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Leo Heunks

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https://www.readbyqxmd.com/read/27898224/recommended-reading-from-radboud-university-medical-centre-fellows
#1
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
https://www.readbyqxmd.com/read/27757516/potentially-modifiable-factors-contributing-to-outcome-from-acute-respiratory-distress-syndrome-the-lung-safe-study
#2
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...
October 18, 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27748627/partial-neuromuscular-blockade-during-partial-ventilatory-support-in-sedated-patients-with-high-tidal-volumes
#3
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
https://www.readbyqxmd.com/read/27498374/levosimendan-beyond-inotropy-and-acute-heart-failure-evidence-of-pleiotropic-effects-on-the-heart-and-other-organs-an-expert-panel-position-paper
#4
REVIEW
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
https://www.readbyqxmd.com/read/27145818/assessment-of-dead-space-ventilation-in-patients-with-acute-respiratory-distress-syndrome-a-prospective-observational-study
#5
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...
2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27091359/strategies-to-optimize-respiratory-muscle-function-in-icu-patients
#6
REVIEW
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
https://www.readbyqxmd.com/read/26854883/the-differential-diagnosis-for-failure-to-wean-from-mechanical-ventilation
#7
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
https://www.readbyqxmd.com/read/26850329/appropriate-positioning-of-the-nava-catheter
#8
LETTER
Willem-Jan M Schellekens, Leo M A Heunks
No abstract text is available yet for this article.
April 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/26540399/comparison-between-neurally-adjusted-ventilatory-assist-and-pressure-support-ventilation-levels-in-terms-of-respiratory-effort
#9
COMPARATIVE STUDY
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
https://www.readbyqxmd.com/read/26196838/effects-of-experimental-human-endotoxemia-on-diaphragm-function
#10
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
https://www.readbyqxmd.com/read/25955983/assisted-ventilation-in-patients-with-acute-respiratory-distress-syndrome-lung-distending-pressure-and-patient-ventilator-interaction
#11
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
https://www.readbyqxmd.com/read/25888356/levosimendan-affects-oxidative-and-inflammatory-pathways-in-the-diaphragm-of-ventilated-endotoxemic-mice
#12
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
https://www.readbyqxmd.com/read/25760684/diaphragm-muscle-fiber-weakness-and-ubiquitin-proteasome-activation-in-critically-ill-patients
#13
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
https://www.readbyqxmd.com/read/25546533/monitoring-and-preventing-diaphragm-injury
#14
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
https://www.readbyqxmd.com/read/25307894/automated-patient-ventilator-interaction-analysis-during-neurally-adjusted-non-invasive-ventilation-and-pressure-support-ventilation-in-chronic-obstructive-pulmonary-disease
#15
COMPARATIVE STUDY
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
https://www.readbyqxmd.com/read/24506836/hypercapnia-attenuates-ventilator-induced-diaphragm-atrophy-and-modulates-dysfunction
#16
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...
2014: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/24314000/noninvasive-ventilation-and-the-upper-airway-should-we-pay-more-attention
#17
REVIEW
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...
2013: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/23845980/time-course-of-diaphragm-function-recovery-after-controlled-mechanical-ventilation-in-rats
#18
Debby Thomas, Karen Maes, Anouk Agten, Leo Heunks, Richard Dekhuijzen, Marc Decramer, Hieronymus Van Hees, Ghislaine Gayan-Ramirez
Controlled mechanical ventilation (CMV) is known to result in rapid and severe diaphragmatic dysfunction, but the recovery response of the diaphragm to normal function after CMV is unknown. Therefore, we examined the time course of diaphragm function recovery in an animal model of CMV. Healthy rats were submitted to CMV for 24-27 h (n = 16), or to 24-h CMV followed by either 1 h (CMV + 1 h SB, n = 9), 2 h (CMV + 2 h SB, n = 9), 3 h (CMV + 3 h SB, n = 9), or 4-7 h (CMV + 4-7 h SB, n = 9) of spontaneous breathing (SB)...
September 2013: Journal of Applied Physiology
https://www.readbyqxmd.com/read/23106947/oxygen-induced-hypercapnia-in-copd-myths-and-facts
#19
REVIEW
Wilson F Abdo, Leo M A Heunks
During our medical training, we learned that oxygen administration in patients with chronic obstructive pulmonary disease (COPD) induces hypercapnia through the 'hypoxic drive' mechanism and can be dangerous. This mindset frequently results in the reluctance of clinicians to administer oxygen to hypoxemic patients with COPD. However, this fear is not based on evidence in the literature. Here, we will review the impact and pathophysiology of oxygen-induced hypercapnia in patients with acute exacerbation of COPD and recommend a titrated oxygen management...
October 29, 2012: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/23103733/monitoring-of-the-respiratory-muscles-in-the-critically-ill
#20
Jonne Doorduin, Hieronymus W H van Hees, Johannes G van der Hoeven, Leo M A Heunks
Evidence has accumulated that respiratory muscle dysfunction develops in critically ill patients and contributes to prolonged weaning from mechanical ventilation. Accordingly, it seems highly appropriate to monitor the respiratory muscles in these patients. Today, we are only at the beginning of routinely monitoring respiratory muscle function. Indeed, most clinicians do not evaluate respiratory muscle function in critically ill patients at all. In our opinion, however, practical issues and the absence of sound scientific data for clinical benefit should not discourage clinicians from having a closer look at respiratory muscle function in critically ill patients...
January 1, 2013: American Journal of Respiratory and Critical Care Medicine
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