Stefan J Schaller

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

Background: Immobilisation predicts adverse outcomes in patients in the surgical intensive care unit (SICU). Attempts to mobilise critically ill patients early after surgery are frequently restricted, but we tested whether early mobilisation leads to improved mobility, decreased SICU length of stay, and increased functional independence of patient...

Sugammadex is the first clinical representative of a new class of drugs called selective relaxant binding agents. It has revolutionized the way anesthesiologists think about drug reversal. Sugammadex selectively binds rocuronium or vecuronium, thereby reversing their neuromuscular blocking action. Due to its 1:1 binding of rocuronium or vecuronium,...

Purpose: Immobilization of critically ill patients leads to muscle weakness, which translates to increased costs of care and long-term functional disability. We tested the validity of a German Surgical Intensive Care Unit (ICU) Optimal Mobilization Score (SOMS) in 2 different cohorts (neurocritical and nonneurocritical care patients). Materials a...

Sugammadex effectively and rapidly reverses deep to moderate rocuronium-induced neuromuscular block. However, the required dose of sugammadex for smaller degrees of residual block is unknown. Therefore we investigated the efficacy of sugammadex and neostigmine at a train-of-four (TOF) ratio of 0.5. After ethics committee (Munich, Germany) approval...

Background We examined the impact of muscle relaxation on surgical conditions and patients’ postoperative outcome during elective laparoscopic cholecystectomy under balanced anaesthesia. Methods After approval and consent, 57 anaesthetized patients were randomly assigned to group no neuromuscular blockade (No NMB) and deep neuromuscular blockade...

Subarachnoid haemorrhage (SAH) is a significant cause of morbidity and mortality worldwide. SAH results from bleeding into the cerebrospinal fluid-filled cisterns between the arachnoid and pia mater. SAH produces a severe, sudden-onset headache that immediately reaches maximal intensity that may be associated with other symptoms and signs. A prompt...

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 This study aimed to assess the impact of duration of early mobilisation on survivors of critical illness. The hypothesis was that interventions lasting over 40 min, as per the German guideline, positively affect the functional status at ICU discharge. Methods Prospective single-centre cohort study conducted in two ICUs in Germany. In 68...

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COV...

Objectives Postoperative monitoring outside intensive and post-anaesthesia care units is seldom, partly due to lack of suitable and approved systems. We therefore aim to validate the oxygen saturation (SpO 2 ) and pulse rate measurement of the in-ear sensor c-med° alpha with a reference pulse oximeter. Methods This prospective agreement study was...

Introduction: The consequences of intensive care unit acquired weakness (ICUAW) are a major long-term problem of surviving critically ill patients. Infammation and therefore proinfammatory cytokines may contribute to muscular changes in the critically ill [1]. To counteract these perturbations, mobilization (e.g., passive mobilization by inbed c...

Introduction: Previous studies demonstrated that an early start of mobilization has a positive efect on diferent intensive care unit (ICU) outcomes [1]. Since there is no uniform defnition of early mobilization (EM) comparing studies is challenging [2]. Objectives: Aim of this systematic review was to investigate the efectiveness of diferent int...

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...

In critical care medicine, where there is a demanding career with a problematic work-life balance, mentoring is an important support tool to grow professionally, creating a network of support throughout the career. The mentoring process consists of evidence-based steps to guide critical care mentors and mentees and pair them with each other accordi...

Background The mobilization quantification score (MQS) provides an opportunity to quantify the duration and intensity of mobilization therapy in the intensive care unit (ICU) and predict functional outcomes in ICU patients after surgery and stroke. MQS is a numerical measurement of early mobilization dose in the ICU, and its relationship with activ...

Objective: To investigate whether goal-directed albumin substitution during surgery and postanesthesia care to maintain a serum albumin concentration >30 g/L can reduce postoperative complications. Summary background data: Hypoalbuminemia is associated with numerous postoperative complications. Since albumin has important physiological functions...

Objective: Mobilization in the intensive care unit (ICU) has the potential to improve patient outcomes following acute stroke. The optimal duration and intensity of mobilization for patients with hemorrhagic or ischemic stroke in the ICU remains unclear. We sought to assess the effect of mobilization dose in the ICU on adverse discharge dispositio...

