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  • 101.
    Eriksson, Mats
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Strandberg, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Lipcsey, Miklós
    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 medicinska vetenskaper, Biokemisk struktur och funktion.
    Intraosseös provtagning kan vara värdefull i akuta lägen2015Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, nr 9, s. 395-396Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    En intraosseös infart kan ha stor klinisk betydelse i den akuta situationen då det är svårt att få kärlaccess.Provtagning via intraosseösanålar har ifrågasatts med tanke på risken att aspirera benmärgs-partiklar.Vi rekommenderar, så långt det är möjligt, patientnära metoder för intraosseösa prov. Detta gäl-ler särskilt då helblod (exempel-vis blodgaser) ska analyseras.Vid centrifugering av intraosse-öst aspirat kommer eventuella benmärgspartiklar att hamna i pelleten. Supernatanten motsva-rar närmast plasma. Vi har på så sätt analyserat kreatinin, morfin och troponin i intraosseösa prov.Leukocyter och trombocyter,vilka bildas i benmärgen, kan ge falskt förhöjda värden vid analys av intraosseösa prov. Risken för hemolys bör övervägas.

  • 102.
    Erlandsson, Ulf
    et al.
    Räddningsverket.
    Huss, Fredrik
    Inst för Experimentell och Klinisk medicin, Linköping.
    [Highly important during Christmas holidays. Elderly persons are overrepresented when it comes to candle light fires].2005Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, nr 50, s. 3897-8Artikel i tidskrift (Refereegranskat)
  • 103. Esibov, Alexander
    et al.
    Banville, Isabelle
    Chapman, Fred W.
    Boomars, Rene
    Box, Martyn
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Mechanical chest compressions improved aspects of CPR in the LINC trial2015Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 91, s. 116-121Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: We studied resuscitation process metrics in patients with out-of-hospital cardiac arrest enrolled in a randomized trial comparing one protocol designed to best use a mechanical CPR device, with another based on the 2005 European Resuscitation Council guidelines for manual CPR. Methods: We analyzed clinical data, ECG signals, and transthoracic impedance signals for a subset of the patients in the LUCAS in Cardiac Arrest (LINC) trial, including 124 patients randomized to mechanical and 82 to manual CPR. Chest compression fraction (CCF) was defined as the fraction of time during cardiac arrest that chest compressions were administered. Results: Patients in the mechanical CPR group had a higher CCF than those in the manual CPR group [0.84 (0.78, 0.91) vs. 0.79 (0.70, 0.86), p < 0.001]. The median duration of their pauses for defibrillation was also shorter [0 s (0, 6.0) vs. 10.0 s (7.0, 14.3), p < 0.001]. Compressions were interrupted for a median of 36.0 s to apply the compression device. There was no difference between groups in duration of the longest pause in compressions [32.5 s vs. 26.0 s, p = 0.24], number of compressions received per minute [86.5 vs. 88.3, p = 0.47], defibrillation success rate [73.2% vs. 81.0%, p = 0.15], or refibrillation rate [74% vs. 77%, p = 0.79]. Conclusions: A protocol using mechanical chest compression devices reduced interruptions in chest compressions, and enabled defibrillation during ongoing compressions, without adversely affecting other resuscitation process metrics. Future emphasis on optimizing device deployment may be beneficial.

  • 104.
    Falla, D.
    et al.
    Univ Hosp Gottingen, Pain Clin, Ctr Anesthesiol Emergency & Intens Care Med, Gottingen, Germany.;Univ Birmingham, Sch Sport Exercise & Rehabil Sci, Coll Life & Environm Sci, Birmingham, W Midlands, England..
    Peolsson, A.
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden..
    Peterson, G.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden..
    Ludvigsson, M. L.
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden.;Cty Council Ostergotland, Rehab Vast, Motala, Sweden..
    Soldini, E.
    Univ Appl Sci & Arts Southern Switzerland SUPSI, Dept Business Econ Hlth & Social Care, Manno, Switzerland..
    Schneebeli, A.
    Univ Appl Sci & Arts Southern Switzerland, Rehabil Res Lab, Dept Business Econ Hlth & Social Care, Manno, Switzerland..
    Barbero, M.
    Univ Appl Sci & Arts Southern Switzerland, Rehabil Res Lab, Dept Business Econ Hlth & Social Care, Manno, Switzerland..
    Perceived pain extent is associated with disability, depression and self-efficacy in individuals with whiplash-associated disorders2016Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, nr 9, s. 1490-1501Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundCompletion of a pain drawing is a familiar task in those presenting with whiplash-associated disorders (WAD). Some people report pain almost over their entire body. Yet the reasons for larger pain extent have not been fully explored. MethodsA novel method was applied to quantify pain extent from the pain drawings of 205 individuals with chronic WAD. Pain extent was evaluated in relation to sex, age, educational level, insurance status and financial status. Multiple linear regression analysis was used to verify whether pain extent was associated with other health indicators including perceived pain and disability, health-related quality of life, pain catastrophizing, anxiety, depression and self-efficacy. ResultsPain extent was influenced by sex ((2):10.392, p<0.001) with larger pain extent in women compared to men (7.887.66% vs. 5.406.44%). People with unsettled insurance claims ((2): 7.500, p<0.05) and those with a worse financial situation ((2):12.223, p<0.01) also had larger pain extent. Multiple linear regression models revealed that, when accounting for age, sex, education, insurance status, financial status and neck pain intensity, pain extent remained associated with perceived disability (p<0.01), depression (p<0.05) and self-efficacy (p<0.001). ConclusionBy utilizing a novel method for pain extent quantification, this study shows that widespread pain is associated with a number of factors including perceived disability, depression and self-efficacy in individuals with chronic WAD. Widespread pain should alert the clinician to consider more specific psychological screening, particularly for depression and self-efficacy, in patients with WAD. What does this study add?Women with chronic WAD, those with unsettled insurance claims and those with poorer financial status perceive more widespread pain. When controlling for these factors, larger pain areas remain associated with perceived pain and disability, depression and self-efficacy. The pain drawing is useful to support psychological screening in people with chronic WAD.

  • 105.
    Farisco, Michele
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Centrum för forsknings- och bioetik. Brain Project Sub-Project 12, Uppsala University, Uppsala.; Biogem, Genetic Research Centre, Ariano Irpino.
    Evers, Kathinka
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Centrum för forsknings- och bioetik. Brain Project Sub-Project 12, Uppsala University, Uppsala.
    The ethical relevance of the unconscious2017Ingår i: Philosophy Ethics and Humanities in Medicine, ISSN 1747-5341, E-ISSN 1747-5341, Vol. 12, nr 11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Ethical analyses of disorders of consciousness traditionally focus on residual awareness. Going one step further, this paper explores the potential ethical relevance of the unawareness retained by patients with disorders of consciousness, focusing specifically on the ethical implications of the description of the unconscious provided by recent scientific research.

    Methods

    A conceptual methodology is used, based on the review and analysis of relevant scientific literature on the unconscious and the logical argumentation in favour of the ethical conclusions.

    Results

    Two conditions (experiential wellbeing and having interests) that are generally considered critical components in the ethical discussion of patients with disorders of consciousness might arguably be both conscious and unconscious.

    Conclusions

    The unconscious, as well as consciousness, should be taken into account in the ethical discussions of patients with disorders of consciousness.

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  • 106.
    Ferrando, Carlos
    et al.
    Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain;Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain.
    Aldecoa, Cesar
    Hosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain.
    Unzueta, Carmen
    Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Javier Belda, F.
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Librero, Julian
    UPNA, REDISSEC Red Invest Serv Salud Enfermedades Cron, Complejo Hosp Navarra, Navarrabiomed, Valencia, Spain.
    Tusman, Gerardo
    Hosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, Mar Del Plata, Buenos Aires, Argentina.
    Suarez-Sipmann, Fernando
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain;Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain.
    Peiro, Salvador
    Fdn Fomento Invest Sanitaria & Biomed Comunidad V, Red Invest Serv Salud Enfermedades Cron REDISSEC, Valencia, Spain.
    Pozo, Natividad
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Brunelli, Andrea
    Hosp Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain.
    Garutti, Ignacio
    Hosp Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain;Hosp Univ Gen Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain.
    Gallego, Clara
    Hosp Univ Ramon & Cajal, Dept Anesthesiol & Crit Care, Madrid, Spain.
    Rodriguez, Aurelio
    Hosp Univ Dr Negrin, Dept Anesthesiol & Crit Care, Las Palmas Gran Canaria, Spain.
    Ignacio Garcia, Jose
    Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain.
    Diaz-Cambronero, Oscar
    Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Balust, Jaume
    Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Redondo, Francisco J.
    Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain.
    de la Matta, Manuel
    Hosp Univ Virgen del Rocio, Dept Anesthesiol & Crit Care, Seville, Spain.
    Gallego-Ligorit, Lucia
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Hernandez, Javier
    Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Martinez, Pascual
    Hosp Albacete, Dept Anesthesiol & Crit Care, Albacete, Spain.
    Perez, Ana
    Hosp Elche, Dept Anesthesiol & Crit Care, Elche, Spain.
    Leal, Sonsoles
    Hosp Povisa, Dept Anesthesiol & Crit Care, Vigo, Spain.
    Alday, Enrique
    Hosp Univ La Princesa, Dept Anesthesiol & Crit Care, Madrid, Spain.
    Monedero, Pablo
    Clin Univ Navarra, Dept Anesthesiol & Crit Care, Pamplona, Spain.
    Gonzalez, Rafael
    Hosp Univ Leon, Dept Anesthesiol & Crit Care, Leon, Spain.
    Mazzirani, Guido
    Hosp Manises, Dept Anesthesiol, Manises, Spain.
    Aguilar, Gerardo
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Lopez-Baamonde, Manuel
    Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Felipe, Mar
    Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Mugarra, Ana
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Torrente, Jara
    Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain.
    Valencia, Lucia
    Hosp Univ Dr Negrin, Dept Anesthesiol & Crit Care, Las Palmas Gran Canaria, Spain.
    Varon, Viviana
    Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain.
    Sanchez, Sergio
    Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain.
    Rodriguez, Benigno
    Hosp Povisa, Dept Anesthesiol & Crit Care, Vigo, Spain.
    Martin, Ana
    Hosp Univ Leon, Dept Anesthesiol & Crit Care, Leon, Spain.
    India, Inmaculada
    Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Azparren, Gonzalo
    Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Molina, Rodrigo
    Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain.
    Villar, Jesus
    Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain;Hosp Univ Dr Negrin, Res Unit, Multidisciplinary Organ Dysfunct Evaluat Res Netw, Las Palmas Gran Canaria, Spain;St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr Biomed Sci, Toronto, ON, Canada.
    Soro, Marina
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Acosta, Jesus
    Hosp Univ Virgen del Rocio, Dept Anesthesiol & Crit Care, Seville, Spain.
    Jose Alberola, Maria
    Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Alcon, Amalia
    Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Almajano, Rosa
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Alvarez, Carlos
    Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain.
    Anaya, Rafael
    Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Aragon, Cristian
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Argilaga, Marta
    Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Arocas, Blanca
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Ayas, Begona
    Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Balandron, Victor
    Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain.
    Barcena, Elizabeth
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Bejarano, Natalia
    Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Belmonte, Luis
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Berges, Vanesa
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Guillen Bermejo, Ma
    Hosp Univ Dr Negrin, Dept Anesthesiol & Crit Care, Las Palmas Gran Canaria, Spain.
    Cabadas, Rafael
    Hosp Povisa, Dept Anesthesiol & Crit Care, Vigo, Spain.
    Cabrera, Sergio
    Hosp Univ Dr Negrin, Dept Anesthesiol & Crit Care, Las Palmas Gran Canaria, Spain.
    Callejas, Raquel
    Clin Univ Navarra, Dept Anesthesiol & Crit Care, Pamplona, Spain.
    Carbonell, Jose
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Carrizo, Juan
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Castillo, Jesus
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Charco, Pedro
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Colas, Ana
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Colomina, Lorena
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Cotter, Laura
    Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain.
    Cruz, Patricia
    Hosp Univ Gen Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain.
    Cuervo, Javier
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Del Castillo, Gema
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Del Rio, Elena
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Delgado, Juan
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Dexeus, Carlos
    Hosp Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain.
    Diaz, Ruben
    Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Dinu, Mandalina
    Hosp Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain.
    Duca, Alejandro
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Duque, Paula
    Clin Univ Navarra, Dept Anesthesiol & Crit Care, Pamplona, Spain.
    Echarri, Gemma
    Clin Univ Navarra, Dept Anesthesiol & Crit Care, Pamplona, Spain.
    Fabra, Patricia
    Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain.
    Fernandez, Carmen
    Hosp Univ Gen Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain.
    Florea, Raluca
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Forcada, Pilar
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Fuentes, Isabel
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Garces, Cristina
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Garcia Del Valle, Santiago
    Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain.
    Garcia, Beatriz
    Hosp Univ Gen Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain.
    Garcia, Esther
    Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain.
    Garcia, Maria
    Hosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain.
    Garcia, Mercedes
    Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Garrigues, Beatriz
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Gil, Fernando
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Gonzalez, Domingo
    Hosp Univ Virgen del Rocio, Dept Anesthesiol & Crit Care, Seville, Spain.
    Gracia, Alejandro
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Gracia, Estefania
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Cranell, Manuel
    Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Guerra, Yessica
    Hosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain.
    Gutierrez, Andrea
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Hernando, Julia
    Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain.
    Herrero, Miriam
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Ibanez, Maite
    Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain.
    Imaz, Ines
    Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain.
    Izquierdo, Blanca
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Jurado, Ana
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Lafuente, Noelia
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Lascorz, Laura
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Leon, Irene
    Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Lopez, Antonio
    Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Lopez-Herrera, Daniel
    Hosp Univ Virgen del Rocio, Dept Anesthesiol & Crit Care, Seville, Spain.
    Lozano, Angels
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Miguel Marcos, Jose
    Hosp Univ Leon, Dept Anesthesiol & Crit Care, Leon, Spain.
    Martinez, Graciela
    Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Martinez, Sara
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Mata, Esperanza
    Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain.
    Matoses, Salome
    Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Mendez, Rosa
    Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain.
    Merino, Maria
    Hosp Univ Leon, Dept Anesthesiol & Crit Care, Leon, Spain.
    Millaruelo, Andres
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Rodrigo Molina, Carlos
    Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain.
    Monleon, Berta
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Mauricio Montenegro, Omar
    Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain.
    Luis Munoz, Jose
    Hosp Elche, Dept Anesthesiol & Crit Care, Elche, Spain.
    Oliver-Fornies, Pablo
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Ortega, Manuel
    Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain.
    Aranzazu Palencia, Maria
    Hosp Univ Gen Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain.
    Parera, Ana
    Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Pastor, Emesto
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    del Mar Perez, Ma
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Perez, Sara
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Pestana, David
    Hosp Univ Ramon & Cajal, Dept Anesthesiol & Crit Care, Madrid, Spain.
    Pinol, Santiago
    Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Puig, Jaume
    Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Pujol, Roger
    Hosp Clin Barcelona, Dept Anesthesiol & Crit Care, Barcelona, Spain.
    Quesada, Natividad
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Ramon, Ana
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Rego, Consuelo
    Hosp Univ Leon, Dept Anesthesiol & Crit Care, Leon, Spain.
    Reviriego, Laura
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Rodriguez, Rayco
    Hosp Univ Dr Negrin, Dept Anesthesiol & Crit Care, Las Palmas Gran Canaria, Spain.
    Romero, Blanca
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Romero, Esther
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Rosello, Marta
    Hosp Gen Valencia, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Rovira, Lucas
    Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Ruiz, Lola
    Hosp Univ La Fe, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Sancho, Laura
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Sandin, Francisco
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Serralta, Ferran
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Tres, Eva
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Valls, Paola
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Vaquero, Laura
    Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain.
    Varela, Marina
    Hosp Povisa, Dept Anesthesiol & Crit Care, Vigo, Spain.
    Vega, Victor
    Hosp Univ La Princesa, Dept Intens Care, Madrid, Spain.
    Viguera, Laura
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Villazala, Ruben
    Hosp Gen Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain.
    Villena, Abigail
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain.
    Visiedo, Sara
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain.
    Effects of oxygen on post-surgical infections during an individualised perioperative open-lung ventilatory strategy: a randomised controlled trial2020Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 124, nr 1, s. 110-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: We aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery. Methods: We performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality. Results: We enrolled 740 subjects: 371 in the high FIO2 group and 369 in the low FIO2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO2 groups (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.59-1.50; P=0.90]). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48-1.25; P=0.38) and myocardial ischaemia (0.6% [n=2] vs 0% [n=0]; P=0.47) did not differ between groups. Conclusions: An oxygenation strategy using high FIO2 compared with conventional FIO2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found.

