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  • 1.
    Adamski, Jan
    et al.
    Satakunta Dist Hosp, Dept Anaesthesia & Intens Care, Pori, Finland..
    Nowakowski, Piotr
    Czerniakowski Hosp, Dept Anaesthesiol & Intens Therapy, Warsaw, Poland..
    Gorynski, Pawel
    Ctr Monitoring Populat Hlth Status, Dept Hyg, Natl Inst Publ Hlth, Warsaw, Poland..
    Onichimowski, Dariusz
    Reg Specialist Hosp, Dept Anaesthesiol & Intens Therapy, Olsztyn, Poland..
    Weigl, Wojciech
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Incidence of in-hospital cardiac arrest in Poland2016In: ANAESTHESIOLOGY INTENSIVE THERAPY, ISSN 1642-5758, Vol. 48, no 5, p. 288-293Article in journal (Refereed)
    Abstract [en]

    Background: In-hospital cardiac arrest with its poor prognosis is a challenging problem in hospitals. The aim of this study was to evaluate in Polish hospitals the frequency of in-hospital cardiac arrests with the subsequent mortality, with special emphasis on the type of unit at which the event occurred, and the patient's demographic data, such as age and sex.

    Methods: The study was a retrospective analysis of data for 2012 registered in the Polish General Hospital Morbidity Study. This research covered all Polish hospitals, excluding only government and psychiatric hospitals. The study inclusion criterion was the incidence of cardiac arrest in any hospital ward, recorded by the respective ICD-10 diagnosis code.

    Results: Of the 7,775,553 patients hospitalized, the diagnosis of cardiac arrest was reported in a total of 22,602 patients, which included 22,317 adults (98.7% of all patients) and 285 children (1.3%). Overall mortality after cardiac arrest among adults was 74.2%, and in children 46.7%. In both absolute numbers and as percentages of all documented cases, cardiac arrests occurred most often at the departments of intensive care, internal medicine, cardiology and emergency medicine. The accompanying mortality was lower than average at the departments of intensive care, cardiology, cardiology high dependency unit and emergency medicine. The median age of patients with cardiac arrest who died in the hospital was higher than the median age of those who survived (72 vs. 64; P < 0.05). Although cardiac arrests were reported more often among men than women (58.2% vs. 41.8%; P < 0.001), the hospital mortality was higher among women (79.2% vs. 71.6%; P < 0.001).

    Conclusion: The frequency of in-hospital cardiac arrests in Polish hospitals and the subsequent mortality is not substantially different from that observed in other countries. However, our study, based on ICD-10 diagnosis codes, gives only limited information about the patients and circumstances of this event. An in-depth analysis of the causes, prognoses, and outcome of in-hospital cardiac arrests could be facilitated by the creation of a national registry.

  • 2.
    Gerega, A.
    et al.
    Polish Acad Sci, Inst Biocybernet & Biomed Engn, Dept Biophys Measurements & Imaging, Warsaw, Poland..
    Weigl, Wojciech
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Janusek, D.
    Polish Acad Sci, Inst Biocybernet & Biomed Engn, Dept Biophys Measurements & Imaging, Warsaw, Poland..
    Kacprzak, M.
    Polish Acad Sci, Inst Biocybernet & Biomed Engn, Dept Biophys Measurements & Imaging, Warsaw, Poland..
    Liebert, A.
    Polish Acad Sci, Inst Biocybernet & Biomed Engn, Dept Biophys Measurements & Imaging, Warsaw, Poland..
    Cerebral hemodynamic responses to hypocapnia and hypercapnia: Multiwavelength time-resolved studies2016In: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016, Vol. 36, no Suppl. 1, p. 765-765, article id 957Article in journal (Other academic)
  • 3.
    Gerega, Anna
    et al.
    Polish Acad Sci, Nalecz Inst Biocybemet & Biomed Engn, Trojdena 4, PL-02109 Warsaw, Poland.
    Milej, Daniel
    Polish Acad Sci, Nalecz Inst Biocybemet & Biomed Engn, Trojdena 4, PL-02109 Warsaw, Poland;Lawson Hlth Res Inst, Imaging Div, London, ON N61 4172, Canada;Western Univ, Dept Med Biophys, London, ON N6A 51, Canada.
    Weigl, Wojciech
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Kacprzak, Michal
    Polish Acad Sci, Nalecz Inst Biocybemet & Biomed Engn, Trojdena 4, PL-02109 Warsaw, Poland.
    Liebert, Adam
    Polish Acad Sci, Nalecz Inst Biocybemet & Biomed Engn, Trojdena 4, PL-02109 Warsaw, Poland.
    Multiwavelength time-resolved near-infrared spectroscopy of the adult head: assessment of intracerebral and extracerebral absorption changes2018In: Biomedical Optics Express, ISSN 2156-7085, E-ISSN 2156-7085, Vol. 9, no 7, p. 2974-2993Article in journal (Refereed)
    Abstract [en]

