Effects of pneumatic tube systems on next-generation viscoelastic coagulation test devices in septic patients and healthy individuals: Results of the randomized controlled VETaPT trial Martin Mirus, Erik Buehrer, Oliver Tiebel, Christian Schnabel, Jan Beyer-Westendorf, et al. Scientific Reports, 2026 Rapid coagulation assessment is essential in critical care to enable timely correction of coagulopathy. Viscoelastic testing (VET) supports this goal but may be affected by mechanical stress during transport by pneumatic tube systems (PTS). As PTS are widely used to expedite sample delivery, evaluating the robustness of next-generation VET and platelet function assays under these conditions is crucial for reliable, time-sensitive diagnostics in intensive care. This study investigated the impact of PTS transport on VET and platelet function testing in healthy individuals and septic patients, including quantitative analysis of acceleration forces. This randomized trial applied a non-systematic sample-level allocation of paired blood samples from 46 healthy volunteers and 45 septic patients to manual and PTS transport. Acceleration was quantified via three-axis accelerometry. Samples were analyzed using ClotPro, ROTEM, TEG PlateletMapping, and Multiplate. Primary objective was the difference in test results following both transport modes. Analyses were performed on paired datasets (manual vs. PTS) per participant and assay. As pre-specified in the protocol, logistic regression modeled the probability of a clinically relevant EX-test clotting time (CT) change (≥ 10 s) within each cohort. Given the absence of associations, secondary equivalence analyses (TOST [two one-sided tests] and bootstrap) assessed whether observed effects were within pre-specified bounds. Neither logistic regression nor correlation analysis indicated an effect of mechanical stress on variable changes (all ρ 0.01). Across platforms, most viscoelastic and platelet function variables remained within predefined equivalence margins after PTS transport. Exceptions were TEG PlateletMapping HKH-R and, by bootstrap, ADP/AA-inhibition. In healthy volunteers, equivalence was confirmed for all variables (TOST p < 0.001). In septic patients, minor shifts remained within clinically acceptable limits, with equivalence confirmed for ClotPro IN-test CT (± 16s, p lower = 0.036; p upper < 0.001), EX-test MCF (± 2 mm, both p < 0.001), ROTEM INTEM CT (± 16s, both p < 0.001), Multiplate TRAP (± 10U, p lower = 0.001; p upper < 0.001), and TEG PlateletMapping ADP/AA inhibition (± 5%, both p < 0.05). Most next-generation viscoelastic and platelet assays are robust to PTS-induced stress. Coagulation diagnostics can include PTS transport without compromising validity. Only selected TEG PlateletMapping variables exhibited variability, indicating limited robustness. Trial registration: The study is retrospectively registered with the German Clinical Trials Register (DRKS00036231; https://drks.de/search/de/trial/DRKS00036231/details on 20.02.2025).
Depressive symptoms are a key determinant of health-related quality of life in ICU survivors with psychological distress Robert Philipp Kosilek, Nora Schröder, Linda Sanftenberg, Daniela Lindemann, Antina Beutel, et al. Scientific Reports, 2026 Survivors of critical illness frequently experience persistent impairments in health-related quality of life (HRQoL), with psychological symptoms contributing substantially to this burden. The relative contribution of co-occurring depression, anxiety, and post traumatic stress symptoms remains insufficiently understood. To address this gap, we conducted a cross-sectional analysis of pre-randomization data from the PICTURE randomized controlled trial, a multicenter study of a brief primary care–based psychological intervention for post-traumatic stress disorder symptoms following critical illness, including 319 intensive care unit survivors. Clinical, demographic, and mental health assessments were obtained after ICU discharge. Latent profile analysis, random forest modeling, and quantile regression were applied to identify determinants of HRQoL measured by the EuroQol Five-Dimension Five-Level (EQ-5D-5L) index and visual analog scale (VAS). The mean EQ-5D-5L index was 0.71 (SD 0.27; median 0.81) and the mean EQ VAS score was 60.7 (SD 19.4; median 60.0), indicating considerable overall impairment. Depression, anxiety, and post-traumatic stress symptoms showed substantial overlap and formed four distinct symptom profiles associated with specific functional impairments. Screening positive for depression on the 2-item Patient Health Questionnaire (PHQ-2) with ≥ 3 points was associated with a median reduction of -0.13 (95% CI -0.19 to -0.07) on the EQ-5D-5L index and -12.45 points (95% CI -17.93 to -6.96) on the EQ VAS, exceeding clinical and demographic predictors. These findings indicate that depressive symptoms are a major determinant of impaired health related quality of life among intensive care survivors with psychological distress and support routine brief depression screening in post-intensive care follow up. Trial registration: ClinTrials.gov: NCT03315390 (Registration date: 2017-10-20); German Clinical Trials Register: DRKS-ID: DRKS00012589 (Registration date: 2017-10-17).