  • 107.
    Ferrando, Carlos
    et al.
    Hosp Clin Univ Valencia, Anesthesiol & Crit Care, Valencia, Spain..
    Romero, Carolina
    Consorci Hosp Gen Univ Valencia, Anesthesiol & Crit Care, Valencia, Spain..
    Tusman, Gerardo
    Hosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, Mar De Plata, Argentina..
    Suarez-Sipmann, Fernando
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain..
    Canet, Jaume
    Hosp Badalona Germans Trias & Pujol, Anesthesiol & Crit Care, Badalona, Spain..
    Dosda, Rosa
    Hosp Clin Univ Valencia, Dept Radiol, Valencia, Spain..
    Valls, Paola
    Hosp Clin Univ Valencia, Anesthesiol & Crit Care, Valencia, Spain..
    Villena, Abigail
    Hosp Clin Univ Valencia, Anesthesiol & Crit Care, Valencia, Spain..
    Serralta, Ferran
    Hosp Clin Univ Valencia, Anesthesiol & Crit Care, Valencia, Spain..
    Jurado, Ana
    Hosp Clin Univ Valencia, Anesthesiol & Crit Care, Valencia, Spain..
    Carrizo, Juan
    Hosp Clin Univ Valencia, Anesthesiol & Crit Care, Valencia, Spain..
    Navarro, Jose
    Hosp Clin Univ Valencia, Anesthesiol & Crit Care, Valencia, Spain..
    Parrilla, Cristina
    Hosp Clin Univ Valencia, Dept Radiol, Valencia, Spain..
    Romero, Jose E.
    Univ Politecn Valencia, ITACA Inst, Grp IBIME, Valencia, Spain..
    Pozo, Natividad
    INCLIVA Clin Res Inst, Valencia, Spain..
    Soro, Marina
    Hosp Clin Univ Valencia, Anesthesiol & Crit Care, Valencia, Spain..
    Villar, Jesus
    Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain.;Hosp Univ Dr Negrin, Res Unit, Las Palmas Gran Canaria, Spain..
    Belda, Francisco Javier
    Hosp Clin Univ Valencia, Anesthesiol & Crit Care, Valencia, Spain..
    The accuracy of postoperative, non-invasive Air-Test to diagnose atelectasis in healthy patients after surgery: a prospective, diagnostic pilot study2017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 5, artikel-id e015560Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To assess the diagnostic accuracy of peripheral capillary oxygen saturation (SpO(2)) while breathing room air for 5 min (the 'Air-Test') in detecting postoperative atelectasis. Design Prospective cohort study. Diagnostic accuracy was assessed by measuring the agreement between the index test and the reference standard CT scan images. Setting Postanaesthetic care unit in a tertiary hospital in Spain. Participants Three hundred and fifty patients from 12 January to 7 February 2015; 170 patients scheduled for surgery under general anaesthesia who were admitted into the postsurgical unit were included. Intervention The Air-Test was performed in conscious extubated patients after a 30 min stabilisation period during which they received supplemental oxygen therapy via a venturi mask. The Air-Test was defined as positive when SpO(2) was >= 96% and negative when SpO(2) was >= 97%. Arterial blood gases were measured in all patients at the end of the Air-Test. In the subsequent 25 min, the presence of atelectasis was evaluated by performing a CT scan in 59 randomly selected patients. Main outcome measures The primary study outcome was assessment of the accuracy of the Air-Test for detecting postoperative atelectasis compared with the reference standard. The secondary outcome was the incidence of positive Air-Test results. Results The Air-Test diagnosed postoperative atelectasis with an area under the receiver operating characteristic curve of 0.90 (95% CI 0.82 to 0.98) with a sensitivity of 82.6% and a specificity of 87.8%. The presence of atelectasis was confirmed by CT scans in all patients (30/30) with positive and in 5 patients (17%) with negative Air-Test results. Based on the Air-Test, postoperative atelectasis was present in 36% of the patients (62 out of 170). Conclusion The Air-Test may represent an accurate, simple, inexpensive and non-invasive method for diagnosing postoperative atelectasis.

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  • 108. Ferrando, Carlos
    et al.
    Soro, Marina
    Canet, Jaume
    Carmen Unzueta, Ma
    Suarez-Sipmann, Fernando
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Librero, Julian
    Peiro, Salvador
    Llombart, Alicia
    Delgado, Carlos
    Leon, Irene
    Rovira, Lucas
    Ramasco, Fernando
    Granell, Manuel
    Aldecoa, Cesar
    Diaz, Oscar
    Balust, Jaume
    Garutti, Ignacio
    de la Matta, Manuel
    Pensado, Alberto
    Gonzalez, Rafael
    Eugenia Duran, Ma
    Gallego, Lucia
    Garcia del Valle, Santiago
    Redondo, Francisco J.
    Diaz, Pedro
    Pestana, David
    Rodriguez, Aurelio
    Aguirre, Javier
    Garcia, Jose M.
    Garcia, Javier
    Espinosa, Elena
    Charco, Pedro
    Navarro, Jose
    Rodriguez, Clara
    Tusman, Gerardo
    Javier Belda, Francisco
    Rationale and study design for an individualized perioperative open lung ventilatory strategy (iPROVE): study protocol for a randomized controlled trial2015Ingår i: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 16, artikel-id 193Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Postoperative pulmonary and non-pulmonary complications are common problems that increase morbidity and mortality in surgical patients, even though the incidence has decreased with the increased use of protective lung ventilation strategies. Previous trials have focused on standard strategies in the intraoperative or postoperative period, but without personalizing these strategies to suit the needs of each individual patient and without considering both these periods as a global perioperative lung-protective approach. The trial presented here aims at comparing postoperative complications when using an individualized ventilatory management strategy in the intraoperative and immediate postoperative periods with those when using a standard protective ventilation strategy in patients scheduled for major abdominal surgery. Methods: This is a comparative, prospective, multicenter, randomized, and controlled, four-arm trial that will include 1012 patients with an intermediate or high risk for postoperative pulmonary complications. The patients will be divided into four groups: (1) individualized perioperative group: intra-and postoperative individualized strategy; (2) intraoperative individualized strategy + postoperative continuous positive airway pressure (CPAP); (3) intraoperative standard ventilation + postoperative CPAP; (4) intra-and postoperative standard strategy (conventional strategy). The primary outcome is a composite analysis of postoperative complications. Discussion: The Individualized Perioperative Open-lung Ventilatory Strategy (iPROVE) is the first multicenter, randomized, and controlled trial to investigate whether an individualized perioperative approach prevents postoperative pulmonary complications.

