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  • 1. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Gerlach, Herwig
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M.
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Pugin, Jerome
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2010: I. Acute renal failure, outcome, risk assessment and ICU performance, sepsis, neuro intensive care and experimentals2011Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 37, nr 1, s. 19-34Artikel, forskningsöversikt (Refereegranskat)
  • 2. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Gerlach, Herwig
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M.
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Pugin, Jerome
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2010: II. Pneumonia and infections, cardiovascular and haemodynamics, organization, education, haematology, nutrition, ethics and miscellanea2011Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 37, nr 2, s. 196-213Artikel, forskningsöversikt (Refereegranskat)
  • 3. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Gerlach, Herwig
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M.
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Pugin, Jerome
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2010: III. ARDS and ALI, mechanical ventilation, noninvasive ventilation, weaning, endotracheal intubation, lung ultrasound and paediatrics2011Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 37, nr 3, s. 394-410Artikel, forskningsöversikt (Refereegranskat)
  • 4. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Lemaire, Francois
    Gerlach, Herwig
    Groeneveld, Johan
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M.
    Mebazaa, Alexandre
    Metnitz, Philipp
    Pugin, Jerome
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine, 2008: I. Brain injury and neurology, renal failure and endocrinology, metabolism and nutrition, sepsis, infections and pneumonia2009Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 35, nr 1, s. 30-44Artikel, forskningsöversikt (Refereegranskat)
  • 5. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Lemaire, Francois
    Gerlach, Herwig
    Groeneveld, Johan
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M.
    Mebazaa, Alexandre
    Metnitz, Philipp
    Pugin, Jerome
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine, 2008: II. Experimental, acute respiratory failure and ARDS, mechanical ventilation and endotracheal intubation2009Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 35, nr 2, s. 215-231Artikel, forskningsöversikt (Refereegranskat)
  • 6. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Lemaire, Francois
    Gerlach, Herwig
    Groeneveld, Johan
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M.
    Mebazaa, Alexandre
    Metnitz, Philipp
    Pugin, Jerome
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine, 2008: III. Paediatrics, Ethics, outcome research and critical care organization, sedation, pharmacology and miscellanea2009Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 35, nr 3, s. 405-416Artikel, forskningsöversikt (Refereegranskat)
  • 7. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Lemaire, François
    Gerlach, Herwig
    Groeneveld, Johan
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M
    Mebazaa, Alexandre
    Metnitz, Philipp
    Pugin, Jerme
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine, 2007. II. Haemodynamics, pneumonia, infections and sepsis, invasive and non-invasive mechanical ventilation, acute respiratory distress syndrome2008Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 34, nr 3, s. 405-422Artikel, forskningsöversikt (Refereegranskat)
  • 8. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Lemaire, François
    Gerlach, Herwig
    Groeneveld, Johan
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M
    Mebazaa, Alexandre
    Metnitz, Philipp
    Pugin, Jerôme
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine, 2007. I. Experimental studies. Clinical studies: brain injury and neurology, renal failure and endocrinology2008Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 34, nr 2, s. 229-242Artikel, forskningsöversikt (Refereegranskat)
  • 9. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Lemaire, François
    Gerlach, Herwig
    Groeneveld, Johan
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore
    Mebazaa, Alexandre
    Metnitz, Philipp
    Pugin, Jerôme
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine, 2007. III. Ethics and legislation, health services research, pharmacology and toxicology, nutrition and paediatrics2008Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 34, nr 4, s. 598-609Artikel i tidskrift (Refereegranskat)
  • 10. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Lemaire, François
    Gerlach, Herwig
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Pugin, Jerôme
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control2010Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 36, nr 2, s. 196-209Artikel, forskningsöversikt (Refereegranskat)
  • 11. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Lemaire, François
    Gerlach, Herwig
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Pugin, Jerôme
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2009: II. Neurology, cardiovascular, experimental, pharmacology and sedation, communication and teaching2010Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 36, nr 3, s. 412-427Artikel i tidskrift (Refereegranskat)
  • 12. Antonelli, Massimo
    et al.
    Azoulay, Elie
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    De Backer, Daniel
    Lemaire, François
    Gerlach, Herwig
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Pugin, Jerôme
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2009. Part III: mechanical ventilation, acute lung injury and respiratory distress syndrome, pediatrics, ethics, and miscellanea2010Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 36, nr 4, s. 567-584Artikel i tidskrift (Refereegranskat)
  • 13. Antonelli, Massimo
    et al.
    Bonten, Marc
    Cecconi, Maurizio
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    Curtis, J. R.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Maggiore, Salvatore M.
    Mancebo, Jordi
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Rocco, Patricia
    Timsit, Jean-Francois
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2012: III. Noninvasive ventilation, monitoring and patient-ventilator interactions, acute respiratory distress syndrome, sedation, paediatrics and miscellanea2013Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 39, nr 4, s. 543-557Artikel, forskningsöversikt (Refereegranskat)
  • 14. Antonelli, Massimo
    et al.
    Bonten, Marc
    Cecconi, Maurizio
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    Curtis, J Randall
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Maggiore, Salvatore M
    Mancebo, Jordi
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Rocco, Patricia
    Timsit, Jean-François
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2012: I. Neurology and neurointensive care, epidemiology and nephrology, biomarkers and inflammation, nutrition, experimentals2013Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 39, nr 2, s. 232-246Artikel, forskningsöversikt (Refereegranskat)
  • 15. Antonelli, Massimo
    et al.
    Bonten, Marc
    Cecconi, Maurizio
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    Curtis, J Randall
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Maggiore, Salvatore M
    Mancebo, Jordi
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Rocco, Patricia
    Timsit, Jean-François
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2012. II: Pneumonia and infection, sepsis, coagulation, hemodynamics, cardiovascular and microcirculation, critical care organization, imaging, ethics and legal issues2013Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 39, nr 3, s. 345-364Artikel i tidskrift (Refereegranskat)
  • 16. Antonelli, Massimo
    et al.
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    Curtis, J. Randall
    De Backer, Daniel
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M.
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Rocco, Patricia
    Timsit, Jean-Francois
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2011: III. ARDS and ECMO, weaning, mechanical ventilation, noninvasive ventilation, pediatrics and miscellanea2012Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 38, nr 4, s. 542-556Artikel, forskningsöversikt (Refereegranskat)
  • 17. Antonelli, Massimo
    et al.
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    Curtis, J Randall
    de Backer, Daniel
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Rocco, Patricia
    Timsit, Jean-François
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2011: I. Nephrology, epidemiology, nutrition and therapeutics, neurology, ethical and legal issues, experimentals2012Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 38, nr 2, s. 192-209Artikel, forskningsöversikt (Refereegranskat)
  • 18. Antonelli, Massimo
    et al.
    Bonten, Marc
    Chastre, Jean
    Citerio, Giuseppe
    Conti, Giorgio
    Curtis, J Randall
    de Backer, Daniel
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Joannidis, Michael
    Macrae, Duncan
    Mancebo, Jordi
    Maggiore, Salvatore M
    Mebazaa, Alexandre
    Preiser, Jean-Charles
    Rocco, Patricia
    Timsit, Jean-François
    Wernerman, Jan
    Zhang, Haibo
    Year in review in Intensive Care Medicine 2011. II.: Cardiovascular, infections, pneumonia and sepsis, critical care organization and outcome, education, ultrasonography, metabolism and coagulation2012Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 38, nr 3, s. 345-358Artikel i tidskrift (Refereegranskat)
  • 19. Backes, Yara
    et al.
    van der Sluijs, Koenraad F
    Mackie, David P
    Tacke, Frank
    Koch, Alexander
    Tenhunen, Jyrki
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Schultz, Marcus J
    Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: a systematic review2012Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 38, nr 9, s. 1418-1428Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    PURPOSE:

    Systemic levels of soluble urokinase-type plasminogen activator receptor (suPAR) positively correlate with the activation level of the immune system. We reviewed the usefulness of systemic levels of suPAR in the care of critically ill patients with sepsis, SIRS, and bacteremia, focusing on its diagnostic and prognostic value.

    METHODS:

    A PubMed search on suPAR was conducted, including manual cross-referencing. The list of papers was narrowed to original studies of critically ill patients. Ten papers on original studies of critically ill patients were identified that report on suPAR in sepsis, SIRS, or bacteremia.

    RESULTS:

    Systematic levels of suPAR have little diagnostic value in critically ill patients with sepsis, SIRS, or bacteremia. Systemic levels of suPAR, however, have superior prognostic power over other commonly used biological markers in these patients. Mortality prediction by other biological markers or severity-of-disease classification system scores improves when combining them with suPAR. Systemic levels of suPAR correlate positively with markers of organ dysfunction and severity-of-disease classification system scores. Finally, systemic levels of suPAR remain elevated for prolonged periods after admission and only tend to decline after several weeks. Notably, the type of assay used to measure suPAR as well as the age of the patients and underlying disease affect systemic levels of suPAR.

    CONCLUSIONS:

    The diagnostic value of suPAR is low in patients with sepsis. Systemic levels of suPAR have prognostic value, and may add to prognostication of patients with sepsis or SIRS complementing severity-of-disease classification systems and other biological markers.

  • 20.
    Batista Borges, João
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Univ Sao Paulo, Hosp Clin, Pulm Div Heart Inst InCor, Sao Paulo, Brazil..
    Hansen, Tomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    The "normal" ventilated airspaces suffer the most damaging effects of mechanical ventilation2017Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 43, nr 7, s. 1057-1058Artikel i tidskrift (Övrigt vetenskapligt)
  • 21. Bellomo, Rinaldo
    et al.
    Lipcsey, Miklos
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. ANZICS CTG, Level 3, 10 Ievers St, Carlton, VIC, 3053, Australia .
    Calzavacca, Paolo
    Haase, Michael
    Haase-Fielitz, Anjia
    Licari, Elisa
    Tee, Augustine
    Cole, Louise
    Cass, Alan
    Finfer, Simon
    Gallagher, Martin
    Lee, Joanne
    Lo, Serigne
    McArthur, Colin
    McGuinness, Shay
    Myburgh, John
    Scheinkestel, Carlos
    Early acid-base and blood pressure effects of continuous renal replacement therapy intensity in patients with metabolic acidosis2013Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 39, nr 3, s. 429-436Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE:

    In acute kidney injury patients, metabolic acidosis is common. Its severity, duration, and associated changes in mean arterial pressure (MAP) and vasopressor therapy may be affected by the intensity of continuous renal replacement therapy (CRRT). We aimed to compare key aspects of acidosis and MAP and vasopressor therapy in patients treated with two different CRRT intensities.

    METHODS:

    We studied a nested cohort of 115 patients from two tertiary intensive care units (ICUs) within a large multicenter randomized controlled trial treated with lower intensity (LI) or higher intensity (HI) CRRT.

    RESULTS:

    Levels of metabolic acidosis at randomization were similar [base excess (BE) of -8 ± 8 vs. -8 ± 7 mEq/l; p = 0.76]. Speed of BE correction did not differ between the two groups. However, the HI group had a greater increase in MAP from baseline to 24 h (7 ± 3 vs. 0 ± 3 mmHg; p < 0.01) and a greater decrease in norepinephrine dose (from 12.5 to 3.5 vs. 5 to 2.5 μg/min; p < 0.05). The correlation (r) coefficients between absolute change in MAP and norepinephrine (NE) dose versus change in BE were 0.05 and -0.37, respectively.

    CONCLUSIONS:

    Overall, LI and HI CRRT have similar acid-base effects in patients with acidosis. However, HI was associated with greater improvements in MAP and vasopressor requirements (clinical trial no. NCT00221013).

  • 22.
    Borges, João Batista
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Hansen, Tomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Hedenstierna, Göran
    The "normal" ventilated airspaces suffer the most damaging effects of mechanical ventilation.2017Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 43, nr 7, s. 1057-1058Artikel i tidskrift (Refereegranskat)
  • 23. Borges, João Batista
    et al.
    Victorino, Josué Almeida
    de Carvalho, Carlos Roberto Ribeiro
    Underestimation of lung collapse and under optimization of a PEEP trial2008Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 34, nr 3, s. 584; author reply 585-586Artikel i tidskrift (Refereegranskat)
  • 24.
    Brochard, Laurent
    et al.
    St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, 30 Bond St, Toronto, ON M5B 1W8, Canada.;Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada..
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Ten physiologic advances that improved treatment for ARDS2016Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 42, nr 5, s. 814-816Artikel i tidskrift (Övrigt vetenskapligt)
  • 25. Bullock, A
    et al.
    Wilde, J D
    Bion, J F
    Clutton-Brock, T
    Flaatten, H
    Mathy, B
    van Mook, W
    Schuwirth, L
    Marsh, B
    Phelan, D
    Shippey, B
    Nimmo, G
    Castel, S
    Hillion, Y
    Bonnet, J
    Chaumont, D
    Rothen, H U
    Reay, H
    Krenn, C
    Germann, P
    Ferdinande, P
    de Backer, D
    Smilov, I
    Keremidchieva, N
    Gasparoviae, V
    Radonic, R
    Kyprianou, T
    Kakas, M
    Sramek, V
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    m.fl., (et al)
    International standards for programmes of training in intensive care medicine in Europe2011Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 37, nr 3, s. 385-393Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE:

    To develop internationally harmonised standards for programmes of training in intensive care medicine (ICM).

