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Hedenstierna, GöranORCID iD iconorcid.org/0000-0002-2923-6012
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Publications (10 of 183) Show all publications
Marchesi, S., Ortiz-Nieto, F., Ahlgren, K. M., Roneus, A., Feinstein, R., Lipcsey, M., . . . Hedenstierna, G. (2019). Abdominal organ perfusion and inflammation in experimental sepsis: a magnetic resonance imaging study. American Journal of Physiology - Gastrointestinal and Liver Physiology, 316(1), G187-G196
Open this publication in new window or tab >>Abdominal organ perfusion and inflammation in experimental sepsis: a magnetic resonance imaging study
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2019 (English)In: American Journal of Physiology - Gastrointestinal and Liver Physiology, ISSN 0193-1857, E-ISSN 1522-1547, Vol. 316, no 1, p. G187-G196Article in journal (Refereed) Published
Abstract [en]

Diffusion-weighted magnetic resonance imaging (DW-MRI) uses water as contrast and enables the study of perfusion in many organs simultaneously in situ. We used DW-MRI in a sepsis model, comparing abdominal organs perfusion with global hemodynamic measurements and inflammation. Sixteen anesthetized piglets were randomized into 3 groups: HighMAP (mean arterial pressure, MAP > 65 mmHg), LowMAP (MAP between 50 and 60 mmHg) and Healthy Controls (HC). Sepsis was obtained with endotoxin and the desired MAP maintained with noradrenaline. After 6 hours DW-MRI was performed. Acute inflammation was assessed with IL-6 and TNFα in abdominal organs, ascites, and blood and by histology of intestine (duodenum). Perfusion of abdominal organs was reduced in the LowMAP group compared to the HighMAP group and HC. Liver perfusion was still reduced by 25% in the HighMAP group compared with HC. Intestinal perfusion did not differ significantly between the study groups. Cytokines concentration were generally higher in the LowMAP group but did not correlate with global hemodynamics. However, cytokines correlated with regional perfusion and, for liver and intestine, also with intra-abdominal pressure. Histopathology of intestine worsened with decreasing perfusion. In conclusion, although a low MAP (≤60 mmHg) indicated impeded abdominal perfusion in experimental sepsis, it did not predict inflammation, nor did other global measures of circulation. Decreased abdominal perfusion predicted partially inflammation but intestine, occupying most of the abdomen, and liver, were also affected by intra-abdominal pressure.

Keywords
Abdominal organs, inflammation, magnetic resonance, perfusion, sepsis
National Category
Surgery Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-364356 (URN)10.1152/ajpgi.00151.2018 (DOI)000455670700012 ()30335473 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research Council
Available from: 2018-10-25 Created: 2018-10-25 Last updated: 2019-02-05Bibliographically approved
Broche, L., Pisa, P., Porra, L., Degrugilliers, L., Bravin, A., Pellegrini, M., . . . Bayat, S. (2019). Individual Airway Closure Characterized In Vivo by Phase-Contrast CT Imaging in Injured Rabbit Lung. Critical Care Medicine, 47(9), E774-E781
Open this publication in new window or tab >>Individual Airway Closure Characterized In Vivo by Phase-Contrast CT Imaging in Injured Rabbit Lung
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2019 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 47, no 9, p. E774-E781Article in journal (Refereed) Published
Abstract [en]

Objectives: Airway closure is involved in adverse effects of mechanical ventilation under both general anesthesia and in acute respiratory distress syndrome patients. However, direct evidence and characterization of individual airway closure is lacking. Here, we studied the same individual peripheral airways in intact lungs of anesthetized and mechanically ventilated rabbits, at baseline and following lung injury, using high-resolution synchrotron phase-contrast CT.

Design: Laboratory animal investigation.

Setting: European synchrotron radiation facility.

Subjects: Six New-Zealand White rabbits.

Interventions: The animals were anesthetized, paralyzed, and mechanically ventilated in pressure-controlled mode (tidal volume, 6 mL/kg; respiratory rate, 40; Fio(2), 0.6; inspiratory:expiratory, 1:2; and positive end-expiratory pressure, 3 cm H2O) at baseline. Imaging was performed with a 47.5 x 47.5 x 47.5 mu m voxel size, at positive end-expiratory pressure 12, 9, 6, 3, and 0 cm H2O. The imaging sequence was repeated after lung injury induced by whole-lung lavage and injurious ventilation in four rabbits. Cross-sections of the same individual airways were measured.

