Triemli City Hospital Zurich

Zürich, Switzerland

Triemli City Hospital Zurich

Zürich, Switzerland

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Vincent J.-L.,Free University of Colombia | Rhodes A.,St Georges Healthcare NHS Trust | Perel A.,Tel Aviv University | Martin G.S.,Emory University | And 12 more authors.
Critical Care | Year: 2011

Hemodynamic monitoring plays a fundamental role in the management of acutely ill patients. With increased concerns about the use of invasive techniques, notably the pulmonary artery catheter, to measure cardiac output, recent years have seen an influx of new, less-invasive means of measuring hemodynamic variables, leaving the clinician somewhat bewildered as to which technique, if any, is best and which he/she should use. In this consensus paper, we try to provide some clarification, offering an objective review of the available monitoring systems, including their specific advantages and limitations, and highlighting some key principles underlying hemodynamic monitoring in critically ill patients. © 2011 BioMed Central Ltd.


Kiefer N.,University of Bonn | Hofer C.K.,Triemli City Hospital Zurich | Marx G.,RWTH Aachen | Geisen M.,Triemli City Hospital Zurich | And 5 more authors.
Critical Care | Year: 2012

Introduction: Transpulmonary thermodilution is used to measure cardiac output (CO), global end-diastolic volume (GEDV) and extravascular lung water (EVLW). A system has been introduced (VolumeView/EV1000™ system, Edwards Lifesciences, Irvine CA, USA) that employs a novel algorithm for the mathematical analysis of the thermodilution curve. Our aim was to evaluate the agreement of this method with the established PiCCO™ method (Pulsion Medical Systems SE, Munich, Germany, clinicaltrials.gov identifier: NCT01405040). Methods: Seventy-two critically ill patients with clinical indication for advanced hemodynamic monitoring were included in this prospective, multicenter, observational study. During a 72-hour observation period, 443 sets of thermodilution measurements were performed with the new system. These measurements were electronically recorded, converted into an analog resistance signal and then re-analyzed by a PiCCO 2™ device (Pulsion Medical Systems SE).Results: For CO, GEDV, and EVLW, the systems showed a high correlation (r 2= 0.981, 0.926 and 0.971, respectively), minimal bias (0.2 L/minute, 29.4 ml and 36.8 ml), and a low percentage error (9.7%, 11.5% and 12.2%). Changes in CO, GEDV and EVLW were tracked with a high concordance between the two systems, with a traditional concordance for CO, GEDV, and EVLW of 98.5%, 95.1%, and 97.7% and a polar plot concordance of 100%, 99.8% and 99.8% for CO, GEDV, and EVLW, respectively. Radial limits of agreement for CO, GEDV and EVLW were 0.31 ml/minute, 81 ml and 40 ml, respectively. The precision of GEDV measurements was significantly better using the VolumeView™ algorithm compared to the PiCCO™ algorithm (0.033 (0.03) versus 0.040 (0.03; median (interquartile range), P = 0.000049).Conclusions: For CO, GEDV, and EVLW, the agreement of both the individual measurements as well as measurements of change showed the interchangeability of the two methods. For the VolumeView method, the higher precision may indicate a more robust GEDV algorithm.Trial registration: clinicaltrials.gov NCT01405040. © 2012 Kiefer et al.; licensee BioMed Central Ltd.


Bendjelid K.,University of Geneva | Marx G.,RWTH Aachen | Kiefer N.,University of Bonn | Simon T.P.,RWTH Aachen | And 4 more authors.
British Journal of Anaesthesia | Year: 2013

