Showing papers by "Christine Lautenschläger published in 2017"

Survival of Hypercapnic Patients with COPD and Obesity Hypoventilation Syndrome Treated with High Intensity Non Invasive Ventilation in the Daily Routine Care

Abstract: BACKGROUND Home ventilation is an effective treatment option for obesity hypoventilation syndrome (OHS). This therapy is still controversial for stable chronic obstructive pulmonary disease (COPD). A recent study showed reduced mortality for COPD patients receiving home ventilation with high inflation pressures and back-up respiratory rates [so called High Intensity non-invasive ventilation (NIV)]. OBJECTIVE The purpose of this study is whether High Intensity NIV applied in the routine care of COPD and OHS patients can lead to CO2 reduction and survival data comparable to data from controlled studies. METHOD In this prospective non interventional study fifty-one patients with COPD (FEV1 0.95l, corr. 32.8%) and 34 patients with OHS (VC 1.74l, corr. 50.7%) with chronic hypercapnic respiratory failure, who were treated with NIV were followed up for four years. RESULTS Elevated CO2 values before NIV in COPD patients (8.6kPa), and in OHS patients (8.3kPa), could be lowered significantly to the upper normal range (COPD: 5.9kPa; OHS: 5.85kPa). The one-, two-, and three-year survival rates for COPD patients were 83%, 73%, and 55%, respectively. The one-, two-, and three-year survival rates for OHS patients were 85%, 72%, and 68%, respectively. CONCLUSION High intensity NIV within routine care is effective in reducing blood CO2 levels in COPD- and in OHS- related chronic respiratory insufficiency. The survival rates obtained here are comparable to data from controlled clinical trials on COPD.

Serum IgG levels and mortality in patients with severe sepsis and septic shock : The SBITS data.

Abstract: The role of intravenous immune globulin (Ig) therapy in patients with severe sepsis and septic shock is discussed controversially. Low initial IgG levels could help to identify those patients who might benefit from an adjunctive Ig treatment. To investigate the effect of initial serum IgG levels on 28-day mortality in patients with severe sepsis and septic shock. In this retrospective analysis of the SBITS trial data, 543 patients were allocated to four groups (quartiles) depending on their initial serum IgG levels (1: IgG ≤ 6.1 g/l; 2: IgG 6.2–8.4 g/l; 3: IgG 8.5–11.9 g/l; 4: IgG > 11.9 g/l). The third quartile was taken as the reference quartile. For the applied logistic regression model clinically relevant confounders were defined and integrated into further risk-adjusted calculations. Patients with the lowest IgG levels had a mortality rate similar to those patients with initial IgG levels in the second and third quartile, representing the physiological IgG range in healthy people. Surprisingly, patients with the highest IgG levels even showed a significantly higher mortality in a risk-adjusted calculation compared to the reference quartile (OR 1.69, CI 1.01–2.81, p = 0.05). Subgroup analyses revealed that initial IgG levels were of no prognostic value in patients presenting with vasopressor-dependent septic shock on admission as well as in patients with either gram-positive or gram-negative sepsis. Initially low IgG levels do not discriminate between survival and nonsurvival in patients with severe sepsis and septic shock. Therefore, low IgG cannot help to identify those patients who might benefit from an adjunctive IgG sepsis therapy. Whether a high initial IgG serum level is an independent mortality risk factor needs to be investigated prospectively.

Prognostische Aussagekraft der Tränenwegsdiagnostik nach Intubatentfernung

Abstract: Die transkanalikulare Operation (OP) der ableitenden Tranenwege (TNW) mit nachfolgender Silikonschlauchintubation hat in den letzten 2 Jahrzehnten zunehmend an Bedeutung gewonnen. Ziel der Arbeit war es zu klaren, ob sich anhand des Ergebnisses der postoperativen (po.) Prufung der Spulbarkeit der ableitenden TNW sowie des Spontanabflusses der Tranenflussigkeit unmittelbar nach Intubatentfernung das Rezidivrisiko im ersten po. Jahr vorhersagen lasst. Durch retrospektive Auswertung unseres transkanalikular operierten Patientengutes von Januar 2001 bis August 2008 konnten 110 po. TNW-Spulungen und 183 Prufungen des po. Spontanabflusses erfasst werden. Der Einsatz dieser Testverfahren war hierbei von der subjektiven Entscheidung des Untersuchers abhangig. Anhand prognostischer Parameter (Bestimmung des positiven [PPW] und negativen pradiktiven Wertes [NPW]) und einer Rezidivfreiheitsanalyse mittels Kaplan-Meier-Schatzer sowie eines Cox-Regressionsmodells wurde die Rezidivprognose beider genannter Verfahren ermittelt. Der Betrachtungszeitraum wurde hierbei auf 12 Monate po. begrenzt. Die Definition eines Rezidivereignisses orientierte sich uberwiegend an der mittels Fragebogen eruierten Patientenzufriedenheit bzw. Beschwerdefreiheit. Die po. Prufung der Spulbarkeit der TNW erreichte einen PPW von 92,31 % und stellt somit ein geeignetes Instrument zur Abschatzung des Rezidivrisikos innerhalb eines Jahres dar. Fur die Prufung des Spontanabflusses konnte ein PPW von 63,33 % ermittelt werden. Aufgrund der nachgewiesenen prognostischen Aussagekraft bezuglich des Rezidivrisikos sollten TNW-Spulung und Prufung des Spontanabflusses der Tranenflussigkeit standardisiert in die po. Nachbetreuung integriert werden. Hierdurch wird der Patient fruhzeitig uber das zu erwartende Rezidivrisiko informiert.