Measurements and Main Results: The airways were measured at baseline (n = 48; radius, 1.7 to 0.21 mm) and after injury (n = 32). Closure was observed at 0 cm H2O in three of 48 airways (6.3%; radius, 0.350.08 mm at positive end-expiratory pressure 12) at baseline and five of 32 (15.6%; radius, 0.28 +/- 0.09 mm) airways after injury. Cross-section was significantly reduced at 3 and 0 cm H2O, after injury, with a significant relation between the relative change in cross-section and airway radius at 12 cm H2O in injured, but not in normal lung (R = 0.60; p < 0.001).

Conclusions: Airway collapsibility increases in the injured lung with a significant dependence on airway caliber. We identify "compliant collapse" as the main mechanism of airway closure in initially patent airways, which can occur at more than one site in individual airways.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2019
Keywords
airway closure, mechanical ventilation, phase-contrast imaging, respiratory distress syndrome, adult, tomography, x-ray computed, ventilator-induced lung injury
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-394204 (URN)10.1097/CCM.0000000000003838 (DOI)000484224200007 ()31162202 (PubMedID)
Available from: 2019-10-04 Created: 2019-10-04 Last updated: 2019-10-04Bibliographically approved
Hedenstierna, G., Tokics, L., Scaramuzzo, G., Rothen, H. U., Edmark, L. & Öhrvik, J. (2019). Oxygenation Impairment during Anesthesia: Influence of Age and Body Weight. Anesthesiology, 131(1), 46-57
Open this publication in new window or tab >>Oxygenation Impairment during Anesthesia: Influence of Age and Body Weight
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2019 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 131, no 1, p. 46-57Article in journal (Refereed) Published
Abstract [en]

Background: Anesthesia is increasingly common in elderly and overweight patients and prompted the current study to explore mechanisms of age- and weight-dependent worsening of arterial oxygen tension (Pao(2)). Methods: This is a primary analysis of pooled data in patients with (1) American Society of Anesthesiologists (ASA) classification of 1; (2) normal forced vital capacity; (3) preoxygenation with an inspired oxygen fraction (FIO2) more than 0.8 and ventilated with FIO2 0.3 to 0.4; (4) measurements done during anesthesia before surgery. Eighty patients (21 women and 59 men, aged 19 to 69 yr, body mass index up to 30 kg/m(2)) were studied with multiple inert gas elimination technique to assess shunt and perfusion of poorly ventilated regions (low ventilation/perfusion ratio [(V) over dot(A)/Q]) and computed tomography to assess atelectasis. Results: Pao(2) /FIO2 was lower during anesthesia than awake (368; 291 to 470 [median; quartiles] vs. 441; 397 to 462 mm Hg; P = 0.003) and fell with increasing age and body mass index. Log shunt was best related to a quadratic function of age with largest shunt at 45 yr (r(2) = 0.17, P = 0.001). Log shunt was linearly related to body mass index (r(2) = 0.15, P < 0.001). A multiple regression analysis including age, age(2), and body mass index strengthened the association further (r(2) = 0.27). Shunt was highly associated to atelectasis (r(2) = 0.58, P < 0.001). Log low (V) over dot(A)/Q showed a linear relation to age (r(2) = 0.14, P = 0.001). Conclusions: Pao(2)/FIO2 ratio was impaired during anesthesia, and the impairment increased with age and body mass index. Shunt was related to atelectasis and was a more important cause of oxygenation impairment in middle-aged patients, whereas low (V) over dot(A)/Q, likely caused by airway closure, was more important in elderly patients. Shunt but not low (V) over dot(A)/Q increased with increasing body mass index. Thus, increasing age and body mass index impaired gas exchange by different mechanisms during anesthesia.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-393526 (URN)10.1097/ALN.0000000000002693 (DOI)000480727700012 ()31045901 (PubMedID)
Available from: 2019-09-24 Created: 2019-09-24 Last updated: 2019-09-24Bibliographically approved
Crockett, D. C., Cronin, J. N., Bommakanti, N., Chen, R., Hahn, C. E., Hedenstierna, G., . . . Formenti, F. (2019). Tidal changes in PaO2 and their relationship to cyclical lung recruitment/derecruitment in a porcine lung injury model. British Journal of Anaesthesia, 122(2), 277-285
Open this publication in new window or tab >>Tidal changes in PaO2 and their relationship to cyclical lung recruitment/derecruitment in a porcine lung injury model
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2019 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 122, no 2, p. 277-285Article in journal (Refereed) Published
Abstract [en]