Outcome of Emergency Pulmonary Lobectomy under ECMO Support in Patients with COVID-19 Ana Beatriz Almeida, Michael Schweigert, Peter Spieth, Attila Dubecz, Marcelo Gama de Abreu, et al. Thoracic and Cardiovascular Surgeon, 2026 Not much is known about the results of nonelective anatomical lung resections in coronavirus disease 2019 (COVID-19) patients put on extracorporeal membrane oxygenation (ECMO). The aim of this study was to analyze the outcome of lobectomy under ECMO support in patients with acute respiratory failure due to severe COVID-19. All COVID-19 patients undergoing anatomical lung resection with ECMO support at a German university hospital were included into a prospective database. Study period was April 1, 2020, to April 30, 2021 (first, second, and third waves in Germany). A total of nine patients (median age 61 years, interquartile range 10 years) were included. There was virtually no preexisting comorbidity (median Charlson score of comorbidity 0.2). The mean interval between first positive COVID-19 test and surgery was 21.9 days. Clinical symptoms at the time of surgery were sepsis (nine of nine), respiratory failure (nine of nine), acute renal failure (five of nine), pleural empyema (five of nine), lung artery embolism (four of nine), and pneumothorax (two of nine). Mean intensive care unit (ICU) and ECMO days before surgery were 15.4 and 6, respectively. Indications for surgery were bacterial superinfection with lung abscess formation and progressive septic shock (seven of nine) and abscess formation with massive pulmonary hemorrhage into the abscess cavity (two of nine). All patients were under venovenous ECMO with femoral-jugular configuration. Operative procedures were lobectomy (eight) and pneumonectomy (one). Weaning from ECMO was successful in four of nine. In-hospital mortality was five of nine. Mean total ECMO days were 10.3 ± 6.2 and mean total ICU days were 27.7 ± 9.9. Mean length of stay was 28.7 ± 8.8 days. Emergency surgery under ECMO support seems to open up a perspective for surgical source control in COVID-19 patients with bacterial superinfection and localized pulmonary abscess.
Defining the bellwether procedures and processes for global trauma care: an international Delphi study Michael F Bath, Joachim Amoako, Thomas Edmiston, Amila Sanjiva Ratnayake, Daphne Kabatoro, et al. BMJ Global Health, 2026 Background The complexity of delivering trauma care makes the assessment of its provision challenging. The identification of bellwether procedures has previously been successful in the evaluation of global surgical care; however, any equivalent in assessing trauma care is currently lacking. Through a Delphi process, we aimed to produce the bellwether procedures and processes for global trauma care. Methods A global Delphi process was undertaken with healthcare professionals and academics involved in trauma care from across the world. A list of potential procedures and processes was identified through literature review and expert opinion, along with subsequent additional options suggested by respondents. Three successive rounds were completed, with respondents rating the importance of each procedure or process to be undertaken at any hospital that cares for trauma patients using a five-point Likert scale. Results A total of 411 respondents from 78 countries completed the initial round of the Delphi process, with minimal attrition observed across rounds. Following three successive rounds of the Delphi and functional aggregation, nine bellwethers of global trauma care were determined, subdivided into three functional categories: ‘Resuscitation & Stabilisation’—(1) Advanced Airway Management, (2) Short-term C-spine Immobilisation, (3) Long Bone Immobilisation; ‘Diagnosis & Monitoring’—(4) Blood Gas Analysis, (5) Focused Assessment with Sonography in Trauma (FAST) Scanning, (6) Continuous Access to CT Imaging; ‘Optimisation & Intervention’—(7) Blood Transfusion, (8) Tube Thoracostomy, (9) Laparotomy and Splenectomy. Conclusion The Global Trauma Care Delphi study has produced nine metrics that provide pragmatic indicators for the overall assessment of trauma care capabilities at any healthcare setting worldwide. These bellwethers of global trauma care can enable hospitals, local managers and health ministries to identify institutions or regions that may require more in-depth assessment, allowing standards in the management of traumatic injuries to improve.
