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Guérin, C., Beuret, P., Constantin, J. M., Bellani, G., Garcia-Olivares, P., Roca, O., . . . Mercat, A. (2018). A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. Intensive Care Medicine, 44(1), 22-37
Open this publication in new window or tab >>A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study
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2018 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 44, no 1, p. 22-37Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: While prone positioning (PP) has been shown to improve patient survival in moderate to severe acute respiratory distress syndrome (ARDS) patients, the rate of application of PP in clinical practice still appears low.

AIM: This study aimed to determine the prevalence of use of PP in ARDS patients (primary endpoint), the physiological effects of PP, and the reasons for not using it (secondary endpoints).

METHODS: The APRONET study was a prospective international 1-day prevalence study performed four times in April, July, and October 2016 and January 2017. On each study day, investigators in each ICU had to screen every patient. For patients with ARDS, use of PP, gas exchange, ventilator settings and plateau pressure (Pplat) were recorded before and at the end of the PP session. Complications of PP and reasons for not using PP were also documented. Values are presented as median (1st-3rd quartiles).

RESULTS: Over the study period, 6723 patients were screened in 141 ICUs from 20 countries (77% of the ICUs were European), of whom 735 had ARDS and were analyzed. Overall 101 ARDS patients had at least one session of PP (13.7%), with no differences among the 4 study days. The rate of PP use was 5.9% (11/187), 10.3% (41/399) and 32.9% (49/149) in mild, moderate and severe ARDS, respectively (P = 0.0001). The duration of the first PP session was 18 (16-23) hours. Measured with the patient in the supine position before and at the end of the first PP session, PaO2/FIO2 increased from 101 (76-136) to 171 (118-220) mmHg (P = 0.0001) driving pressure decreased from 14 [11-17] to 13 [10-16] cmH2O (P = 0.001), and Pplat decreased from 26 [23-29] to 25 [23-28] cmH2O (P = 0.04). The most prevalent reason for not using PP (64.3%) was that hypoxemia was not considered sufficiently severe. Complications were reported in 12 patients (11.9%) in whom PP was used (pressure sores in five, hypoxemia in two, endotracheal tube-related in two ocular in two, and a transient increase in intracranial pressure in one).

CONCLUSIONS: In conclusion, this prospective international prevalence study found that PP was used in 32.9% of patients with severe ARDS, and was associated with low complication rates, significant increase in oxygenation and a significant decrease in driving pressure.

Keywords
ARDS, Epidemiology, Mechanical ventilation, Prone position
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-336055 (URN)10.1007/s00134-017-4996-5 (DOI)000422809000003 ()29218379 (PubMedID)
Available from: 2017-12-12 Created: 2017-12-12 Last updated: 2018-02-26Bibliographically approved
Thomassen, S. A., Kjaergaard, B., Alstrup, A. K., Munk, O. L., Frokiaer, J., Larsson, A. & Rasmussen, B. S. (2018). Cerebral blood flow measured by positron emission tomography during normothermic cardiopulmonary bypass: an experimental porcine study. Perfusion, 33(5), 346-353
Open this publication in new window or tab >>Cerebral blood flow measured by positron emission tomography during normothermic cardiopulmonary bypass: an experimental porcine study
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2018 (English)In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 5, p. 346-353Article in journal (Refereed) Published
Abstract [en]

Background: Mean arterial blood pressure (MAP) and/or pump flow during normothermic cardiopulmonary bypass (CPB) are the most important factors of cerebral perfusion. The aim of this study was to explore the influence of CPB blood flow on cerebral blood flow (CBF) measured by dynamic positron emission tomography (PET) using O-15-labelled water with no pharmacological interventions to maintain the MAP.

Methods: Eight pigs (69-71 kg) were connected to normothermic CPB. After 60 minutes (min) with a CPB pump flow of 60 mL/kg/min, the pigs were changed to either 35 mL/kg/min or 47.5 mL/kg/min for 60 min and, thereafter, all the pigs returned to 60 mL/kg/min for another 60 min. The MAP was measured continuously and the CBF was measured by positron emission tomography (PET) during spontaneous circulation and at each CPB pump flow after 30 min of steady state.

