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Kassebaum, N., Kyu, H. H., Zoeckler, L., Olsen, H. E., Thomas, K., Pinho, C., . . . Vos, T. (2017). Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study. JAMA pediatrics, 171(6), 573-592.
Open this publication in new window or tab >>Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study
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2017 (English)In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 171, no 6, 573-592 p.Article in journal (Refereed) Published
Abstract [en]

Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.

Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.

Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.

Findings: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.

Conclusions and Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-319725 (URN)10.1001/jamapediatrics.2017.0250 (DOI)000402714300018 ()28384795 (PubMedID)
Available from: 2017-04-07 Created: 2017-04-07 Last updated: 2017-08-28Bibliographically approved
Holzgraefe, B., Andersson, C., Kalzén, H., von Bahr, V., Mosskin, M., Larsson, E.-M., . . . Larsson, A. (2017). Does permissive hypoxaemia during extracorporeal membrane oxygenation cause long-term neurological impairment?: A study in patients with H1N1-induced severe respiratory failure. European Journal of Anaesthesiology, 34(2), 98-103.
Open this publication in new window or tab >>Does permissive hypoxaemia during extracorporeal membrane oxygenation cause long-term neurological impairment?: A study in patients with H1N1-induced severe respiratory failure
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2017 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, no 2, 98-103 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Extracorporeal Life Support Organisation accepts permissive hypoxaemia in adult patients during extracorporeal membrane oxygenation (ECMO). The neurological long-term outcome of this approach has not yet been studied.

OBJECTIVES: We investigated the prevalence of brain lesions and cognitive dysfunction in survivors from the Influenza A/H1N1 2009 pandemic treated with permissive hypoxaemia during ECMO for severe acute respiratory distress syndrome (ARDS). Our hypothesis was that this method is reasonable if tissue hypoxia is avoided.

DESIGN: Long-term follow-up study after ECMO.

SETTING: Karolinska University Hospital, Sweden, from October 2012 to July 2013.

PATIENTS: Seven patients treated with ECMO for severe influenza A/H1N1-induced ARDS were studied 3.2 years after treatment. Blood lactate concentrations were used as a surrogate for tissue oxygenation.

INTERVENTIONS: Neurocognitive outcome was studied with standardised cognitive tests and MRI of the brain.

MAIN OUTCOME MEASURES: Cognitive functioning and hypoxic brain lesions after permissive hypoxaemia during ECMO. The observation period was the first 10 days of ECMO or the entire treatment period if shorter than 10 days.

RESULTS: Eleven of 13 patients were still alive 3 years after ECMO. We were able to contact seven of these patients (mean age 31 years), who all agreed to participate in this study. Mean +/- SD peripherally measured arterial saturation during the observation period was 79 +/- 10%. Full-scale Intelligence Quotient was within one standard deviation or above from the mean of a healthy population in five patients, and was 1.5 SD below the mean in one patient. In one other patient, it could not be determined because of a lack of formal education. Memory functioning was normal in all patients. MRI showed no changes related to cerebral hypoxia.