The measurement of quality indicators supports quality improvement initiatives. The German Interdisciplinary Society of Intensive Care Medicine (DIVI) has published quality indicators for intensive care medicine for the fourth time now. After a scheduled evaluation after three years, changes in several indicators were made. Other indicators were no...

Aims: Anemia is common in the old and often observed in critically ill patients. Increased age is associated with higher mortality following a COVID-19 infection, making old patients prone to poor outcomes. We investigated whether anemia at admission to the ICU or the need for blood transfusion was associated with 90-day mortality in older, critic...

Preoperative risk assessment is essential for shared decision-making and adequate perioperative care. Common scores provide limited predictive quality and lack personalized information. The aim of this study was to create an interpretable machine-learning-based model to assess the patient’s individual risk of postoperative mortality based on preope...

Background: Corona Virus Disease 2019 (COVID-19) patients display risk factors for intensive care unit acquired weakness (ICUAW). The pandemic increased existing barriers to mobilisation. This study aimed to compare mobilisation practices in COVID-19 and non-COVID-19 patients. Methods: This retrospective cohort study was conducted at Charité-Uni...

Background: Mechanical ventilation has side effects such as ventilator-induced diaphragm dysfunction, resulting in prolonged intensive care unit length of stays. Artificially evoked diaphragmatic muscle contraction may potentially maintain diaphragmatic muscle function and thereby ameliorate or counteract ventilator-induced diaphragm dysfunction....

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...

[This corrects the article DOI: 10.3389/fmed.2021.748812.].

Background and goal of study Cardiopulmonary resuscitation (CPR) in prehospital care is a major reason for emergency medical service (EMS) dispatches. CPR outcome depends on various factors, such as bystander CPR and initial heart rhythm. Our aim was to investigate whether short-term outcomes such as the return of spontaneous circulation (ROSC) and...

Background: The decline in the downstream signal transduction pathway of anabolic hormone, insulin, could play a key role in the muscle atrophy and insulin resistance observed in patients with intensive care unit acquired weakness (ICUAW). This study investigated the impact of immobilisation via surgical knee and ankle fixation and inflammation vi...

Older people demonstrate a higher risk for the occurrence of peri- and postsurgical complications. A frequent risk factor for this is the prevalence of a status called “frailty”. In general, this status can be reversed by adequate therapeutic and medical interventions. More, current evidence suggests that these measures, as part of a so-called preh...

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their assoc...

Background Patients with critical illness can lose more than 15% of muscle mass in one week, and this can have long-term detrimental effects. However, there is currently no synthesis of the data of intensive care unit (ICU) muscle wasting studies, so the true mean rate of muscle loss across all studies is unknown. The aim of this project was theref...

Background While early mobilization is commonly implemented in intensive care unit treatment guidelines to improve functional outcome, the characterization of the optimal individual dosage (frequency, level or duration) remains unclear. The aim of this study was to demonstrate that artificial intelligence-based clustering of a large ICU cohort can...

Background Noninvasive ventilation (NIV) is a promising alternative to invasive mechanical ventilation (IMV) with a particular importance amidst the shortage of intensive care unit (ICU) beds during the COVID-19 pandemic. We aimed to evaluate the use of NIV in Europe and factors associated with outcomes of patients treated with NIV. Methods This i...

Background The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary an...

Background: The objective was to investigate the role of gene expression and plasma levels of the muscular protein myostatin in intensive care unit-acquired weakness (ICUAW). This was performed to evaluate a potential clinical and/or pathophysiological rationale of therapeutic myostatin inhibition. Methods: A retrospective analysis from pooled d...

Detektion des Delirs durch Angehörige auf der Intensivstation: Übersetzung, transkulturelle Adaption und Validierung der Family Confusion Assessment Method (FAM-CAM) für den deutschsprachigen Raum

Older people demonstrate a higher risk for the occurrence of peri- and postsurgical complications. A frequent risk factor for this is the prevalence of a status called “frailty”. In general, this status can be reversed by adequate therapeutic and medical interventions. More, current evidence suggests that these measures, as part of a so-called preh...

Various limitations in everyday life can indicate a frailty syndrome. These limitations are not always directly visible and result from a wide variety of domains. Fried et al. described these limitations of different domains as frailty syndrome. This syndrome can be acutely worsened by different influencing factors. One major risk factor is an upco...

