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Weigl, Wojciech
Publications (10 of 15) Show all publications
Weigl, W., Milej, D., Gerega, A., Toczylowska, B., Sawosz, P., Kacprzak, M., . . . Liebert, A. (2018). Confirmation of brain death using optical methods based on tracking of an optical contrast agent: assessment of diagnostic feasibility. Scientific Reports, 8, Article ID 7332.
Open this publication in new window or tab >>Confirmation of brain death using optical methods based on tracking of an optical contrast agent: assessment of diagnostic feasibility
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2018 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 7332Article in journal (Refereed) Published
Abstract [en]

We aimed to determine whether optical methods based on bolus tracking of an optical contrast agent are useful for the confirmation of cerebral circulation cessation in patients being evaluated for brain death. Different stages of cerebral perfusion disturbance were compared in three groups of subjects: controls, patients with posttraumatic cerebral edema, and patients with brain death. We used a time-resolved near-infrared spectroscopy setup and indocyanine green (ICG) as an intravascular flow tracer. Orthogonal partial least squares-discriminant analysis (OPLS-DA) was carried out to build statistical models allowing for group separation. Thirty of 37 subjects (81.1%) were classified correctly (8 of 9 control subjects, 88.9%; 13 of 15 patients with edema, 86.7%; and 9 of 13 patients with brain death, 69.2%; p < 0.0001). Depending on the combination of variables used in the OPLS-DA model, sensitivity, specificity, and accuracy were 66.7-92.9%, 81.8-92.9%, and 77.3-89.3%, respectively. The method was feasible and promising in the demanding intensive care unit environment. However, its accuracy did not reach the level required for brain death confirmation. The potential usefulness of the method may be improved by increasing the depth of light penetration, confirming its accuracy against other methods evaluating cerebral flow cessation, and developing absolute parameters for cerebral perfusion.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2018
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-358097 (URN)10.1038/s41598-018-25351-6 (DOI)000431737300018 ()29743483 (PubMedID)
Funder
EU, FP7, Seventh Framework Programme, 201076
Available from: 2018-08-24 Created: 2018-08-24 Last updated: 2018-08-24Bibliographically approved
Gerega, A., Milej, D., Weigl, W., Kacprzak, M. & Liebert, A. (2018). Multiwavelength time-resolved near-infrared spectroscopy of the adult head: assessment of intracerebral and extracerebral absorption changes. Biomedical Optics Express, 9(7), 2974-2993
Open this publication in new window or tab >>Multiwavelength time-resolved near-infrared spectroscopy of the adult head: assessment of intracerebral and extracerebral absorption changes
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2018 (English)In: Biomedical Optics Express, ISSN 2156-7085, E-ISSN 2156-7085, Vol. 9, no 7, p. 2974-2993Article in journal (Refereed) Published
Abstract [en]

An optical technique based on diffuse reflectance measurement combined with indocyanine green (ICG) bolus tracking is extensively tested as a method for the clinical assessment of brain perfusion at the bedside. We report on multiwavelength time-resolved diffuse reflectance spectroscopy measurements carried out on the head of a healthy adult during the intravenous administration of a bolus of ICG. Intracerebral and extracerebral changes in absorption were estimated from an analysis of changes in statistical moments (total number of photons, mean time of flight and variance) of the distributions of times of flight (DTOF) of photons recorded simultaneously at 16 wavelengths from the range of 650-850 nm using sensitivity factors estimated by diffusion approximation based on a layered model of the studied medium. We validated the proposed method in a series of phantom experiments and in-vivo measurements. The results obtained show that changes in the concentration of the ICG can be assessed as a function of time of the experiment and depth in the tissue. Thus, the separation of changes in ICG concentration appearing in intra-and extracerebral tissues can be estimated from optical data acquired at a single source-detector pair of fibers/fiber bundles positioned on the surface of the head.

