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Peter Vernon van Heerden

Peter Vernon van Heerden
Hadassah Medical Center and the Hebrew University of Jerusalem Israel · Dept. of Anesthesiology Critical care and Pain medicine

MBBCh, MMed, PhD, FFFARCSI, FANZCA, FCICM, FJFICMI

About

158
Publications
17,144
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2,418
Citations
Additional affiliations
July 2015 - April 2020
Hadassah Medical Center
Position
  • Managing Director
July 2012 - July 2015
Hadassah Medical Center
Position
  • Managing Director
July 2000 - March 2014
University of Western Australia
Position
  • Professor

Publications

Publications (158)
Article
Full-text available
Background The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions re...
Article
Full-text available
There is ongoing demographic ageing and increasing longevity of the population, with previously devastating and often-fatal diseases now transformed into chronic conditions. This is turning multi-morbidity into a major challenge in the world of critical care. After many years of research and innovation, mainly in geriatric care, the concept of mult...
Article
Full-text available
Background: The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe. Methods: This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to Decem...
Article
Full-text available
Background Sepsis has no proven specific pharmacologic treatment and reported mortality ranges from 30%–45%. The primary aim of this phase IB study was to determine the safety profile of Allocetra™-OTS (early apoptotic cell) infusion in subjects presenting to the emergency room with sepsis. The secondary aims were to measure organ dysfunction, inte...
Article
PURPOSECritically ill elderly patients who suffer from Sars-CoV-2 disease are at high risk for organ failure. The modified MELD-XI score has not been evaluated for outcome prediction in these most vulnerable patients.METHODS The Corona Virus disease (COVID19) in Very Elderly Intensive Care Patients study (COVIP, NCT04321265) prospectively recruited...
Article
Full-text available
Purpose: Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly affected during the initial surge in 2020. Methods: This prospective international observation study (The COVIP st...
Article
Full-text available
Purpose: Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly affected during the initial surge in 2020. Methods: This prospective international observation study (The COVIP study...
Article
Full-text available
Purpose: Lactate is an established prognosticator in critical care. However, there still is insufficient evidence about its role in predicting outcome in COVID-19. This is of particular concern in older patients who have been mostly affected during the initial surge in 2020. Methods: This prospective international observation study (The COVIP study...
Article
Purpose: Old (>64 years) and very old (>79 years) intensive care patients with sepsis have a high mortality. In the very old, the value of critical care has been questioned. We aimed to compare the mortality, rates of organ support, and the length of stay in old vs. very old patients with sepsis and septic shock in intensive care. Methods: This ana...
Article
Full-text available
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...
Article
Full-text available
Objectives In Europe, there is a distinction between two different healthcare organisation systems, the tax-based healthcare system (THS) and the social health insurance system (SHI). Our aim was to investigate whether the characteristics, treatment and mortality of older, critically ill patients in the intensive care unit (ICU) differed between TH...
Article
In 2010, following the publication of two large trials of corticosteroids in septic shock, an international survey of corticosteroid use in the management of septic shock reported marked variability in practice. Two large randomised controlled trials of corticosteroids in septic shock (ie, the ADRENAL trial comparing hydrocortisone v placebo 4 and...
Article
Full-text available
Background: The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions r...
Article
Purpose To assess whether the combination of intra-abdominal hypertension (IAH, intra-abdominal pressure ≥ 12 mmHg) and hypoxic respiratory failure (HRF, PaO2/FiO2 ratio < 300 mmHg) in patients receiving invasive ventilation is an independent risk factor for 90- and 28-day mortality as well as ICU- and ventilation-free days. Methods Mechanically v...
Article
Background: The growing proportion of elderly intensive care patients constitutes a public health challenge. The benefit of critical care in these patients remains unclear. We compared outcomes in elderly versus very elderly subjects receiving mechanical ventilation. Methods: In total, 5,557 mechanically ventilated subjects were included in our...
Preprint
Full-text available
Background The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions re...
Article
Predicting the future course of critical conditions involves personal experience, heuristics and statistical models. Although these methods may perform well for some cases and population averages, they suffer from substantial shortcomings when applied to individual patients. The reasons include methodological problems of statistical modeling as wel...
Article
Full-text available
In Europe there are increasing numbers of old (more than 65 years old) and very old (more than 80 years old) patients (very old intensive care patients - VIPs) (Figure 1). In addition to combinations of chronic conditions (multi-morbidity), there are geriatric disabilities and functional limitations, with a profound impact on management in the ICU...
