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The current COVID-19 pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has an enormous impact on human health and economy. In search for therapeutic options, researchers have proposed resveratrol, a food supplement with known antiviral, anti-inflammatory, and antioxidant properties as an advantageous antiviral therapy for SARS-CoV-2 infection. Here, we provide evidence that both resveratrol and its metabolically more stable structural analog, pterostilbene, exhibit potent antiviral properties against SARS-CoV-2 in vitro. First, we show that resveratrol and pterostilbene antiviral activity in African green monkey kidney cells. Both compounds actively inhibit virus replication within infected cells as reduced virus progeny production was observed when the compound was added at post-inoculation conditions. Without replenishment of the compound, antiviral activity was observed up to roughly five rounds of replication, demonstrating the long-lasting effect of these compounds. Second, as the upper respiratory tract represents the initial site of SARS-CoV-2 replication, we also assessed antiviral activity in air–liquid interface (ALI) cultured human primary bronchial epithelial cells, isolated from healthy volunteers. Resveratrol and pterostilbene showed a strong antiviral effect in these cells up to 48 h post-infection. Collectively, our data indicate that resveratrol and pterostilbene are promising antiviral compounds to inhibit SARS-CoV-2 infection. Because these results represent laboratory findings in cells, we advocate evaluation of these compounds in clinical trials before statements are made whether these drugs are advantageous for COVID-19 treatment.
Bram ter Ellen; Nilima Dinesh Kumar; Ellen Bouma; Berit Troost; Denise van de Pol; Heidi van der Ende-Metselaar; Leonie Apperloo; Djoke van Gosliga; Maarten Van Den Berge; Martijn Nawijn; Peter van der Voort; Jill Moser; Izabela Rodenhuis-Zybert; Jolanda Smit. Resveratrol and Pterostilbene Inhibit SARS-CoV-2 Replication in Air–Liquid Interface Cultured Human Primary Bronchial Epithelial Cells. Viruses 2021, 13, 1335 .
AMA StyleBram ter Ellen, Nilima Dinesh Kumar, Ellen Bouma, Berit Troost, Denise van de Pol, Heidi van der Ende-Metselaar, Leonie Apperloo, Djoke van Gosliga, Maarten Van Den Berge, Martijn Nawijn, Peter van der Voort, Jill Moser, Izabela Rodenhuis-Zybert, Jolanda Smit. Resveratrol and Pterostilbene Inhibit SARS-CoV-2 Replication in Air–Liquid Interface Cultured Human Primary Bronchial Epithelial Cells. Viruses. 2021; 13 (7):1335.
Chicago/Turabian StyleBram ter Ellen; Nilima Dinesh Kumar; Ellen Bouma; Berit Troost; Denise van de Pol; Heidi van der Ende-Metselaar; Leonie Apperloo; Djoke van Gosliga; Maarten Van Den Berge; Martijn Nawijn; Peter van der Voort; Jill Moser; Izabela Rodenhuis-Zybert; Jolanda Smit. 2021. "Resveratrol and Pterostilbene Inhibit SARS-CoV-2 Replication in Air–Liquid Interface Cultured Human Primary Bronchial Epithelial Cells." Viruses 13, no. 7: 1335.
Background: The COVID-19 pandemic has resulted in a major influx of intensive care unit (ICU) admissions. Currently, there is limited knowledge on the long-term outcomes of COVID-19 ICU-survivors and the impact on family members. This study aimed to gain an insight into the long-term physical, social and psychological functioning of COVID-19 ICU-survivors and their family members at three- and six-months following ICU discharge. Methods: A single-center, prospective cohort study was conducted among COVID-19 ICU-survivors and their family members. Participants received questionnaires at three and six months after ICU discharge. Physical functioning was evaluated using the MOS Short-Form General Health Survey, Clinical Frailty Scale and spirometry tests. Social functioning was determined using the McMaster Family Assessment Device and return to work. Psychological functioning was assessed using the Hospital Anxiety and Depression Scale. Results: Sixty COVID-19 ICU-survivors and 78 family members participated in this study. Physical functioning was impaired in ICU-survivors as reflected by a score of 33.3 (IQR 16.7–66.7) and 50 (IQR 16.7–83.3) out of 100 at 3- and 6-month follow-ups, respectively. Ninety percent of ICU-survivors reported persistent symptoms after 6 months. Social functioning was impaired since 90% of COVID-19 ICU-survivors had not reached their pre-ICU work level 6 months after ICU-discharge. Psychological functioning was unaffected in COVID-19 ICU-survivors. Family members experienced worse work status in 35% and 34% of cases, including a decrease in work rate among 18.3% and 7.4% of cases at 3- and 6-months post ICU-discharge, respectively. Psychologically, 63% of family members reported ongoing impaired well-being due to the COVID-19-related mandatory physical distance from their relatives. Conclusion: COVID-19 ICU-survivors suffer from a prolonged disease burden, which is prominent in physical and social functioning, work status and persisting symptoms among 90% of patients. Family members reported a reduction in return to work and impaired well-being. Further research is needed to extend the follow-up period and study the effects of standardized rehabilitation in COVID-19 patients and their family members.
Nadine van Veenendaal; Ingeborg van der Meulen; Marisa Onrust; Wolter Paans; Willem Dieperink; Peter van der Voort. Six-Month Outcomes in COVID-19 ICU Patients and Their Family Members: A Prospective Cohort Study. Healthcare 2021, 9, 865 .
AMA StyleNadine van Veenendaal, Ingeborg van der Meulen, Marisa Onrust, Wolter Paans, Willem Dieperink, Peter van der Voort. Six-Month Outcomes in COVID-19 ICU Patients and Their Family Members: A Prospective Cohort Study. Healthcare. 2021; 9 (7):865.
Chicago/Turabian StyleNadine van Veenendaal; Ingeborg van der Meulen; Marisa Onrust; Wolter Paans; Willem Dieperink; Peter van der Voort. 2021. "Six-Month Outcomes in COVID-19 ICU Patients and Their Family Members: A Prospective Cohort Study." Healthcare 9, no. 7: 865.