Perioperative hemodynamic therapy: Goal-directed or meta-directed? Minerva Anestesiologica, 2016
Randomized controlled trials – A matter of design Timo Siepmann, Peter Markus Spieth, Anne Sophie Kubasch, Ana Isabel Penzlin, Ben Min-Woo Illigens, et al. Neuropsychiatric Disease and Treatment, 2016
A year in review in Minerva Anestesiologica 2013 Minerva Anestesiologica, 2014
0896. Temporal changes in tidal recruitment compared to histologic outcome in experimental acute respiratory distress syndrome Intensive Care Medicine Experimental, 2014
Individualized anticoagulation monitoring in critically ill patients: study protocol for a prospective observational comparison of Anti-Xa, viscoelastic testing, and thrombin … M Mirus, S Scholz, A Schmidt, PL Petrick, O Grottke, P Spieth, L Heubner Frontiers in Medicine 13, 1758025 , 2026 2026
Regulatory T-cell Notch4 expression correlates with mortality in hospitalized COVID-19 patients S Alkarkoukly, S Hambo, M Menk, P Spieth, P Antczak, H Harb The Journal of Infectious Diseases, jiag203 , 2026 2026
Palliative care in cardiovascular medicine E Cekaj, F Sand, DHV Vogel, PM Spieth, B Schrage, A Uribarri, ... European Heart Journal, ehag219 , 2026 2026 Citations: 1
Viscoelastic point-of-care testing for monitoring unfractionated heparin in critically ill patients: a prospective observational study comparing ClotPro® IN/HI-Test, aPTT and … M Mirus, A Dietze, O Tiebel, J Beyer-Westendorf, O Grottke, F Tesch, ... BMC anesthesiology , 2026 2026 Citations: 1
Regionalanästhesie unter Antikoagulation SF Buhrmann, L Heubner, O Vicent, PM Spieth Der Schmerz, 1-12 , 2026 2026
Variable Pressure Support Ventilation vs. Biphasic Positive Airway Pressure/Airway Pressure Release Ventilation in experimental acute respiratory failure T Bluth, M Fritzsche, D Haufe, T Kiss, T Koch, MG Abreu, PM Spieth, ... 2026
A year in review in Minerva Anestesiologica 2025. Anesthesia, analgesia, and perioperative medicine F Cavaliere, M Allegri, A Apan, L Brazzi, M Carassiti, E Cohen, PDI Marco, ... Minerva Anestesiologica 92 (3), 252-266 , 2026 2026
Ventilation strategies in intensive care medicine C Jung, PM Spieth Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS 61 … , 2026 2026
Delirium in cardiovascular medicine E Cekaj, DHV Vogel, PM Spieth, B Schrage, A Uribarri, F De Roeck, ... European Heart Journal, ehag088 , 2026 2026 Citations: 1
Beatmungsstrategien in der Intensivmedizin C Jung, PM Spieth AINS-Anästhesiologie· Intensivmedizin· Notfallmedizin· Schmerztherapie 61 … , 2026 2026
In vivo real-time monitoring of tissue perfusion via L-lactate levels in interstitial fluid: an innovative and portable microfluidic device trial using a pig model X Zhao, TA Schröder, L Heubner, Ž Janićijević, R Bockholt, J Melius, ... International Journal of Surgery 112 (2), 2623-2635 , 2026 2026
Putative anaphylactic shock during insertion of a double J ureteral stent D Heisig, P Spieth, T Richter Die Anaesthesiologie 75 (3), 195 , 2026 2026
Vermeintlicher anaphylaktischer Schock während einer DJ-Anlage D Heisig, P Spieth, T Richter Die Anaesthesiologie, 1-3 , 2026 2026