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  • 109.
    Ferrando, Carlos
    et al.
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain.;Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain..
    Soro, Marina
    Unzueta, Carmen
    Hosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain..
    Suarez-Sipmann, Fernando
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain..
    Canet, Jaume
    Hosp Univ Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain..
    Librero, Julian
    REDISSEC, Navarrabiomed Fdn Miguel Servet, Pamplona, Spain..
    Pozo, Natividad
    Hosp Clin Univ Valencia, INCLIVA Clin Res Inst, Valencia, Spain..
    Peiro, Salvador
    REDISSEC, CSISP FISABIO, Valencia, Spain..
    Llombart, Alicia
    Hosp Univ Politecn Fe, IISLAFE Clin Res Inst, Valencia, Spain..
    Leon, Irene
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain..
    India, Inmaculada
    Hosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain..
    Aldecoa, Cesar
    Hosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain..
    Diaz-Cambronero, Oscar
    Hosp Univ Politecn Fe, Dept Anesthesiol & Crit Care, Valencia, Spain..
    Pestana, David
    Hosp Univ Ramon & Cajal, Dept Anesthesiol & Crit Care, Madrid, Spain..
    Redondo, Francisco J.
    Hosp Gen Univ Ciudad Real, Dept Anesthesiol & Crit Care, Ciudad Real, Spain..
    Garutti, Ignacio
    Hosp Gen Univ Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain..
    Balust, Jaume
    Hosp Clin & Prov Univ, Dept Anesthesiol & Crit Care, Barcelona, Spain..
    Garcia, Jose I.
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain.;Hosp Univ Politecn Fe, Dept Anesthesiol & Crit Care, Valencia, Spain.;Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain.;Hosp Univ Puerta Hierro, Dept Anesthesiol & Crit Care, Madrid, Spain..
    Ibanez, Maite
    Hosp Marina Baixa Vila Joiosa, Dept Anesthesiol, Alicante, Spain..
    Granell, Manuel
    Hosp Gen Univ, Dept Anesthesiol & Crit Care, Valencia, Spain..
    Rodriguez, Aurelio
    Hosp Univ Doctor Negrin, Dept Anesthesiol, Las Palmas Gran Canaria, Spain..
    Gallego, Lucia
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain..
    de la Matta, Manuel
    Hosp Univ Virgen Rocio, Dept Anesthesiol & Crit Care, Seville, Spain..
    Gonzalez, Rafael
    Hosp Univ Leon, Dept Anesthesiol, Leon, Spain..
    Brunelli, Andrea
    Hosp Univ Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain..
    Garcia, Javier
    Rovira, Lucas
    Hosp Manises, Dept Anesthesiol, Valencia, Spain..
    Barrios, Francisco
    Hosp Principe Asturias Madrid, Dept Anesthesiol & Crit Care, Madrid, Spain..
    Torres, Vicente
    Hosp Son Espases, Dept Anesthesiol & Crit Care, Palma de Mallorca, Spain..
    Hernandez, Samuel
    Hosp NS Candelaria, Dept Anesthesiol, Santa Cruz de Tenerife, Spain..
    Gracia, Estefania
    Gine, Marta
    Hosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain..
    Garcia, Maria
    Hosp Univ Rio Hortega, Dept Anesthesiol & Crit Care, Valladolid, Spain..
    Garcia, Nuria
    Miguel, Lisset
    Sanchez, Sergio
    Pineiro, Patricia
    Pujol, Roger
    Hosp Clin & Prov Univ, Dept Anesthesiol & Crit Care, Barcelona, Spain..
    Garcia-del-Valle, Santiago
    Hosp Fdn Alcorcon, Dept Anesthesiol & Crit Care, Alcorcon, Spain..
    Valdivia, Jose
    Hosp Marina Baixa Vila Joiosa, Dept Anesthesiol, Alicante, Spain..
    Hernandez, Maria J.
    Hosp Gen Univ, Dept Anesthesiol & Crit Care, Valencia, Spain..
    Padron, Oto
    Hosp Univ Doctor Negrin, Dept Anesthesiol, Las Palmas Gran Canaria, Spain..
    Colas, Ana
    Hosp Univ Miguel Servet, Dept Anesthesiol & Crit Care, Zaragoza, Spain..
    Puig, Jaume
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain..
    Azparren, Gonzalo
    Hosp Univ Sant Pau, Dept Anesthesiol & Crit Care, Barcelona, Spain..
    Tusman, Gerardo
    Hosp Privado Comunidad Mar Plata, Dept Anesthesiol, Mar Del Plata, Buenos Aires, Argentina..
    Villar, Jesus
    Hosp Univ Doctor Negrin, Multidisciplinary Organ Dysfunct Evaluat Res Netw, Las Palmas Gran Canaria, Spain..
    Belda, Javier
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia 46010, Spain.;Univ Valencia, Dept Surg, Valencia, Spain..
    Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial2018Ingår i: The Lancet Respiratory Medicine, ISSN 2213-2600, E-ISSN 2213-2619, Vol. 6, nr 3, s. 193-203Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. Methods We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m(2). Patients were randomly assigned (1: 1: 1: 1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O-2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. Findings Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic complications did not differ for patients in OLA-iCPAP (110 [46%] of 241, relative risk 0.89 [95% CI 0.74-1.07; p=0.25]), OLA-CPAP (111 [47%] of 238, 0.91 [0.76-1.09; p=0.35]), or STD-CPAP groups (118 [48%] of 244, 0.95 [0.80-1.14; p=0.65]) when compared with patients in the STD-O-2 group (125 [51%] of 244). Intraoperatively, PEEP was increased in 69 (14%) of patients in the standard perioperative ventilation groups because of hypoxaemia, and no patients from either of the OLA groups required rescue manoeuvres. Interpretation In patients who have major abdominal surgery, the different perioperative open lung approaches tested in this study did not reduce the risk of postoperative complications when compared with standard lung-protective mechanical ventilation.

  • 110. Ferrando, Carlos
    et al.
    Suarez-Sipmann, Fernando
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Gutierrez, Andrea
    Tusman, Gerardo
    Carbonell, Jose
    Garcia, Marisa
    Piqueras, Laura
    Compan, Desamparados
    Flores, Susanie
    Soro, Marina
    Llombart, Alicia
    Javier Belda, Francisco
    Adjusting tidal volume to stress index in an open lung condition optimizes ventilation and prevents overdistension in an experimental model of lung injury and reduced chest wall compliance2015Ingår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 19, artikel-id 9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The stress index ( SI), a parameter derived from the shape of the pressure-time curve, can identify injurious mechanical ventilation. We tested the hypothesis that adjusting tidal volume (VT) to a non-injurious SI in an open lung condition avoids hypoventilation while preventing overdistension in an experimental model of combined lung injury and low chest-wall compliance (Ccw). Methods: Lung injury was induced by repeated lung lavages using warm saline solution, and Ccw was reduced by controlled intra-abdominal air-insufflation in 22 anesthetized, paralyzed and mechanically ventilated pigs. After injury animals were recruited and submitted to a positive end-expiratory pressure (PEEP) titration trial to find the PEEP level resulting in maximum compliance. During a subsequent four hours of mechanical ventilation, VT was adjusted to keep a plateau pressure (Pplat) of 30 cmH2O (Pplat-group, n = 11) or to a SI between 0.95 and 1.05 (SI-group, n = 11). Respiratory rate was adjusted to maintain a 'normal' PaCO2 (35 to 65 mmHg). SI, lung mechanics, arterial-blood gases haemodynamics pro-inflammatory cytokines and histopathology were analyzed. In addition Computed Tomography (CT) data were acquired at end expiration and end inspiration in six animals. Results: PaCO2 was significantly higher in the Pplat-group (82 versus 53 mmHg, P = 0.01), with a resulting lower pH (7.19 versus 7.34, P = 0.01). We observed significant differences in VT (7.3 versus 5.4 mlKg-1, P = 0.002) and Pplat values (30 versus 35 cmH2O, P = 0.001) between the Pplat-group and SI-group respectively. SI (1.03 versus 0.99, P = 0.42) and end-inspiratory transpulmonary pressure (PTP) (17 versus 18 cmH2O, P = 0.42) were similar in the Pplat-and SI-groups respectively, without differences in overinflated lung areas at end-inspiration in both groups. Cytokines and histopathology showed no differences. Conclusions: Setting tidal volume to a non-injurious stress index in an open lung condition improves alveolar ventilation and prevents overdistension without increasing lung injury. This is in comparison with limited Pplat protective ventilation in a model of lung injury with low chest-wall compliance.

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  • 111.
    Fors, Diddi
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Eiriksson, K.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Waage, A.
    Arvidsson, D.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    High-frequency jet ventilation shortened the duration of gas embolization during laparoscopic liver resection in a porcine model2014Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 113, nr 3, s. 484-490Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Positive pressure mechanical ventilation causes rhythmic changes in thoracic pressure and central blood flow. If entrainment occurs, it could be easier for carbon dioxide to enter through a wounded vein during laparoscopic liver lobe resection (LLR). High-frequency jet ventilation (HFJV) is a ventilating method that does not cause pronounced pressure or blood flow changes. This study aimed to investigate whether HFJV could influence the frequency, severity, or duration of gas embolism (GE) during LLR. Methods. Twenty-four anaesthetized piglets underwent lobe resection and were randomly assigned to either normal frequency ventilation (NFV) or HFJV (n=12 per group). During resection, a standardized injury to the left hepatic vein was created to increase the risk of GE. Haemodynamic and respiratory variables were monitored. Online blood gas monitoring and transoesophageal echocardiography were used. GE occurrence and severity were graded as 0 (none), 1 (minor), or 2 (major), depending on the echocardiography results. Results. GE duration was shorter in the HFJV group (P=0.008). However, no differences were found between the two groups in the frequency or severity of embolism. Incidence of Grade 2 embolism was less than that found in previous studies and physiological responses to embolism were variable. Conclusion. HFJV shortened the mean duration of GE during LLR and was a feasible ventilation method during the procedure. Individual physiological responses to GE were unpredictable.

  • 112.
    Foss, Stein
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Transplantationskirurgi. Oslo Univ Hosp, Rigshosp, Dept Transplantat Med, Oslo, Norway.
    Nordheim, Espen
    Oslo Univ Hosp, Rigshosp, Dept Transplantat Med, Oslo, Norway;Univ Oslo, Inst Clin Med, Oslo, Norway.
    Sorensen, Dag W.
    Oslo Univ Hosp, Div Emergencies & Crit Care, Oslo, Norway.
    Syversen, Torgunn B.
    Oslo Univ Hosp, Div Emergencies & Crit Care, Oslo, Norway.
    Midtvedt, Karsten
    Oslo Univ Hosp, Rigshosp, Dept Transplantat Med, Oslo, Norway;Univ Oslo, Inst Clin Med, Oslo, Norway.
    Asberg, Anders
    Oslo Univ Hosp, Rigshosp, Dept Transplantat Med, Oslo, Norway;Univ Oslo, Sch Pharm, Oslo, Norway.
    Dahl, Thorleif
    Oslo Univ Hosp, Dept Cardiothorac Surg, Oslo, Norway.
    Bakkan, Per A.
    Oslo Univ Hosp, Rigshosp, Dept Transplantat Med, Oslo, Norway.
    Foss, Aksel E.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Transplantationskirurgi. Oslo Univ Hosp, Rigshosp, Dept Transplantat Med, Oslo, Norway.
    Geiran, Odd R.
    Oslo Univ Hosp, Dept Cardiothorac Surg, Oslo, Norway;Univ Oslo, Inst Clin Med, Oslo, Norway.
    Fiane, Arnt E.
    Oslo Univ Hosp, Dept Cardiothorac Surg, Oslo, Norway;Univ Oslo, Inst Clin Med, Oslo, Norway.
    Line, Pal-Dag
    Oslo Univ Hosp, Rigshosp, Dept Transplantat Med, Oslo, Norway;Univ Oslo, Inst Clin Med, Oslo, Norway.
    First Scandinavian Protocol for Controlled Donation After Circulatory Death Using Normothermic Regional Perfusion2018Ingår i: Transplantation direct, E-ISSN 2373-8731, Vol. 4, nr 7, artikel-id e366Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Donation after circulatory death (DCD) can increase the pool of available organs for transplantation. This pilot study evaluates the implementation of a controlled DCD (cDCD) protocol using normothermic regional perfusion in Norway. Methods. Patients aged 16 to 60 years that are in coma with documented devastating brain injury in need of mechanical ventilation, who would most likely attain cardiac arrest within 60 minutes after extubation, were eligible. With the acceptance from the next of kin and their wish for organ donation, life support was withdrawn and cardiac arrest observed. After a 5-minute no-touch period, extracorporeal membrane oxygenation for post mortem regional normothermic regional perfusion was established. Cerebral and cardiac reperfusion was prevented by an aortic occlusion catheter. Measured glomerular filtration rates 1 year postengraftment were compared between cDCD grafts and age-matched grafts donated after brain death (DBD). Results. Eight cDCD were performed from 2014 to 2015. Circulation ceased median 12 (range, 6-24) minutes after withdrawal of life-sustaining treatment. Fourteen kidneys and 2 livers were retrieved and subsequently transplanted. Functional warm ischemic time was 26 (20-51) minutes. Regional perfusion was applied for 97 minutes (54-106 minutes). Measured glomerular filtration rate 1 year postengraftment was not significantly different between cDCD and donation after brain death organs, 75 (65-76) vs 60 (37-112) mL/min per 1.73 m(2) (P = 0.23). No complications have been observed in the 2 cDCD livers. Conclusion. A protocol for cDCD is successfully established in Norway. Excellent transplant outcomes have encouraged us to continue this work addressing the shortage of organs for transplantation.

