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Valipour A.,Otto Wagner Hospital | Herth F.J.F.,Pneumology and Critical Care Medicine | Burghuber O.C.,Otto Wagner Hospital | Criner G.,Temple University | And 4 more authors.
European Respiratory Journal | Year: 2014

Endobronchial valve (EBV) therapy may be associated with improvements in chronic obstructive pulmonary disease-related outcomes and may therefore be linked to improvements in the body mass index, airflow obstruction, dyspnoea, exercise capacity (BODE) index. Data from 416 patients with advanced emphysema and hyperinflation across Europe and USA, who were randomised to EBV (n5284) or conservative therapy (n5132) were analysed. Quantitative image analysis was used to compare the volume of the targeted lobe at baseline and at 6 months to determine target lobe volume reduction (TLVR). 44% of patients receiving EBV therapy (versus 24.7% of controls) had clinically significant improvements in the BODE index (p<0.001). BODE index was significantly reduced by mean±SD 1.4±1.8, 0.2±1.3 and 0.1±1.3 points in patients with TLVR .50%, 20%-50% and ,20%, respectively (intergroup differences p<0.001), but increased by 0.3±1.2 points in controls. Changes in BODE were predicted by baseline BODE and correlated significantly with lobar exclusion and lung volumes at 6 months. A greater proportion of patients in the treatment group than in the control group achieved a clinically meaningful improvement in BODE index; however, the likelihood of benefit was less than half in both groups. Patients in whom TLVR was obtained had greater improvements in clinical outcomes. Copyright © ERS 2014.


Valipour A.,Ludwig Boltzmann Research Institute | Burghuber O.C.,Otto Wagner Hospital
Therapeutic Advances in Respiratory Disease | Year: 2015

Lung volume reduction surgery has been shown to be effective in patients with heterogeneous emphysema, but is also associated with a relatively high perioperative morbidity and mortality. Accordingly, several novel and potentially less invasive methods for bronchoscopic lung volume reduction have been developed. Endobronchial valve (EBV) therapy is one such therapeutic approach in patients with advanced emphysema. It has been the most widely studied technique over the past years and represents an effective treatment option for patients with severe heterogeneous upper- or lower-lobe-predominant emphysema. The choice of EBV therapy largely depends on the distribution of emphysema and the presence or absence of interlobar collateral ventilation. Adequate patient selection and technical success of valve implantation with the intention of lobar exclusion are predictive factors for positive outcomes. This review attempts to highlight the milestones in the development of bronchoscopic lung volume reduction with one-way valve implantation over the past few years. © 2015 The Author(s).


Lindner G.,University of Bern | Funk G.-C.,Otto Wagner Hospital
Journal of Critical Care | Year: 2013

Hypernatremia is common in intensive care units. It has detrimental effects on various physiologic functions and was shown to be an independent risk factor for increased mortality in critically ill patients. Mechanisms of hypernatremia include sodium gain and/or loss of free water and can be discriminated by clinical assessment and urine electrolyte analysis. Because many critically ill patients have impaired levels of consciousness, their water balance can no longer be regulated by thirst and water uptake but is managed by the physician. Therefore, the intensivists should be very careful to provide the adequate sodium and water balance for them. Hypernatremia is treated by the administration of free water and/or diuretics, which promote renal excretion of sodium. The rate of correction is critical and must be adjusted to the rapidity of the development of hypernatremia. © 2013 Elsevier Inc.


Michael Roberts C.,Queen Mary, University of London | Lopez-Campos J.L.,Hospital Universitario Virgen del Rocio | Lopez-Campos J.L.,Institute Salud Carlos III | Pozo-Rodriguez F.,Institute Salud Carlos III | And 2 more authors.
Thorax | Year: 2013

Understanding how European care of chronic obstructive pulmonary disease (COPD) admissions vary against guideline standards provides an opportunity to target appropriate quality improvement interventions. In 2010-2011 an audit of care against the 2010 'Global initiative for chronic Obstructive Lung Disease' (GOLD) standards was performed in 16 018 patients from 384 hospitals in 13 countries. Clinicians prospectively identified consecutive COPD admissions over a period of 8 weeks, recording clinical care measures on a web-based data tool. Data were analysed comparing adherence to 10 key management recommendations. Adherence varied between hospitals and across countries. The lack of available spirometry results and variable use of oxygen and non-invasive ventilation (NIV) are high impact areas identified for improvement.