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

  • 4.
    Janusek, D.
    et al.
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland.
    Svehlikova, J.
    Slovak Acad Sci, Inst Measurement Sci, Bratislava, Slovakia.
    Zelinka, J.
    Slovak Acad Sci, Inst Measurement Sci, Bratislava, Slovakia.
    Weigl, Wojciech
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Zaczek, R.
    Med Univ Warsaw, Cent Clin Hosp, Dept Cardiol, Warsaw, Poland.
    Opolski, G.
    Med Univ Warsaw, Cent Clin Hosp, Dept Cardiol, Warsaw, Poland.
    Tysler, M.
    Slovak Acad Sci, Inst Measurement Sci, Bratislava, Slovakia.
    Maniewski, R.
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland.
    The roles of mid-myocardial and epicardial cells in T-wave alternans development: a simulation study2018In: Biomedical engineering online, ISSN 1475-925X, E-ISSN 1475-925X, Vol. 17, article id 57Article in journal (Refereed)
    Abstract [en]

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

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

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

  • 5.
    Kacprzak, Michal
    et al.
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Trojdena 4, PL-02109 Warsaw, Poland.
    Sawosz, Piotr
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Trojdena 4, PL-02109 Warsaw, Poland.
    Weigl, Wojciech
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Milej, Daniel
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Trojdena 4, PL-02109 Warsaw, Poland;Western Univ, Dept Med Biophys, London, ON N6A 5C1, Canada;Lawson Hlth Res Inst, Imaging Div, London, ON N6A 4V2, Canada.
    Gerega, Anna
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Trojdena 4, PL-02109 Warsaw, Poland.
    Liebert, Adam
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Trojdena 4, PL-02109 Warsaw, Poland.
    Frequency analysis of oscillations in cerebral hemodynamics measured by time domain near infrared spectroscopy2019In: Biomedical Optics Express, ISSN 2156-7085, E-ISSN 2156-7085, Vol. 10, no 2, p. 761-771Article in journal (Refereed)
    Abstract [en]

    In this paper, we propose the application of time-domain near-infrared spectroscopy to the assessment of oscillations in cerebral hemodynamics. These oscillations were observed in the statistical moments of the distributions of time of flight of photons (DTOFs) measured on the head. We analyzed the zeroth and second centralized moments of DTOFs (total number of photons and variance) to obtain their spectra to provide parameters for the frequency components of microcirculation, which differ between the extracerebral and intracerebral layers of the head. Analysis of these moments revealed statistically significant differences between a control group of healthy subjects and a group of patients with severe neurovascular disorders, which is a promising result for the assessment of cerebral microcirculation and cerebral autoregulation mechanisms.

  • 6.
    Milej, Daniel
    et al.
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, PL-02109 Warsaw, Poland..
    Janusek, Dariusz
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, PL-02109 Warsaw, Poland..
    Gerega, Anna
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, PL-02109 Warsaw, Poland..
    Wojtkiewicz, Stanislaw
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, PL-02109 Warsaw, Poland..
    Sawosz, Piotr
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, PL-02109 Warsaw, Poland..
    Treszczanowicz, Joanna
    Warsaw Praski Hosp, Dept Intens Care & Anesthesiol, PL-03401 Warsaw, Poland..
    Weigl, Wojciech
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Warsaw Praski Hosp, Dept Intens Care & Anesthesiol, PL-03401 Warsaw, Poland..
    Liebert, Adam
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, PL-02109 Warsaw, Poland..
    Optimization of the method for assessment of brain perfusion in humans using contrast-enhanced reflectometry: multidistance time-resolved measurements2015In: Journal of Biomedical Optics, ISSN 1083-3668, E-ISSN 1560-2281, Vol. 20, no 10, article id 106013Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to determine optimal measurement conditions for assessment of brain perfusion with the use of optical contrast agent and time-resolved diffuse reflectometry in the near-infrared wavelength range. The source-detector separation at which the distribution of time of flights (DTOF) of photons provided useful information on the inflow of the contrast agent to the intracerebral brain tissue compartments was determined. Series of Monte Carlo simulations was performed in which the inflow and washout of the dye in extra-and intracerebral tissue compartments was modeled and the DTOFs were obtained at different source-detector separations. Furthermore, tests on diffuse phantoms were carried out using a time-resolved setup allowing the measurement of DTOFs at 16 source-detector separations. Finally, the setup was applied in experiments carried out on the heads of adult volunteers during intravenous injection of indocyanine green. Analysis of statistical moments of the measured DTOFs showed that the source-detector separation of 6 cm is recommended for monitoring of inflow of optical contrast to the intracerebral brain tissue compartments with the use of continuous wave reflectometry, whereas the separation of 4 cm is enough when the higher-order moments of DTOFs are available.

