Sankt Gallen, Switzerland
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PubMed | Asklepios Fachkliniken Munich Gauting, Lungenklinik Hemer, Asklepios Klinikum Barmbeck, Lungenklinik and 15 more.
Type: Journal Article | Journal: Pneumologie (Stuttgart, Germany) | Year: 2015

The non-invasive ventilation (NIV) is widespread in the clinical medicine and has attained meanwhile a high value in the clinical daily routine. The application of NIV reduces the length of ICU stay and hospitalization as well as mortality of patients with hypercapnic acute respiratory failure. Patients with acute respiratory failure in context of a cardiopulmonary edema should be treated in addition to necessary cardiological interventions with continuous positive airway pressure (CPAP) or NIV. In case of other forms of acute hypoxaemic respiratory failure it is recommended the application of NIV to be limited to mild forms of ARDS as the application of NIV in severe forms of ARDS is associated with higher rates of treatment failure and mortality. In weaning process from invasive ventilation the NIV reduces the risk of reintubation essentially in hypercapnic patients. A delayed intubation of patients with NIV failure leads to an increase of mortality and should therefore be avoided. With appropriate monitoring in intensive care NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency. Furthermore NIV can be useful within palliative care for reduction of dyspnea and improving quality of life. The aim of the guideline update is, taking into account the growing scientific evidence, to outline the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.


Maeder M.T.,Baker IDI Heart and Diabetes Institute | Ammann P.,Kantonsspital St. Gallen | Schoch O.D.,Multidisciplinary Sleep Center | Rickli H.,Kantonsspital St. Gallen | And 5 more authors.
Chest | Year: 2010

Background: Young patients with obstructive sleep apnea syndrome(OSAS) display an attenuated heart rate recovery(HRR) during the first minute(HRR-1) and the first 2 min(HRR-2) postexercise. We sought to compare determinants of HRR-1 and HRR-2 in OSAS and to assess whether these associations depend on age. Methods: Exercise testing with measurements of HRR-1 and HRR-2 was performed in 54 patients with untreated OSAS(median [interquartile range] apnea-hypopnea index 27.5 [12.0-42.4] h-1, desaturation index [DSI] 10.6 [5.1-25.0] h-1). Results: Overall, higher DSI(P<.001) and higher total cholesterol([TC] P =.02) were independent predictors of lower HRR-1, whereas lower peak heart rate(P<.001), higher resting heart rate(P =.006), and higher DSI(P =.01) were independently associated with lower HRR-2. In the below-median age group(age ≤ 48 years;n = 27), higher DSI(P =.002) was the only independent predictor of lower HRR-1, and lower peak heart rate(P<.001) and higher DSI(P =.003) were independently associated with lower HRR-2. In contrast, in the above-median age group(age>48 years;n = 27) higher TC(P =.006), higher insulin resistance(P =.009), and higher resting heart rate(P =.048) were independently associated with lower HRR-1, and lower estimated glomerular filtration rate(P =.001), higher resting heart rate(P =.002), higher TC(P =.005), and lower peak heart rate(P =.01) were independently associated with HRR-2. Conclusions: Assessment of HRR-2 provides additional information on different aspects of OSAS compared with HRR-1. Markers of OSAS severity, such as DSI, are independently associated with HRR in younger patients only, whereas in older patients, HRR reflects OSAS-related metabolic and renal dysfunction. © 2010 American College of Chest Physicians.