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  • 113.
    Foss, Stein
    et al.
    Oslo universitetssykehus, Rikshospitalet.
    Sanner, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Mathisen, Juan Robbie
    Eide, Hilde
    Høgskolan i Oslo og Akershus.
    Legers holdninger till organdonasjon2014Ingår i: Tidsskrift for Den norske lægeforening, ISSN 0029-2001, E-ISSN 0807-7096, Vol. 134, nr 11, s. 1142-1145Artikel i tidskrift (Refereegranskat)
    Abstract [no]

    BAKGRUNN Behovet for organer til transplantasjon øker. Behandlingsteamets kunnskap om og holdninger til organdonasjon kan påvirke donasjonsprosessen. Når åndedrett og hjertevirksomhet blir opprettholdt med kunstige midler, krever norsk lov angiografisk påvist opphevet cerebral sirkulasjon i tillegg til klinisk undersøkelse før organdonasjon kan gjennomføres. Vi ønsket å kartlegge norske legers holdning til organdonasjon og hvordan donasjonsprosessen håndteres.

    MATERIALE OG METODE Et spørreskjema med definerte svaralternativer ble sendt til leger ved intensivavdelinger og til spesialister og utdanningskandidater i nevrokirurgi ved landets donorsykehus i 2008/09.

    RESULTATER 435 leger (55 %) returnerte spørreskjemaet. 315 av 420 (75 %) svarte at de kunne tenke seg å starte organbevarende behandling når det ikke finnes håp for pasienten, mens 18 % var i tvil og 7 % svarte at de ikke kunne tenke seg dette. 68 av 424 (16 %) mente at dersom organdonasjon var aktuelt og de så bort fra eksisterende lovverk, var klinisk diagostikk tilstrekkelig til å kunne stille dødsdiagnosen. 22 % var i tvil, mens 62 % mente at klinisk diagostikk ikke var tilstrekkelig. 258 av 416 (62 %) svarte at de trodde pårørende som oftest forsto hva total ødeleggelse av hjernen innebar etter at de var blitt det forklart.

    FORTOLKNING I fremtidig undervisning bør man legge vekt på muligheten for organbevarende behandling når man forventer dødelig utgang.

  • 114.
    Fraser, Sheila
    et al.
    Univ Sydney, Endocrine Surg Unit, Sydney, NSW, Australia.
    Norlén, Olov
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi. Univ Sydney, Endocrine Surg Unit, Sydney, NSW, Australia.
    Bender, Kyle
    Univ Sydney, Endocrine Surg Unit, Sydney, NSW, Australia.
    Davidson, Joanne
    Royal North Shore Hosp, Dept Anaesthesia, Sydney, NSW, Australia.
    Bajenov, Sonya
    Royal North Shore Hosp, Dept Anaesthesia, Sydney, NSW, Australia.
    Fahey, David
    Royal North Shore Hosp, Dept Anaesthesia, Sydney, NSW, Australia.
    Li, Shawn
    Royal North Shore Hosp, Dept Anaesthesia, Sydney, NSW, Australia.
    Sidhu, Stan
    Univ Sydney, Endocrine Surg Unit, Sydney, NSW, Australia.
    Sywak, Mark
    Univ Sydney, Endocrine Surg Unit, Sydney, NSW, Australia.
    Randomized trial of low versus high carbon dioxide insufflation pressures in posterior retroperitoneoscopic adrenalectomy2018Ingår i: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 163, nr 5, s. 1128-1133Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Posterior retroperitoneoscopic adrenalectomy has gained widespread acceptance for the removal of benign adrenal tumors. Higher insufflation pressures using carbon dioxide (CO2) are required, although the ideal starting pressure is unclear. This prospective, randomized, single-blinded, study aims to compare physiologic differences with 2 different CO2 insufflation pressures during posterior retroperitoneoscopic adrenalectomy.

    Methods: Participants were randomly assigned to a starting insufflation pressure of 20 mm Hg (low pressure) or 25 mm Hg (high pressure). The primary outcome measure was partial pressure of arterial CO2 at 60 minutes. Secondary outcomes included end-tidal CO2, arterial pH, blood pressure, and peak airway pressure. Breaches of protocol to change insufflation pressure were permitted if required and were recorded.

    Results: A prospective randomized trial including 31 patients (low pressure: n = 16; high pressure: n = 15) was undertaken. At 60 minutes, the high pressure group had greater mean partial pressure of arterial CO2 (64 vs 50 mm Hg, P = .003) and end-tidal CO2 (54 vs 45 mm Hg, P = .008) and a lesser pH (7.21 vs 7.29, P = .0005). There were no significant differences in base excess, peak airway pressure, operative time, or duration of hospital stay. Clinically indicated protocol breaches were more common in the low pressure than the high pressure group (8 vs 3, P = .03).

    Conclusion: In posterior retroperitoneoscopic adrenalectomy, greater insufflation pressures are associated with greater partial pressure of arterial CO2 and end-tidal CO2 and lesser pH at 60 minutes, be significant. Commencing with lesser CO2 insufflation pressures decreases intraoperative acidosis.

  • 115.
    Fredriksson, Camilla
    et al.
    Inst för Experimentell och Klinisk medicin, Linköping.
    Kratz, Gunnar
    Inst för Experimentell och Klinisk medicin, Linköping.
    Huss, Fredrik
    Inst för Experimentell och Klinisk medicin, Linköping.
    Transplantation of cultured human keratinocytes in single cell suspension: a comparative in vitro study of different application techniques.2008Ingår i: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 34, nr 2, s. 212-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Transplantation of autologous cultured keratinocytes in single cell suspension is useful in the treatment of burns. The reduced time needed for culture, and the fact that keratinocytes in suspension can be transported from the laboratory to the patient in small vials, thus reducing the costs involved and be stored (frozen) in the clinic for transplantation when the wound surfaces are ready, makes it appealing. We found few published data in the literature about actual cell survival after transplantation of keratinocytes in single cell suspension and so did a comparative in vitro study, considering commonly used application techniques. Human primary keratinocytes were transplanted in vitro in a standard manner using different techniques. Keratinocytes were counted before and after transplantation, were subsequently allowed to proliferate, and counted again on days 4, 8, and 14 by vital staining. Cell survival varied, ranging from 47 to >90%, depending on the technique. However, the proliferation assays showed that the differences in numbers diminished after 8 days of culture. Our findings indicate that a great number of cells die during transplantation but that this effect is diminished if cells are allowed to proliferate in an optimal milieu. A burned patient's wounds cannot be regarded as the optimal milieu, and using less harsh methods of transplantation may increase the take rate and wound closing properties of autologous keratinocytes transplanted in a single cell suspension.

  • 116.
    Frithiof, Robert
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Bandert, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    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.
    Smekal, David
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Central Venous Line and Dialysis Catheter Position Affects Drug Clearance during Continuous Renal Replacement Therapy in an Animal Model.2019Ingår i: ASAIO journal (1992), ISSN 1058-2916, E-ISSN 1538-943X, Vol. 65, nr 4, s. 408-413Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In intensive care, drugs are commonly administered through central venous catheters (CVC). These catheters and central venous dialysis catheters (CVDC) are often placed in the same vessel for practical reasons. The aim of this experimental study was to investigate if the position of CVC and CVDC influences the elimination of infused drugs, during continuous renal replacement therapy (CRRT). In a randomized, cross-over model, anesthetized piglets received both a CVC and a CVDC in a jugular vein. Another CVDC was placed in a femoral vein for comparison. After baseline measurements, CRRT was performed in either of the CVDC, each CRRT-period separated by another baseline period. Hypotension was induced by peripherally given sodium nitroprusside. In the CVC, both gentamicin and noradrenaline were administered. Noradrenaline was titrated to reach a target blood pressure. When CRRT was performed using the CVDC in the same vessel as the drugs were infused, the plasma concentration of gentamicin was reduced compared with when the infusion and CVDC were in different vessels (5.66 [standard deviation (SD) ± 1.23] vs. 7.76 [SD ± 2.30] mg/L [p = 0.02]). The noradrenaline infusion rate needed to reach the target blood pressure was more than doubled (0.32 [SD ± 0.16] vs. 0.15 [SD ± 0.08] µg/kg/min [p = 0.006]). This experimental study indicates that the removal of drugs is increased if infusion is in close vicinity of the CVDC, during CRRT.

  • 117.
    Frykholm, Peter
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Hammarskjöld, Fredrik
    Vascular access: guidance for success2016Ingår i: Anaesthesia, ISSN 0003-2409, E-ISSN 1365-2044, Vol. 71, nr 5, s. 494-497Artikel i tidskrift (Refereegranskat)
  • 118.
    Frykholm, Peter
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Pikwer, A.
    Hammarskjold, F.
    Larsson, A. T.
    Lindgren, S.
    Lindwall, R.
    Taxbro, K.
    Oberg, F.
    Acosta, S.
    Akeson, J.
    Clinical guidelines on central venous catheterisation2014Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, nr 5, s. 508-524Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.

  • 119.
    Frykholm, Peter
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Schindler, E.
    Asklepios Klin Sankt Augustin, Dept Paediat Anaesthesia, St Augustin, NRW, Germany.
    Suempelmann, R.
    Hannover Med Sch, Clin Anaesthesiol & Intens Care Med, Hannover, Germany.
    Walker, R.
    Royal Manchester Childrens Hosp, Manchester, Lancs, England.
    Weiss, M.
    Univ Childrens Hosp, Dept Anaesthesia, Zurich, Switzerland.
    Preoperative fasting in children: review of existing guidelines and recent developments2018Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 120, nr 3, s. 469-474Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The current guidelines for preoperative fasting recommend intervals of 6, 4, and 2 h (6-4-2) of fasting for solids, breast milk, and clear fluids, respectively. The objective is to minimize the risk of pulmonary aspiration of gastric contents, but also to prevent unnecessarily long fasting intervals. Pulmonary aspiration is rare and associated with nearly no mortality in paediatric anaesthesia. The incidence may have decreased during the last decades, judging from several audits published recently. However, several reports of very long fasting intervals have also been published, in spite of the implementation of the 6-4-2 fasting regimens. In this review, we examine the physiological basis for various fasting recommendations, the temporal relationship between fluid intake and residual gastric content, and the pathophysiological effects of preoperative fasting, and review recent publications of various attempts to reduce the incidence of prolonged fasting in children. The pros and cons of the current guidelines will be addressed, and possible strategies for a future revision will be suggested.

