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  • 1.
    Gavali, Hamid
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Mani, Kevin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Tegler, Gustaf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Covaciu, Lucian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Wanhainen, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kärlkirurgi.
    Editor's Choice - Prolonged ICU Length of Stay after AAA Repair: Analysis of Time Trends and Long-term Outcome2017Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, nr 2, s. 157-163Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of the study was to investigate the frequency and outcome of prolonged intensive care unit (ICU) length of stay (LOS) after abdominal aortic aneurysm (AAA) repair in the endovascular era.

    Methods: All patients operated on for AAA between 1999 and 2013 at Uppsala University hospital were identified. Data were retrieved from the Swedish Vascular registry, the Swedish Intensive Care registry, the National Population registry, and case records. Prolonged ICU LOS was defined as >= 48 h during the primary hospital stay. Patients surviving >= 48 h after AAA surgery were included in the analysis.

    Results: A total of 725 patients were identified, of whom 707 (97.5%) survived >= 48 h; 563 (79.6%) underwent intact AAA repair and 144 (20.4%) ruptured AAA repair. A total of 548 patients (77.5%) required < 48 h of intensive care, 115 (16.3%) 2-6 days and 44 (6.2%) >= 7 days. The rate of prolonged ICU LOS declined considerably over time, from 41.4% of all AAA repairs in 1999 to 7.3% in 2013 (p < .001) whereas the use of endovascular aortic repair (EVAR) increased from 6.9% in 1999 to 78.0% in 2013 (p < .001). The 30 day survival rate was 98.2% for those with < 48 h ICU stay versus 93.0% for 2-6 days versus 81.8% for >= 7 days (p < .001); the corresponding 90 day survival was 97.1% versus 86.1% versus 63.6% (p < .001) respectively. For patients surviving 90 days after repair, there was no difference in long-term survival between the groups.

    Conclusion: During the period of progressively increasing use of EVAR, a simultaneous significant reduction in frequency of prolonged ICU LOS occurred. Although prolonged ICU LOS was associated with a high short-term mortality, long-term outcome among those surviving the initial 90 days was less affected.

  • 2.
    Horst, Sandra
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Rasmusson, J
    Department of Anesthesiology and Intensive Care, Gävle County Hospital, Gävle, Sweden.
    Pikwer, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Castegren, M
    Perioperative Medicine and Intensive Care, Karolinska University Hospital and CLINTEC, Karolinska Institute, Stockholm, Sweden.
    Lipcsey, Miklós
    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.
    Impact of resuscitation fluid bag size availability on volume of fluid administration in the intensive care unit2018Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 9, s. 1261-1266Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Iatrogenic fluid overload is associated with increased mortality in the intensive care unit (ICU). Decisions on fluid therapy may, at times, be based on other factors than physiological endpoints. We hypothesized that because of psychological factors volume of available fluid bags would affect the amount of resuscitation fluid administered to ICU patients.

    METHODS: We performed a prospective intervention cross-over study at 3 Swedish ICUs by replacing the standard resuscitation fluid bag of Ringer's Acetate 1000 mL with 500 mL bags (intervention group) for 5 separate months and then compared it with the standard bag size for 5 months (control group). Primary endpoint was the amount of Ringer's Acetate per patient during ICU stay. Secondary endpoints were differences between the groups in cumulative fluid balance and change in body weight, hemoglobin and creatinine levels, urine output, acute kidney failure (measured as the need for renal replacement therapy, RRT) and 90-day mortality.

    RESULTS: Six hundred and thirty-five ICU patients were included (291 in the intervention group, 344 in the control group). There was no difference in the amount of resuscitation fluid per patient during the ICU stay (2200 mL [1000-4500 median IQR] vs 2245 mL [1000-5630 median IQR]), RRT rate (11 vs 9%), 90-day mortality (11 vs 10%) or total fluid balance between the groups. The daily amount of Ringer's acetate administered per day was lower in the intervention group (1040 (280-2000) vs 1520 (460-3000) mL; P = .03).

    CONCLUSIONS: The amount of resuscitation fluid administered to ICU patients was not affected by the size of the available fluid bags. However, altering fluid bag size could have influenced fluid prescription behavior.