    METHODS:

    Standards were developed by using consensus techniques. A nine-member nominal group of European intensive care experts developed a preliminary set of standards. These were revised and refined through a modified Delphi process involving 28 European national coordinators representing national training organisations using a combination of moderated discussion meetings, email, and a Web-based tool for determining the level of agreement with each proposed standard, and whether the standard could be achieved in the respondent's country.

    RESULTS:

    The nominal group developed an initial set of 52 possible standards which underwent four iterations to achieve maximal consensus. All national coordinators approved a final set of 29 standards in four domains: training centres, training programmes, selection of trainees, and trainers' profiles. Only three standards were considered immediately achievable by all countries, demonstrating a willingness to aspire to quality rather than merely setting a minimum level. Nine proposed standards which did not achieve full consensus were identified as potential candidates for future review.

    CONCLUSIONS:

    This preliminary set of clearly defined and agreed standards provides a transparent framework for assuring the quality of training programmes, and a foundation for international harmonisation and quality improvement of training in ICM.

  • 26. Costa, Eduardo L V
    et al.
    Borges, João Batista
    Melo, Alexandre
    Suarez-Sipmann, Fernando
    Toufen, Carlos
    Bohm, Stephan H
    Amato, Marcelo B P
    Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography2009Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 35, nr 6, s. 1132-1137Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:

    To present a novel algorithm for estimating recruitable alveolar collapse and hyperdistension based on electrical impedance tomography (EIT) during a decremental positive end-expiratory pressure (PEEP) titration.

    DESIGN:

    Technical note with illustrative case reports.

    SETTING:

    Respiratory intensive care unit.

    PATIENT:

    Patients with acute respiratory distress syndrome.

    INTERVENTIONS:

    Lung recruitment and PEEP titration maneuver.

    MEASUREMENTS AND RESULTS:

    Simultaneous acquisition of EIT and X-ray computerized tomography (CT) data. We found good agreement (in terms of amount and spatial location) between the collapse estimated by EIT and CT for all levels of PEEP. The optimal PEEP values detected by EIT for patients 1 and 2 (keeping lung collapse <10%) were 19 and 17 cmH2O, respectively. Although pointing to the same non-dependent lung regions, EIT estimates of hyperdistension represent the functional deterioration of lung units, instead of their anatomical changes, and could not be compared directly with static CT estimates for hyperinflation.

    CONCLUSIONS:

    We described an EIT-based method for estimating recruitable alveolar collapse at the bedside, pointing out its regional distribution. Additionally, we proposed a measure of lung hyperdistension based on regional lung mechanics.

  • 27.
    Covaciu, Lucian
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Weis, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för radiologi.
    Bengtsson, Caroline
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Allers, M
    Lunderquist, A
    Ahlström, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för radiologi.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Brain temperature in volunteers subjected to intranasal cooling2011Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 37, nr 8, s. 1277-1284Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Intranasal cooling can be used to initiate therapeutic hypothermia. However, direct measurement of brain temperature is difficult and the intra-cerebral distribution of temperature changes with cooling is unknown. The purpose of this study was to measure the brain temperature of human volunteers subjected to intranasal cooling using non-invasive magnetic resonance (MR) methods. Intranasal balloons catheters circulated with saline at 20A degrees C were applied for 60 min in ten awake volunteers. No sedation was used. Brain temperature changes were measured and mapped using MR spectroscopic imaging (MRSI) and phase-mapping techniques. Heart rate and blood pressure were monitored throughout the experiment. Rectal temperature was measured before and after the cooling. Mini Mental State Examination (MMSE) test and nasal inspection were done before and after the cooling. Questionnaires about the subjects' personal experience were completed after the experiment. Brain temperature decrease measured by MRSI was -1.7 +/- A 0.8A degrees C and by phase-mapping -1.8 +/- A 0.9A degrees C (n = 9) at the end of cooling. Spatial distribution of temperature changes was relatively uniform. Rectal temperature decreased by -0.5 +/- A 0.3A degrees C (n = 5). The physiological parameters were stable and no shivering was reported. The volunteers remained alert during cooling and no cognitive dysfunctions were apparent in the MMSE test. Postcooling nasal examination detected increased nasal secretion in nine of the ten volunteers. Volunteers' acceptance of the method was good. Both MR techniques revealed brain temperature reductions after 60 min of intranasal cooling with balloons circulated with saline at 20A degrees C in awake, unsedated volunteers.

  • 28.
    Covaciu, Lucian
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Weis, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi.
    Bengtsson, Caroline
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
    Allers, Mats
    Division of thoracic sciences, Department of clinical sciences, Lund University.
    Lunderquist, Anders
    Department of radiology, Lund University.
    Ahlström, Håkan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Brain temperature in healthy volunteers subjected to intranasal cooling2011Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 37, nr 8, s. 1277-1284Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Purpose:

    Intranasal cooling can be used to initiate therapeutic hypothermia. However, direct measurement of brain temperature is difficult and the intra-cerebral distribution of temperature changes with cooling is unknown. The purpose of this study was to measure the brain temperature of human volunteers subjected to intranasal cooling using non-invasive magnetic resonance (MR) methods.

    Methods:

    Intranasal balloons catheters circulated with saline at 20 °C were applied for 60 min in 10 healthy, unsedated volunteers. Brain temperature changes were measured and mapped using MR spectroscopic imaging (MRSI) and phase-mapping techniques. Heart rate and blood pressure were monitored throughout the experiment. Rectal temperature was measured before and after the cooling. Mini Mental State Examination (MMSE) test and nasal inspection were done before and after the cooling. Questionnaires about the subjects personal experience were filled after the experiment.

