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  • 1.
    Drevhammar, Thomas
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Ostersund Hosp, Dept Anaesthesiol, S-83183 Ostersund, Sweden..
    Nilsson, Kjell
    Ventinvent AB, Ostersund, Sweden..
    Zetterstrom, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Jonsson, Baldvin
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Seven Ventilators Challenged With Leaks During Neonatal Nasal CPAP: An Experimental Pilot Study2015In: Respiratory care, ISSN 0020-1324, E-ISSN 1943-3654, Vol. 60, no 7, p. 1000-1006Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nasal CPAP is the most common respiratory support for neonates. Several factors are considered important for effective treatment, including leaks at the patient interface and the delivery of pressure-stable CPAP. Investigations of pressure stability during leaks should include both the change in the mean delivered CPAP and the pressure variation during each breath. The aim of this study was to examine the response of ventilators delivering nasal CPAP when challenged with leaks at the patient interface. METHODS: Seven ventilators providing nasal CPAP at 4 cmH(2)O were challenged with leaks during simulated neonatal breathing. Leak was applied for 15 consecutive breaths at a constant level (1-4 L/min). RESULTS: The 2 aspects of pressure stability were evaluated by measuring the mean delivered CPAP and the amplitude of pressure swings before, during, and after leaks. The ability to maintain the delivered CPAP and the amplitude of pressure swings varied greatly among the 7 ventilators before, during, and after leaks. Four of the ventilators tested have built-in leak compensation. CONCLUSIONS: There was no simple relationship between maintaining delivered CPAP during leaks and providing CPAP with low pressure swing amplitude. Maintaining the delivered CPAP and providing this without pressure swings are 2 separate aspects of pressure stability, and investigations concerning the clinical importance of pressure stability should address both aspects. This study also shows that compensation for leaks does not necessarily provide pressure-stable CPAP.

  • 2. Drevhammar, Thomas
    et al.
    Nilsson, Kjell
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Jonsson, Baldvin
    Comparison of Nasal Continuous Positive Airway Pressure Delivered by Seven Ventilators Using Simulated Neonatal Breathing2013In: Pediatric Critical Care Medicine, ISSN 1529-7535, E-ISSN 1947-3893, Vol. 14, no 4, p. E196-E201Article in journal (Refereed)
    Abstract [en]

    Objectives: Nasal continuous positive airway pressure (NCPAP) is an established treatment for respiratory distress in neonates. Most modern ventilators are able to provide NCPAP. There have been no large studies examining the properties of NCPAP delivered by ventilators. The aim of this study was to compare pressure stability and imposed work of breathing (iWOB) for NCPAP delivered by ventilators using simulated neonatal breathing. Design: Experimental in vitro study. Setting: Research laboratory in Sweden. Intervention: None. Measurements and Main Results: Neonatal breathing was simulated using a mechanical lung simulator. Seven ventilators were tested at different CPAP levels using two breath profiles. Pressure stability and iWOB were determined. Results from three ventilators revealed that they provided a slight pressure support. For these ventilators, iWOB could not be calculated. There were large differences in pressure stability and iWOB between the tested ventilators. For simulations using the 3.4-kg breath profile, the pressure swings around the mean pressure were more than five times greater, and iWOB more than four times higher, for the system with the highest measured values compared with the system with the lowest. Overall, the Fabian ventilator was the most pressure stable system. Evita XL and SERVO-i were found more pressure stable than Fabian in some simulations. The results for iWOB were in accordance with pressure stability for systems that allowed determination of this variable. Conclusions: Some of the tested ventilators unexpectedly provided a minor degree of pressure support. In terms of pressure stability, we have not found any advantages of ventilators as a group compared with Bubble CPAP, Neopuff, and variable flow generators that were tested in our previous study. The variation between individual systems is great within both categories. The clinical importance of these findings needs further investigation.