  • 3.
    Höstman, Staffan
    et al.
    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.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Perchiazzi, Gaetano
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    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.
    THAM administration reduces pulmonary carbon dioxide elimination in hypercapnia: an experimental porcine study2018Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 6, s. 820-828Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 4.
    Jung, Christian
    et al.
    Univ Hosp, Dep Cardiol Pulmonol & Angiol, Dusseldorf, Germany;Heinrich Heine Univ, Div Cardiol & Intens Care, Univ Hosp Dusseldorf, Dusseldorf, Germany;Univ Hosp Dusseldorf, Heinrich Heine Univ Dusseldorf, Med Fac, Div Cardiol Pulmonol & Vasc Med, Dusseldorf, Germany.
    Wernly, Bernhard
    Paracelsus Med Univ, Dept Cardiol, Salzburg, Austria.
    Muessig, Johanna M.
    Univ Hosp, Dep Cardiol Pulmonol & Angiol, Dusseldorf, Germany.
    Kelm, Malte
    Univ Hosp, Dep Cardiol Pulmonol & Angiol, Dusseldorf, Germany.
    Boumendil, Ariane
    Hop St Antoine, AP HP, Serv Reanimat Med, F-75012 Paris, France.
    Morandi, Alessandro
    Hosp Ancelle Cremona, Dept Rehabil, Geriatr Res Grp, Brescia, Italy.
    Andersen, Finn H.
    Alesund Hosp, Dep Anaesthesia & Intens Care, Alesund, Norway;NTNU, Dep Circulat & Med Imaging, Trondheim, Norway;Alesund Hosp, ICU, Alesund, Norway.
    Artigas, Antonio
    Autonomous Univ Barcelona, Dept Intens Care Med, CIBER Enjermedades Respiratorias, Corp Sanitaria Univ Parc Tauli, Sabadell, Spain;Univ Hosp Sagrad Corazon, Dept Intens Care Med, Barcelona, Spain;Univ Hosp Gen Catalunya, Barcelona, Spain.
    Bertolini, Guido
    IRCCS, Ist Ric Farmacol Mario Negri, Lab Epidemiol Clin, Ctr Coordinamento GiViTI,Dipartimento Salute Pubb, I-24020 Bergamo, Italy.
    Cecconi, Maurizio
    Humanitas Univ, Dept Anaesthesia, IRCCS, Inst Clin Humanitas, Milan, Italy.
    Christensen, Steffen
    Aarhus Univ Hosp, Dept Anaesthesia & Intens Care Med, Aarhus, Denmark;Aarhus Univ Hosp, Skejby, Denmark.
    Faraldi, Loredana
    Grande Osped Metropolitano Niguarda, Milan, Italy.
    Fjolner, Jesper
    Aarhus Univ Hosp, Dept Anaesthesia & Intens Care Med, Aarhus, Denmark;Randers Reg Hosp, ITA, Randers, Denmark.
    Lichtenauer, Michael
    Paracelsus Med Univ, Dept Cardiol, Salzburg, Austria.
    Bruno, Raphael Romano
    Univ Hosp, Dep Cardiol Pulmonol & Angiol, Dusseldorf, Germany.
    Marsh, Brian
    Mater Misericordiae Univ Hosp, Dublin, Ireland;Mater Misericordiae Univ Hosp, Dept Crit Care Med, Dublin, Ireland.
    Moreno, Rui
    Hosp Sao Jose, Ctr Hosp Lisboa Cent, Unidade Cuidados Intensivos Neurocrit, Fac Ciencia Med Lisboa,Nova Med Sch, Lisbon, Portugal.
    Oeyen, Sandra
    Ghent Univ Hosp, Dept Intens Care, 1K12IC, Ghent, Belgium;Ghent Univ Hosp, Dept Intensive Care, Ghent, Belgium.
    Ohman, Christina Agvald
    Karolinska Univ Hosp, Solna, Sweden.
    Pinto, Bernadro Bollen
    Geneva Univ Hosp, Geneva, Netherlands;Geneva Univ Hosp, Peri Intervent Intermidate Care SINPI, Geneva, Switzerland.
    Soliman, Ivo W.
    Univ Utrecht, Dept Intens Care Med, Univ Med Ctr, Utrecht, Netherlands.
    Szczeklik, Wojciech
    Jagiellonian Univ, Intens Care & Perioperat Med Div, Med Coll, Krakow, Poland;Univ Hosp Krakow, Dept Intens Care & Perioperat Med, Krakow, Poland.
    Valentin, Andreas
    Kardinal Schwarzenberg Hosp, Schwarzach, Austria.
    Watson, Ximena
    St Georges Univ Hosp, London, England.
    Zafeiridis, Tilemachos
    Gen Hosp Larissa Tsakalof Larissa, Intens Care Unit, Larisa, Greece.
    De Lange, Dylan W.
    Univ Utrecht, Dept Intens Care Med, Univ Med Ctr, Utrecht, Netherlands.
    Guidet, Bertrand
    Hop St Antoine, Hop Paris, Serv Reanimat Med, F-75012 Paris, France;UPMC Univ Paris 06, Sorbonne Univ, UMR S 1136, Inst Pierre Louis Epidemiol & Sante Publ, F-75013 Paris, France;INSERM, UMR S 1136, Inst Pierre Louis Epidemiol & Sante Publ, F-75013 Paris, France;Reanimat Med, St Antoine, France.
    Flaatten, Hans
    Univ Bergen, Dept Clin Med, Dept Anaestesia & Intens Care, Haukeland Univ Hosp, Bergen, Norway;Haukeland Hosp, Gen ICU, Bergen, Norway.
    Schmutz, Rene
    Hosp St John God Vienna, B5, Vienna, Austria.
    Wimmer, Franz
    Kardinal Schwarzenbergsches Krankenhaus, Schwarzach Im Pongau, Austria.
    Eller, Philipp
    Med Univ Graz, Intensivstn Univ, Klin Innere Med, Graz, Austria.
    Joannidis, Michael
    Univ Hosp Innsbruck, MICU, Innsbruck, Austria.
    De Buysscher, Pieter
    AZ Sint Lucas Ghent, Dept Intens Care, Ghent, Belgium.
    De Neve, Nikolaas
    OL Vrouwhosp Aalst, Aalst, Belgium.
    Swinnen, Walter
    AZ Sint Blasius Dendermonde, Dept Intens Care Med, Dendermonde, Belgium.
    Abraham, Paul
    Geneva Univ Hosp, Adult Intens Care SIA, Geneva, Switzerland.
    Hergafi, Leila
    Hop Fribourgeois, Serv Soins Intensifs, Fribourg, Switzerland.
    Schefold, Joerg C.
    Univ Bern, Univ Klin Intensivmed, Inselspital, Bern Univ Hosp, Bern, Switzerland.
    Biskup, Ewelina
    Univ Hosp Basel, Med ICU, Basel, Switzerland.
    Piza, Petr
    IKEM, KARIP, Prague, Czech Republic.
    Taliadoros, Ioannis
    Nicosia Gen Hosp, CY001, Aglandjia, Cyprus.
    Dey, Nilanjan
    Reg Hosp Herning, Intens Herning, Herning, Denmark.
    Solling, Christoffer
    Reg Hosp Viborg, Viborg, Denmark.
    Rasmussen, Bodil Steen
    Aalborg Univ Hosp, ICU, Aalborg, Denmark.
    Forceville, Xavier
    Ctr Hosp Meaux, Reanimat Med Chirurg, Meaux, France.
    Besch, Guillaume
    CHRU Besancon, Dept Anesthesie Reanimat Chirurg, Besancon, France.
    Mentec, Herve
    Ctr Hosp Victor Dupouy Argenteuil, Serv Reanimat Polyvalente, Argenteuil, France.
    Michel, Philippe
    CH Camelle Portes Oise, Beaumont Sur Oise, France;CH Rene Dubos, Reanimat Med Chirurg, Pontoise, France.
    Mateu, Philippe
    CH Charleville Mezieres, Reanimat Polyvalente, Charleville Mezieres, France.
    Vettoretti, Lucie
    CHRU Besancon, Reanimat Med, Besancon, France.
    Bourenne, Jeremy
    CHU Marseille Timone, Reanimat Urgences & Med, Marseille, France.
    Marin, Nathalie
    Hop Cochin, Reanimat Med, Paris, France.
    Guillot, Max
    Hop Hautepierre, Reanimat Med, Strasbourg, France.
    Aissaoui, Naida
    Hop Europeen Georges Pompidou, Reanimat Med, Paris, France.
    Goulenok, Cyril
    Hop Prive Jacques CARTIER, Reanimat Med, Massy, France.
    Thieulot-Rolin, Nathalie
    Hosp Marc Jacquet, Intens Care Med Dept, F-77000 Melun, France.
    Messika, Jonathan
    Louis Mourier, Reanimat Med Chirurg, Colombes, France.
    Lamhaut, Lionel
    Necker AP HP, Polyvalente Adult ICU, Paris, France.
    Charron, Cyril
    Univ Hosp Ambroise Pare, Med Surg ICU, Paris, France.
    Lauten, Alexander
    Charite Univ Med Berlin, Dept Cardiol, Berlin, Germany;Charite Univ Med Berlin, DZHK Berlin Partner Side, Berlin, Germany.
    Sacher, Anna Lena
    Charite Univ Med Berlin, Dept Anesthesiol, Berlin, Germany.
    Brenner, Thorsten
    Heidelberg Univ Hosp, Dept Anesthesiol, Heidelberg, Germany.
    Franz, Marcus
    Friedrich Schiller Univ, Jena Univ Hosp, Dept Internal Med, Jena, Germany.
    Bloos, Frank
    Friedrich Schiller Univ, Jena Univ Hosp, Dept Anesthesiol, Jena, Germany.
    Ebelt, Henning
    Catholic Hosp St Johann Nepomuk, Dept Med 2, Erfurt, Germany.
    Schaller, Stefan J.
    Tech Univ Munich, Klinikum Rechts Isar, Dept Anesthesiol, Munich, Germany.
    Fuest, Kristina
    Tech Univ Munich, Klinikum Rechts Isar, Dept Anesthesiol, Munich, Germany.
    Rabe, Christian
    Tech Univ Munich, Klinikum Rechts Isar, Dept Clin Toxicol, Munich, Germany.
    Dieck, Thorben