Significance: Hydrogen sulfide (H2S) is one of the three main gasotransmitters which is endogenously produced in humans and is protective against oxidative stress. Recent findings from studies focusing on coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), shifted our attention to a potential modulatory role of H2S in this viral respiratory disease. Recent Advances: H2S levels at hospital admission may be of importance since this gasotransmitter has been shown to be protective against lung damage through its antiviral, antioxidant and anti-inflammatory actions. Furthermore, many COVID-19 cases have been described demonstrating remarkable clinical improvement upon administration of high doses of N-acetylcysteine (NAC). NAC is a renowned pharmacological antioxidant substance acting as a source of cysteine, thereby promoting endogenous glutathione (GSH) biosynthesis as well as generation of sulfane sulfur species when desulfurated to H2S. Critical Issues: Combining H2S physiology and currently available knowledge of COVID-19, H2S is hypothesized to target three main vulnerabilities of SARS-CoV-2: 1) cell entry through interfering with functional host receptors, 2) viral replication through acting on RNA-dependent RNA-polymerase (RdRp), and 3) the escalation of inflammation to a potentially lethal hyperinflammatory cytokine storm (TLR4 pathway and NLRP3 inflammasome). Future Directions: Dissecting the breakdown of NAC reveals the possibility of increasing endogenous H2S levels, which may provide a convenient rationale for the application of H2S-targeted therapeutics. Further randomized controlled trials (RCT) are warranted to investigate its definitive role.
Arno R. Bourgonje; Ms. Annette K. Offringa; Ms. Larissa E. van Eijk; Ms. Amaal E. Abdulle; Jan-Luuk Hillebrands; Peter H. J. van der Voort; Harry van Goor; Ed J. van Hezik. N-Acetylcysteine and Hydrogen Sulfide in Coronavirus Disease 2019. Antioxidants & Redox Signaling 2021, 1 .
AMA StyleArno R. Bourgonje, Ms. Annette K. Offringa, Ms. Larissa E. van Eijk, Ms. Amaal E. Abdulle, Jan-Luuk Hillebrands, Peter H. J. van der Voort, Harry van Goor, Ed J. van Hezik. N-Acetylcysteine and Hydrogen Sulfide in Coronavirus Disease 2019. Antioxidants & Redox Signaling. 2021; ():1.
Chicago/Turabian StyleArno R. Bourgonje; Ms. Annette K. Offringa; Ms. Larissa E. van Eijk; Ms. Amaal E. Abdulle; Jan-Luuk Hillebrands; Peter H. J. van der Voort; Harry van Goor; Ed J. van Hezik. 2021. "N-Acetylcysteine and Hydrogen Sulfide in Coronavirus Disease 2019." Antioxidants & Redox Signaling , no. : 1.
Intensive care patients experience anxiety, pain, uncertainty, and total dependency. In general, it is important to develop trust between the healthcare professionals (HCPs), patients, and their family. Trust building in the ICU setting is challenging because of the time sensitivity of decision making and the dependency of patients on health care professionals. The objectives of this study are the development of a trust framework and then to use this framework in a case study in the intensive care. In three steps we developed a comprehensive trust framework from the literature concerning trust. First, we identified the elements of trust. Second, we adapted and integrated the dimensions to six concepts to construct the trust framework. Third, these concepts are incorporated into a comprehensive trust framework. In a case study we explored the facilitators and barriers within this framework in eight semi-open interviews with healthcare professionals and eight patients or partners. Trust was first explored inductively and then deductively. We showed that HCPs, patients, and family have largely the same perspective regarding the facilitators of trust, in which communication emerged as the most important one. Other facilitators are maintaining an open feedback culture for HCPs and being aware of patients’ physical and informational privacy. Patients want to be approached as an individual with individual needs. Dishonesty and differences in values and norms were the most important barriers. To contribute to a positive perception of health delivery and to avoid conflicts between HCP and patients or their family we formulated five practical recommendations.
Anne-Lotte Lemmers; Peter van der Voort. Trust in Intensive Care Patients, Family, and Healthcare Professionals: The Development of a Conceptual Framework Followed by a Case Study. Healthcare 2021, 9, 208 .
AMA StyleAnne-Lotte Lemmers, Peter van der Voort. Trust in Intensive Care Patients, Family, and Healthcare Professionals: The Development of a Conceptual Framework Followed by a Case Study. Healthcare. 2021; 9 (2):208.
Chicago/Turabian StyleAnne-Lotte Lemmers; Peter van der Voort. 2021. "Trust in Intensive Care Patients, Family, and Healthcare Professionals: The Development of a Conceptual Framework Followed by a Case Study." Healthcare 9, no. 2: 208.
Coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), continues to spread globally despite the worldwide implementation of preventive measures to combat the disease. Although most COVID‐19 cases are characterised by a mild, self‐limiting disease course, a considerable subset of patients develop a more severe condition, varying from pneumonia and acute respiratory distress syndrome (ARDS) to multi‐organ failure (MOF). Progression of COVID‐19 is thought to occur as a result of a complex interplay between multiple pathophysiological mechanisms, all of which may orchestrate SARS‐CoV‐2 infection and contribute to organ‐specific tissue damage. In this respect, dissecting currently available knowledge of COVID‐19 immunopathogenesis is crucially important, not only to improve our understanding of its pathophysiology, but also to fuel the rationale of both novel and repurposed treatment modalities. Various immune‐mediated pathways during SARS‐CoV‐2 infection are relevant in this context, which relate to innate immunity, adaptive immunity, and autoimmunity. Pathological findings in tissue specimens of patients with COVID‐19 provide valuable information with regard to our understanding of pathophysiology as well as the development of evidence‐based treatment regimens. This review provides an updated overview of the main pathological changes observed in COVID‐19 within the most commonly affected organ systems, with special emphasis on immunopathology. Current management strategies for COVID‐19 include supportive care and the use of repurposed or symptomatic drugs, such as dexamethasone, remdesivir, and anticoagulants. Ultimately, prevention is key to combat COVID‐19 and this requires appropriate measures to attenuate its spread and, above all, the development and implementation of effective vaccines.