Background: Tidal recruitment/derecruitment (R/D) of collapsed regions in lung injury has been presumed to cause respiratory oscillations in the partial pressure of arterial oxygen (PaO2). These phenomena have not yet been studied simultaneously. We examined the relationship between R/D and PaO2 oscillations by contemporaneous measurement of lung-density changes and PaO2. Methods: Five anaesthetised pigs were studied after surfactant depletion via a saline-lavage model of R/D. The animals were ventilated with a mean fraction of inspired O-2 (FiO(2)) of 0.7 and a tidal volume of 10 ml kg(-1) Protocolised changes in pressure-and volume-controlled modes, inspiratory: expiratory ratio (I:E), and three types of breath-hold manoeuvres were undertaken. Lung collapse and PaO2 were recorded using dynamic computed tomography (dCT) and a rapid PaO2 sensor. Results: During tidal ventilation, the expiratory lung collapse increased when I: E <1 [mean (standard deviation) lung collapse = .7 (8.7)%; P<0.05], but the amplitude of respiratory PaO2 oscillations [ 2.2 (0.8) kPa] did not change during the respiratory cycle. The expected relationship between respiratory PaO2 oscillation amplitude and R/D was therefore not clear. Lung collapse increased during breath-hold manoeuvres at end-expiration and end-inspiration (14% vs 0.9-2.1%; P<0.0001). The mean change in PaO2 from beginning to end of breath-hold manoeuvres was significantly different with each type of breath-hold manoeuvre (P<0.0001). Conclusions: This study in a porcine model of collapse-prone lungs did not demonstrate the expected association between PaO2 oscillation amplitude and the degree of recruitment/derecruitment. The results suggest that changes in pulmonary ventilation are not the sole determinant of changes in PaO2 during mechanical ventilation in lung injury.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2019
Keywords
diagnostic imaging, dynamic computed tomorgraphy, lung injury, pulmonary atelectasis, respiration, ventilation
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-377219 (URN)10.1016/j.bja.2018.09.011 (DOI)000456793300025 ()30686314 (PubMedID)
Funder
Swedish Research Council, K2015-99X-2273101-4
Available from: 2019-02-15 Created: 2019-02-15 Last updated: 2019-02-15Bibliographically approved
Gudmundsson, M., Perchiazzi, G., Pellegrini, M., Vena, A., Hedenstierna, G. & Rylander, C. (2018). Atelectasis is inversely proportional to transpulmonary pressure during weaning from ventilator support in a large animal model. Acta Anaesthesiologica Scandinavica, 62(1), 94-104
Open this publication in new window or tab >>Atelectasis is inversely proportional to transpulmonary pressure during weaning from ventilator support in a large animal model
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 1, p. 94-104Article in journal (Refereed) Published
Abstract [en]

Background

In mechanically ventilated, lung injured, patients without spontaneous breathing effort, atelectasis with shunt and desaturation may appear suddenly when ventilator pressures are decreased. It is not known how such a formation of atelectasis is related to transpulmonary pressure (PL) during weaning from mechanical ventilation when the spontaneous breathing effort is increased. If the relation between PL and atelectasis were known, monitoring of PL might help to avoid formation of atelectasis and cyclic collapse during weaning. The main purpose of this study was to determine the relation between PL and atelectasis in an experimental model representing weaning from mechanical ventilation.

Methods

Dynamic transverse computed tomography scans were acquired in ten anaesthetized, surfactant-depleted pigs with preserved spontaneous breathing, as ventilator support was lowered by sequentially reducing inspiratory pressure and positive end expiratory pressure in steps. The volumes of gas and atelectasis in the lungs were correlated with PL obtained using oesophageal pressure recordings. Work of breathing (WOB) was assessed from Campbell diagrams.