    Hosp Hannover, Med Sch, Dept Anaesthesiol & Intens Care, Hannover, Germany.
    Steiner, Stephan
    St Vincenz Krankenhaus Limburg, Dept Cardiol Pneumol & Intens Care, Limburg, Germany.
    Graf, Tobias
    Univ Heart Ctr Luebeck, Dept Cardiol, Lubeck, Germany.
    Nia, Amir M.
    Heinrich Heine Univ, Div Cardiol & Intens Care, Univ Hosp Dusseldorf, Dusseldorf, Germany.
    Janosi, Rolf Alexander
    Univ Hosp Essen, Dept Cardiol & Vasc Dis, Essen, Germany.
    Meybohm, Patrick
    Frankfurt Univ Hosp, Dept Anaesthesiol Intens Care Med & Pain Therapy, Frankfurt, Germany.
    Simon, Philipp
    Univ Hosp Leipzig, Dept Anaesthesiol & ICM, Leipzig, Germany.
    Utzolino, Stefan
    Univ Klinikum Freiburg, Dept Gen & Visceral Surg, Freiburg, Germany.
    Rahmel, Tim
    Univ Hosp Knappschaftskrankenhaus Bochum, Dept Anaesthesiol Intens Care Med, Bochum, Germany.
    Barth, Eberhard
    Univ Ulm, Dept Anaesthesiol, Ulm, Germany.
    Schuster, Michael
    Univ Hosp Mainz, Dept Anaesthesiol, Mainz, Germany.
    Aidoni, Zoi
    UGHT AHEPA, ICU, Athens, Greece.
    Aloizos, Stavros
    Army Share Fund Hosp, ICU, Athens, Greece.
    Tasioudis, Polychronis
    G Gennimatas Hosp Thessaloniki, ICU, Thessaloniki, Greece.
    Lampiri, Kleri
    Gen Hosp Kavala, ICU, Kavala, Greece.
    Zisopoulou, Vasiliki
    Gen Hosp Larissa, ICU1, Larisa, Greece.
    Ravani, Ifigenia
    Gen Hosp & Atras, ICU, Achaea, Greece.
    Pagaki, Eumorfia
    Gen Hosp Trikala Greece, ICU, Trikala, Greece.
    Antoniou, Angela
    Volos Gen Hosp, ICU, Volos, Greece.
    Katsoulas, Theodoros A.
    Ag Anargyroi Gen Hosp, ICU, Kifisia, Greece.
    Kounougeri, Aikaterini
    Konstantopoule Gen Hosp, ICU, Athens, Greece.
    Marinakis, George
    Korgialenio Benakio G Hosp Athens, ICU, Athens, Greece.
    Tsimpoukas, Fotios
    Lamia Gen Hosp, ICU, Lamia, Greece.
    Spyropoulou, Anastasia
    Panarkadian Gen Hosp Tripolis, ICU, Tripoli, Greece.
    Zygoulis, Paris
    Univ Hosp Larisa, Gen ICU, Thessaly, Greece.
    Kyparissi, Aikaterini
    HIPPOCRATEIO Gen Hosp Athens, ICU, Athens, Greece.
    Gupta, Manish
    Max Super Special Hosp, MICU, Vaishali, India.
    Gurjar, Mohan
    Sanjay Gandhi Postgrad Inst Med Sci, Dept Crit Care Med, Lucknow, Uttar Pradesh, India.
    Maji, Ismail M.
    St Johns Med Coll Hosp, MICU, Bangaluri, India.
    Hayes, Ivan
    Cork Univ Hosp, CUH GICU, Cork, Ireland.
    Kelly, Yvelynne
    St James Hosp, Gen ICU, Dublin, Ireland.
    Westbrook, Andrew
    St Vincents Univ Hosp, ICU, Dublin, Ireland.
    Fitzpatrick, Gerry
    Tallaght Hosp, Tallaght Intens Care, Dublin, Ireland.
    Maheshwari, Darshana
    Univ Hosp Galway, UHG ICU, Galway, Ireland.
    Motherway, Catherine
    Univ Hosp Limerick, ICU, Limerick, Ireland.
    Negri, Giovanni
    Osped G Fornaroli, ASST Ovest Milanese Presidio Magenta, Magenta, Italy.
    Spadaro, Savino
    Azienda Osped Univ St Anna, Units Terapia Intens Serv Anestesia, Ferrara, Italy.
    Nattino, Giuseppe
    ASST Lecco Osped A Manzoni, Rianimaz Gen, Lecce, Italy.
    Pedeferri, Matteo
    Presidio Osped S Leopoldo Mand, Rianimaz, AO Prov Lecco, Merate, Italy.
    Boscolo, Annalisa
    Azienda Osped Padova, Giustiniani I & II Istar, Padua, Italy.
    Rossi, Simona
    Azienda Osped G Salvini, Presidio Osped Rho, Serv Anestesia Rianimaz, Rhod, Italy.
    Calicchio, Giuseppe
    Azienda Osped Univ San Giovanni Dio & Ruggi Arago, Ctr Rianimaz, Salerno, Italy.
    Cubattoli, Lucia
    Azienda Osped Univ Senese, Rianimaz Gen, Siena, Italy.
    Di Lascio, Gabriella
    Azienda Osped Univ Careggi, Terapia Intens Emergenza, Florence, Italy.
    Barbagallo, Maria
    Azienda Osped Univ Parma, UO Anestesia Rianimaz Terapia Intens 2, Parma, Italy.
    Berruto, Francesco
    Osped E Agnelli, Rianimaz, Pinerolo, Italy.
    Codazzi, Daniela
    Fdn IRCCS Ist Nazl Tumori, Unita Terapia Intens, Milan, Italy.
    Bottazzi, Andrea
    Fdn IRCCS Policlin S Matteo, Rianimaz 2, Pavia, Italy.
    Fumagalli, Paolo
    Fdn Policlin San Matteo, Rianimaz 1, Pavia, Italy.
    Negro, Giancarlo
    Osped Francesco Ferrari, Anestesia & Rianimaz 1, Casarano, Italy.
    Lupi, Giuseppe
    Osped Maggiore, Serv Anestesia & Rianimaz, Cremona, Italy.
    Savelli, Flavia
    Osped Maurizio Bufalini, Anestesia & Rianimaz TI 2, Cesena, Italy.
    Vulcano, Giuseppe A.
    Osped Civile Nicola Giannettasio, Terapia Intens, Rossano, Italy.
    Fumagalli, Roberto
    Osped Niguarda Ca Granda, Anestesia & Rianimaz 1, Milan, Italy.
    Marudi, Andrea
    Nuovo Osped Civile St Agostino Estense, Rianimaz Neurorianimaz, Modena, Italy.
    Lefons, Ugo
    Osped Alta Val dElsa, Terapia Intens, Poggibonsi, Italy.
    Lembo, Rita
    Osped Castelli Verbania, Rianimaz Gen, Verbania, Italy.
    Babini, Maria
    Osped Civile Lugo, Serv Anestesia & Rianimaz, Lugo, Italy.
    Paggioro, Alessandra
    Osped Infermi Biella, ASL BI, Struttura Semplice Rianimaz & Terapia Intens, Biella, Italy.
    Parrini, Vieri
    Osped Mugello, Anestesia & Rianimaz, Borgo San Lorenzo, Italy.
    Zaccaria, Maria
    Osped Cirie, Rianimaz & Terapia Intens, Turin, Italy.
    Clementi, Stefano
    Osped Sesto San Giovanni, Terapia Intens Polivalente, Sesto San Giovanni, Italy.
    Gigliuto, Carmelo
    Azienda Osped Prov Pavia, Osped Vigevano, Rianimaz, Vigevano, Italy.
    Facondini, Francesca
    Osped Infermi, Reparto Rianimaz & Terapia Intens, Rimini, Italy.
    Pastorini, Simonetta
    Osped P Cosma AUSL 15 Alta Padovana, Serv Anestesia Rianimaz, Camposampiero, Italy.
    Munaron, Susanna
    Osped San Giacomo Augusta, Unita Terapia Intens, Castelfranco Veneto, Italy.
    Calamai, Italo
    Osped San Giuseppe, Rianimaz, Empoli, Italy.
    Bocchi, Anna
    Osped San Luca, Terapia Intens, Trecenta, Italy.
    Adorni, Adele
    Osped Valduce, Unita Terapia Intens Rianimatoria, Como, Italy.
    Bocci, Maria Grazia
    Policlin Agostino Gemelli, Ctr Rianimaz, Rome, Italy.
    Cortegiani, Andrea
    Univ Palermo, Unita Terapia Intens Polivalente, Policlin P Giaccone, Palermo, Italy.
    Casalicchio, Tiziana
    Osped San Giovanni Bosco, Terapia Intens, Turin, Italy.
    Mellea, Serena
    Osped Santa Maria Misericordia, Unita Terapia Intens, Perugia, Italy.
    Graziani, Elia
    Santa Maria Croci, Unita Operat Anestesia & Rianimaz, Ravenna, Italy.
    Barattini, Massimo
    Osped Santa Maria Nuova, Rianimaz, Florence, Italy.
    Brizio, Elisabetta
    Osped SS Annunziata, Serv Rianimaz, Taranto, Italy.
    Rossi, Maurizio
    Azienda Osped St Anna Como Presidio Menaggio, UO Anestesia & Rianimaz, Menaggio, Italy.
    Hahn, Michael
    Haugesund Hosp, ICU, Haugesund, Norway.
    Kemmerer, Nicolai
    Kongsberg Hosp, ICU, Kongsberg, Norway.
    Strietzel, Hans Frank
    Kristiansund Hosp, ICU, Kristiansand, Norway.
    Dybwik, Knut
    Nordlandssykehuset Bodo, ICU, Bodo, Norway.
    Legernaes, Terje
    Hamar Hosp, ICU, Hamar, Norway.
    Klepstad, Pal
    St Olavs Univ Hosp, Dept Intens Care Med, Trondheim, Norway.
    Olaussen, Even Braut
    Stavanger Univ Hosp, ICU, Stavanger, Norway.
    Olsen, Knut Inge
    Namsos Hosp, ICU, Namsos, Norway.
    Brresen, Ole Marius
    Telemark Hosp, ICU, Skien, Norway.
    Bjorsvik, Geir
    Univ Hosp Tromso, ICU, Tromso, Norway.
    Maini, Sameer
    Alesund Hosp, Med ICU, Alesund, Norway.
    Fehrle, Lutz
    Molde Hosp, ICU, Molde, Norway.
    Czuczwar, Miroslaw
    First Publ Teaching Hosp Lublin, ICU, Lublin, Poland.
    Krawczyk, Pawel
    Univ Hosp Krakow, ICU, Krakow, Poland.
    Zietkiewicz, Miroslaw
    John Paul II Hosp Krakow, Resp & Thorac Surg ICU, Krakow, Poland.
    Nowak, Lukasz R.
    Oncol Krakow Branch, Dept Anaesthesiol & Intens Care, Maria Sklodowska Curie Memo Rial Inst, Krakow, Poland.