Background. A new calibrated pulse wave analysis method (VolumeView TM/EV1000TM, Edwards Lifesciences, Irvine, CA, USA) has been developed to continuously monitor cardiac output (CO). The aim of this study was to compare the performance of the VolumeView method, and of the PiCCO2 TM pulse contour method (Pulsion Medical Systems, Munich, Germany), with reference transpulmonary thermodilution (TPTD) CO measurements. Methods. Thiswas a prospective,multicentre observational study performed in the surgical and interdisciplinary intensive care units of four tertiary hospitals. Seventy-two critically ill patients were monitored with a central venous catheter, and a thermistor-tipped femoral arterial VolumeViewTM catheter connected to the EV1000TM monitor. After initial calibration by TPTD CO was continuously assessed using the VolumeView-CCO software (CCOVolumeView) during a 72 h period. TPTD was performed in order to obtain reference CO values (COREF). TPTD and arterial wave signals were transmitted to a PiCCO2 TM monitor in order to obtain CCOPiCCO values. CCOVolumeView and CCOPiCCO were recorded over a 5 min interval before assessment of COTPTD. Bland-Altman analysis, %errors, and concordance (trend analysis) were calculated. Results. A total of 338 matched sets of data were available for comparison. Bias for CCOVolumeView-COREF was -0.07 litre min-1 and for CCOPiCCO-COREF +0.03 litre min21. Corresponding limits of agreement were 2.00 and 2.48 litre min-1 (P<0.01),%errors 29 and 37%, respectively. Trending capabilities were comparable for both techniques. Conclusions. The performance of the new VolumeViewTM-CCO method is as reliable as the PiCCO 2 TM-CCO pulse wave analysis in critically ill patients. However, an improved precision was observed with the VolumeViewTM technique. Clinicaltrials.gov identifier. NCT01405040. © The Author [2013]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.


Hofer C.K.,Triemli City Hospital Zurich | Rex S.,University Hospitals Leuven | Rex S.,Catholic University of Leuven | Ganter M.T.,Institute of Anesthesiology and Pain Medicine
Current Opinion in Anaesthesiology | Year: 2014

PURPOSE OF REVIEW: Advanced hemodynamic monitoring is indispensable for adequate management of patients undergoing major surgery. This article will summarize minimally invasive hemodynamic monitoring technologies and their potential use in thoracic anesthesia. RECENT FINDINGS: According to their inherent principle, currently available technologies can be classified into four groups: bioimpedance and bioreactance, applied FickÊs principle, pulse wave analysis and Doppler. All devices measure stroke volume and cardiac output. Functional hemodynamic variables and volumetric parameters have been integrated in some devices. Two major indications can be identified: the 'hemodynamically unstable' patient and the patient 'at risk' for hemodynamic instability. Although there is evidence for the first indication, pre-emptive hemodynamic therapy or perioperative hemodynamic optimization for the patient 'at risk' is still an issue of ongoing debate. There is a growing body of evidence that this approach can positively influence patients' outcome with less postoperative complications in selected patient groups. SUMMARY: Many different minimally invasive hemodynamic monitoring devices have been developed and clinically introduced in the last years. They offer the advantage of being less invasive and easier to use. However, these techniques have several limitations and data are scarce in patients undergoing thoracic anesthesia, preventing their widespread use so far. © 2014 Lippincott Williams and Wilkins.


Cannesson M.,University of California at Irvine | Aboy M.,Oregon Institute of Technology | Hofer C.K.,Triemli City Hospital Zurich | Rehman M.,Children's Hospital of Philadelphia
Journal of Clinical Monitoring and Computing | Year: 2011

In the present review we will describe and discuss the physiological and technological background necessary in understanding the dynamic parameters of fluid responsiveness and how they relate to recent softwares and algorithms' applications. We will also discuss the potential clinical applications of these parameters in the management of patients under general anesthesia and mechanical ventilation along with the potential improvements in the computational algorithms. © 2010 Springer Science+Business Media, LLC.