  • 120.
    Försth, Peter
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Sandén, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Fusion Surgery for Lumbar Spinal Stenosis REPLY2016Ingår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 375, nr 6, s. 599-600Artikel i tidskrift (Övrigt vetenskapligt)
  • 121.
    Gagnon, David J.
    et al.
    Maine Med Ctr, Dept Pharm, Portland, ME, USA.
    Nielsen, Niklas
    Helsingborg Hosp, Dept Anesthesia & Intens Care, Helsingborg, Sweden.
    Fraser, Gilles L.
    Maine Med Ctr, Dept Pharm, Portland, ME 04102 USA.;Maine Med Ctr, Dept Crit Care Serv, Portland, ME 04102 USA..
    Riker, Richard R.
    Maine Med Ctr, Dept Crit Care Serv, Portland, ME 04102 USA.;Maine Med Ctr, Neurosci Inst, Portland, ME 04102 USA.;Maine Med Ctr, Div Pulm Med, Portland, ME 04102 USA..
    Dziodzio, John
    Maine Med Ctr, Dept Crit Care Serv, Portland, ME 04102 USA..
    Sunde, Kjetil
    Oslo Univ Hosp Ulleval, Dept Anesthesiol, Div Emergencies & Crit Care, Oslo, Norway..
    Hovdenes, Jan
    Natl Hosp Norway, Oslo Univ Hosp, Dept Anesthesiol, Div Emergencies & Crit Care, Oslo, Norway..
    Stammet, Pascal
    Ctr Hosp Luxembourg, Dept Anesthesia & Intens Care, Luxembourg, Luxembourg..
    Friberg, Hans
    Lund Univ, Dept Clin Sci, Lund, Sweden..
    Rubertsson, Sten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Wanscher, Michael
    Rigshosp, Copenhagen Univ Hosp, Dept Cardiothorac Anesthesia, DK-2100 Copenhagen, Denmark..
    Seder, David B.
    Maine Med Ctr, Dept Crit Care Serv, Portland, ME 04102 USA.;Maine Med Ctr, Neurosci Inst, Portland, ME 04102 USA.;Maine Med Ctr, Div Pulm Med, Portland, ME 04102 USA..
    Prophylactic antibiotics are associated with a lower incidence of pneumonia in cardiac arrest survivors treated with targeted temperature management2015Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 92, s. 154-159Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Prophylactic antibiotics (PRO) reduce the incidence of early-onset pneumonia in comatose patients with structural brain injury, but have not been examined in cardiac arrest survivors undergoing targeted temperature management (TTM). We investigated the effect of PRO on the development of pneumonia in that population. Methods: We conducted a retrospective cohort study comparing patients treated with PRO to those not receiving PRO (no-PRO) using Northern Hypothermia Network registry data. Cardiac arrest survivors >= 18 years of age with a GCS < 8 at hospital admission and treated with TTM at 32-34 degrees C were enrolled in the registry. Differences were analyzed in univariate analyses and with logistic regression models to evaluate independent associations of clinical factors with incidence of pneumonia and good functional outcome. Results: 416 of 1240 patients (33.5%) received PRO. Groups were similar in age, gender, arrest location, initial rhythm, and time from collapse to return of spontaneous circulation. PRO patients had less pneumonia (12.6% vs. 54.9%, p < 0.001) and less sepsis (1.2 vs. 5.7%, p < 0.001) compared to no-PRO patients. ICU length of stay (98 vs. 100 h, p = 0.2) and incidence of a good functional outcome (41.1 vs. 36.6%, p = 0.19) were similar between groups. Backwards stepwise logistic regression demonstrated PRO were independently associated with a lower incidence of pneumonia (OR 0.09, 95% 0.06-0.14, p < 0.001) and a similar incidence of good functional outcome. Conclusions: Prophylactic antibiotics were associated with a reduced incidence of pneumonia but a similar rate of good functional outcome.

  • 122.
    Garcia-Fernandez, J.
    et al.
    Hosp Univ Puerta Hierro, Serv Anestesiol Cuidados Crit & Dolor, Madrid, Spain;Univ Autonoma, Fac Med, Dept Cirugia, Madrid, Spain.
    Romero, A.
    Hosp Univ Puerta Hierro, Serv Anestesiol Cuidados Crit & Dolor, Madrid, Spain.
    Blanco, A.
    Hosp Univ Puerta Hierro, Serv Anestesiol Cuidados Crit & Dolor, Madrid, Spain.
    Gonzalez, Patricio
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Abad-Gurumeta, A.
    Hosp Univ Infanta Leonor, Serv Anestesiol Cuidados Crit & Dolor, Madrid, Spain;Univ Complutense, Fac Med, Dept Farmacol, Revista Espanola Anestesiol & Reanimat, Madrid, Spain;Ohio State Univ, Neurosurg Anesthesia, Dept Anesthesiol, Columbus, OH 43210 USA.
    Bergese, S. D.
    Ohio State Univ, Neurosurg Anesthesia, Dept Neurol Surg, Columbus, OH 43210 USA.
    Maniobras de reclutamiento en anestesia: ¿qué más excusas para no usarlas?2018Ingår i: Revista Española de Anestesiología y Reanimación, ISSN 0034-9356, Vol. 65, nr 4, s. 209-217Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Pulmonary recruitment manoeuvres (RM) are intended to reopen collapsed lung areas. RMs are present in nature as a physiological mechanism to get a newborn to open their lungs for the first time at birth, and we also use them, in our usual anaesthesiological clinical practice, after induction or during general anaesthesia when a patient is desaturated. However, there is much confusion in clinical practice regarding their safety, the best way to perform them, when to do them, in which patients they are indicated, and in those where they are totally contraindicated. There are important differences between RM in the patient with adult respiratory distress syndrome, and in a healthy patient during general anaesthesia. Our intention is to review, from a clinical and practical point of view, the use of RM, specifically in anaesthesia.

  • 123.
    Gedeborg, Rolf
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR). Swedish medical products agency, Uppsala, Sweden.
    Cline, Charles
    Zethelius, Björn
    Salmonson, Tomas
    Pragmatic clinical trials in the context of regulation of medicines2018Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, s. 1-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The pragmatic clinical trial addresses scientific questions in a setting close to routine clinical practice and sometimes using routinely collected data. From a regulatory perspective, when evaluating a new medicine before approving marketing authorization, there will never be enough patients studied in all subgroups that may potentially be at higher risk for adverse outcomes, or sufficient patients to detect rare adverse events, or sufficient follow-up time to detect late adverse events that require long exposure times to develop. It may therefore be relevant that post-marketing trials sometimes have more pragmatic characteristics, if there is a need for further efficacy and safety information. A pragmatic study design may reflect a situation close to clinical practice, but may also have greater potential methodological concerns, e.g. regarding the validity and completeness of data when using routinely collected information from registries and health records, the handling of intercurrent events, and misclassification of outcomes. In a regulatory evaluation it is important to be able to isolate the effect of a specific product or substance, and to have a defined population that the results can be referred to. A study feature such as having a wide and permissive inclusion of patients might therefore actually hamper the utility of the results for regulatory purposes. Randomization in a registry-based setting addresses confounding that could otherwise complicate a corresponding non-interventional design, but not any other methodological issues. Attention to methodological basics can help generate reliable study results, and is more important than labelling studies as 'pragmatic'.

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  • 124.
    Gedeborg, Rolf
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniskt forskningscentrum (UCR).
    Thiblin, Ingemar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Rättsmedicin.
    Byberg, Liisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Wernroth, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniskt forskningscentrum (UCR).
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniskt forskningscentrum (UCR).
    The impact of clinically undiagnosed injuries on survival estimates2009Ingår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 37, nr 2, s. 449-55Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES:: Missed injury diagnoses may cause potentially preventable deaths. To estimate the effect of clinically undiagnosed injuries on injury-specific survival estimates and the accuracy of an injury severity score. To also estimate the potentially preventable mortality attributable to these injuries. DESIGN, SETTING, AND PATIENTS:: In a nation-wide, population-based study, data were collected from all hospital admissions for injuries in Sweden between 1998 and 2004. We studied 8627 deaths in hospital among 598,137 incident hospital admissions. MEASUREMENTS AND MAIN RESULTS:: New specific-injury categories were added in 7.4% (95% confidence interval [CI] 6.8-8.0) of all deaths with an autopsy rate of 24.2%. It was estimated that this proportion would have increased to 25.1% (95% CI 23.0-27.2), if all deaths had been autopsied. The most pronounced effect of clinically undiagnosed injuries was found for internal organ injury in the abdomen or pelvis, where they reduced the estimated survival from 0.83 to 0.69 (95% CI for the difference: 0.09-0.20). Autopsy diagnoses also revealed substantial bias of survival estimates for vascular injuries in the thorax and crush injuries to the head. The performance of the International Classification of Diseases Injury Severity Score improved when autopsy diagnoses were added to hospital discharge diagnoses. The maximum proportion of injury deaths attributable to missed injuries was estimated to be 6.5%. CONCLUSIONS:: Maintaining a high autopsy rate and merging accurate hospital discharge data and autopsy data are effective ways to improve the accuracy of survival estimates and mortality prediction models, and to estimate mortality attributable to diagnostic failures.

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  • 125.
    Glette, Mari
    et al.
    Norwegian Univ Sci & Technol, Dept Circulat & Med Imaging, Trondheim, Norway;St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Landmark, Tormod
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway;Norwegian Univ Sci & Technol, Dept Psychol, Trondheim, Norway.
    Jensen, Mark P.
    Univ Washington, Sch Med, Dept Rehabil Med, Seattle, WA 98195 USA.
    Woodhouse, Astrid
    Norwegian Univ Sci & Technol, Dept Circulat & Med Imaging, Trondheim, Norway;St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway;Univ Hosp Uppsala, Pain Ctr, Uppsala, Sweden.
    Borchgrevink, Petter C.
    Norwegian Univ Sci & Technol, Dept Circulat & Med Imaging, Trondheim, Norway;St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Stiles, Tore C.
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway;Norwegian Univ Sci & Technol, Dept Psychol, Trondheim, Norway.
    Catastrophizing, Solicitous Responses From Significant Others, and Function in Individuals With Neuropathic Pain, Osteoarthritis, or Spinal Pain in the General Population2018Ingår i: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 19, nr 9, s. 983-995Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    That certain psychological factors are negatively associated with function in patients with chronic pain is well established. However, few studies have evaluated these factors in individuals with chronic pain from the general population. The aims of this study were to: 1) evaluate the unique associations between catastrophizing and perceived solicitous responses and psychological function, physical function, and insomnia severity in individuals with neuropathic pain, osteoarthritis, or spinal pain in the general population; and 2) determine if diagnosis moderates the associations found. Five hundred fifty-one individuals from the general population underwent examinations with a physician and physiotherapist, and a total of 334 individuals were diagnosed with either neuropathic pain (n = 34), osteoarthritis (n = 78), or spinal pain (n = 222). Results showed that catastrophizing was significantly associated with reduced psychological and physical function, explaining 24% and 2% of the variance respectively, whereas catastrophizing as well as perceived solicitous responding were significantly and uniquely associated with insomnia severity, explaining 8% of the variance. Perceived solicitous responding was significantly negatively associated with insomnia severity. Moderator analyses indicated that: 1) the association between catastrophizing and psychological function was greater among individuals with spinal pain and neuropathic pain than those with osteoarthritis, and 2) the association between catastrophizing and insomnia was greater among individuals with spinal pain and osteoarthritis than those with neuropathic pain. No statistically significant interactions including perceived solicitous responses were found. The findings support earlier findings of an association between catastrophizing and function among individuals with chronic pain in the general population, and suggest that diagnosis may serve a moderating role in some of these associations. Perspective: When examining persons with pain in the general population, catastrophizing is associated with several aspects of function, and diagnosis serves as a moderator for these associations. The replication of these associations in the general population support their reliability and generalizability.

  • 126.
    Gogniat, Emiliano
    et al.
    Hosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina.
    Ducrey, Marcela
    Hosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina.
    Dianti, Jose
    Hosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina.
    Madorno, Matias
    Inst Tecnol Buenos Aires ITBA, Buenos Aires, DF, Argentina.
    Roux, Nicolas
    Hosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina.
    Midley, Alejandro
    Hosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina.
    Raffo, Julio
    Hosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina.
    Giannasi, Sergio
    Hosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina.
    San Roman, Eduardo
    Hosp Italiano Buenos Aires, Dept Intens Care Med, Buenos Aires, DF, Argentina.
    Suarez-Sipmann, Fernando
    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. CIBERES, Madrid, Spain;Hosp Univ & Politecn La Fe, Serv Med Intens, Valencia, Spain.
    Tusman, Gerardo
    Hosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, Mar Del Plata, Buenos Aires, Argentina.
    Dead space analysis at different levels of positive end-expiratory pressure in acute respiratory distress syndrome patients2018Ingår i: Journal of critical care, ISSN 0883-9441, E-ISSN 1557-8615, Vol. 45, s. 231-238Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To analyze the effects of positive end-expiratory pressure (PEEP) on Bohr's dead space (VDBohr/VT) in patients with acute respiratory distress syndrome (ARDS).