  • 3. Drevhammar, Thomas
    et al.
    Nilsson, Kjell
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Jonsson, Baldvin
    Comparison of seven infant continuous positive airway pressure systems using simulated neonatal breathing2012In: Pediatric Critical Care Medicine, ISSN 1529-7535, E-ISSN 1947-3893, Vol. 13, no 2, p. E113-E119Article in journal (Refereed)
    Abstract [en]

    Objective: Continuous positive airway pressure is an established treatment for respiratory distress in neonates. Continuous positive airway pressure has been applied to infants using an array of devices. The aim of this experimental study was to investigate the characteristics of seven continuous positive airway pressure systems using simulated breath profiles from newborns. Design: Experimental in vitro study. Setting: Research laboratory in Sweden. Intervention: None. Measurements and Main Results: In vitro simulation of spontaneous neonatal breathing was achieved with a mechanical lung model. Simulation included two breath profiles, three levels of continuous positive airway pressure with and without short binasal prongs and different levels of constant leak. Pressure stability and imposed work of breathing were determined. Seven continuous positive airway pressure systems were tested. There were large differences in pressure stability and imposed work of breathing between tested continuous positive airway pressure systems. Neopuff and Medijet had the highest pressure instability and imposed work of breathing. Benveniste, Hamilton Universal (Arabella), and Bubble continuous positive airway pressure showed intermediate results. AirLife and Infant Flow had the lowest pressure instability and imposed work of breathing. AirLife and Infant Flow showed the least decrease in delivered pressure when challenged with constant leak. Conclusion: The seven tested continuous positive airway pressure systems showed large variations in pressure stability and imposed work of breathing. They also showed large differences in how well they maintain continuous positive airway pressure when exposed to leak. For most systems, imposed work of breathing increased with increasing continuous positive airway pressure level. The clinical importance of the difference in pressure stability is uncertain. Our results may facilitate the design of clinical studies examining the effect of pressure stability on outcome. 

  • 4.
    Edmark, Lennart
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Östberg, Erland
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Scheer, H
    Wallquist, W
    Hedenstierna, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Preserved oxygenation in obese patients receiving protective ventilation during laparoscopic surgery: a randomized controlled study2016In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 1, p. 26-35Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Venous admixture from atelectasis and airway closure impedes oxygenation during general anaesthesia. We tested the hypothesis that continuous positive airway pressure (CPAP) during pre-oxygenation and reduced fraction of inspiratory oxygen (FIO2 ) during emergence from anaesthesia can improve oxygenation in patients with obesity undergoing laparoscopic surgery.

    METHODS: In the intervention group (n = 20, median BMI 41.9), a CPAP of 10 cmH2 O was used during pre-oxygenation and induction of anaesthesia, but no CPAP was used in the control group (n = 20, median BMI 38.1). During anaesthesia, all patients were ventilated in volume-controlled mode with an FIO2 of 0.4 and a positive end-expiratory pressure (PEEP) of 10 cmH2 O. During emergence, before extubation, the control group was given an FIO2 of 1.0 and the intervention group was divided into two subgroups, which were given an FIO2 of 1.0 or 0.31. Oxygenation was assessed perioperatively by the estimated venous admixture (EVA).

    RESULTS: The median EVA before pre-oxygenation was about 8% in both groups. During anaesthesia after intubation, the median EVA was 8.2% in the intervention vs. 13.2% in the control group (P = 0.048). After CO2 pneumoperitoneum, the median EVA was 8.4% in the intervention vs. 9.9% in the control group (P > 0.05). One hour post-operatively, oxygenation had deteriorated in patients given an FIO2 of 1.0 during emergence but not in patients given an FIO2 of 0.31.

    CONCLUSIONS: A CPAP of 10 cmH2 O during pre-oxygenation and induction, followed by PEEP after intubation, seemed to preserve oxygenation during anaesthesia. Post-operative oxygenation depended on the FIO2 used during emergence.