Larissa E Eijk; Mathijs Binkhorst; Arno R. Bourgonje; Annette K. Offringa; Douwe J. Mulder; Eelke M. Bos; Nikola Kolundzic; Amaal E. Abdulle; Peter H.J. van der Voort; Marcel G.M. Olde Rikkert; Johannes G. van der Hoeven; Wilfred F.A. Den Dunnen; Jan‐Luuk Hillebrands; Harry van Goor. COVID ‐19: immunopathology, pathophysiological mechanisms, and treatment options. The Journal of Pathology 2021, 254, 307 -331.
AMA StyleLarissa E Eijk, Mathijs Binkhorst, Arno R. Bourgonje, Annette K. Offringa, Douwe J. Mulder, Eelke M. Bos, Nikola Kolundzic, Amaal E. Abdulle, Peter H.J. van der Voort, Marcel G.M. Olde Rikkert, Johannes G. van der Hoeven, Wilfred F.A. Den Dunnen, Jan‐Luuk Hillebrands, Harry van Goor. COVID ‐19: immunopathology, pathophysiological mechanisms, and treatment options. The Journal of Pathology. 2021; 254 (4):307-331.
Chicago/Turabian StyleLarissa E Eijk; Mathijs Binkhorst; Arno R. Bourgonje; Annette K. Offringa; Douwe J. Mulder; Eelke M. Bos; Nikola Kolundzic; Amaal E. Abdulle; Peter H.J. van der Voort; Marcel G.M. Olde Rikkert; Johannes G. van der Hoeven; Wilfred F.A. Den Dunnen; Jan‐Luuk Hillebrands; Harry van Goor. 2021. "COVID ‐19: immunopathology, pathophysiological mechanisms, and treatment options." The Journal of Pathology 254, no. 4: 307-331.
ROTEM® readout of EXTEM variables in healthy patients and COVID-19 patients.Unlabelled Image
Nadine van Veenendaal; Thomas W.L. Scheeren; Karina Meijer; Peter H.J. van der Voort. Rotational thromboelastometry to assess hypercoagulability in COVID-19 patients. Thrombosis Research 2020, 196, 379 -381.
AMA StyleNadine van Veenendaal, Thomas W.L. Scheeren, Karina Meijer, Peter H.J. van der Voort. Rotational thromboelastometry to assess hypercoagulability in COVID-19 patients. Thrombosis Research. 2020; 196 ():379-381.
Chicago/Turabian StyleNadine van Veenendaal; Thomas W.L. Scheeren; Karina Meijer; Peter H.J. van der Voort. 2020. "Rotational thromboelastometry to assess hypercoagulability in COVID-19 patients." Thrombosis Research 196, no. : 379-381.
Obesity is a risk factor for SARS-CoV-2 infected patients to develop respiratory failure. Leptin produced in visceral fat might play a role in the deterioration to mechanical ventilation. A cross sectional study was performed. The mean BMI was 31 kg/m2 (range 24.8–48.4) for the 31 SARS-CoV-2 ventilated patients and 26 kg/m2 (range 22.4–33.5) for 8 critically ill non-infected control patients. SARS-CoV-2 infected patients with a similar BMI as control patients appear to have significantly higher levels of serum leptin. The mean leptin level was 21.2 (6.0–85.2) vs 5.6 (2.4–8.2) ug/L for SARS-CoV-2 and controls respectively (p = 0.0007). With these findings we describe a clinical and biological framework that may explain these clinical observations. The ACE2 utilization by the virus leads to local pulmonary inflammation due to ACE2-ATII disbalance. This might be enhanced by an increase in leptin production induced by SARS-CoV-2 infection of visceral fat. Leptin receptors in the lungs are now more activated to enhance local pulmonary inflammation. This adds to the pre-existent chronic inflammation in obese patients. Visceral fat, lung tissue and leptin production play an interconnecting role. This insight can lead the way to further research and treatment.
Peter H.J. van der Voort; Jill Moser; Durk F. Zandstra; Anneke C. Muller Kobold; Marjolein Knoester; Cornelis F. Calkhoven; Inge Hamming; Matijs van Meurs. Leptin levels in SARS-CoV-2 infection related respiratory failure: A cross-sectional study and a pathophysiological framework on the role of fat tissue. Heliyon 2020, 6, e04696 -e04696.
AMA StylePeter H.J. van der Voort, Jill Moser, Durk F. Zandstra, Anneke C. Muller Kobold, Marjolein Knoester, Cornelis F. Calkhoven, Inge Hamming, Matijs van Meurs. Leptin levels in SARS-CoV-2 infection related respiratory failure: A cross-sectional study and a pathophysiological framework on the role of fat tissue. Heliyon. 2020; 6 (8):e04696-e04696.
Chicago/Turabian StylePeter H.J. van der Voort; Jill Moser; Durk F. Zandstra; Anneke C. Muller Kobold; Marjolein Knoester; Cornelis F. Calkhoven; Inge Hamming; Matijs van Meurs. 2020. "Leptin levels in SARS-CoV-2 infection related respiratory failure: A cross-sectional study and a pathophysiological framework on the role of fat tissue." Heliyon 6, no. 8: e04696-e04696.
Obesity is a risk factor for SARS-CoV-2 infected patients to develop respiratory failure. Leptin produced in visceral fat might play a role in the deterioration to mechanical ventilation. A cross sectional study was performed. The mean BMI was 31 kg/m2 (range 24.8 – 48.4) for the 31 SARS-CoV-2 ventilated patients and 26 kg/m2 (range 22.4-33.5) for the 8 controls. SARS-CoV-2 infected patients with a similar BMI as control patients appear to have significantly higher levels of serum leptin. The mean leptin level was 21.2 (6.0-85.2) vs 5.6 (2.4-8.2) ug/L for SARS-CoV-2 and controls respectively (p=0.0007). With these findings we designed a clinical and biological framework that explains clinical observations. The ACE2 utilization by the virus leads to local pulmonary inflammation due to ACE2-ATII disbalance. This is enhanced by an increase in leptin production induced by SARS-CoV-2 infection of visceral fat. Leptin receptors in the lungs are now more activated to enhance local pulmonary inflammation. This adds to the pre-existent chronic inflammation in obese patients. Visceral fat, lung tissue and leptin production play an interconnecting role. This insight can lead the way to further research and treatment.
