Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Die Debatte um die Einheiten der natürlichen Selektion. Pluralistische Lösungsansätze

Kaiser MI. Die Debatte um die Einheiten der natürlichen Selektion. Pluralistische Lösungsansätze. Saarbrücken: VDM Verlag Dr. Müller; 2008.Auf welcher Ebene der biologischen Organisation wirkt die nat{\"u}rliche Selektion? Sind es Gene, Organismen oder Gruppen, die in evolution{\"a}ren Prozessen selektiert werden? {\"U}ber diese Frage wird seit 50 Jahren im Grenzbereich zwischen Philosophie und Evolutionsbiologie eine Debatte gef{\"u}hrt. Einige Teilnehmer haben in letzter Zeit neue L{\"o}sungswege eingeschlagen, die alle in einem bestimmten Sinn als 'pluralistisch' bezeichnet werden k{\"o}nnen. Die Autorin Marie I. Kaiser f{\"u}hrt zun{\"a}chst in die evolutionsbiologischen Grundlagen, die zentralen Begrifflichkeiten und die Debatte in ihrer historischen Entwicklung ein. Darauf aufbauend entwirft sie eine Landkarte der Debatte, auf der sie die drei Hauptpositionen - den klassischen Genselektionismus, die Multilevel-Selektionstheorie und den Beschreibungs-Pluralismus - verortet. Anschlie{\ss}end setzt sie sich kritisch mit verschiedenen Varianten des Beschreibungs-Pluralismus auseinander und beurteilt, wie {\"u}berzeugend die von den Beschreibungs-Pluralisten gelieferte L{\"o}sung des Problems der Bestimmung der Einheiten der Selektion ist. Das Buch richtet sich an alle, die sich f{\"u}r das interdisziplin{\"a}re Forschungsgebiet der Philosophie der Biologie interessieren

An Ontic Account of Explanatory Reduction in Biology: PhD thesis

Kaiser MI. An Ontic Account of Explanatory Reduction in Biology: PhD thesis. Köln: Universität zu Köln; 2012

Reductive Explanation in the Biological Sciences

Kaiser MI. Reductive Explanation in the Biological Sciences. History, Philosophy and Theory of the Life Sciences. Cham: Springer International Publishing; 2015.This book develops a philosophical account that reveals the major characteristics that make an explanation in the life sciences reductive and distinguish them from non-reductive explanations. Understanding what reductive explanations are enables one to assess the conditions under which reductive explanations are adequate and thus enhances debates about explanatory reductionism. The account of reductive explanation presented in this book has three major characteristics. First, it emerges from a critical reconstruction of the explanatory practice of the life sciences itself. Second, the account is monistic since it specifies one set of criteria that apply to explanations in the life sciences in general. Finally, the account is ontic in that it traces the reductivity of an explanation back to certain relations that exist between objects in the world (such as part-whole relations and level relations), rather than to the logical relations between sentences. Beginning with a disclosure of the meta-philosophical assumptions that underlie the author's analysis of reductive explanation, the book leads into the debate about reduction(ism) in the philosophy of biology and continues with a discussion on the two perspectives on explanatory reduction that have been proposed in the philosophy of biology so far. The author scrutinizes how the issue of reduction becomes entangled with explanation and analyzes two concepts, the concept of a biological part and the concept of a level of organization. The results of these five chapters constitute the ground on which the author bases her final chapter, developing her ontic account of reductive explanatio

Der evolutionäre Naturalismus in der Ethik

Kaiser MI. Der evolutionäre Naturalismus in der Ethik. In: Oehler J, ed. Der Mensch - Evolution, Natur und Kultur. Vol 74. Berlin, Heidelberg: Springer ; 2011: 261-283

Philip Kitcher. Pragmatic Naturalism

Kaiser MI, Seide A, eds. Philip Kitcher. Pragmatic Naturalism . Münstersche Vorlesungen zur Philosophie. Vol 15. Berlin ; Boston: De Gruyter; 2013

Themen aus den Lebenswissenschaften

Kaiser MI. Themen aus den Lebenswissenschaften. In: Schrenk M, ed. Handbuch Metaphysik. Stuttgart: J. B. Metzler; 2017: 325-330

Was ist gute Wissenschaft? Philip Kitcher

Kaiser MI. Was ist gute Wissenschaft? Philip Kitcher. In: Müller-Salo J, ed. Analytische Philosophie. Eine Einführung in 16 Fragen und Antworten. UTB. Vol 5111. Paderborn: Wilhem Fink Verlag; 2020: 111-124

Well-Ordered Philosophy? Reflections on Kitcher's Proposal for a Renewal of Philosophy

Jung E-M, Kaiser MI, Seide A. Well-Ordered Philosophy? Reflections on Kitcher's Proposal for a Renewal of Philosophy. In: Kaiser MI, Seide A, eds. Philip Kitcher. Pragmatic naturalism. Münstersche Vorlesungen zur Philosophie. Vol 15. Frankfurt i. e. Heusenstamm: Ontos-Verl.; 2013: 161-174