    Results:

    Brain temperature decrease measured by MRSI was -1.7 ± 0.8°C and by phase-mapping -1.8 ± 0.9°C at the end of cooling. Spatial distribution of temperature changes was relatively uniform. Rectal temperature decreased by -0.5 ± 0.3°C. The physiological parameters were stable and no shivering was reported. The volunteers remained alert during cooling and no cognitive dysfunctions were apparent at MMSE test. Postcooling nasal examination detected increased nasal secretion in 9 of the 10 volunteers. Volunteer’s acceptance of the method was good.   

    Conclusion:

    Both MR techniques revealed brain temperature reductions after 60 min intranasal cooling with balloons circulated with saline at 20 °C in healthy and unsedated volunteers.

  • 29. De Waele, J.
    et al.
    Debergh, D.
    Björck, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Malbrain, M.
    Nesbitt, I.
    Cohen, J.
    Kaiolani, V.
    Iratury, R.
    Mone, M.
    Kimball, T.
    Decompressive Laparotomy for ACS: Effect on Organ Function and Mortality (WSACS Ctwg Study 007)2014Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 40, s. S32-S33Artikel i tidskrift (Övrigt vetenskapligt)
  • 30. Dellaca, Raffaele L.
    et al.
    Andersson Olerud, Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Zannin, Emanuela
    Kostic, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Pompilio, Pasquale P.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Pedotti, Antonio
    Frykholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Lung recruitment assessed by total respiratory system input reactance2009Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 35, nr 12, s. 2164-2172Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: ALI and ARDS are associated with lung volume derecruitment, usually counteracted by PEEP and recruitment maneuvers (RM), which should be accurately tailored to the patient's needs. The aim of this study was to investigate the possibility of monitoring the amount of derecruited lung by the forced oscillation technique (FOT). METHODS: We studied six piglets (26 +/- 2.5 kg) ventilated by a mechanical ventilator connected to a FOT device that produced sinusoidal pressure forcing at 5 Hz. The percentage of non-aerated lung tissue (V (tiss)NA%) was measured by whole-body CT scans at end-expiration with zero end-expiratory pressure. Respiratory system oscillatory input reactance (X (rs)) was measured simultaneously to CT and used to derive oscillatory compliance (C (X5)), which we used as an index of recruited lung. Measurements were performed at baseline and after several interventions in the following sequence: mono-lateral reabsorption atelectasis, RM, bi-lateral derecruitment induced by broncho-alveolar lavage and a second RM. RESULTS: By pooling data from all experimental conditions and all pigs, C (X5) was linearly correlated to V (tiss)NA% (r (2) = 0.89) regardless of the procedure used to de-recruit the lung (reabsorption atelectasis or pulmonary lavage). Separate correlation analysis on single pigs showed similar regression equations, with an even higher coefficient of determination (r (2) = 0.91 +/- 0.07). CONCLUSION: These results suggest that FOT and the measurement of C (X5) could be a useful tool for the non-invasive measurement of lung volume recruitment/derecruitment.

  • 31. Dellaca, Raffaele L.
    et al.
    Zannin, Emanuela
    Kostic, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Olerud, Marie Andersson
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Pompilio, Pasquale P.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Pedotti, Antonio
    Frykholm, Peter
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Optimisation of positive end-expiratory pressure by forced oscillation technique in a lavage model of acute lung injury2011Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 37, nr 6, s. 1021-1030Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We evaluated whether oscillatory compliance (C-X5) measured by forced oscillation technique (FOT) at 5 Hz may be useful for positive end-expiratory pressure (PEEP) optimisation. We studied seven pigs in which lung injury was induced by broncho-alveolar lavage. The animals were ventilated in volume control mode with a tidal volume of 6 ml/kg. Forced oscillations were superimposed on the ventilation waveform for the assessment of respiratory mechanics. PEEP was increased from 0 to 24 cmH(2)O in steps of 4 cmH(2)O and subsequently decreased from 24 to 0 in steps of 2 cmH(2)O. At each 8-min step, a CT scan was acquired during an end-expiratory hold, and blood gas analysis was performed. C-X5 was monitored continuously, and data relative to the expiratory hold were selected and averaged for comparison with CT and oxygenation. Open lung PEEP (PEEPol) was defined as the level of PEEP corresponding to the maximum value of C-X5 on the decremental limb of the PEEP trial. PEEPol was on average 13.4 (+/- 1.0) cmH(2)O. For higher levels of PEEP, there were no significant changes in the amount of non-aerated tissue (V-tissNA%). In contrast, when PEEP was reduced below PEEPol, V-tissNA% dramatically increased. PEEPol was able to prevent a 5% drop in V-tissNA% with 100% sensitivity and 92% specificity. At PEEPol V-tissNA% was significantly lower than at the corresponding PEEP level on the incremental limb. The assessment of C-X5 allowed the definition of PEEPol to be in agreement with CT data. Thus, FOT measurements of C-X5 may provide a non-invasive bedside tool for PEEP titration.

  • 32. Glassford, Neil J.
    et al.
    Schneider, Antoine G.
    Xu, Shengyuan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Eastwood, Glenn M.
    Young, Helen
    Peck, Leah
    Venge, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Bellomo, Rinaldo
    The nature and discriminatory value of urinary neutrophil gelatinase-associated lipocalin in critically ill patients at risk of acute kidney injury2013Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 39, nr 10, s. 1714-1724Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Different molecular forms of urinary neutrophil gelatinase-associated lipocalin (NGAL) have recently been discovered. We aimed to explore the nature, source and discriminatory value of urinary NGAL in intensive care unit (ICU) patients. We simultaneously measured plasma NGAL (pNGAL), urinary NGAL (uNGAL), and estimated monomeric and homodimeric uNGAL contribution using Western blotting-validated enzyme-linked immunosorbent assays [uNGAL(E1) and uNGAL(E2)] and their calculated ratio in 102 patients with the systemic inflammatory response syndrome and oliguria, and/or a creatinine rise of > 25 mu mol/L. Bland-Altman analysis demonstrated that, despite correlating well (r = 0.988), uNGAL and uNGAL(E1) were clinically distinct, lacking both accuracy and precision (bias: 266.23; 95 % CI 82.03-450.44 ng/mg creatinine; limits of agreement: -1,573.86 to 2,106.32 ng/mg creatinine). At best, urinary forms of NGAL are fair (area under the receiver operating characteristic [AUROC] a parts per thousand currency sign0.799) predictors of renal or patient outcome; most perform significantly worse. The 44 patients with a primarily monomeric source of uNGAL had higher pNGAL (118.5 ng/ml vs. 72.5 ng/ml; p < 0.001), remaining significant following Bonferroni correction. uNGAL is not a useful predictor of outcome in this ICU population. uNGAL patterns may predict distinct clinical phenotypes. The nature and source of uNGAL are complex and challenge the utility of NGAL as a uniform biomarker.

