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Leo Heunks

Mark Haaksma, Pieter Roel Tuinman, Leo Heunks
Ultrasound of the diaphragm in critically ill patients has become a diagnostic technique of emerging interest among clinicians and scientists. The advantages include that it is widely available, non-invasive and examination can be performed after relatively short training and at low costs. It is used to estimate muscle mass by measurement of muscle thickness and diagnose weakness by the assessment of diaphragm movement during unassisted breathing. Thickening of the muscle during inspiration has been used to quantify force generation...
March 2017: Annals of Translational Medicine
Annemijn H Jonkman, Diana Jansen, Leo M A Heunks
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2017. Other selected articles can be found online at . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from .
March 21, 2017: Critical Care: the Official Journal of the Critical Care Forum
Xiaoping Zhu, Hieronymus W H van Hees, Leo Heunks, Feifei Wang, Lei Shao, Jiaru Huang, Lei Shi, Shaolin Ma
BACKGROUND: Controlled mechanical ventilation (CMV) is associated with diaphragm dysfunction. Dysfunction results from muscle atrophy and injury of diaphragm muscle fibers. Enhanced proteolysis and reduced protein synthesis play an important role in the development of atrophy. The current study is to evaluate the effects of the calpains inhibitor calpeptin on the development of diaphragm atrophy and activation of key enzymes of the ubiquitin-proteasome pathway in rats under CMV. METHODS: Three groups of rats were studied: control animals (CON, n = 8), rats subjected to 24 h of MV (CMV, n = 8), and rats subjected to 24 h of MV after administration of the calpain inhibitor calpeptin (CMVC, n = 8)...
December 2017: Intensive Care Medicine Experimental
Willem-Jan M Schellekens, Diana Jansen, Mirrin J Dorresteijn, Leo M A Heunks
No abstract text is available yet for this article.
November 29, 2016: American Journal of Respiratory and Critical Care Medicine
John G Laffey, Giacomo Bellani, Tài Pham, Eddy Fan, Fabiana Madotto, Ednan K Bajwa, Laurent Brochard, Kevin Clarkson, Andres Esteban, Luciano Gattinoni, Frank van Haren, Leo M Heunks, Kiyoyasu Kurahashi, Jon Henrik Laake, Anders Larsson, Daniel F McAuley, Lia McNamee, Nicolas Nin, Haibo Qiu, Marco Ranieri, Gordon D Rubenfeld, B Taylor Thompson, Hermann Wrigge, Arthur S Slutsky, Antonio Pesenti
PURPOSE: To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality. METHODS: The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents...
December 2016: Intensive Care Medicine
Jonne Doorduin, Joeke L Nollet, Lisanne H Roesthuis, Hieronymus W H van Hees, Laurent J Brochard, Christer A Sinderby, Johannes G van der Hoeven, Leo M A Heunks
RATIONALE: Controlled mechanical ventilation is used to deliver lung-protective ventilation in patients with acute respiratory distress syndrome. Despite recognized benefits, such as preserved diaphragm activity, partial support ventilation modes may be incompatible with lung-protective ventilation due to high tidal volume and high transpulmonary pressure. As an alternative to high dose sedatives and controlled mechanical ventilation, pharmacologically induced neuromechanical uncoupling of the diaphragm should facilitate lung-protective ventilation under partial support modes...
October 17, 2016: American Journal of Respiratory and Critical Care Medicine
Dimitrios Farmakis, Julian Alvarez, Tuvia Ben Gal, Dulce Brito, Francesco Fedele, Candida Fonseca, Anthony C Gordon, Israel Gotsman, Elena Grossini, Fabio Guarracino, Veli-Pekka Harjola, Yaron Hellman, Leo Heunks, Visnja Ivancan, Apostolos Karavidas, Matti Kivikko, Vladimir Lomivorotov, Dan Longrois, Josep Masip, Marco Metra, Andrea Morelli, Maria Nikolaou, Zoltán Papp, Alexander Parkhomenko, Gerhard Poelzl, Piero Pollesello, Hanne Berg Ravn, Steffen Rex, Hynek Riha, Sven-Erik Ricksten, Robert H G Schwinger, Bojan Vrtovec, M Birhan Yilmaz, Marzenna Zielinska, John Parissis
Levosimendan is a positive inotrope with vasodilating properties (inodilator) indicated for decompensated heart failure (HF) patients with low cardiac output. Accumulated evidence supports several pleiotropic effects of levosimendan beyond inotropy, the heart and decompensated HF. Those effects are not readily explained by cardiac function enhancement and seem to be related to additional properties of the drug such as anti-inflammatory, anti-oxidative and anti-apoptotic ones. Mechanistic and proof-of-concept studies are still required to clarify the underlying mechanisms involved, while properly designed clinical trials are warranted to translate preclinical or early-phase clinical data into more robust clinical evidence...