    Kotfis, Katarzyna
    Pomeranian Med Univ, Dept Anaesthesia Intens Care & Acute Poisonin, Teaching Hosp 2, Szczecin, Poland.
    Cwyl, Katarzyna
    RCZ Lublin, ICU, Lublin, Poland.
    Gajdosz, Ryszard
    Scanmed St Raphael Hosp Krakow, Dept Anaesthesiol & Intens Care, Krakow, Poland.
    Biernawska, Jowita
    Pomeranian Med Univ, Dept Anaesthesiol & Intens Care, Teaching Hosp 1, Szczecin, Poland.
    Bohatyrewicz, Romuald
    Pomeranian Med Univ, Dept Anaesthesiol & Intens Care, Teaching Hosp 1, Szczecin, Poland.
    Gawda, Ryszard
    Univ Hosp Opole, Dept Anaesthesiol & Intens Care, Opole, Poland.
    Grudzien, Pawel
    Edward Szczekl Specialist Hosp Tarnow, ICU, Tarnow, Poland.
    Nasilowski, Pawel
    Gabriel Narutowicz Specialist Hosp Krakow, Dept Anaesthesiol & Intensive Care, Krakow, Poland.
    Popek, Natalia
    Stefan Zeromski Specialist Hosp Krakow, Dept Anaesthesiol & Intens Care, Krakow, Poland.
    Cyrankiewicz, Waldemar
    Antoni Jurasz Univ Hosp 1 Bydgoszcz, Dept Anaesthesiol & Intens Care, Bydgoszcz, Poland.
    Wawrzyniak, Katarzyna
    Antoni Jurasz Univ Hosp 1 Bydgoszcz, Dept Anaesthesiol & Intens Care, Bydgoszcz, Poland.
    Wnuk, Marek
    John Paul II Mem Hosp Belchatow, Dept Anaesthesiol & Intens Care, Belchatow, Poland.
    Maciejewski, Dariusz
    Prov Hosp Bielsko Biala, Dept Anaesthesiol & Intens Care, Bielsko Biala, Poland.
    Studzinska, Dorota
    St John Grande Hosp, Dept Anaesthesiol Ogy & Intens Care, Krakow, Poland.
    Zukowski, Maciej
    Pomeranian Med Univ, Dept Anaesthesiol Intens Care & Acute Poisoning, Teaching Hosp 2 Szczecin, Szczecin, Poland.
    Bernas, Szymon
    Dr Wladyslaw Bieganski Reg Specialist Hosp Lodz, Dept Anaesthesiol & Intens Therapy, Ctr Artificial Extracorporeal Kidney & Liver Supp, Lodz, Poland.
    Piechota, Mariusz
    Dr Wladyslaw Bieganski Reg Specialist Hosp Lodz, Dept Anaesthesiol & Intens Therapy, Ctr Artificial Extracorporeal Kidney & Liver Supp, Lodz, Poland;Ctr Artificial Extracorporeal Kidney & Liver Supp, Szczecin, Poland.
    Nowak, Ilona
    Univ Hosp Krakow, Dept Intens Care & Perioperat Med, Krakow, Poland.
    Fronczek, Jakub
    Univ Hosp Krakow, Dept Intens Care & Perioperat Med, Krakow, Poland.
    Serwa, Marta
    Med Univ Lodz, Univ Hosp, Lodz, Poland;Med Univ Lodz, Educ Ctr, Lodz, Poland.
    Machala, Waldemar
    Med Univ Lodz, Educ Ctr, Lodz, Poland;Med Univ Lodz, Dept Anaesthesiol & Intensive Care, Univ Hosp, Lodz, Poland.
    Stefaniak, Jan
    Univ Clin Ctr Gdansk, Dept Anaesthesiol & Intens Care, Gdansk, Poland.
    Wujtewicz, Maria
    Univ Clin Ctr Gdansk, Dept Anaesthesiol & Intens Care, Gdansk, Poland.
    Maciejewski, Pawel
    Orthoped Rehabil Univ Hosp Zakopane, Dept Anaesthesiol & Intens Care, Zakopane, Poland.
    Szymkowiak, Malgorzata
    Jozef Strus Hosp Poznan, Dept Anaesthesiol & Intens Care, Poznan, Poland.
    Adamik, Barbara
    Wroclaw Univ Hosp, Dept Anaesthesiol & Intens Care, Wroclaw, Poland.
    Catorze, Nuno
    CH Medio TEJO, UCIP, Tomar, Portugal.
    Branco, Miguel Castelo
    EPE, Ctr Hosp Cova Beira, Unidade Cuidados Intensivos, Covilha, Portugal.
    Barros, Ines
    Ctr Hosp Tondela Viseu, Unidade Cuidados Intensivos Polivalente, Viseu, Portugal.
    Barros, Nelson
    Ctr Hosp Tras os Montes & Alto Douro, Serv Med Intens, Vila Real, Portugal.
    Krystopchuk, Andriy
    Hosp Faro, Ctr Hosp Algarve, Intens Care & Emergency Dept, Faro, Portugal.
    Honrado, Teresa
    Hosp Sao Joao, Unidade Cuidados INtensivos Polivalente, Porto, Portugal.
    Sousa, Cristina
    Hosp Luz, UCI, Lisbon, Portugal.
    Munoz, Francisco
    Hosp SAMS, UMI, Lisbon, Portugal.
    Rebelo, Marta
    Hosp Egas Moniz, UCIP, Lisbon, Portugal.
    Gomes, Rui
    Hosp Garcia Orta, UCI, Almada, Portugal.
    Nunes, Jorge
    Hosp Lusiadas Lisboa, Unidade Cuidados Intensivos, Lisbon, Portugal.
    Dias, Celeste
    Hosp Lusiadas Lisboa, Unidade Cuidados Intensivos, Lisbon, Portugal.
    Fernandes, Ana Margarida
    Hosp S Jose CHLC EPE, UCI Neurocrit, Lisbon, Portugal.
    Petrisor, Cristina
    Clin Emergency Cty Hosp Cluj, Anaesthesia & Intensive Care 1, Cluj Napoca, Portugal.
    Constantin, Bodolea
    Municipal Hosp, ATI, Viana Do castelo, Portugal.
    Belskiy, Vladislav
    Privolzhskiy Dist Med Ctr, Dept Anesthesiol & Intens Care, Moscow, Russia.
    Boskholov, Boris
    Zhadkevich Clin Hosp, Dept Intens Care, Moscow, Russia.
    Rodriguez, Enver
    Gen Univ Castellon, UCI, Castellon De La Plana, Spain.
    Rebollo, Sergio
    HGU Santa Lucia, ICU, Murcia, Spain.
    Aguilar, Gerardo
    Hosp Clin Univ Valencia, Unidad Reanimac, Surg ICU, Valencia, Spain.
    Masdeu, Gaspar
    Hosp Tortosa Verge Cinta, Servei Med Intens, Tortosa, Spain.
    Irazabal Jaimes, Marian
    Hosp Gen Cataluna, Crit Care Unit, Barcelona, Spain.
    Prado Mira, Angela
    Hosp Gen Univ Albacete, Med Intens, Albacete, Spain.
    Bodi, Maria A.
    Hosp Univ Tarragona Joan XXIII, Gen ICU, Tarragona, Spain.
    Barea Mendoza, Jesus A.
    Hosp Univ 12 Octubre, Serv Med Intens, Madrid, Spain.
    Lopez-Cuenca, Sonia
    Hosp Univ Getafe, Serv Med Intens & Grandes Quemados, Getafe, Spain.
    Homez Guzman, Marcela
    Hosp Univ Henares, ICU, Coslada, Spain.
    Rico-Feijoo, Jesus
    Hosp Univ Rio Hortega Valladolid, Postoperat Crit Care Unit & Reanimat, Valladolid, Spain.
    Ibarz, Mercedes
    Hosp Univ Sagrad Corazon, ICU Hosp Univ Sagrad Corazon, Barcelona, Spain.
    Trenado Alvarez, Josep
    Hosp Univ Mutua Terassa, Intens Care Dept, UCI Semicrit, Terassa, Spain.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Sivik, Joakim
    Alingsas Lasarett, IVA Alingsas Lasarett, Alingsas, Sweden.
    Nauska, Jessica
    Blekingesjukhuset Karlskrona, Intensivvardsavdelning 31, Karlskrona, Sweden.
    Smole, Daniel
    Centralsjukhuset & Karlstad, IVA, Karlstad, Sweden.
    Parenmark, Fredric
    Gavle Sjukhus, IVA, Galve, Sweden.
    Lyren, Johanna
    Hudiksvalls Sjukhus, Intensivvardsavdelning, Gavleborg, Sweden.
    Rockstroh, Katalin
    Kalmar Lanssjukhus, IVA, Kalmar, Sweden.
    Ryden, Sara
    Karolinska Univ Hosp Huddinge, Karolinska ICU Huddinge, Huddinge, Sweden.
    Spangfors, Martin
    Intensiven, Kristianstad, Sweden.
    Strinnholm, Morten
    Kungalvs Hosp, ICU Kungalvs Hosp, Kungalv, Sweden.
    Walther, Sten
    Linkoping Univ Hosp, Cardiothorac ICU, Linkoping, Sweden.
    De Geer, Lina
    Linkoping Univ Hosp, ICU, Linkoping, Sweden.
    Nordlund, Peter
    Lanssjukhuset Ryhov, OP IVA Kliniken, Jonkoping, Sweden.
    Palsson, Staffan
    Intensivvardsavdelningen, Norrtalje, Sweden.
    Zetterquist, Harald
    Nykopings Lasarett, IVA, Nykoping, Sweden.
    Nilsson, Annika
    Ornskoldsviks Hosp, Ornskoldsv, IVA, Ornskoldsvik, Sweden.
    Thiringer, Karin
    Sahlgrenska Univ Hosp Molndal, IVA, Avdelning 227, Gothenburg, Sweden.
    Jungner, Marten
    Skane Univ Hosp, ICU SUS Malmo, Lund, Sweden.
    Bark, Bjorn
    Skane Univ Hosp, IVA Lund, Lund, Sweden.
    Nordling, Berit
    IVA Sundsvall, Sundsvall, Sweden.
    Skold, Hans
    Torsby Sjukhus, ICU, Torsby, Sweden.
    Brorsson, Camilla
    Univ Hosp Northern Sweden, CIP, Umea, Sweden.
    Persson, Stefan
    Univ Hosp Orebro, Intensivvarsdavdelningen USO, Orebro, Sweden.
    Bergstrom, Anna
    Vrinnevi Hosp, IVA Vrinnevisjukhuset, Norrkoping, Sweden.
    Berkius, Johan
    Vastervikssjukhus, IVA Vastervikssjukhus, Vastervik, Sweden.
    Holmstrom, Johanna
    Vastmanlands Sjukhus, Intensivvardsavdelningen Vasteras, Vasteras, Sweden.
    van Dijk, I
    Alrijne Ziekenhuis, Intens Care, Leiderdorp, Netherlands.
    van Lelyveld-Haas, L. E. M.
    Diakonessenhuis Utrecht, Intens Care, Utrecht, Netherlands.