Hemodynamic monitoring: basic principles in operation room and intensive care unit M Mirus, B Saugel, PM Spieth Journal of Clinical Monitoring and Computing, 1-15 , 2026 2026 Citations: 2
A preventive care strategy to reduce moderate or severe acute kidney injury after major surgery (BigpAK-2); a multinational, randomised clinical trial A Zarbock, M Ostermann, L Forni, C Bode, L Wild, C Putensen, DP Roux, ... The Lancet 406 (10521), 2782-2791 , 2025 2025 Citations: 25
Effects of Pneumatic Tube Systems on Next-Generation Viscoelastic Coagulation Test Devices in Septic Patients and Healthy Individuals: Results of the Randomized Controlled … M Mirus, E Buehrer, O Tiebel, C Schnabel, J Beyer-Westendorf, T Koch, ... 2025
Individual and combined effects of chemical and mechanical power on postoperative pulmonary complications: a secondary analysis of the REPEAT study LM Müller‐Wirtz, TA Lilien, WM Patterson, S Ott, RCE Francis, ... Anaesthesia 80 (12), 1510-1518 , 2025 2025 Citations: 5
Effects of the primary lung infection on outcomes in patients with severe ARDS treated with ECMO: a retrospective analysis M Mirus, L Heubner, M Brückner, T Birkner, A Güldner, A Rand, M Menk, ... Frontiers in Medicine 12, 1662239 , 2025 2025
Blutungsmanagement unter Therapie mit direkten oralen Antikoagulanzien–Experten-Empfehlungen zu Diagnostik und Vorgehen im Notfall. PL Petrick, L Heubner, T Kramer, M Mirus, J Beyer-Westendorf, PM Spieth Anaesthesiologie & Intensivmedizin 66 (11) , 2025 2025
Postoperative pulmonary complications in conventional laparoscopic vs robot-assisted abdominal surgery SC Serafini, SNT Hemmes, VNF Queiroz, A Serpa Neto, C Gregoretti, ... JAMA surgery 160 (11), 1222-1231 , 2025 2025 Citations: 14
MOST CITED SCHOLAR PUBLICATIONS
Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end … A Güldner, T Kiss, AS Neto, SNT Hemmes, J Canet, PM Spieth, ... Anesthesiology 123 (3), 692-713 , 2015 2015 Citations: 577
Randomized controlled trials–a matter of design PM Spieth, AS Kubasch, AI Penzlin, BMW Illigens, K Barlinn, T Siepmann Neuropsychiatric disease and treatment, 1341-1349 , 2016 2016 Citations: 554
Mechanical ventilation–associated lung fibrosis in acute respiratory distress syndrome a significant contributor to poor outcome NE Cabrera-Benitez, JG Laffey, M Parotto, PM Spieth, J Villar, H Zhang, ... Anesthesiology 121 (1), 189 , 2014 2014 Citations: 257
Mechanical stress induces lung fibrosis by epithelial–mesenchymal transition NE Cabrera-Benitez, M Parotto, M Post, B Han, PM Spieth, WE Cheng, ... Critical care medicine 40 (2), 510-517 , 2012 2012 Citations: 235
Molecular dynamics of lipopolysaccharide-induced lung injury in rodents H Domscheit, MA Hegeman, N Carvalho, PM Spieth Frontiers in physiology 11, 36 , 2020 2020 Citations: 207
Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS: an observational study in 29 countries MJ Schultz, SNT Hemmes, AS Neto, JM Binnekade, J Canet, ... European journal of anaesthesiology 34 (8), 492-507 , 2017 2017 Citations: 203
