uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Fredén, Filip
Publications (10 of 12) Show all publications
Reinius, H., Batista Borges, J., Engström, J., Ahlgren, O., Lennmyr, F., Larsson, A. & Fredén, F. (2019). Optimal PEEP during one-lung ventilation with capnothorax: An experimental study. Acta Anaesthesiologica Scandinavica, 63(2), 222-231
Open this publication in new window or tab >>Optimal PEEP during one-lung ventilation with capnothorax: An experimental study
Show others...
2019 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, no 2, p. 222-231Article in journal (Refereed) Published
Abstract [en]

Background: One‐lung ventilation (OLV) with induced capnothorax carries the risk of severely impaired ventilation and circulation. Optimal PEEP may mitigate the physiological perturbations during these conditions.

Methods: Right‐sided OLV with capnothorax (16 cm H2O) on the left side was initiated in eight anesthetized, muscle‐relaxed piglets. A recruitment maneuver and a decremental PEEP titration from PEEP 20 cm H2O to zero end‐expiratory pressure (ZEEP) was performed. Regional ventilation and perfusion were studied with electrical impedance tomography and computer tomography of the chest was used. End‐expiratory lung volume and hemodynamics were recorded and.

Results: PaO2 peaked at PEEP 12 cm H2O (49 ± 14 kPa) and decreased to 11 ± 5 kPa at ZEEP (P < 0.001). PaCO2 was 9.5 ± 1.3 kPa at 20 cm H2O PEEP and did not change when PEEP step‐wise was reduced to 12 cm H2O PaCO2. At lower PEEP, PaCO2 increased markedly. The ventilatory driving pressure was lowest at PEEP 14 cm H2O (19.6 ± 5.8 cm H2O) and increased to 38.3 ± 6.1 cm H2O at ZEEP (P < 0.001). When reducing PEEP below 12‐14 cm H2O ventilation shifted from the dependent to the nondependent regions of the ventilated lung (P = 0.003), and perfusion shifted from the ventilated to the nonventilated lung (P = 0.02).

Conclusion: Optimal PEEP was 12‐18 cm H2O and probably relates to capnothorax insufflation pressure. With suboptimal PEEP, ventilation/perfusion mismatch in the ventilated lung and redistribution of blood flow to the nonventilated lung occurred.

Keywords
anesthesia, capnothorax, cardio-thoracic surgery, one lung ventilation, optimal PEEP, PEEP titration
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-268620 (URN)10.1111/aas.13247 (DOI)000454814700012 ()30132806 (PubMedID)
Funder
Swedish Heart Lung Foundation
Note

Title in thesis list of papers: Optimal PEEP during one lung ventilation with capnothorax. An experimental study

Available from: 2015-12-08 Created: 2015-12-08 Last updated: 2019-01-31Bibliographically approved
Bergquist, M., Hastbacka, J., Glaumann, C., Fredén, F., Huss, F. & Lipcsey, M. (2019). The time-course of the inflammatory response to major burn injury and its relation to organ failure and outcome. Burns, 45(2), 354-363
Open this publication in new window or tab >>The time-course of the inflammatory response to major burn injury and its relation to organ failure and outcome
Show others...
2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 2, p. 354-363Article in journal (Refereed) Published
Abstract [en]

Burn injury causes major inflammatory activation and cytokine release, however, the temporal resolution of the acute and sub-acute inflammatory response has not yet been fully delineated. To this end, we have quantified 20 inflammatory mediators in plasma from 44 adult patients 0-21 days after burn injury and related the time course of these mediators to % total body surface area (TBSA) burned, clinical parameters, organ failure and outcome. Of the cytokines analyzed in these patients, interleukin 6 (IL-6), IL-8, IL-10 and monocyte chemoattractant protein 1 (MCP-1) correlated to the size of the injury at 24-48h after burn injury. In our study, the concentration of IL-10 had prognostic value in patients with burn injury both measured at admission and at 24-48h after injury. However, simple demographic data such as age, % burned TBSA, inhalation injury and their combination, the Baux score and modified Baux score, outperform most of the cytokines, with the exception of IL-8 and MCP1 levels on admission, in predicting death.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2019
Keywords
Cytokines, Burns, Mortality, Multiple organ failure, Severity of illness index
National Category
Anesthesiology and Intensive Care Surgery
Identifiers
urn:nbn:se:uu:diva-380482 (URN)10.1016/j.burns.2018.09.001 (DOI)000461044900012 ()30274808 (PubMedID)
Available from: 2019-04-15 Created: 2019-04-15 Last updated: 2019-04-15Bibliographically approved
Bergquist, M., Huss, F., Hästbacka, J., Lindholm, C., Martijn, C., Rylander, C., . . . Fredén, F. (2016). Glucocorticoid receptor expression and binding capacity in patients with burn injury. Acta Anaesthesiologica Scandinavica, 60(2), 213-221
Open this publication in new window or tab >>Glucocorticoid receptor expression and binding capacity in patients with burn injury
Show others...
2016 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 2, p. 213-221Article in journal (Refereed) Published
Abstract [en]