Cannesson M.,University of California at Irvine | De Backer D.,Free University of Brussels | Hofer C.K.,Triemli City Hospital Zurich
Expert Review of Medical Devices | Year: 2011

Predicting the effects of volume expansion on cardiac output and oxygen delivery is of major importance in different clinical scenarios. Functional hemodynamic parameters based on pulse waveform analysis, which are relying on the effects of mechanical ventilation on stroke volume and its surrogates, have been shown to be reliable predictors of fluid responsiveness during anesthesia and intensive care unit treatment, as demonstrated by several clinical studies and meta-analyses. However, different limitations of these parameters have to be considered when they are used in clinical practice. Today, they can be continuously and automatically monitored by a variety of commercially available devices. These parameters have been introduced into the concept of perioperative fluid management and hemodynamic optimization - an approach that may positively impact postoperative patients' outcomes. In this article, technical aspects of the assessment of the functional hemodynamic parameters derived from pulse waveform analysis are summarized, emphasizing their advantages, limitations and potential applications, primarily in a perioperative setting in order to improve patient outcome. © 2011 Expert Reviews Ltd.


Zingg U.,University of Basel | Forberger J.,Triemli City Hospital Zurich | Frey D.M.,University of Basel | Esterman A.J.,University of South Australia | And 3 more authors.
European Cytokine Network | Year: 2010

Introduction. Open, right-sided, transthoracic esophagectomy with one-lung ventilation (OLV) triggers a massive inflammatory reaction. The influence of the OLV on the inflammatory cascade is unclear. Data on the inflammatory response in the ventilated left and collapsed right lung, respectively, are scarce. The aim of this study was to analyze this reaction in bronchoalveolar lavage (BAL) fluid from both lungs, the right pleural space and the peripheral blood, and to study its time course. Methods. Concentrations of interleukin (IL)-6, IL-8, IL-10 and IL-1RA in the BAL fluids from the right and left lungs, respectively, in the peripheral blood and in the right pleural space in patients undergoing transthoracic esophagectomy for cancer, were determined using enzyme-linked immunosorbent assays in 29 patients. Results. Assay of the pro-inflammatory cytokines in the bilateral BAL fluids showed significantly higher concentrations in the ventilated left lung at the time of extubation. The anti-inflammatory response was only seen with respect to IL-1RA, but not IL-10, and was mostly restricted to the ventilated left lung. In the blood, only IL-6, IL-10 and IL-1RA increased, whereas IL-8 showed little change. The response was already observed at the end of surgery, indicating a rapid reaction to the surgical and anesthetic trauma. In the pleural fluid, all cytokine concentrations increased, and the highest values were detected on day one post-surgery, and decreased thereafter. Pulmonary complications or anastomotic leakage were not related to the cytokine concentrations. Conclusion. Both the ventilated left and the collapsed right lung showed an inflammatory response. The response was more pronounced on the ventilated left side and the time courses were significantly different. In the blood, the pro-inflammatory IL-6 and both antiinflammatory cytokines increased early on. All cytokines increased in the pleural cavity. The findings underline the complexity of the inflammatory reaction associated with OLV in transthoracic esophagectomy.


PubMed | University of Zürich, King Abdulaziz University, Institute of Anaesthesiology and Pain Medicine and Triemli City Hospital Zurich
Type: Comparative Study | Journal: Journal of clinical monitoring and computing | Year: 2016

Septic shock is a serious medical condition. With increased concerns about invasive techniques, a number of non-invasive and semi-invasive devices measuring cardiac output (CO) have become commercially available. The aim of the present study was to determine the accuracy, precision and trending abilities of the FloTrac and the continuous pulmonary artery catheter thermodilution technique determining CO in septic shock patients. Consecutive septic shock patients were included in two centres and CO was measured every 4h up to 48h by FloTrac (APCO) and by pulmonary artery catheter (PAC) using the continuous (CCO) and intermittent (ICO) technique. Forty-seven septic shock patients with 326 matched sets of APCO, CCO and ICO data were available for analysis. Bland and Altman analysis revealed a mean bias 2 SD of 0.02.14 L min(-1) for APCO-ICO (%error=34.5%) and 0.232.55 L min(-1) for CCO-ICO (%error=40.4%). Trend analysis showed a concordance of 85 and 81% for APCO and CCO, respectively. In contrast to CCO, APCO was influenced by systemic vascular resistance and by mean arterial pressure. In septic shock patients, APCO measurements assessed by FloTrac but also the established CCO measurements using the PAC did not meet the currently accepted statistical criteria indicating acceptable clinical performance.