Background Mobilisation and exercise intervention in general are safe and feasible in critically ill patients. For patients requiring catecholamines, however, doses of norepinephrine safe for mobilisation in the intensive care unit (ICU) are not defined. This study aimed to describe mobilisation practice in our hospital and identify doses of norepi...

Background: Intensive care unit (ICU)-acquired weakness often develops in patients who are undergoing invasive mechanical ventilation. Early active mobilization may mitigate ICU-acquired weakness, increase survival, and reduce disability. Methods: We randomly assigned 750 adult patients in the ICU who were undergoing invasive mechanical ventilat...

Background: Muscle ultrasound represents a promising approach to aid diagnoses of neuromuscular diseases in critically ill patients. Unfortunately, standardization of ultrasound measurements in clinical research is lacking, making direct comparisons between studies difficult. Protocols are required to assess qualitative muscle changes during an IC...

Purpose of Review Impaired recovery following an intensive care unit (ICU) admission is thought related to muscle wasting. Nutrition and physical activity are considered potential avenues to attenuate muscle wasting. The aim of this review was to present evidence for these interventions in attenuating muscle loss or improving strength and function....

Following publication of the original article [1], an error was identified in the article title: COVID‑19 was incorrectly captured as COIVD‑19. The article title has been updated above and in the original article.

Background and Objectives: Intensive care unit-acquired weakness (ICU-AW) is one of the most frequent neuromuscular complications in critically ill patients. We conducted a global survey to evaluate the current practices of diagnostics, treatment and prevention in patients with ICU-AW. Materials and Methods: A pre-survey was created with internatio...

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...

Background Post-operative delirium is common in elderly patients and associated with increased morbidity and mortality. We evaluated in this pilot study whether a perioperative goal-directed hemodynamic optimization algorithm improves cerebral oxygenation and can reduce the incidence of delirium. Materials and Methods Patients older than 70 years...

Seizures are a common reason for calling emergency medical services. A lack of guidelines on prehospital treatment in Germany leads to high transportation rates and reduced confidence in decision making by professionals. Our aim was to investigate the reasons for hospitalization and evaluate their necessity. A retrospective analysis of all emergenc...

Background Frailty is expressed by a reduction in physical capacity, mobility, muscle strength, and endurance. (Pre-)frailty is present in up to 42% of the older surgical population, with an increased risk for peri- and postoperative complications. Consequently, these patients often suffer from a delayed or limited recovery, loss of autonomy and qu...

Background Intensive care unit (ICU) acquired weakness is associated with reduced physical function, increased mortality and reduced quality of life, and affects about 43% of survivors of critical illness. Lacking therapeutic options, the prevention of known risk factors and implementation of early mobilization is essential. Robotic assistance devi...

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...

Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organization...

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 Frailty is accompanied with a reduced physical capacity, mobility, muscle strength and endurance. (Pre-)Frailty is present in an older surgical population in up to 50% with an increased risk for peri- and post-surgical complications. Consequently, these patients often suffer from a delayed or diminished recovery, loss of autonomy and qua...

Purpose Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. Methods The COVIP study is a prospective international...

Aim The aim of this study was the translation, cross‐cultural adaptation and validation of the Family Confusion Assessment Method in critically ill patients. Background Delirium is a frequently unrecognized disorder in critically ill patients. Visiting family members might be the first to notice subtle changes in a patient's cognition and behaviou...

Purpose: Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. Methods: The COVIP study is a prospective internatio...

Purpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without CO...

Background Intensive care unit-acquired weakness (ICU-AW) is one of the most frequent causes of neuromuscular dysfunction in intensive care medicine. To date no evidence-based recommendations exist for the diagnostics, monitoring or further intensive care treatment.Objective To evaluate the current clinical practice of diagnostics, monitoring and t...

Zusammenfassung (Früh-)Mobilisation ist ein wichtiges Element auf der Intensivstation – es dient der Prävention und Therapie der durch eine kritische Erkrankung verursachten Einschränkungen der körperlichen Funktion. Aufgrund diverser Barrieren werden die aktuellen Leitlinien-Ziele aber nicht immer erreicht. In diesem Beitrag geht es um die Integra...

Background: health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. Objective: to quantify HRQoL in order to identify areas of interventions. Design: prospective observation study. Setting: admissions to E...

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...