  • 5. Johansson, Joakim
    et al.
    Sjöberg, Jonas
    Nordgren, Marie
    Sandstrom, Erik
    Sjöberg, Folke
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Prehospital analgesia using nasal administration of S-ketamine: a case series2013In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, article id 38Article in journal (Refereed)
    Abstract [en]

    Pain is a problem that often has to be addressed in the prehospital setting. The delivery of analgesia may sometimes prove challenging due to problems establishing intravenous access or a harsh winter environment. To solve the problem of intravenous access, intranasal administration of drugs is used in some settings. In cases where vascular access was foreseen or proved hard to establish (one or two missed attempts) on the scene of the accident we use nasally administered S-Ketamine for prehospital analgesia. Here we describe the use of nasally administered S-Ketamine in 9 cases. The doses used were in the range of 0,45-1,25 mg/kg. 8 patients were treated in outdoor winter-conditions in Sweden. 1 patient was treated indoor. VAS-score decreased from a median of 10 (interquartile range 8-10) to 3 (interquartile range 2-4). Nasally administered S-Ketamine offers a possible last resource to be used in cases where establishing vascular access is difficult or impossible. Side-effects in these 9 cases were few and non serious. Nasally administered drugs offer a needleless approach that is advantageous for the patient as well as for health personnel in especially challenging selected cases. Nasal as opposed to intravenous analgesia may reduce the time spent on the scene of the accident and most likely reduces the need to expose the patient to the environment in especially challenging cases of prehospital analgesia. Nasal administration of S-ketamine is off label and as such we only use it as a last resource and propose that the effect and safety of the treatment should be further studied.

  • 6. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Calculation of end-tidal carbon dioxide fractions in the Bain system1989In: Acta Anaesthesiologica Scandinavica, Vol. 33, p. 71-74Article in journal (Refereed)
  • 7. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Flow pattern and respiratory charac­teristics during halothane anaesthesia1985In: Acta Anaesthesiologica Scandinavica, Vol. 29, p. 309-314Article in journal (Refereed)
  • 8. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Fresh gas flow in coaxial Mapleson A and D circuits during spontaneous breating1986In: Acta Anaesthesiologica Scandinavica, Vol. 30, p. 588-593Article in journal (Refereed)
  • 9. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Influence of the respiratory flow pattern on rebreathing in Mapleson A and D circuits1987In: Acta Anaesthesiologica Scandinavica, Vol. 31, p. 174-178Article in journal (Refereed)
  • 10. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Rebreathing, resistance and external work of breathing in three different coaxial Mapleson D systems1989In: Acta Anaesthesiologica Scandinavica, Vol. 33, p. 66-70Article in journal (Refereed)
  • 11. Jonsson, Lars O
    et al.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Johansson, S L G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Rebreathing and ventilatory response to different fresh gas flows in the Bain and Lack systems: A clinical study1989In: Acta Anaesthesiologica Scandinavica, Vol. 33, p. 71-74Article in journal (Refereed)
  • 12. Moa, Gunnar
    et al.
    Nilsson, Kjell
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Jonsson, Lars O
    A new device för administration of nasal CPAP in the newborn1988In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 16, p. 1238-1242Article in journal (Refereed)
  • 13. Moa, Gunnar
    et al.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Sublingual buprenorphin as postoperative analgesic - a double blind comparison with pethidine1990In: Acta Anaesthesiologica Scandinavica, Vol. 34, p. 69-71Article in journal (Refereed)
  • 14. Nordin, P
    et al.
    Zetterstrom, Henrik
    Gunnarsson, U
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Nilsson, E
    Local, regional, or general anaesthesia in groin hernia repair:multicentre randomised trial.2003In: Lancet, Vol. 362, p. 853-Article in journal (Refereed)
  • 15. Nordin, P
    et al.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Carlsson, P
    Nilsson, E
    Cost-effectiveness analysis of local, regional, or general anaesthesia for inguinal hernia repair using data from a randomized clinical trial2007In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 94, p. 500-505Article in journal (Refereed)
  • 16. Schollin Borg, M
    et al.
    Nordin, P
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Johansson, J
    Blood lactate is a useful indicator for the Medical Emergency Team2016In: Critical Care Research and Practice, ISSN 2090-1305, E-ISSN 2090-1313, article id 5765202Article in journal (Refereed)
    Abstract [en]

