risk for post-operative infections, sepsis, and mortality. The aim of this study was to evaluate whether etomidate increases the risk of postoperativ...
Article
Full-text available
Background Postoperative cognitive dysfunction (POCD) is an adverse outcome that impacts patients' quality of life. Its diagnosis relies on formal cognitive testing performed before and after surgery. The substantial heterogeneity in methodology limits comparability and meta-analysis of studies. This systematic review critically appraises the metho...
Article
Full-text available
Background. Most of intensive care scoring systems are helpful to objectively assess the severity of an illness and morbidity. Therefore, scoring systems are used to assess the probability of mortality in ICU-patients and to compare patient populations. Recently, SOFA-score was incorporated into sepsis definition models to improve discrimination of...
Article
Full-text available
Background: Postoperative delirium (POD) is a frequent and serious complication after surgery. Evidence of a relationship between anticholinergic medication and the development of delirium is inconclusive, but studies on POD are rare. Objectives: The objective of this study was to evaluate the anticholinergic load of preoperative medication in o...
Article
The high demand for intensive care, which is predicted to further increase in the future, is contrasted by a shortage of trained intensivists and specialized nurses. Telemedicine has been heralded as a promising solution. Yet, there is considerable heterogeneity in tele-critical care when it comes to measurable effects. However, the focus has been...
Article
Background: Anecdotally, cholinergic stimulation has been used to treat delirium and reduce cognitive dysfunction. Objective: The aim of this investigation was to evaluate whether physostigmine reduced the incidence of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) in patients undergoing liver resection. Design: Th...
Article
Communication and teamwork skills are, besides clinical knowledge, key components of high quality care in modern intensive care units. In light of high staff fluctuations among intensive care unit teams and disparities in clinical experience, an ongoing training is essential to ensure optimal performance in stressfull situations. Further, when impl...
Article
There is a high demand for critical care, which is forecasted to further grow in the future. Increasing patient morbidity and complexity concurring with a shortage of trained intensivists imposes challenges on critical care clinicians. Weathering these challenges, telemedical programs can help utilize and allocate resources more efficiently as well...
Article
Full-text available
Background This prospective, cross-sectional, observational study examined associations between sense of coherence (SOC), mental well-being, and perceived preoperative hospital and surgery related stress of surgical patients with malignant, benign, and no neoplasms. The objective was to assess a putative association between SOC and preoperative str...
Article
Full-text available
Survivors of critical illness and their caregivers frequently face long-term impairments of cognition, mental health, mobility and beyond, which demand for a patient-centred transition management and well-coordinated, outpatient post-ICU care.
Article
Full-text available
Objective Delirium is a frequent complication after surgery with important negative outcomes for affected patients and society. However, it is still largely unknown why some patients have a predisposition for delirium and others not. To increase our understanding of the neural substrate of postoperative delirium, we studied the association between...
Article
Full-text available
Introduction: Survival after critical illness has noticeably improved over the last decades due to advances in critical care medicine. Besides, there is an increasing number of elderly patients with chronic diseases being treated in the intensive care unit (ICU). More than half of the survivors of critical illness suffer from medium-term or long-t...
Article
Full-text available
Background/objective: Postdural puncture headache (PDPH) is a severe complication after spinal anesthesia. The aim of this study was to investigate the incidence of PDPH in two different operative cohorts and to identify risk factors for its occurrence as well as to analyze its influence on the duration of hospital stay. Material and methods: In...
Article
Full-text available
IntroductionSelective dorsal rhizotomy (SDR) consists of microsurgical partial deafferentation of sensory nerve roots (L1–S2). It is primarily used today in decreasing spasticity in young cerebral palsy (CP) patients. Intraoperative monitoring (IOM) is an essential part of the surgical decision-making process, aimed at improving functional results....
Article
Full-text available
IntroductionSpinal reflexes reorganize in cerebral palsy (CP), producing hyperreflexia and spasticity. CP is more common among male infants, and gender might also influence brain and spinal–cord reorganization. This retrospective study investigated the frequency of higher-graded EMG responses elicited by electrical nerve–root stimulation during sel...
Article
Full-text available
Background and objectives: The use of delirium screening instruments (DSIs) is recommended in critical care practice for a timely detection of delirium. We hypothesize that the patient-related factors “level of sedation” and “mechanical ventilation” impact test validity of DSIs. Materials and Methods: This is a prospective, bi-center observational...
Article
Background A pre-existing neurocognitive disorder (NCD) is a relevant factor for the outcome of surgical patients. To improve understanding of these conditions, we investigated the association between parameters of the cholinergic system and NCD. Methods This investigation is part of the BioCog project (www.biocog.eu), which is a prospective multi...
Article
Full-text available
Delirium, the clinical expression of acute encephalopathy, is a common neuropsychiatric syndrome that is related to poor outcomes, such as long-term cognitive impairment. Disturbances of functional brain networks are hypothesized to predispose for delirium. The aim of this study in non-delirious elderly individuals was to investigate whether predis...
Article
Full-text available
Objective In this survey, we assessed the current clinical management of postoperative delirium (POD) among Chinese anesthesiologists, after publishing the European POD guideline. Methods We administered an electronic survey, designed according to the European POD guideline. The survey was completed using mobile devices. Results In total, 1,514 r...
Article
Background There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care. Methods We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investi...
Article
Background Clinical practice guidelines (CPGs) facilitate the provision of standardized, high-quality intensive care medicine. For the management of pain, agitation and delirium, several coexisting CPGs have been published. This study aims at the identification of CPGs on pain, agitation and delirium management in the intensive care unit to (a) ide...