Background

Burn injuries are associated with strong inflammation and risk of secondary sepsis which both may affect the function of the glucocorticoid receptor (GR). The aim of this study was to determine GR expression and binding capacity in leucocytes from patients admitted to a tertiary burn center.

Methods

Blood was sampled from 13 patients on admission and days 7, 14 and 21, and once from 16 healthy subjects. Patients were grouped according to the extent of burn and to any sepsis on day 7. Expression and binding capacity of GR were determined as arbitrary units using flow cytometry.

Results

GR expression and binding capacity were increased compared to healthy subjects in most circulating leucocyte subsets on admission irrespective of burn size. Patients with sepsis on day 7 displayed increased GR expression in T lymphocytes (51.8%, < 0.01) compared to admission. There was a negative correlation between GR binding capacity in neutrophils and burn size after 14 days (< 0.05).

Conclusions

GR expression and binding capacity are increased in most types of circulating leucocytes of severely burned patients on their admission to specialized burn care. If sepsis is present after 1 week, it is associated with higher GR expression in T lymphocytes and NK cells.

National Category
Cell and Molecular Biology
Identifiers
urn:nbn:se:uu:diva-229116 (URN)10.1111/aas.12604 (DOI)000368139700009 ()
Funder
Swedish Research Council, 5315
Available from: 2014-07-31 Created: 2014-07-31 Last updated: 2018-01-11
Persson, A., Myrlund, H., Huss, F. & Fredén, F. (2015). Is Nitrous oxide effective enough as wound care analgesia in an outpatient clinic?. Paper presented at 16th European Burns Association Congress Hannover, Tyskland, 2015.. Annals of Burns and Fire Disasters
Open this publication in new window or tab >>Is Nitrous oxide effective enough as wound care analgesia in an outpatient clinic?
2015 (English)In: Annals of Burns and Fire Disasters, ISSN 1121-1539, E-ISSN 1592-9558Article in journal, Meeting abstract (Refereed) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-368478 (URN)
Conference
16th European Burns Association Congress Hannover, Tyskland, 2015.
Note

Congress abstracts: 16th European Burns Association Congress Hannover, Tyskland, 2015.

Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2019-02-28Bibliographically approved
Hastbacka, J., Fredén, F., Hult, M., Bergquist, M., Wilkman, E., Vuola, J., . . . Huss, F. (2015). Matrix Metalloproteinases-8 and-9 and Tissue Inhibitor of Metalloproteinase-1 in Burn Patients. A Prospective Observational Study. PLoS ONE, 10(5), Article ID e0125918.
Open this publication in new window or tab >>Matrix Metalloproteinases-8 and-9 and Tissue Inhibitor of Metalloproteinase-1 in Burn Patients. A Prospective Observational Study
Show others...
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0125918Article in journal (Refereed) Published
Abstract [en]