  • 7.
    Sawosz, P.
    et al.
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Wojtkiewicz, S.
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Kacprzak, M.
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Weigl, Wojciech
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Akademiska Hospital, Uppsala, Sweden .
    Borowska-Solonynko, A.
    Med Univ Warsaw, Dept Forens Med, Warsaw, Poland..
    Krajewski, P.
    Med Univ Warsaw, Dept Forens Med, Warsaw, Poland..
    Bejm, K.
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Milej, D.
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Ciszek, B.
    Med Univ Warsaw, Dept Descript & Clin Anat, Warsaw, Poland..
    Maniewski, R.
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Liebert, A.
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Human skull translucency: post mortem studies2016In: Biomedical Optics Express, ISSN 2156-7085, E-ISSN 2156-7085, Vol. 7, no 12, p. 5010-5020Article in journal (Refereed)
    Abstract [en]

    Measurements of optical translucency of human skulls were carried out. An incandescent light source and a CCD camera were used to measure the distribution of light transmitted through the skull in 10 subjects post-mortem. We noticed that intra-individual differences in optical translucency may be up to 100 times but inter-individual translucency differences across the skull reach 105 times. Based on the measurement results, a "theoretical" experiment was simulated. Monte-Carlo calculations were used in order to evaluate the influence of the differences in optical translucency of the skull on results of NIRS measurements. In these calculations a functional stimulation was done, in which the oxyhemoglobin and deoxyhemoglobin concentrations in the brain cortex change by 5 mu M and -5 mu M respectively. The maximal discrepancies between assumed hemoglobin concentration changes and hemoglobin concentration changes estimated with Monte-Carlo simulation may reach 50% depending of the translucency of the skull.

  • 8.
    Siegel, Tomasz
    et al.
    Czerniakowski Hosp, Dept Anaesthesiol & Intens Therapy, PL-00739 Warsaw, Poland..
    Adamski, Jan
    Satakunta Dist Hosp, Dept Anaesthesiol Intens Care, Pori, Finland..
    Nowakowski, Piotr
    Czerniakowski Hosp, Dept Anaesthesiol & Intens Therapy, PL-00739 Warsaw, Poland..
    Onichimowski, Dariusz
    Reg Hosp Olsztyn, Dept Anaesthesiol & Intens Therapy, Olsztyn, Poland..
    Weigl, Wojciech
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Prospective assessment of the standardized mortality ratio (SMR) as a measure of quality of care in an intensive care unit - a single-centre study2015In: ANAESTHESIOLOGY INTENSIVE THERAPY, ISSN 1642-5758, Vol. 47, no 4, p. 328-332Article in journal (Refereed)
    Abstract [en]

    Background: The standardized mortality ratio (SMR) is a recognized indicator of critical care quality. This ratio is used to compare actual hospital mortality of all patients treated in an Intensive Care Unit (ICU) with predicted mortality. The aim of this study was a prospective analysis of SMR as a measure of the quality of care in a single ICU. Methods: A prospective study was performed during a 12-month period in the ICU of the Czerniakowski Hospital in Warsaw. Predicted hospital mortality was calculated using the SAPS 3 model. The value of the SMR was evaluated in three risk groups (low, moderate, and high risk) and included the surgical status of patients (nonoperative, after elective or emergency surgery). Results: A total of 341 patients were included. The SMR in the general population was 0.98 (95% CI 0.74-1.28). In the low-and high-risk groups, the value of the SMR did not differ significantly from 1. In the average risk group, as well as among patients undergoing elective surgery, the value of the SMR tended to exceed 1. Conclusions: In groups of patients with low and high risk, the values of the SMR indicated a favourable quality of care. Study results should prompt a detailed analysis of the course of treatment for patients with an average risk of death. Analysis of the treatment course and qualification criteria for surgery in patients undergoing elective surgery is also indicated.