Place, publisher, year, edition, pages
OPTICAL SOC AMER, 2018
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-360194 (URN)10.1364/BOE.9.002974 (DOI)000437460600007 ()29984079 (PubMedID)
Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2018-09-11Bibliographically approved
Janusek, D., Svehlikova, J., Zelinka, J., Weigl, W., Zaczek, R., Opolski, G., . . . Maniewski, R. (2018). The roles of mid-myocardial and epicardial cells in T-wave alternans development: a simulation study. Biomedical engineering online, 17, Article ID 57.
Open this publication in new window or tab >>The roles of mid-myocardial and epicardial cells in T-wave alternans development: a simulation study
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2018 (English)In: Biomedical engineering online, ISSN 1475-925X, E-ISSN 1475-925X, Vol. 17, article id 57Article in journal (Refereed) Published
Abstract [en]

Background: The occurrence of T-wave alternans in electrocardiographic signals was recently linked to susceptibility to ventricular arrhythmias and sudden cardiac death. Thus, by detecting and comprehending the origins of T-wave alternans, it might be possible to prevent such events.

Results: Here, we simulated T-wave alternans in a computer-generated human heart model by modulating the action potential duration and amplitude during the first part of the repolarization phase. We hypothesized that changes in the intracardiac alternans patterns of action potential properties would differentially influence T-wave alternans measurements at the body surface. Specifically, changes were simulated globally in the whole left and right ventricles to simulate concordant T-wave alternans, and locally in selected regions to simulate discordant and regional discordant, hereinafter referred to as “regional”, T-wave alternans. Body surface potential maps and 12-lead electrocardiographic signals were then computed. In depth discrimination, the influence of epicardial layers on T-wave alternans development was significantly higher than that of mid-myocardial cells. Meanwhile, spatial discrimination revealed that discordant and regional action potential property changes had a higher influence on T-wave alternans amplitude than concordant changes. Notably, varying T-wave alternans sources yielded distinct body surface potential map patterns for T-wave alternans amplitude, which can be used for location of regions within hearts exhibiting impaired repolarization. The highest ability for T-wave alternans detection was achieved in lead V1. Ultimately, we proposed new parameters Vector Magnitude Alternans and Vector Angle Alternans, with higher ability for T-wave alternans detection when using multi-lead electrocardiographic signals processing than for single leads. Finally, QT alternans was found to be associated with the process of T-wave alternans generation.

Conclusions: The distributions of the body surface T-wave alternans amplitude have been shown to have unique patterns depending on the type of alternans (concordant, discordant or regional) and the location of the disturbance in the heart. The influence of epicardial cells on T-wave alternans development is significantly higher than that of mid-myocardial cells, among which the sub-endocardial layer exerted the highest influence. QT interval alternans is identified as a phenomenon that correlate with T-wave alternans.

Keywords
T-wave alternans, Heart model, ECG signal simulation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-356496 (URN)10.1186/s12938-018-0492-6 (DOI)000431878300001 ()29739399 (PubMedID)
Available from: 2018-07-30 Created: 2018-07-30 Last updated: 2018-07-30Bibliographically approved
Weigl, W., Adamski, J., Gorynski, P., Kanski, A. & Hultström, M. (2017). Comparison of ICU outcomes in Poland to other European countries: reasons for high mortality rates. Acta Anaesthesiologica Scandinavica, 61(8), 1022-1023
Open this publication in new window or tab >>Comparison of ICU outcomes in Poland to other European countries: reasons for high mortality rates
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2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1022-1023Article 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-342128 (URN)000407231100106 ()
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-02-22Bibliographically approved
Weigl, W., Adamski, J., Goryński, P., Kański, A. & Hultström, M. (2017). Mortality rate is higher in Polish intensive care units than in other European countries. [Letter to the editor]. Intensive Care Medicine, 43(9), 1430-1432
Open this publication in new window or tab >>Mortality rate is higher in Polish intensive care units than in other European countries.
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2017 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 43, no 9, p. 1430-1432Article in journal, Letter (Other academic) Published
Keywords
Mortality, Intensive Care Medicine
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-322534 (URN)10.1007/s00134-017-4804-2 (DOI)000408116700034 ()28484784 (PubMedID)
Funder
Swedish Society for Medical Research (SSMF)
Available from: 2017-05-24 Created: 2017-05-24 Last updated: 2017-11-29Bibliographically approved
Weigl, W., Milej, D., Gerega, A., Toczylowska, B., Sawosz, P., Kacprzak, M., . . . Liebert, A. (2017). Optical methods based on tracking of optical contrast agent in confirmation of brain death: preliminary results. Acta Anaesthesiologica Scandinavica, 61(8), 979-980
Open this publication in new window or tab >>Optical methods based on tracking of optical contrast agent in confirmation of brain death: preliminary results
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2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 979-980Article 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-342123 (URN)000407231100039 ()
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-02-22Bibliographically approved
Weigl, W., Bierylo, A., Wielgus, M., Krzemien-Wiczynska, S., Kolacz, M. & Dabrowski, M. J. (2017). Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section: A randomized controlled study. Medicine (Baltimore, Md.), 96(48), Article ID e8892.
Open this publication in new window or tab >>Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section: A randomized controlled study
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2017 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 48, article id e8892Article in journal (Refereed) Published
Abstract [en]