Introduction Matrix metalloproteinases (MMPs) -8 and -9 are released from neutrophils in acute inflammation and may contribute to permeability changes in burn injury. In retrospective studies on sepsis, levels of MMP-8, MMP-9, and tissue inhibitor of metalloproteinase-1 (TIMP-1) differed from those of healthy controls, and TIMP-1 showed an association with outcome. Our objective was to investigate the relationship between these proteins and disease severity and outcome in burn patients. Methods In this prospective, observational, two-center study, we collected plasma samples from admission to day 21 post-burn, and burn blister fluid samples on admission. We compared MMP-8, -9, and TIMP-1 levels between TBSA<20% (N = 19) and TBSA>20% (N = 30) injured patients and healthy controls, and between 90-day survivors and non-survivors. MMP-8, -9, and TIMP-1 levels at 24-48 hours from injury, their maximal levels, and their time-adjusted means were compared between groups. Correlations with clinical parameters and the extent of burn were analyzed. MMP-8, -9, and TIMP-1 levels in burn blister fluids were also studied. Results Plasma MMP-8 and -9 were higher in patients than in healthy controls (P<0.001 and P = 0.016), but only MMP-8 differed between the TBSA<20% and TBSA>20% groups. MMP-8 and -9 were not associated with clinical severity or outcome measures. TIMP-1 differed significantly between patients and controls (P<0.001) and between TBSA<20% and TBSA>20% groups (P<0.002). TIMP-1 was associated with 90-day mortality and correlated with the extent of injury and clinical measures of disease severity. TIMP-1 may serve as a new biomarker in outcome prognostication of burn patients.

National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:uu:diva-256129 (URN)10.1371/journal.pone.0125918 (DOI)000354049700096 ()25945788 (PubMedID)
Available from: 2015-06-22 Created: 2015-06-22 Last updated: 2017-12-04Bibliographically approved
Reinius, H., Borges, J. B., Fredén, F., Jideus, L., Camargo, E. D., Amato, M. B., . . . Lennmyr, F. (2015). Real-time ventilation and perfusion distributions by electrical impedance tomography during one-lung ventilation with capnothorax. Acta Anaesthesiologica Scandinavica, 59(3), 354-368
Open this publication in new window or tab >>Real-time ventilation and perfusion distributions by electrical impedance tomography during one-lung ventilation with capnothorax
Show others...
2015 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 3, p. 354-368Article in journal (Refereed) Published
Abstract [en]

Background: Carbon dioxide insufflation into the pleural cavity, capnothorax, with one-lung ventilation (OLV) may entail respiratory and hemodynamic impairments. We investigated the online physiological effects of OLV/capnothorax by electrical impedance tomography (EIT) in a porcine model mimicking the clinical setting.

Methods: Five anesthetized, muscle-relaxed piglets were subjected to first right and then left capnothorax with an intra-pleural pressure of 19cm H2O. The contra-lateral lung was mechanically ventilated with a double-lumen tube at positive end-expiratory pressure 5 and subsequently 10cm H2O. Regional lung perfusion and ventilation were assessed by EIT. Hemodynamics, cerebral tissue oxygenation and lung gas exchange were also measured.

Results: During right-sided capnothorax, mixed venous oxygen saturation (P=0.018), as well as a tissue oxygenation index (P=0.038) decreased. There was also an increase in central venous pressure (P=0.006), and a decrease in mean arterial pressure (P=0.045) and cardiac output (P=0.017). During the left-sided capnothorax, the hemodynamic impairment was less than during the right side. EIT revealed that during the first period of OLV/capnothorax, no or very minor ventilation on the right side could be seen (33% vs. 97 +/- 3%, right vs. left, P=0.007), perfusion decreased in the non-ventilated and increased in the ventilated lung (18 +/- 2% vs. 82 +/- 2%, right vs. left, P=0.03). During the second OLV/capnothorax period, a similar distribution of perfusion was seen in the animals with successful separation (84 +/- 4% vs. 16 +/- 4%, right vs. left).

Conclusion: EIT detected in real-time dynamic changes in pulmonary ventilation and perfusion distributions. OLV to the left lung with right-sided capnothorax caused a decrease in cardiac output, arterial oxygenation and mixed venous saturation.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-248178 (URN)10.1111/aas.12455 (DOI)000349604000010 ()25556329 (PubMedID)
Note

De 2 första författarna delar förstaförfattarskapet.