  • 33. Guérin, C
    et al.
    Beuret, P
    Constantin, J M
    Bellani, G
    Garcia-Olivares, P
    Roca, O
    Meertens, J H
    Maia, P Azevedo
    Becher, T
    Peterson, J
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Gurjar, M
    Hajjej, Z
    Kovari, F
    Assiri, A H
    Mainas, E
    Hasan, M S
    Morocho-Tutillo, D R
    Baboi, L
    Chrétien, J M
    François, G
    Ayzac, L
    Chen, L
    Brochard, L
    Mercat, A
    A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study2018Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 44, nr 1, s. 22-37Artikel i tidskrift (Refereegranskat)
    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.

  • 34.
    Hedenstierna, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Meyhoff, Christian S.
    Bispebjerg & Frederiksberg Hosp, Dept Anaesthesia & Intens Care, Copenhagen, Denmark;Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark.
    Oxygen toxicity in major emergency surgery-anything new?2019Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 45, nr 12Artikel i tidskrift (Övrigt vetenskapligt)
  • 35.
    Howells, Tim
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Lewen, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Sköld, Mattias K.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Ronne-Engström, Elisabeth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    Enblad, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Neurokirurgi.
    An evaluation of three measures of intracranial compliance in traumatic brain injury patients2012Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 38, nr 6, s. 1061-1068Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To compare intracranial pressure (ICP) amplitude, ICP slope, and the correlation of ICP amplitude and ICP mean (RAP index) as measures of compliance in a cohort of traumatic brain injury (TBI) patients. Mean values of the three measures were calculated in the 2-h periods before and after surgery (craniectomies and evacuations), and in the 12-h periods preceding and following thiopental treatment, and during periods of thiopental coma. The changes in the metrics were evaluated using the Wilcoxon test. The correlations of 10-day mean values for the three metrics with age, admission Glasgow Motor Score (GMS), and Extended Glasgow Outcome Score (GOSe) were evaluated. Patients under and over 60 years old were also compared using the Student test. The correlation of ICP amplitude with systemic pulse amplitude was analyzed. ICP amplitude was significantly correlated with GMS, and also with age for patients 35 years old and older. The correlations of ICP slope and the RAP index with GMS and with age were not significant. All three metrics indicated significant improvements in compliance following surgery and during thiopental coma. None of the metrics were significantly correlated with outcome, possibly due to confounding effects of treatment factors. The correlation of systemic pulse amplitude with ICP amplitude was low ( = 0.18), only explaining 3 % of the variance. This study provides further validation for all three of these features of the ICP waveform as measures of compliance. ICP amplitude had the best performance in these tests.

  • 36. Hutchinson, Peter J
    et al.
    Jalloh, Ibrahim
    Helmy, Adel
    Carpenter, Keri L H
    Rostami, Elham
    Participants of the 2014 International Microdialysis ForumUniversity of Cambridge, Cambridge, UK.
    Bellander, Bo-Michael
    Boutelle, Martyn G
    Chen, Jeff W
    Claassen, Jan
    Dahyot-Fizelier, Claire
    Enblad, Per
    Gallagher, Clare N
    Helbok, Raimund
    Hillered, Lars
    Le Roux, Peter D
    Magnoni, Sandra
    Mangat, Halinder S
    Menon, David K
    Nordström, Carl-Henrik
    O'Phelan, Kristine H
    Oddo, Mauro
    Perez Barcena, Jon
    Robertson, Claudia
    Ronne-Engström, Elisabeth
    Sahuquillo, Juan
    Smith, Martin
    Stocchetti, Nino
    Belli, Antonio
    Carpenter, T Adrian
    Coles, Jonathan P
    Czosnyka, Marek
    Dizdar, Nil
    Goodman, J Clay
    Gupta, Arun K
    Nielsen, Troels H
    Marklund, Niklas
    Montcriol, Ambroise
    O'Connell, Mark T
    Poca, Maria A
    Sarrafzadeh, Asita
    Shannon, Richard J
    Skjøth-Rasmussen, Jane
    Smielewski, Peter
    Stover, John F
    Timofeev, Ivan
    Vespa, Paul
    Zavala, Elizabeth
    Ungerstedt, Urban
    Consensus statement from the 2014 International Microdialysis Forum2015Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 41, nr 9, s. 1517-1528Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Microdialysis enables the chemistry of the extracellular interstitial space to be monitored. Use of this technique in patients with acute brain injury has increased our understanding of the pathophysiology of several acute neurological disorders. In 2004, a consensus document on the clinical application of cerebral microdialysis was published. Since then, there have been significant advances in the clinical use of microdialysis in neurocritical care. The objective of this review is to report on the International Microdialysis Forum held in Cambridge, UK, in April 2014 and to produce a revised and updated consensus statement about its clinical use including technique, data interpretation, relationship with outcome, role in guiding therapy in neurocritical care and research applications.

  • 37. Isbister, Geoffrey K.
    et al.
    Friberg, Lena E.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Duffull, Stephen B.
    Application of pharmacokinetic-pharmacodynamic modeling in management of QT abnormalities after citalopram overdose. Reply to A. Manini2007Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 33, nr 4, s. 739-739Artikel i tidskrift (Refereegranskat)
  • 38. Isbister, Geoffrey K.
    et al.
    Friberg, Lena E.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Duffull, Stephen B.
    Reply to Dr. Megarbane et al. regarding "Pharmacokinetic/pharmacodynamic modelling of cardiac toxicity in venlafaxine overdose"2007Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 33, nr 1, s. 197-197Artikel i tidskrift (Refereegranskat)
  • 39. Jalkanen, V.
    et al.
    Yang, R.
    Vaahersalo, J.
    Kurola, J.
    Ruokonen, E.
    Huhtala, H.
    Kuitunen, A.
    Pettila, V.
    Tenhunen, Jyrki
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Low Serum Super Concentration Predicts 90-Day Survival after Out-Of-Hospital Cardiac Arrest2014Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 40, s. S213-S214Artikel i tidskrift (Övrigt vetenskapligt)
  • 40. Jalkanen, Ville
    et al.
    Yang, Runkuan
    Linko, Rita
    Huhtala, Heini
    Okkonen, Marjatta
    Varpula, Tero
    Pettilä, Ville
    Tenhunen, Jyrki
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    SuPAR and PAI-1 in critically ill, mechanically ventilated patients2013Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 39, nr 3, s. 489-496Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE:

    SuPAR (soluble urokinase plasminogen activator receptor) and PAI-1 (plasminogen activator inhibitor 1) are active in the coagulation-fibrinolysis pathway. Both have been suggested as biomarkers for disease severity. We evaluated them in prediction of mortality, acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), sepsis and renal replacement therapy (RRT) in operative and non-operative ventilated patients.