CONCLUSIONS: Permissive hypoxaemia during ECMO might not negatively affect long-term cognitive outcome if adequate organ perfusion is maintained.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-310232 (URN)10.1097/EJA.0000000000000544 (DOI)000392170300008 ()28030441 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research Council
Available from: 2016-12-13 Created: 2016-12-13 Last updated: 2017-11-29Bibliographically approved
Broche, L., Perchiazzi, G., Porra, L., Tannoia, A., Pellegrini, M., Derosa, S., . . . Bayat, S. (2017). Dynamic Mechanical Interactions Between Neighboring Airspaces Determine Cyclic Opening and Closure in Injured Lung. Critical Care Medicine, 45(4), 687-694.
Open this publication in new window or tab >>Dynamic Mechanical Interactions Between Neighboring Airspaces Determine Cyclic Opening and Closure in Injured Lung
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2017 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 45, no 4, 687-694 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: Positive pressure ventilation exposes the lung to mechanical stresses that can exacerbate injury. The exact mechanism of this pathologic process remains elusive. The goal of this study was to describe recruitment/derecruitment at acinar length scales over short-time frames and test the hypothesis that mechanical interdependence between neighboring lung units determines the spatial and temporal distributions of recruitment/derecruitment, using a computational model. Design: Experimental animal study. Setting: International synchrotron radiation laboratory. Subjects: Four anesthetized rabbits, ventilated in pressure controlled mode. Interventions: The lung was consecutively imaged at - 1.5-minute intervals using phase-contrast synchrotron imaging, at positive end expiratory pressures of 12, 9, 6, 3, and 0 cm H2O before and after lavage and mechanical ventilation induced injury. The extent and spatial distribution of recruitment/derecruitment was analyzed by subtracting subsequent images. In a realistic lung structure, we implemented a mechanistic model in which each unit has individual pressures and speeds of opening and closing. Derecruited and recruited lung fractions (F-derecruaed, F-recruited) were computed based on the comparison of the aerated volumes at successive time points. Measurements and Main Results: Alternative recruitment/derecruitment occurred in neighboring alveoli over short-time scales in all tested positive end-expiratory pressure levels and despite stable pressure controlled mode. The computational model reproduced this behavior only when parenchymal interdependence between neighboring acini was accounted for. Simulations closely mimicked the experimental magnitude of F-derecruited and F-recruited when mechanical interdependence was included, while its exclusion gave F-recruited values of zero at positive end -expiratory pressure greater than or equal to 3 cm H2O. Conclusions: These findings give further insight into the microscopic behavior of the injured lung and provide a means of testing protective-ventilation strategies to prevent recruitment/derecruitment and subsequent lung damage.

Keyword
acute respiratory distress syndrome, assisted ventilation, imaging/computed tomography, pulmonary oedema, synchrotron
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-321336 (URN)10.1097/CCM.0000000000002234 (DOI)000396798700016 ()28107207 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research CouncilNIH (National Institute of Health)
Available from: 2017-05-31 Created: 2017-05-31 Last updated: 2017-05-31Bibliographically approved
Fardin, L., Broche, L., Coll, J.-L. -., Larsson, A., Bayat, S. & Bravin, A. (2017). Enhancing Lung Tumor Visibility Using In-Vivo Analyzer-Based X-Ray Phase Contrast Imaging In Mouse: A Feasibility Study. Paper presented at International Conference of the American-Thoracic-Society (ATS), MAY 19-24, 2017, Washington, AFGHANISTAN. American Journal of Respiratory and Critical Care Medicine, 195, Article ID A6514.
Open this publication in new window or tab >>Enhancing Lung Tumor Visibility Using In-Vivo Analyzer-Based X-Ray Phase Contrast Imaging In Mouse: A Feasibility Study
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2017 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 195, A6514Article in journal, Meeting abstract (Other academic) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-332906 (URN)000400372506473 ()
Conference
International Conference of the American-Thoracic-Society (ATS), MAY 19-24, 2017, Washington, AFGHANISTAN
Funder
Swedish Heart Lung FoundationSwedish Research Council
Available from: 2017-11-06 Created: 2017-11-06 Last updated: 2017-11-06Bibliographically approved
Tanum, L., Backryd, E., Lind, A.-L., Larsson, A. & Gordh, T. (2017). Evidence of both Systemic Inflammation and Neuroinflammation in Patients with Chronic Widespread Pain. Paper presented at 72nd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 18-20, 2017, San Diego, CA. Biological Psychiatry, 81(10), S231-S232.
Open this publication in new window or tab >>Evidence of both Systemic Inflammation and Neuroinflammation in Patients with Chronic Widespread Pain
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2017 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 81, no 10, S231-S232 p.Article in journal, Meeting abstract (Other academic) Published
Keyword
Cytokines and Chemokines, chronic pain, Neuroinflammation, immunoinflammation, cerebrospinal fluid
National Category
Neurology Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-331810 (URN)10.1016/j.biopsych.2017.02.443 (DOI)000400348700570 ()
Conference
72nd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 18-20, 2017, San Diego, CA
Funder
Swedish Research Council
Available from: 2017-10-18 Created: 2017-10-18 Last updated: 2017-10-18Bibliographically approved
Perchiazzi, G., Rylander, C., Pellegrini, M., Larsson, A. & Hedenstierna, G. (2017). Monitoring of total positive end-expiratory pressure during mechanical ventilation by artificial neural networks. Journal of clinical monitoring and computing, 31(3), 551-559.
Open this publication in new window or tab >>Monitoring of total positive end-expiratory pressure during mechanical ventilation by artificial neural networks
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2017 (English)In: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 31, no 3, 551-559 p.Article in journal (Refereed) Published
Abstract [en]