Objectives: Intrathecal morphine is used in the postoperative management of pain after caesarean section (CS), but might not be optimal for intraoperative analgesia. We hypothesized that intrathecal fentanyl could supplement intraoperative analgesia when added to a local anesthetic and morphine without affecting management of postoperative pain.

Methods: This prospective, randomized, double-blind, parallel-group study included 60 parturients scheduled for elective CS. Spinal anesthesia consisted of bupivacaine with either morphine 100 mu g (M group), or fentanyl 25 mu g and morphine 100 mu g (FM group). The frequency of intraoperative pain and pethidine consumption in the 24 hours postoperatively was recorded.

Results: Fewer patients in the FM group required additional intraoperative analgesia (P < .01, relative risk 0.06, 95% confidence interval [CI] 0.004-1.04). The FM group was noninferior to the M group for 24-hour opioid consumption (95% CI -10.0 mg to 45.7 mg, which was below the prespecified boundary of 50 mg). Pethidine consumption in postoperative hours 1 to 12 was significantly higher in the FM group (P=.02). Postoperative nausea and vomiting (PONV) were more common in the FM group (P=.01). Visual analog scale scores, effective analgesia, Apgar scores, and rates of pruritus and respiratory depression were similar between the groups.

Conclusions: Intrathecal combination of fentanyl and morphine may provide better perioperative analgesia than morphine alone in CS and could be useful when the time from anesthesia to skin incision is short. However, an increase in PONV and possible acute spinal opioid tolerance after addition of intrathecal fentanyl warrants further investigation using lower doses of fentanyl.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2017
Keywords
acute opioid tolerance, hydrophilic and lipophilic opioids, patient-controlled analgesia (PCA), post-caesarean pain management, spinal anesthesia, spinal opioids, superiority and noninferiority trial
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-341815 (URN)10.1097/MD.0000000000008892 (DOI)000419636400056 ()29310376 (PubMedID)
Available from: 2018-02-16 Created: 2018-02-16 Last updated: 2018-02-16Bibliographically approved
Weigl, W., Bierylo, A., Wielgus, M., Krzemien-Wiczynska, S., Kolacz, M. & Dabrowski, M. J. (2017). Peri-operative analgesia with intrathecal opioids for Caesarean section. Acta Anaesthesiologica Scandinavica, 61(8), 1014-1015
Open this publication in new window or tab >>Peri-operative analgesia with intrathecal opioids for Caesarean section
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2017 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1014-1015Article 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-342127 (URN)000407231100093 ()
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-02-22Bibliographically approved
Weigl, W., Bierylo, A., Wielgus, M., Krzemien-Wiczynska, S., Szymusik, I., Kolacz, M. & Dabrowski, M. J. (2016). Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section A randomized controlled study. Medicine (Baltimore, Md.), 95(24), Article ID e3827.
Open this publication in new window or tab >>Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section A randomized controlled study
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2016 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 95, no 24, article id e3827Article in journal (Refereed) Published
Abstract [en]