    METHODS:

    We conducted a prospective, multicenter, observational study. Blood samples and data of intensive care were collected. Mechanically ventilated patients with baseline suPAR and PAI-1 measurements were included in the analysis, and healthy volunteers were analysed for comparison. Receiver operating characteristics (ROC), logistic regression, likelihood ratios and Kaplan-Meier analysis were performed.

    RESULTS:

    Baseline suPAR was 11.6 ng/ml (quartiles Q1-Q3, 9.6-14.0), compared to healthy volunteers with suPAR of 0.6 ng/ml (0.5-11.0). PAI-1 concentrations were 2.67 ng/ml (1.53-4.69) and 0.3 ng/ml (0.3-0.4), respectively. ROC analysis for suPAR 90-day mortality areas under receiver operating characteristic curves (AUC) 0.61 (95 % confidence interval (CI): 0.55-0.67), sepsis 0.68 (0.61-0.76), ALI/ARDS 0.64 (0.56-0.73) and RRT 0.65 (0.56-0.73). Patients with the highest quartile of suPAR concentrations had an odds ratio of 2.52 (1.37-4.64, p = 0.003) for 90-day mortality and 3.16 (1.19-8.41, p = 0.02) for ALI/ARDS. In non-operative patients, the AUC's for suPAR were 90-day mortality 0.61 (0.54-0.68), RRT 0.73 (0.64-0.83), sepsis 0.70 (0.60-0.80), ALI/ARDS 0.61 (0.51-0.71). Predictive value of PAI-1 was negligible.

    CONCLUSIONS:

    In non-operative patients, low concentrations of suPAR were predictive for survival and high concentrations for RRT and mortality. SuPAR may be used for screening for patients with potentially good survival. The association with RRT may supply an early warning sign for acute renal failure.

  • 41. Kirkpatrick, Andrew W
    et al.
    Roberts, Derek J
    De Waele, Jan
    Jaeschke, Roman
    Malbrain, Manu L N G
    De Keulenaer, Bart
    Duchesne, Juan
    Björck, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Leppaniemi, Ari
    Ejike, Janeth C
    Sugrue, Michael
    Cheatham, Michael
    Ivatury, Rao
    Ball, Chad G
    Reintam Blaser, Annika
    Regli, Adrian
    Balogh, Zsolt J
    D'Amours, Scott
    Debergh, Dieter
    Kaplan, Mark
    Kimball, Edward
    Olvera, Claudia
    Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome2013Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 39, nr 7, s. 1190-1206Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE:

    To update the World Society of the Abdominal Compartment Syndrome (WSACS) consensus definitions and management statements relating to intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS).

    METHODS:

    We conducted systematic or structured reviews to identify relevant studies relating to IAH or ACS. Updated consensus definitions and management statements were then derived using a modified Delphi method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) guidelines, respectively. Quality of evidence was graded from high (A) to very low (D) and management statements from strong RECOMMENDATIONS (desirable effects clearly outweigh potential undesirable ones) to weaker SUGGESTIONS (potential risks and benefits of the intervention are less clear).

    RESULTS:

    In addition to reviewing the consensus definitions proposed in 2006, the WSACS defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, and abdominal compliance, and proposed an open abdomen classification system. RECOMMENDATIONS included intra-abdominal pressure (IAP) measurement, avoidance of sustained IAH, protocolized IAP monitoring and management, decompressive laparotomy for overt ACS, and negative pressure wound therapy and efforts to achieve same-hospital-stay fascial closure among patients with an open abdomen. SUGGESTIONS included use of medical therapies and percutaneous catheter drainage for treatment of IAH/ACS, considering the association between body position and IAP, attempts to avoid a positive fluid balance after initial patient resuscitation, use of enhanced ratios of plasma to red blood cells and prophylactic open abdominal strategies, and avoidance of routine early biologic mesh use among patients with open abdominal wounds. NO RECOMMENDATIONS were possible regarding monitoring of abdominal perfusion pressure or the use of diuretics, renal replacement therapies, albumin, or acute component-parts separation.

    CONCLUSION:

    Although IAH and ACS are common and frequently associated with poor outcomes, the overall quality of evidence available to guide development of RECOMMENDATIONS was generally low. Appropriately designed intervention trials are urgently needed for patients with IAH and ACS.

  • 42. Knapik, Piotr
    et al.
    Krzych, Łukasz J
    Weigl, Wojciech
    Adamski, Jan
    Hultström, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk cellbiologi, Integrativ Fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Mortality rate in Polish intensive care units is lower than predicted according to the APACHE II scoring system.2017Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 43, s. 1745-1746Artikel i tidskrift (Övrigt vetenskapligt)
  • 43. Laffey, John G
    et al.
    Bellani, Giacomo
    Pham, Tài
    Fan, Eddy
    Madotto, Fabiana
    Bajwa, Ednan K
    Brochard, Laurent
    Clarkson, Kevin
    Esteban, Andres
    Gattinoni, Luciano
    van Haren, Frank
    Heunks, Leo M
    Kurahashi, Kiyoyasu
    Laake, Jon Henrik
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    McAuley, Daniel F
    McNamee, Lia
    Nin, Nicolas
    Qiu, Haibo
    Ranieri, Marco
    Rubenfeld, Gordon D
    Thompson, B Taylor
    Wrigge, Hermann
    Slutsky, Arthur S
    Pesenti, Antonio
    Correction to: Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome2018Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 44, nr 1, s. 157-165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Correction to: Intensive Care Med (2016) 42:1865-1876 DOI 10.1007/s00134-016-4571-5.