    Ramnarain, D.
    Elisabeth Tweesteden Hosp Tilburg, Intens Care, Tilburg, Netherlands.
    Jansen, Tim
    HagaZiekenhuis, Intens Care, The Hague, Netherlands.
    Nooteboom, Fleur
    Laurentius Ziekenhuis, IC LZR, Roermond, Netherlands.
    van der Voort, Peter H. J.
    OLVG, ICU OLVG, Amsterdam, Netherlands.
    de Lange, Dylan
    UMC Utrecht, Dept Intens Care Med, Utrecht, Netherlands.
    Dieperink, Willem
    Univ Med Ctr Groningen, Dept Crit Care, Groningen, Netherlands.
    de Waard, Monique C.
    VU Univ Med Ctr Amsterdam, Intens Care Adults, Amsterdam, Netherlands.
    de Smet, Annemarie G. E.
    Univ Groningen, Univ Med Ctr, Intens Care Unit, Groningen, Netherlands.
    Bormans, Laura
    Zuyderland Med Centrer, Intens Care, Heerlen, Netherlands.
    Dormans, Tom
    Zuyderland Med Centrer, Intens Care, Heerlen, Netherlands.
    Dempsey, Ged
    Aintree Univ Hosp NHS Fdn Trust, Crit Care Unit, Liverpool, Merseyside, England.
    Mathew, Shiju J.
    Alexandra Hosp, ICU, Harlow, Essex, England.
    Raj, Ashok S.
    Batts Hlth NHS Trust, Whipps Cross Hosp, ICU, London, England.
    Grecu, Irina
    Basingstoke & North Hampshire Hosp, ITU HDU, Basingstoke, Hants, England;Royal Hampshire Cty Hosp, ICU, Winchester, Hants, England.
    Cupitt, Jason
    Blackpool Teaching Hosp NHS Fdn Trust, Crit Care Unit, Basingstoke, Hants, England.
    Lawton, Tom
    Bradford Royal Infirm, Crit Care Unit, Bradford, W Yorkshire, England.
    Clark, Richard
    Cent Manchester Fdn Trust, ICU, Manchester, Lancs, England.
    Popescu, Monica
    Chelsea & Westminster Fdn Trust, West Middlesex Univ Hosp, ICU, London, England.
    Spittle, Nick
    Chesterfield Royal Hosp, ICU, Calow, England.
    Faulkner, Maria
    Countess Chester Hosp NHS Fdn Trust, ICU, Chester, Cheshire, England.
    Cowton, Amanda
    Darlington Mem Hosp CDDFT, ICU, Darlington, Durham, England;Univ Hospl North Durham, ICU, Durham, England.
    Elloway, Esme
    Derriford Hosp, ICU, Plymouth, Devon, England.
    Williams, Patricia
    Dorset Cty Hosp, Crit Care Unit, Dorchester, England.
    Reay, Michael
    Russells Hall Hosp, Dudley Grp Hosp NHSFT, Dudley, England.
    Chukkambotla, Srikanth
    East Lancashire Hosp NHS Trust, Crit Care Unit, Burnley, Lancs, England.
    Kumar, Ravi
    East Surrey Hosp, CCU, Redhill, Surrey, England.
    Al-Subaie, Nawaf
    Espsom & St Helier Univ Hosp, ICU, Epsom, Surrey, England.
    Kent, Linda
    Fairfield Hosp, Crit Care Unit, Bury St Edmunds, Suffolk, England;Royal Oldham Hosp, ICU, Oldham, England.
    Tamm, Tiina
    Wexham Pk Hosp, Frimley Hlth, ICU, Slough, Berks, England.
    Kajtor, Istvan
    Frimley Pk Hosp, ICU, Frimley, England.
    Burns, Karen
    Furness Gen, ICU, Barrow In Furness, England.
    Pugh, Richard
    Glan Clwyd Gen Hosp, Crit Care Unit, Bodelwyddan, Wales.
    Ostermann, Marlies
    Guys & St Thomas Hosp, ICU, London, England.
    Kam, Elisa
    Hillingdon Hosp, ICU, Uxbridge, Middx, England.
    Bowyer, Helen
    Hinchingbrooke Healthcare NHS Trust, Crit Care Ctr, Huntingdon, England.
    Smith, Neil
    Hull Royal Infirm, HICU 1&2, Kingston Upon Hull, N Humberside, England.
    Templeton, Maie
    Imperial Coll Healthcare NHS Trust, Crit Care UNIT, London, England.
    Henning, Jeremy
    James Cook Univeristy Hosp, ICU 2 & 3, Middlesbrough, Cleveland, England.
    Goffin, Kelly
    James Paget Univ Hosp, ICU, Great Yarmouth, England.
    Kapoor, Ritoo
    Kent & Canterbury Hosp, K&C ITU, Canterbury, Kent, England.
    Laha, Shondipon
    Lancashire Leaching Hosp NHS Fdn Trust, CrCU, Preston, Lancs, England.
    Chilton, Phil
    Leighton Hosp, Crit Care Unit, Crewe, England.
    Khaliq, Waqas
    Lewisham & Greenwich NHS Trust, ITU HDU, London, England.
    Crayford, Alison
    ITU HDU, Maidstone, Kent, England.
    Coetzee, Samantha
    Medway NHS Fdn Trust, ICU, Gillingham, England.
    Tait, Moira
    Adult ICU, Musgrove Pk, Taunton, Somerset, England.
    Stoker, Wendy
    Northumbria Specialist Emergency Care Hosp, ICU, Cramlington, England.
    Gimenez, Marc
    Papworth Hosp NHS Fdn Trust, ICU, Cambridge, England.
    Pope, Alan
    Peterborough City Hosp, Crit Care Unit, Peterborough, Cambs, England.
    Camsooksai, Julie
    Poole Hosp NHS Trust, Crit Care Unit, Poole, Dorset, England.
    Pogson, David
    Queen Alexandra Hosp Portsmouth, Dept Crit Care, Portsmouth, Hants, England.
    Quigley, Kate
    Queen Elizabeth Hosp, ICU, Birmingham, W Midlands, England.
    Ritzema, Jenny
    Queen Elizabeth Hosp, Crit Care Dept, Gateshead, England.
    Hormis, Anil
    Rotherham NHS Fdn Trust, Crit Care Unit, Rotherham, S Yorkshire, England.
    Boulanger, Carole
    Royal Devon & Exeter NHS Fdn Trust, ICU, Exeter, Devon, England.
    Balasubramaniam, M.
    Royal Bolton NHS Hosp Trust, ICU & HCU, Farnworth, England.
    Vamplew, Luke
    Royal Bournemouth Hosp, Crit Care Unit, Bournemouth, Dorset, England.
    Burt, Karen
    Royal Cornwall Hosp NHS Trust, Crit Care Unit, Truro, England.
    Martin, Daniel
    Royal Free London NHS Fdn Trust, ICU, London, England.
    Craig, Jayne
    Royal Lancaster Infirm, ICU, Lancaster, England.
    Prowle, John
    Royal London Hosp, Adult Crit Care Unit, London, England.
    Doyle, Nanci
    Royal Surrey Cty Hosp, ICU, Guildford, Surrey, England.
    Shelton, Jonathon
    Royal Victoria Infirm, Ward 38 ICU, Newcastle Upon Tyne, Tyne & Wear, England.
    Scott, Carmen
    Royal Victoria Infirm, Ward 18 ICU, Newcastle Upon Tyne, Tyne & Wear, England.
    Donnison, Phil
    Salisbury Dist Hosp, ICU, Salisbury, Wilts, England.
    Shelton, Sarah
    Sherwood Forest Hosp NHS Fdn Trust, ICU, Sutton In Ashfield, England.
    Frey, Christian
    South Tyneside Dist Hosp, ITU HDU, South Shields, England.
    Ryan, Christine
    St George Hosp, GICU, London, England;St Georges Hosp NHS Trust London, Acute Dependency Unit, London, England.
    Spray, Dominic
    St George Hosp, Cardiothorac ICU, London, England.
    Barnes, Veronica
    St Georges Univ Hosp NHS Fdn Trust, Neuro ICU, London, England.
    Barnes, Kerry
    St Helier Hosp, ITU, Sutton, Surrey, England.
    Ridgway, Stephanie
    NHS Fdn Trust, Tameside Gen Hosp, Crit Care Unit, Ashton Under Lyne, England.
    Saha, Rajnish
    Princess Alexandra NHS Hosp, Crit Care Unit, Harlow, Essex, England.
    Clark, Thomas
    Torbay Hosp, ICU, Torquay, England.
    Wood, James
    Tunbridge Wells Hosp, ICU, Pembury, England.
    Bolger, Clare
    Univ Hosp Southampton NHS Fdn Trust, Gen Intens Care, Southampton, Hants, England.
    Bassford, Christopher
    Univ Hosp Coventry, Gen Crit Care, Coventry, W Midlands, England.
    Lewandowski, John
    Univ Hosp North Tees, Crit Care Unit, Stockton On Tees, England.
    Zhao, Xiaobei
    West Hertfortshire NHS Trust, Watford Gen Hosp, ICU, Level 6, Watford, England.
    Humphreys, Sally
    West Suffolk NHS Fdn Trust, Crit Care, Bury St Edmunds, Suffolk, England.
    Dowling, Susan
    Ward 4E Crit Care Unit, Whiston, England.
    Richardson, Neil
    William Harvey Hosp, ICU, Ashford, Kent, England.
    Burtenshaw, Andrew
    Worcestershire Royal Hosp, Crit Care Unit, Worcester, England.
    Stevenson, Carl
    Wye Valley NHS Trust, ICU, Hereford, England.
    Wilcock, Danielle
    York Teaching Hosp NHS Fdn Trust, Crit Care Unit, York, N Yorkshire, England.
    Nalapko, Yuiry
    Lugansk State Med Univ, Anaesthesia & Intens Care, Lugansk, Ukraine.
    A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention2019Ingår i: Journal of critical care, ISSN 0883-9441, E-ISSN 1557-8615, Vol. 52, s. 141-148Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.