Cesarean section (CS) is one of the most common surgical procedures in female patients. We aimed to evaluate the postoperative analgesic efficacy of intrathecal fentanyl during the period of greatest postoperative analgesic demand after CS. This period was defined by detailed analysis of patient-controlled analgesia (PCA) usage. This double-blind, placebo-controlled, parallel-group randomized trial included 60 parturients who were scheduled for elective CS. Participants received spinal anesthesia with bupivacaine supplemented with normal saline (control group) or with fentanyl 25 mg (fentanyl group). To evaluate primary endpoints, we measured total pethidine consumption over the period of greatest PCA pethidine requirement. For verification of secondary endpoints, we recorded intravenous PCA requirement in other time windows, duration of effective analgesia, pain scores assessed by visual analog scale, opioid side effects, hemodynamic changes, neonatal Apgar scores, and intraoperative pain. Detailed analysis of hour-by-hour PCA opioid requirements showed that the greatest demand for analgesics among patients in the control group occurred during the first 12 hours after surgery. Patients in the fentanyl group had significantly reduced opioid consumption compared with the controls during this period and had a prolonged duration of effective analgesia. The groups were similar in visual analog scale, incidence of analgesia-related side effects (nausea/vomiting, pruritus, oversedation, and respiratory depression), and neonatal Apgar scores. Mild respiratory depression occurred in 1 patient in each group. Fewer patients experienced intraoperative pain in the fentanyl group (3% vs 23%; relative risk 6.8, 95% confidence interval 0.9-51.6). The requirement for postoperative analgesics is greatest during the first 12hours after induction of anesthesia in patients undergoing CS. The addition of intrathecal fentanyl to spinal anesthesia is effective for intraoperative analgesia and decreases opioid consumption during the period of the highest analgesic demand after CS, without an increase in maternal or neonatal side effects. We recommend using intrathecal fentanyl for CS in medical centers not using morphine or other opioids intrathecally at present.

Keywords
cesarean section, fentanyl, intrathecal, opioids, postoperative pain, spinal anesthesia
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-299737 (URN)10.1097/MD.0000000000003827 (DOI)000378053000018 ()27310958 (PubMedID)
Available from: 2016-07-26 Created: 2016-07-26 Last updated: 2017-11-28Bibliographically approved
Weigl, W., Milej, D., Janusek, D., Wojtkiewicz, S., Sawosz, P., Kacprzak, M., . . . Liebert, A. (2016). Application of optical methods in the monitoring of traumatic brain injury: A review. Journal of Cerebral Blood Flow and Metabolism, 36(11), 1825-1843
Open this publication in new window or tab >>Application of optical methods in the monitoring of traumatic brain injury: A review
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2016 (English)In: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016, Vol. 36, no 11, p. 1825-1843Article, review/survey (Refereed) Published
Abstract [en]

We present an overview of the wide range of potential applications of optical methods for monitoring traumatic brain injury. The MEDLINE database was electronically searched with the following search terms: traumatic brain injury, head injury, or head trauma, and optical methods, NIRS, near-infrared spectroscopy, cerebral oxygenation, or cerebral oximetry. Original reports concerning human subjects published from January 1980 to June 2015 in English were analyzed. Fifty-four studies met our inclusion criteria. Optical methods have been tested for detection of intracranial lesions, monitoring brain oxygenation, assessment of brain perfusion, and evaluation of cerebral autoregulation or intracellular metabolic processes in the brain. Some studies have also examined the applicability of optical methods during the recovery phase of traumatic brain injury . The limitations of currently available optical methods and promising directions of future development are described in this review. Considering the outstanding technical challenges, the limited number of patients studied, and the mixed results and opinions gathered from other reviews on this subject, we believe that optical methods must remain primarily research tools for the present. More studies are needed to gain confidence in the use of these techniques for neuromonitoring of traumatic brain injury patients.

Keywords
Cerebral oximetry, near-infrared spectroscopy, neuromonitoring, optical methods, traumatic brain injury
National Category
Endocrinology and Diabetes Hematology Neurology
Identifiers
urn:nbn:se:uu:diva-311078 (URN)10.1177/0271678X16667953 (DOI)000387263300001 ()27604312 (PubMedID)
Funder
EU, FP7, Seventh Framework Programme, 201076
Available from: 2016-12-21 Created: 2016-12-21 Last updated: 2017-11-29Bibliographically approved
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