  • 44. Laffey, John G
    et al.
    Bellani, Giacomo
    Pham, Tài
    Fan, Eddy
    Madotto, Fabiana
    Bajwa, Ednan K
    Brochard, Laurent
    Clarkson, Kevin
    Esteban, Andres
    Gattinoni, Luciano
    van Haren, Frank
    Heunks, Leo M
    Kurahashi, Kiyoyasu
    Laake, Jon Henrik
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    McAuley, Daniel F
    McNamee, Lia
    Nin, Nicolas
    Qiu, Haibo
    Ranieri, Marco
    Rubenfeld, Gordon D
    Thompson, B Taylor
    Wrigge, Hermann
    Slutsky, Arthur S
    Pesenti, Antonio
    Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study2016Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 42, nr 12, s. 1865-1876Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality.

    METHODS: The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents. A pre-specified secondary aim was to examine the factors associated with outcome. Analyses were restricted to patients (93.1 %) fulfilling ARDS criteria on day 1-2 who received invasive mechanical ventilation.

    RESULTS: 2377 patients were included in the analysis. Potentially modifiable factors associated with increased hospital mortality in multivariable analyses include lower PEEP, higher peak inspiratory, plateau, and driving pressures, and increased respiratory rate. The impact of tidal volume on outcome was unclear. Having fewer ICU beds was also associated with higher hospital mortality. Non-modifiable factors associated with worsened outcome from ARDS included older age, active neoplasm, hematologic neoplasm, and chronic liver failure. Severity of illness indices including lower pH, lower PaO2/FiO2 ratio, and higher non-pulmonary SOFA score were associated with poorer outcome. Of the 578 (24.3 %) patients with a limitation of life-sustaining therapies or measures decision, 498 (86.0 %) died in hospital. Factors associated with increased likelihood of limitation of life-sustaining therapies or measures decision included older age, immunosuppression, neoplasia, lower pH and increased non-pulmonary SOFA scores.

    CONCLUSIONS: Higher PEEP, lower peak, plateau, and driving pressures, and lower respiratory rate are associated with improved survival from ARDS.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT02010073.

  • 45.
    Larsson, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Dhonneur, Gilles
    Videolaryngoscopy: towards a new standard method for tracheal intubation in the ICU?2013Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 39, nr 12, s. 2220-2222Artikel i tidskrift (Övrigt vetenskapligt)
  • 46.
    Linde, Torbjörn
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Sandhagen, Bo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Fugman, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Lithell, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Berne, Christian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Lind, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Improved hemorheological properties during infusion of a lipid emulsion(Intralipid) in healthy subjects2000Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 26, nr 10, s. 1462-1465Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Lipid emulsions are commonly used for nutrition in critically ill patients. In these patients interventions resulting in deteriorated blood rheology and thereby an impaired microcirculation may be deleterious. This study examined the acute hemorrheological effects of the lipid emulsion Intralipid. We have recently shown that hyperinsulinemia exerts a negative effect on erythrocyte deformability, and here the effect of hyperinsulinemia combined with Intralipid was studied.

    SUBJECTS AND INTERVENTIONS: Eleven healthy subjects received Intralipid (200 mg/ml) intravenously as a bolus injection (0.5 ml/kg) over 10 min and thereafter as a continuous intravenous infusion (90 ml/h) for 4 h combined with heparin (200 U/h) to stimulate lipolysis. During the final 2 h an euglycemic hyperinsulinemic clamp was added. Five subjects underwent the same protocol with the exception that saline was given instead of Intralipid and heparin.

    MEASUREMENTS AND RESULTS: Whole blood viscosity, plasma viscosity, erythrocyte aggregation tendency and fluidity were measured by rotational viscometry. Compared with basal and control values the Intralipid infusion caused greater erythrocyte fluidity (p < 0.05) and less aggregation tendency (p < 0.05). Whole blood and plasma viscosity remained unchanged. Hyperinsulinemia had no significant effect on the hemorrheological variables measured.

    CONCLUSIONS: Intralipid has no deleterious effects on blood rheology in healthy subjects. Instead, it leads to improved erythrocyte aggregation tendency and fluidity. If the emulsion exerts the same effects in patients with impaired circulation, the use of Intralipid may be beneficial in these patients.

  • 47. Martensson, Johan
    et al.
    Bell, Max
    Oldner, Anders
    Xu, Shengyuan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Venge, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Martling, Claes-Roland
    Neutrophil gelatinase-associated lipocalin in adult septic patients with and without acute kidney injury2010Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 36, nr 8, s. 1333-1340Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To study the impact of inflammation/sepsis on the concentrations of neutrophil gelatinase-associated lipocalin (NGAL) in plasma and urine in adult intensive care unit (ICU) patients and to estimate the predictive properties of NGAL in plasma and urine for early detection of acute kidney injury (AKI) in patients with septic shock. Sixty-five patients admitted to the general ICU at the Karolinska University Hospital Solna, Sweden, with normal plasma creatinine were assessed for eligibility. Twenty-seven patients with systemic inflammatory response syndrome (SIRS), severe sepsis, or septic shock without AKI and 18 patients with septic shock and concomitant AKI were included in the final analysis. Plasma and urine were analyzed twice daily for plasma NGAL (pNGAL), C-reactive protein (CRP), procalcitonin, myeloperoxidase, plasma cystatin C, plasma creatinine, urine NGAL (uNGAL), urine cystatin C, and urine alpha 1-microglobulin. Of the 45 patients, 40 had elevated peak levels of pNGAL. Peak levels of pNGAL were not significantly different between septic shock patients with and without AKI. Peak levels of uNGAL were below the upper reference limit in all but four patients without AKI. uNGAL was a good predictor (area under ROC 0.86) whereas pNGAL was a poor predictor (area under ROC 0.67) for AKI within the next 12 h in patients with septic shock. pNGAL is raised in patients with SIRS, severe sepsis, and septic shock and should be used with caution as a marker of AKI in ICU patients with septic shock. uNGAL is more useful in predicting AKI as the levels are not elevated in septic patients without AKI.

  • 48. Martin-Loeches, I
    et al.
    Lisboa, T
    Rhodes, A
    Moreno, R P
    Silva, E
    Sprung, C
    Chiche, J D
    Barahona, D
    Villabon, M
    Balasini, C
    Pearse, R M
    Matos, R
    Rello, J
    Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection2011Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 37, nr 2, s. 272-283Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION:

    Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial.

    METHODS:

    Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry.

    RESULTS:

    Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1-4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1-7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7-2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0-4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed.

    CONCLUSIONS:

    Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.