  • 9.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Adamski, Jan
    Satakunta Dist Hosp, Dept Anaesthesia & Intens Care, Pori, Finland..
    Gorynski, Pawel
    Natl Inst Publ Hlth, Natl Inst Hyg, Ctr Monitoring & Anal Populat Hlth Status, Warsaw, Poland..
    Kanski, Andrzej
    Med Univ Warsaw, Cent Teaching Hosp, Dept Anesthesiol & Intens Care 2, Warsaw, Poland..
    Hultström, Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology.
    Comparison of ICU outcomes in Poland to other European countries: reasons for high mortality rates2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1022-1023Article in journal (Other academic)
  • 10.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Adamski, Jan
    Satakunta Cent Hosp, Dept Anaesthesia & Intens Care, Pori, Finland.
    Goryński, Paweł
    Natl Inst Hyg, Natl Inst Publ Hlth, Ctr Monitoring & Anal Populat Hlth Status, Warsaw, Poland.
    Kański, Andrzej
    Med Univ Warsaw, Cent Teaching Hosp, Dept Anaesthesiol & Intens Care 2, Warsaw, Poland.
    Hultström, Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    ICU mortality and variables associated with ICU survival in Poland: A nationwide database study2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 12, p. 949-954Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Recently published international comparison data across European countries revealed high mortality rates in Polish ICUs.

    OBJECTIVES: Estimation of the rate of ICU mortality and identification of variables associated with ICU survival in Poland.

    DESIGN: Retrospective analyses of a database reporting ICU stays in Poland.

    SETTINGS AND PATIENTS: The study included data from all adult patients admitted to an ICU in Poland from 1 January 2012 to 31 December 2012.

    MAIN OUTCOME MEASURES: ICU mortality and variables associated with ICU survival.

    RESULTS: A total of 48 282 patients were treated in 347 ICUs (mean age 63.1 ± 16.8 years, 59% men) with 20 278 deaths (42.0%). Variables associated with ICU survival were: tertiary level of hospital care [relative risk (RR) 0.86, 95% confidence interval (CI) 0.80 to 0.92, P < 0.001]; high annual patient volume in the ICU (RR 0.9995 patient year, 95% CI 0.9994 to 0.9996, P < 0.001); younger patient age (RR 1.025 year, 95% CI 1.024 to 1.026, P < 0.001); female sex (RR 0.92, 95% CI 0.88 to 0.96; P < 0.001); and lower number of comorbidities (RR 1.33, 95% CI 1.31 to 1.35, P < 0.001).

    CONCLUSION: ICU mortality was high in Poland. Structural variables, such as the level of hospital care and annual patient volume, may be associated with ICU survival.

