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  • 1.
    Karlsson, Victoria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Aspects of neonatal intensive care and anesthesia: Thermal balance and respiratory management2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    This thesis is based on four articles originating from three studies conducted in the neonatal intensive care unit and the children’s operating deparment at Uppsala University Hospital, Sweden.

    The overall aim was to obtain new knowledge about thermal balance and care environment in extremely preterm infants during skin-to-skin care (SSC), evaluate different methods of intraoperative monitoring of carbon dioxide (CO2), and to investigate how different levels of inhaled oxygen affect infants’ oxygenation during anesthesia and surgery. Study I investigated infant thermal balance and the physical environment for extremely preterm infants during SSC. Study II formed part of a prospective study to assess the performance of non-invasive transcutaneous and end-tidal technique to continuously monitor CO2 levels in the infants blood during anesthesia. Study III was a prospective randomized trial to investigate oxygenation during induction of anesthesia with room air versus high fraction (80%) of oxygen in healthy newborn infants.

    The infants maintained normal body temperature during SSC. In comparison to care in an incubator, during SSC ambient humidity was lower and insensible water loss through the skin was higher. Compared to blood gas Pco, transcutaneous carbon dioxide monitoring yielded a bias of 0.3 ± 0.7 kPa, and end-tidal technique a bias of -1.9 ± 0.9 kPa. After intubation, saturation measured by pulse oximetry was lower (p < .05) in the group breathing room air than in the group with high oxygen (93% ± 6.7 and 99% ± 1.5). None of the infants spent time below the pre-specified safety oxygen saturation targets to mandate supplemental oxygen.

    This thesis provides new knowledge about early initiation of SSC after birth for extremely preterm infants, the results will be useful to guide safe routines for implementation of early SSC. These results suggest that during anesthesia would transcutaneous monitoring of carbon dioxide be beneficial, end-tidal monitoring correlated poorly to blood gas and induction of general anesthesia in newborn infants can be safely performed without the use of high levels of supplemental oxygen. Taken together, this new knowledge has the potential to improve intraoperative respiratory management.

    Delarbeid
    1. Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment
    Åpne denne publikasjonen i ny fane eller vindu >>Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment
    Vise andre…
    2012 (engelsk)Inngår i: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 161, nr 3, s. 422-426Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Objective

    To evaluate infant thermal balance and the physical environment in extremely preterm infants during skin-to-skin care (SSC).

    Study design

    Measurements were performed in 26 extremely preterm infants (gestational age 22-26 weeks; postnatal age, 2-9 days) during pretest (in incubator), test (during SSC), and posttest (in incubator) periods. Infants' skin temperature and body temperature, ambient temperature, and relative humidity were measured. Evaporimetry was used to determine transepidermal water loss, and insensible water loss through the skin was calculated.

    Results

    The infants maintained a normal body temperature during SSC. Transfer to and from SSC was associated with a drop in skin temperature, which increased during SSC. Ambient humidity and temperature were lower during SSC than during incubator care. Insensible water loss through the skin was higher during SSC.

    Conclusion

    SSC can be safely used in extremely preterminfants. SSC can be initiated during the first week of life and is feasible in infants requiring neonatal intensive care, including ventilator treatment. During SSC, the conduction of heat from parent to infant is sufficiently high to compensate for the increase in evaporative and convective heat loss. The increased water loss through the skin during SSC is small and should not affect the infant's fluid balance.

    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-182517 (URN)10.1016/j.jpeds.2012.02.034 (DOI)000308141700014 ()22497906 (PubMedID)
    Tilgjengelig fra: 2012-10-15 Laget: 2012-10-11 Sist oppdatert: 2018-06-27bibliografisk kontrollert
    2. Transcutaneousp PCO2 monitoring in newborn infants during general anesthesia is technically feasible
    Åpne denne publikasjonen i ny fane eller vindu >>Transcutaneousp PCO2 monitoring in newborn infants during general anesthesia is technically feasible
    2016 (engelsk)Inngår i: Anesthesia and Analgesia, ISSN 0003-2999, EISSN 1526-7598, Vol. 123, nr 4, s. 1004-1007, artikkel-id 10.1213/ANE.0000000000001462Artikkel i tidsskrift (Fagfellevurdert) Published
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-353906 (URN)10.1213/ANE.0000000000001462 (DOI)
    Tilgjengelig fra: 2018-06-17 Laget: 2018-06-17 Sist oppdatert: 2018-09-26bibliografisk kontrollert
    3. Poor performance of main-stream capnography in newborn infants during general anesthesia
    Åpne denne publikasjonen i ny fane eller vindu >>Poor performance of main-stream capnography in newborn infants during general anesthesia
    2017 (engelsk)Inngår i: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 27, nr 12, s. 1235-1240Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background

    Endtidal (ET) measurement of carbon dioxide is well established for intraoperative respiratory monitoring of adults and children, but the method's accuracy for intraoperative use in small newborn infants has been less extensively investigated.