Minassian K.,Medical University of Vienna | McKay W.B.,Crawford Research Institute | Binder H.,Otto Wagner Hospital | Hofstoetter U.S.,Medical University of Vienna
Neurotherapeutics | Year: 2016

Epidural spinal cord stimulation has a long history of application for improving motor control in spinal cord injury. This review focuses on its resurgence following the progress made in understanding the underlying neurophysiological mechanisms and on recent reports of its augmentative effects upon otherwise subfunctional volitional motor control. Early work revealed that the spinal circuitry involved in lower-limb motor control can be accessed by stimulating through electrodes placed epidurally over the posterior aspect of the lumbar spinal cord below a paralyzing injury. Current understanding is that such stimulation activates large-to-medium-diameter sensory fibers within the posterior roots. Those fibers then trans-synaptically activate various spinal reflex circuits and plurisegmentally organized interneuronal networks that control more complex contraction and relaxation patterns involving multiple muscles. The induced change in responsiveness of this spinal motor circuitry to any residual supraspinal input via clinically silent translesional neural connections that have survived the injury may be a likely explanation for rudimentary volitional control enabled by epidural stimulation in otherwise paralyzed muscles. Technological developments that allow dynamic control of stimulation parameters and the potential for activity-dependent beneficial plasticity may further unveil the remarkable capacity of spinal motor processing that remains even after severe spinal cord injuries. © 2016, The Author(s).


Valipour A.,Otto Wagner Hospital
Pneumologie | Year: 2012

The obstructive sleep apnea syndrome (OSAS) is associated with increased morbidity and mortality. Epidemiological studies suggest a two-fold higher prevalence of OSAS in men than in women. Differences in pharyngeal collapsibility and central respiratory drive may play a significant role in the gender-specific pathogenesis. Compared with their male counterparts, female patients experience OSAS at an older age (postmenopausal) and with higher body-mass-index. Female OSAS patients furthermore more frequently report atypical symptoms, such as insomnia, depression, and/or restless legs, and thus are less likely to be referred for the evaluation of sleep disordered breathing. Knowledge about these distinct gender-related differences in clinical features of OSAS may contribute to an increased awareness, improved diagnosis and its therapeutic consequences. © 2012 Georg Thieme Verlag KG Stuttgart New York.


A variety of causes may result in nasal obstruction including allergic and non-allergic rhinitis, anatomic abnormalities, and postoperative nasal packing. There is both an epidemiological and clinical relationship between nasal obstruction and sleep disordered breathing. Subsequently, improving nasal patency via surgical or non-surgical means is expected to relieve sleep disordered breathing. The present review will discuss and review some of the literature related to the pathophysiological interaction of the human nose and sleep disordered breathing and provide a summary of the effects of related intervention trials. © Georg Thieme Verlag KG Stuttgart. New York.


Fazekas A.S.,Otto Wagner Hospital | Wewalka M.,Vienna University Hospital | Zauner C.,Vienna University Hospital | Funk G.-C.,Otto Wagner Hospital
Critical Care | Year: 2012

Introduction: Critical illness leads to increased endogenous production of carbon monoxide (CO) due to the induction of the stress-response enzyme, heme oxygenase-1 (HO-1). There is evidence for the cytoprotective and anti-inflammatory effects of CO based on animal studies. In critically ill patients after cardiothoracic surgery, low minimum and high maximum carboxyhemoglobin (COHb) levels were shown to be associated with increased mortality, which suggests that there is an 'optimal range' for HO-1 activity. Our study aimed to test whether this relationship between COHb and outcome exists in non-surgical ICU patients.Methods: We conducted a retrospective, observational study in a medical ICU at a university hospital in Vienna, Austria involving 868 critically ill patients. No interventions were undertaken. Arterial COHb was measured on admission and during the course of treatment in the ICU. The association between arterial COHb levels and ICU mortality was evaluated using bivariate tests and a logistic regression model.Results: Minimum COHb levels were slightly lower in non-survivors compared to survivors (0.9%, 0.7% to 1.2% versus 1.2%, 0.9% to 1.5%; P = 0.0001), and the average COHb levels were marginally lower in non-survivors compared to survivors (1.5%, 1.2% to 1.8% versus 1.6%, 1.4% to 1.9%, P = 0.003). The multivariate logistic regression analysis revealed that the association between a low minimum COHb level and increased mortality was independent of the severity of illness and the type of organ failure.Conclusions: Critically ill patients surviving the admission to a medical ICU had slightly higher minimum and marginally higher average COHb levels when compared to non-survivors. Even though the observed differences are statistically significant, the minute margins would not qualify COHb as a predictive marker for ICU mortality. © 2012 Fazekas et al.; licensee BioMed Central Ltd.