Peter Hj Van Der Voort; Jill Moser; Durk F Zandstra; Anneke C Muller Kobold; Marjolein Knoester; Cornelis F. Calkhoven; Inge Hamming; Matijs Van Meurs. A clinical and biological framework on the role of visceral fat tissue and leptin in SARS-CoV-2 infection related respiratory failure. 2020, 1 .
AMA StylePeter Hj Van Der Voort, Jill Moser, Durk F Zandstra, Anneke C Muller Kobold, Marjolein Knoester, Cornelis F. Calkhoven, Inge Hamming, Matijs Van Meurs. A clinical and biological framework on the role of visceral fat tissue and leptin in SARS-CoV-2 infection related respiratory failure. . 2020; ():1.
Chicago/Turabian StylePeter Hj Van Der Voort; Jill Moser; Durk F Zandstra; Anneke C Muller Kobold; Marjolein Knoester; Cornelis F. Calkhoven; Inge Hamming; Matijs Van Meurs. 2020. "A clinical and biological framework on the role of visceral fat tissue and leptin in SARS-CoV-2 infection related respiratory failure." , no. : 1.
Background Antibiotic exposure is often inadequate in critically ill patients with severe sepsis or septic shock and this is associated with worse outcomes. Despite markedly altered and rapidly changing pharmacokinetics in these patients, guidelines and clinicians continue to rely on standard dosing schemes. To address this challenge, we developed AutoKinetics, a clinical decision support system for antibiotic dosing. By feeding large amounts of electronic health record patient data into pharmacokinetic models, patient-specific predicted future plasma concentrations are displayed graphically. In addition, a tailored dosing advice is provided at the bedside in real time. To evaluate the effect of AutoKinetics on pharmacometric and clinical endpoints, we are conducting the Right Dose Right Now multicenter, randomized controlled, two-arm, parallel-group, non-blinded, superiority trial. Methods All adult intensive care patients with a suspected or proven infection and having either lactatemia or receiving vasopressor support are eligible for inclusion. Randomization to the AutoKinetics or control group is initiated at the bedside when prescribing at least one of four commonly administered antibiotics: ceftriaxone, ciprofloxacin, meropenem and vancomycin. Dosing advice is available for patients in the AutoKinetics group, whereas patients in the control group receive standard dosing. The primary outcome of the study is pharmacometric target attainment during the first 24 h. Power analysis revealed the need for inclusion of 42 patients per group per antibiotic. Thus, a total of 336 patients will be included, 168 in each group. Secondary pharmacometric endpoints include time to target attainment and fraction of target attainment during an entire antibiotic course. Secondary clinical endpoints include mortality, clinical cure and days free from organ support. Several other exploratory and subgroup analyses are planned. Discussion This is the first randomized controlled trial to assess the effectiveness and safety of bedside data-driven automated antibiotic dosing advice. This is important as adequate antibiotic exposure may be crucial to treat severe sepsis and septic shock. In addition, the trial could prove to be a significant contribution to clinical pharmacometrics and serve as a stepping stone for the use of big data and artificial intelligence in the field. Trial registration Netherlands Trial Register (NTR), NL6501/NTR6689. Registered on 25 August 2017. European Clinical Trials Database (EudraCT), 2017-002478-37. Registered on 6 November 2017.
Luca F. Roggeveen; Lucas M. Fleuren; Tingjie Guo; Patrick Thoral; Harm Jan De Grooth; Eleonora L. Swart; Thomas L. T. Klausch; Peter H. J. Van Der Voort; Armand R. J. Girbes; Rob J. Bosman; Paul W. G. Elbers. Right Dose Right Now: bedside data-driven personalized antibiotic dosing in severe sepsis and septic shock — rationale and design of a multicenter randomized controlled superiority trial. Trials 2019, 20, 1 -13.
AMA StyleLuca F. Roggeveen, Lucas M. Fleuren, Tingjie Guo, Patrick Thoral, Harm Jan De Grooth, Eleonora L. Swart, Thomas L. T. Klausch, Peter H. J. Van Der Voort, Armand R. J. Girbes, Rob J. Bosman, Paul W. G. Elbers. Right Dose Right Now: bedside data-driven personalized antibiotic dosing in severe sepsis and septic shock — rationale and design of a multicenter randomized controlled superiority trial. Trials. 2019; 20 (1):1-13.
Chicago/Turabian StyleLuca F. Roggeveen; Lucas M. Fleuren; Tingjie Guo; Patrick Thoral; Harm Jan De Grooth; Eleonora L. Swart; Thomas L. T. Klausch; Peter H. J. Van Der Voort; Armand R. J. Girbes; Rob J. Bosman; Paul W. G. Elbers. 2019. "Right Dose Right Now: bedside data-driven personalized antibiotic dosing in severe sepsis and septic shock — rationale and design of a multicenter randomized controlled superiority trial." Trials 20, no. 1: 1-13.