Results: Two pigs were excluded due to complications. CBF increased from spontaneous circulation to a CPB pump flow of 60 mL/kg/min. A reduction in CPB pump flow to 47.5 mL/kg/min (n=3) resulted in only minor changes in CBF while a reduction to 35 mL/kg/min (n=3) caused a pronounced change (correlation coefficient (R-2) 0.56). A return of CPB pump flow to 60 mL/kg/min was followed by an increase in CBF, except in the one pig with the lowest CBF during low flow (R-2=0.44). CBF and MAP were not correlated (R-2=0.20).

Conclusion: In this experimental porcine study, a relationship was observed between pump flow and CBF under normothermic low-flow CPB. The effect of low pump flow on MAP showed substantial variations, with no correlation between CBF and MAP.

Keywords
animal study, cardiopulmonary bypass, pump flow, mean arterial blood pressure, cerebral blood flow, positron emission tomography
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-358372 (URN)10.1177/0267659118755271 (DOI)000434703000004 ()29380669 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-08-31Bibliographically approved
Holzgraefe, B., Larsson, A. & von Kobyletzki, L. (2018). Do we have scientific evidence about the effect of hypoxaemia on cognitive outcome in adult patients with severe acute respiratory failure? [Letter to the editor]. Upsala Journal of Medical Sciences, 123(1), 68-70
Open this publication in new window or tab >>Do we have scientific evidence about the effect of hypoxaemia on cognitive outcome in adult patients with severe acute respiratory failure?
2018 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, no 1, p. 68-70Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-356902 (URN)10.1080/03009734.2018.1433255 (DOI)000428060300009 ()29485932 (PubMedID)
Funder
Swedish Research Council, K2015-99X-22731-01-4
Available from: 2018-08-09 Created: 2018-08-09 Last updated: 2018-08-09Bibliographically approved
Skorup, P., Maudsdotter, L., Tano, E., Lipcsey, M., Castegren, M., Larsson, A. & Sjölin, J. (2018). Dynamics of Endotoxin, Inflammatory Variables, and Organ Dysfunction After Treatment With Antibiotics in an Escherichia coli Porcine Intensive Care Sepsis Model. Critical Care Medicine, 46(7), e634-e641
Open this publication in new window or tab >>Dynamics of Endotoxin, Inflammatory Variables, and Organ Dysfunction After Treatment With Antibiotics in an Escherichia coli Porcine Intensive Care Sepsis Model
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2018 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 46, no 7, p. e634-e641Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate the dynamics of antibiotic-induced endotoxin liberation and inflammatory response in vivo in a clinically relevant large animal intensive care sepsis model and whether the addition of an aminoglycoside to a β-lactam antibiotic affects these responses.

DESIGN: Prospective, placebo-controlled interventional experimental study.

SETTING: University research unit.

SUBJECTS: Thirty-six healthy pigs administered Escherichia coli as a 3-hour infusion.

INTERVENTIONS: After 2 hours, during E. coli infusion, the animals were exposed to cefuroxime alone, the combination of cefuroxime and tobramycin, or saline.

MEASUREMENTS AND MAIN RESULTS: Plasma endotoxin, interleukin-6, tumor necrosis factor-α, leucocytes, and organ dysfunction were recorded for 4 hours after antibiotic treatment, and differences to the values before treatment were calculated. In vitro experiments were performed to ascertain whether endotoxin is released during antibiotic-induced bacterial killing of this E. coli strain. Despite differences between the treatment arms in vitro, no differences in plasma endotoxin were observed in vivo. Antibiotic-treated animals demonstrated a higher interleukin-6 response (p < 0.001), greater leucocyte activation (p < 0.001), and more pronounced deterioration in pulmonary static compliance (p < 0.01) over time than controls. Animals treated with the combination showed a trend toward less inflammation.

CONCLUSIONS: Treatment with antibiotics may elicit an increased inflammatory interleukin-6 response that is associated with leucocyte activation and pulmonary organ dysfunction. No observable differences were detected in plasma endotoxin concentrations. The reduction in cefuroxime-induced endotoxin release after the addition of an aminoglycoside in vitro could not be reproduced in this model.