Ventilation treatment of acute lung injury (ALI) requires the application of positive airway pressure at the end of expiration (PEEPapp) to avoid lung collapse. However, the total pressure exerted on the alveolar walls (PEEPtot) is the sum of PEEPapp and intrinsic PEEP (PEEPi), a hidden component. To measure PEEPtot, ventilation must be discontinued with an end-expiratory hold maneuver (EEHM). We hypothesized that artificial neural networks (ANN) could estimate the PEEPtot from flow and pressure tracings during ongoing mechanical ventilation. Ten pigs were mechanically ventilated, and the time constant of their respiratory system (τRS) was measured. We shortened their expiratory time (TE) according to multiples of τRS, obtaining different respiratory patterns (Rpat). Pressure (PAW) and flow (V'AW) at the airway opening during ongoing mechanical ventilation were simultaneously recorded, with and without the addition of external resistance. The last breath of each Rpat included an EEHM, which was used to compute the reference PEEPtot. The entire protocol was repeated after the induction of ALI with i.v. injection of oleic acid, and 382 tracings were obtained. The ANN had to extract the PEEPtot, from the tracings without an EEHM. ANN agreement with reference PEEPtot was assessed with the Bland-Altman method. Bland Altman analysis of estimation error by ANN showed -0.40 ± 2.84 (expressed as bias ± precision) and ±5.58 as limits of agreement (data expressed as cmH2O). The ANNs estimated the PEEPtot well at different levels of PEEPapp under dynamic conditions, opening up new possibilities in monitoring PEEPi in critically ill patients who require ventilator treatment.

Keyword
Artificial neural networks, Acute lung injury, Intrinsic positive end expiratory pressure, Animal model
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-307912 (URN)10.1007/s10877-016-9874-0 (DOI)000400077100009 ()27067075 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2016-11-22 Created: 2016-11-22 Last updated: 2017-05-30Bibliographically approved
Bellani, G., Laffey, J. G., Pham, T., Madotto, F., Fan, E., Brochard, L., . . . Pesenti, A. (2017). Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study.. American Journal of Respiratory and Critical Care Medicine, 195(1), 67-77.
Open this publication in new window or tab >>Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study.
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2017 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 195, no 1, 67-77 p.Article in journal (Refereed) Published
Abstract [en]

Rationale: Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse.

Objectives: To determine whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful.

Methods: The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy examines the current practice of NIV use in ARDS, the utility of the PaO2/FiO2 ratio in classifying patients receiving NIV, and the impact of NIV on outcome.

Measurements and Main Results: Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on PaO2/FiO2 ratio was associated with an increase in intensity of ventilatory support, NIV failure, and intensive care unit (ICU) mortality. NIV failure occurred in 22.2% of mild, 42.3% of moderate, and 47.1% of patients with severe ARDS. Hospital mortality in patients with NIV success and failure was 16.1% and 45.4%, respectively. NIV use was independently associated with increased ICU (hazard ratio, 1.446 [95% confidence interval, 1.159–1.805]), but not hospital, mortality. In a propensity matched analysis, ICU mortality was higher in NIV than invasively ventilated patients with a PaO2/FiO2 lower than 150 mm Hg.