  • 11.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Adamski, Jan
    Goryński, Paweł
    Kański, Andrzej
    Hultström, Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology, Integrative Physiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Mortality rate is higher in Polish intensive care units than in other European countries2017In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 43, no 9, p. 1430-1432Article in journal (Other academic)
  • 12.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland.
    Bierylo, Andrzej
    Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland..
    Wielgus, Monika
    Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland.;Gruca Orthoped & Trauma Teaching Hosp, Ctr Postgrad Med Educ, Dept Anesthesiol & Intens Care, Otwock, Poland..
    Krzemien-Wiczynska, Swietlana
    Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland..
    Kolacz, Marcin
    Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland..
    Dabrowski, Michal J.
    Polish Acad Sci, Inst Comp Sci, Jana Kazimierza 5, PL-01248 Warsaw, Poland..
    Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section: A randomized controlled study2017In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 48, article id e8892Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 13.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Med Univ Warsaw, Dept Anaesthesiol & Intens Care 1, Warsaw, Poland..
    Bierylo, Andrzej
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care 1, Warsaw, Poland..
    Wielgus, Monika
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care 1, Warsaw, Poland.;Gruca Orthoped & Trauma Teaching Hosp, Ctr Postgrad Med Educ, Dept Anesthesiol & Intens Care, Otwock, Poland..
    Krzemien-Wiczynska, Swietlana
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care 1, Warsaw, Poland..
    Kolacz, Marcin
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care 1, Warsaw, Poland..
    Dabrowski, Michal Jerzy
    Polish Acad Sci, Inst Comp Sci, Warsaw, Poland..
    Peri-operative analgesia with intrathecal opioids for Caesarean section2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 1014-1015Article in journal (Other academic)
  • 14.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Med Univ Warsaw, Dept Anaesthesiol & Intens Care, Lindleya 4th St, Warsaw, Poland..
    Bierylo, Andrzej
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care, Lindleya 4th St, Warsaw, Poland..
    Wielgus, Monika
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care, Lindleya 4th St, Warsaw, Poland.;Prof Gruca Teaching Hosp, Dept Anaesthesiol & Intens Care, Postgrad Med Educ Ctr, Konarskiego 13, Otwock, Poland..
    Krzemien-Wiczynska, Swietlana
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care, Lindleya 4th St, Warsaw, Poland..
    Szymusik, Iwona
    Med Univ Warsaw, Dept Obstet & Gynaecol 1, Warsaw, Poland..
    Kolacz, Marcin
    Med Univ Warsaw, Dept Anaesthesiol & Intens Care, Lindleya 4th St, Warsaw, Poland..
    Dabrowski, Michal J.
    Polish Acad Sci, Inst Comp Sci, Jana Kazimierza 5, PL-01248 Warsaw, Poland..
    Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section A randomized controlled study2016In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 95, no 24, article id e3827Article in journal (Refereed)
    Abstract [en]

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

  • 15.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Warsaw, Poland..
    Milej, Daniel
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Gerega, Anna
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Toczylowska, Beata
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Sawosz, Piotr
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Kacprzak, Michal
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Janusek, Dariusz
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Wojtkiewicz, Stanislaw
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Maniewski, Roman
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Liebert, Adam
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw, Poland..
    Optical methods based on tracking of optical contrast agent in confirmation of brain death: preliminary results2017In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 61, no 8, p. 979-980Article in journal (Other academic)
  • 16.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Med Univ Warsaw, Dept Anesthesiol & Intens Care 1, Lindleya 4 St, Warsaw, Poland.
    Milej, Daniel
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Ks Trojdena 4 St, PL-02109 Warsaw, Poland.
    Gerega, Anna
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Ks Trojdena 4 St, PL-02109 Warsaw, Poland.
    Toczylowska, Beata
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Ks Trojdena 4 St, PL-02109 Warsaw, Poland.
    Sawosz, Piotr
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Ks Trojdena 4 St, PL-02109 Warsaw, Poland.
    Kacprzak, Michel
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Ks Trojdena 4 St, PL-02109 Warsaw, Poland.
    Janusek, Dariusz
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Ks Trojdena 4 St, PL-02109 Warsaw, Poland.
    Wojtkiewicz, Stanislaw
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Ks Trojdena 4 St, PL-02109 Warsaw, Poland.
    Maniewski, Roman
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Ks Trojdena 4 St, PL-02109 Warsaw, Poland.
    Liebert, Adam
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Ks Trojdena 4 St, PL-02109 Warsaw, Poland.
    Confirmation of brain death using optical methods based on tracking of an optical contrast agent: assessment of diagnostic feasibility2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 7332Article in journal (Refereed)
    Abstract [en]

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

  • 17.
    Weigl, Wojciech
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Milej, Daniel
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw 42, Poland..
    Janusek, Dariusz
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw 42, Poland..
    Wojtkiewicz, Stanislaw
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw 42, Poland..
    Sawosz, Piotr
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw 42, Poland..
    Kacprzak, Michal
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw 42, Poland..
    Gerega, Anna
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw 42, Poland..
    Maniewski, Roman
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw 42, Poland..
    Liebert, Adam
    Polish Acad Sci, Nalecz Inst Biocybernet & Biomed Engn, Warsaw 42, Poland..
    Application of optical methods in the monitoring of traumatic brain injury: A review2016In: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016, Vol. 36, no 11, p. 1825-1843Article, review/survey (Refereed)
    Abstract [en]

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

1 - 17 of 17
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