    Material and methods: Fourteen ARDS patients under lung protective ventilation settingswere submitted to 4 different levels of PEEP (0, 6, 10, 16 cmH(2)O). Respiratory mechanics, hemodynamics and volumetric capnography were recorded at each protocol step.

    Results: Two groups of patients responded differently to PEEP when comparing baseline with 16-PEEP: those in which driving pressure increased > 15% (Delta P.(15%), n = 7, p = .016) and those in which the change was <= 15% (Delta P-<= 15%, n = 7, p = .700). VDBohr/VT was higher in Delta P-<= 15% than in Delta P-<= 15% patients at baseline ventilation [0.58 (0.49-0.60) vs 0.46 (0.43-0.46) p = .018], at 0-PEEP [0.50 (0.47-0.54) vs 0.41 (0.40-0.43) p = .012], at 6-PEEP [0.55 (0.49-0.57) vs 0.44 (0.42-0.45) p = .008], at 10-PEEP [0.59 (0.51-0.59) vs 0.45 (0.44-0.46) p = .006] and at 16-PEEP [0.61 (0.56-0.65) vs 0.47 (0.45-0.48) p =. 001]. We found a good correlation between Delta P and VDBohr/VT only in the Delta P.(15%) group (r = 0.74, p < .001).

    Conclusions: Increases in PEEP result in higher VDBohr/VT only when associated with an increase in driving pressure.

  • 127.
    Gordh, Torsten E.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Jensen, Troels S.
    Kalso, Eija
    Reporting of Trials of Gabapentin2010Ingår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 362, nr 17, s. 1641-1641Artikel i tidskrift (Refereegranskat)
  • 128.
    Gordh, Torsten
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Lind, Anne-Li
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Bodolea, Constatin
    Hewitt, Ellen
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk struktur och funktion.
    Cathepsin S is increased in cerebrospinal fluid from patients with neuropathic pain: A support of the microglia hypothesis in humans2014Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, nr 3, s. 208-209Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: Cathepsin S has been reported to be a biomarker of spinal microglial activation, a process suggested to be involved in the pathophysiology of chronic neuropathic pain. So far this has been shown only in animal experiments. The aim of this study was to investigate the concentrations of cathepsin S in human cerebrospinal fluid (CSF) samples from a well-defined patient cohort suffering from neuropathic pain as compared to controls.

    Methods: CSF samples from patients suffering from chronic neuropathic pain (n = 14) were analyzed for cathepsin S levels using commercial sandwich ELISAs (DY1183, R&D Systems, Minneapolis, MN, USA). Control CSF was sampled from patients undergoing minor urological surgical procedures under spinal anaesthesia (n = 70), having no obvious pain suffering.

    Results: The neuropathic pain group had significantly higher levels of CSF cathepsin S (median 15189 pg/mL, range 3213–40,040), than the control group (median 5911 pg/mL, range 1909–17,188) (p < 0.005, Mann–Whitney U-test).

    Conclusion: The results support the existence of microglial activation in chronic neuropathic pain patients. CSF Cathepsin S may serve as a potential biomarker for this specific mechanism linked to neuropathic pain. In the future, Cathepsin S inhibiting drugs might become a new treatment alternative for neurophatic pain.

  • 129.
    Gudbjartsson, Tomas
    et al.
    Landspitali Univ Hosp, Dept Cardiothorac Surg, Reykjavik, Iceland;Univ Iceland, Fac Med, Reykjavik, Iceland.
    Helgadottir, Solveig
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Sigurdsson, Martin Ingi
    Univ Iceland, Fac Med, Reykjavik, Iceland;Landspitali Univ Hosp, Dept Anaesthesia & Crit Care, Reykjavik, Iceland.
    Taha, Amar
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden;Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Jeppsson, Anders
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Cardiothorac Surg, Gothenburg, Sweden.
    Christensen, Thomas Decker
    Aarhus Univ Hosp, Dept Cardiothorac & Vasc Surg, Dept Clin Med, Aarhus, Denmark.
    Riber, Lars Peter Schoedt
    Univ Southern Denmark, Odense Univ Hosp, Dept Cardiothorac & Vasc Surg, Dept Clin Med, Odense, Denmark.
    New-onset postoperative atrial fibrillation after heart surgery2020Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 64, nr 2, s. 145-155Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background

    New‐onset postoperative atrial fibrillation (poAF) complicates approximately 20‐60% of all cardiac surgical procedures and is associated with an increased periprocedural mortality and morbitity, prolonged hospital stay, increased costs, and worse long‐term survival. Unfortunately multiple advances in surgery and perioperative care over the last two decades have not led to a reduction in the incidence of poAF or associated complications in the daily clinical practice.

    Methods

    A narrative review of the available literature was performed.

    Results

    An extensive review of the pathophysiology of poAF following cardiac surgery, clinical, and procedural risk‐factors is provided, as well as prophylactic measures and treatment.

    Conclusion

    Multiple strategies to prevent and manage poAF following heart surgery already exist. Our hope is that this review will facilitate more rigorous testing of prevention strategies, implementation of prophylaxis regimens as well as optimal treatment of this common and serious complication.

  • 130.
    Gudmundsson, M
    et al.
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Perchiazzi, G
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Pellegrini, Mariangela
    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.
    Vena, A
    Department of Emergency and Organ Transplant, Bari University, Bari, Italy.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Rylander, Christian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper. Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Atelectasis is inversely proportional to transpulmonary pressure during weaning from ventilator support in a large animal model2018Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 1, s. 94-104Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    In mechanically ventilated, lung injured, patients without spontaneous breathing effort, atelectasis with shunt and desaturation may appear suddenly when ventilator pressures are decreased. It is not known how such a formation of atelectasis is related to transpulmonary pressure (PL) during weaning from mechanical ventilation when the spontaneous breathing effort is increased. If the relation between PL and atelectasis were known, monitoring of PL might help to avoid formation of atelectasis and cyclic collapse during weaning. The main purpose of this study was to determine the relation between PL and atelectasis in an experimental model representing weaning from mechanical ventilation.

    Methods

    Dynamic transverse computed tomography scans were acquired in ten anaesthetized, surfactant-depleted pigs with preserved spontaneous breathing, as ventilator support was lowered by sequentially reducing inspiratory pressure and positive end expiratory pressure in steps. The volumes of gas and atelectasis in the lungs were correlated with PL obtained using oesophageal pressure recordings. Work of breathing (WOB) was assessed from Campbell diagrams.

    Results

    Gradual decrease in PL in both end-expiration and end-inspiration caused a proportional increase in atelectasis and decrease in the gas content (linear mixed model with an autoregressive correlation matrix; P < 0.001) as the WOB increased. However, cyclic alveolar collapse during tidal ventilation did not increase significantly.

    Conclusion

    We found a proportional correlation between atelectasis and PL during the ‘weaning process’ in experimental mild lung injury. If confirmed in the clinical setting, a gradual tapering of ventilator support can be recommended for weaning without risk of sudden formation of atelectasis.

  • 131.
    Hardig, Bjarne Madsen
    et al.
    Physio Control, Lund, Sweden..
    Lindgren, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Östlund, Ollie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Herlitz, Johan
    Univ Boras, Prehosp Res Ctr Western Sweden, Res Ctr PreHospen, Sch Hlth Sci, Boras, Sweden..
    Karlsten, Rolf
    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.
    Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial-A randomised, controlled trial2017Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 115, s. 155-162Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3 min' mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2 min' manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2 min' algorithm found worse outcome for patients with initial VF/VT in the LUCAS group and they received more adrenalin compared to the manual group. We wanted to evaluate if these algorithms had any outcome effect for patients still in VF/VT after the initial defibrillation and how adrenalin timing impacted it. Method: Both groups received manual chest compressions first. Based on non-electronic CPR process documentation, outcome, neurologic status and its relation to CPR duration prior to the first detected return of spontaneous circulation (ROSC), time to defibrillation and adrenalin given were analysed in the subgroup of VF/VT patients. Results: Seven hundred and fifty-seven patients had still VF/VT after initial chest compressions combined with a defibrillation attempt (374 received mechanical CPR) or not (383 received manual CPR). No differences were found for ROSC (mechanical CPR 58.3% vs. manual CPR 58.6%, p = 0.94), or 6-month survival with good neurologic outcome (mechanical CPR 25.1% vs. manual CPR 23.0%, p = 0.50). A significant difference was found regarding the time from start of manual chest compression to the first defibrillation (mechanical CPR: 4 (2-5) min vs manual CPR 3 (2-4) min, P < 0.001). The time from the start of manual chest compressions to ROSC was longer in the mechanical CPR group. Conclusions: No difference in short-or long-term outcomes was found between the 2 algorithms for patients still in VF/VT after the initial defibrillation. The time to the 1st defibrillation and the interval between defibrillations were longer in the mechanical CPR group without impacting the overall outcome. The number of defibrillations required to achieve ROSC or adrenalin doses did not differ between the groups.

  • 132.
    Haugland, Helge
    et al.
    Norwegian Air Ambulance Fdn, Oslo, Norway;St Olavs Univ Hosp, Dept Emergency Med & Prehosp Serv, Trondheim, Norway.
    Olkinuora, Anna
    FinnHEMS Ltd, Res & Dev Unit, Vantaa, Finland.
    Rognas, Leif
    Aarhus Univ Hosp, Dept Anaesthesiol, Aarhus N, Denmark;Danish Air Ambulance, Aarhus, Denmark.
    Ohlen, David
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Thoraxkirurgi. Uppsala Univ Hosp, Dept Anaesthesia Perioperat Management & Intens C, Airborne Intens Care Unit, Uppsala, Sweden.
    Kruger, Andreas
    Norwegian Air Ambulance Fdn, Oslo, Norway;St Olavs Univ Hosp, Dept Emergency Med & Prehosp Serv, Trondheim, Norway.
    Testing quality indicators and proposing benchmarks for physician-staffed emergency medical services: a prospective Nordic multicentre study2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 11, artikel-id e030626Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives A consensus study from 2017 developed 15 response-specific quality indicators (QIs) for physician-staffed emergency medical services (P-EMS). The aim of this study was to test these OIs for important characteristics in a real clinical setting. These characteristics were feasibility, rankability, variability, actionability and documentation. We further aimed to propose benchmarks for future quality measurements in P-EMS. Design In this prospective observational study, physician-staffed helicopter emergency services registered data for the 15 QIs. The feasibility of the QIs was assessed based on the comments of the recording physicians. The other four OI characteristics were assessed by the authors. Benchmarks were proposed based on the quartiles in the dataset. Setting Nordic physician-staffed helicopter emergency medical services. Participants 16 physician-staffed helicopter emergency services in Finland, Sweden, Denmark and Norway. Results The dataset consists of 5638 requests to the participating P-EMSs. There were 2814 requests resulting in completed responses with patient contact. All OIs were feasible to obtain. The variability of 14 out of 15 OIs was adequate. Rankability was adequate for all Us. Actionability was assessed as being adequate for 10 OIs. Documentation was adequate for 14 OIs. Benchmarks for all OIs were proposed. Conclusions All 15 OIs seem possible to use in everyday quality measurement and improvement. However, it seems reasonable to not analyse the QI 'Adverse Events' with a strictly quantitative approach because of a low rate of adverse events. Rather, this QI should be used to identify adverse events so that they can be analysed as sentinel events. The actionability of the QIs 'Able to respond immediately when alarmed', 'Time to arrival of P-EMS', 'Time to preferred destination', 'Provision of advanced treatment' and 'Significant logistical contribution' was assessed as being poor. Benchmarks for the OIs and a total quality score are proposed for future quality measurements.