To determine the clinical effects of perioperative endotoxin reduction in the gut lumen in patients undergoing cardiac surgery with cardiopulmonary bypass. Retrospective cohort analysis with propensity score matching according to treatment group. Tertiary center for cardiopulmonary diseases and intensive care medicine. Included were patients who underwent cardiac surgery with cardiopulmonary bypass between 2008 and 2017. Excluded were readmitted patients. Endotoxin reduction in the gut lumen by ingestion of oral tobramycin 80 mg and polymyxin B 100 mg 4 times daily (TP) as part of selective digestive tract decontamination, which contains amphotericin B 500 mg as well. A total of 6,394 patients were included, of whom 2,044 patients were in the intervention group. A total of 835 patients received both pre- and postoperative TP (Pre+/Post+), and 1,165 patients received TP only postoperatively (Pre-/Post+). The control group, not treated with TP at any moment, consisted of 4,350 patients (Pre-/Post-). After matching, 652 Pre+/Post+ patients were compared with an equal number of controls (Pre-/Post-). Pre+/Post+ group did not do better for any clinical outcome. A total of 682 Pre+/Post+ patients matched with an equal number of Pre-/Post+ patients. The latter group had a 0.3 points higher mean Sequential Organ Failure Assessment score and in the regression analysis a significantly higher intensive care unit mortality but not hospital mortality. A significant reduction in length of stay and length of mechanical ventilation for the Pre+/Post+ group was shown compared with Pre-/Post+, but these differences can be explained by unbalanced differences in the severity of illness. Cardiosurgical patients who receive tobramycin and polymyxin orally preoperatively to reduce the gut endotoxin level do not expose convincing and relevant beneficial effects on clinical outcomes in this retrospective propensity score matching cohort study.
Michelle X.F. Chan; Sophie Buitinck; Wim Stooker; Eric A.F. Haak; Jos P.J. Wester; Rob J. Bosman; Peter H.J. Van Der Voort. Clinical Effects of Perioperative Selective Decontamination of the Digestive Tract (SDD) in Cardiac Surgery: A Propensity Score Matched Cohort Analysis. Journal of Cardiothoracic and Vascular Anesthesia 2019, 33, 3001 -3009.
AMA StyleMichelle X.F. Chan, Sophie Buitinck, Wim Stooker, Eric A.F. Haak, Jos P.J. Wester, Rob J. Bosman, Peter H.J. Van Der Voort. Clinical Effects of Perioperative Selective Decontamination of the Digestive Tract (SDD) in Cardiac Surgery: A Propensity Score Matched Cohort Analysis. Journal of Cardiothoracic and Vascular Anesthesia. 2019; 33 (11):3001-3009.
Chicago/Turabian StyleMichelle X.F. Chan; Sophie Buitinck; Wim Stooker; Eric A.F. Haak; Jos P.J. Wester; Rob J. Bosman; Peter H.J. Van Der Voort. 2019. "Clinical Effects of Perioperative Selective Decontamination of the Digestive Tract (SDD) in Cardiac Surgery: A Propensity Score Matched Cohort Analysis." Journal of Cardiothoracic and Vascular Anesthesia 33, no. 11: 3001-3009.
The long-term ecological effects on the emergence of antimicrobial resistance at the ICU level during selective decontamination of the digestive tract (SDD) are unknown. We determined the incidence of newly acquired antimicrobial resistance of aerobic gram-negative potentially pathogenic bacteria (AGNB) during SDD. In a single-centre observational cohort study over a 21-year period, all consecutive patients, treated with or without SDD, admitted to the ICU were included. The antibiotic regime was unchanged over the study period. Incidence rates for ICU-acquired AGNB’s resistance for third-generation cephalosporins, colistin/polymyxin B, tobramycin/gentamicin or ciprofloxacin were calculated per year. Changes over time were tested by negative binomial regression in a generalized linear model. Eighty-six percent of 14,015 patients were treated with SDD. Most cultures were taken from the digestive tract (41.9%) and sputum (21.1%). A total of 20,593 isolates of AGNB were identified. The two most often found bacteria were Escherichia coli (N = 6409) and Pseudomonas (N = 5269). The incidence rate per 1000 patient-day for ICU-acquired resistance to cephalosporins was 2.03, for polymyxin B/colistin 0.51, for tobramycin 2.59 and for ciprofloxacin 2.2. The incidence rates for ICU-acquired resistant microbes per year ranged from 0 to 4.94 per 1000 patient-days, and no significant time-trend in incidence rates were found for any of the antimicrobials. The background prevalence rates of resistant strains measured on admission for cephalosporins, polymyxin B/colistin and ciprofloxacin rose over time with 7.9%, 3.5% and 8.0% respectively. During more than 21-year SDD, the incidence rates of resistant microbes at the ICU level did not significantly increase over time but the background resistance rates increased. An overall ecological effect of prolonged application of SDD by counting resistant microorganisms in the ICU was not shown in a country with relatively low rates of resistant microorganisms.
Sophie Buitinck; Rogier Jansen; Saskia Rijkenberg; Jos P. J. Wester; Rob J. Bosman; Nardo J. M. Van Der Meer; Peter H. J. Van Der Voort. The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study. Critical Care 2019, 23, 208 .
AMA StyleSophie Buitinck, Rogier Jansen, Saskia Rijkenberg, Jos P. J. Wester, Rob J. Bosman, Nardo J. M. Van Der Meer, Peter H. J. Van Der Voort. The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study. Critical Care. 2019; 23 (1):208.
Chicago/Turabian StyleSophie Buitinck; Rogier Jansen; Saskia Rijkenberg; Jos P. J. Wester; Rob J. Bosman; Nardo J. M. Van Der Meer; Peter H. J. Van Der Voort. 2019. "The ecological effects of selective decontamination of the digestive tract (SDD) on antimicrobial resistance: a 21-year longitudinal single-centre study." Critical Care 23, no. 1: 208.