    Methods: In total, 5063 VIPs were induded in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.

    Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 +/- 5 vs 7 +/- 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).

    Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery. 

  • 5.
    Kawati, R
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Rubertsson, S
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Malpositioning of fine bore feeding tube: a serious complication2005Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 49, nr 1, s. 58-61Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Feeding tubes are used frequently in the intensive care unit to provide enteral nutrition. For critically ill patients, enteral nutrition is preferable to parenteral in terms of cost, complication and gut mucosal maintenance. Fine bore feeding tubes are always preferred because their soft, flexible construction and narrow diameter enables these tubes to be well tolerated by patients and they rarely contribute to sinus infections or obstruction of breathing. On the other hand it is not uncommon that these tubes are misplaced in the tracheobronchial tree or the pleural cavity, especially in high-risk patients, i.e. sedated patients, patients with weak cough reflex, endotracheally intubated patients and agitated patients (1–3). Malpositioning in the peritoneal cavity or the mediastinum through gastric or esophageal perforation is also possible ( 1, 4–7); even intravascular ( 8, 9) and intracranial misplacement have been reported (10–13). The incidence of misplacement of a feeding tube is difficult to estimate because few studies have been performed. The largest study of 1100 such tubes revealed an overall malposition rate of 1.3% ( 1), but it should be mentioned that this study included only radiographically detected misplacements. Other researchers estimate the occurrence of accidental misplacement and migration out of position as high as 13% to 20% in high-risk patients ( 14, 15).