  • 49.
    May, Teresa L.
    et al.
    Maine Med Ctr, Dept Crit Care Serv, 22 Bramhall St, Portland, ME 04102 USA;Tufts Univ, Clin & Translat Sci Inst, Boston, MA 02111 USA.
    Lary, Christine W.
    Maine Med Ctr, Ctr Outcomes Res, Portland, ME 04102 USA.
    Riker, Richard R.
    Maine Med Ctr, Dept Crit Care Serv, 22 Bramhall St, Portland, ME 04102 USA.
    Friberg, Hans
    Lund Univ, Dept Anesthesia & Intens Care, Skane Univ Hosp, Lund, Sweden.
    Patel, Nainesh
    Lehigh Valley Hosp & Hlth Network, Div Cardiovasc Med, Allentown, PA USA.
    Soreide, Eldar
    Stavanger Univ Hosp, Crit Care & Anesthesiol Res Grp, Stavanger, Norway;Univ Bergen, Dept Clin Med, Bergen, Norway.
    McPherson, John A.
    Vanderbilt Univ, Med Ctr, Div Cardiovasc Med, Nashville, TN USA.
    Unden, Johan
    Lund Univ, Dept Clin Sci, S-22185 Lund, Sweden;Skane Univ Hosp, Dept Intens & Perioperat Care, Malmo, Sweden.
    Hand, Robert
    Eastern Maine Med Ctr, Dept Crit Care, Bangor, ME USA.
    Sunde, Kjetil
    Oslo Univ Hosp, Dept Anaesthesiol, Div Emergencies & Crit Care, Oslo, Norway;Univ Oslo, Inst Clin Med, Oslo, Norway.
    Stammet, Pascal
    Med Dept Natl Rescue Serv, 14 Rue Stumper, L-2557 Luxembourg, Luxembourg.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Belohlvaek, Jan
    Charles Univ Prague, Dept Internal Med 2, Cardiovasc Med, Gen Teaching Hosp, Prague, Czech Republic;Charles Univ Prague, Med Sch 1, Prague, Czech Republic.
    Dupont, Allison
    Northeast Georgia Med Ctr, Dept Cardiol, Gainesville, FL USA.
    Hirsch, Karen G.
    Stanford Univ, Sch Med, Dept Neurol & Neurol Surg, Stanford Neurocrit Care Program, Stanford, CA 94305 USA.
    Valsson, Felix
    Landspitali Univ Hosp, Dept Anesthesia & Intens Care, Reykyavik, Iceland.
    Kern, Karl
    Univ Arizona, Div Cardiol, Sarver Heart Ctr, Tucson, AZ USA.
    Sadaka, Farid
    St Louis Univ, Mercy Hosp St Louis, St Louis, MO 63103 USA.
    Israelsson, Johan
    Kalmar Cty Hosp, Dept Internal Med, Div Cardiol, Kalmar, Sweden.
    Dankiewicz, Josef
    Vanderbilt Univ, Med Ctr, Div Cardiovasc Med, Nashville, TN USA;Skane Univ Hosp, Dept Intens & Perioperat Care, Lund, Sweden.
    Nielsen, Niklas
    Lund Univ, Dept Clin Sci Anesthesia & Intens Care, Helsingborg Hosp, Helsingborg, Sweden.
    Seder, David B.
    Maine Med Ctr, Dept Crit Care Serv, 22 Bramhall St, Portland, ME 04102 USA.
    Agarwal, Sachin
    Columbia Presbyterian Med Ctr, Dept Neurol, New York, NY 10032 USA.
    Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry2019Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 45, nr 5, s. 637-646Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers.

    Methods

    Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average.

    Results

    A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11-63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37-0.58) to 0.20 (0.12-0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 degrees C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers.

    Conclusions

    Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.

  • 50.
    Milton, A.
    et al.
    Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden;Karolinska Univ Hosp, Dept Perioperat Med & Intens Care, Stockholm, Sweden.
    Schandl, A.
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    Soliman, I. W.
    Univ Utrecht, Univ Med Ctr Utrecht, Dept Intens Care Med, Utrecht, Netherlands.
    Meijers, K.
    Soder Sjukhuset, Dept Anaesthesiol & Intens Care, Stockholm, Sweden.
    van den Boogaard, M.
    Radboud Univ Nijmegen, Med Ctr, Dept Intens Care Med, Nijmegen, Netherlands.
    Larsson, Ing-Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Brorsson, C.
    Umea Univ, Dept Surg & Perioperat Sci, Umea, Sweden.
    Ostberg, U.
    Ostersund Hosp, Dept Anaesthesiol & Intens Care, Ostersund, Sweden.
    Oxenboll-Collet, M.
    Rigshosp Copenhagen, Dept Intens Care, Copenhagen, Denmark.
    Savilampi, J.
    Orebro Univ Hosp, Dept Anaesthesiol & Intens Care, Orebro, Sweden.
    Paskins, S.
    Odense Univ Hosp, Dept Intens Care, Odense, Denmark.
    Bottai, M.
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Sackey, P. V.
    Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden.
    Development of an ICU discharge instrument predicting psychological morbidity: a multinational study2018Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 44, nr 12, s. 2038-2047Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PurposeTo develop an instrument for use at ICU discharge for prediction of psychological problems in ICU survivors.MethodsMultinational, prospective cohort study in ten general ICUs in secondary and tertiary care hospitals in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay12h were eligible for inclusion. Patients in need of neurointensive care, with documented cognitive impairment, unable to communicate in the local language, without a home address or with more than one limitation of therapy were excluded. Primary outcome was psychological morbidity 3months after ICU discharge, defined as Hospital Anxiety and Depression Scale (HADS) subscale score11 or Post-traumatic Stress Symptoms Checklist-14 (PTSS-14) part B score>45.ResultsA total of 572 patients were included and 78% of patients alive at follow-up responded to questionnaires. Twenty percent were classified as having psychological problems post-ICU. Of 18 potential risk factors, four were included in the final prediction model after multivariable logistic regression analysis: symptoms of depression [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.10-1.50], traumatic memories (OR 1.44, 95% CI 1.13-1.82), lack of social support (OR 3.28, 95% CI 1.47-7.32) and age (age-dependent OR, peak risk at age 49-65years). The area under the receiver operating characteristics curve (AUC) for the instrument was 0.76 (95% CI 0.70-0.81).ConclusionsWe developed an instrument to predict individual patients' risk for psychological problems 3months post-ICU, http://www.imm.ki.se/biostatistics/calculators/psychmorb/. The instrument can be used for triage of patients for psychological ICU follow-up.Trial registrationThe study was registered at clinicaltrials.gov, NCT02679157.

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