Antibiotic exposure in intensive care patients with sepsis is frequently inadequate and is associated with poorer outcomes. Antibiotic dosing is challenging in the intensive care, as critically ill patients have altered and fluctuating antibiotic pharmacokinetics that make current one-size-fits-all regimens unsatisfactory. Real-time bedside dosing software is not available yet, and therapeutic drug monitoring is typically used for few antibiotic classes and only allows for delayed dosing adaptation. Thus, adequate and timely antibiotic dosing continues to rely largely on the level of pharmacokinetic expertise in the ICU. Therefore, we set out to assess the level of knowledge on antibiotic pharmacokinetics among these intensive care professionals. In May 2018, we carried out a cross-sectional study by sending out an online survey on antibiotic dosing to more than 20,000 intensive care professionals. Questions were designed to cover relevant topics in pharmacokinetics related to intensive care antibiotic dosing. The preliminary pass mark was set by members of the examination committee for the European Diploma of Intensive Care using a modified Angoff approach. The final pass mark was corrected for clinical relevance as assessed for each question by international experts on pharmacokinetics. A total of 1448 respondents completed the survey. Most of the respondents were intensivists (927 respondents, 64%) from 97 countries. Nearly all questions were considered clinically relevant by pharmacokinetic experts. The pass mark corrected for clinical relevance was 52.8 out of 93.7 points. Pass rates were 42.5% for intensivists, 36.1% for fellows, 24.8% for residents, and 5.8% for nurses. Scores without correction for clinical relevance were worse, indicating that respondents perform better on more relevant topics. Correct answers and concise clinical background are provided. Clinically relevant pharmacokinetic knowledge on antibiotic dosing among intensive care professionals is insufficient. This should be addressed given the importance of adequate antibiotic exposure in critically ill patients with sepsis. Solutions include improved education, intensified pharmacy support, therapeutic drug monitoring, or the use of real-time bedside dosing software. Questions may provide useful for teaching purposes.
Lucas M. Fleuren; Luca F. Roggeveen; Tingjie Guo; Petr Waldauf; Peter H. J. Van Der Voort; Rob J. Bosman; Eleonora L. Swart; Armand R. J. Girbes; Paul W. G. Elbers. Clinically relevant pharmacokinetic knowledge on antibiotic dosing among intensive care professionals is insufficient: a cross-sectional study. Critical Care 2019, 23, 1 -9.
AMA StyleLucas M. Fleuren, Luca F. Roggeveen, Tingjie Guo, Petr Waldauf, Peter H. J. Van Der Voort, Rob J. Bosman, Eleonora L. Swart, Armand R. J. Girbes, Paul W. G. Elbers. Clinically relevant pharmacokinetic knowledge on antibiotic dosing among intensive care professionals is insufficient: a cross-sectional study. Critical Care. 2019; 23 (1):1-9.
Chicago/Turabian StyleLucas M. Fleuren; Luca F. Roggeveen; Tingjie Guo; Petr Waldauf; Peter H. J. Van Der Voort; Rob J. Bosman; Eleonora L. Swart; Armand R. J. Girbes; Paul W. G. Elbers. 2019. "Clinically relevant pharmacokinetic knowledge on antibiotic dosing among intensive care professionals is insufficient: a cross-sectional study." Critical Care 23, no. 1: 1-9.
Jennilee Nahar; Sophie Buitinck; Rogier Jansen; Eric A.F. Haak; Peter H.J. Van Der Voort. Use of enteral amikacin to eliminate carriership with multidrug resistant Enterobacteriaceae. Journal of Infection 2019, 78, 409 -421.
AMA StyleJennilee Nahar, Sophie Buitinck, Rogier Jansen, Eric A.F. Haak, Peter H.J. Van Der Voort. Use of enteral amikacin to eliminate carriership with multidrug resistant Enterobacteriaceae. Journal of Infection. 2019; 78 (5):409-421.
Chicago/Turabian StyleJennilee Nahar; Sophie Buitinck; Rogier Jansen; Eric A.F. Haak; Peter H.J. Van Der Voort. 2019. "Use of enteral amikacin to eliminate carriership with multidrug resistant Enterobacteriaceae." Journal of Infection 78, no. 5: 409-421.
Peter Hj Van Der Voort. The organization of timely care in septic patients. Journal of Emergency and Critical Care Medicine 2018, 2, 84 -84.
AMA StylePeter Hj Van Der Voort. The organization of timely care in septic patients. Journal of Emergency and Critical Care Medicine. 2018; 2 ():84-84.
Chicago/Turabian StylePeter Hj Van Der Voort. 2018. "The organization of timely care in septic patients." Journal of Emergency and Critical Care Medicine 2, no. : 84-84.
Anne W. Van Schijndel; Eric J. F. Franssen; Peter Pickkers; Saskia Rijkenberg; Mark Van Den Boogaard; Peter H. J. Van Der Voort. Haloperidol serum concentrations in critically ill patients included in the REDUCE study. Intensive Care Medicine 2018, 44, 1774 -1775.
AMA StyleAnne W. Van Schijndel, Eric J. F. Franssen, Peter Pickkers, Saskia Rijkenberg, Mark Van Den Boogaard, Peter H. J. Van Der Voort. Haloperidol serum concentrations in critically ill patients included in the REDUCE study. Intensive Care Medicine. 2018; 44 (10):1774-1775.
Chicago/Turabian StyleAnne W. Van Schijndel; Eric J. F. Franssen; Peter Pickkers; Saskia Rijkenberg; Mark Van Den Boogaard; Peter H. J. Van Der Voort. 2018. "Haloperidol serum concentrations in critically ill patients included in the REDUCE study." Intensive Care Medicine 44, no. 10: 1774-1775.
Background Enteral low‐carbohydrate formulas (LCFs) could serve as a noninsulin alternative for the treatment of stress hyperglycemia in critically ill patients. We compared the glycemic effects of an LCF with a standard formula. Methods We conducted an open‐label randomized trial in patients admitted to our intensive care unit between September 2015 and June 2016. Adult patients with an indication for enteral nutrition were randomized to an LCF (Glucerna 1.5 kcal) or a standard enteral formula (Fresubin Energy Fibre, with additional protein supplement). Primary outcome was glucose variability defined as mean absolute glucose (MAG) change (mmol/L/h). Secondary outcomes were mean glucose, time in target, hypoglycemic and hyperglycemic events, and insulin requirements. We assessed glycemic outcomes per blinded continuous glucose monitoring (CGM) system and compared outcomes with glucose measurements per blood gas analysis and point‐of‐care device. Results We randomized 107 patients (LCF: n = 53; standard: n = 54). Six patients had no CGM data, leaving 101 patients (n = 52; n = 49) for the intention‐to‐treat analysis. MAG change and time in target range were not different between groups. LCF gave a lower mean glucose measured per point‐of‐care device (7.8 ± 1.0 vs 8.4 ± 1.1 mmol/L, P = .007). LCF patients required significantly less insulin on the second study day (46.8 vs 68.0 IU, P = .036). Conclusion LCF showed a trend toward a modestly reduced mean glucose and significantly lower insulin requirements as compared with standard feeding but had no effect on glucose variability or time in target range.