Results

Gradual decrease in PL in both end-expiration and end-inspiration caused a proportional increase in atelectasis and decrease in the gas content (linear mixed model with an autoregressive correlation matrix; P < 0.001) as the WOB increased. However, cyclic alveolar collapse during tidal ventilation did not increase significantly.

Conclusion

We found a proportional correlation between atelectasis and PL during the ‘weaning process’ in experimental mild lung injury. If confirmed in the clinical setting, a gradual tapering of ventilator support can be recommended for weaning without risk of sudden formation of atelectasis.

National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care; Clinical Physiology
Identifiers
urn:nbn:se:uu:diva-342403 (URN)10.1111/aas.13015 (DOI)000417184800010 ()29058315 (PubMedID)
Funder
Swedish Research Council, 2008-5315; 2011-5315
Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2018-03-05Bibliographically approved
Hedenstierna, G., Lundin, S., Pesenti, A., Chiumello, D., Larsson, A. S. & Stenqvist, O. (2018). Chest Wall Elastance During Passive Mechanical Ventilation: An Alternative Hypothesis. Paper presented at International Conference of the American-Thoracic-Society, MAY 18-23, 2018, San Diego, CA.. American Journal of Respiratory and Critical Care Medicine, 197
Open this publication in new window or tab >>Chest Wall Elastance During Passive Mechanical Ventilation: An Alternative Hypothesis
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2018 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 197Article in journal, Meeting abstract (Other academic) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-373345 (URN)000449980304559 ()
Conference
International Conference of the American-Thoracic-Society, MAY 18-23, 2018, San Diego, CA.
Funder
Swedish Heart Lung Foundation
Note

Meeting Abstract: A7233

Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2019-01-21Bibliographically approved
Bergmann, A., Breitling, C., Hedenstierna, G., Larsson, A., Kretzschmar, M., Kozian, A., . . . Schilling, T. (2018). Data on the effects of remote ischemic preconditioning in the lungs after one-lung ventilation. Data in Brief, 21, 441-448
Open this publication in new window or tab >>Data on the effects of remote ischemic preconditioning in the lungs after one-lung ventilation
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2018 (English)In: Data in Brief, E-ISSN 2352-3409, Vol. 21, p. 441-448Article in journal (Refereed) Published
Abstract [en]

This article contains data on experimental endpoints of a randomized controlled animal trial. Fourteen healthy piglets underwent mechanical ventilation including injurious one-lung ventilation (OLV), seven of them experienced four cycles of remote ischemic preconditioning (RIP) on one hind limb immediately before OLV, seven of them did not receive RIP and served as controls, in a randomized manner. The two major endpoints were (1) pulmonary damage assessed with the diffuse alveolar damage (DAD) score and (2) the inflammatory response assessed by cytokine concentrations in serum and in bronchoalveolar lavage fluids (BAL). The cytokine levels in the homogenized lung tissue samples are presented in the original article. Further interpretation and discussion of these data can be found in Bergmann et al. (in press).

Keywords
Animal model, Diffuse alveolar damage, One-lung ventilation, Pulmonary inflammatory response, Remote ischemic preconditioning
National Category
Respiratory Medicine and Allergy Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-365776 (URN)10.1016/j.dib.2018.09.085 (DOI)000457925900066 ()30364722 (PubMedID)
Funder
Swedish Research Council, 5315Swedish Research Council, X2015-99x-22731-01-04Swedish Heart Lung Foundation
Available from: 2018-11-14 Created: 2018-11-14 Last updated: 2019-03-12Bibliographically approved
Retamal, J., Hurtado, D., Villarroel, N., Bruhn, A., Bugedo, G., Amato, M. B., . . . Batista Borges, J. (2018). Does Regional Lung Strain Correlate With Regional Inflammation in Acute Respiratory Distress Syndrome During Nonprotective Ventilation?: An Experimental Porcine Study. Critical Care Medicine, 46(6), e591-e599
Open this publication in new window or tab >>Does Regional Lung Strain Correlate With Regional Inflammation in Acute Respiratory Distress Syndrome During Nonprotective Ventilation?: An Experimental Porcine Study
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2018 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 46, no 6, p. e591-e599Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: It is known that ventilator-induced lung injury causes increased pulmonary inflammation. It has been suggested that one of the underlying mechanisms may be strain. The aim of this study was to investigate whether lung regional strain correlates with regional inflammation in a porcine model of acute respiratory distress syndrome.