Preprint
Full-text available
Background Sepsis has no proven specific pharmacologic treatment. Reported mortality in sepsis ranges from 30%–45%. This study was designed to determine the safety preliminary efficacy of allogenic apoptotic cells administered for immunomodulation in septic patients. Methods The primary aim of this phase IB study was to determine the safety profil...
Article
Full-text available
INTRODUCTION Sepsis is a host response to infection, which when exaggerated can lead to multiple organ dysfunction and death. Early treatment of sepsis decreases mortality and early diagnosis of sepsis, especially in critically ill patients, is essential. OBJECTIVES This study aimed to analyze abnormal body temperature patterns in intensive care p...
Article
Background: In Israel, critically ill patients are ventilated and managed in intensive care units or general wards. Objectives: To compare the mortality rates and long-term cognitive and functional outcomes of ventilated patients who underwent tracheostomy insertion in the Medical ICU (MICU) versus those cared for in the in-patient wards. Metho...
Article
Purpose Demonstrate the practical range of information that can be obtained about ICU mortality/survival from limited administrative data. Materials and Methods Prospectively collected administrative data (length-of stay, survival/mortality, referring service) from a university medical center’s General ICU was subjected to retrospective analysis t...
Article
Full-text available
In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. Howe...
Article
Full-text available
The study of the human response to injury has been hampered by the inherent heterogeneity in the models and methods used. By studying a standard injury longitudinally, using individual patient‐level analysis, we endeavoured to better describe its dynamics. We analysed clinical variables, clinical laboratory and plasma cytokines from 20 patients at...
Article
Extensive multicolour photometry and low-resolution spectroscopy obtained for HD 81589 place the star in the gap between δ Scuti and slowly pulsating B pulsators on the main sequence. A clear episode of pulsation mode switching has apparently occurred in HD 81589, with its primary pulsation frequency switching from 4.57 to 3.71 c d−1 in less than 6...
Article
Full-text available
Background: Sepsis-associated immune dysregulation, involving hyper-inflammation and immunosuppression, is common in intensive care patients, often leading to multiple organ dysfunction and death. The aim of this study was to identify the main driving force underlying immunosuppression in sepsis, and to suggest new therapeutic avenues for controll...
Article
Full-text available
Background: Prognosticating the course of diseases to inform decision-making is a key component of intensive care medicine. For several applications in medicine, new methods from the field of artificial intelligence (AI) and machine learning have already outperformed conventional prediction models. Due to their technical characteristics, these met...
Article
The inflammatory response to acute injury among humans has proven difficult to study due to the significant heterogeneity encountered in actual patients. We set out to characterize the immune response to a model injury with reduced heterogeneity, a tracheostomy, among stable critical care patients, using a broad cytokine panel and clinical data. 23...
Article
Full-text available
Background The literature is replete with attempts to design and promote customized guidelines to reduce infections during the care continuum. Paradoxically, these efforts sometimes result in gray areas where many staff members are unaware of what is required of them, which then leads to confusion, frustration, and uncertainty. We coined the phrase...
Article
Full-text available
Gastro-esophageal reflux (GER) is common in ventilated patients and is a cause of ventilator associated pneumonia (VAP). The novel persistaltic feeding tube (PFT) uses simulated peristalsis to seal the esophagus to fluid moving in a retrograde manner, whilst allowing normal drainage of fluid and secretions moving in an ante-grade manner. This study...
Article
Full-text available
Background Increasing intra-abdominal volume (IAV) can lead to intra-abdominal hypertension (IAH) or abdominal compartment syndrome. Both are associated with raised morbidity and mortality. IAH can increase airway pressures and impair ventilation. The relationship between increasing IAV and airway pressures is not known. We therefore assessed the e...
Article
Purpose: Intra-abdominal hypertension (IAH) is associated with impaired respiratory function. Animal data suggest that positive end-expiratory pressure (PEEP) levels adjusted to intra-abdominal pressure (IAP) levels may counteract IAH-induced respiratory dysfunction. In this pilot study, our aim was to assess whether PEEP adjusted for IAP can be a...
Article
Full-text available
Isaac Ginsburg,1 Peter Vernon van Heerden,2 Erez Koren1 1Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, 2General Intensive Care Unit, Hadassah University Hospital, Jerusalem, Israel Abstract: This paper describes the evolution of our understanding of the biological role played by synthetic and natural...
Article
Variable mortality rates have been reported for patients with rheumatic diseases admitted to an intensive care unit (ICU). Due to the absence of appropriate control groups in previous studies, it is not known whether the presence of a rheumatic disease constitutes a risk factor. Moreover, the accuracy of the Acute Physiology and Chronic Health Eval...