Hegglin A.,Geriatrische Klinik | Schoch O.D.,Multidisciplinary Center for Sleep Medicine | Korte W.,Institute for Clinical Chemistry | Korte W.,University of Bern | And 4 more authors.
Sleep and Breathing | Year: 2012

Objectives: The aim of this study was to assess serum tumor necrosis factor alpha (TNFA) concentrations 8 months of continuous positive airway pressure (CPAP) therapy. Design: This study used prospective, observational clinical trial. Patients: Sixty-six patients with newly diagnosed sleep apnea syndrome (12 women, 54 men), age 52.3±9.8 (mean±SD) with a body mass index of 29.7±4.4 and an apnea-hypopnea index of 39.7±26.8, were studied. Intervention CPAP was administered for a mean of 7.8± 1.3 months. Measurements and results: TNFA concentrations using an ultrasensitive ELISA assay at baseline and follow-up. TNFA decreased in men with high (5.2±1.7 h/night, -0.46±1.1 ng/l, p=0.001) and with low (2.5±1.0 h/night -0.63±0.77 ng/l, p=0.001) adherence but not in women. Average number of hours of CPAP use correlated positively with delta TNFA (R 2 0.08, p=0.04) Conclusion: Long-term CPAP positively affects TNFA even in men with poor adherence to CPAP. © Springer-Verlag 2011.


Munzer T.,Geriatrische Klinik | Munzer T.,University of Bern | Hegglin A.,Geriatrische Klinik | Hegglin A.,University of Bern | And 8 more authors.
European Journal of Endocrinology | Year: 2010

Objective: To investigate the long-term effects of nasal continuous positive airway pressure (CPAP) ventilation in patients with obstructive sleep apnea syndrome (OSAS) on body composition (BC) and IGF1. Design: Observational study. Subjects: Seventy-eight (11 females and 67 males) OSAS patients who were compliant with CPAP (age 51±1.1 years) participated in the study. We assessed body mass index (BMI), total body mass (TBM), total body fat (TBF; kg) and lean body mass (LBM; kg), abdominal subcutaneous (SC) and visceral (V) fat (cm2), and waist circumference (WC; cm) by magnetic resonance imaging, and IGF1 (ng/ml) before and after 7.8±1.3 months of CPAP use of an average of 5.9±1.2 h. Results: Women had a higher BMI, WC; TBM, TBF, and more SC fat. Men had a higher LBM and more V fat. CPAP increased WC (+2.8±9.6 cm, P=0.02) and LBM (2.2±0.5 kg, P=0.006), but not IGF1. In men, CPAP increased BMI (0.5±0.2 kg/m2, P=0.02), WC (1.7±6.9 cm, P=0.002), TBM (1.7±0.4 kg, P=0.0001), LBM (1.5±0.4 kg, P=0.0003), SC fat (12.9±5.1 cm2, P=0.02), and IGF1 (13.6±4.2 ng/ml, P=0.002). Compliance with CPAP increased LBM in men aged <60 years, but not in those aged >60 years, and IGF1 increased in men aged 40-60 years only. Conclusions: Long-term CPAP increased LBM in both sexes and IGF1 in men, while fat mass remained unchanged, suggesting a sexually dimorphic response of IGF1 to CPAP. The role of the GH axis activity and age to this response is unclear. The metabolic consequences of changes in LBM are still to be determined. Future studies on the effects of CPAP on BC should include LBM as an outcome. © 2010 European Society of Endocrinology.


The demographic shift is leading to a rapid rise in the number of elderly citizens. Accordingly, the number of geriatric problems is also increasing within the population of rheumatic patients. Geriatric patients are characterized through the triad of high age, multimorbidity and functional deficits. Almost all will show signs of arthritis and other degenerative musculoskeletal illnesses. Inflammatory rheumatic diseases within the geriatric population are found to be mostly in the chronic stage or with defective conditions. Problems typical of this population, such as comorbidities especially in the cardiovascular sector, must be assessed prior to the application of therapeutic concepts. The focus is on activating therapies, such as physiotherapy and occupational therapy, where the functional usefulness is proven. The use of thermal therapy, especially applied in the form of heat, as well as electrotherapy and high frequency therapy are also useful when indicated. Balneotherapy and hydrotherapy, as well as massage therapy and lymphatic drainage, must be adapted to the cardiovascular function of geriatric patients; this applies especially to heart failure patients. Physical therapy concepts in elderly rheumatic patients should preferably be implemented and managed by a multidisciplinary geriatric team. © Springer-Verlag 2012.