  • 6.
    Kawati, Rafael
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Covaciu, Lucian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Hypothermia after drowning in paediatric patients2009Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 80, nr 11, s. 1325-1326Artikel i tidskrift (Refereegranskat)
  • 7.
    Kawati, Rafael
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Brain death due to fat embolism - could moderate hypercapnia and prone position be blamed for the tonsillar herniation?2013Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 118, nr 4, s. 276-278Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fat embolism to the systemic circulation in polytrauma patients is very common. The fat embolism syndrome (FES), however, is a rare condition. We describe a case of traumatic femur fracture with FES that was presented as acute tonsillar herniation (coning) and brain death postoperatively. We believe that in this case the prone position and moderate hypercapnia contributed to the acute coning.

  • 8.
    Kawati, Rafael
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Lattuada, Marco
    Sjöstrand, Ulf
    Guttmann, Josef
    Hedenstierna, Göran
    Helmer, Alois
    Lichtwarck-Aschoff, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Peak airway pressure increase is late warning sign of partial endotracheal tube obstruction whereas change in expiratory flow is an early warning sign2005Ingår i: Anesthesia and Analgesia, Vol. 100, nr 3, s. 889-893Artikel i tidskrift (Refereegranskat)
  • 9.
    Kawati, Rafael
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Vimlati, Laszlo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Guttmann, Josef
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Sjöstrand, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Schumann, Stefan
    Lichtwarck-Aschoff, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Change in expiratory flow detects partial endotracheal tube obstruction in pressure-controlled ventilation2006Ingår i: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 103, nr 3, s. 650-657Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Only extreme degrees of endotracheal tube (ETT) narrowing can be detected with monitoring of tidal volume (V-T) during pressure-controlled ventilation (PCV). To assess the degree of ETT obstruction in PCV and to compare it to V,, monitoring, we produced 3 levels of partial ETT obstruction in 11 healthy anesthetized piglets using ETTs of 4 different inner diameters (IDs 9.0, 8.0, 7.0, and 6.0 mm). An expiratory flow over volume (<(V)over dot >(e)-V) curve was plotted and the time constant (tau(e)) at 15% of expiration time (T-e) was calculated. We also calculated the fractional volume expired during the first 15% of T-e (V-ex (fract, 15)) and compared those variables to full expiratory V, for each of the 3 obstructions. V-T monitoring failed to detect ETT narrowing. By contrast, V-ex (fract,15) decreased and tau(e)e increased significantly with increasing ETT narrowing (for IDs 9.0, 8.0, 7.0, and 6.0, mean V-ex (fract,15) was 195, 180, 146, and 134 mL respectively and mean tau(e) was 380, 491, 635, 794 ms for IDs 9.0, 8.0, 7.0, and 6.0 respectively). We conclude that when the elastic recoil that drives <(V)over dot >(e) is appropriately considered, analysis of <(V)over dot >(e) and V-ex (fract,15) detects partial ETT obstruction during PCV.

  • 10.
    Kawati, Rafael
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Vimlati, Laszlo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Sjöstrand, Ulf
    Hedenstierna, Göran
    Guttmann, Josef
    Lichtwarck-Aschoff, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Change in expiratory flow can early detect partial endotracheal tube obstruction in pressure controlled ventilationArtikel i tidskrift (Refereegranskat)
  • 11.
    Lichtwarck-Aschoff, Michael
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Helmer, Alois
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Lattuada, Marco
    Sjöstrand, Ulf
    Zugel, N
    Guttmann, Josef
    Hedenstierna, Göran
    Good short-term agreement between measured and calculated tracheal pressure2003Ingår i: British Journal of Anaesthesia, Vol. 91, nr 3, s. 239-248Artikel i tidskrift (Refereegranskat)
  • 12.
    Lichtwarck-Aschoff, Michael
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Suki, Bela
    Hedlund, Anders
    Sjöstrand, Ulf
    Markström, Agneta
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Hedenstierna, Göran
    Guttmann, Josef
    cardiogenic oscillations reflects decreasing compliance of the respiratory system during long-term ventilation2004Ingår i: Journal of Applied physiology, Vol. 96, nr 3, s. 879-884Artikel i tidskrift (Refereegranskat)
  • 13.
    Lichtwarck-Aschoff, Michael
    et al.
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Suki, Bela
    Hedlund, Anders
    Sjöstrand, Ulf
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Markström, Agneta
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Kawati, Rafael
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Hedenstierna, Göran
    Institutionen för medicinska vetenskaper.
    Guttmann, Josef
    Decreasing size of cardiogenic oscillations reflects decreasing compliance of the respiratory system during long-term ventilation.2004Ingår i: J Appl Physiol, ISSN 8750-7587, Vol. 96, nr 3, s. 879-84Artikel i tidskrift (Refereegranskat)
  • 14.
    Lipcsey, Miklós
    et al.
    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.
    Tenhunen, Jyrki
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Sjölin, Jan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionssjukdomar.
    Frithiof, Robert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Bendel, Stepani
    Kuopio Univ Hosp, Dept Intens Care, Kuopio, Finland..
    Flaatten, Hans
    UiB, Haukeland Univ Hosp, Dept Clin Med, Bergen, Norway..
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Kuitunen, Anne
    Tampere Univ Hosp, Crit Care Med Res Grp, POB 200033521, Tampere, Finland..
    Tonnessen, Tor Inge
    Oslo Univ Hosp, Div Emergencies & Crit Care, N-0450 Oslo, Norway.;Inst Clin Med, N-0450 Oslo, Norway..
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Abdominal Septic Shock - Endotoxin Adsorption Treatment (ASSET) - endotoxin removal in abdominal and urogenital septic shock with the Alteco (R) LPS Adsorber: study protocol for a double-blinded, randomized placebo-controlled trial2016Ingår i: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 17, artikel-id 587Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Severe sepsis and septic shock are common in intensive care and carry high mortality rates. In patients with Gram-negative infections, early and extensive removal of endotoxin may limit the inflammatory response that characterizes septic shock. The Alteco (R) LPS Adsorber (hereafter referred to cited as the lipopolysaccharide (LPS) Adsorber) can be used for endotoxin removal and attenuate the deleterious inflammatory and clinical responses seen in septic shock. Methods/design: The Abdominal Septic Shock - Endotoxin Adsorption Treatment (ASSET) trial is a pilot study investigating the feasibility and safety of LPS Adsorber therapy. This pilot, multicenter, stratified, parallel, double-blinded, randomized, phase IIa, feasibility clinical investigation will be performed in five Scandinavian intensive care units. Thirty-two subjects with early septic shock and organ failure, following adequate resuscitation, will be randomized to receive either: extracorporeal veno-venous hemoperfusion therapy with the LPS Adsorber or veno-venous hemoperfusion therapy with a placebo adsorber (without active LPS-binding peptide). Patients will be stratified by infection focus such that 20 subjects with an abdominal focus (stratum A) and 12 subjects with a urogenital focus (stratum B) will be included in a parallel design. Thereafter, an interim analysis will be performed and an additional 12 patients may be included in the study. The study is designed as adaptive a priori: the patients from this study can be included in a later phase IIb study. The aim of the study is to investigate the feasibility of LPS Adsorber therapy commenced early in the time-course of septic shock. The primary endpoint will be a characterization of all reported unanticipated serious adverse device effects and anticipated serious adverse device effects. Secondary outcomes are decrease in endotoxin plasma concentration, impact on clinical outcome measures and impact on inflammatory response by LPS Adsorber therapy, as well as detailed description of the relevant mediators bound to the LPS Adsorber. Recruitment of patients will start in September 2015. Discussion: The ASSET trial will give insight into the feasibility and safety of this LPS Adsorber therapy and preliminary data on its potential clinical effects in septic shock. Moreover, this pilot trial will provide with necessary data for designing future studies.