Article
Full-text available
Objective: Age-related disorders, such as dementia, significantly contribute to the global burden of disease. Adequate screening in the primary care setting is critical for early detection and proper management. The Addenbrooke's Cognitive Examination III (ACE-III) is an open-source neuropsychological test with superior diagnostic quality in compar...
Article
Full-text available
Background Postoperative anaemia is a frequent surgical complication and in contrast to preoperative anaemia has not been validated in relation to mortality, morbidity and its associated health economic effect. Postoperative anaemia can predispose postoperative delirium through impairment of cerebral oxygenation. The aim of this secondary analysis...
Preprint
Full-text available
Introduction Survival after critical illness has noticeably improved over the last decades due to advances in critical care medicine. Besides, there are an increasing number of elderly patients with chronic diseases being treated in the intensive care unit (ICU). More than half of the survivors of critical illness suffer from medium- or long-term c...
Article
Full-text available
Background: Serum potassium concentrations are commonly between 3.5 and 5.0 mmol/l. Standardised protocols for potassium range and supplementation in the ICU are lacking. The purpose of this retrospective analysis of ICU patients was to investigate potassium concentrations, variability and supplementation, and their association with in-hospital mo...
Article
Full-text available
Background: Postoperative delirium is a severe brain dysfunction. Although data indicates a high relevance, no survey has investigated the routine practice to monitor delirium outside the ICU setting after surgery. Prior to publishing of the new ESA guidelines on postoperative delirium, a international survey was conducted to assess current practi...
Article
Background: Different studies in adults reported significant outcome improvement for patients treated with high adherence to guidelines. The present study was initiated to evaluate the impact of adherence to antibiotic prescription guidelines on health outcomes of children on paediatric intensive care unit (PICU) suffering from pneumonia. Methods...
Article
Background: Postoperative delirium (POD) is a common complication after surgery. Objective: We sought to determine the association between preoperative anticholinergic load calculated using the anticholinergic drug scale (ADS) and POD in cancer patients over 65 years of age. Design: A retrospective sub-investigation of a randomised controlled...
Article
Full-text available
BACKGROUND: Hyperglycemia frequently occurs during major surgery and is associated with adverse postoperative outcomes. This study aimed to investigate the influence of intraoperative hyperglycemia on incidences of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). METHODS: 87 Patients aged ≥65 years undergoing elective s...
Article
Full-text available
Objectives: Mechanical ventilation can cause ventilator-induced brain injury via afferent vagal signaling and hippocampal neurotransmitter imbalances. The triggering mechanisms for vagal signaling during mechanical ventilation are unknown. The objective of this study was to assess whether pulmonary transient receptor potential vanilloid type-4 (TR...
Article
Full-text available
Background: General (GA)- and epidural-anesthesia may cause a drop in body-core-temperature (BCTdrop), and hypothermia, which may alter tissue oxygenation (StO2) and microperfusion after cytoreductive surgery for ovarian cancer. Cell metabolism of subcutaneous fat- or skeletal muscle cells, measured in microdialysis, may be affected. We hypothesiz...
Article
Full-text available
Frailty is a common syndrome in older individuals that is associated with poor cognitive outcome. The underlying brain correlates of frailty are unclear. The aim of this study was to investigate the association between frailty and MRI features of cerebral small vessel disease in a group of non-demented older individuals. We included 170 participant...
Article
Background: Recent guidelines on postoperative delirium (POD) recommend POD screening in all patients, using a validated tool, starting in the recovery room. An operationalisation of the Confusion Assessment Method (CAM) criteria, the 3-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM), has been developed for use in general medical uni...
Article
Full-text available
To the Editor Dr Wildes and colleagues¹ analyzed whether intraoperative electroencephalography (EEG) guidance may reduce the rate of postoperative delirium. No reduction in the incidence of postoperative delirium was observed, which is in contradiction to a meta-analysis of randomized trials² and guideline recommendations.³,4
Chapter
Im operativ-chirurgischen Bereich besteht eine hohe Prävalenz von Suchterkrankungen. Substanzmissbrauch ist mit einer erhöhten Morbidität assoziiert. Dies bedingt einen häufigen Kontakt des klinisch tätigen Anästhesisten mit suchtkranken Patienten. Beim suchtkranken Patienten ist ein gezieltes diagnostisches Vorgehen erforderlich, da die Suchtdiagn...
Article
Full-text available
Background: Early mobilization improves physical independency of critically ill patients at hospital discharge in a general intensive care unit (ICU)-cohort. We aimed to investigate clinical and molecular benefits or detriments of early mobilization and muscle activating measures in a high-risk ICU-acquired weakness cohort. Methods: Fifty patien...
Article
Background: Emergence delirium (ED) is an important postanesthetic complication in children. Although it has been thoroughly studied, data on frequency, predictive factors, and therapy of this phenomenon are inconclusive. In this study, we seek to obtain a better understanding of the frequency of ED and different therapeutic approaches, making use...
Article
Background: The cholinergic system is considered to play a key role in the development of postoperative delirium (POD), which is a common complication after surgery. Objectives: To determine whether peri-operative acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are associated with the development of POD in in-hospital su...
Article
Full-text available
Tissue damage and pathogen invasion during surgical trauma have been identified as contributing factors leading to neuroinflammation in the hippocampus, which can be protected by stimulation of the cholinergic anti-inflammatory pathway using the acetylcholinesterase inhibitor physostigmine. Macroautophagy, an intracellular degradation pathway used...
Book
Full-text available
Die Entwicklung der Intensivmedizin hat viel dazu beigetragen, dass die Überlebensraten nach Behandlung kritischer Erkrankungen auf Intensivstationen deutlich verbessert werden konnten. Die Auswirkungen solcher lebensrettenden Maßnahmen auf das Leben der Betroffenen auf lange Sicht standen bisher aber weniger im Fokus. Dazu gehören erhebliche Einsc...