Available from: 2015-04-12 Created: 2015-03-30 Last updated: 2017-12-04Bibliographically approved
Nilsson, M., Hambraeus-Jonzon, K., Alving, K., Wiklund, P., Bergquist, M. & Fredén, F. (2013). Distant effects of nitric oxide inhalation in lavage induced lung injury in anaesthetised pigs. Acta Anaesthesiologica Scandinavica, 57(3), 326-333
Open this publication in new window or tab >>Distant effects of nitric oxide inhalation in lavage induced lung injury in anaesthetised pigs
Show others...
2013 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 3, p. 326-333Article in journal (Refereed) Published
Abstract [en]

Background Inhalation of nitric oxide (INO) exerts both local and distanteffects. INO in healthy pigs causes down-regulation of endogenous nitric oxide(NO) production and vasoconstriction in lung regions not reached by INO, especially in hypoxic regions, which augments hypoxic pulmonary vasoconstriction. In contrast, in pigs with endotoxemia-induced lung injury, INO causes increased NO production in lung regions not reached by INO. The aim ofthis study was to investigate whether INO exerts distant effects in surfactant-depleted lungs. Methods Twelve pigs were anaesthetised, and the left lower lobe (LLL) was separately ventilated. Lavage injury was induced in all lung regions, except the LLL. In six pigs, 40 ppm INO was given to the LLL (INO group), and theeffects on endogenous NO production and blood flow in the lavage-injured lungregions were studied. Six pigs served as a control group. NO concentration inexhaled air (ENO), NO synthase (NOS) activity and cyclic guanosine monophosphate (cGMP) in lung tissue, and regional pulmonary blood flow were measured. Results The calcium (Ca2+)-dependent NOS activity was lower (P<0.05) in the lavage-injured lung regions in the INO group than in the control group. There were no measurable differences between the groups for Ca2+-independent NOS activity, cGMP, ENO, or regional pulmonary blood flow. Conclusions Regional INO did not increase endogenous NO production in lavage-injured lung regions not directly reached by INO, but instead down-regulated the constitutive calcium-dependent nitric oxide synthase activity, indicating that NO may inhibit its own synthesis.

Keywords
Nitric oxide, Nitric oxide synthase, Lavage induced lung injury, pulmonary blood flow, exhaled nitric oxide, cyclic guanosine monophosphate
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-157085 (URN)10.1111/aas.12030 (DOI)000314652400009 ()
Available from: 2011-08-15 Created: 2011-08-15 Last updated: 2017-12-08Bibliographically approved
Nilsson, M. C. A., Fredén, F., Larsson, A., Wiklund, P., Bergquist, M. & Hambraeus-Jonzon, K. (2012). Hypercapnic acidosis transiently weakens hypoxic pulmonary vasoconstriction in anesthetized pigs, without affecting the endogenous pulmonary nitric oxide production.. Intensive Care Medicine, 38(3), 509-517
Open this publication in new window or tab >>Hypercapnic acidosis transiently weakens hypoxic pulmonary vasoconstriction in anesthetized pigs, without affecting the endogenous pulmonary nitric oxide production.
Show others...
2012 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 38, no 3, p. 509-517Article in journal (Refereed) Published
Abstract [en]

Purpose  Hypercapnic acidosis often occurs in critically ill patients and during protective mechanical ventilation; however, the effect of hypercapnic acidosis on endogenous nitric oxide (NO) production and hypoxic pulmonary vasoconstriction (HPV) presents conflicting results. The aim of this study is to test the hypothesis that hypercapnic acidosis augments HPV without changing endogenous NO production in both hyperoxic and hypoxic lung regions in pigs.

Methods  Sixteen healthy anesthetized pigs were separately ventilated with hypoxic gas to the left lower lobe (LLL) and hyperoxic gas to the rest of the lung. Eight pigs received 10% carbon dioxide (CO2) inhalation to both lung regions (hypercapnia group), and eight pigs formed the control group. NO concentration in exhaled air (ENO), nitric oxide synthase (NOS) activity, cyclic guanosine monophosphate (cGMP) in lung tissue, and regional pulmonary blood flow were measured.

Results  There were no differences between the groups for ENO, Ca2+-independent or Ca2+-dependent NOS activity, or cGMP in hypoxic or hyperoxic lung regions. Relative perfusion to LLL (Q LLL/Q T) was reduced similarly in both groups when LLL hypoxia was induced. During the first 90 min of hypercapnia, Q LLL/Q T increased from 6% (1%) [mean (standard deviation, SD)] to 9% (2%) (p < 0.01), and then decreased to the same level as the control group, where Q LLL/Q T remained unchanged. Cardiac output increased during hypercapnia (p < 0.01), resulting in increased oxygen delivery (p < 0.01), despite decreased PaO2 (p < 0.01).