National Category
Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-349226 (URN)10.1097/CCM.0000000000003139 (DOI)000435290400002 ()29595561 (PubMedID)
Available from: 2018-04-23 Created: 2018-04-23 Last updated: 2018-08-31Bibliographically 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: 2018-05-09Bibliographically approved
Befekadu, R., Christiansen, K., Larsson, A. & Grenegård, M. (2018). Increased plasma cathepsin S and trombospondin-1 in patients with acute ST segment elevation myocardial infarction.. Cardiology journal
Open this publication in new window or tab >>Increased plasma cathepsin S and trombospondin-1 in patients with acute ST segment elevation myocardial infarction.
2018 (English)In: Cardiology journal, ISSN 1897-5593Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The role of cathepsins in the pathological progression of atherosclerotic lesions in ischemic heart disease have been defined in detail more than numerous times. This investigation examined the platelet-specific biomarker trombospondin-1 (TSP-1) and platelet function ex vivo, and compared this with cathepsin S (Cat-S; a biomarker unrelated to platelet activation but also associated this with increased mortality risk) in patients with ST segment elevation myocardial infarction (STEMI).

METHODS: The STEMI patients were divided into two groups depending on the degree of coronary vessel occlusion: those with closed (n = 90) and open culprit vessel (n = 40). Cat-S and TSP-1 were analyzed before, 1-3 days after and 3 months after percutanous coronary intervention (PCI).

RESULTS: During acute STEMI, plasma TSP-1 was significantly elevated in patients with closed culprit lesions, but rapidly declined after PCI. In fact, TSP-1 after PCI was significantly lower inpatient samples compared to healthy individuals. In comparison, plasma Cat-S was significantly elevated both before and after PCI. In patients with closed culprit lesions, Cat-S was significantly higher compared to patients with open culprit lesions 3 months after PCI. Although troponin-I were higher (p < 0.01) in patients with closed culprit lesion, there was no correlation with Cat-S and TSP-1.

CONCLUSIONS: Cat-S but not TSP-1 may be a useful risk biomarker in relation to the severity of STEMI. However, the causality of Cat-S as a predictor for long-term mortality in STEMI remains to be ascertained in future studies.

Keywords
ST segment elevation myocardial infarction, cathepsin S, percutaneous coronary intervention, platelets
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-349225 (URN)10.5603/CJ.a2018.0030 (DOI)29611169 (PubMedID)
Available from: 2018-04-23 Created: 2018-04-23 Last updated: 2018-05-09Bibliographically approved
Kostic, P., Lo Mauro, A., Larsson, A., Hedenstierna, G., Frykholm, P. & Aliverti, A. (2018). Specific anesthesia-induced lung volume changes from induction to emergence: a pilot study.. Acta Anaesthesiologica Scandinavica, 62(3), 282-292
Open this publication in new window or tab >>Specific anesthesia-induced lung volume changes from induction to emergence: a pilot study.
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 3, p. 282-292Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Studies aimed at maintaining intraoperative lung volume to reduce post-operative pulmonary complications have been inconclusive because they mixed up the effect of general anesthesia and the surgical procedure. Our aims were to study: (1) lung volume during the entire course of anesthesia without the confounding effects of surgical procedures; (2) the combination of three interventions to maintain lung volume; and (3) the emergence phase with focus on the restored activation of the respiratory muscles.

METHODS: Eighteen ASA I-II patients undergoing ENT surgery under general anesthesia without muscle relaxants were randomized to an intervention group, receiving lung recruitment maneuver (LRM) after induction, 7 cmH2 O positive end-expiratory pressure (PEEP) during anesthesia and continuous positive airway pressure (CPAP) during emergence with 0.4 inspired oxygen fraction (FiO2 ) or a control group, ventilated without LRM, with 0 cmH2 O PEEP, and 1.0 FiO2 during emergence without CPAP application. End-expiratory lung volume (EELV) was continuously estimated by opto-electronic plethysmography. Inspiratory and expiratory ribcage muscles electromyography was measured in a subset of seven patients.