    Lactate has been thoroughly studied and found useful for stratification of patients with sepsis, in the Intensive Care Unit, and trauma care. However, little is known about lactate as a risk-stratification marker in the Medical Emergency Team- (MET-) call setting. We aimed to determine whether the arterial blood lactate level at the time of a MET-call is associated with increased 30-day mortality. This is an observational study on a prospectively gathered cohort at a regional secondary referral hospital. All MET-calls during the two-year study period were eligible. Beside blood lactate, age and vital signs were registered at the call. Among the 211 calls included, there were 64 deaths (30.3%). Median lactate concentration at the time of the MET-call was 1.82 mmol/L (IQR 1.16–2.7). We found differences between survivors and nonsurvivors for lactate and oxygen saturation, a trend for age, but no significant correlations between mortality and systolic blood pressure, respiratory rate, and heart rate. As compared to normal lactate (<2.44 mmol/L), OR for 30-day mortality was 3.54 (p < 0.0006) for lactate 2.44–5.0 mmol/L and 4.45 (p < 0.0016) for lactate > 5.0 mmol/L. The present results support that immediate measurement of blood lactate in MET call patients is a useful tool in the judgment of illness severity.

  • 17. Stenqvist, Ola
    et al.
    Hallén, Börje
    Lennmarken, Claes
    Lindahl, Sten
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Guidelines for increased safety in anaesthesiology1991In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 88, p. 242-243Article in journal (Refereed)
  • 18. Westling, Folke
    et al.
    Milsom, F
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Ekström-Jodal, B
    Effects of nitrous oxide/oxygen inhalation on the maternal circulation during vaginal delivery1992In: Acta Anaesthesiologica Scandinavica, Vol. 36, p. 171-181Article in journal (Refereed)
  • 19.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    A slide-rule for assessment of venous admixture1989In: Acta Anaesthesiologica Scandinavica, Vol. 33, p. 250-254Article in journal (Refereed)
  • 20.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Albumin treatment following major surgery: II. Effects on postoperative lung function and circulatory adaptation1981In: Acta Anaesthesiologica Scandinavica, Vol. 25, p. 133-141Article in journal (Refereed)
  • 21.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Assessment of the efficiency of pulmonary oxygenation. The choice of oxygenation index1989In: Acta Anaesthesiologica Scandinavica, Vol. 33, p. 66-70Article in journal (Refereed)
  • 22.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Att välja anestesiform2016In: Anestesi / [ed] Sten Lindahl, Ola Winsö och Jonas Åkeson, Liber, 2016, 3, p. 249-258Chapter in book (Other academic)
  • 23.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Dokumentation2005In: Anestesi / [ed] Halldin M A B, Lindahl G E, Liber , 2005, 2, p. 330-340Chapter in book (Other academic)
  • 24.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Helicopters in health care – experiences and views from Jämtland1984In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 81, p. 1432-1436Article in journal (Refereed)
  • 25.
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Letter to the editor: Who needs the Respiratory Index/Pulmonary shunt relationship?1990Other (Refereed)
  • 26.
    Zetterström, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Artursson, Gösta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Plasma oncotic pressure and plasma protein concentration in patients following thermal injury1980In: Acta Anaesthesiologica Scandinavica, ISSN ISSN 0001-5172, Vol. 24, p. 288-294Article in journal (Refereed)
  • 27.
    Zetterström, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hedstrand, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Albumin treatment following major sur­gery: I. Effects on plasma oncotic pressure, renal function and periferal oedema1981In: Acta Anaesthesiologica Scandinavica, Vol. 25, p. 125-132Article in journal (Refereed)
  • 28.
    Zetterström, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Högman, C F