Vogt L.,Goethe University Frankfurt | Lucki K.,Goethe University Frankfurt | Bach M.,Geriatrische Klinik | Banzer W.,Goethe University Frankfurt
Journal of Rehabilitation Research and Development | Year: 2010

In a quasi-experimental preand postdesign, we examined the effect of rollator use on functional rehabilitation outcome in geriatric patients. From a sample of 458 geriatric inpatients, we matched 30 subjects who were not using assistive devices in their everyday lives but received a wheeled walker at the time of hospital admission (first-time user group) according to their admission scores on three motor performance tests (Timed Up-and-Go, Five-Times-Sit-to-Stand, and Performance-Oriented Mobility Assessment-Balance) with 30 patients who were actively using rollators as their primary walking aid for at least 3 months (long-term user group) and 30 control subjects without walking-aid assistance. Measurements were repeated after the inpatient rehabilitation regimen. The Kruskal-Wallis test did not reveal significant group differences in rehabilitation progress. Controls and device users, regardless of walking-aid experience, demonstrated nearly comparable mobility, strength, and balance improvements. More than half of each cohort (controls, n = 22; first-time, n = 17; long-term, n = 18) achieved functional gains in all three motor tests. The study showed that rollator assistance does not interfere with rehabilitation outcome and, to some extent, legitimates the prescription of assistive devices to improve confidence and restore or maintain motor ability at the highest possible level.


Mau W.,Martin Luther University of Halle Wittenberg | Reuter S.,Geriatrische Klinik
Deutsche Medizinische Wochenschrift | Year: 2011

Considering the increasing disability with higher age and the demographic changes health promotion, prevention and rehabilitation are of high relevance for the maintenance and restoration of activity and participation of the elderly. Among the most important goals of prevention are mobility including physical activity and prevention of falls, adequate nutrition, maintenance of mental health, social integration and function. Different conditions of geriatric rehabilitation in Germany focussing either on acute care hospitals with early rehabilitation (inpatient or outpatient) or on rehabilitation in specialized centres lead to regional disparities. The application for rehabilitation measures has to consider the need, ability to participate, specified goals and prognosis after the interventions. Disease specific rehabilitation has to be differentiated from general geriatric rehabilitation addressing typical multimorbidity and geriatric syndromes. Significant characteristics of geriatric rehabilitation are regular patient oriented discussions within the multi-professional and interdisciplinary team coordinated by geriatricians. This includes prioritizing the patients problems according to their significance and availability of effective therapy, evaluation of the results and adjustment of treatment goals if necessary. Standardised geriatric assessments should be applied. Geriatric rehabilitation including the interdisciplinary team increases function and reduces the risks of nursing home admissions and mortality. Therefore, the access to and the capacities of geriatric rehabilitation should be further improved. © Georg Thieme Verlag KG Stuttgart.


Fiedler M.,Geriatrische Klinik | Gerhardt L.-C.,Empa - Swiss Federal Laboratories for Materials Science and Technology | Derler S.,Empa - Swiss Federal Laboratories for Materials Science and Technology | Bischofberger G.,Geriatrische Klinik | And 3 more authors.
Gerontology | Year: 2012