Article
In this communication we argue that it is improbable that the main cause of death in sepsis is that, upon release of extracellular traps from neutrophils adhering to endothelial cells, highly cationic toxic histones uniquely cause endothelial dysregulation, organ failure and death. Activation of neutrophils is always accompanied by a plethora of pr...
Article
We introduced a simple checklist to act as an aid to memory for our junior medical staff to ensure that every patient in the intensive care unit (ICU) received every appropriate element of a bundle of care every day. The checklist was developed in consultation with our junior doctors and was designed to be completed every morning for every patient...
Article
Vitamin B12 is an essential micronutrient, as humans have no capacity to produce the vitamin and it needs to be ingested from animal proteins. The ingested Vitamin B12 undergoes a complex process of absorption and assimilation. Vitamin B12 is essential for cellular function. Deficiency affects 15% of patients older than 65 and results in haematolog...
Article
Full-text available
Mycoplasma pneumoniae is a leading cause of respiratory disease. In the Intensive Care Unit (ICU) setting M. pneumoniae is not considered a common pathogen. In 2010-13 an epidemic of M. pneumoniae-associated infections was reported and we observed an increase of M. pneumoniae patients admitted to ICU. We analysed the cohort of all M. pneumoniae-pos...
Article
Full-text available
Introduction: Gastro-esophageal Reflux (GER) in mechanically ventilated patients is a contributing factor in the development of Ventilator-Associated Pneumonia (VAP). In this paper, we report pilot studies in an animal model and in human volunteers describing a new Peristaltic Feeding Tube (PFT) comprised of three balloons integrated into a nasogas...
Article
Vitamin B12 is an essential micronutrient, with significant intracellular functions. Vitamin B12 deficiency is common in the critically ill population and is associated with significant deficiency syndromes. Increased vitamin B12 levels are associated with worse outcomes in critically ill patients and warrant systemic workup for malignancies and ch...
Article
Full-text available
BACKGROUND: Intellivent-adaptive support ventilation (ASV) is a closed-loop, fully automatic method of mechanical ventilation. This advanced mode of ventilation adjusts ventilation and oxygenation parameters according to patient weight, lung function (as assessed by the ventilator) and continuous input of end-tidal carbon dioxide and oxygen saturat...
Article
The 4-hour rule has been introduced in Western Australia, requiring that emergency department (ED) patients be admitted to hospital or discharged from the ED within 4 hours of presentation. We hypothesised that this rule might have been associated with changes in medical emergency team (MET) calls and intensive care unit exit bed block. Hospital da...
Article
Decision-making in intensive care units (ICUs) is often made by surrogates, since patients are unconscious or incompetent. In Israel, Legal Guardians (LGs), appointed by the court, are required to make these decisions. To qualitatively assess the attitudes of LGs required to make decisions on behalf of their relatives. Demographic and semi-structur...
Article
This study was conducted to determine the association between vasopressor requirement and outcome in medical intensive care patients in an environment where treatment is not withdrawn. This was an observational study of patients in the medical intensive care unit (ICU) over a period of 18 months to determine the correlation between vasopressor requ...
Article
Full-text available
Introduction Intra-abdominal hypertension (IAH) causes atelectasis, reduces lung volumes and increases respiratory system elastance. Positive end-expiratory pressure (PEEP) in the setting of IAH and healthy lungs improves lung volumes but not oxygenation. However, critically ill patients with IAH often suffer from acute lung injury (ALI). This stud...
Data
Various respiratory scatter plots. Scatter plots depicting end-expiratory lung volume (EELV), arterial partial pressure per inspiratory fraction of oxygen (P/F ratio), static elastance of the respiratory system (ERS), of the chest wall (ECW) and of the lung (EL) against resulting end-expiratory transdiaphragmatic pressure, transpulmonary pressure a...
Article
Full-text available
Traditional mechanical ventilation used tidal volumes (Vt) of between 10 to 15 ml/kg of body weight in order to achieve normal values of pH and partial pressure of carbon dioxide (PaCO2). Many clinicians today however, adopt lower volumes as a conservative 'safe' ventilation strategy in most mechanically ventilated patients. The method by which thi...
Article
Intra-abdominal hypertension is common in critically ill patients and is associated with increased morbidity and mortality. In a previous experimental study, positive end-expiratory pressures of up to 15 cm H2O did not prevent end-expiratory lung volume decline caused by intra-abdominal hypertension. Therefore, we examined the effect of matching po...
Article
Full-text available
The Australian and New Zealand Intensive Care Society (ANZICS) guidelines for the determination of brain death involve clinical testing and/or the use of brain blood flow analysis techniques. Recently, there has been professional and lay discussion regarding the role of brain blood flow analysis in the determination of brain death. To determine the...