    Aims

    The aim of this study was to compare carbon dioxide from ET measurements with arterialized capillary blood samples in newborn infants during general anesthesia and surgery.

    Methods

    Endtidal carbon dioxide was continuously measured during anesthesia and surgery and compared with simultaneous blood gas analyses obtained from capillary blood samples. Fifty-nine sample sets of ET to blood gas carbon dioxide were obtained from 23 prospectively enrolled infants with a gestational age of 23-41 weeks and a birth weight of 670-4110 g.

    Results

    Endtidal levels of carbon dioxide were considerably lower in all sample sets and only 4/23 individual ET-blood gas sample pairs differed <7.5 mm Hg (1 kPa). Bland-Altman analysis indicated a poor agreement with a bias of -13 7 mm Hg and a precision of +/- 14 mm Hg. The performance of ET measurements was particularly poor in infants weighing below 2.5 kg, in infants in need of respiratory support prior to anesthesia, and when the true (blood gas) carbon dioxide level was high, above 45 mm Hg.

    Conclusion

    Main-stream capnography during anesthesia and surgery correlated poorly to blood gas values in small and/or respiratory compromised infants. We conclude that caution should be exercised when relying solely on ET measurements to guide mechanical ventilation in the OR.

    Emneord
    capnography, infant, mechanical ventilation, neonatal, perioperative, surgery
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-341986 (URN)10.1111/pan.13266 (DOI)000414571000009 ()29072363 (PubMedID)
    Tilgjengelig fra: 2018-02-19 Laget: 2018-02-19 Sist oppdatert: 2018-06-27
    4. Randomized controlled trial of room air vs. 80% oxygen for induction of neonatal anesthesia: Feasibility and safety
    Åpne denne publikasjonen i ny fane eller vindu >>Randomized controlled trial of room air vs. 80% oxygen for induction of neonatal anesthesia: Feasibility and safety
    (engelsk)Manuskript (preprint) (Annet vitenskapelig)
    HSV kategori
    Identifikatorer
    urn:nbn:se:uu:diva-352666 (URN)
    Tilgjengelig fra: 2018-06-06 Laget: 2018-06-06 Sist oppdatert: 2018-06-27
  • 2.
    Karlsson, Victoria
    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 kvinnors och barns hälsa.
    Heinemann, Ann-Britt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Sjörs, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Nyqvist, Kerstin Hedberg
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Ågren, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment2012Inngår i: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 161, nr 3, s. 422-426Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To evaluate infant thermal balance and the physical environment in extremely preterm infants during skin-to-skin care (SSC).

    Study design

    Measurements were performed in 26 extremely preterm infants (gestational age 22-26 weeks; postnatal age, 2-9 days) during pretest (in incubator), test (during SSC), and posttest (in incubator) periods. Infants' skin temperature and body temperature, ambient temperature, and relative humidity were measured. Evaporimetry was used to determine transepidermal water loss, and insensible water loss through the skin was calculated.

    Results

    The infants maintained a normal body temperature during SSC. Transfer to and from SSC was associated with a drop in skin temperature, which increased during SSC. Ambient humidity and temperature were lower during SSC than during incubator care. Insensible water loss through the skin was higher during SSC.

    Conclusion

    SSC can be safely used in extremely preterminfants. SSC can be initiated during the first week of life and is feasible in infants requiring neonatal intensive care, including ventilator treatment. During SSC, the conduction of heat from parent to infant is sufficiently high to compensate for the increase in evaporative and convective heat loss. The increased water loss through the skin during SSC is small and should not affect the infant's fluid balance.

