Summary: Background: There is controversy about the impact of acute illness on vitamin D levels. This study was carried out to assess the influence of perioperative fluid loading on 25-hydroxy-vitamin D [25(OH)D] levels. The study evaluated the clinical utility of a commonly available chemiluminescence assay (ECLIA, IDS-iSYS) and liquid chromatography/mass spectrometry (LC-MS/MS) in the diagnosis of vitamin D deficiency in this setting. Methods: In this prospective observational pilot study in adult patients undergoing cardiovascular surgery on cardiopulmonary bypass (CPB), blood samples drawn at preoperative baseline (t1), after weaning from CPB (t2), on intensive care unit (ICU) admission (t3) and on the first (t4) and second (t5) postoperative days were analyzed. Results: A total of 26 patients (130 samples) were included in this study. Fluid loading by CPB led to a median reduction of 25(OH)D by −22.6% (range −54.5% to −19.5%) between t1 and t2. Cohen’s kappa (κ) for method agreement for vitamin D deficiency (tested cut-off values 20 ng/ml and 12 ng/ml), was κ = 0.291 (p < 0.001) and κ = 0.469 (p < 0.001), respectively. The mean difference between measurements by ECLIA and LC-MS/MS was 4.8 ng/ml (±5.7), Pearson’s r for correlation was 0.73 (p < 0.001). The biologically inactive C3-epimer did not contribute to 25(OH)D levels assessed by LC-MS/MS. Conclusion: The 25(OH)D measurements by chemiluminescence assays can noticeably deviate from those measured by LC-MS/MS, which can be considered the unequivocal gold standard. These assays may still be acceptably reliable in the screening for vitamin D deficiency, especially in the setting of low vitamin D levels. Stricter definitions, e.g. serum 25(OH)D levels lower than 12 ng/ml, may be used to diagnose deficiency with low false positive rate. Trial Registration: DRKS00009216, German Clinical Trials Registry (www.drks.de)

Secondary sclerosing cholangitis in critically ill patients (SC-CIP) is a rare cholestatic liver disease triggered by long-term intensive care treatment. The aim of this study was to evaluate the frequency and characteristics of gastrointestinal bleeding in SC-CIP. Patients with diagnosed SC-CIP were retrospectively identified and compared to a control group of patients with cardiac surgery and intensive care treatment but without the development of SC-CIP. Fifty-three patients with SC-CIP and 19 controls were included in the study. The frequency of gastrointestinal bleeding was 30% in SC-CIP (16 patients) and 5% in the control group (1 patient) (p = 0.03). Bleeding occured in the mean 13 months after admission to an intensive care unit in SC-CIP, three patients (19%) suffered bleeding during intensive care treatment. Three SC-CIP patients (19%) had cirrhosis at the time of bleeding, five (31%) had splenomegaly, and four (25%) received oral anticoagulation. In SC-CIP, 13 bleedings were identified in the upper gastrointestinal tract, two in the lower, and one remained unknown. The most common reasons for bleeding were gastroduodenal ulcers. In total, 80% of patients needed blood units, and one death due to bleeding occurred in SC-CIP. In conclusion, gastrointestinal bleeding is a frequent complication in patients with SC-CIP. Whether the liver disease itself or cofactors cause the susceptibility for bleeding remains unclear.

Background: Caudal anesthesia is an important regional anesthetic technique in neonates. The placement of a catheter can provide excellent analgesia for a prolonged period; the role of adjuvants, in particular morphine, however, remains unclear. We aimed to describe our experience with caudal catheters for major surgery in neonates. Methods: We included all neonates who had a caudal catheter placed for major abdominal and thoracic surgery and explored postoperative pain management and catheter complications. This retrospective case series included neonates with caudal catheter placement from October 2012 to April 2018 at a tertiary university hospital. Results: A total of 33 caudal catheter placements in 32 neonates were included in this study, of which 28 (85%) were a laparotomy and 5 (15%) a thoracotomy. The mean catheter duration was 135 h with a postoperative failure rate of 3%. Patients who did not receive intravenous opioids postoperatively had a significantly shorter stay in the intensive care unit than those who did (341 h vs. 674 h, p = 0.01). All patients received continuous local anesthetics over the catheter, and 79% received additional intermittent epidural morphine postoperatively for a median period of 42 h. No infectious complications were reported. Conclusions: Caudal catheters are a valuable option for perioperative analgesia for major surgery in neonates. We found no serious catheter-related complication. Further research is needed to define the optimal approach and combination of different analgesic techniques.