Barton M.,University of Zürich | Meyer M.R.,University of Zürich | Meyer M.R.,Triemli City Hospital Zurich | Meyer M.R.,University of New Mexico | Prossnitz E.R.,University of New Mexico
Journal of Cardiovascular Pharmacology | Year: 2013

In view of recent findings on the anatomic heterogeneity of rapid vasodilation via estrogen receptor (ER)-dependent mechanisms, it is obvious that with regard to human physiology and disease much of it is still unknown, and research in this area is urgently needed. This is also important because chronic drug therapy with estrogens in women systemically affects the circulation and may affect certain arterial beds but not others. It is conceivable that the presence of any vascular disease (as was the case for coronary and carotid atherosclerosis in many of the patients in the large randomized controlled trials HERS and WHI) is likely to affect vascular responses to estrogens as well, and that any beneficial effects may be attenuated or even completely lost. Further work is required to decipher the mechanisms of vasodilation brought about by estrogens in humans and experimental animals, whether anatomic heterogeneity exists with regard to vascular beds and individual estrogen receptors, and how vascular disease (atherosclerosis in particular) affects responsiveness. Also, pharmacologcial tools for newly identified ERs are now available. The hypothesis that disease may modify or even abrogate estrogen-dependent or ER-selective vasodilation should also be tested. Finally, given that certain clinically approved drugs such as SERM or SERDs (thought only to block or downregulate nuclear ERs) actually cause vasodilation through GPER and have been shown in recent clinical studies to provide cardiovascular protection in postmenopausal women, we may have to rethink our current understanding, concepts, and strategies of how to interfere with the increased risk of vascular disease in women with estrogen deficiency or after menopause. Copyright © 2013 by Lippincott Williams & Wilkins.


Muenst S.,University of Basel | Thies S.,University of Basel | Thies S.,University of Zürich | Went P.,Triemli City Hospital Zurich | And 3 more authors.
Human Pathology | Year: 2011

Gastrointestinal stromal tumors are the most common mesenchymal tumors of the human digestive tract. Up to 85% of these tumors show somatic gain-of-function mutation of the receptor tyrosine kinase c-KIT gene. A recent study has shown a high frequency (22.5%) of minute gastrointestinal stromal tumors in stomachs examined during routine autopsies. The aims of our study were to confirm the previously reported incidence of gastric gastrointestinal stromal tumors in routine autopsies and to investigate their molecular alterations. Gastrointestinal stromal tumors were collected prospectively from 578 autopsies over an 18-month period. After recording the size and location of each lesion, representative tissue samples were processed for hematoxylin and eosin staining and immunohistochemically stained for CD117 and CD34. Microdissected DNA from all identified gastrointestinal stromal tumors was studied for c-KIT and platelet-derived growth factor receptor α mutations. We identified 17 gastrointestinal stromal tumors in 578 consecutive autopsies (2.9%) located in the gastric body (47%) and fundus (47%). One tumor location was not recorded. All tumors were immunohistochemically positive for CD117 and CD34. DNA analysis showed c-KIT mutations in 11 cases. One platelet-derived growth factor receptor α mutation was found. The incidence of gastric minute gastrointestinal stromal tumors (2.9%) is higher than the reported clinical incidence. All are benign tumors, and most, including minute tumors, contain c-KIT mutations. This finding highlights the fact that c-KIT mutations are an early event in the evolution of gastrointestinal stromal tumors but are not sufficient per se for clinically relevant disease. © 2011 Elsevier Inc. All rights reserved.

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