Mueller M.R.,Otto Wagner Hospital | Marzluf B.A.,Otto Wagner Hospital
Journal of Thoracic Disease | Year: 2014

The incidence of any kind of air leaks after lung resections is reportedly around 50% of patients. The majority of these leaks doesn't require any specific intervention and ceases within a few hours or days. The recent literature defines a prolonged air leak (PAL) as an air leak lasting beyond postoperative day 5. PAL is associated with a generally worse outcome with a more complicated postoperative course anxd prolonged hospital stay and increased costs. Some authors therefore consider any PAL as surgical complication. PAL is the most prevalent postoperative complication following lung resection and the most important determinant of postoperative length of hospital stay. A low predicted postoperative forced expiratory volume in 1 second (ppoFEV1) and upper lobe disease have been identified as significant risk factors involved in developing air leaks. Infectious conditions have also been reported to increase the risk of PAL. In contrast to the problem of PAL, there is only limited information from the literature regarding apical spaces after lung resection, probably because this common finding rarely leads to clinical consequences. This article addresses the pathogenesis of PAL and apical spaces, their prediction, prevention and treatment with a special focus on surgery for infectious conditions. Different predictive models to identify patients at higher risk for the development of PAL are provided. The discussion of surgical treatment options includes the use of pneumoperitoneum, blood patch, intrabronchial valves (IBV) and the flutter valve, and addresses the old question, whether or not to apply suction to chest tubes. The discussed prophylactic armentarium comprises of pleural tenting, prophylactic intraoperative pneumoperitoneum, sealing of the lung, buttressing of staple lines, capitonnage after resection of hydatid cysts, and plastic surgical options. ©Pioneer Bioscience Publishing Company.


Kammerlander A.A.,Medical University of Vienna | Marzluf B.A.,Otto Wagner Hospital | Graf A.,Medical University of Vienna | Bachmann A.,Medical University of Vienna | And 3 more authors.
Journal of the American College of Cardiology | Year: 2014

Background Significant tricuspid regurgitation (TR) late after left heart valve procedure is frequent and associated with increased morbidity. Surgical correction carries a significant mortality risk, whereas the impact of TR on survival in these patients is unclear.Objectives This study sought to assess the impact of significant TR late after left heart valve procedure.Methods A total of 539 consecutive patients with previous left heart valve procedure (time interval from valve procedure to enrollment 50 ± 30 months) were prospectively followed for 53 ± 15 months.Results Significant TR (defined as moderate or greater severity by echocardiography) was present in 91 (17%) patients (65% female). Patients with TR presented with more symptoms (New York Heart Association functional class ≥II 55% vs. 31%), lower glomerular filtration rates (61 ± 19 ml/min vs. 68 ± 18 ml/min), and a higher likelihood of atrial fibrillation (41% vs. 20%), all statistically significant. Right ventricular (RV) systolic function was worse in patients with significant TR (RV fractional area change 43 ± 11% vs. 47 ± 9%, p < 0.001). A total of 117 (22%) patients died during follow-up. By Kaplan-Meier analysis, overall survival was significantly worse in patients with significant TR (log-rank p < 0.001). However, by multivariable Cox analysis, only RV fractional area change, age, left atrial size, diabetes, and previous coronary artery bypass graft procedure were significantly associated with mortality, but not tricuspid regurgitation.Conclusions RV dysfunction, but not significant TR, is independently associated with survival late after left heart valve procedure. © 2014 American College of Cardiology Foundation.

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