Background: Skin aging is a risk factor for a decubitus and biophysical skin properties could help to identify persons at risk. Whether such biophysical properties of aged human skin differ between areas is undetermined. Objective: To investigate whether viscoelasticity, hydration or friction differ between important areas for decubitus risk. Methods: Pilot study in 32 (18 female, 14 male) acute and subacute old patients aged 81.9 ± 5.9 years (±SD), without active skin disease after an average of 10 days of stay. Assessment of skin resilience/viscoelasticity (E) and hydration (H) at the volar forearm (VF), trochanter (TR) and the sacrum (SA), nutrition by a Mini Nutritional Assessment (MNA), total body water (TBW), lean body mass (LBM), % body fat (%F) by bioimpedance and routine laboratory parameters (hemoglobin, hematocrit, leukocytes, C-reactive protein, serum proteins and creatinine). Results: Mean body mass index (27 ± 4.2), MNA (22.5 ± 2.9), Braden score (20 ± 2.5), E (68.5 ± 6.0%) and H (38.3 ± 6.7) at any site and laboratory parameters did not differ by sex. Men had more TBW (+12 ± 1.5 liters), LBM (+9 ± 2 kg), less %F (-8.8 ± 2.1%), increased H-TR (+7.11 ± 2.8) and H-SA (+5.68 ± 2.5). Overall E-VF correlated significantly with E-TR (r2 = 0.40, p < 0.0001) and E-SA (r 2 = 0.40, p < 0.0001). In contrast, skin hydration was not correlated. Conclusion: Results of forearm elasticity experiments can be used as a model for other body sites at risk for the development of pressure ulcers. Copyright © 2012 S. Karger AG, Basel.


Singler K.,Abteilung fur Geriatrie | Singler K.,Friedrich - Alexander - University, Erlangen - Nuremberg | Thiem U.,Ruhr University Bochum | Christ M.,Klinik fur Notfall und internistische Intensivmedizin | And 4 more authors.
Zeitschrift fur Gerontologie und Geriatrie | Year: 2014

Background: The prevalence of delirium in hospitalized patients is high, but delirium is frequently not identified by treating physicians in emergency departments (EDs). Although the number of elderly patients admitted to EDs is increasing, no data on prevalence, identification and outcome of delirious elderly patients in German EDs exist.Objectives: To evaluate the prevalence and identification of delirium in elderly patients in a German ED and to identify characteristics of delirium in elderly ED patients.Methods: Evaluation of data from a prospective single-center observational study. The study was conducted in the interdisciplinary ED of an urban university-affiliated hospital receiving approximately 80,000 visits per year. The shortened Confusion Assessment Method (CAM) was used to screen 133 consecutive ED patients, aged 75 years and older, for delirium. Comorbid conditions were ascertained by patient interview and review of medical records. Data concerning patient mortality and current living status were collected 28 days after the ED visit in a structured telephone interview.Results: A positive CAM result was recorded in 14.3 % of cases; 68.4 % of these CAM-positive patients were not identified as being delirious by the ED physician. The 28-day mortality was higher among patients with delirium. Dependency on external help, polypharmacy, pre-existing cognitive or mobility impairments and the presence of any care level were strongly associated with delirium.Conclusion: Elderly patients with known risk factors should be routinely assessed for delirium in the ED with a standardized assessment tool such as the CAM. © 2014, Springer-Verlag Berlin Heidelberg.


PubMed | Geriatrische Klinik
Type: Clinical Trial | Journal: Sleep & breathing = Schlaf & Atmung | Year: 2012

The aim of this study was to assess serum tumor necrosis factor alpha (TNFA) concentrations 8months of continuous positive airway pressure (CPAP) therapy.This study used prospective, observational clinical trial.Sixty-six patients with newly diagnosed sleep apnea syndrome (12 women, 54 men), age 52.39.8 (meanSD) with a body mass index of 29.74.4 and an apnea-hypopnea index of 39.726.8, were studied.CPAP was administered for a mean of 7.81.3months.TNFA concentrations using an ultrasensitive ELISA assay at baseline and follow-up. TNFA decreased in men with high (5.21.7h/night, -0.461.1ng/l, p=0.001) and with low (2.51.0h/night -0.630.77ng/l, p=0.001) adherence but not in women. Average number of hours of CPAP use correlated positively with delta TNFA (R (2) 0.08, p=0.04)Long-term CPAP positively affects TNFA even in men with poor adherence to CPAP.

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