BackgroundVolatile breath biomarkers provide a non-invasive window to observe physiological and pathological processes in the body. This study was intended to assess the impact of heart surgery with extracorporeal circulation (ECC) onto breath biomarker profiles. Special attention was attributed to oxidative or metabolic stress during surgery and extracorporeal circulation, which can cause organ damage and poor outcome.Methods24 patients undergoing cardiac surgery with extracorporeal circulation were enrolled into this observational study. Alveolar breath samples (10 mL) were taken after induction of anesthesia, after sternotomy, 5 min after end of ECC, and 30, 60, 90, 120 and 150 min after end of surgery. Alveolar gas samples were withdrawn from the circuit under visual control of expired CO2. Inspiratory samples were taken near the ventilator inlet. Volatile substances in breath were preconcentrated by means of solid phase micro extraction, separated by gas chromatography, detected and identified by mass spectrometry.ResultsMean exhaled concentrations of acetone, pentane and isoprene determined in this study were in accordance with results from the literature. Exhaled substance concentrations showed considerable inter-individual variation, and inspired pentane concentrations sometimes had the same order of magnitude than expired values. This is the reason why, concentrations were normalized by the values measured 120 min after surgery. Exhaled acetone concentrations increased slightly after sternotomy and markedly after end of ECC. Exhaled acetone concentrations exhibited positive correlation to serum C-reactive protein concentrations and to serum troponine-T concentrations. Exhaled pentane concentrations increased markedly after sternotomy and dropped below initial values after ECC. Breath pentane concentrations showed correlations with serum creatinine (CK) levels. Patients with an elevated CK-MB (myocardial&brain)/CK ratio had also high concentrations of pentane in exhaled air. Exhaled isoprene concentrations raised significantly after sternotomy and decreased to initial levels at 30 min after end of ECC. Exhaled isoprene concentrations showed a correlation with cardiac output.ConclusionOxidative and metabolic stress during cardiac surgery could be assessed continuously and non-invasively by means of breath analysis. Correlations between breath acetone profiles and clinical conditions underline the potential of breath biomarker monitoring for diagnostics and timely initiation of life saving therapy.
Background In 2016 the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthetists (BDA) published 10 quality indicators (QI) to compare and improve the quality of anesthesia care in Germany. So far, there is no evidence for the feasibility of implementation of these QI in hospitals. Objective This study tested the hypothesis that the implementation of the 10 QI is feasible in German hospitals. Material and methods This prospective three-phase national multicenter quality improvement study was conducted in 15 German hospitals and 1 outpatient anesthesia center from March 2017 to February 2018. The trial consisted of an initial evaluation of pre-existing structures and processes by the heads of the participating anesthesia departments, followed by a 6-month implementation phase of the QI as well as a final re-evaluation phase. The implementation procedure was supported by web-based implementation aids (www.qi-an.org) and internal quality management programs. The primary endpoint was the difference in the number of implemented QI per center before and after implementation. Secondary endpoints were the number of newly implemented QI per center, the overall number of successful implementations of each QI, the identification of problems during the implementation as well as the kind of impediments preventing the QI implementation. Results The average number of implemented QI increased from 5.8 to 6.8 (mean of the differences 1.1 ± 1.3; P < 0.01). Most frequently the QI perioperative morbidity and mortality report (5 centers) and the QI temperature management (4 centers) could be implemented. After the implementation phase, the QI incidence management and patient blood management were implemented in all 16 centers. Implementation of other quality indicators failed mainly due to a lack of time and lack of structural resources. Conclusion In this study the implementation of QI was proven to be mostly feasible in the participating German hospitals. Although several QI could be implemented with minor effort, more time, financial and structural resources would be required for some QI, such as the QI postoperative visit.
Zusammenfassung Hintergrund Im Jahr 2016 hat die Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) und der Bund Deutscher Anästhesisten (BDA) 10 Qualitätsindikatoren (QI) veröffentlicht, um die Qualität anästhesiologischer Behandlungen vergleichen und verbessern zu können. Bis heute gibt es keine Evidenz darüber, inwieweit sich die Maßnahmen zur Implementierung der QI in den Kliniken umsetzen lassen. Ziel der Arbeit Im Rahmen dieser Studie wurde die Hypothese getestet, inwieweit die vorliegenden 10 QI in deutschen Krankenhäusern implementierbar sind. Material und Methoden Diese prospektive, dreiphasige, nationale, Multizenterstudie wurde in 15 deutschen Krankenhäusern und einem ambulanten Anästhesie-Zentrum von März 2017 bis Februar 2018 durchgeführt. Die Studie bestand aus einer initialen Evaluation präexistierender Strukturen und Prozesse durch die Chefärzte der beteiligten Anästhesieabteilungen, gefolgt von einer sechsmonatigen Implementierungsphase der QI und einer finalen Reevaluation. Der Prozess der Implementierung wurde durch web-basierte Implementierungshilfen (www.qi-an.org) und interne Qualitätsmanagementprogramme der Zentren unterstützt. Der primäre Endpunkt war die Differenz der Anzahl implementierter QI pro Zentrum vor und nach der sechsmonatigen Implementierungsphase. Sekundäre Endpunkte waren die Anzahl neu implementierter QI pro Zentrum, die Gesamtzahl erfolgreicher Implementierungen pro einzelnem QI, die Identifizierung von Problemen während der Implementierung sowie die Gründe, die die Implementierung eines QI verhindert haben. Ergebnisse Die durchschnittliche Anzahl implementierter QI pro Zentrum stieg von 5,8 auf 6,8 (Mittelwert der Differenzen 1,1 ± 1,3; p < 0,01). Am häufigsten konnten die QI Perioperativer Morbiditäts- und Mortalitätsbericht (5 Zentren) und QI Temperatur-Management (4 Zentren) implementiert werden. Nach der Implementierungsphase waren die QI Fehlermanagement und Patient-Blood-Management in allen Zentren implementiert. Die Implementierung anderer QI scheiterte in den häufigsten Fällen an Zeitmangel sowie fehlenden personellen und strukturellen Ressourcen. Diskussion Im Rahmen der Studie konnte die Implementierbarkeit der vorliegenden 10 QI in deutschen Krankenhäusern überwiegend belegt werden. Viele der QI konnten mit relativ geringem Aufwand implementiert werden. Für einige QI wären jedoch mehr Personal sowie größere strukturelle und finanzielle Ressourcen notwendig, so z.B. für den QI Postoperative Visite.
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