Sigrid C. van Steen; Saskia Rijkenberg; Marjolein K. Sechterberger; J. Hans Devries; Peter H.J. Van Der Voort. Glycemic Effects of a Low-Carbohydrate Enteral Formula Compared With an Enteral Formula of Standard Composition in Critically Ill Patients: An Open-Label Randomized Controlled Clinical Trial. Journal of Parenteral and Enteral Nutrition 2017, 42, 1035 -1045.
AMA StyleSigrid C. van Steen, Saskia Rijkenberg, Marjolein K. Sechterberger, J. Hans Devries, Peter H.J. Van Der Voort. Glycemic Effects of a Low-Carbohydrate Enteral Formula Compared With an Enteral Formula of Standard Composition in Critically Ill Patients: An Open-Label Randomized Controlled Clinical Trial. Journal of Parenteral and Enteral Nutrition. 2017; 42 (6):1035-1045.
Chicago/Turabian StyleSigrid C. van Steen; Saskia Rijkenberg; Marjolein K. Sechterberger; J. Hans Devries; Peter H.J. Van Der Voort. 2017. "Glycemic Effects of a Low-Carbohydrate Enteral Formula Compared With an Enteral Formula of Standard Composition in Critically Ill Patients: An Open-Label Randomized Controlled Clinical Trial." Journal of Parenteral and Enteral Nutrition 42, no. 6: 1035-1045.
Stress ulceration and subsequent bleeding in critically ill patients shows an incidence of 2–6%. The pathophysiology is complex and begins with vasoconstriction. Mucosal ischemia ultimately leads to stress ulcer related bleeding (SURB). Upper gastrointestinal bleeding (UGIB) can also originate from other places, for instance reflux esophagitis, which has a different approach. Recently, it has become clear that acid suppression does not prevent UGIB or SURB. The meta-analyses on acid suppression are summarized in this review and show no clear effect on the incidence of UGIB or mortality. This knowledge urges us to reassess the pathophysiology of SURB. A conceptual model is presented based on pathophysiological studies. Insight in the pathophysiological process of SURB can lead to a multi-focused approach based on this conceptual model. In addition, a stepwise approach for the management of UGIB in critically ill patients is presented.
Peter H. J. Van Der Voort. How to prevent and treat gastrointestinal bleeding in the critically ill patient: a pathophysiological approach. Journal of Emergency and Critical Care Medicine 2017, 1, 35 -35.
AMA StylePeter H. J. Van Der Voort. How to prevent and treat gastrointestinal bleeding in the critically ill patient: a pathophysiological approach. Journal of Emergency and Critical Care Medicine. 2017; 1 (11):35-35.
Chicago/Turabian StylePeter H. J. Van Der Voort. 2017. "How to prevent and treat gastrointestinal bleeding in the critically ill patient: a pathophysiological approach." Journal of Emergency and Critical Care Medicine 1, no. 11: 35-35.
Mildly elevated lactate levels (i.e., 1–2 mmol/L) are increasingly recognized as a prognostic finding in critically ill patients. One of several possible underlying mechanisms, microcirculatory dysfunction, can be assessed at the bedside using sublingual direct in vivo microscopy. We aimed to evaluate the association between relative hyperlactatemia, microcirculatory flow, and outcome. This study was a predefined subanalysis of a multicenter international point prevalence study on microcirculatory flow abnormalities, the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Microcirculatory flow abnormalities were assessed with sidestream dark-field imaging. Abnormal microcirculatory flow was defined as a microvascular flow index (MFI) < 2.6. MFI is a semiquantitative score ranging from 0 (no flow) to 3 (continuous flow). Associations between microcirculatory flow abnormalities, single-spot lactate measurements, and outcome were analyzed. In 338 of 501 patients, lactate levels were available. For this substudy, all 257 patients with lactate levels ≤ 2 mmol/L (median [IQR] 1.04 [0.80–1.40] mmol/L) were included. Crude ICU mortality increased with each lactate quartile. In a multivariable analysis, a lactate level > 1.5 mmol/L was independently associated with a MFI < 2.6 (OR 2.5, 95% CI 1.1–5.7, P = 0.027). In a heterogeneous ICU population, a single-spot mildly elevated lactate level (even within the reference range) was independently associated with increased mortality and microvascular flow abnormalities. In vivo microscopy of the microcirculation may be helpful in discriminating between flow- and non-flow-related causes of mildly elevated lactate levels. ClinicalTrials.gov, NCT01179243. Registered on August 3, 2010.
Namkje A. R. Vellinga; for the microSOAP study group; E. Christiaan Boerma; Matty Koopmans; Abele Donati; Arnaldo Dubin; Nathan I. Shapiro; Rupert M. Pearse; Peter H. J. Van Der Voort; Arjen M. Dondorp; Tony Bafi; Michael Fries; Tulin Akarsu-Ayazoglu; Andrius Pranskunas; Steven Hollenberg; Gianmarco Balestra; Mat Van Iterson; Farid Sadaka; Gary Minto; Ulku Aypar; F. Javier Hurtado; Giampaolo Martinelli; Didier Payen; Frank Van Haren; Anthony Holley; Hernando Gomez; Ravindra L. Mehta; Alejandro H. Rodriguez; Carolina Ruiz; Héctor S. Canales; Jacques Duranteau; Peter E. Spronk; Shaman Jhanji; Sheena Hubble; Marialuisa Chierego; Christian Jung; Daniel Martin; Carlo Sorbara; Jan Bakker; Can Ince. Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis. Critical Care 2017, 21, 1 -9.