Conclusions: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV seems to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mm Hg.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-307917 (URN)10.1164/rccm.201606-1306OC (DOI)000390982100016 ()27753501 (PubMedID)
Available from: 2016-11-22 Created: 2016-11-22 Last updated: 2017-11-29Bibliographically approved
Engström, J., Bruno, E., Reinius, H., Fröjd, C., Jonsson, H., Sannervik, J. & Larsson, A. (2017). Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study. Acta Anaesthesiologica Scandinavica, 61(1), 62-72.
Open this publication in new window or tab >>Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study
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2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 1, 62-72 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Nursing procedures that are routinely performed in the intensive care unit (ICU) are assumed to have minimal side effects. However, these procedures may sometimes cause physiological changes that negatively affect the patient. We hypothesized that physiological changes associated with routine nursing procedures in the ICU are common.

METHODS: A clinical observational study of 16 critically ill patients in a nine-bed mixed university hospital ICU. All nursing procedures were observed, and physiological data were collected and subsequently analyzed. Minor physiological changes were defined as minimal changes in respiratory or circulatory variables, and major physiological changes were marked as hyper/hypotension, bradycardia/tachycardia, bradypnea/tachypnea, ventilatory distress, and peripheral blood oxygen desaturation.

RESULTS: In the 16 patients, 668 procedures generated 158 major and 692 minor physiological changes during 187 observational hours. The most common procedure was patient position change, which also generated the majority of the physiological changes. The most common major physiological changes were blood oxygen desaturation, ventilatory distress, and hypotension, and the most common minor changes were arterial pressure alteration, coughing, and increase in respiratory rate.

CONCLUSION: In this pilot study, we examined physiological changes in connection with all regular routine nursing procedures in the ICU. We found that physiological changes were common and sometimes severe.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-307946 (URN)10.1111/aas.12827 (DOI)000394907900010 ()27813055 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research Council
Available from: 2016-11-23 Created: 2016-11-23 Last updated: 2017-11-29Bibliographically approved
Santos, A., Monge-Garcia, M., Batista Borges, J., Gomez-Penalver, E., Retamal, J., Lucchetta, L., . . . Suarez-Sipmann, F. (2017). Pulmonary Vascular Efficiency Worsening And Cardiac Energy Wasting During Early Stages Of Experimental Acute Respiratory Distress Syndrome. Paper presented at International Conference of the American-Thoracic-Society (ATS), MAY 19-24, 2017, Washington, AFGHANISTAN. American Journal of Respiratory and Critical Care Medicine, 195(D27), Article ID A7698.
Open this publication in new window or tab >>Pulmonary Vascular Efficiency Worsening And Cardiac Energy Wasting During Early Stages Of Experimental Acute Respiratory Distress Syndrome
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2017 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 195, no D27, A7698Article in journal, Meeting abstract (Other academic) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-332912 (URN)000400372507798 ()
Conference
International Conference of the American-Thoracic-Society (ATS), MAY 19-24, 2017, Washington, AFGHANISTAN
Available from: 2017-11-06 Created: 2017-11-06 Last updated: 2017-11-06Bibliographically approved
Batista Borges, J., Santos, A., Lucchetta, L., Hedenstierna, G., Larsson, A. & Suarez-Sipmann, F. (2017). Redistribution Of Regional Lung Perfusion During Mechanical Ventilation With An Open Lung Approach Impacts Pulmonary Vascular Mechanics. Paper presented at International Conference of the American-Thoracic-Society (ATS), MAY 19-24, 2017, Washington, AFGHANISTAN. American Journal of Respiratory and Critical Care Medicine, 195, Article ID A3751.
Open this publication in new window or tab >>Redistribution Of Regional Lung Perfusion During Mechanical Ventilation With An Open Lung Approach Impacts Pulmonary Vascular Mechanics
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2017 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 195, A3751Article in journal, Meeting abstract (Other academic) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-332904 (URN)000400372503242 ()
Conference
International Conference of the American-Thoracic-Society (ATS), MAY 19-24, 2017, Washington, AFGHANISTAN
Funder
Swedish Research Council, K2015-99X-22731-01-4Swedish Heart Lung Foundation
Available from: 2017-11-06 Created: 2017-11-06 Last updated: 2017-11-06Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0702-8343

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