November 1, 2016: International Journal of Cardiology
Jonne Doorduin, Joeke L Nollet, Manon P A J Vugts, Lisanne H Roesthuis, Ferdi Akankan, Johannes G van der Hoeven, Hieronymus W H van Hees, Leo M A Heunks
BACKGROUND: Physiological dead space (VD/VT) represents the fraction of ventilation not participating in gas exchange. In patients with acute respiratory distress syndrome (ARDS), VD/VT has prognostic value and can be used to guide ventilator settings. However, VD/VT is rarely calculated in clinical practice, because its measurement is perceived as challenging. Recently, a novel technique to calculate partial pressure of carbon dioxide in alveolar air (PACO2) using volumetric capnography (VCap) was validated...
May 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
Willem-Jan M Schellekens, Hieronymus W H van Hees, Jonne Doorduin, Lisanne H Roesthuis, Gert Jan Scheffer, Johannes G van der Hoeven, Leo M A Heunks
Respiratory muscle dysfunction may develop rapidly in critically ill ventilated patients and is associated with increased morbidity, length of intensive care unit stay, costs, and mortality. This review briefly discusses the pathophysiology of respiratory muscle dysfunction in intensive care unit patients and then focuses on strategies that prevent the development of muscle weakness or, if weakness has developed, how respiratory muscle function may be improved. We propose a simple strategy for how these can be implemented in clinical care...
April 19, 2016: Critical Care: the Official Journal of the Critical Care Forum
Jonne Doorduin, Johannes G van der Hoeven, Leo M A Heunks
PURPOSE OF REVIEW: In this review, we discuss the causes for a failed weaning trial and specific diagnostic tests that could be conducted to identify the cause for weaning failure. We briefly highlight treatment strategies that may enhance the chance of weaning success. RECENT FINDINGS: Impaired respiratory mechanics, respiratory muscle dysfunction, cardiac dysfunction, cognitive dysfunction, and metabolic disorders are recognized causes for weaning failure. In addition, iatrogenic factors may be at play...
April 2016: Current Opinion in Anaesthesiology
Willem-Jan M Schellekens, Leo M A Heunks
No abstract text is available yet for this article.
April 2016: Intensive Care Medicine
Guillaume Carteaux, Ana Córdoba-Izquierdo, Aissam Lyazidi, Leo Heunks, Arnaud W Thille, Laurent Brochard
OBJECTIVES: To understand the potential equivalence between neurally adjusted ventilatory assist and pressure support ventilation levels in terms of respiratory muscle unloading. To compare the respiratory pattern, variability, synchronization, and neuromuscular coupling within comparable ranges of assistance. DESIGN: Prospective single-center physiologic study. SETTING: A 13-bed university medical ICU. PATIENTS: Eleven patients recovering from respiratory failure...
March 2016: Critical Care Medicine
Jonne Doorduin, Jenneke Leentjens, Matthijs Kox, Hieronymus W H van Hees, Johannes G van der Hoeven, Peter Pickkers, Leo M A Heunks
INTRODUCTION: Systemic inflammation is a well-known risk factor for respiratory muscle weakness. Studies using animal models of inflammation have shown that endotoxin administration induces diaphragm dysfunction. However, the effects of in vivo endotoxin administration on diaphragm function in humans have not been studied. Our aim was to evaluate diaphragm function in a model of systemic inflammation in healthy subjects. METHODS: Two groups of 12 male volunteers received an intravenous bolus of 2 ng/kg of Escherichia coli lipopolysaccharide (LPS) and were monitored until 8 h after LPS administration...
October 2015: Shock
Jonne Doorduin, Christer A Sinderby, Jennifer Beck, Johannes G van der Hoeven, Leo M A Heunks
BACKGROUND: In patients with acute respiratory distress syndrome (ARDS), the use of assisted mechanical ventilation is a subject of debate. Assisted ventilation has benefits over controlled ventilation, such as preserved diaphragm function and improved oxygenation. Therefore, higher level of "patient control" of ventilator assist may be preferable in ARDS. However, assisted modes may also increase the risk of high tidal volumes and lung-distending pressures. The current study aims to quantify how differences in freedom to control the ventilator affect lung-protective ventilation, breathing pattern variability, and patient-ventilator interaction...
