0000000000974907

AUTHOR

Andreas Güldner

showing 5 related works from this author

A non-canonical chemical feedback self-limits nitric oxide-cyclic GMP signaling in health and disease

2018

Endothelial nitric oxide (NO) stimulates the heme protein, soluble guanylyl cyclase (sGC) to form vasoprotective cyclic GMP (cGMP). In different disease states such as pulmonary hypertension, NO-cGMP signaling is pharmacologically augmented, yet the pathomechanisms leading to its dysregulation are incompletely understood. Here we show in pulmonary artery endothelial cells that endogenous NO or NO donor compounds acutely stimulate sGC activity, but chronically down-regulate both sGC protein and cGMP formation. Surprisingly, this endogenous feedback mechanism was independent of canonical cGMP signaling via cGMP-dependent protein kinase. It did not involve thiol-dependent modulation, a process…

inorganic chemicalsActivator (genetics)ChemistryEndogenyPharmacologymedicine.diseasePulmonary hypertensionVasoprotectiveNitric oxidechemistry.chemical_compoundcardiovascular systemmedicineheterocyclic compoundsProtein kinase ASoluble guanylyl cyclaseHeme
researchProduct

Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical…

2022

BACKGROUND: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. METHODS: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperati…

AdultLung Diseases*PEEP*postoperative pulmonary complicationsmechanical ventilationPositive-Pressure RespirationsurgeryAnesthesiology and Pain MedicinePostoperative ComplicationsTidal Volume*surgeryHumanspostoperative pulmonary complicationsPostoperative Period*mechanical ventilationmechanical ventilation; PEEP; postoperative pulmonary complications; surgery; Adult; Humans; Lung; Postoperative Complications; Postoperative Period; Randomized Controlled Trials as Topic; Tidal Volume; Lung Diseases; Positive-Pressure RespirationLungPEEPRandomized Controlled Trials as Topic
researchProduct

Kinetics of plasma biomarkers of inflammation and lung injury in surgical patients with or without postoperative pulmonary complications

2017

Background Postoperative pulmonary complications (PPCs) are common after major abdominal surgery. The kinetics of plasma biomarkers could improve identification of patients developing PPCs, but the kinetics may depend on intraoperative ventilator settings. Objective To test whether the kinetics of plasma biomarkers are capable of identifying patients who will develop PPCs, and whether the kinetics depend on the intraoperative level of positive end-expiratory pressure (PEEP). Design A preplanned substudy of a randomised controlled trial. Setting Operation room of five centres. Patients Two hundred and forty-two adult patients scheduled for abdominal surgery at risk of developing PPCs. Interv…

AdultMalemedicine.medical_specialtyInflammationLung injuryGastroenterologyArticlelaw.inventionPositive-Pressure Respiration03 medical and health sciencesPostoperative Complications0302 clinical medicineRandomized controlled trial030202 anesthesiologylawInternal medicinemedicineHumansInflammationLungReceiver operating characteristicbusiness.industryLung InjuryAnesthesiology and Pain Medicinemedicine.anatomical_structure030228 respiratory systemAnesthesiaAdult; Biomarkers; Female; Humans; Inflammation; Inflammation Mediators; Lung Injury; Male; Positive-Pressure Respiration; Postoperative Complications; Anesthesiology and Pain MedicineBiomarker (medicine)FemaleInflammation Mediatorsmedicine.symptombusinessBiomarkersAbdominal surgeryBlood samplingEuropean Journal of Anaesthesiology
researchProduct

Association between pre-operative biological phenotypes and postoperative pulmonary complications: An unbiased cluster analysis

2018

BACKGROUND: Biological phenotypes have been identified within several heterogeneous pulmonary diseases, with potential therapeutic consequences. OBJECTIVE: To assess whether distinct biological phenotypes exist within surgical patients, and whether development of postoperative pulmonary complications (PPCs) and subsequent dependence of intra-operative positive end-expiratory pressure (PEEP) differ between such phenotypes. SETTING: Operating rooms of six hospitals in Europe and USA. DESIGN: Secondary analysis of the 'PROtective Ventilation with HIgh or LOw PEEP' trial. PATIENTS: Adult patients scheduled for abdominal surgery who are at risk of PPCs. INTERVENTIONS: Measurement of pre-operativ…

Lung DiseasesMalemedicine.medical_specialtyInternationalityLung injuryDisease clusterlaw.inventionPositive-Pressure Respiration03 medical and health sciences0302 clinical medicinePostoperative ComplicationsRandomized controlled triallawInternal medicinePreoperative CareMedicineCluster AnalysisHumans030212 general & internal medicineAgedbusiness.industryIncidence (epidemiology)Middle AgedPhenotypePhenotypeAnesthesiology and Pain Medicine030228 respiratory systemBreathingBiomarker (medicine)FemaleInflammation MediatorsbusinessBiomarkersAbdominal surgery
researchProduct

Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol…

2017

Background Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. Methods/design The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multice…

MaleLung DiseasesTime Factors[SDV]Life Sciences [q-bio]Respiratory Medicine and Allergymedicine.medical_treatmentRESPIRATORY-DISTRESS-SYNDROMEMedicine (miscellaneous)HemodynamicsMechanical ventilation; Obesity; Positive end-expiratory pressure; Postoperative pulmonary complication; Recruitment maneuver; Medicine (miscellaneous); Pharmacology (medical)LAPAROSCOPIC BARIATRIC SURGERYLung DiseaseBody Mass Indexlaw.inventionPositive-Pressure RespirationStudy Protocol0302 clinical medicineMechanical ventilationClinical ProtocolsRandomized controlled trialRisk Factors030202 anesthesiologylawMedicine and Health SciencesClinical endpointAnesthesiaPharmacology (medical)Respiratory function030212 general & internal medicineLungLungmedicin och allergi2. Zero hungerlcsh:R5-920ddc:617Positive end-expiratory pressurerespiratory systemOperative3. Good healthTreatment OutcomeRecruitment maneuverTIDAL VOLUMESResearch DesignMechanical ventilation Positive end-expiratory pressure Recruitment maneuver Obesity Postoperative pulmonary complicationSurgical Procedures OperativeAnesthesiaBreathingFemaleErratumlcsh:Medicine (General)ALVEOLAR RECRUITMENT MANEUVERHumancirculatory and respiratory physiologymedicine.medical_specialtyTime FactorMechanical ventilation ; Obesity ; Positive end-expiratory pressure ; Postoperative pulmonary complication ; Recruitment maneuverAnesthesia GeneralLung injuryMechanical ventilation; Obesity; Positive end-expiratory pressure; Postoperative pulmonary complication; Recruitment maneuver; Body Mass Index; Clinical Protocols; Female; Humans; Intraoperative Care; Lung; Lung Diseases; Male; Obesity; Positive-Pressure Respiration; Protective Factors; Research Design; Risk Factors; Time Factors; Treatment Outcome; Anesthesia General; Surgical Procedures Operative; Medicine (miscellaneous); Pharmacology (medical)NOGENERAL-ANESTHESIADRIVING PRESSURE03 medical and health sciencesmedicineHumansddc:610ObesityClinical ProtocolGeneralProtective FactorPositive end-expiratory pressurePOSTOPERATIVE PULMONARY COMPLICATIONSMechanical ventilationSurgical ProceduresIntraoperative CareINTERNATIONAL CONSENSUSbusiness.industryRisk FactorProtective FactorsSurgeryMechanical ventilation; Obesity; Positive end-expiratory pressure; Postoperative pulmonary complication; Recruitment maneuverrespiratory tract diseasesbusinessPostoperative pulmonary complicationLUNG INJURY
researchProduct