DESIGN: Retrospective analysis of CT images and positron emission tomography images using [18F]fluoro-2-deoxy-D-glucose.

SETTING: University animal research laboratory.

SUBJECTS: Seven piglets subjected to experimental acute respiratory distress syndrome and five ventilated controls.

INTERVENTIONS: Acute respiratory distress syndrome was induced by repeated lung lavages, followed by 210 minutes of injurious mechanical ventilation using low positive end-expiratory pressures (mean, 4 cm H2O) and high inspiratory pressures (mean plateau pressure, 45 cm H2O). All animals were subsequently studied with CT scans acquired at end-expiration and end-inspiration, to obtain maps of volumetric strain (inspiratory volume - expiratory volume)/expiratory volume, and dynamic positron emission tomography imaging. Strain maps and positron emission tomography images were divided into 10 isogravitational horizontal regions-of-interest, from which spatial correlation was calculated for each animal.

MEASUREMENTS AND MAIN RESULTS: The acute respiratory distress syndrome model resulted in a decrease in respiratory system compliance (20.3 ± 3.4 to 14.0 ± 4.9 mL/cm H2O; p < 0.05) and oxygenation (PaO2/FIO2, 489 ± 80 to 92 ± 59; p < 0.05), whereas the control animals did not exhibit changes. In the acute respiratory distress syndrome group, strain maps showed a heterogeneous distribution with a greater concentration in the intermediate gravitational regions, which was similar to the distribution of [18F]fluoro-2-deoxy-D-glucose uptake observed in the positron emission tomography images, resulting in a positive spatial correlation between both variables (median R2 = 0.71 [0.02-0.84]; p < 0.05 in five of seven animals), which was not observed in the control animals.

CONCLUSION: In this porcine acute respiratory distress syndrome model, regional lung strain was spatially correlated with regional inflammation, supporting that strain is a relevant and prominent determinant of ventilator-induced lung injury.

Keywords
acute lung injury, positron emission tomography, respiration, artificial, tomography, x-ray computed
National Category
Anesthesiology and Intensive Care
Research subject
Physiology
Identifiers
urn:nbn:se:uu:diva-365775 (URN)10.1097/CCM.0000000000003072 (DOI)000439575100016 ()29528946 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research Council, K2015-99X-22731-01-4
Available from: 2018-11-13 Created: 2018-11-13 Last updated: 2019-06-28Bibliographically approved
Meyhoff, C. S., Larsson, A., Perchiazzi, G. & Hedenstierna, G. (2018). In Reply [Letter to the editor]. Anesthesiology, 128(1), 222-224
Open this publication in new window or tab >>In Reply
2018 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 128, no 1, p. 222-224Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-350092 (URN)10.1097/ALN.0000000000001942 (DOI)000422905300032 ()29232228 (PubMedID)
Note

Wos title: World Health Organization Responds to Concerns about Surgical Site Infection Prevention Recommendations Reply

Available from: 2018-05-04 Created: 2018-05-04 Last updated: 2018-12-06Bibliographically approved
Perchiazzi, G., Pellegrini, M., Hedenstierna, G., Roneus, A. & Larsson, A. S. (2018). Multiple Transients of Local Gas Redistribution During Spontaneous Breathing Are Influenced by Ventilatory Settings. Paper presented at International Conference of the American-Thoracic-Society, MAY 18-23, 2018, San Diego, CA.. American Journal of Respiratory and Critical Care Medicine, 197
Open this publication in new window or tab >>Multiple Transients of Local Gas Redistribution During Spontaneous Breathing Are Influenced by Ventilatory Settings
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2018 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 197Article in journal, Meeting abstract (Other academic) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-373348 (URN)000449980304539 ()
Conference
International Conference of the American-Thoracic-Society, MAY 18-23, 2018, San Diego, CA.
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Note

Meeting Abstract: A7213

Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2019-01-21Bibliographically approved
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