    Ladda ner fulltext (pdf)
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  • 133.
    Haukenes, Inger
    et al.
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Hensing, G.
    Stålnacke, Britt-Marie
    Umeå universitet, Rehabiliteringsmedicin.
    Hammarström, Anne
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Does pain severity guide selection to multimodal pain rehabilitation across gender?2015Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 19, nr 6, s. 826-833Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Studies have addressed the effect of multimodal pain rehabilitation (MMR), whereas criteria for selection are sparse. This study examines whether higher scores on musculoskeletal pain measures are associated with selection to MMR, and whether this differs across gender.

    Method A clinical population of 262 male and 589 female patients was recruited consecutively during 3 years, 2007-2010. The patients were referred from primary care to a pain rehabilitation clinic in Northern Sweden for assessment and selection to MMR. Register-based data on self-reported pain were linked to patients' records where outcome (MMR or not) was stated. We modelled odds ratios for selection to MMR by higher scores on validated pain measures (pain severity, interference with daily life, pain sites and localized pain vs. varying pain location). Covariates were age, educational level and multiple pain measures. Anxiety and depression (Hospital, Anxiety and Depression Scale) and working status were used in sensitivity tests.

    Results Higher scores of self-reported pain were not associated with selection to MMR in multivariate models. Among women, higher scores on pain severity, pain sites and varying pain location (localized pain=reference) were negatively associated with selection to MMR. After adjustment for multiple pain measures, the negative odds ratio for varying location persisted (OR=0.59, 95% CI=0.39-0.89).

    Conclusion Higher scores on self-reported pain did not guide selection to MMR and a negative trend was found among women. Studies of referral patterns and decision processes may contribute to a better understanding of the clinical practice that decides selection to MMR.

  • 134.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Effects of anaesthesia on ventilation/perfusion matching2014Ingår i: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 31, nr 9, s. 447-449Artikel i tidskrift (Övrigt vetenskapligt)
  • 135.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Open is Better Than Closed2016Ingår i: TURKISH JOURNAL OF ANAESTHESIOLOGY AND REANIMATION, ISSN 2149-0937, Vol. 44, nr 4, s. 167-168Artikel i tidskrift (Refereegranskat)
  • 136.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Optimum PEEP During Anesthesia and in Intensive Care is a Compromise but is Better than Nothing2016Ingår i: TURKISH JOURNAL OF ANAESTHESIOLOGY AND REANIMATION, ISSN 2149-0937, Vol. 44, nr 4, s. 161-162Artikel i tidskrift (Refereegranskat)
  • 137.
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Small Tidal Volumes, Positive End-expiratory Pressure, and Lung Recruitment Maneuvers during Anesthesia: Good or Bad?2015Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 123, nr 3, s. 501-503Artikel i tidskrift (Refereegranskat)
  • 138.
    Hedenstierna, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Edmark, Lennart
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Does high oxygen concentration reduce postoperative infection?2014Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 120, nr 4, s. 1050-1050Artikel i tidskrift (Refereegranskat)
  • 139.
    Hedenstierna, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Edmark, Lennart
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    In reply to: Calculating Ideal Body Weight: Keep It Simple Reply2017Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 127, nr 1, s. 204-204Artikel i tidskrift (Övrigt vetenskapligt)
  • 140.
    Hedenstierna, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Edmark, Lennart
    Vasteras Hosp, Dept Anesthesia & Intens Care, Vasteras, Sweden..
    Protective Ventilation during Anesthesia Is It Meaningful?2016Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 125, nr 6, s. 1079-1082Artikel i tidskrift (Refereegranskat)
  • 141.
    Hedenstierna, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Meyhoff, Christian S.
    Bispebjerg & Frederiksberg Hosp, Dept Anaesthesia & Intens Care, Copenhagen, Denmark;Univ Copenhagen, Dept Clin Med, Copenhagen, Denmark.
    Oxygen toxicity in major emergency surgery-anything new?2019Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 45, nr 12Artikel i tidskrift (Övrigt vetenskapligt)
    Ladda ner fulltext (pdf)
    FULLTEXT01
  • 142.
    Hedenstierna, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Meyhoff, Christian S.
    Univ Copenhagen, Bispebjerg & Frederiksberg Hosp, Dept Anaesthesia & Intens Care, Copenhagen, Denmark.
    Perchiazzi, Gaetano
    Uppsala Univ, Dept Surg Sci, Hedenstierna Lab, Uppsala, Sweden.
    Larsson, Anders
    Uppsala Univ, Dept Surg Sci, Hedenstierna Lab, Uppsala, Sweden.
    Wetterslev, Jörn
    Copenhagen Univ Hosp, Rigshosp, Ctr Clin Intervent Res, Copenhagen Trial Unit, Copenhagen, Denmark.
    Rasmussen, Lars S.
    Univ Copenhagen, Rigshosp, Dept Anesthesia, Copenhagen, Denmark.
    Modification of the World Health Organization Global Guidelines for Prevention of Surgical Site Infection Is Needed2019Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 131, nr 4, s. 765-768Artikel i tidskrift (Övrigt vetenskapligt)
  • 143.
    Hedenstierna, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi.
    Tokics, Leif
    Karolinska Hosp, Dept Anaesthesia & Intens Care, Huddinge, Sweden.
    Reinius, Henrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Rothen, Hans U.
    Univ Bern, Univ Hosp Inselspital, Dept Intens Care Med, Bern, Switzerland.
    Östberg, Erland
    Vasteras Hosp, Dept Anaesthesia & Intens Care, Vasteras, Sweden.
    Öhrvik, John
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Higher age and obesity limit atelectasis formation during anaesthesia: an analysis of computed tomography data in 243 subjects2020Ingår i: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 124, nr 3, s. 336-344Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: General anaesthesia is increasingly common in elderly and obese patients. Greater age and body mass index (BMI) worsen gas exchange. We assessed whether this is related to increasing atelectasis during general anaesthesia.

    Methods: This primary analysis included pooled data from previously published studies of 243 subjects aged 18-78 yr, with BMI of 18-52 kg m(-2). The subjects had no clinical signs of cardiopulmonary disease, and they underwent computed tomography (CT) awake and during anaesthesia before surgery after preoxygenation with an inspired oxygen fraction (FIO2) of >0.8, followed by mechanical ventilation with FIO2 of 0.3 or higher with no PEEP. Atelectasis was assessed by CT.

    Results: Atelectasis area of up to 39 cm(2) in a transverse scan near the diaphragm was seen in 90% of the subjects during anaesthesia. The log of atelectasis area was related to a quadratic function of (age+age(2)) with the most atelectasis at similar to 50 yr (r(2)=0.08; P<0.001). Log atelectasis area was also related to a broken-line function of the BMI with the knee at 30 kg m(-2) (r(2)=0.06; P<0.001). Greater atelectasis was seen in the subjects receiving FIO2 of 1.0 than FIO2 of 0.3-0.5 (12.8 vs 8.1 cm(2); P<0.001). A multiple regression analysis, including a quadratic function of age, a broken-line function of the BMI, and dichotomised FIO2 (0.3-0.5/1.0) adjusting for ventilatory frequency, strengthened the association (r(2)= 0.23; P<0.001). PaO2 decreased with both age and BMI.

    Conclusions: Atelectasis during general anaesthesia increased with age up to 50 yr and decreased beyond that. Atelectasis increased with BMI in normal and overweight patients, but showed no further increase in obese subjects (BMI >= 30 kg m(-2)). Therefore, greater age and obesity appear to limit atelectasis formation during general anaesthesia.

  • 144.
    Hedenstierna, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Tokics, Leif
    Karolinska Hosp, Dept Anesthesia & Intens Care, Huddinge, Sweden.
    Scaramuzzo, Gaetano
    Univ Ferrara, Dept Morphol Surg & Expt Med, Sect Anesthesia & Intens Care, Ferrara, Italy.
    Rothen, Hans U.
    Univ Bern, Univ Hosp, Dept Intens Care Med, Inselspital, Bern, Switzerland.
    Edmark, Lennart
    Vasteras Hosp, Dept Anesthesia & Intens Care, Vasteras, Sweden.
    Öhrvik, John
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Oxygenation Impairment during Anesthesia: Influence of Age and Body Weight2019Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 131, nr 1, s. 46-57Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Anesthesia is increasingly common in elderly and overweight patients and prompted the current study to explore mechanisms of age- and weight-dependent worsening of arterial oxygen tension (Pao(2)). Methods: This is a primary analysis of pooled data in patients with (1) American Society of Anesthesiologists (ASA) classification of 1; (2) normal forced vital capacity; (3) preoxygenation with an inspired oxygen fraction (FIO2) more than 0.8 and ventilated with FIO2 0.3 to 0.4; (4) measurements done during anesthesia before surgery. Eighty patients (21 women and 59 men, aged 19 to 69 yr, body mass index up to 30 kg/m(2)) were studied with multiple inert gas elimination technique to assess shunt and perfusion of poorly ventilated regions (low ventilation/perfusion ratio [(V) over dot(A)/Q]) and computed tomography to assess atelectasis. Results: Pao(2) /FIO2 was lower during anesthesia than awake (368; 291 to 470 [median; quartiles] vs. 441; 397 to 462 mm Hg; P = 0.003) and fell with increasing age and body mass index. Log shunt was best related to a quadratic function of age with largest shunt at 45 yr (r(2) = 0.17, P = 0.001). Log shunt was linearly related to body mass index (r(2) = 0.15, P < 0.001). A multiple regression analysis including age, age(2), and body mass index strengthened the association further (r(2) = 0.27). Shunt was highly associated to atelectasis (r(2) = 0.58, P < 0.001). Log low (V) over dot(A)/Q showed a linear relation to age (r(2) = 0.14, P = 0.001). Conclusions: Pao(2)/FIO2 ratio was impaired during anesthesia, and the impairment increased with age and body mass index. Shunt was related to atelectasis and was a more important cause of oxygenation impairment in middle-aged patients, whereas low (V) over dot(A)/Q, likely caused by airway closure, was more important in elderly patients. Shunt but not low (V) over dot(A)/Q increased with increasing body mass index. Thus, increasing age and body mass index impaired gas exchange by different mechanisms during anesthesia.

  • 145.
    Heili-Frades, Sarah
    et al.
    UAM, CIBERES, IIS Fdn Jimenez Diaz, Intermediate Resp Care Unit,Pulmonol Dept, Madrid, Spain;Inst Carlos III, CIBER Enfermedades Resp, Madrid, Spain.
    Suarez-Sipmann, Fernando
    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. Hosp Univ Princesa, Serv Med Intensiva, Madrid, Spain;Inst Carlos III, CIBER Enfermedades Resp, Madrid, Spain;Uppsala Univ Hosp, Uppsala, Sweden.
    Santos, Arnoldo
    CIBER Enfermedades Resp CIBERES, ITC, Madrid, Spain.
    Pilar Carballosa, Maria
    UAM, CIBERES, IIS Fdn Jimenez Diaz, Intermediate Resp Care Unit,Pulmonol Dept, Madrid, Spain.
    Naya-Prieto, Alba
    UAM, CIBERES, IIS Fdn Jimenez Diaz, Intermediate Resp Care Unit,Pulmonol Dept, Madrid, Spain.
    Castilla-Reparaz, Carlos
    IIS Fdn Jimenez Diaz, Dept Expt Surg, Madrid, Spain.
    Jesus Rodriguez-Nieto, Maria
    UAM, CIBERES, IIS Fdn Jimenez Diaz, Intermediate Resp Care Unit,Pulmonol Dept, Madrid, Spain;Inst Carlos III, CIBER Enfermedades Resp, Madrid, Spain.
    Gonzalez-Mangado, Nicolas
    UAM, CIBERES, IIS Fdn Jimenez Diaz, Intermediate Resp Care Unit,Pulmonol Dept, Madrid, Spain;Inst Carlos III, CIBER Enfermedades Resp, Madrid, Spain.
    Peces-Barba, German
    UAM, CIBERES, IIS Fdn Jimenez Diaz, Intermediate Resp Care Unit,Pulmonol Dept, Madrid, Spain;Inst Carlos III, CIBER Enfermedades Resp, Madrid, Spain.
    Continuous monitoring of intrinsic PEEP based on expired CO2 kinetics: an experimental validation study2019Ingår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 23, artikel-id 192Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Quantification of intrinsic PEEP (PEEPi) has important implications for patients subjected to invasive mechanical ventilation. A new non-invasive breath-by-breath method (etCO(2)D) for determination of PEEPi is evaluated. MethodsIn 12 mechanically ventilated pigs, dynamic hyperinflation was induced by interposing a resistance in the endotracheal tube. Airway pressure, flow, and exhaled CO2 were measured at the airway opening. Combining different I:E ratios, respiratory rates, and tidal volumes, 52 different levels of PEEPi (range 1.8-11.7cmH(2)O; mean 8.450.32cmH(2)O) were studied. The etCO(2)D is based on the detection of the end-tidal dilution of the capnogram. This is measured at the airway opening by means of a CO2 sensor in which a 2-mm leak is added to the sensing chamber. This allows to detect a capnogram dilution with fresh air when the pressure coming from the ventilator exceeds the PEEPi. This method was compared with the occlusion method. Results The etCO(2)D method detected PEEPi step changes of 0.2cmH(2)O. Reference and etCO(2)D PEEPi presented a good correlation (R-2 0.80, P<0.0001) and good agreement, bias -0.26, and limits of agreement +/- 1.96 SD (2.23, -2.74) (P<0.0001). Conclusions The etCO(2)D method is a promising accurate simple way of continuously measure and monitor PEEPi. Its clinical validity needs, however, to be confirmed in clinical studies and in conditions with heterogeneous lung diseases.