Variable tidal volumes improve lung protective ventilation strategies in experimental lung injury PM Spieth, AR Carvalho, P Pelosi, C Hoehn, C Meissner, M Kasper, ... American journal of respiratory and critical care medicine 179 (8), 684-693 , 2009 2009 Citations: 194
Mechanical stress and the induction of lung fibrosis via the midkine signaling pathway R Zhang, Y Pan, V Fanelli, S Wu, AA Luo, D Islam, B Han, P Mao, ... American journal of respiratory and critical care medicine 192 (3), 315-323 , 2015 2015 Citations: 151
Circadian rhythms: from basic mechanisms to the intensive care unit MC Chan, PM Spieth, K Quinn, M Parotto, H Zhang, AS Slutsky Critical care medicine 40 (1), 246-253 , 2012 2012 Citations: 139
Noisy pressure support ventilation: a pilot study on a new assisted ventilation mode in experimental lung injury MG de Abreu, PM Spieth, P Pelosi, AR Carvalho, C Walter, ... Critical care medicine 36 (3), 818-827 , 2008 2008 Citations: 139
Ability of dynamic airway pressure curve profile and elastance for positive end-expiratory pressure titration AR Carvalho, PM Spieth, P Pelosi, MF Vidal Melo, T Koch, FC Jandre, ... Intensive care medicine 34 (12), 2291-2299 , 2008 2008 Citations: 111
Pressure support improves oxygenation and lung protection compared to pressure-controlled ventilation and is further improved by random variation of pressure support PM Spieth, AR Carvalho, A Güldner, M Kasper, R Schubert, NC Carvalho, ... Critical care medicine 39 (4), 746-755 , 2011 2011 Citations: 105
Results of the CAPSID randomized trial for high-dose convalescent plasma in patients with severe COVID-19 S Körper, M Weiss, D Zickler, T Wiesmann, K Zacharowski, VM Corman, ... The Journal of clinical investigation 131 (20) , 2021 2021 Citations: 102
Increased risk of acute stroke among patients with severe COVID‐19: a multicenter study and meta‐analysis T Siepmann, A Sedghi, E Simon, S Winzer, J Barlinn, K De With, L Mirow, ... European Journal of Neurology 28 (1), 238-247 , 2021 2021 Citations: 96
Effects of different levels of pressure support variability in experimental lung injury M Cruz, A Japiassú Anesthesiology , 2009 2009 Citations: 95
Mechanotransduction in the lungs. PM Spieth, T Bluth, M Gama De Abreu, A Bacelis, AE Goetz, R Kiefmann Minerva anestesiologica 80 (8), 933-941 , 2013 2013 Citations: 86
Personalized medicine for ARDS: the 2035 research agenda JR Beitler, EC Goligher, M Schmidt, PM Spieth, A Zanella, ... Intensive care medicine 42 (5), 756-767 , 2016 2016 Citations: 85
Effects of anesthetic regimes on inflammatory responses in a rat model of acute lung injury S Fortis, PM Spieth, WY Lu, M Parotto, JJ Haitsma, AS Slutsky, N Zhong, ... Intensive care medicine 38 (9), 1548-1555 , 2012 2012 Citations: 81
Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications A Cortegiani, C Gregoretti, AS Neto, SNT Hemmes, L Ball, J Canet, ... British journal of anaesthesia 122 (3), 361-369 , 2019 2019 Citations: 76
Higher levels of spontaneous breathing induce lung recruitment and reduce global stress/strain in experimental lung injury A Güldner, A Braune, N Carvalho, A Beda, S Zeidler, B Wiedemann, ... Anesthesiology 120 (3), 673-682 , 2014 2014 Citations: 72