RESULTS: End-expiratory lung volume decreased after induction in both groups. It remained low in the control group and further decreased at emergence, because of active expiratory muscle contraction. In the intervention group, EELV increased after LRM and remained high after extubation.

CONCLUSION: A combined intervention consisting of LRM, PEEP and CPAP during emergence may effectively maintain EELV during anesthesia and even after extubation. An unexpected finding was that the activation of the expiratory muscles may contribute to EELV reduction during the emergence phase.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-334187 (URN)10.1111/aas.13026 (DOI)000424150200001 ()29105056 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research Council, 5315, K2015-99X-22731-01-4
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2018-03-15Bibliographically approved
Höstman, S., Kawati, R., Perchiazzi, G. & Larsson, A. (2018). THAM administration reduces pulmonary carbon dioxide elimination in hypercapnia: an experimental porcine study. Acta Anaesthesiologica Scandinavica, 62(6), 820-828
Open this publication in new window or tab >>THAM administration reduces pulmonary carbon dioxide elimination in hypercapnia: an experimental porcine study
2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 6, p. 820-828Article in journal (Refereed) Published
Abstract [en]

Background: In a previous study, we found a rebound of arterial carbon dioxide tension (PaCO2) after stopping THAM buffer administration. We hypothesized that this was due to reduced pulmonary CO2 elimination during THAM administration. The aim of this study was to investigate this hypothesis in an experimental porcine hypercapnic model.

Methods: In seven, initially normoventilated, anesthetized pigs (22-27 kg) minute ventilation was reduced by 66% for 7 h. Two hours after commencing hypoventilation, THAM was infused IV for 3 h in a dose targeting a pH of 7.35 followed by a 2 h observation period. Acid-base status, blood-gas content and exhaled CO2 were measured.

Results: THAM raised pH (7.07 0.04 to 7.41 +/- 0.04, P < 0.05) and lowered PaCO2 (15.2 +/- 1.4 to 12.2 +/- 1.1 kPa, P < 0.05). After the infusion, pH decreased and PaCO2 increased again. At the end of the observation period, pH and PaCO2 were 7.24 +/- 0.03 and 16.6 +/- 1.2 kPa, respectively (P < 0.05). Pulmonary CO2 excretion decreased from 109 +/- 12 to 74 +/- 12 ml/min (P < 0.05) during the THAM infusion but returned at the end of the observation period to 111 +/- 15 ml/min (P < 0.05). The estimated reduction of pulmonary CO2 elimination during the infusion was 5800 ml.

Conclusions: In this respiratory acidosis model, THAM reduced PaCO2, but seemed not to increase the total CO2 elimination due to decreased pulmonary CO2 excretion(,) suggesting only cautious use of THAM in hypercapnic acidosis.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-358364 (URN)10.1111/aas.13097 (DOI)000434205100012 ()29532468 (PubMedID)
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-08-31Bibliographically approved
Pino, F., Ball, L., Scaramuzzo, G., Pinol Ribas, M., Pelosi, P., Hedenstierna, G., . . . Perchiazzi, G. (2017). A comparison between PEEP titration methods in a porcine ARDS model. Acta Anaesthesiologica Scandinavica, 61(8), 1024-1025
Open this publication in new window or tab >>A comparison between PEEP titration methods in a porcine ARDS model
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2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1024-1025Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
WILEY, 2017
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-342129 (URN)000407231100108 ()
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-02-22Bibliographically approved
Formenti, F., Bommakanti, N., Chen, R., Cronin, J., McPeak, H., Holopherne-Doran, D., . . . Farmery, A. (2017). Alveolar oxygen respiratory oscillations measured in arterial blood. Acta Physiologica, 221(SI), 20-20
Open this publication in new window or tab >>Alveolar oxygen respiratory oscillations measured in arterial blood
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2017 (English)In: Acta Physiologica, ISSN 1748-1708, E-ISSN 1748-1716, Vol. 221, no SI, p. 20-20Article in journal, Meeting abstract (Other academic) Published
National Category
Physiology
Identifiers
urn:nbn:se:uu:diva-346512 (URN)000408842000038 ()
Available from: 2018-03-19 Created: 2018-03-19 Last updated: 2018-03-19Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0702-8343

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