Conclusions  Hypercapnic acidosis does not potentiate HPV, but rather transiently weakens HPV, and does not affect endogenous NO production in either hypoxic or hyperoxic lung regions.

Keywords
Nitric oxide, hypercapnic acidosis, hypoxic pulmonary vasoconstriction, exhaled nitric oxide, cyclic guanosine monophosphate, pulmonary blood flow.
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-157084 (URN)10.1007/s00134-012-2482-7 (DOI)000300776300020 ()
Available from: 2011-08-15 Created: 2011-08-15 Last updated: 2017-12-08Bibliographically approved
Reinius, H., Jonsson, L., Gustafsson, S., Sundbom, M., Duvernoy, O., Pelosi, P., . . . Fredén, F. (2009). Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study. Anesthesiology, 111(5), 979-987
Open this publication in new window or tab >>Prevention of atelectasis in morbidly obese patients during general anesthesia and paralysis: a computerized tomography study
Show others...
2009 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 111, no 5, p. 979-987Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Morbidly obese patients show impaired pulmonary function during anesthesia and paralysis, partly due to formation of atelectasis. This study analyzed the effect of general anesthesia and three different ventilatory strategies to reduce the amount of atelectasis and improve respiratory function. METHODS: Thirty patients (body mass index 45 +/- 4 kg/m) scheduled for gastric bypass surgery were prospectively randomized into three groups: (1) positive end-expiratory pressure of 10 cm H2O (PEEP), (2) a recruitment maneuver with 55 cm H2O for 10 s followed by zero end-expiratory pressure, (3) a recruitment maneuver followed by PEEP. Transverse lung computerized tomography scans and blood gas analysis were recorded: awake, 5 min after induction of anesthesia and paralysis at zero end-expiratory pressure, and 5 min and 20 min after intervention. In addition, spiral computerized tomography scans were performed at two occasions in 23 of the patients. RESULTS: After induction of anesthesia, atelectasis increased from 1 +/- 0.5% to 11 +/- 6% of total lung volume (P < 0.0001). End-expiratory lung volume decreased from 1,387 +/- 581 ml to 697 +/- 157 ml (P = 0.0014). A recruitment maneuver + PEEP reduced atelectasis to 3 +/- 4% (P = 0.0002), increased end-expiratory lung volume and increased Pao2/Fio2 from 266 +/- 70 mmHg to 412 +/- 99 mmHg (P < 0.0001). PEEP alone did not reduce the amount of atelectasis or improve oxygenation. A recruitment maneuver + zero end-expiratory pressure had a transient positive effect on respiratory function. All values are presented as mean +/- SD. CONCLUSIONS: A recruitment maneuver followed by PEEP reduced atelectasis and improved oxygenation in morbidly obese patients, whereas PEEP or a recruitment maneuver alone did not.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-113069 (URN)10.1097/ALN.0b013e3181b87edb (DOI)000271172500009 ()19809292 (PubMedID)
Available from: 2010-01-25 Created: 2010-01-25 Last updated: 2017-12-12Bibliographically approved
Nielsen, J., Nilsson, M., Fredén, F., Hultman, J., Alström, U., Kjergaard, J., . . . Larsson, A. (2006). Central hemodynamics during lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia. A study by echocardiography and continuous pulmonary artery flow measurements in lung-injured pigs.. Intensive Care Med, 32(4), 585-594
Open this publication in new window or tab >>Central hemodynamics during lung recruitment maneuvers at hypovolemia, normovolemia and hypervolemia. A study by echocardiography and continuous pulmonary artery flow measurements in lung-injured pigs.
Show others...
2006 (English)In: Intensive Care Med, ISSN 0342-4642, Vol. 32, no 4, p. 585-594Article in journal (Refereed) Published
Keywords
acute lung injury, acute respiratory distress syndrome, cardiac output, echocardiography, hypovolemia, hypervolemia, lung recruitment maneuvers
Identifiers
urn:nbn:se:uu:diva-80708 (URN)10.1007/s00134-006-0082-0 (DOI)16520996 (PubMedID)
Available from: 2007-02-28 Created: 2007-02-28 Last updated: 2015-06-12
Organisations

Search in DiVA

Show all publications