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  • 146.
    Hellevuo, H.
    et al.
    Tampere Univ Hosp, Dept Intens Care Med, POB 2000, FI-33521 Tampere, Finland.;Univ Tampere, Tampere, Finland..
    Sainio, M.
    Tampere Univ Hosp, Dept Intens Care Med, POB 2000, FI-33521 Tampere, Finland.;Univ Tampere, Tampere, Finland.;Univ Turku, Dept Emergency Med, Emergency Med Serv, Turku, Finland.;Turku Univ Hosp, Turku, Finland..
    Huhtala, H.
    Univ Tampere, Fac Social Sci, Tampere, Finland..
    Olkkola, K. T.
    Univ Helsinki, Dept Anaesthesiol Intens Care & Pain Med, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland..
    Tenhunen, Jyrki
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Hoppu, S.
    Tampere Univ Hosp, Dept Intens Care Med, POB 2000, FI-33521 Tampere, Finland.;Univ Tampere, Tampere, Finland..
    Good quality of life before cardiac arrest predicts good quality of life after resuscitation2018Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, nr 4, s. 515-521Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The survival rate of cardiac arrest patients is increasing. Our aim was to compare the quality of life before and after cardiac arrest and analyse the factors associated with outcome.

    Methods. All adult cardiac arrest patients admitted to the Tampere University Hospital intensive care unit between 2009 and 2011 were included in a retrospective follow-up study if surviving to discharge and were asked to return a questionnaire after 6 months. Data on patient demographics and pre-arrest quality of life were retrieved from medical records. Data are given as means (SD) or medians [Q(1), Q(3)]. We used logistic regression to identify factors associated with better quality of life after cardiac arrest.

    Results. Six months after cardiac arrest, 36% (79/222) were alive and 70% (55/79) of those patients completed the follow-up EuroQoL (EQ-5D) quality of life questionnaire. Median values for the EQ-5D before and after cardiac arrest were 0.89 [0.63, 1] and 0.89 [0.62, 1], respectively (P = 0.75). Only the EQ-5D prior to cardiac arrest was associated with better quality of life afterwards (OR 1.2; 95% CI 1.0-1.3; P = 0.02).

    Conclusions. Quality of life remained good after cardiac arrest especially in those patients who had good quality of life before cardiac arrest.

  • 147.
    Helliksson, Fredrik
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, CLINTEC, Stockholm, Sweden.;Cent Hosp Karlstad, Dept Anesthesiol & Intens Care, SE-65285 Karlstad, Sweden..
    Wernerman, Jan
    Karolinska Inst, Dept Clin Sci Intervent & Technol, CLINTEC, Stockholm, Sweden..
    Wiklund, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala Univ, Dept Surg Sci, Uppsala, Sweden..
    Rosell, Jon
    Cent Hosp Karlstad, Dept Anesthesiol & Intens Care, SE-65285 Karlstad, Sweden..
    Karlsson, Mathias
    Karolinska Inst Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden.;Cent Hosp Karlstad, Dept Clin Chem, Karlstad, Sweden..
    The combined use of three widely available biochemical markers as predictor of organ failure in critically ill patients2016Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 76, nr 6, s. 479-485Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: We hypothesized that lactate dehydrogenase, LDH/albumin ratio in combination with or without magnesium (Mg2+) could predict organ failure in critically ill adult patients. The aim of this study was to describe a new risk index for organ failure or mortality in critically ill patients based on a combination of these routinely available biochemical plasma biomarkers.Methods: Patients18 years admitted to the intensive care unit (ICU) were screened. Albumin and LDH were analyzed at the time of admission to ICU (n=347). Organ failure assessed with Sequential Organ Failure Assessment' (SOFA) score was used, and 30-day mortality was recorded. The predictive value of the test was calculated using the areas under the receiving operating characteristic (ROC) curve.Results: The LDH/albumin ratio was higher in patients who developed organ failure as compared to those who did not (p<0.001). The areas under the ROC curve were 0.77 both for prediction of multiple organ failure and for 30-day mortality. In a subgroup of patients (n=183) admitted to ICU from the emergency department, the predictive values were 0.86 and 0.80, respectively.Conclusion: The LDH/albumin ratio at ICU admission was associated with the development of multiple organ failure and 30-day mortality in this prospective study. The clinical value of this biomarker as a predictor of organ failure in critically ill patients is yet to be defined.

  • 148.
    Hellström, Per M.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Gastroenterologi/hepatologi.
    Samuelsson, Bodil
    Danderyd Hosp, Div Orthoped, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Sophiahemmet Univ Coll, Stockholm, Sweden..
    Al-Ani, Amer N.
    Karolinska Univ Hosp, Dept Clin Sci & Technol Clintec, Div Orthoped, Karolinska Inst, Huddinge, Sweden..
    Hedström, Margareta
    Karolinska Univ Hosp, Dept Clin Sci & Technol Clintec, Div Orthoped, Karolinska Inst, Huddinge, Sweden..
    Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture: a pilot study2017Ingår i: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 17, artikel-id 23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture. Methods: In a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77-97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45-71 and ten healthy volunteers, age 28-55. Results: The mean gastric half-emptying time in the elderly study group was 53 +/- 5 (39-82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 +/- 4 (41-106) and 59 +/- 5 (33-72) minutes, indicating normal gastric emptying time in elderly with hip fracture. Conclusion: This pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate-rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture.

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  • 149.
    Hemmes, Sabrine N. T.
    et al.
    Acad Med Ctr, Amsterdam, Netherlands..
    Neto, Ary Serpa
    Hosp Israelita Albert Einstein, Sao Paulo, Brazil.;Fac Med ABC, Sao Paulo, Brazil..
    Binnekade, Jan M.
    Acad Med Ctr, Amsterdam, Netherlands..
    Canet, Jaume
    Hosp Badalona Germans Trias & Pujol, Barcelona, Spain..
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Univ Hosp Uppsala, Uppsala, Sweden..
    Jaber, Samir
    St Eloi Univ Hosp, Montpellier, France..
    Hiesmayr, Michael
    Med Univ Vienna, Vienna, Austria..
    Hollmann, Markus W.
    Acad Med Ctr, Amsterdam, Netherlands..
    Mills, Gary H.
    Sheffield Teaching Hosp, Sheffield, S Yorkshire, England..
    Melo, Marcos F. Vidal
    Massachusetts Gen Hosp, Boston, MA 02114 USA..
    Pearse, Rupert
    Queen Mary Univ London, London, England..
    Putensen, Christian
    Univ Hosp Bonn, Bonn, Germany..
    Schmid, Werner
    Med Univ Vienna, Vienna, Austria..
    Severgnini, Paolo
    Univ Insubria, Varese, Italy..
    Wrigge, Hermann
    Univ Leipzig, Leipzig, Germany..
    de Abreu, Marcelo Gama
    Univ Hosp Dresden, Dresden, Germany..
    Pelosi, Paolo
    Univ Genoa, IRCCS AOU San Martino IST Hosp, Genoa, Italy..
    Schultz, Marcus J.
    Acad Med Ctr, Amsterdam, Netherlands..
    Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries2017Ingår i: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, nr 8, s. 492-507Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome. TRIAL REGISTRATION The study was registered at Clinicaltrials.gov, number NCT01601223.

  • 150.
    Holzgraefe, Bernhard
    et al.
    Karolinska Univ Hosp, ECMO Dept Karolinska, Huddinge, Sweden; Karolinska Univ Hosp, Dept Physiol & Pharmacol, Sect Anesthesiol & Intens Care Med, Huddinge, Sweden.
    Andersson, Christin
    Karolinska Univ Hosp, Dept Psychol, Huddinge, Sweden; Karolinska Univ Hosp, Dept Clin Neurosci, Stockholm, Sweden.
    Kalzén, Håkan
    Karolinska Univ Hosp, ECMO Dept Karolinska, Q9 00, S-17176 Stockholm, Sweden.
    von Bahr, Viktor
    Karolinska Univ Hosp, ECMO Dept Karolinska, Huddinge, Sweden; Karolinska Univ Hosp, Dept Physiol & Pharmacol, Sect Anesthesiol & Intens Care Med, Huddinge, Sweden.
    Mosskin, Mikael
    Karolinska Univ Hosp, Dept Neuroradiol, Stockholm, Sweden.
    Larsson, Elna-Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Palmér, Kenneth
    Karolinska Univ Hosp, ECMO Dept Karolinska, Q9 00, S-17176 Stockholm, Sweden.
    Frenckner, Björn
    Karolinska Univ Hosp, ECMO Dept Karolinska, Q9 00, S-17176 Stockholm, Sweden.
    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.
    Does permissive hypoxaemia during extracorporeal membrane oxygenation cause long-term neurological impairment?: A study in patients with H1N1-induced severe respiratory failure2017Ingår i: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, nr 2, s. 98-103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The Extracorporeal Life Support Organisation accepts permissive hypoxaemia in adult patients during extracorporeal membrane oxygenation (ECMO). The neurological long-term outcome of this approach has not yet been studied.

    OBJECTIVES: We investigated the prevalence of brain lesions and cognitive dysfunction in survivors from the Influenza A/H1N1 2009 pandemic treated with permissive hypoxaemia during ECMO for severe acute respiratory distress syndrome (ARDS). Our hypothesis was that this method is reasonable if tissue hypoxia is avoided.

    DESIGN: Long-term follow-up study after ECMO.

    SETTING: Karolinska University Hospital, Sweden, from October 2012 to July 2013.

    PATIENTS: Seven patients treated with ECMO for severe influenza A/H1N1-induced ARDS were studied 3.2 years after treatment. Blood lactate concentrations were used as a surrogate for tissue oxygenation.

    INTERVENTIONS: Neurocognitive outcome was studied with standardised cognitive tests and MRI of the brain.

    MAIN OUTCOME MEASURES: Cognitive functioning and hypoxic brain lesions after permissive hypoxaemia during ECMO. The observation period was the first 10 days of ECMO or the entire treatment period if shorter than 10 days.

    RESULTS: Eleven of 13 patients were still alive 3 years after ECMO. We were able to contact seven of these patients (mean age 31 years), who all agreed to participate in this study. Mean +/- SD peripherally measured arterial saturation during the observation period was 79 +/- 10%. Full-scale Intelligence Quotient was within one standard deviation or above from the mean of a healthy population in five patients, and was 1.5 SD below the mean in one patient. In one other patient, it could not be determined because of a lack of formal education. Memory functioning was normal in all patients. MRI showed no changes related to cerebral hypoxia.

    CONCLUSIONS: Permissive hypoxaemia during ECMO might not negatively affect long-term cognitive outcome if adequate organ perfusion is maintained.

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