AMA StyleNamkje A. R. Vellinga, for the microSOAP study group, E. Christiaan Boerma, Matty Koopmans, Abele Donati, Arnaldo Dubin, Nathan I. Shapiro, Rupert M. Pearse, Peter H. J. Van Der Voort, Arjen M. Dondorp, Tony Bafi, Michael Fries, Tulin Akarsu-Ayazoglu, Andrius Pranskunas, Steven Hollenberg, Gianmarco Balestra, Mat Van Iterson, Farid Sadaka, Gary Minto, Ulku Aypar, F. Javier Hurtado, Giampaolo Martinelli, Didier Payen, Frank Van Haren, Anthony Holley, Hernando Gomez, Ravindra L. Mehta, Alejandro H. Rodriguez, Carolina Ruiz, Héctor S. Canales, Jacques Duranteau, Peter E. Spronk, Shaman Jhanji, Sheena Hubble, Marialuisa Chierego, Christian Jung, Daniel Martin, Carlo Sorbara, Jan Bakker, Can Ince. Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis. Critical Care. 2017; 21 (1):1-9.
Chicago/Turabian StyleNamkje A. R. Vellinga; for the microSOAP study group; E. Christiaan Boerma; Matty Koopmans; Abele Donati; Arnaldo Dubin; Nathan I. Shapiro; Rupert M. Pearse; Peter H. J. Van Der Voort; Arjen M. Dondorp; Tony Bafi; Michael Fries; Tulin Akarsu-Ayazoglu; Andrius Pranskunas; Steven Hollenberg; Gianmarco Balestra; Mat Van Iterson; Farid Sadaka; Gary Minto; Ulku Aypar; F. Javier Hurtado; Giampaolo Martinelli; Didier Payen; Frank Van Haren; Anthony Holley; Hernando Gomez; Ravindra L. Mehta; Alejandro H. Rodriguez; Carolina Ruiz; Héctor S. Canales; Jacques Duranteau; Peter E. Spronk; Shaman Jhanji; Sheena Hubble; Marialuisa Chierego; Christian Jung; Daniel Martin; Carlo Sorbara; Jan Bakker; Can Ince. 2017. "Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis." Critical Care 21, no. 1: 1-9.
The Behavioral Pain Scale (BPS) and Critical-Care Pain Observation Tool (CPOT) are behavioral pain assessment tools for sedated and unconscious critically ill patients. The aim of this study was to compare the reliability, internal consistency, and discriminant validation of the BPS and the CPOT simultaneously in mechanically ventilated patients after cardiac surgery.A prospective, observational cohort study.A 20-bed closed-format intensive care unit with mixed medical, surgical, and cardiac surgery patients in a teaching hospital in Amsterdam, The Netherlands.The study comprised 72 consecutive intubated and mechanically ventilated patients after cardiac surgery who were not able to self-report pain.Two nurses assessed the BPS and CPOT simultaneously and independently at the following 4 moments: rest, a nonpainful procedure (oral care), rest, and a painful procedure (turning). Both scores showed a significant increase of 2 points between rest and turning. The median BPS score of nurse 1 showed a significant increase of 1 point between rest and the nonpainful procedure (oral care), whereas both median CPOT scores did not change. The interrater reliability of the BPS and CPOT showed fair-to-good agreement of 0.74 overall. During the periods of rest 1 and rest 2, values ranged from 0.24 to 0.46. Cronbach's alpha values for the BPS were 0.62 (nurse 1) and 0.59 (nurse 2) compared with 0.65 and 0.58, respectively, for the CPOT.The BPS and CPOT are reliable and valid pain assessment tools in a daily clinical setting. However, the discriminant validation of both scores seems less satisfactory in sedated or agitated patients and this topic requires further investigation.
Saskia Rijkenberg; Willemke Stilma; Robert J. Bosman; Nardo J. van der Meer; Peter H.J. van der Voort. Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT). Journal of Cardiothoracic and Vascular Anesthesia 2017, 31, 1227 -1234.
AMA StyleSaskia Rijkenberg, Willemke Stilma, Robert J. Bosman, Nardo J. van der Meer, Peter H.J. van der Voort. Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT). Journal of Cardiothoracic and Vascular Anesthesia. 2017; 31 (4):1227-1234.
Chicago/Turabian StyleSaskia Rijkenberg; Willemke Stilma; Robert J. Bosman; Nardo J. van der Meer; Peter H.J. van der Voort. 2017. "Pain Measurement in Mechanically Ventilated Patients After Cardiac Surgery: Comparison of the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT)." Journal of Cardiothoracic and Vascular Anesthesia 31, no. 4: 1227-1234.
Patients with type 1 diabetes showed a higher glucose variability, but overall glycemic control was not different between patients with type 1 and type 2 diabetes. Very few diabetes patients admitted to the ICU have type 1 diabetes.
Marjolein K. Sechterberger; Sigrid C.J. Van Steen; Esther M.N. Boerboom; Peter H.J. Van Der Voort; Rob J. Bosman; Joost B.L. Hoekstra; J. Hans Devries. Higher glucose variability in type 1 than in type 2 diabetes patients admitted to the intensive care unit: A retrospective cohort study. Journal of Critical Care 2017, 38, 300 -303.
AMA StyleMarjolein K. Sechterberger, Sigrid C.J. Van Steen, Esther M.N. Boerboom, Peter H.J. Van Der Voort, Rob J. Bosman, Joost B.L. Hoekstra, J. Hans Devries. Higher glucose variability in type 1 than in type 2 diabetes patients admitted to the intensive care unit: A retrospective cohort study. Journal of Critical Care. 2017; 38 ():300-303.
Chicago/Turabian StyleMarjolein K. Sechterberger; Sigrid C.J. Van Steen; Esther M.N. Boerboom; Peter H.J. Van Der Voort; Rob J. Bosman; Joost B.L. Hoekstra; J. Hans Devries. 2017. "Higher glucose variability in type 1 than in type 2 diabetes patients admitted to the intensive care unit: A retrospective cohort study." Journal of Critical Care 38, no. : 300-303.