  • 3.
    Karlsson, Victoria
    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 kvinnors och barns hälsa.
    Sporre, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Fredén, Filip
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Ågren, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning.
    Randomized controlled trial of room air vs. 80% oxygen for induction of neonatal anesthesia: Feasibility and safetyManuskript (preprint) (Annet vitenskapelig)
  • 4.
    Karlsson, Victoria
    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 kvinnors och barns hälsa. Univ Hosp, Unit Pediat Anesthesia, Uppsala, Sweden.;Univ Childrens Hosp, Div Neonatol, Uppsala, Sweden..
    Sporre, Bengt
    Univ Hosp, Unit Pediat Anesthesia, Uppsala, Sweden..
    Hellström-Westas, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning. Univ Childrens Hosp, Div Neonatol, Uppsala, Sweden..
    Ågren, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning. Univ Childrens Hosp, Div Neonatol, Uppsala, Sweden..
    Poor performance of main-stream capnography in newborn infants during general anesthesia2017Inngår i: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 27, nr 12, s. 1235-1240Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Endtidal (ET) measurement of carbon dioxide is well established for intraoperative respiratory monitoring of adults and children, but the method's accuracy for intraoperative use in small newborn infants has been less extensively investigated.

    Aims

    The aim of this study was to compare carbon dioxide from ET measurements with arterialized capillary blood samples in newborn infants during general anesthesia and surgery.

    Methods

    Endtidal carbon dioxide was continuously measured during anesthesia and surgery and compared with simultaneous blood gas analyses obtained from capillary blood samples. Fifty-nine sample sets of ET to blood gas carbon dioxide were obtained from 23 prospectively enrolled infants with a gestational age of 23-41 weeks and a birth weight of 670-4110 g.

    Results

    Endtidal levels of carbon dioxide were considerably lower in all sample sets and only 4/23 individual ET-blood gas sample pairs differed <7.5 mm Hg (1 kPa). Bland-Altman analysis indicated a poor agreement with a bias of -13 7 mm Hg and a precision of +/- 14 mm Hg. The performance of ET measurements was particularly poor in infants weighing below 2.5 kg, in infants in need of respiratory support prior to anesthesia, and when the true (blood gas) carbon dioxide level was high, above 45 mm Hg.

    Conclusion

    Main-stream capnography during anesthesia and surgery correlated poorly to blood gas values in small and/or respiratory compromised infants. We conclude that caution should be exercised when relying solely on ET measurements to guide mechanical ventilation in the OR.

  • 5.
    Karlsson, Victoria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Sporre, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Ågren, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning.
    Transcutaneousp PCO2 monitoring in newborn infants during general anesthesia is technically feasible2016Inngår i: Anesthesia and Analgesia, ISSN 0003-2999, EISSN 1526-7598, Vol. 123, nr 4, s. 1004-1007, artikkel-id 10.1213/ANE.0000000000001462Artikkel i tidsskrift (Fagfellevurdert)
  • 6.
    Larsson, Christina
    et al.
    Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Karlsson, Victoria
    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 kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Blomqvist, Ylva Thernström
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Nurse Decision Making and Attitudes About Circuit Disconnection During Ventilator Therapy at a Swedish Neonatal Intensive Care Unit2018Inngår i: Advances in Neonatal Care, ISSN 1536-0903, E-ISSN 1536-0911, Vol. 18, nr 6, s. E13-E20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There are many challenges to providing care to infants in need of ventilator therapy. Yet, few studies describe the practical handling of the ventilator circuit during nursing care.

    Purpose: To describe neonatal intensive care unit (NICU) nurses' decision making regarding whether or not to disconnect the ventilator circuit when changing the infant's position and to investigate the grounds for their decisions.

    Methods: A descriptive questionnaire study with both quantitative and qualitative elements was conducted. In 2015, a convenience sample of nurses working in an NICU completed a questionnaire including both closed-ended and open-ended, free-text questions. Answers to the closed-ended questions were analyzed with descriptive statistics, whereas answers to the free-text questions were analyzed using qualitative content analysis.

    Results: Nurses' decisions on whether to disconnect or keep the ventilator circuit closed were based on the infant's needs for ventilator support. The nurses gave several reasons and motivations both for why they disconnected the circuit and for why they did not. The handling of the circuit and the reasons and motivations given were inconsistent among the nurses.

    Implications for Practice: This study highlights the need for continuous, repetitive education and training for NICU nurses, as well as demonstrating the importance of clear and distinct guidelines and working methods regarding the care of infants on ventilator support.

    Implications for Research: Future research should continue to find ways of working and handling an infant on ventilator support that are least harmful to the infant.

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