July 2015: Anesthesiology
Willem-Jan M Schellekens, Hieronymus W H van Hees, Marianne Linkels, P N Richard Dekhuijzen, Gert Jan Scheffer, Johannes G van der Hoeven, Leo M A Heunks
INTRODUCTION: Controlled mechanical ventilation and endotoxemia are associated with diaphragm muscle atrophy and dysfunction. Oxidative stress and activation of inflammatory pathways are involved in the pathogenesis of diaphragmatic dysfunction. Levosimendan, a cardiac inotrope, has been reported to possess anti-oxidative and anti-inflammatory properties. The aim of the present study was to investigate the effects of levosimendan on markers for diaphragm nitrosative and oxidative stress, inflammation and proteolysis in a mouse model of endotoxemia and mechanical ventilation...
March 2, 2015: Critical Care: the Official Journal of the Critical Care Forum
Pleuni E Hooijman, Albertus Beishuizen, Christian C Witt, Monique C de Waard, Armand R J Girbes, Angelique M E Spoelstra-de Man, Hans W M Niessen, Emmy Manders, Hieronymus W H van Hees, Charissa E van den Brom, Vera Silderhuis, Michael W Lawlor, Siegfried Labeit, Ger J M Stienen, Koen J Hartemink, Marinus A Paul, Leo M A Heunks, Coen A C Ottenheijm
RATIONALE: The clinical significance of diaphragm weakness in critically ill patients is evident: it prolongs ventilator dependency, and increases morbidity and duration of hospital stay. To date, the nature of diaphragm weakness and its underlying pathophysiologic mechanisms are poorly understood. OBJECTIVES: We hypothesized that diaphragm muscle fibers of mechanically ventilated critically ill patients display atrophy and contractile weakness, and that the ubiquitin-proteasome pathway is activated in the diaphragm...
May 15, 2015: American Journal of Respiratory and Critical Care Medicine
Leo M A Heunks, Jonne Doorduin, Johannes G van der Hoeven
PURPOSE OF REVIEW: The present review summarizes developments in the field of respiratory muscle monitoring, in particular in critically ill patients. RECENT FINDINGS: Patients admitted to the ICU may develop severe respiratory muscle dysfunction in a very short time span. Among other factors, disuse and sepsis have been associated with respiratory muscle dysfunction in these patients. Because weakness is associated with adverse outcome, including prolonged mechanical ventilation and mortality, it is surprising that respiratory muscle dysfunction largely develops without being noticed by the clinician...
February 2015: Current Opinion in Critical Care
Jonne Doorduin, Christer A Sinderby, Jennifer Beck, Johannes G van der Hoeven, Leo M A Heunks
INTRODUCTION: Delivering synchronous assist during non-invasive ventilation (NIV) is challenging with flow- or pressure-controlled ventilators, especially in patients with chronic obstructive pulmonary disease (COPD). Neurally adjusted ventilatory assist (NAVA) uses diaphragm electrical activity (EAdi) to control the ventilator. We evaluated patient-ventilator interaction in patients with COPD during NIV with pressure support ventilation (PSV) and NAVA using a recently introduced automated analysis...
October 13, 2014: Critical Care: the Official Journal of the Critical Care Forum
Willem-Jan M Schellekens, Hieronymus W H van Hees, Matthijs Kox, Marianne Linkels, Gilberto L Andrade Acuña, P N Richard Dekhuijzen, Gert Jan Scheffer, Johannes G van der Hoeven, Leo M A Heunks
INTRODUCTION: Diaphragm weakness induced by prolonged mechanical ventilation may contribute to difficult weaning from the ventilator. Hypercapnia is an accepted side effect of low tidal volume mechanical ventilation, but the effects of hypercapnia on respiratory muscle function are largely unknown. The present study investigated the effect of hypercapnia on ventilator-induced diaphragm inflammation, atrophy and function. METHODS: Male Wistar rats (n = 10 per group) were unventilated (CON), mechanically ventilated for 18 hours without (MV) or with hypercapnia (MV + H, Fico2 = 0...
February 9, 2014: Critical Care: the Official Journal of the Critical Care Forum
Eline Oppersma, Jonne Doorduin, Erik H F M van der Heijden, Johannes G van der Hoeven, Leo M A Heunks
In an effort to reduce the complications related to invasive ventilation, the use of noninvasive ventilation (NIV) has increased over the last years in patients with acute respiratory failure. However, failure rates for NIV remain high in specific patient categories. Several studies have identified factors that contribute to NIV failure, including low experience of the medical team and patient-ventilator asynchrony. An important difference between invasive ventilation and NIV is the role of the upper airway...
December 5, 2013: Critical Care: the Official Journal of the Critical Care Forum
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