  • 15.
    Perchiazzi, Gaetano
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Höstman, Staffan
    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.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    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.
    Tham Administration Reduces Pulmonary Carbon Dioxide Elimination, Causing Rebound In Arterial Carbon Dioxide Tension: An Experimental Study In Hypoventilated Pigs2017Ingår i: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 195, artikel-id A7518Artikel i tidskrift (Övrigt vetenskapligt)
  • 16.
    Schumann, S.
    et al.
    Univ Freiburg, Fac Med, Med Ctr, Dept Anesthesiol & Crit Care, Freiburg, Germany.
    Vimlati, Laszlo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Guttmann, J.
    Univ Freiburg, Fac Med, Med Ctr, Dept Anesthesiol & Crit Care, Freiburg, Germany.
    Lichtwarck-Aschoff, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Cardiogenic oscillations to detect intratidal derecruitment and overdistension in a porcine model of healthy and atelectatic lungs2018Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 121, nr 4, s. 928-935Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Low positive end-expiratory pressure (PEEP) can result in alveolar derecruitment, and high PEEP or high tidal volume (V-T) in lung overdistension. We investigated cardiogenic oscillations (COS) in the airway pressure signal to investigate whether these oscillations can assess unfavourable intratidal events. COS induce short instantaneous compliance increases within the pressure-volume curve, and consequently in the compliance-volume curve. We hypothesised that increases in COS-induced compliance reflect non-linear intratidal respiratory system mechanics. Methods: In mechanically ventilated anaesthetised pigs with healthy (n = 13) or atelectatic (n = 12) lungs, pressure-volume relationships and the ECG were acquired at a PEEP of 0, 5, 10, and 15 cm H2O. During inspiration, the peak compliance of successive COS (C-COS) was compared with intratidal respiratory system compliance (C-RS) within incremental volume steps up to the full V-T of 12 ml kg(-1). We analysed whether C-COS variation corresponded with systolic arterial pressure variation. Results: C-COS-volume curves showed characteristic intratidal patterns depending on the PEEP level and on atelectasis. Increasing C-RS- or C-COS-volume patterns were associated with intratidal derecruitment with low PEEP, and decreasing patterns above 6 ml kg(-1) and high PEEP showed overdistension. C-COS was not associated with systolic arterial pressure variations. Conclusions: Heartbeat-induced oscillations within the course of the inspiratory pressure-volume curve reflect nonlinear intratidal respiratory system mechanics. The analysis of these cardiogenic oscillations can be used to detect intratidal derecruitment and overdistension and, hence, to guide PEEP and V-T settings that are optimal for respiratory system mechanics.

  • 17. Schumann, Stefan
    et al.
    Vimlati, Laszlo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Guttmann, Josef
    Lichtwarck-Aschoff, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Analysis of Dynamic Intratidal Compliance in a Lung Collapse Model2011Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 114, nr 5, s. 1111-1117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: For mechanical ventilation to be lung-protective, an accepted suggestion is to place the tidal volume (V-T) between the lower and upper inflection point of the airway pressure-volume relation. The drawback of this approach is, however, that the pressure-volume relation is assessed under quasistatic, no-flow conditions, which the lungs never experience during ventilation. Intratidal nonlinearity must be assessed under real (i.e., dynamic) conditions. With the dynamic gliding-SLICE technique that generates a high-resolution description of intratidal mechanics, the current study analyzed the profile of the compliance of the respiratory system (C-RS).

    Methods: In 12 anesthetized piglets with lung collapse, the pressure-volume relation was acquired at different levels of positive end-expiratory pressure (PEEP: 0, 5, 10, and 15 cm H2O). Lung collapse was assessed by computed tomography and the intratidal course of C-RS using the gliding-SLICE method.

    Results: Depending on PEEP, C-RS showed characteristic profiles. With low PEEP, C-RS increased up to 20% above the compliance at early inspiration, suggesting intratidal recruitment; whereas a profile of decreasing C-RS, signaling overdistension, occurred with V-T > 5 ml/kg and high PEEP levels. At the highest volume range, C-RS was up to 60% less than the maximum. With PEEP 10 cm H2O, C-RS was high and did not decrease before 5 ml/kg V-T was delivered.

    Conclusions: The profile of dynamic C-RS reflects nonlinear intratidal mechanics of the respiratory system. The SLICE analysis has the potential to detect intratidal recruitment and overdistension. This might help in finding a combination of PEEP and V-T level that is protective from a lung-mechanics perspective.

  • 18.
    Vimlati, Laszlo
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Kawati, Rafael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Lichtwarck-Aschoff, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Spontaneous Breathing Improves Shunt Fraction and Oxygenation in Comparison with Controlled Ventilation at a Similar Amount of Lung Collapse2011Ingår i: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 113, nr 5, s. 1089-1095Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Spontaneous breathing (SB), when allowed during mechanical ventilation (MV), improves oxygenation in different models of acute lung injury. However, it is not known whether oxygenation is improved during mechanically unsupported SB. Therefore, we compared SB without any support with controlled MV at identical tidal volume (V(T)) and respiratory rate (RR) without positive end-expiratory pressure in a porcine lung collapse model.

    METHODS: In 25 anesthetized piglets, stable lung collapse was induced by application of negative pressure, and animals were randomized to either resume SB or to be kept on MV at identical VT (5 mL/kg; 95% confidence interval: 3.8 to 6.4) and RR (65 per minute [57 to 73]) as had been measured during an initial SB period. Oxygenation was assessed by blood gas analysis (n = 15) completed by multiple inert gas elimination technique (n = 8 of the 15) for shunt measurement. In addition, possible lung recruitment was studied with computed tomography of the chest (n = 10).

    RESULTS: After induction of lung collapse, PaO(2)/FIO(2) decreased to 90 mm Hg (76 to 103). With SB, PaO(2)/FIO(2) increased to 235 mm Hg (177 to 293) within 15 minutes, whereas MV at identical VT and RR did not cause any improvement in oxygenation. Intrapulmonary shunt by 45 minutes after induction of lung collapse was lower during SB (SB: 27% [24 to 30] versus MV: 41% [28 to 55]; P = 0.017). Neither SB nor MV reduced collapsed lung areas on computed tomography.

    CONCLUSIONS: SB without any support improves oxygenation and reduces shunt in comparison with MV at identical settings. This seems to be achieved without any major signs of recruitment of collapsed lung regions.

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