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hedlund, K
    Clinical usefulness of red cells preserved in protein-poor media1978In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, ISSN ISSN 0028-4793, Vol. 299, p. 1377-1382Article in journal (Refereed)
  • 29.
    Zetterström, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Jakobson, Sven
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Janerås, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Influence of plasma oncotic pressure on lung water accumulation and gas exchange after experimental lung injury in the pig1981In: Acta Anaesthesiologica Scandinavica, Vol. 25, p. 117-124Article in journal (Refereed)
  • 30.
    Zetterström, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Jakobson, Sven
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Lörelius, L-E
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Assessment of lung water content by roentgen videodensitometry1984In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 12, p. 457-460Article in journal (Refereed)
  • 31.
    Zetterström, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Jonsson, Lars O
    Pressure characteristics of the Ambu CPAP system and  the Servo ventilator 900C  in CPAP mode1987In: Acta Anaesthesiologica Scandinavica, Vol. 31, p. 104-110Article in journal (Refereed)
  • 32.
    Zetterström, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Jonsson, Lars O
    Kronander, H
    Simulated spontaneous breathing. A new lung model for testing anaesthetic circuits1985In: Acta Anaesthesiologica Scandinavica, Vol. 29, p. 265-268Article in journal (Refereed)
  • 33.
    Zetterström, Henrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Wiklund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    A new nomogram facilitating adequate haemodilution1986In: Acta Anaesthesiologica Scandinavica, Vol. 30, p. 300-304Article in journal (Refereed)
  • 34.
    Östberg, Erland
    et al.
    Västerås & Koping Hosp, Dept Anaesthesia & Intens Care, Västerås, Sweden..
    Auner, Udo
    Vasteras Hosp, Dept Radiol, Västerås, Sweden..
    Enlund, Mats
    Clin Res Ctr, Västerås, Sweden..
    Zetterström, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Edmark, Lennart
    Västeras & Koping Hosp, Dept Anaesthesia & Intens Care, Västerås, Sweden..
    Minimizing atelectasis formation during general anaesthesia-oxygen washout is a non-essential supplement to PEEP2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 2, p. 92-98Article in journal (Refereed)
    Abstract [en]

    Background: Following preoxygenation and induction of anaesthesia, most patients develop atelectasis. We hypothesized that an immediate restoration to a low oxygen level in the alveoli would prevent atelectasis formation and improve oxygenation during the ensuing anaesthesia. Methods: We randomly assigned 24 patients to either a control group (n=12) or an intervention group (n=12) receiving an oxygen washout procedure directly after intubation. Both groups were, depending on body mass index, ventilated with a positive end-expiratory pressure (PEEP) of 6-8 cmH(2)O during surgery. The atelectasis area was studied by computed tomography before emergence. Oxygenation levels were evaluated by measuring blood gases and calculating estimated venous admixture (EVA). Results: The atelectasis areas expressed as percentages of the total lung area were 2.0 (1.5-2.7) (median [interquartile range]) and 1.8 (1.4-3.3) in the intervention and control groups, respectively. The difference was non-significant, and also oxygenation was similar between the two groups. Compared to oxygenation before the start of anaesthesia, oxygenation at the end of surgery was improved in the intervention group, mean (SD) EVA from 7.6% (6.6%) to 3.9% (2.9%) (P=.019) and preserved in the control group, mean (SD) EVA from 5.0% (5.3%) to 5.6% (7.1%) (P=.59). .Conclusion: Although the oxygen washout restored a low pulmonary oxygen level within minutes, it did not further reduce atelectasis size. Both study groups had small atelectasis and good oxygenation. These results suggest that a moderate PEEP alone is sufficient to minimize atelectasis and maintain oxygenation in healthy patients.

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